External Beam Planning RG

External Beam Planning
Reference Guide
Eclipse
P/ N B 5 0 1 3 4 3 R 0 1 B MARCH 2008
Abstract ExternalBeamPlanningReferenceGuide(P/NB501343R01B),documentversion
2.0,providesreferenceinformationandproceduresforusingtheExternalBeam
PlanningtaskoftheEclipseapplication,version8.5.
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3
4 External Beam Planning Reference Guide
Contents
CHAPTER 1 INTRODUCTION................................................................................... 39
About This Manual........................................................................................................... 39
Before You Begin ..................................................................................................... 39
Who Should Read This Manual ........................................................................... 39
Visual Cues............................................................................................................... 40
Bold text........................................................................................................... 40
Courier font ..................................................................................................... 40
Quotation marks............................................................................................ 40
Italics.................................................................................................................. 41
Procedures ................................................................................................................ 41
Whats New in Eclipse .....................................................................................................42
Related Publications ........................................................................................................ 45
Contacting Support .........................................................................................................45
Ordering Additional Documents......................................................................... 45
Communicating Via the World Wide Web ...................................................... 46
Sending E-Mail........................................................................................................ 46
CHAPTER 2 WORKFLOWS FOR EXTERNAL BEAM PLANNING ............................... 47

Workflows for Preparing Images ..................................................................................47
Contouring with 3D Images ..................................................................................47
Contouring with Digitizer..................................................................................... 48
External Beam Planning Workflows ........................................................................... 49
Forward Planning in the External Beam Planning Task ................................ 49
Before you begin................................................................................... 49
IMRT Planning in the External Beam Planning Task ........................................51
Before you begin.....................................................................................51
IMRT Planning with Fluence Optimization ...............................................51
IMRT Planning with Beam Angle Optimization
and Fluence Optimization................................................................... 52
Dose Dynamic Arc Planning for RapidArc
in the External Beam Planning Task .......................................................... 53
Before you begin.................................................................................... 53
External Beam Planning with Clinical Protocol................................................54
4D Planning in the External Beam Planning Task............................................54
5
Before you begin .............................................................................................54
CHAPTER 3 GETTING FAMILIAR WITH EXTERNAL

BEAM PLANNING IN ECLIPSE ................................................................................57
About External Beam Planning Task ........................................................................... 57
Selection Workspace ...............................................................................................58
Managing Patient Data.................................................................................58
Managing Image Data ..................................................................................58
Managing Image Filters ................................................................................58
Registration Workspace..........................................................................................59
Contouring Workspace ...........................................................................................59
Field Setup Workspace............................................................................................59
Plan Evaluation Workspace ..................................................................................60
Starting the Application........................................................................................60
To Start the First Application Instance ...................................................... 61
To Start Multiple Application Instances................................................... 62
Navigating in the Workspaces............................................................................. 62
To Access the Workspaces ........................................................................... 62
Navigating in the Selection Workspace....................................................63
Navigating in the Registration Workspace ............................................. 64
Navigating in the Contouring Workspace................................................65
Navigating in the Field Setup Workspace ............................................... 66
Navigating in the Plan Evaluation Workspace ....................................... 68
To Change Image View Layouts ................................................................. 68
Managing Objects in Eclipse ........................................................................................ 69
Context Window in the Selection,
Registration and Contouring Workspaces............................................... 69
Context Window in the Field Setup and
Plan Evaluation Workspaces ....................................................................... 70
Object Explorer ......................................................................................................... 72
Saving Information.................................................................................................. 73
To Save Your Work to the Database ........................................................... 73
Closing Items............................................................................................................. 73
To Close Items..................................................................................................74
Deleting Information ..............................................................................................74
To Delete Information from the Database ...............................................74
Properties Dialog Boxes..........................................................................................74

Info Window ...................................................................................................................... 75
Info Window in the Field Setup Workspace ...................................................... 75
Info Window in the Plan Evaluation Workspace.............................................. 75
CHAPTER 4 VISUALIZATION OF IMAGES................................................................77

About 3D Modeling .......................................................................................................... 77
About 4D Modeling .........................................................................................................78
Coordinate Systems .........................................................................................................79
Standard Coordinate System ............................................................................... 80
IEC 61217 Coordinate System ................................................................................. 81
User-Defined Coordinate System......................................................................... 81
DICOM Coordinate System ....................................................................................82
Image Views ......................................................................................................................82
2D Views.....................................................................................................................83
Orthogonal Views ................................................................................................... 84
3D View.......................................................................................................................85
Model View................................................................................................................85
Selecting the Viewing Plane Displayed in the 2D Views............................... 86
Using the Plane Sliders to Select the Viewing Plane .............................87
To Select the Viewing Plane with the Plane Sliders..................... 88
Browsing the 3D Image ................................................................................ 88
To Browse the 3D Image in 2D Views .............................................. 89
To Browse the 3D Image in the Model View.................................. 89
Patient Orientation Labels ....................................................................................90
Patient Orientation Indicator...............................................................................90
Orthogonal Viewing Planes and the Model View ........................................... 91
Using the Movie Control Tool ....................................................................................... 92
To Use the Movie Control Tool ..............................................................................93
Using Color and Style in the Image Views ................................................................ 94
To Select Color and Style ........................................................................................95
Changing Brightness and Contrast ............................................................................. 96
Image Histogram ............................................................................................................. 96
To Define Window Range and Level ....................................................................97
To Adjust Window/Level Settings Automatically ........................................... 98
To Adjust Window/Level Settings Manually .................................................... 98
Zooming the Image Views ............................................................................................ 98
7
To Zoom In................................................................................................................. 99
To Zoom Out ............................................................................................................. 99
To Move Visible Plane........................................................................................... 100
Measuring Information in Images ............................................................................ 100
To Measure Pixel Values or CT Numbers ......................................................... 100
To Measure Distances ........................................................................................... 101
Changing View Options ................................................................................................102
To Display the Slice Position ................................................................................102
To Display the Viewing Planes in the Model View.........................................102
Clipping Structures ........................................................................................................ 103
To Clip Structures ...................................................................................................104
CHAPTER 5 IMAGE MANAGEMENT ......................................................................105

Importing Images ...........................................................................................................105
Importing 4D Image Data................................................................................... 106
To Import Images with the Wizard.................................................................... 107
Visualization of Images in the Context Window .................................................. 109
Viewing Images .............................................................................................................. 110
Viewing 4D Images..................................................................................................111
To View 2D Images..................................................................................................114
To View 3D Images.................................................................................................. 115
To View 4D Images..................................................................................................116
Viewing DRR images ......................................................................................................116
To View DRR Images in the Selection Workspace........................................... 117
To Select the Viewing Direction for Images ..................................................... 117
Scaling Images ................................................................................................................. 117
To Scale an Image....................................................................................................118
Cropping Images .............................................................................................................119
To Crop Images ........................................................................................................119
Extracting Images ..........................................................................................................120
Extraction Parameters .......................................................................................... 121
To Extract an Image from a Film ......................................................................... 121
Extending a Scanned Image Set ................................................................................. 124
To Extend an Image Series with Artificial Slices..............................................125
About Creating 3D Images ........................................................................................... 126
About Creating 4D Images ...................................................................................127

Parameters Used for Constructing 3D Images ................................................127
To Create 3D Images .............................................................................................. 128
To Create 4D Images.............................................................................................. 129
To Delete 4D Images.............................................................................................. 130
To Create Phantom Image Sets .......................................................................... 130
Setting the User Origin.......................................................................................... 131
To Set the User Origin...................................................................................132
To Move the Viewing Planes to the User Origin ....................................133
Editing Image Parameters .............................................................................................133
Changing the Image Orientation....................................................................... 134
To Change the Image Orientation ............................................................ 134
Changing the Patient Imaging Position in Relation to the Couch..............135
Available Patient Imaging Position Options ...........................................135
To Change the Patient Position ................................................................. 136
Inverting the 3D Image Slice Order ............................................................................ 136
To Invert the 3D Image Slice Order .....................................................................137
Adding Annotations to Images ....................................................................................137
To Add Annotations ............................................................................................... 138
Rotating and Mirroring Images .................................................................................. 138
To Rotate or Mirror an Image .............................................................................. 138
Approving Images .......................................................................................................... 139
To Approve Images.................................................................................................140
Exporting Images ...........................................................................................................140
To Export Images....................................................................................................140
CHAPTER 6 IMAGE REGISTRATION ....................................................................... 143

About Image Registration ............................................................................................ 143
Registration Methods ...........................................................................................144
Accuracy of Registration....................................................................................... 145
Registering 3D Images ..................................................................................................146
To Load Images for Registration ......................................................................... 147
To Show the Images from the Same Orientation .......................................... 147
Automatic Image Registration Using Pixel Data ...........................................148
Using VOI in Automatic Registration.......................................................149
Prioritizing a Structure Volume in Automatic Registration ...............150
To Use a VOI in Automatic Registration ................................................... 151
9
To Automatically Register 3D Images Using Pixel Data ....................... 151
Automatic Image Registration Using DICOM Coordinate System .............152
To Register 3D Images with the Same DICOM Coordinate System...153
Assigning a New DICOM FOR for Re-Registration of Images .............153
To Assign a New DICOM FOR for Re-Registration of Images ..............153
Image Registration Using Registration Points................................................ 154
Location of the Registration Points ...........................................................155
Mean Error Indicator.................................................................................... 156
To Register 3D Images Using Registration Points ..................................157
To Move the Viewing Planes to a Registration Point ........................... 158
Image Registration Using Manual Tools .......................................................... 158
To Register 3D Images Using Manual Tools ........................................... 159
Multiple Registrations Between the Same Two Images ............................. 160
Registering 4D Images ...................................................................................................161
To Register 4D Images............................................................................................161
Verifying Image Registration ........................................................................................161
Visualization Methods for Registered Images................................................ 163
Split and Chess Verification Views .................................................................... 163
To Use the Split View and the Chess View .............................................164
Spy Glass Tool.......................................................................................................... 165
To Use the Spy Glass Tool............................................................................166
Blend Verification View ........................................................................................ 167
Using the Blend Control Tool .....................................................................169
To Use the Blend Verification View .......................................................... 170
To Blend Images in Other Workspaces..................................................... 171
Normal Verification Method ................................................................................ 171
Modifying the Registration ...........................................................................................172
Fine-Tuning Registration Result Manually........................................................173
To Fine-Tune Registration Result Manually............................................ 174
To Undo or Redo Registration Changes ............................................................ 174
To Edit an Existing Registration.......................................................................... 174
To Modify or Display Registration Properties ..................................................175
Exporting and Importing a Registration ................................................................... 176
To Export a Registration ....................................................................................... 176

CHAPTER 7 STRUCTURES ...................................................................................... 177
About Structures .............................................................................................................177
Structure Set ............................................................................................................177
Structure Group...................................................................................................... 178
Patient Volumes ..................................................................................................... 179
Patient Volume Codes..................................................................................180
Patient Volume Types ..................................................................................180
Body Structure .........................................................................................................181
Target Volumes........................................................................................................181
Organs at Risk ..........................................................................................................181
Structure Properties in Contouring ....................................................................181
General Structure Properties ..................................................................... 182
Assign CT Value ............................................................................................. 182
Adding Structures or Structure Groups .................................................................... 183
To Create a New Structure Set ............................................................................ 183
To Add a New Structure........................................................................................ 183
To Assign a CT Value for a Structure..................................................................184
Modifying Structures .................................................................................................... 185
To Modify Structures ............................................................................................. 185
To Measure the Volume of a Structure.............................................................186
To Clear a Structure from the Current Plane of the Primary Image ..........186
To Clear a Structure from All Planes of the Primary Image or
from All 3D Images in a 4D Image............................................................186
To Duplicate a Structure Set................................................................................186
To Delete a Structure............................................................................................. 187
Copying Structures to Registered Images ................................................................ 187
Copying Structure Sets .........................................................................................188
To Copy Structure Sets from One 3D Image to Another .....................188
Copying Individual Structures ............................................................................189
To Copy Structures from the Original Image
to the Registered Image ....................................................................189
Couch Modeling in Eclipse .......................................................................................... 190
Inserting Couch Structures in an Image........................................................... 192
To Insert Couch Structures in an Image .................................................. 192
To Move All Couch Structures.................................................................... 193
Approving Structures .................................................................................................... 193
11
To Approve a Structure .........................................................................................194
To Approve All Structures in a Structure Set ................................................... 195
CHAPTER 8 SEGMENTATION AND CONTOURING ................................................ 197

About Structures, Segments and Contours ............................................................. 197
Segmentation Methods ................................................................................................199
Segmentation and 4D Images ....................................................................................201
Selecting the Area to Work on in Segmentation ....................................................201
To Select a VOI (Volume of Interest)................................................................. 202
To Select Individual Planes.................................................................................. 203
Visual Aids for Segmentation ..................................................................................... 204
To Show the Contours on Other Planes...........................................................204
To Use the Circle Cursor.......................................................................................204
Segmenting Small Structures Using High Resolution ......................................... 205
To Increase the Resolution of a Structure .......................................................206
Using Automatic Segmentation Tools ..................................................................... 207
Defining the Body Structure .............................................................................. 207
To Define and Segment the Body Structure ......................................... 207
To Modify the Search Body Tool Settings .............................................. 208
Segmentation with the Segmentation Wizard............................................... 211
To Segment with the Segmentation Wizard ......................................... 212
Using the CT Ranger Tool ......................................................................................213
To Select a CT Range for Segmentation in the CT Ranger ...................213
Using the Flood Fill Tool ....................................................................................... 214
To Use the Flood Fill Tool..............................................................................215
Interpolating and Extending Segments and Contours ................................ 216
About the Interpolate Structure Tool ...................................................... 216
To Use the Interpolate Structure Tool...................................................... 216
About the Extend Segmentation Tool ......................................................217
To Use the Extend Segmentation Tool .....................................................217
Using Manual Segmentation Tools ........................................................................... 218
About the Brush Tool............................................................................................. 218
3D Brush .......................................................................................................... 219
To Paint Segments with the Brush Tool ................................................. 220
To Quickly Erase Part of a Segment.......................................................... 221
About the Eraser Tool ............................................................................................ 221

To Erase a Segment ......................................................................................222
About Freehand Contours and Segments........................................................222
To Draw a Segment Using the Freehand Tool........................................225
To Copy a Segment or Contour with the Freehand Tool .....................225
To Copy a Contour to a Structure in Another Image........................... 226
To Move Contours and Segments with the Freehand Tool ............... 226
To Reshape a Segment or a Contour with the Freehand Tool........... 226
To Add or Remove a Part of a Segment or Contour with
the Freehand Tool................................................................................227
To Optimize a Segment or a Contour with the Freehand Tool ..........228
To Resize Segments or Contours with the Freehand Tool.................. 229
To Rotate a Segment or a Contour with the Freehand Tool .............. 229
To Mirror a Segment or a Contour with the Freehand Tool .............. 230
Defining Rectangular and Elliptical Segments and Contours ................... 230
To Define a Rectangular Segment or Contour...................................... 230
To Define an Elliptical Segment or Contour............................................231
Using Boolean Operators in Segmentation ..............................................................231
To Use Boolean Structures...................................................................................232
Merging 4D Structures .................................................................................................. 233
To Merge 4D Structures........................................................................................ 233
Using Post-Processing Tools ........................................................................................234
To Start the Post-Processing Chain....................................................................234
To Remove Small Structure Parts ....................................................................... 235
To Remove Selected Structure Parts................................................................. 236
To Remove Parts Overlapping with Another Structure ............................... 236
To Keep the Selected Structure Parts ................................................................ 237
To Keep Large Structure Parts .............................................................................238
To Disconnect or Connect Structure Parts ...................................................... 239
To Smooth Out the Segment Outline .............................................................. 240
To Fill the Selected Cavities in Structures ....................................................... 240
To Fill Small Cavities in Structures ..................................................................... 241
To Fill All Cavities in Structures...........................................................................242
Extracting the Wall of a Structure ..............................................................................242
To Extract the Wall of a Structure ......................................................................243
Cropping a Structure .....................................................................................................243
To Crop a Structure ............................................................................................... 244
13
Adding a 3D Margin to a Structure ............................................................................245
To Add a 3D Margin to a Structure.................................................................... 246
Moving a Structure ....................................................................................................... 246
To Move a Structure...............................................................................................247
Using Registered Images in Contouring ...................................................................247
To Define Structures to the Original Image
while Showing the Registered Image..................................................... 248
To Copy Structures to a Registered Image ...................................................... 248
Contouring with the Digitizer .................................................................................... 249
To Digitize a Contour............................................................................................ 249
About Isocenter Markers ............................................................................................. 250
Isocenter Marker Visualization............................................................................251
Location of the Isocenter Marker.............................................................. 253
Adding Isocenter Markers.................................................................................... 253
To Add an Isocenter Marker ....................................................................... 253
Editing Isocenter Markers ....................................................................................253
To Edit Isocenter Markers............................................................................254
About Markers .................................................................................................................254
Marker Visualization .............................................................................................255
Location of the Markers .............................................................................. 257
Adding Markers ......................................................................................................258
To Add Markers..............................................................................................258
Editing Markers ......................................................................................................258
To Edit Markers..............................................................................................258
CHAPTER 9 COURSES AND PLANS ....................................................................... 259

Plan-Related Concepts ................................................................................................. 259
Plan ........................................................................................................................... 259
Fraction.................................................................................................................... 259
Fractionation .......................................................................................................... 259
Dose Prescription ..................................................................................................260
Dose..........................................................................................................................260
Plan-Related Concepts and the Context Window in
the External Beam Planning Task ............................................................260
Creating New Plans ........................................................................................................ 261
Using Physicians Intents..................................................................................... 262
To Create a New Plan ........................................................................................... 263

To Prescribe the Dose for a Plan in the
External Beam Planning Task ................................................................... 265
Dose Prescription Tab of the Info Window..................................................... 265
To Open Existing Plans......................................................................................... 266
Saving Plans.............................................................................................................267
To Save a Plan.................................................................................................267
Copying and Pasting Plans ..................................................................................267
To Copy Plans in the External Beam Planning Task..............................267
Copying and Pasting Plans between 3D Images in
the External Beam Planning Task....................................................267
To Copy Plans between 3D Images in
the External Beam Planning Task ......................................... 268
Using the Plan Organizer ............................................................................................ 269
About the Plan Organizer ...................................................................................269
All Plans Tab (Plan Organizer)................................................................... 270
Ref. Points Tab (Plan Organizer) ............................................................... 270
Tabs for Individual Fractionations in the Plans ......................................271
Modifying Information in the Plan Organizer .................................................271
To Prescribe the Dose in the Plan Organizer
in the External Beam Planning Task ...............................................272
To Add Fractionations to Plans
To Delete Fractionations from Plans
in the External Beam Planning Task ............................................... 273
About Defining the Primary Reference Point in the Plan Organizer......... 273
To Define the Primary Reference Point in the Plan Organizer........... 273
To Evaluate the Planned Dose for the Reference Points ..................... 273
Managing Courses .........................................................................................................274
To Create a New Course........................................................................................274
To Open a Course....................................................................................................275
To Modify Courses.................................................................................................. 275
Managing Diagnoses ....................................................................................................275
Re-Planning ..................................................................................................................... 276
Re-Planning of Approved Plans ......................................................................... 276
Associating Plans with 3D Images..................................................................... 277
Copying and Pasting Plans between 3D Images................................... 277
15
Assigning Patient Images and Structure Sets
to Plans and Plan Copies.................................................................... 277
To Assign a Patient Image and a Structure Set to a Plan...........278
Associating Fields with Field Images ................................................................278
To Add Field Images .................................................................................... 279
To Align Field Images in the External Beam Planning Task............... 279
To Show Field Images in the 3D View ..................................................... 280
To Select the Reference Image of a Field in
the External Beam Planning Task.................................................... 281
Copying Structure Sets between 3D Images................................................... 281
To Copy Structure Sets from One 3D Image to Another ..................... 281
Copying Reference Point Locations between 3D Images .............................282
To Copy Reference Points from One 3D Image to Another.................282
CHAPTER 10 TEMPLATES AND CLINICAL PROTOCOLS........................................... 285

About Templates .............................................................................................................285
Structure Templates ..............................................................................................285
Plan Templates....................................................................................................... 286
Physicians Intent in Plan Templates....................................................... 286
Objective Templates..............................................................................................287
Template Managers.............................................................................................. 288
Structure Template Manager ................................................................... 288
Structure Template Group Properties ........................................... 289
Plan Template Manager.............................................................................290
Plan Template Properties .................................................................. 291
Objective Template Manager .................................................................... 291
Objective Template Group Properties ........................................... 293
Creating Templates .......................................................................................................296
Creating Structure Template Groups and Structure Templates................296
To Create a Structure Template Group and a Structure
Template from the Structure Template Manager ......................296
To Create a Structure Template Group from Image............................ 297
To Duplicate a Structure Template Group ............................................. 297
Creating Plan Templates ..................................................................................... 298
Plan Geometry and Energy in Templates
for External Beam Plans.................................................................... 299

To Create a Plan Template from a Plan in the
External Beam Planning Task ..........................................................300
To Duplicate a Plan Template .................................................................... 301
Creating Objective Templates............................................................................ 302
To Create an Objective Template from an External Plan ................... 303
To Duplicate an Objective Template ....................................................... 303
Using Templates to Create New Structures, Objectives and Plans ................... 304
To Insert New Structures in an Image from a Structure Template........... 305
To Create a Plan Using a Plan Template in
the External Beam Planning Task ............................................................306
To Insert New Objectives in a Plan from an Objective Template .............. 308
Managing Templates ....................................................................................................309
Editing Templates .................................................................................................309
To Edit Structure Template Groups and Structure Templates ..........309
To Edit Plan Templates................................................................................. 310
To Edit Objective Template Properties......................................................312
To Edit Objective Templates in the Numeric Form ................................313
To Edit Objective Templates in the Graphic Form................................. 314
Deleting Templates.................................................................................................315
To Delete Structure Template Groups and Structure Templates ...... 316
To Delete Plan Templates............................................................................ 316
To Delete Objective Templates ...................................................................317
Importing and Exporting Templates ......................................................................... 318
To Import Templates.............................................................................................. 318
To Export Templates .............................................................................................. 319
About Clinical Protocols ............................................................................................... 320
Visibility of Clinical Protocol Information in Plans .........................................321
Plan Objectives in Clinical Protocols ..................................................................321
Plan Objectives in the External Beam Planning Task ..........................322
To View Plan Objectives in the Dose Volume Histogram View.........324
To Define Plan Objective Tolerance .......................................................... 325
Plan Objectives Tab of the Info Window.......................................................... 325
Optimization Objectives Tab of the Info Window ......................................... 327
To View Optimization Objectives in the Dose Volume
Histogram View ...................................................................................328
Clinical Protocol Manager................................................................................... 329
17
Protocol Properties ...................................................................................... 329
Creating Clinical Protocols .......................................................................................... 330
Creating a Clinical Protocol from a Plan.......................................................... 330
To Open the Protocol Properties Dialog Box
for Creating a Clinical Protocol ....................................................... 330
To Fill in Protocol Information in the General Tab .................................331
To Modify Protocol Information in the Structures Tab........................ 332
To Modify Protocol Information in the Plan Objectives Tab .............. 333
To Modify Protocol Information in the Plan Setups Tab .....................334
To Modify Protocol Information in
the Optimization Objectives Tab..................................................... 335
To Modify Protocol Information in the Review Tab.............................. 337
Using Clinical Protocols to Create New
Structures, Objectives and Plans .......................................................................338
Inserting a Clinical Protocol Reference to a Patient ......................................338
To Insert a Clinical Protocol Reference to a Patient..............................338
Creating Structures According to a Clinical Protocol ....................................339
To Create Structures According to a Clinical Protocol
in the External Beam Planning Task .............................................. 340
Creating Plans According to Clinical Protocol Plans..................................... 340
To Create Plans According to Clinical Protocol Plans ........................... 341
Changing the Clinical Protocol Reference of a Protocol Plan......................342
To Change the Clinical Protocol Reference of a Protocol Plan ...........342
Deleting a Clinical Protocol Reference from a Course ..................................343
To Delete a Clinical Protocol Reference from a Course........................343
Managing Clinical Protocols ........................................................................................343
Editing Clinical Protocols......................................................................................343
for Editing a Clinical Protocol .......................................................... 344
To Modify Protocol Information in the General Tab ........................... 344
To Modify Protocol Information in the Structures Tab........................345
To Modify Protocol Information in the Plan Objectives Tab ............. 346
To Modify Protocol Information in the Plan Setups Tab .....................347
the Optimization Objectives Tab.................................................... 348
To Modify Protocol Information in the Review Tab............................. 350
Adapting the Clinical Protocol for an Individual Patient...............................351

To Adapt the Clinical Protocol Reference
for an Individual Patient .....................................................................351
Deleting Clinical Protocols....................................................................................351
To Delete a Clinical Protocol from the
Clinical Protocol Manager ..................................................................351
Importing and Exporting Clinical Protocols ............................................................. 352
To Import a Clinical Protocol ............................................................................... 352
To Export a Clinical Protocol ................................................................................ 353
Searching Templates and Clinical Protocols ............................................................354
To Search Templates and Clinical Protocols.....................................................354
Previewing and Printing Templates
and Clinical Protocols ........................................................................................... 355
To Preview and Print Template Groups and Templates ................................ 355
To Preview and Print Clinical Protocols from
the Clinical Protocol Manager ...................................................................356
To Preview and Print Clinical Protocol References
Inserted to a Patient..................................................................................... 357
Changing the Approval Status of Templates,
Clinical Protocols and Clinical Protocol References ......................................358
To Change the Approval Status of a Template................................................358
To Change the Approval Status of a Clinical Protocol...................................359
To Change the Approval Status of a Clinical Protocol Reference ..............360
CHAPTER 11 FIELDS ................................................................................................. 361

About Fields ..................................................................................................................... 361
Field Types................................................................................................................ 361
Field Techniques .................................................................................................... 362
Field Visualization ..........................................................................................................363
Field Visualization in 2D Views.......................................................................... 364
To Change Between the Cut Mode and Projection Mode ................. 368
To Show the Field Labels ............................................................................ 368
To Move the Field Labels ............................................................................ 368
To Cut the Fields at the Isocenter ............................................................ 368
Field Visualization in the Model View ............................................................. 369
To Rotate Model View with the Mouse....................................................371
To Display the Field Shapes on the Body Surface ................................. 372
To Show the Field Paths as Cones ............................................................. 373
19
To Show the CAX Only .................................................................................374
To Move the Viewing Planes ......................................................................374
Field Visualization in the Beams Eye View (BEV)...........................................374
To Show the BEV ........................................................................................... 375
To Show the Transversal Plane in the BEV .............................................. 375
Field Visualization in the Arc Plane View .........................................................376
To Show the Arc Plane View....................................................................... 377
Showing and Hiding Fields.................................................................................. 377
To Show or Hide Fields.................................................................................378
Adding Static Fields to Plans .......................................................................................379
Default Field Parameters..................................................................................... 380
Actual and Planned SSD Values ................................................................ 381
Fields Tab of the Info Window ............................................................................ 381
To Insert a Static Field .......................................................................................... 384
Adding Arc Fields to Plans ............................................................................................385
Limits in the Arc Field Rotation Span ................................................................385
To Add an Arc Field................................................................................................ 386
To Add a Conformal Arc Field ..............................................................................387
Viewing Arc Field Movement ..............................................................................387
To Animate Arc Fields in the BEV ..............................................................387
Adding Opposing Fields ............................................................................................... 388
Wedges in Opposing Fields ................................................................................ 389
To Insert an Opposing Field ................................................................................390
Defining the Hard Wedge Direction in the Opposing Field .......................390
To Define the Hard Wedge Direction in the Opposing Field.............390
Aligning Fields ................................................................................................................. 391
Field Alignments Tab of the Info Window ...................................................... 392
To Define a Field Alignment Rule ...................................................................... 394
To Modify a Field Alignment Rule ..................................................................... 396
To Delete a Field Alignment Rule ...................................................................... 396
Moving Fields ................................................................................................................. 396
Moving Handle ..................................................................................................... 396
To Move the Field Isocenter or Entry Point ......................................................397
To Move Fields Graphically in the 2D Views ................................................... 398
To Move Fields Graphically in the BEV ............................................................. 399
To Move Fields Graphically in the Model View.............................................. 399

To Move Fields by Modifying their Isocenter Coordinates ........................ 400
Grouping Fields ............................................................................................................. 400
To Group Fields .......................................................................................................401
To Move Grouped Fields .......................................................................................401
To Refit Grouped Fields .........................................................................................401
Rotating Fields ................................................................................................................ 402
Rotation Handle ................................................................................................... 402
To Rotate Fields Graphically in the 2D Views ................................................. 403
To Rotate Fields Graphically in the BEV ........................................................... 403
To Rotate Photon Fields Graphically in the Model View .............................404
To Change the Arc Field Rotation Span............................................................404
To Change the Collimator Rotation in the BEV.............................................. 405
To Change the Rotation Parameters for a Static Field
by Modifying the Field Properties ...........................................................406
To Change the Rotation Span Parameters for an Arc Field
by Modifying the Field Properties ...........................................................406
Resizing Fields ................................................................................................................ 407
Symmetrical and Asymmetrical Fields ............................................................ 407
To Define Field Symmetry or Asymmetry .......................................................408
Converting Asymmetrical Fields into Symmetrical Fields ..........................409
To Convert an Asymmetrical Field to a Symmetrical Field ................409
To Resize Fields Graphically .................................................................................410
To Resize Fields by Modifying the Field Properties ........................................410
To Resize Fields by Fitting the Collimator Jaws to a Structure.....................411
Copying Fields ................................................................................................................. 412
To Copy Fields.......................................................................................................... 412
Measuring the Water-Equivalent Depth .................................................................. 413
Calculation of Water-Equivalent Depth .......................................................... 413
To Measure the Water-Equivalent Length between Two Points ................ 413
To Measure the Water-Equivalent Depth for a Single Point .......................414
Changing Treatment Unit ............................................................................................414
To Change Treatment Unit for Fields ................................................................416
CHAPTER 12 BEAM ANGLE OPTIMIZATION............................................................ 417

About Beam Angle Optimization ............................................................................... 417
Optimizing Beam Angles with the Beam Angle Optimization ...........................418
21
Optimization Parameters.....................................................................................418
Structure Model ............................................................................................419
Upper and Lower Dose-Volume Objective ............................................ 420
Calculation Options for the Beam Angle Optimization...................... 421
Beam Angle Optimization Modes ............................................................422
Global Optimization ...........................................................................422
Local Optimization Mode ..................................................................423
Normal Tissue Objective .............................................................................423
Beam Angle Optimization Dialog Box.....................................................425
Default Optimization Parameters .....................................................................427
Objective Templates............................................................................................. 428
To Start the Beam Angle Optimization ........................................................... 429
CHAPTER 13 REFERENCE POINTS AND REFERENCE LINES ...................................... 431

About Reference Points and Reference Lines .......................................................... 431
Primary Reference Point .......................................................................................432
Reference Points and Geometrical Locations..................................................432
Reference Point Visualization .............................................................................433
Location of the Reference Points ..............................................................435
Adding Reference Points .............................................................................................. 436
To Insert a Reference Point with a Geometrical Location
in the External Beam Planning Task ....................................................... 436
To Insert a Reference Point without a Geometrical Location......................437
To Insert a Location for an Existing Reference Point .....................................437
Adding Reference Lines .................................................................................................437
To Add a Reference Line to an External Plan .................................................. 438
Defining the Use of Reference Points ....................................................................... 438
To Include Reference Points in Plans ................................................................ 439
To Define the Primary Reference Point
in the Reference Point Organizer............................................................. 439
Modifying Reference Points or Reference Lines ..................................................... 439
To Edit Reference Point or Reference Line Properties...................................440
To Move Reference Points ...................................................................................440
To Move the Viewing Planes to a Reference Point........................................440
To Move a Reference Point to the Isocenter or Entry Point.........................440
To Delete Reference Points ..................................................................................441
Copying Reference Points between 3D Images ..............................................441

To Copy Reference Points from One 3D Image to Another................ 442
CHAPTER 14 DOSE VOLUME OPTIMIZATION ........................................................ 443

About Dose Volume Optimization ............................................................................ 443
Inverse Planning and Dose Optimization Process in Eclipse IMRT ........... 445
Preparing the images ................................................................................. 445
Field setup ..................................................................................................... 445
Dose objectives ............................................................................................446
Interactive optimization ............................................................................446
Optimal fluences .........................................................................................446
Actual fluences............................................................................................. 447
Final dose calculation ................................................................................. 447
Optimizing Plans with Eclipse IMRT ......................................................................... 447
Optimization Parameters.................................................................................... 448
Structure Model ...........................................................................................449
Upper and Lower Dose-Volume Objective ............................................ 450
Time Limit and Iterations............................................................................ 451
Optimization Parameters for the MLC Device....................................... 451
MLC ......................................................................................................... 451
Optimization method ........................................................................452
X smooth and Y smooth ....................................................................452
Minimize Dose .....................................................................................452
Fixed jaws..............................................................................................453
Normal Tissue Objective .............................................................................453
Optimization Dialog Box ............................................................................455
Default Optimization Parameters .................................................................... 456
Objective Templates in Eclipse IMRT................................................................ 458
To Start Optimization in Eclipse IMRT.............................................................. 458
To Define Dose Objectives in Eclipse IMRT ..................................................... 459
Base Dose for Optimization ........................................................................................ 462
To Use a Base Dose in Dose Optimization in Eclipse IMRT ......................... 462
Planning for Aperture Modulated Therapy in Eclipse IMRT ............................... 463
To Use Aperture Modulated Radiation Therapy in Eclipse IMRT............... 463
Displaying and Editing Optimal Fluences in the BEV ........................................... 463
Fluence Editor ........................................................................................................464
To View a Fluence.................................................................................................. 465
23
To Edit a Fluence....................................................................................................466
Fluence Editor Brush Parameters...................................................................... 467
Square Brush................................................................................................. 467
Circular Brush ...............................................................................................468
Conical Brush ................................................................................................468
Gaussian Brush.............................................................................................469
Fluence Editor Tools.............................................................................................. 470
Set to Given Value tool ............................................................................... 470
Set to Zero tool ............................................................................................. 470
Change above Given Value tool ................................................................ 471
Change below Given Value tool................................................................ 471
Increase by Defined Value tool..................................................................472
Decrease by Defined Value tool ................................................................472
Build up Transmission Factors tool ..........................................................472
Erase Transmission Factors tool ................................................................473
Smooth Transmission Factors tool ...........................................................473
Extending Fluence with the Skin Flash Tool ............................................................474
To Extend Fluence with the Skin Flash Tool.....................................................475
Skin Flash Dialog Box and Parameters ............................................................ 476
Brush Size........................................................................................................477
Transmission Factor .....................................................................................477
Fill Method .................................................................................................... 478
Brush Ceiling................................................................................................. 478
Cut Range ...................................................................................................... 479
Erosion Range and Dilation Range ..........................................................480
Reconstructing an Interrupted Treatment ...............................................................481
To Create a Partial Treatment Plan ....................................................................481
CHAPTER 15 DOSE DYNAMIC ARC PLANNING FOR RAPIDARC............................. 483

About Dose Dynamic Arc Planning ........................................................................... 483
Dose Dynamic Arc Planning Process in Eclipse.............................................. 484
Preparing the Images ................................................................................. 484
Inserting a New Field.................................................................................. 485
Dose Objectives............................................................................................ 485
Interactive Optimization............................................................................486
Dose Calculation ..........................................................................................486

Optimizing Dose Dynamic Arc Plans ........................................................................486
Optimization Parameters.................................................................................... 487
Structure Model ...........................................................................................488
Upper and Lower Dose-Volume Objective ............................................489
Normal Tissue Objective ............................................................................490
MU Objective ................................................................................................ 492
Arc Optimization Dialog Box .................................................................... 492
Default Optimization Parameters .................................................................... 493
Objective Templates in Arc Optimization ....................................................... 495
To Start Arc Optimization.................................................................................... 495
To Define Dose Objectives in Arc Optimization ............................................ 497
Base Dose for Optimization ........................................................................................499
To Use a Base Dose in Dose Dynamic Arc Planning......................................499
Editing Dose Dynamic Arc Plans ................................................................................500
Verifying Dose Dynamic Arc Plans ............................................................................500
Reconstructing a Partially Treated Plan ...................................................................500
To Create a Partial Treatment Plan ....................................................................501
CHAPTER 16 MULTILEAF COLLIMATORS................................................................ 503

About MLC Systems ...................................................................................................... 503
MLC in Static and Arc Photon Fields ................................................................. 504
MLC Visualization.................................................................................................. 504
MLC in the Image Views............................................................................. 504
MLC Margin Types.................................................................................................506
Circular Margin.............................................................................................506
Elliptical Margin ...........................................................................................506
Manual Margin............................................................................................. 507
MLC Coordinate Axis Types................................................................................. 507
BEV Coordinate Axis.................................................................................... 508
Collimator Coordinate Axis ....................................................................... 508
MLC Leaf Fit ............................................................................................................509
MLC Leaf Bank.......................................................................................................... 511
MLC Leaf and Leaf Bank Maximum Span ................................................ 511
Closed Leaf Meeting Position ..................................................................... 511
Adding MLCs .....................................................................................................................513
To Add MLCs to Static Fields .................................................................................513
25
To Add MLCs to Arc Fields..................................................................................... 514
To View the Motions of a Dynamic MLC .......................................................... 514
Moving MLC Leaves .........................................................................................................515
About the Fit and Shield Tool .............................................................................. 516
Fit and Shield Tool in Conformal Arc Fields .............................................517
To Move MLC Leaves with the Fit to Structure Tool........................................517
To Fit MLC Outlines to Shield Critical Structures............................................ 519
To Show Multiple MLC Outlines in the BEV.................................................... 520
To Move MLC Leaves Manually with the Shaping Tool................................ 520
To Move MLC Leaves Manually with the Mouse .............................................521
To Move All MLC Leaves Manually .....................................................................522
To Move Static MLC Leaves Manually with
the Leaf Coordinates....................................................................................522
To Digitize the MLC Outline................................................................................. 523
To Lock the MLC Leaves......................................................................................... 523
Converting MLCs into Blocks .......................................................................................524
To Convert an MLC into an Aperture Block ......................................................524
Verifying MLC Leaf Positions ....................................................................................... 525
To Verify and Correct MLC Leaf Positions ........................................................ 526
About the Field-in-Field Technique ........................................................................... 526
Merging Subfields into Segmental MLC Fields.............................................. 527
To Create Subfields (Field in Field) ..................................................................... 527
To Merge Subfields into a New Plan .................................................................528
CHAPTER 17 DYNAMIC MLCS.................................................................................. 531

About Dynamic MLCs .....................................................................................................531
How a DMLC Produces Intensity Modulation in the Treatment ................532
Sliding Window Technique......................................................................... 533
Multiple Static Segments Technique.......................................................534
Converting Field Fluences to DMLC Leaf Motions ..................................................534
To Convert Optimal Fluences into Leaf Motions
for Varian DMLC (Interdigitation Allowed) ............................................ 535
for Non-Varian DMLC (Interdigitation Not Allowed) ...........................536
Converting DMLC Leaf Motions to Actual Fluence ................................................ 537
To Convert DMLC to Actual Fluence .................................................................. 537
Verifying the Leaf Motions ...........................................................................................538

To View the DMLC Leaf Motions in the BEV ....................................................538
CHAPTER 18 ELECTRON FIELD ACCESSORIES.......................................................... 541

Electron Applicators ....................................................................................................... 541
To Change an Applicator in an Electron Field .................................................542
Cut-Outs in Electron Fields ...........................................................................................543
Bolus in Electron Fields .................................................................................................543
CHAPTER 19 COMPENSATORS ................................................................................545

About Compensators .....................................................................................................545
Photon Compensator Parameters .................................................................... 546
Compensation Plane................................................................................... 546
Compensator Penumbra Margin ............................................................. 546
Compensator Grid ........................................................................................547
Compensator Thickness..............................................................................547
Compensator Visualization ................................................................................ 548
Compensator Icons...................................................................................... 548
Compensator in the Image Views .......................................................... 548
Adding Compensators ................................................................................................... 552
To Add a Plane Compensator to a Photon Field .............................................552
Editing Compensators ................................................................................................... 553
Compensator Editor .............................................................................................. 553
To Edit the Compensator Matrix ........................................................................554
Compensator Editor Brush Parameters ............................................................ 555
Square Brush.................................................................................................. 555
Circular Brush ................................................................................................556
Conical Brush .................................................................................................556
Gaussian Brush.............................................................................................. 557
Compensator Editor Tools....................................................................................558
Set to Given Value tool ................................................................................558
Set to Zero tool ..............................................................................................558
Change above Given Value tool ................................................................559
Change below Given Value tool................................................................559
Increase by Defined Value tool.................................................................560
Decrease by Defined Value tool ...............................................................560
Build up Transmission Factors tool .........................................................560
Erase Transmission Factors tool ................................................................ 561
27
Smooth Transmission Factors tool ........................................................... 561
To Select the Compensator Isolevels................................................................ 562
CHAPTER 20 ELECTRONIC COMPENSATORS.......................................................... 563

About Electronic Compensators .................................................................................563
Electronic Compensator Calculation.................................................................563
Using Electronic Compensators ................................................................................. 564
Availability of Electronic Compensation ........................................................ 564
To Add an Electronic Compensator....................................................................565
About Irregular Surface Compensators ....................................................................565
Irregular Surface Compensator Algorithm..................................................... 566
To Add an Irregular Surface Compensator to a Field.....................................567
CHAPTER 21 BLOCKS .............................................................................................. 569

About Blocks ................................................................................................................... 569
Block Types.............................................................................................................. 570
Block Visualization................................................................................................ 570
Block in the Image Views........................................................................... 570
Block Margin Types................................................................................................572
Circular Margin.............................................................................................. 572
Elliptical Margin ............................................................................................ 572
Block Coordinate Axis Types................................................................................ 573
BEV Coordinate Axis..................................................................................... 573
Collimator Coordinate Axis ........................................................................574
Adding Blocks to Fields .................................................................................................574
To Add the Block Object........................................................................................574
Delineating Block Outlines .......................................................................................... 575
To Delineate the Block Outlines Automatically..............................................576
To Add a Standard Aperture Block .....................................................................576
To Delineate the Block Outlines Manually ...................................................... 577
To Digitize the Block Outline...............................................................................578
Modifying Blocks ............................................................................................................579
To Reshape the Block Outline............................................................................. 580
To Edit Standard Aperture Blocks....................................................................... 581
To Move Blocks........................................................................................................ 581
To Rotate Blocks by Degrees................................................................................582
To Mirror Blocks ......................................................................................................583

To Copy Blocks.........................................................................................................583
Converting Blocks into MLCs.............................................................................. 584
To Convert an Aperture Block into an MLC............................................ 584
To Delete Block Outlines ......................................................................................585
CHAPTER 22 WEDGES..............................................................................................587
About Wedges .................................................................................................................587
Wedge Directions...................................................................................................587
Wedge Width ......................................................................................................... 588
Calculation of Motorized Wedges ............................................................................. 589
Weight Factor for Motorized Wedges............................................................. 589
Dose Distribution for Motorized Wedges...................................................... 589
Wedge Visualization .....................................................................................................590
Wedge Icon ............................................................................................................ 590
Wedges in the Image Views .............................................................................. 590
Adding Wedges in Fields ............................................................................................. 592
To Add a Wedge..................................................................................................... 592
Modifying Wedges ............................................................................................... 592
To Modify Wedges in Fields........................................................................593
To View the Physical Wedge Properties ..................................................593
CHAPTER 23 BOLUS................................................................................................ 595

About Bolus ......................................................................................................................595
Bolus Visualization ................................................................................................595
Bolus Icons......................................................................................................595
Bolus Structures ........................................................................................... 596
Dose Calculation and Bolus.................................................................................597
Adding Bolus ....................................................................................................................597
To Create the Bolus Structure ............................................................................ 598
Linking Bolus to Fields ......................................................................................... 599
To Link a Bolus to a Field ............................................................................ 599
Modifying Bolus ............................................................................................................ 600
To Edit the Bolus Shape and Thickness with the VOI Tool ......................... 600
To Edit the Bolus Outlines with the Freehand Tool ...................................... 601
To Delete a Bolus ................................................................................................... 601
29
CHAPTER 24 DOSE CALCULATION ......................................................................... 603
Calculation Options for External Beam Plans................................................603
Calculation Models Tab of the Info Window..................................................604
To Select the Calculation Model for External Beam Plans.................605
To Clear All Calculation Model Selections
from an External Beam Plan............................................................605
To Select Default Calculation Models for an External Beam Plan ...605
To Change the Plan-Specific Calculation Options
for an External Beam Plan ........................................................................ 606
Dose Matrix .....................................................................................................................607
To Edit the Calculation Volume for External Beam Plans........................... 608
To Reset the Calculation Volume for External Beam Plans........................ 608
To View Dose Matrix Properties for External Beam Plans ......................... 608
Dose Distribution Calculation for
External Beam Plans ........................................................................................... 609
Image Requirements for Planning................................................................... 610
Calculation Progress Indicator in the External Beam Planning Task........611
To Calculate the Dose Distribution.................................................................... 612
Dose Calculation Based on MU .......................................................................... 613
To Calculate the Dose Distribution Based on MU ................................614
Using Field Weight Factors .......................................................................................... 615
To Change the Field Weight Factors.................................................................. 617
Managing the Dose Visualization ..............................................................................618
Isodoses in the External Beam Planning Task.................................................619
Color Wash in the External Beam Planning Task ..........................................620
Defining the Dose Levels Displayed in the Color Wash Mode ................... 622
Showing the Persistent Dose ............................................................................. 623
To Show the Persistent Dose..................................................................... 625
Showing the Absolute or Relative Dose .......................................................... 625
To Show Absolute or Relative Dose ......................................................... 625
To Show the Dose as Isodoses or in the Color Wash Mode ........................ 626
To Show the Surface Dose in the Model View ...............................................626
To Select the Dose Color Wash Levels in the 2D Image Views ...................626
To Select the Isodose Levels Displayed in the Model View......................... 627
To Select a Predefined Isodose Set.................................................................... 627
To Modify the Isodose Levels in an Isodose Set............................................. 628

To Add Isodose Levels to an Isodose Set.......................................................... 628
To Delete Isodose Levels from an Isodose Set................................................ 628
Converting an Isodose Level to a Structure....................................................629
To Convert an Isodose Level to a Structure ...........................................629
Dose Statistics........................................................................................................630
Dose Maximum (Dmax) Point..................................................................630
Statistical Dose Information...................................................................... 631
To Show or Hide the Dose Statistics ....................................................... 632
To Show or Hide the Dose Maximum Point ...........................................633
To Move Viewing Planes to the Dose.......................................................633
Plan Normalization ....................................................................................................... 634
Plan Normalization Options................................................................................635
To Normalize the Plan.......................................................................................... 636
To Define the Default Plan Normalization Method .................................... 636
CHAPTER 25 EVALUATING PLANS.......................................................................... 639

About Evaluating Plans ................................................................................................ 639
Point Dose Value and Dose Profile ............................................................................ 639
Displaying the Point Dose...................................................................................640
To Display the Dose at the Selected Point
Creating a Dose Profile .........................................................................................641
To Display the Dose Along a Line ............................................................. 642
To Export the Dose Profile ......................................................................... 642
To Print out the Dose Profile ..................................................................... 642
Dose-Volume Histogram ............................................................................................. 643
Viewing the DVH Graph ...................................................................................... 643
To View the DVH Graph..............................................................................644
Available DVH Types............................................................................................. 645
Cumulative DVH .......................................................................................... 645
Differential DVH...........................................................................................646
Natural DVH.................................................................................................. 647
Dose Statistics Tab of the Info Window .......................................................... 647
DVH for a Single Plan ...........................................................................................649
To Display a DVH for One Plan..................................................................650
DVH for Multiple Plans ......................................................................................... 651
31
To Display a DVH for Multiple Plans in the
Field Setup Workspace (External Beam Planning Task).............653
Plan Evaluation Workspace.............................................................. 654
To Use the DVH Tools .................................................................................. 654
DVH Type .............................................................................................. 654
Absolute/Relative Mode................................................................... 654
Volume Scale ....................................................................................... 654
Zooming.................................................................................................655
Panning ..................................................................................................655
Dose Along a DVH Line ......................................................................655
Grid ........................................................................................................ 656
Dose Levels........................................................................................... 656
DVH Graph Background.................................................................... 656
DVH Scale ............................................................................................. 656
DVH Columns .......................................................................................657
To Calculate a DVH for Summed Plans....................................................657
Boolean Operations in DVH Calculation ..........................................................657
To Create Boolean Structures for DVH Calculation ............................. 658
Modifying the Style of a DVH Line.................................................................... 659
To Modify the Style of a DVH Line ........................................................... 659
Exporting DVHs .................................................................................................... 660
About the DVH Export File ....................................................................... 660
To Export a DVH ...........................................................................................662
DVH Print-Outs ...................................................................................................... 663
Accuracy of the DVH.............................................................................................664
Comparing Plans Visually ............................................................................................ 665
To Compare Plans Visually .................................................................................. 665
Summing Plans ............................................................................................................. 666
Dose Matrices in Summed Plans.......................................................................668
Plan Sum Tab of the Info Window ....................................................................668
Plan Sum Visualization ....................................................................................... 669
To Sum and Subtract Plans ..................................................................................672
To Create a New Plan Sum and New Plans Simultaneously ...................... 674
Reference Points in Plan Sums........................................................................... 674
To Insert a Reference Point in a Plan Sum ..............................................675

Evaluating and Editing Plan Sums .....................................................................675
To Evaluate the Plan Sum .......................................................................... 676
To Show or Hide Fields and DRRs in the Image Views........................ 676
To Add Plans to a Plan Sum (External Beam Planning) ...................... 676
To Remove Plans from a Plan Sum .......................................................... 676
Copying and Pasting Plan Sums.........................................................................677
To Copy and Paste a Plan Sum ...................................................................677
Using Digitally Reconstructed Radiograph Images ...............................................677
Predefined Parameter Sets for DRR Calculation............................................ 679
To Add DRR Images.............................................................................................. 680
To Use Detailed Calculation Parameters for DRR Images ............................681
To Manage DRR Parameter Sets ........................................................................ 683
Printing DRR Images ............................................................................................ 683
Displaying Field Images in the BEV or Model View...................................... 683
To Display Field Image ................................................................................684
To Display Structure Outlines in a DRR Image .....................................684
To Display the Graticule in a DRR Image................................................ 685
Verification of Treatment Planning .......................................................................... 685
Verification with Phantom .................................................................................686
Verification with Portal Dose Prediction.........................................................686
Portal Dose Prediction Calculation.......................................................... 687
To Create a Verification Plan Using a Phantom............................................. 687
To Create a Verification Plan Using Portal Dose Prediction........................689
Verifying the DMLC Leaf Motions ............................................................................ 690
To Verify the Leaf Motions Using Test Fluences ........................................... 690
To Verify the Leaf Motions Using a Re-Generated DMLC........................... 690
Creating Setup Fields .....................................................................................................691
To Generate Setup Fields......................................................................................691
To Create New Setup Fields ................................................................................ 692
Approving Plans for Treatment .................................................................................. 692
Plan Approval Statuses ........................................................................................ 693
Unapproved Status...................................................................................... 693
Rejected Status.............................................................................................694
Reviewed Status...........................................................................................694
Planning Approved Status.........................................................................694
Large DMLC Fields and Approving Plans for Treatment .............................. 695
33
Defining Default Field Split Option for Large IMRT Fields................ 696
Calculation of the Treatment Time.................................................................. 696
To Approve External Plans for Treatment........................................................ 697
Exporting Plans to Virtual Simulation ..................................................................... 697
About Virtual Simulation with Gammex........................................................698
About Virtual Simulation with LAP ..................................................................698
About Virtual Simulation with AJ2.................................................................. 699
General Virtual Simulation Process in Eclipse .............................................. 699
Processing of Data in the Export to Virtual Simulation ..............................700
Marking the Field Coordinates in the
Virtual Simulation Export ................................................................. 701
Marking the MLC Aperture in the Virtual Simulation Export........... 702
Reviewing the Laser Markings in the Virtual Simulation Export.............. 703
Configuring the Laser Alignment System.......................................................706
To Configure the Laser Alignment System and CT Scanner..............706
LAP Laser Alignment System Parameters..............................................706
Gammex Laser Alignment System Parameters ................................... 707
CT Scanner Parameters .............................................................................. 708
To Export a Plan for Virtual Simulation
with Three Moving Laser Axes .................................................................709
with One or Two Moving Laser Axes......................................................... 711
CHAPTER 26 PRINTING PLAN INFORMATION ........................................................ 713

Printing Image and Plan Information ........................................................................713
Printing the Screen .................................................................................................713
To Print Screens and Windows .................................................................. 714
Printing the Active Image View.......................................................................... 714
Print Settings for Active Image Views ......................................................715
DVH Settings for Printing...................................................................715
BEV Settings for Printing ................................................................... 716
Arc Plane View Settings for Printing ...............................................717
Model View Settings for Printing.................................................... 719
2D View Settings for Printing ............................................................721
To Print 2D Views, the Model View or the Arc Plane View .................722
To Print the Beams Eye View ..................................................................... 723
To Print a DVH................................................................................................724

Information in Print-Outs of Active Views ...................................................... 725
Textual Information in Print-Outs of Active Views .............................. 725
Graphical Information in Print-Outs of Active Views .......................... 727
Field Information in Print-Outs of Active Views .................................. 729
DICOM Print .................................................................................................................... 730
DICOM Settings for Printing............................................................................... 730
To Use DICOM Print ............................................................................................... 732
Using Print Templates ................................................................................................... 732
To Access Print Templates .................................................................................... 732
To Print Images Using a Template ..................................................................... 733
Print Setup Dialog Box..........................................................................................734
DVH, Plan Report, BEV, Model View, 2D View
and Arc Plane View Prints .................................................................734
DICOM Prints .................................................................................................734
To Create a New Print Template ......................................................................... 735
To Modify a Print Template..................................................................................736
To Set a Default Print Template ..........................................................................736
To Delete a Print Template................................................................................... 737
About Treatment Reports ............................................................................................. 737
Treatment Report Print Settings ........................................................................738
To Print Treatment Reports..................................................................................738
Content of Treatment Reports for External Beam Plans .............................739
Layout of Information on a Default Treatment Report
for an External Beam Plan.................................................................739
Information Entries on a Full Treatment Report.................................. 740
Information Entries on a Plan Sum Report Cover Page...................... 749
CHAPTER 27 EXPORT AND IMPORT........................................................................ 751

Exporting Plan and Image Data ...................................................................................751
About Export Options ........................................................................................... 752
Export as IHE-RO Geometric Plan ............................................................752
Include Structure Set ................................................................................... 752
Include Reference Images in Export......................................................... 752
Dose Export ....................................................................................................752
Planar Dose Details in Export .................................................................... 753
DVH Export Details....................................................................................... 753
DVH Dose Bin Width Parameter......................................................754
35
To Use the Export/Import Wizard for Exporting............................................754
To Export the Dose Plane ..................................................................................... 755
Exporting IHE-RO Compliant Plans ................................................................... 755
Exporting Data with DICOM ........................................................................................756
Transforming DICOM Files to ASCII Files..........................................................758
To Transform DICOM Format Files to the ASCII Format ......................758
Exporting Plan Data to the ATC ..........................................................................758
To Export Planning Data for the ATC in DICOM Format ......................759
Importing Plan and Image Data ................................................................................760
To Use the Export/Import Wizard for Importing ..........................................760
Exporting and Importing Fluences ........................................................................... 762
Exporting and Importing Fluences in DICOM Files ...................................... 762
DICOM Fluence Export File .........................................................................763
DICOM Fluence Import File (ASCII)...........................................................763
To Export Fluences with DICOM............................................................... 764
Importing Fluences in ASCII Files.......................................................................765
To Import Fluences in ASCII Files ..............................................................765
To Transform the DICOM format to ASCII...............................................765
Exporting and Importing MLC/DMLC Plans ........................................................... 766
Exporting MLC/DMLC Plans ............................................................................... 766
To Export MLC or DMLC Files..................................................................... 766
Importing MLC/DMLC Plans................................................................................767
To Import MLC or DMLC Files .....................................................................767
APPENDIX A USING PATIENT EXPLORER ............................................................... 769

Searching for Records................................................................................................... 770
Patient Record Searches ..................................................................................... 770
Identifying a Patient ID......................................................................................... 771
Search Using Advanced Filters........................................................................... 773
Search Using Status Filters ................................................................................. 775
Image Status..................................................................................................776
Plan and Treatment Status Filters ............................................................776
Treatments Approved Status .....................................................................776
Other Display Options ......................................................................................... 777
Show Recent Patients .................................................................................. 777
Search .............................................................................................................. 777

Clear Filters..................................................................................................... 777
Restore Filters ................................................................................................ 777
Found Patient Records ......................................................................................... 778
Patient List Right-Click Menu ....................................................................778
Print Preview Toolbar Controls ..................................................................779
Printed Patient Search List..........................................................................779
Editing a Patient Record............................................................................................... 780
Recording New Patient Data ....................................................................................... 782
Adding a New Patient Record ............................................................................ 783
Adding Patient Personal Data............................................................................ 785
Adding Patient IDs ................................................................................................ 787
Patient IDs Audit History ........................................................................... 789
Patient IDs Marked Error............................................................................ 789
Recording Patient Addresses............................................................................. 790
Identifying Providers ............................................................................................ 791
Referring Physician....................................................................................... 791
Adding A Primary Care Physician............................................................. 794
Adding the Patients Oncologist .............................................................. 796
Adding Department and Patient Status......................................................... 798
Selecting Treatment Departments.................................................................. 799
APPENDIX B IMPORT AND EXPORT FILTERS.......................................................... 801

Configuring Import and Export Filters ......................................................................801
To Add New Import and Export Filters..............................................................801
To Modify the Import/Export Filter Configuration.......................................802
To Delete Import/Export Filters......................................................................... 802
APPENDIX C CALIBRATING THE DIGITIZER............................................................ 803

About Digitizers ............................................................................................................. 803
To Configure a Digitizer .......................................................................................804
Calibrating Digitizers ....................................................................................................804
To Calibrate a Digitizer for Contouring............................................................ 805
To Calibrate a Digitizer in the BEV for External Beam Planning............... 806
APPENDIX D KEYBOARD SHORTCUTS .................................................................. 809
APPENDIX E EDITING REPORT TEMPLATES ............................................................ 811
37
Editing Report Templates ..............................................................................................811
Report Template File Structure........................................................................... 812
Report Template Commands .............................................................................. 812
Report Template Syntax ......................................................................................820
Report Template Variables...................................................................................823
INDEX...........................................................................................................................841

Chapter 1 Introduction
Thischaptercoversthenotationusedthroughoutthismanualandlists
otherpublicationsrelatedtothismanual.
About This Manual

Thissectionprovidesbackgroundinformationnecessaryforusingthe
application,whothismanualismeantfor,andthenotationused
throughoutthismanual.
Before You Begin

ThismanualassumesthatyouarefamiliarwithMicrosoftWindows
2000ProfessionalorWindowsXP.Beforeyoubeginusingthe
application,readyourMicrosoftWindowsdocumentationtobecome
familiarwiththeWindowsenvironment.
Who Should Read This Manual

Thisguideiswrittenmainlyformedicalpersonnelwhomayhave
specifictasksinthetreatmentplanningprocess,forinstance,
physicistsoranyotherpersonnelresponsibleforsettingupfields,
calculatingthedosedistributionandevaluatingplans.
WARNING: Before or when using the Eclipse Treatment Planning System

(Eclipse TPS), notice the following:
The Eclipse TPS intended use is for dose estimations in the planning of
radiation therapy treatments for patients having malignant or benign
disease. Eclipse TPS should only be used by qualified medical professionals.
Ensure that individuals authorized to perform treatment planning
functions are appropriately trained for the functions they perform.
All treatment plan reports shall be approved by a qualified person before
the information in them is used for radiotherapy treatment purposes.
Always be aware that the quality of the output depends critically on the
quality of the input data, and any irregularities or uncertainties about
input data units, identification, or quality of any other nature shall be
thoroughly investigated before the data are used.
39
Visual Cues
Thissectionpresentsthetypesofnotesandprecautionarynoticesused
inthemanual,alongwiththeiricons.TheEclipsedocumentationuses
thefollowingnotationalconventions:
Note: Anotedescribesactionsorconditionsthatcanhelptheusertoobtain
optimumperformancefromtheequipmentorsoftware.
CAUTION: A caution describes actions or conditions that could result in minor or

moderate injury or damage to equipment or loss of data.
WARNING: A warning describes actions or conditions that could result in

serious injury or death.
Bold text
Thisguideusesboldtextfor
Menusandmenucommands.Example:ChooseEdit >Delete.
Commandbuttons.Example:Toconfirm,clickYes.
Optionbuttons.Example:Inthedialogbox,selectthe3Doption
button.
Checkboxes.Example:Inthedialogbox,selecttheImport
Structurescheckbox.
Textboxes.Example:IntheIDandNametextboxes,typethe
appropriateinformation.
Courier font
Programmingcode,textinexportfiles,namesofenvironment
variables,filesandotheritemsrelatedtoprogrammingarewritten
withtheCourierfont.
Quotation marks
Thisguideusesquotationmarksfor
Internalcrossreferences.Example:SeeTopicofInterestonpageX.
Textthatyoutypeintheuserinterface.Example:Inthecell,type
Data.

Italics
Thisguideusesitalicsfor
Referencestootherpublications.Example:RefertoExternalBeam
PlanningReferenceGuide.
Emphasis.Example:Alwaysverifyplansvisually.
Procedures
Aprocedureisagroupofnumbered,sequentialinstructionsthatmust
befollowedintheordergiven.Thebasicformatforproceduresisthe
following:
1. Dothis
Thiswillhappen.
Anynoteregardingthestepbeingtaken.
2. Dothis
Thiswillhappen.
Someprocedurescontainalternativeactionsofwhichoneorseveral
canbefollowed.Alternativeactionsareprintedinthefollowing
format:
3. Dooneofthefollowing:
Dotheactionthisway.
Dotheactionthisway.
Thiswillhappen.
Somecommandsareavailablefrombothmenusandtoolbars.The
proceduresindicatethetoolbarbuttonsrelatedtothemenu
commandswiththepictureofthetoolbarbuttonasfollows:
1. ChooseXYZ >ABC
Thiswillhappen.
Introduction 41
Whats New in Eclipse
Eclipsecontainsnewandenhancedfeatures.Thischapterlistsmajor
newfeatures.Inadditiontotheitemslisted,Eclipsecontainsseveral
enhancements.
Chapter/Section in
New/Enhanced Feature
This Guide
Dose InDoseDynamicArcplanningforRapidArc, Chapter 1,Section
DynamicArc dynamicarctreatmentsareproducedbasedon DoseDynamicArc
Planningfor volumetricdoseoptimization.DoseDynamic Planningonpage 1
RapidArc Arcsofferatreatmentusingasinglegantry
rotation,DynamicMLCandvariabledoseper
degree.Variabledoseperdegreeisachieved
withacombinationofvariabledoserateand
variablegantryspeed.
Couch ExactandExactIGRTcouchescannowbe Chapter 8,Section

Modeling modeledinEclipse.Acouchismodeledasaset CouchModelingin
ofcouchstructuresinsidea3Dimage. Eclipseonpage 230
Enhanced Eclipsecontainsanenhanceddialogboxfor Chapter 24,Section

PlanSums insertingnewplansums.Youcanmodifyplan SummingPlanson
IDs,planweights,plantargets,prescribeddose page 624
percentages,fractiondoses,fractions,total
dosesandplannormalizationmodesofthe
individualplanswheninsertinganewplan
sum.ThePlanSumtaboftheInfoWindowalso
containsmoreoptionsformodifyingthe
individualplansinaplansum.Youcannow
addandremoveplanstoplansums,insertnew
referencepointstoplansincludedinaplan
sum,show/hideallfieldsandDRRsofthe
plansinaplansumatonce,show/hidedosesof
theindividualplansintheplansum,andusea
plansumasabasedoseplan.
Enhanced YoucannowuseaVolumeofInterest(VOI) Chapter 6,Section

Registration toolorselectastructurevolumetobe ImageRegistration
Toolsand prioritizedduringautomaticregistrationusing onpage 131
Verification pixeldata.Registrationresultscanbeviewedin
Methods orthogonalverificationviews,andaSpyGlass
toolcanbeusedtoviewaspecificregionof
interestintheregistration.Youcanuse
registrationfinetuningtoolstofinetune
registrationresultsmanually.

Chapter/Section in
This Guide
Structure Structurescanbeapprovedtopreventfurther Chapter 8,Section
Approval modificationsoraccidentalchangesofa Approving
structureafteritiscreated,contoured,and Structureson
verified. page 236
AutomaticCT Eclipseisnowmorefullyintegratedwiththe
Segmentation SmartSegmentationautomaticcontouring
utility.SmartSegmentationisdesignedto
reducetheoveralltimeneededtocontour
structuresina3DCTdatasetbysegmenting
anatomicalstructuresautomatically.
FormoreinformationonSmartSegmentation,
refertoSmartSegmentationReferenceGuide.
Improved TheDICOMstandardconformanceofEclipse Chapter 8,Section

DICOM isimproved.Asanexample,supportfor StructureSeton
Conformance structuresetswasadded.Whenyouexport page 214and
structuresetsandplans,youcancheckthat Chapter 26,Section
theyareIHEROcompliant(Integratingthe ExportingPlanand
HealthcareEnterpriseRadiationOncology). ImageDataon
page 683
Equivalent Toidentifythewaterequivalentdistancesina Chapter 11,Section

depthtool patientimage,youcanusetheWEDforField Measuringthe
tooltomeasurethepathwaylengthfromthe WaterEquivalent
bodyoutlinetotheselectedpoint,ortheWED Depthonpage 405
andDistancetooltomeasurethe
waterequivalentdistanceandgeometrical
distancebetweentwoselectedpoints.
Scrolling Togetabetteroverviewof,forinstance,the Chapter 4,Section

dosedistribution,youcaneasilybrowse Browsingthe3D
throughtheentire3Dimagestackinanyofthe Imageonpage 88
2Dviews,topogramviews,andtheModel
Viewusingthemousescrollwheel.
High Youcanaccuratelydefinesmallvolumesby Chapter 7,Section

resolution usingahighersegmentationresolutionthan SegmentingSmall
structures thedefaultresolution.Theresolutioncanbe StructuresAccurately
manuallyincreasedforsegmentswhenthe onpage 235
imagesizeislargerthan256 256voxels.
Introduction 43
Chapter/Section in
This Guide
Enhanced SupportforIMRSplanninginEclipseis
supportfor improved.
IMRS
planning Theconceptofclinicalprotocolsismodifiedto Chapter 11,Section
bettersupportIMRSplanning. AboutClinical
Youcandocumenttherequirementfor Protocolsonpage 337
immobilizationandpatientpositionor
verificationonacasebycasebasisin
clinicalprotocols.Itisalsopossibletodefine
therequiredconformityanddosegradient
indicesinclinicalprotocols.
Theprotocolcanbeadjustedasnecessary
foreachpatientafteraddingittothe
patient.
Foreasierplanevaluation,thedoseconformity, Chapter 6,Section

dosegradientandequivalentspherediameter DoseVolume
forthetargetareshownintheDVHstatistical Histogramon
information,andincludedintreatmentreports. page 186
Plandisplayisimprovedtomakeitmore Chapter 11,Section

intuitiveforviewingstereotacticplans: FieldVisualization
ModifiedBeamsEyeView(BEVfixedto onpage 331
thegantry).
ArcPlaneViewmodeforassessingthedose
distributioninorientationsthatmakeit
easiertoadjuststartandstopangles.
Adisplayofthefieldcentralaxesonly
whenviewingmultiplefields.
Inaddition,anewnormalizationmethodwas Chapter 23,Section

added(100%toBodymax). PlanNormalizationin
ExternalBeam
Planningonpage 598
Couchshift YoucannowhaveEclipseautomatically Chapter 5,Section

calculatethecouchshiftsrequiredfromthe SettingtheUser
simulationisocenter(fromtheCTscannerora Originonpage 131
conventionalsimulator)tothetreatment
isocenterforthepatienttreatment.Thisisdone
bysettingtheuserorigintomarkthefiducials
inthepatientimage.Thecalculatedcouch
shiftscanbeprintedinthetreatmentplan
reportoftheplan.

Related Publications
Foradditionalinformation,refertothefollowingsources:
ExternalBeamPlanningInstructionsforUseProvidesbasic
informationandproceduresforusingtheEclipsetreatment
planningsystemforphotonandelectrontherapyplanninginthe
dailyworkflow.
BeamConfigurationReferenceGuideProvidesreference
informationandproceduresforbeamdataconfigurationrequired
forperformingdosecalculationforexternaltreatmentplansinthe
Eclipsetreatmentplanningsystem.
EclipseAlgorithmsReferenceGuideDescribesalgorithms
supportedintheEclipsetreatmentplanningsystem.
OnlinehelpProvidesbackgroundinformationanddetailed
instructionsforhowtouseARIAandEclipsetasks,anddescribes
allfunctionsavailableintheARIAandEclipseapplications.
Contacting Support
Supportservicesareavailablewithoutchargeduringtheinitial
warrantyperiod.Ifyouseekinformationnotincludedinthis
publication,callVarianMedicalSystemssupportatthefollowing
locations:
NorthAmericatollfreetelephonesupport +1.888.827.4265
TocontactthesupportlocationnearestyouforService,Partsor
Support,seethelistattheVarianMedicalSystemswebsite:
WorldwideListing
http://www.varian.com/us/oncology/services_and_support/contacts.html
Ordering Additional Documents

Toorderadditionaldocuments,callthefollowing:
NorthAmerica +1.888.827.4265(Press2forparts)
Global +1.702.938.4700
Introduction 45
Communicating Via the World Wide Web
IfyouhaveaccesstotheInternet,youwillfindVarianMedicalSystem
supportatthefollowinglocation:
OncologySystemshttp://my.varian.com
Sending E-Mail
Sendyouremailstothefollowinglocationsforsupport:
InformationManagementSystems [email protected]
DigitalImagingManagement [email protected]
Systems
DeliverySystems [email protected]
TreatmentPlanningSystems [email protected]
BrachytherapySystems [email protected]
(pleaseleavethesubjectlineblank)

Chapter 2 Workflows for External Beam
Planning
Workflows for Preparing Images

Thesesectionsintroducetypicalworkflowsusedwhenpreparing
imagesforuseintreatmentplanninginEclipse.
Contouring with 3D Images
Step See page Workspace

Create the patient Selection
Createthepatientwiththecorrectidentification 797
information.Youcanalsocreatethepatientwhile
importingtheimages.
Import the 2D images Selection

Selecttheimportfilterandtheimagestoimport. 107
Connecttheimagestothecreatedpatient,or 107
createanewpatientandconnecttheimagesto
thenewpatient.
Ifnecessary,extract,cropandscaletheimages. 119,121
Create the 3D image

Selectthe2Dimagestouseandcreatea3D 128
image.
Checktheimageorientation. 136
Optional: Register CT and MR image sets Registration

Defineregistrationpointsoruseautomatic 148
registrationtools.
Verifyandaccepttheregistration. 163
Create structures Contouring
47
Createastructuresetforthepatientandinsert 185
therequiredstructureobjects,forinstance:Body,
PTV,GTV,CTV,organsatrisk.
Createcouchstructures,ifappropriate. 194
Useastructuretemplate,ifappropriate. 306
Segment the structures Contouring

Useanautomaticsegmentationtool. 209
Visuallyverifyeachslice. 77,107
Usepostprocessingtools. 236
Ifnecessary,correctmanually,or 220
Drawacontourforeachstructureoneachimage 220
slice,orpaintthestructuresegmentoneach
imageslice.
Contouring with Digitizer

Create the patient 797 Selection
Create the phantom images 132 Selection

Insertthestructureobjects:Body,PTV,GTV,CTV, 185
organsatrisk.
Useastructuretemplate,ifappropriate. 306
Digitize the structures Contouring

Drawacontourforeachstructureoneachimage 251
slice,usingthedigitizer.

External Beam Planning Workflows
Thesesectionsintroducetypicalworkflowsusedwhencreating
forwardtreatmentplans,IMRTtreatmentplansandDoseDynamic
Arcplansforexternalradiotherapy.
Forward Planning in the External Beam Planning Task
Before you begin
Openthepatient.Checkthatthepatientandpossiblecouch
structuresarecorrectlycontoured.Forinstructions,refertothe
onlinehelpandChapter 8,SegmentationandContouring,on
page 199.

Create a plan for the patient Field Setup
Ifnecessary,createacoursefortheplan. 276
Createaplanforthepatient. 263
Prescribethedosefortheplan. 267
Ifdesired,definethefractionationsfortheplan. 274
Insert fields and field accessories into the plan Field Setup
Insertfieldstotheplan. 383,389
Movethefieldsasnecessary. 400
Rotatethefieldsasnecessary 406
Resizethefieldstoconformtothetargetvolume 411
MLC:InsertMLCobject,adjusttheleavestothe 519
targetvolume
Blocks:Insertblockobject,delineatetheblock 580
Wedges:Definewedgetype,directionandwidth. 598
Compensator:Insertcompensatorobject,verifythe 558
compensatormatrixandeditifnecessary
Workflows for External Beam Planning 49

Bolus:Insertbolusstructure,linkthestructureto 603
thefield(s)
Calculate the dose distribution Field Setup

Setthecalculationoptions. 609
Definethecalculationvolume. 614
Calculatethedosedistribution. 619
Evaluate the plan Field Setup,

Plan
Evaluation
CalculateandevaluatetheDVHforthePTVand 654
eachcriticalorgan.
Evaluatethedosedistributionwiththe 649
measurementtools.
Create reference points to the plan Field Setup

Createthenecessaryreferencepointsanddefine 442
thereferencepointlocations.
Linkthepointstoplananddefineoneofthemas 444
primaryreferencepoint.
Compare the plan with alternative plans Field Setup,

Plan
Evaluation
Iftherearemultipleplans,
Comparetheplansvisually 677
Comparebysummingup 678
Comparebysubtracting 684
Send the plan to virtual simulation 709 Field Setup
Approve the plan for treatment 704 Field Setup,

Plan
Evaluation

IMRT Planning in the External Beam Planning Task
Before you begin
Openthepatient.Importthepatientsimages,createa3Dimage,
patientstructuresandpossiblecouchstructures.Contourthe
structures.Payparticularattentiontoaccuratecontouring.For
instructionsonopeningthepatient,imageimportandcontouring,
refertotheonlinehelp,theSectionImportingImageson
page 107andChapter 8,SegmentationandContouring,on
page 199.
IMRT Planning with Fluence Optimization
Step in IMRT Planning See page Workspace

Create a plan for the patient. 263 Field Setup
Insert fields into the plan. 383, 389 Field Setup

Inserteachfieldandrotatethemtothedesired 406
anglemanually.
Optimize the fluences. Field Setup

Definethedoseobjectivesforthetargetandall 465
criticalorgans.Adjustthedoseprioritiesand
fluencesmoothingobjectivesinteractivelyduring
theoptimizationtodefinethedesireddose
distribution.
Calculate the dose distribution. 616 Field Setup
Evaluate the plan. 649 Field Setup,

Plan
Evaluation
Create reference points in the plan. 442 Field Setup
Compare the plan with alternative plans. 677, 678 Plan

Evaluation
Verify the plan. Field Setup

Verifytheplaneitherbyusingawaterphantomor 697
portaldoseverification.

Approve the plan for treatment. 704 Field Setup
IMRT Planning with Beam Angle Optimization

and Fluence Optimization

Insert one initial field for the Beam Angle 383, 389 Field Setup
Optimization.
Optimize the field geometry with Beam Angle 424 Field Setup
Optimization.
criticalorgans.
Optimize the fluences. Field Setup

Youcanmodifytheoptimizationobjectives,but 464
bearinmindthatthebestresultsareachievedby
usingthesameobjectivesforbeamangle
optimizationandfluenceoptimization.

Plan
Evaluation
Create reference points in the plan. 442 Field Setup

Evaluation

Verifytheplaneitherbyusingawaterphantomor 697
portaldoseverification.

Dose Dynamic Arc Planning for RapidArc
in the External Beam Planning Task
Before you begin

Openthepatient.Importthepatientsimages,createa3Dimage,
patientstructuresandpossiblecouchstructures.Contourthe
structures.Payparticularattentiontoaccuratecontouring.For
instructionsonopeningthepatient,imageimportandcontouring,
refertotheonlinehelp,theSectionImportingImageson
page 107andChapter 8,SegmentationandContouring,on
page 199.Forinstructionsonaddingcouchstructures,see
Chapter 7,InsertingCouchStructuresinanImage,onpage 194.
Step in Dose Dynamic Arc Planning See page Workspace

Insert one static or arc field for the arc 383, 389 Field Setup
optimization.
Define the dose prescription for the plan. 267 Field Setup
Optimize the plan with arc optimization. 492 Field Setup

criticalorgans.
Adjustthefieldgeometryoruseabasedoseplan, 501,505
ifappropriate.

Thiscanalsobeautomated.

Plan
Evaluation

Evaluation

Verifytheplanbyusingawaterphantom. 697

External Beam Planning with Clinical Protocol

Open the patient Field Setup
Insertaclinicalprotocolreferencetothepatient. 342
Create structures according to a clinical protocol 343 Contouring

Selectthereferencepointlocationsthatneedtobe 344
created.
Segmentthestructures. 199
Create plans according to clinical protocol plans Field Setup

Createasingleclinicalprotocolplan. 344
Createallclinicalprotocolplans. 344
Modifytheplanasnecessary. 49
Setthecalculationoptions. 609
Definethecalculationvolume 614
Calculatethedosedistribution. 619
Evaluate the plan 49 Field Setup,

Plan
Evaluation
Approve the plan 49 Field Setup,

Plan
Evaluation
4D Planning in the External Beam Planning Task
Before you begin
Openthepatient.

Import 4D image data Selection

Importa4DimagingstudyintoEclipsefrom 108
a4Dimagingdevice
Optional:Createa3Dimageforeach 128
respiratoryphase

Definestructurestooneofthe3Dimages 179
Copystructureinformation,either 283
individualstructuresorstructuresets,from
theprimary3Dimagetoany/allregistered
3Dimage(s)
Visuallyverifythestructuresandselectone 77,107
3Dimageforcreatingatreatmentplan
Create a plan Field Setup

Createatreatmentplanusingtheselected3D 265,308,
image 344
Copyandpastetheplantoanother3Dimage 269
orallother3Dimages,includingthe
isocenterpositionandreferencepoints
Calculatethedosedistribution 49
Evaluate the plan 49 Field Setup,

Plan Evaluation
Approve the plan for treatment 49 Field Setup,

Plan Evaluation

Chapter 3 Getting Familiar with External
Beam Planning in Eclipse
ThischapterprovidesashortintroductiontotheSelection,
Registration,Contouring,FieldSetupandPlanEvaluationworkspaces
oftheExternalBeamPlanningtask,brieflydescribingtheactions
possibleineachworkspace.Thechapterdescribesthelayoutofeach
workspaceandprovidesinformationonmovingaroundinthe
workspaces.
FormoreinformationonworkingintheWindowsenvironment,refer
totheonlinehelporyourWindowsmanuals.
About External Beam Planning Task

TheExternalBeamPlanningtaskofEclipseisdesignedfor3Dimage
viewing,definitionofthetumorandotheranatomicalstructures,field
setup,virtualsimulation,dosecalculationandplanevaluation.
Thetaskisdividedintodifferentworkspaces,eachusedforspecific
purposesatdifferentphasesoftreatmentplanning.
TheSelection,RegistrationandContouringworkspacesareintendedfor
preparingpatientimagesforactualtreatmentplanning,whereasthe
otherworkspaces(FieldSetup,PlanEvaluation)providetoolsfor
treatmentplanningandevaluationofthecompletedtreatmentplans.
PreparingimagedatafortreatmentplanningintheSelection,
RegistrationandContouringworkspacesinvolves
Importingandexportingtherapeuticanddiagnosticimages(for
instance,CT,MR,PET)
Constructingandregistering3Dimagedata,viewingtheimagesin
different3Dmodes
Delineatingtreatmentvolumesandanatomicalvolumesbyusing
diagnosticimagestoaidinthetargetdefinition
57
ExternalbeamplanningintheFieldSetupandPlanEvaluation
workspacesinvolves
Creatingplansbysettingupfields
Evaluatingandcomparingplans
Sendingplanstovirtualsimulation
Approvingplansfortreatment
Selection Workspace
TheSelectionworkspaceisusedtomanagepatientdata,imagedata
andimagefilters.
Managing Patient Data
TheSelectionworkspacecontainstoolsforaddingnewpatientstothe
database,openingpatientfilessavedinthedatabase,anddeleting
unnecessarypatientfilesfromthedatabase.
Managing Image Data
TheSelectionworkspacecontainsspeciallydesignedimagecontrol
toolsforviewing,selecting,addinganddeletingimages,importing
newimagesandmanipulatingtheimportedimages.Originalslices
(2Dimagesproducedbyvariousimagingdevices)ofthepatientare
firstimportedtotheSelectionworkspace.Imagescanbeconstructed
andimportedonremovablemediaorvianetworklinksfromseveral
sources,includingCTandMRimagingdevices.Afterimportingthe
images,theyareusedtoforma3Dmodelofthepatient,thatis,a3D
image.
Inadditiontoimportingimagedataandcreating3Dimages,images
canbemanipulatedonscreentoimproveviewingofparticulardatain
theimages,informationontheimagescanbemeasured,andallthe
imagesorselectedimageviewsonscreencanbeprintedout.
Managing Image Filters
TheSelectionworkspacealsofeaturesfunctionstoconfigureimage
exportandimportfilters.Differentimagefiltersareusedforimporting
andexportingimagestoconvertdifferentimagefileformatstoa

formatthattheapplicationunderstands.Thefiltersareusually
installedwiththeprogram,andanyadding,deletingorconfiguringof
filterscanthenbedonebysystemadministratorsonly.
Registration Workspace
TheRegistrationworkspaceisusedtoregisterpairsofimagesets,such
asCTandMRimages.Registrationisperformed:
Manuallybyusingregistrationpointsdefinedinbothimagesor
freerotationandtranslation
AutomaticallybyusingtheimageDICOMcoordinatesorthepixel
data.
Throughimageregistration,contouring,settingupfieldsordefining
brachytherapyapplicatorscanbemademoreaccuratebythedifferent
anatomicalinformationdisplayedintheimages.
Contouring Workspace
IntheContouringworkspace,youcanview2Dor3Dimagesof
differentmodalities,outlineanatomicalandtreatmentstructures
usingeitherautomaticormanualcontouringandsegmenting
methods,andmanagestructures.TheContouringworkspacecontains
toolsfordefiningaccuratedataforeachpatienttoachieveprecise
patientdosimetry.ThisdataincludestheBodystructure,outlinesof
relevantinternalstructures,andthelocationandsizeoftheTarget
structure.CTorMRimagescanalsobecheckedandanalyzedinthe
Contouringworkspace.
Field Setup Workspace

TheFieldSetupworkspaceisusedtoconstructtreatmentplansto
irradiatethetargetvolumes.Thepurposeoftheplansistoachievethe
prescribeddosewiththerequirednumberoffields.Inthisworkspace,
yousetupandvisuallyoptimizethepositionoffieldsina
twodimensionalorthreedimensionalpatientanatomy.Ifnecessary,
youthendefinetherelevantfieldaccessories,includingMLCs,blocks,
wedges,compensators,andbolus.Foreachfield,youcandisplayan
Getting Familiar with External Beam Planning in Eclipse 59

interactiveDRRforcomparisonwithsimulatorimagesorportal
images.Whenthefieldsetupiscompleted,youcalculatethedose
distributionfortheplan.
PlanscanalsobesenttovirtualsimulationfromtheFieldSetup
workspace.
Plan Evaluation Workspace

ThePlanEvaluationworkspaceisusedforanalyzingandcomparing
alternativeplanstodeterminethemostappropriateplanor
combinationofplanstoapprovefortreatment.
Aftercalculatingthedoseforatreatmentplan,youcanviewthedose
distributiondatatwodimensionallybyusingisodoselinesanddose
colorwash,orthreedimensionallybyusingisodosesurfacesanddose
cloudmode.Inadditiontovisualevaluation,youcanevaluatethe
planbydisplayingDVHsformultipleplansorstructures.Inthe
ExternalBeamPlanningtask,theworkspacealsoprovidestoolsfor
viewingthedoseatreferencepoints,normalizingandweighting
fields,verifyingtheabsolutedoseandtheresultingMUs.These
functionsarealsoavailableintheFieldSetupworkspace.
ThespecialfunctionalitiesinthePlanEvaluationworkspaceenable
visualcomparisonofdifferentplanssidebyside,andcomparisonof
plansbysubtractingoradding(bothbrachytherapyandexternalbeam
plans).Youcanalsosumseveralplanstogether.
Tofinishthetreatmentplanning,youmayacceptplansfortreatment
byapprovingthem.
Starting the Application

YoucanuseuptofourinstancesofExternalBeamPlanningtask
simultaneouslyonthesameworkstationwhenallapplication
instancesusethesamedatabase.
Usingmultipleapplicationinstancesallowsyouto
Opendataofmultiplepatientsatthesametimeforviewingor
editing.
Workononepatientwhiletheapplicationisprocessingtheother,
forinstance,performingoptimization.

YoucanstartanewapplicationinstancefromtheFilemenuofthe
applicationthatiscurrentlyopen,orfromtheWindowsStartmenu.
WhenanewapplicationinstanceisstartedfromtheFilemenu,the
systemlogsyouintoanewinstanceautomaticallyusingtheuserID
andpasswordofthepreviousinstance.Whenanewapplication
instanceisstartedfromtheWindowsStartmenu,auserIDand
passwordarerequiredforeachnewinstance.
Eachadditionalapplicationinstancestartedafterthefirstinstanceis
indicatedwitharunninginstancenumberintheapplicationtitlebar
(forexample[3]).Thefirstapplicationinstancedoesnothavean
instancenumber.Eachinstancenumberisusedonlyonce.Thismeans
thatifyouclose,forexample,theapplicationinstancenumber[4]and
openanewone,thenewinstancewillhaveinstancenumber[5].The
instancenumberingisrestartedfrom[2]afterallapplicationinstances
areclosed.
WARNING: Always check the patient information displayed on screen to make

sure that you are working on the correct patient. The patient information is
displayed in the title bar of the application main window.
WARNING: The system uses a central database that allows access to the data by
multiple simultaneous users. In some cases this may lead to situations where
another user has modified and saved the data that you are currently working
with. In this situation, you may lose your changes when trying to save them. If
the system was not able to save your changes, it will synchronize the data from
your workstation with the data contained in the database. Carefully verify the
synchronized data, because it may contain changes made by both you and the
other user.
To Start the First Application Instance
1. ChooseStart >Programs >VarianTreatmentPlanning >Eclipse.

2. LogintotheapplicationwithyouruserIDandpassword.
3. Gotothedesiredworkspace.Forinstructions,seeNavigatingin
theWorkspacesonpage 62.

To Start Multiple Application Instances
Intheapplicationinstancethatiscurrentlyopen,chooseFile >
NewInstance.
Anewapplicationinstanceisopened.Aninstancenumberis
displayedinthetitlebar.
Youcanstartotherapplicationinstancesinthesamewayfromanyofthe
openapplicationinstances.
Navigating in the Workspaces

Theworkspaceseachhave:
Specialwindowlayoutstoprovideanoptimalenvironmentfor
performingtheselectedprocedure
Menusandtoolbarsthatcontainbothasetofcommon,andarange
oftaskspecificfeaturesandfunctions
Themenubarcontainscommandsrelatedtotheworkspace.Themost
commonlyusedmenucommandsarealsoavailableastoolbarbuttons.
TheContextwindowdisplaystherelevantobjectsbelongingtothe
selectedpatientintheworkspaces.Thetitlebaroftheapplication
mainwindowshowstheinformationofthecurrentlyactivepatient.
WARNING: Always check the patient information displayed on screen to make

sure that you are working on the correct patient. The patient information is
displayed in the title bar of the application main window.
To Access the Workspaces
Dooneofthefollowing:
ChooseWorkspace >theworkspaceyouwishtogoto.
or
1. ChooseWindow >Workspacebar.
TheworkspacebarisshownatthebottomoftheFocuswindow
andimageviews.

2. IntheWorkspacebar,clickthetaboftheworkspaceyouwishtogo
to.
TheapplicationwillrememberthelastWorkspacebarsettingonthe
particularworkstationwhereyoumadechanges.
Navigating in the Selection Workspace
TheSelectionworkspaceconsistsofamenubar,toolbar,theContext
window,imageviewsandtheImageGallery.Figure 1onpage 63
showstheSelectionworkspace.
A.MenubarB.ScopewindowC.ContextwindowD.FocuswindowE.ToolbarF.Imagegallery
G.2DimageviewsH.Patientorientationindicator
Figure 1 Elements of Selection Workspace
TheImageviewsdisplayimagesselectedfromtheImageGalleryor
theScopewindow.Ineachimageview,thepatientorientation
indicatorinthelowerleftcornershowstheviewingangletothe
selectedpatient.Formoreinformationaboutthepatientorientation
indicator,seePatientOrientationIndicatoronpage 90.
TheImageGallerydisplaysthumbnailsoftheimagesinanimage
series.TheimagesarealsodisplayedinthetreestructureintheScope
window.

Navigating in the Registration Workspace
TheRegistrationworkspaceconsistsofamenubar,toolbar,Context
windowand2Dimageviews.Figure 2onpage 64showsanexample
oftheRegistrationworkspace:
A.MenubarB.ScopewindowC.ContextwindowD.FocuswindowE.ToolbarF.2Dimage
views
Figure 2 Elements of Registration Workspace
TheFocuswindowdisplaysthestructuresetandtheindividual
structuresforthe3DimagethatisselectedintheScopewindow.The
registrationpointsofthe3Dimagescanbeseenintheleftandright
views.Ifthe3Dimagehasbeenregisteredwithanother3Dimage,the
nameofthatimageisalsoshown.
Theplanesofthe3DimagesselectedintheObjectExplorerare
displayedinthesixorthogonalimageviews.Ineachimageview,the
patientorientationindicatorinthelowerleftcornershowstheviewing
directiontotheselectedpatient.
Registered3Dimagescanalsobeshowninorthogonalverification
views.Theoverlappingregisteredimagescanbeviewedin
transversal,frontalandsagittalviews,andanyoftheorthogonal
viewscanbeshowninthelargestview.

Navigating in the Contouring Workspace
TheContouringworkspaceconsistsofamenubar,toolbar,theContext
window,themainimageview,twosecondaryimageviews,anda
Modelview.Therearethreeoptionalimageviewlayouts:
TopogramViewsOnelargeorthogonalview,twosmall
topogramviewsandModelview
OrthogonalViewsOnelargeandtwosmallorthogonalviews,
andModelview
CombinedViewsTwoorthogonalviews,twotopogramviews
andModelview
MultiplePlaneViewsNinetransversalorthogonalviews
Figure 3onpage 65illustratestheoptionalimageviewlayouts.
Topogram Orthogonal Orthogonal Orthogonal Orthogonal Orthogonal

view view view view view view
Frontal Frontal Frontal Transversal Transversal Transversal
Orthogonal view
Transversal
Orthogonal view Topogram Orthogonal view Orthogonal Orthogonal Orthogonal Orthogonal
Transversal view Transversal view view view view
Sagittal Sagittal Transversal Transversal Transversal
Model
Topogram Topogram view Orthogonal Orthogonal Orthogonal
Model Model view view view view view
view view Sagittal Frontal Transversal Transversal Transversal
Figure 3 Optional Image View Layouts in Contouring Workspace
TheMainimageview(thelargestimageview)displaysoneimage
planeatatime,andshowsthedirectionoftheprimaryplane.For
example,inthetransversaldirection,youarelookingeitherupor
downalongtheZaxisattheXYplane.TheMainviewdisplayseither
originalorinterpolatedplanes(seeChapter 5,SectionParameters
UsedforConstructing3DImagesonpage 129),anditisusedfor
drawingcontoursorpaintingsegmentsofaselectedstructure.
RotatingorpanningtheimagedisplayedintheMainorthogonalview
isalsoreflectedinthesmallerorthogonalview.
Dependingontheviewlayout,partofthesecondaryviewsdisplay
eithertopogramimagesororthogonalimages.Inthecaseofthe
MultiplePlanesview,eachtransversalimageviewshowsthe
precedingorfollowingtransversalplane.
Anadditionalsecondaryview,theModelview,displaysthestructure
modelofthepatient.Thestructuremodelcontainsalldefined
structuresthatyouhaveselectedtobevisible.

Ineachimageview,thepatientorientationindicatorinthelowerleft
cornershowstheviewinganglefortheselectedpatient.
Formoreinformationonusingtheimageviews,seeChapter 4,
VisualizationofImages,onpage 77.Formoreinformationonthe
imageplanes,seeOrthogonalViewsonpage 84.
Figure 4onpage 66showsanexampleoftheContouringworkspace
withonelargeorthogonalview,twosmalltopogramviewsandModel
view(TopogramViewslayout):
A.MenubarB.ScopewindowC.ContextwindowD.FocuswindowE.ToolbarF.Mainimage
viewG.Secondaryviews,topogramviewmodeH.Modelview
Figure 4 Contouring Workspace Screen (Topogram Views Layout)
Navigating in the Field Setup Workspace
TheFieldSetupworkspaceconsistsofamenubar,toolbars,the
Contextwindow,theInfoview,andimageviews.Theimageview
layoutoftheFieldSetupworkspaceconsistsofthreeorthogonalviews
andaModelview.
Figure 5onpage 67presentsanexampleofthelayoutoftheField
Setupworkspace.

A.MenubarB.ScopewindowC.ContextwindowD.FocuswindowE.InfowindowF.Toolbar
G.3DimageviewH.2Dimageviews
Figure 5 Field Setup Workspace
Threeoftheimageviewsdisplay2Dimagesofthepatientfromthree
directions:transversal,sagittalandfrontal.Theorderoftheviews
dependsonthepatientspositionwhentheoriginalCTimageswere
produced.
ThefourthimageviewistheModelviewthatdisplayseitherasolid
3DoraBEVimageofthepatient.Formoreinformationontheimage
andplanvisualization,seeChapter 4,VisualizationofImages,on
page 77andChapter 11,SectionAboutFieldsonpage 365.
TheareaundertheContextwindowandtheimageviewsiscalledthe
Infoview.Itdisplaysthefieldparametersforeachfieldcontainedin
theplan.FormoreinformationontheInfoview,seeAddingStatic
FieldstoPlansonpage 383.
TheContextwindowoftheFieldSetupworkspaceindicatesthe
selectedpatientandimagesetattachedtotheplanaswellasthe
selectedplanandfieldswithfieldaccessories,ifany,containedinthe
plan.

Navigating in the Plan Evaluation Workspace
ThePlanEvaluationworkspaceconsistsofamenubar,atoolbar,the
Contextwindowandimageviews.Youcanchoosefromthefollowing
imageviewlayouts:
TwoorthogonalviewsTwoviewsetsconsistingofthree2D
views(transversal,frontalandsagittal).
Twomodel/BEVviewsTwoviewsetsconsistingofa3Dview.
MultipleplaneviewsOneviewsetconsistingofninetransversal
viewsdisplayingadjacentimageplanes.
OrthoviewsandBEVOneviewsetconsistingofthree2Dviews
(transversal,frontalandsagittal)anda3Dview.
MultipleplansSixtransversal2Dviews
A.MenubarB.ScopewindowC.ContextwindowD.FocuswindowE.ToolbarF.ImagesetG.
Infowindow
Figure 6 Plan Evaluation Workspace
To Change Image View Layouts
1. ChooseWindow >ViewLayouts.
TheSwitchLayoutdialogboxopens.

2. Intheselectedlayoutlist,clicktherowofalayouttoseeits
preview.
3. Toselectthelayout,clickOK.
Managing Objects in Eclipse

TheContextwindowisameansofviewingthepatient,imageand
planinformation.TheinformationintheContextwindowisdisplayed
asfoldersthatarehierarchicallyorganizedinatreestructure.Itis
dividedintotwoparts,theScopewindowandtheFocuswindow.
Context Window in the Selection,

Registration and Contouring Workspaces
BelowisanexampleoftheContextwindowintheSelection,
RegistrationandContouringworkspaces.
A.ScopewindowdisplaystheobjectsopenedintheObjectExplorer.B.Focuswindowdisplays
thecontentsoftheobjectselectedintheScopewindow.C.Selectedobject.
Figure 7 Context Window

Intheexample,theobjectsdisplayedintheScopewindowarethe
patient,thestudies,theimages,thecourseandtheplan,withthe
patientatthetopofthehierarchy.Thepatienthastwoimageseries,
two3Dimagesandonecourse.Thecoursecontainsoneplan.The
contentsoftheFocuswindowdependontheobjectselectedinthe
Scopewindow.Inthisexample,oneofthe3Dimagesisselected,and
thestructuresetandtheindividualstructuresdefinedforthe3D
imagearedisplayedintheFocuswindow.
Youcancontrolthevisibilityofobjectsintheimageviewsbyselecting
orclearingthevisibilitycheckboxesintheFocuswindow.Theactive
(selected)objectisalwaysvisibleintheimageviews,regardlessofthe
settinginthevisibilitycheckbox.
Note: Rememberthatyouhavetoselectanobjectbeforeyoucanmodifyit.For
example,tocontourablockyouhavetoselecttheblocktocontour.
Context Window in the Field Setup and

Plan Evaluation Workspaces
BelowisanexampleoftheContextwindowintheFieldSetup
workspaceandthePlanEvaluationworkspaceintheExternalBeam
Planningtask.

A.ScopewindowdisplaystheobjectsopenedintheObjectExplorer.B.Focuswindowdisplays
thecontentsoftheobjectselectedintheScopewindow.C.Selectedobjectishighlighted.
Figure 8 Context Window
Intheexample,theobjectsdisplayedintheScopewindowarethe
patient,thestudy,theimage,thecourseandtheplans,withthepatient
atthetopofthehierarchy.Thepatienthasanimageseries,3Dimage
andonecoursewhichcontainstwoplans.
ThecontentsoftheFocuswindowdependontheobjectselectedinthe
Scopewindow.Inthisexample,aplanisselected,anditscontentsare
shownintheFocuswindow.Theplanislinkedtoa3Dimageanda
structureset,andcontainsfieldsandthedosedistribution.Thefields
containanMLCandablock.The3Dimagecontainsstructuresanda
referencepointwhicharedisplayedintheirownfolders.

Youcancontrolthevisibilityofobjectsintheimageviewsbyselecting
orclearingthevisibilitycheckboxesintheFocuswindow.Theactive
(selected)objectisalwaysvisibleintheimageviews,regardlessofthe
settinginthevisibilitycheckbox.
Note: Rememberthatyouhavetoselectanobjectbeforeyoucanmodifyit.For
example,firstselecttheplantowhichyouwanttoaddfields.
Object Explorer
TheObjectExplorerisadialogboxusedtoopendifferentobjectsfrom
thedatabase.Theseobjectsaretypicallyimages,structuresets,courses
andplans.TheObjectExplorershowsallthedataandplanscontained
ineachselectedobject.Figure 9onpage 72showstheObjectExplorer.
A.SelectedobjectB.Thisboxdisplaysdetailsfortheobjectselectedintheleftbox.
Figure 9 Object Explorer
TherightboxoftheObjectExplorerdisplaysmoredetailsforthe
objectselectedintheleftbox.Formoreinformationonusingthe
ObjectExplorer,refertotheonlinehelpsystem.

Saving Information
Alldatayouworkwithisstoredinthedatabase,andyouloadthe
appropriatedatatothememoryofyourcomputertoviewandmodify
it.Thedatamodificationsmadearenotautomaticallysavedtothe
databasefromyourcomputer.
Note: Toavoidlosingimportantinformation,
Saveyourworkregularlytoavoidlosingimportantinformation.
Makeregularbackupsofyoursystem.Especiallybeamdataandthe
patientdatabase,includingimagedirectories,shouldbebackedupat
regularintervals.
WARNING: The database allows multiple users to work on a central database.

In some cases, another user may have modified and saved the data that you are
currently working with. If this occurs, you lose your changes when trying to
save your data. To minimize the risk of this situation, use the Reload All
command before starting to make changes to the data.
To Save Your Work to the Database
ChooseFile >SaveAll.
Theinformationissavedtothedatabase
Closing Items
SometimesmultipleobjectsopenedintheScopeorFocuswindoware
distracting.Tocleanuptheview,andtoavoidsituationswhereyou
makechangestothewrongitem,youcancloseextraneousitemsthat
youdonotneedtoworkwithanylonger.Closeditemsarejust
removedfromtheapplicationwindows;theyarenotremovedfrom
thedatabase.

To Close Items
1. IntheFocusorScopewindow,selecttheitemtobeclosed.
2. ChooseFile >Close.
Ifyouhavemadechangestotheitem,youarepromptedtosaveor
discardthechanges.Iftherearenochanges,theitemisclosed
withoutprompts.
Deleting Information
Alldatayouworkwithisstoredinthedatabase.Sincethedata
modificationsmadearenotautomaticallysavedtothedatabasefrom
yourcomputer,youneedtocommunicatedeletionstothedatabaseby
savingthedeletion.Toavoidinformationlosses,becarefulwhen
deletinginformation.Forexample,ifyouaccidentallydeleteacourse
oraplan,youcanreloadtheobjectsfromthedatabasetoreturntothe
previouslysavedstate.
To Delete Information from the Database
1. ChooseEdit >Delete.
Theinformationisdeletedfromthememoryofyourcomputer.
2. ChooseFile >SaveAll.
Theinformationisdeletedfromthedatabase.
Note: PatientscannotbedeletedfromthedatabasewhileintheExternalBeam
Planningtask.
Properties Dialog Boxes

DataandsettingsforallobjectsusedinEclipsecanbedisplayedand
modifiedindialogboxesdesignedforthispurpose.Todisplaythe
Propertiesdialogboxofastructure,forinstance,selectthestructurein
theFocuswindowandchooseEdit >Properties .Thismanual
describesonlythepartsofthepropertydialogboxesthatarerelevant
totreatmentplanning.FormoreinformationonthePropertiesdialog
boxesandthetabscontainedinthem,refertotheonlinehelpsystem.

Info Window
TheInfowindowdisplaysparametervaluessetfortheplans,plan
sumsandfields.Italsoprovidesaneasywaytosetoreditsomeof
thesevalues.IntheExternalBeamPlanningtask,theInfowindowis
availableintheFieldSetupandPlanEvaluationworkspaces.
Bydefault,theInfowindowisshownbelowtheimageviewsandthe
Focuswindow.Youcanalsomovethewindowandhaveitfloatover
theimageviewsortheFocuswindow.
ToshowtheInfowindow,chooseWindow >InfoWindow.
WARNING: Do not use screen print-outs containing the Info window for
conveying any planning information to the treatment. Some of the information
contained in it can only be viewed on screen by changing the column widths in
or by scrolling the Info window.
Info Window in the Field Setup Workspace

IntheFieldSetupworkspace,theInfowindowcontainsthefollowing
tabs:Fields,DosePrescription,FieldAlignments,PlanObjectives,
OptimizationObjectives,DoseStatistics,CalculationModels,andPlan
Sum.
A.TomaketheInfowindowfloat,pointhereanddragthewindow.
Figure 10 Info Window in the Field Setup Workspace
Info Window in the Plan Evaluation Workspace

IntheExternalBeamPlanningtask,theInfowindowcontainsthe
followingtabsinthePlanEvaluationworkspace:Fields,Dose
Prescription,DoseStatisticsandPlanSum.

A.TomaketheInfowindowfloat,pointhereanddragthewindow.
Figure 11 Info Window in the Plan Evaluation Workspace

Chapter 4 Visualization of Images
Thischapterlaysouttheprinciplesofvisualizingthepatientimagesin
thetwoandthreedimensionalviews.Describedarethe
threedimensionalpatientmodelandthecoordinatesystemsusedin
it,theuseofthe3DmodelandviewingitintheModelviewandthe
orthogonal2Dimageviews.Thechapterprovidesinstructionsfor
definingthecolorandstyleforobjectsonscreen.Themethodsusedto
adjusttheimagesonscreenarealsocovered:improvingtheir
visualizationsettings,viewingthemfromdifferentangles,measuring
informationintheimagesandusingcutawayplanestoimprovethe
visualizationofitemsinthe3Dpatientmodel.
About 3D Modeling
Mostimagestudiesproducedbymedicalimagingdevicesandused
forradiationtreatmentplanningarearrangedasaseriesof2Ddigital
images.Theseimagesareimportedfromtheimagingdevicesindigital
format.The2Ddigitalimagedataisthenusedasabasisforgenerating
athreedimensional(3D)modelofthepatient.
Thethreedimensionalmodel,calledthe3Dimage,isformedfroma
stackofimported2Dslicescalledtheimageset.Assumingthatthe
slicesintheimagesetareperfectlyalignedandofexactlythesame
size,theirouterlimitswouldformtheoutersurfaceofthe3Dmodelas
inthefollowingfigure.
A.NormalB.Interpolatedplanes
Figure 12 Stack of 2D Images
77
Thegapsbetweentheslicescanvaryconsiderably.Inordertorender
thebest3Dmodelpossible,planesareinterpolatedintolargergaps
betweenactualslicestomaketheimageplanesequidistant.Ifthe3D
imagecontainsinterpolatedimageplanes,anewimageseriesis
createdinthedatabase.Thisimageseriesconsistsoftheinterpolated
slicesandcopiesoftheactualimageslices.
Theslicesusedinconstructingthe3Dimagemusthaveparallel
normals,andtheimageplanesmaynotberotatedaroundthenormal.
Eclipseapplicationsfeaturefunctionsdesignedtoovercome
inconsistenciesintheimages,forinstance,differencesincoordinate
axesorimagesizes.
About 4D Modeling
MotionofthepatientduringCTimagingcancreateunwantedmotion
artifactsthatcanchangetheapparentgeometricalshapeand/or
locationoftheorgansorthetargetstructure.Fourdimensional(4D)
imagingintroducestheadditionaldimensionoftimethat
accommodatesmovementduringimaging.With4Dimaging,itis
possibletoviewstructuremovement.
In4Dimaging,imagedatasetsaretypicallyobtainedatvariousstages
oftherespiratorycycle.Theobtainedimagedataisbinned;3Dimages
areorganizedaccordingtothestagesoftherespiratorycycleusinga
thirdpartyexternalprogram.Theimagedatacanbeeither
phasebinned(phaseofarespiratorycycle)oramplitudebinned(such
asbreathingamplitude).Theseimagedatasetsarethenusedfor
creating4Dimages.A4Dimagecanbeconsideredasanorderedsetof
3Dimages.

A3Dimagethatispartofa4Dimagestudycanbeoneofthe
followingimagetypes:
FreeBreathingimage(FB)AconventionalCTscanwherethe
patientisscannedwithoutanattempttocontrolthepatients
respiratorycycleorcorrecttheCTscandataforrespiration
movement
PhaseimageAnimagetakenduringaparticularphaseofthe
respiratorycycleandlabelledwithaphasenumber(forexample,
50%,60%).Phaseimagescanbedisplayedinamovieloop.
MaximumIntensityProjectionimage(MIP)Animagecontaining
themaximumintensitypixelsderivedfromallphases.AMIP
imageisuseful,forexample,forshowingbones,oratumorthatis
ofhigherdensitythanthesurroundingarea.
Averageimage(Ave)Animagewheretheimagedatavaluesfor
eachpixeloneachsliceareaveragesofalltheimagevaluesatthe
samepixellocationsonthecorrespondingslicesineachbin.
Minimumintensityprojectionimage(MinorMinIP)Animage
containinglowintensitypixelsderivedfromofallphases.
A3Dimagecanbelongtoonlyone4Dimage.A4Dimagecancontain
onlyone3Dimageofeachtype,exceptphaseimages,forwhichthe
phasenumbershavetobeunique.
Youcanview3Dimagesthatarepartofa4Dimageinamovieloopor
blended,andalsodisplaytemporaryDRRimagesforthem.
Coordinate Systems
ThreedimensionalmodelingintheExternalBeamPlanningtaskis
basedonaplanningcoordinatesystemthatdefinesastatic,clinicwide
coordinateaxissystem.Theplanningcoordinatesystemdefineshow
the(image)coordinatevaluesenteredinthesystemareinterpreted.
Theplanningcoordinatesystemcanbesettoconformtothefollowing
coordinatesystems:theStandardcoordinatesystem,IEC61217
coordinatesystem,andauserdefinedimagecoordinatesystem.The
planningcoordinatesystemisindependentofanypatientcoordinate
system.
Visualization of Images 79
TheplanningcoordinatesystemisconfiguredintheAdministration
task.Thesystemshouldbeconfiguredtocorrespondtothecoordinate
systemoftheprimarytreatmentunit.
WARNING: If you change the coordinate system, the directions of the

coordinate axes described here are no longer valid. For more information on
modifying the axis orientations, refer to the online help.
Standard Coordinate System

Bydefault,theplanningcoordinatesystemissettoconformtothe
Standardcoordinatesystem,inwhichtheZaxispointstowardsthe
gantry,theXaxispointstotherightwhenfacingthegantry,andthe
Yaxispointstowardsthefloor.TheStandardcoordinatesystemis
illustratedinFigure 13onpage 80.Inthefigure,theDICOMpatient
orientationisFeetFirstSupine(FFS),butithasnoeffectonthe
Standardcoordinatesystem.
Figure 13 Standard Coordinate System

IEC 61217 Coordinate System
TheplanningcoordinatesystemcanalsobesettoconformtotheIEC
61217coordinatesystem.Inthiscoordinatesystem,theYaxispoints
towardsthegantry,theXaxispointstotherightwhenfacingthe
gantry,andtheZaxispointstowardstheroof.TheIEC61217systemis
illustratedinFigure 14onpage 81.Inthefigure,theDICOMpatient
orientationisFeetFirstSupine(FFS),butithasnoeffectontheIEC
61217coordinatesystem.
Figure 14 IEC 61217 Coordinate System
User-Defined Coordinate System

IfneitherthestandardnorIEC61217coordinatesystemmeetsyour
clinicalrequirements,thesystemallowsdefininganarbitrary
righthandedcoordinatesystem.Useadescriptivenameforthe
coordinatesystem.
DICOM Coordinate System
TheDICOMcoordinatesystem,usedinimagingdevices,isseparate
fromtheplanningcoordinatesystemusedinEclipse.TheDICOM
patientcoordinatesystemisbasedonthreeaxes(X,YandZ)as
illustratedinFigure 15onpage 82.
Figure 15 DICOM Coordinate System
Inrelationtothepatient,theZaxisisthefeetheadaxis.TheYaxisis
thefrontbackaxis,andtheXaxistheshouldershoulderaxis.The
directionsoftheaxesarealwaysthesameanddonotdependonthe
positionofthepatientonthecouch.
Image Views
Theimportedimageswhichareincludedintheimagesetofthe
patientcanbeexaminedintwokindsofviews:2Dviewsand3Dview.
The2Dimageviewsdisplayplanesextractedfromthe3Dimage.They
canalsodisplayoriginalindividual2Dslices.Formoreinformation,
see2DViewsonpage 83.
The3Dviewisdesignedforexaminingthestructuremodelofthe
patient.ItisalsopossibletodisplayDRRimages,fieldimages(portal
andsimulationimages),fields,orthogonalplanesandthedose
distributioninthe3Dview.Formoreinformation,see3DViewon
page 85.

Allobjectsarevisualizedbothinthe2Dand3Dviews.Thisdoesnot
necessarilygivearealisticvisualizationinallviews,butanobjectcan
beshownrealisticallyina2Dviewandasasymbolina3Dview.
2D Views
The2Dviewsdisplaytwodimensionalplanes,eitherthoseextracted
fromthe3Dmodelororiginalslices.Ineverydayterms,youcould
thinkoftheseviewsasflat.Theposition,layoutandsizeofthe2D
viewsdependonthecurrentworkspace.Chapter 3,GettingFamiliar
withExternalBeamPlanninginEclipse,onpage 57.Figure 16on
page 83showsanexampleoftheimageinformationshownina2D
view.
A.PlaneslidersandpatientorientationlabelsB.ImageoriginC.AxisorientationD.Patient
orientationE.ApprovedimagemarkerF.PositionofplaneonZaxis(shownonlyifselectedin
theViewOptionsdialogbox)
Figure 16 2D Image View
Note: Theplanesdisplayedinthe2DviewsarenotnecessarilytheactualCT
orMRimagestakenofthepatient.Whena3Dimageisviewed,the2Dviews
displayplanesthatareconstructedfromthe3Dmodel.
Orthogonal Views
The3Dmodeldisplayedinthe3Dviewisdividedintothree
orthogonalviewingplanes,eachdisplayedintheirownview.By
default,theseviewingplanesaretransversal,frontalandsagittal.
Figure 17onpage 84illustratesthedirectionsofthesethreeplanes.
A.TransversalplaneB.FrontalplaneC.Sagittalplane
Figure 17 Viewing Planes in Relation to 3D Model
Bydefault,the2Dviews,inwhichtheviewingplanesaredisplayed,
aredefinedbythreecoordinateaxes,namelytheX,YandZaxisof
thepatientcoordinatesystem.Figure 18onpage 84showsthethree
differentviewingdirectionsofapatientimage.
A.TransversalB.FrontalC.Sagittal
Figure 18 Directions of the Orthogonal (2D) Views

Inthetransversaldirection(Ainthefigure),youarelookingeitherup
ordownalongtheZaxisattheXYplane.TheXaxisrunsleftand
right,andtheYaxisupanddown.TheZaxisistheprimaryaxisin
thisdirection.
Inthefrontaldirection(Binthefigure),theXaxisrunsleftandright.
ThedirectionoftheZaxisisvertical,andyouarelookingattheimage
alongtheYaxis.TheYaxisistheprimaryaxisinthisdirection.
Inthesagittaldirection(Cinthefigure),theYaxisrunshorizontally
leftandright.TheZaxisisvertical,andyouarelookingattheimage
alongtheXaxis.TheXaxisistheprimaryaxisinthisdirection.
Orthogonalplanescanalsobefreelyrotatedwiththemouse.
3D View
The3Dviewdisplaysthethreedimensional(perspective)structure
modelofthepatient.
Dependingonthesettingsandthecurrentworkspace,theimagecan
beviewedeitherina
Modelview(ExternalBeamPlanningandBrachytherapyPlanning
task)
BeamsEyeView,BEV(ExternalBeamPlanningtask)
ThelocationoftheModelviewonscreenalsodependsontheselected
workspace.Formoreinformation,seeChapter 3,GettingFamiliar
withExternalBeamPlanninginEclipse,onpage 57.
CAUTION: Since the 3D view is a perspective view and the proportions in the
image are not realistic, measurements done in it are not reliable.
Model View
TheModelviewdisplaysthestructuremodelofthepatientfroma
freelyselectedviewingangle.Bymeansoftheviewingtools,youcan
changetheviewinganglebyrotatingthestructuremodel.Figure 19on
page 86presentsanexampleoftheModelview.
A.PatientorientationlabelsB.ImageoriginC.ClinicaxissettingsymbolandlabelD.Thepatient
orientationindicatorshowstheviewingangletothepatient.
Figure 19 Model View
HowthestructuresaredisplayedintheModelviewdependsonthe
colorandstyleselectedforthestructures(formoreinformation,see
UsingColorandStyleintheImageViewsonpage 94).Inthe
ExternalBeamPlanningtask,youalsocanshowaBeamsEyeView
insteadoftheModelview.Formoreinformation,seeToShowthe
BEVonpage 379.
Selecting the Viewing Plane Displayed in the 2D Views

Whenviewingtheplanesconstructedfromthe3Dimagein2Dimage
views,youcanmovefromoneplanetoanothertoviewparticular
areasofinterest.Thiscanbedoneinthefollowingways:
Usetheplanesliderscontainedineach2Dview.
Browsethroughthe3Dimagewiththemousescrollwheel.
Browsethroughthe3DimagewiththePAGE UPandPAGE DOWN
keysonthekeyboard.
Browsethroughthe3DimagewiththeNextPlaneandPrevious
Planetoolbarbuttons.

Ineach2Dview,theplaneslidersmarkthepositionoftheviewing
planesshownintheother2Dviews.Youcanmovetheplaneslidersto
showdifferentplanesintheother2Dviews,andwhenyoubrowse
throughthe3Dimage,theplaneslidersshowthelocationofeach
currentviewingplane.Figure 20onpage 87showsa2Dview
containingatransversalviewingplane.Inthiscase,theplanesliders
markthepositionofthefrontalandsagittalplanesdisplayedinthe
other2Dviews.
A. Positionofthesagittalplaneshowninanother2Dview.Movethisslidertoshowanother
sagittalplane.B. Positionofthefrontalplaneshowninanother2Dview.Movethissliderto
showanotherfrontalplane.
Figure 20 Plane Sliders in 2D Views
Each2Dviewalsoindicatesthecurrentlydisplayedplanebyshowing
theX,YorZcoordinateatwhichtheplaneislocatediftheplaneis
paralleltothenormalaxes.
Using the Plane Sliders to Select the Viewing Plane
Ineach2Dview,theplaneslidersmarkthepositionoftheviewing
planesshownintheother2Dviews.Youcanmovetheplaneslidersto
showdifferentplanesintheother2Dviews.Figure 20onpage 87
showsa2Dviewcontainingatransversalviewingplane.Inthiscase,
theplaneslidersmarkthepositionofthefrontalandsagittalplanes
displayedintheother2Dviews.
To Select the Viewing Plane with the Plane Sliders
1. Ina2Dview,pointatthehandleofaplanesliderwiththemouse.
Themousepointerchangestoaresizepointer.
2. Toshowanotherplanein2Dviews,dragtheplanesliderhandle.
IfyouareintheCombinedViewslayoutintheContouringworkspace,
youcanclicktheplanesliderhandleintheMainviewtoselectwhether
thesagittalorfrontalplaneisshowninthesecondary2Dview.
Browsing the 3D Image
Togetabetteroverviewof,forinstance,thedosedistribution,youcan
easilybrowsethroughtheentire3Dimageinthe2Dviews,topogram
views,andtheModelView.Thismeansthatyoucanmovethroughthe
3Dimageplanebyplaneusingthemousescrollwheel,thePGUPand
PGDOWNkeysortheNextPlaneandPreviousPlanetoolbarbuttons.
Youcanbrowsethroughthe3Dimageinevery2Dviewinthe
directionnormaltotheaxisview.Inotherwords,inthecaseofa
rotatedplane,theimageplanesarenotbrowsedalongthemainaxis
(X,YorZaxis).
Thestepofplanesshownwhenbrowsingiscontrolledwiththeplane
distancevalueinalldirections.Whenbrowsingthe3Dimageina
directionnormaltotheimageslices,theplanedisplayedateachstepis
thenearestsliceafterthestep.Theplanedistancevaluedefinesthe
browsestepasfollows:
Zdirection:Planedistancedirectlydefinesthebrowsestep.
XandYdirection:Planedistancevalueequalsthenativeimage
resolutionalongtheaxis.Usuallytheimageresolutionishigherin
theXandYdirectionsthanintheZdirection.
Rotatedimages:Planedistancevalueismodifiedtofallbetween
theimageresolutionandtheslicespacing.
Whenbrowsingthe3DimageintheModelview,itishelpfultofirst
displaytheviewingplanesintheModelviewandrotatethepatient
modeltoviewitfromthedesiredangle.BrowsingintheModelview
movestheintersectionpointoftheviewingplanesalongtheaxis
perpendiculartotheModelview.Dependingontheorientationofthe
3Dmodel,allthreeplanes,twoplanesoronlyoneplanemoves.For
instance,ifthepatientcoordinatesZaxisisperpendiculartothe
ModelView,onlythefrontalandsagittalplanesmovewhenbrowsing.

Tobeabletobrowsethe3Dimageinanimageview,youneedto
activateanimageviewandplacethemousepointerinsidetheview.
Browsingisavailableinallworkspaces.
To Browse the 3D Image in 2D Views
1. Activatethe2Dviewinwhichyouwishtobrowsethroughthe
imageplanes.
Youcanalsomaximizetheactivated2Dview.
2. Todefinetheintervalatwhichtheplanesareshown,gotothe
Displaytoolbaranddefinetheplanedistancevalueinthegreen
box( ).Thevaluemustbeanintegerintherangeof199.
3. Tobrowsethroughtheimageplanes,dooneofthefollowing:
Usethemousescrollwheel.
PressthePGUPandPGDOWNkeys.
ClicktheNextPlane andPreviousPlane toolbar
buttons.
Theimageplanesarebrowsedinthedirectionnormaltotheactive
view.
To Browse the 3D Image in the Model View

1. ShowtheviewingplanesintheModelView.Forinstructions,see
ToDisplaytheViewingPlanesintheModelViewonpage 103.
2. ActivatetheModelView.
3. Todefinetheintervalatwhichtheplanesareshown,gotothe
Displaytoolbaranddefinetheplanedistancevalueinthegreen
box( ).Thevaluemustbeanintegerintherangeof199.
4. Tobrowsethroughtheimageplanes,dooneofthefollowing:
Usethemousescrollwheel.
PressthePGUPandPGDOWNkeys.
ClicktheNext Plane andPrevious Plane toolbar
buttons.
Patient Orientation Labels
Youcanshowpatientorientationlabelsnexttotheplaneslidersinthe
imageviewstoindicatetheorientationofthepatient.Thisoptionis
definedintheViewOptionsdialogbox.
Table 1onpage 90liststhepatientorientationlabelsinuse.
Table 1 Patient Orientation Labels
Indicator Meaning
A Anterior
F Feet
H Head
L Left
P Posterior
R Right
Patient Orientation Indicator

Thepatientorientationindicator,visibleintheimageviews,showsthe
viewingangletothepatient.Thereddotrepresentsthepatientsleft
hand.Thefollowingtablelistssomeexamplesofthepatient
orientationindicator.
Table 2 Patient Orientation Indicators
Indicator Meaning
Youarelookingatthepatientsface,alongtheYaxis
Youarelookingatthepatientsback,alongtheYaxis
Youarelookingatthepatientshead,alongtheZaxis
Youarelookingatthepatientsfeet,alongtheZaxis

Table 2 Patient Orientation Indicators
Indicator Meaning
Youarelookingatthepatientsleftside,alongtheXaxis
Youarelookingatthepatientsrightside,alongtheXaxis
Orthogonal Viewing Planes and the Model View

Theviewingplanesextractedfromthe3Dimagecanbedisplayedin
theModelview.Theplanescanperpendicularlyintersecteachotherat
anypoint.
A.SagittalplaneB.FrontalplaneC.Transversalplane
Figure 21 Orthogonal Planes in Model View
Forinstructions,seeToDisplaytheViewingPlanesintheModel
Viewonpage 103.Movingorrotatingtheplanesintheorthogonal
2DviewsupdatestheModelviewaccordingly.Youcanalsobrowse
throughtheimageplanesintheModelView.Forinstructions,seeTo
Browsethe3DImageintheModelViewonpage 89.
Using the Movie Control Tool
TheMovieControltoolisvisibleinthemainimageviewwhenyouare
workingona3Dimagethatispartofa4Dimage.TheMovieControl
toolbecomesvisiblealsoinotherimageviewswhentheimageviews
aremaximized.PressingthePlaybuttonoftheMovieControltool
activatesamovieloopthatshowsthephasesofthe4Dimage,for
example,therespiratoryphasesofthepatient.
DifferentphasesareindicatedwithtabsaroundthePlaybutton.
Clickingthesetabschangestheimagevisibleintheimageviews.You
canalsousetherightarrowkeytoviewthenext3Dimagecontained
inthe4Dimage,andtheleftarrowkeytoviewtheprevious3Dimage
containedinthe4Dimage.Whenthemovieloopisrunning,thetabof
thecurrentlyactivephaseisdisplayed.Theprimaryimageisindicated
withabluetab(formoreinformationontheprimaryimage,see
Viewing4DImagesonpage 114).Youcanchangetheprimary
imagebypressingSHIFTandclickingthetabofthedesiredphase.
Whenyouhavedefinedastructureinall3Dimages,youcanalsoview
themotionofthedefinedstructureintheModelviewandintheBEV.
Similarly,ifyouhavecreatedDRRimages,youcanviewDRR
movementintheModelviewandintheBEV.
Nonphaseimages(MIP,Min,AveandFBimages)canbepartof4D
images,butcannotbeincludedinthemovieloop.Theseimagesare
displayedasimagebuttonsontheleftsideoftheMovieControlTool.
Youcanviewthembyclickingtheimagebuttons.
A.Imagebuttonsforimagesthatarepartofthe4Dimagebutcannotbeincludedinthemovie
loop.Clickthebuttonstodisplaytheimages.B.Buttonopeningtheonlinehelptopicforthe
MovieControltool.C.Playbuttonactivatingamovieloopthatdisplaysmotiononthe
orthogonalimageplanes.D.Theprimaryimageintherespiratorycycle.E.Tabindicatinga
phaseintherespiratorycycle.Clickthetabtojumptothephase.
Figure 22 Movie Control Tool

Youcan,forexample,moveviewingplanes,zoominorout,display
thelineprofile,andcontourwhilethemovieloopisrunning.The
contoursoftheselectedstructureintheprimaryimagearehighlighted
whenthemovieloopisrunning.Allcontoursdrawnwhilethemovie
loopisrunningaresavedintheprimaryimage.
Youcanaddorremoveimagestothemovieloopinthe4DImage
Propertiesdialogboxwhilethemovieloopisrunning.Thisisuseful,
forexample,whendecidingtherespiratoryphaseusedinagated
treatment.
YoucanusetheMovieControltooltogetherwiththeBlendControl
tool.Iftwo4Dimagesareblended,themovielooploopstheminthe
samephase,providedthattheimageshavethesameamountofphases
andthecorrespondingphasesareblendedwhenthemovieloopis
started.Ifa4Dimageisblendedwitha3Dimage,themovieloop
loopsonlythe4Dimageandblendsitwiththe3Dimage.Youcan
blendthephaseimagesbypressingCTRLandclickingthedialsofthe
phasestoblend.Blendingismaintainedwhenchangingfromone3D
imagetoanotherifyouusetherightandleftarrowkeysintheMovie
Controltooltoviewthenextandprevious3Dimageinthe4Dimage.
WhenthemovieloopisrunningintheFieldSetupworkspace,the
dosedisplayedintheimageviewisthatoftheplanningimage.
To Use the Movie Control Tool

1. Draga3Dimagethatispartofa4Dimageintotheimageview.
TheMovieControltoolappearsinthelowerrightcornerofthe
imageview.
2. Toviewmotion,clickthePlaybutton .
YoucanalsostartandstopthemovielooppressingtheSPACEbar.
Themovieloopisstartedandthedialsofcurrentlyactive3D
imagesaredisplayedaroundthePlaybutton.Ifthisisthefirsttime
youareviewingtheimagesinamovieloop,allowamomentfor
theimagestoload.
3. Youcanadjustthespeedofthemovieloopbyrightclickingthe
PlaybuttonandchoosingSlow,MediumorFast.
4. Tostopthemovieloop,clickthePlaybuttonagain.
5. Tojumpintoadesired3Dimageofthe4Dimage,movethemouse
ontheedgeofthePlaybuttonandwhenthetabsappear,clickthe
tabofthedesired3Dimage.Youcanalsojumpintoadesired3D
imagewhenthemovieloopisrunning.
Youcanalsousetherightandleftarrowkeystojumptothenext
orprevious3Dimage.
YoucanblendthephaseimagesbypressingCTRLandclickingthetabsof
the3Dimagestoblend.
6. ToviewaMIP,Min,FBorAvetypeofimagethatispartofthe4D
imagebutcannotbeincludedinthemovieloop,clicktheimage
buttonsontheleftsideoftheMovieControltool.
Using Color and Style in the Image Views

Theselecteddisplaycolorandstyledefineshowstructures(for
instance,Body,BoneorTargetstructure)aredisplayedinthe3Dand
2Dviews.Thisenablesyoutodisplaystructuresinawaythatgives
thebestviewingresult.
Thestyleoptionsforstructuresare
Contourlines
Solidsurface
Translucentsurface
Predefinedrenderings(forairchannels,boneandskin)
Allviewingcolorsandstylesareavailableforallstructuresinall
imageviews.However,structuresdisplayedastranslucentsurfacesin
theModelviewaredisplayedascontoursinthe2Dimageviews.If
youchoosetodisplayastructureasasolidsurfaceintheModelview,
itisrenderedasafilledareainthe2Dimageviews.Moreover,some
stylescanbedisplayeddifferentlyin2Dand3Dviews.Configure
colorandstylesettingsintheAdministrationtask.
Whenyouchangethecolorandstylesettingsofastructure,thechange
isappliedtoallimagesunderthepatient.

Figure 23onpage 95showsBodyandLungstructuresdisplayedusing
adifferentstyleintheModelview.TheleftpictureusesContourlines
torepresenttheBodystructureandSegmenttorepresenttheLung
structure.TherightpictureusesTranslucentBodyrenderingand
displaystheLungstructureasaTranslucentSegment.
Figure 23 Body and Lung Structures with Different Styles
Forsurfacemodels,differentlevelsoftransparencycanbeconfigured,
whichcanbeusefulinviewingseveraloverlappingstructuresinthe
Modelview.Youcandisplaytheinnermostofthesestructuresasa
solidsurface,andincreasetheleveloftransparencyforthestructures
overlappingit.
Note: Selectingcolorandstyleisonlypossibleforstructures.
To Select Color and Style

1. Ifnecessary,intheFocuswindow,displaythestructuresetandthe
structuresbelonginginit.
2. Rightclickthestructurewhosecolorandstyleyouwishtochange
andchooseColorandStyle.
TheColorandStyledialogboxopens.
3. IntheColorandStyledropdownlist,selectthedesired
appearance.
4. Toacceptanduseyoursettings,clickOK.
Ifyouchangethecolorandstylesettingsofastructure,thechange
isappliedtoallimagesunderthepatient.
Changing Brightness and Contrast

Youchangetheimagebrightnessandcontrastintheimageviewsby
modifyingthewindow/levelsettings.Adjustingthewindow/level
settingdefinesthecontrastofpixelswithinthespecifiedwindow
range.Thebroadertherange,thelowerthecontrast.Therangeis
definedbytwomodifiableparameters:
WindowWidthoftherangeselectedfromthescale
LevelMiddlepointontheselectedrange.
A.LowerwindowvalueB.WindowvaluesC.UpperwindowvalueD.LevelvalueE.Screen
grayscaledisplayvaluesF.Hounsfieldunits(HU)
Figure 24 Window/Level Parameters
Image Histogram
Whenyouselectthecommandtomodifythewindow/levelsettings,
thewindow/levelsliderwiththeimagehistogramappearstothe
righthandsideofthe2Dimageviews.

A.SelectedupperwindowvalueB.Window/levelsliderC.LevelD.Window/levelsliderE.
GrayscalehistogramF.Selectedlowerwindowvalue
Figure 25 Window/Level Slider and Image Histogram
Thecurrentlyselectedupperandlowerwindowvaluesareshown
aboveandbelowthesliderbar.Youchangethewindow/levelsettings
bymovingthesliders,andthelevelsettingsbymovingthemiddle
areabetweenthesliders.
TheimagehistogramisagraphicalrepresentationoftheCTor
grayscalevaluesintheimage.Therangeofthevaluesappearsonthe
verticalaxis,andthehorizontalaxisindicatestheportionofthe
imagesvaluesthatmatcheachpointontherange.
Whenyouadjustthewindow/levelsettingsofanimagethatispartof
a4Dimage,thechangeaffectsalltheimagesinthe4Dimagingstudy.
Formoreinformationona4Dimagingstudy,seeImporting4D
ImageDataonpage 108.
Note: Bydefault,thesliderisdisplayedonlyinone2Dview.Youcanshowthe
hiddensliderintheotherimageviewsbymaximizingtheview.
To Define Window Range and Level

1. ChooseView >ViewParameters.
TheViewParametersdialogboxopens.
2. TypenewvaluesintheWindowandLeveltextboxes.
3. ClickOKtochangetheview.
To Adjust Window/Level Settings Automatically

ChooseView >AutoWindow/Level.
Thewindowlevelissettoanoverviewvalue.
To Adjust Window/Level Settings Manually

1. ChooseView >Window/Level .
2. Tochangethewindowvalue,movetheupperorlowerwindow
levelsliderwiththemousetothedesiredvalue.
Asyouslidethehandle,thebrightnessandcontrastofall2D
imagesarechanged.
3. Tochangethelevelvalueonly,movethemousepointerbetween
thewindow/levelsliders,andkeepingthemousebuttondown,
movetheleveltothedesiredposition.
Asyoumovethemouse,thelevelvaluesofall2Dimagesare
changed.
Whenyouadjustthewindow/levelsettingsofanimagethatispart
ofa4Dimage,thechangeaffectsalltheimagesinthe4Dimaging
study.
4. Tohidethewindowlevelsliderbar,selecttheWindow/Level
commandagain.
Bydefault,thesliderisdisplayedonlyinone2Dview.Youcanshowthe
hiddensliderintheotherimageviewsbymaximizingtheview.
5. IntheContouringworkspace,toupdatethetopogramviewsin
accordancewiththechangedwindowing,rightclickineitherof
thetopogramviews.
Zooming the Image Views

YoucanzoominandouttheimageviewsbyusingtheZoomInand
ZoomOuttoolbarbuttonsorwiththemousewheel.

To Zoom In
1. ChooseView >Zoom >ZoomIn .
Themousepointerchangestoanarrowwithasmallcircle.
2. Placethemousepointeronthedesiredpositionintheactiveimage
andclickandholddownthemousebutton.
3. Movethemousepointertoformarectangulararea.
Aredrectangleisdrawnontheactiveimage.
4. Releasethemousebuttonwhentherectanglecoversthepartofthe
imageyouwishtozoom.Youcanrepeatzoomingasmanytimes
asneeded.
Whenyouzoominanimagethatispartofa4Dimage,allimage
viewsfortheimagesinthe4Dimagingstudyarezoomedin
accordingly.
Note: Whilezoominginnotethat:
Ifyouaccidentallystarttodragthezoomingrectangleandwishtocancel
theoperation,presstherightmousebuttonwhilestillholdingdownthe
leftmousebutton.Onceyoureleasetheleftmousebuttonthezoom
operationcannotbecanceled.
Tozoominwiththemousescrollwheel,pressCTRLkeyandrotatethe
wheel.
To Zoom Out
ChooseView >Zoom >ZoomOut .
Theimageiszoomedout.
Whenyouzoomoutanimagethatispartofa4Dimage,allimage
viewsfortheimagesinthe4Dimagingstudyarezoomedout
accordingly.
Note: Tozoomoutwiththemousescrollwheel,pressCTRLkeyandrotatethe
wheel.
To Move Visible Plane
Afterzoominginontheimage,theimagemaygrowsobigasnottofit
inthewindow.Toexamineallpartsoftheimage,youcanshift,orpan,
theimageintheimagewindow.
1. ChooseView >Pan .
Themousepointerturnsintoawhitecross.
2. Placethemousepointerontheimageandpressthemousebutton.
3. Keepingthemousebuttondown,movetheimageuntilyouseethe
partyouwishtoexamineandreleasethemousebutton.
Theactiveimagemoveswiththemouse.Theinactiveimages
changetoindicatethecorrespondingposition.
Whenyoupananimagethatispartofa4Dimage,alltheimages
inthe4Dimagingstudyarepannedaccordingly.
Note: Onthescrollmouseyoucanalsousethescrollwheeltopantheimage.
Pressthescrollwheelanddragtheimageasdesiredwhileholdingthescroll
wheeldown.
Measuring Information in Images
WARNING: Since the Model view is a perspective view and the proportions in
the image are not realistic, you cannot do measurements in it. The Beams Eye
View shows realistic proportions only at the active fields Source-to-Axis
Distance (SAD) level. Do not do any measurements anywhere else in the BEV.
To Measure Pixel Values or CT Numbers

ThepointmeasurementtoolshowstheimagepixelvalueorCT
numberattheselectedpoint.

1. ChooseView >Measure >Pixel/CTValue .
2. Clickonthedesiredpointintheimage.
Thecrosshairisfixedtotheimage,andaflagindicatingtheHUor
pixelvalueatthatpointappearsnexttothecrosshair.
A.Clickheretodeletethecrosshairandtheflag.
3. Clicktheflagtodeletethecrosshairandthemeasurementflag.
To Measure Distances
Youcanmeasuredistancesbetweentwopoints,forexample,tocheck
quantitativelocationsforreferenceorforselectingoptimization
points.
Note: Beforemeasuringdistancesontheimage,ensurethattheimageisscaled.
Otherwisenodistancescanbemeasured.
1. ChooseView >Measure >Distance .
2. Movethemousepointertothestartpointofthemeasuredlineand
click.

3. Movethemousepointertotheendpointofthemeasuredlineand
click.
Asyoumovethemouse,aredlineappearsontheimage,anda
flagindicatesthedrawndistancenexttoit.
A.Clickheretodeletethelineandtheflag.
4. Clicktheflagtodeletetheredlineandthemeasurementflag.
Note: Youcanconvertthedistancemeasurementintoameasurementlayerby
rightclickingonthemeasurementflag.
Changing View Options
To Display the Slice Position

1. ChooseView >Options.
2. GototheGeneraltabandselecttheDisplayslicepositioncheck
box.
3. ClickOK.
Thecoordinatesoftheplanecurrentlydisplayedinthe2Dimage
viewsareshowninthelowerleftcorneroftheview.
To Display the Viewing Planes in the Model View

TheorthogonalviewingplanescanbedisplayedintheModelviewin
theFieldSetupworkspaceandthePlanEvaluationworkspace.

2. GotothePlanViewingtabandselecttheOrthogonalPlanesin
ModelViewcheckbox.
3. ClickOK.
TheorthogonalviewingplanesaredisplayedintheModelview.
Note: YoucanalsobrowsethroughtheimageplanesintheModelView.For
instructions,seeToBrowsethe3DImageintheModelViewonpage 89.
Clipping Structures
Tobetterviewstructuresunderorbehindanotherstructure,cutaway
partoftheBodystructureintheModelviewtobetterseethetarget
structuresunderneath.ThisclippingfunctionisavailableintheField
SetupandPlanEvaluationworkspaces.
A.ClippingplanesB.Movinghandle
Figure 26 Clipping Structures

To Clip Structures
1. IntheFocuswindow,selectthestructuretoclip.
2. ClickthetitlebaroftheModelviewtoactivateit.
3. OntheClippingPlanestoolbar,clickClippingPlanes .
TheClippingPlanesfunctionisenabled.
4. OntheClippingPlanestoolbar,clicktheClippingPlanesbuttons
.
TheselectedclippingplanesappearintheModelview.
Toresizetheclippedpartsoftheselectedstructure,movethe
planeswiththemouse.
Toswitchthepartshown,presstheCTRLkeyandclickthe
movinghandleoftheplane.
ToshowtheCTdataontheplanes,presstheCTRLandSHIFT
keysandclickaBodystructureplanehandle.

Chapter 5 Image Management
Selection Workspace
Thischapterdescribesandprovidesinstructionsforvarious
proceduresthatcanbecarriedoutwithimagesintheSelection
Workspace.Instructionsareprovidedforimportingpatientimagesto
beusedforcontouringandtreatmentplanning,andviewing,scaling,
croppingandextractingtheimportedimagesintheimageviews.The
chapteralsoprovidesinstructionsforviewingDRRimagesinthe
SelectionandContouringworkspaces.Theimportedimagesareused
tocreateathreedimensionalpatientmodel,a3Dimage.Thischapter
goesthroughtheprocessofcreating3Dimages.3Dimageparameters
thatcanbechangedarealsodescribed.Finally,thechapterdirectsin
approvingimagesandexportingthemtoothersystems.
Importing Images
OneofthemainpurposesoftheSelectionworkspaceisimporting
images.TheImportwizardisusedfortransferringimagedatafrom
variousimagingdevices,usingdifferentimageformatsandmedia.
Toimportimages,starttheImport/exportwizard,thenselectthe
importfilter,thedatatobeimportedandthetargetoftheimport.The
Import/Exportwizardguidesyouthroughtheimageimportprocess.
InthedialogboxesoftheImportwizard,usethefollowingbuttons:
ClickNexttocontinuetothefollowingstep
ClickBacktoreturntothepreviousstep
ClickCanceltoclosethewizarddiscardingthechanges
ClickFinishtoacceptthechangesandclosethewizard
105
Note: Beforestartingtheimageimport,
Makesurethattheimagingdevicesareproperlyconfiguredand
calibrated.Checkthecalibrationbyimagingandplottingtestphantoms
regularly.
Toavoidtheacquiredimagebeingaccidentallymirroredwhenimporting
afilmimage,writethenameofthepatientonthefilmiftheinformationis
notyetmarkedonit.Ifyouplacethefilmupsidedown,thetextonthe
filmwillbemirroredonscannedimage.Thiswillalsoprevent
accidentallyconnectingwrongimagestoapatient.
Becarefultomanuallyselectthecorrectpatientwhenimportingimages
thatdonotincludepatientdemographicinformation.
Verifytheimageaspectratio,especiallyifyouareusingacamerabased
imagingsystem.
Savetheimportedimagesbeforeusingthem,forinstance,tocreatea3D
image.
Whenimportingimagesfromscannedfilmsthatconsistofmultiple
images,youneedtoextracttheimagesfromthefilmstobeabletocreate
3Dimagesofthesescannedimages.TheXandYcoordinatesneededfor
the3Dimagearedefinedasextractionparameters.Forinstructions,see
CroppingImagesonpage 121andExtractingImagesonpage 122.
Useimageapprovaltopreventaccidentalchanges.Forinstructions,see
ApprovingImagesonpage 141.
Importing 4D Image Data

Note: Whenimporting4Dimagedata:
The4Ddatatobeimportedmustcontainimageseriescommentsfroman
externalbinningsoftware.Ifthecommentsaremissing,Eclipseisunable
toautomaticallycreate4Dimages.
Importinglargeamountsof4Dimagedataatoncecanfailifthememory
resourcesofthecomputeranditsoperatingsystemareinsufficient.Ifthis
occurs,importthe4Dimagestudyintwoormoresmallergroups.
Whenimportinga4Dimagingstudy(asetofbinned3Dimagesthat
havethesamecoordinatesystemandmodality),Eclipserecognizesthe
imagesasbeingregisteredwitheachotherandcreatesa4Dimage
object.Thesystemalsoautomaticallycreatesthe3Dimagesforeach
phaseandtheBodystructure,ifsodefinedinimport.Iftheimported
4Dimagingstudyisalreadyorganizedintoseparatebutrelatedimage

series(forexample,phasebinned,MIPorAve),thesystemcreates3D
imagesforeachoftheseparateseries.Bydefault,a4Dimageobject
containsallthe3Dimagesthathavethesamecoordinatesystem
(DICOMFrameofReference)andmodality.Theseimagescannotbe
unregistered.
Patientimagesacquiredduringonesessionsharethesamecoordinate
system.Whenthepatienthasbeenscannedduringthesamesession
fortwodifferentimagemodalities(forexample,CTandPET),Eclipse
considersthe3Dimagesinthetwo4Dimagingstudiesasbeing
registeredwitheachotherintheimport.Theseimagescannotbe
unregistered.
Ifthepatientimagesofdifferentmodalitieshavebeenacquiredduring
differentimagingsessions,youneedtomanuallyregisterthe3D
imagesinthetwo4Dimagingstudies.Formoreinformation,see
Registering4DImagesonpage 163.
Aftertheimportiscomplete,a4Dimageobjectcontainingthe
informationofa4DimagingstudyappearsintheScopewindow.The
3Dimagesautomaticallycreatedinthestudyaregroupedtogether
andsortedtoforma4Dimageset.Eachimportedimagecontainsan
imageseriescommentcontaininginformationonthephasesofthe
respiratorycycle.
To Import Images with the Wizard

1. Ifyouareimporting4Dimagedata,makesurethatyouhave
selectedtheStudyViewoptionintheimportfiltersettings.For
moreinformationonaddingandconfiguringimportfilters,see
Appendix Bonpage 815.
2. ChooseFile >Import >Wizard.
TheImportwizardopens.
3. SelecttheappropriateimportfilterandclickNext.
Thewizardproceedstothenextstep.
4. Toviewthe4Ddataseriesinformation,selecttheSeriesoption
fromtheviewoptionsonthetopoftheWizard.
Theseriesnumberandseriesdescriptioncontaininginformation
onrespiratoryphasesaredisplayedinthewizard.
Image Management 107

5. Iftheimageseriesarelocatedinseparatesubdirectories,selectthe
ScanSubdirectoriescheckbox.
Selectthedatatobeimportedfromthedefaultdirectory.
Touseanotherdirectory,clickChangeDirectory,selectthe
appropriatedirectory,clickOpen,andthenselectthedatato
beimportedfromthelistdisplayedinthewizard.
7. Toaddmoredatatobeimported,clickAdd,selecttheappropriate
directoryandselectthedatatobeaddedinthelistdisplayedinthe
wizard.
8. Toremovedatafromthelist,selectthemandclickRemove
Selected.
9. ClickNext.
Thewizardproceedstothenextstep.TheSourcePatient
Informationboxdisplaysthepatientinformationfoundinthe
data.
10. Selectthetargetpatienttowhomtoimportthedata.Thedetailed
informationabouttheselectedpatientwillbedisplayedinthe
SelectedTargetPatientgroupbox.
SelectapatientsuggestedbythewizardintheClosest
MatchesinDatabasebox.
Toimportthedatatothepatientcurrentlyopen,clickTask
Patient.
ToopenthePatientExplorerandimportthedatatoapatient
existinginthedatabase,clickOpen.
Tocreateanewpatienttoimportthedatato,clickNew.
Youcanconnecttheimagestotheobjecthierarchyunderthe
selectedpatienteitherautomaticallyorbyhand.Toletthe
wizardautomaticallyimportthedatatotheselectedpatient,
selecttheTryautomaticimportcheckbox.
IfyouselecttheTryautomaticimportcheckboxwhen
importingimagedata,the3Dimage(s),thestructureset,Body
structureandthepossible4Dimageobjectarecreated
automatically.TheBodystructureiscreatedusingthedefault
valuessetintheSearchBodytool.

11. ClickNext.
Automaticimport:Thewizardclosesaftertheautomaticimportis
completed.
Importbyhand:Thewizardproceedstothenextstep.
Ifyouwantthesystemtocreatethe3Dimagesanddefinethe
Bodystructureinthemautomatically,selecttheCreate
VolumeImageAutomaticallycheckbox.
Ifthedatahasgrayindicatorsinthetreestructuresinthe
ImportDataandARIADatapanes,youneedtoconnectthe
datatotheobjecthierarchyundertheselectedpatient.Todo
this,dragthedatafromtheImportDatapanetoanappropriate
placeunderthepatientintheARIADatapane.ClickFinishto
closethewizard.
Ifthedatahasgreenindicatorsinthetreestructure,click
Finish.
Whenimportingimagesthatdonothaveanycalibration
informationorwhosecalibrationinformationisinadequate,the
applicationpromptsyoutoscaletheimages.
13. Savetheimportedimages.
Forinstructionsonimportingstructuresetsandplans,seeChapter 27,
ExportandImport,onpage 765.
Visualization of Images in the Context Window

BelowisanexampleoftheContextwindowintheSelection
workspaceafteranimageserieshasbeenimportedtoapatient.

A.TheStudytheimageseriesbelongstoB.ImageseriesC.TheimageselectedintheScope
windowisdisplayedintheFocuswindow
Figure 27 Images in Context Window
Theimageseriesandthestudythattheseriesbelongstoaredisplayed
underthepatientintheScopewindow.IntheDICOMhierarchyan
imageseriesbelongstoastudy.Intheexample,theIDofthestudyis
10343.
TheimageserieshasauniqueIDandtheseriescontainsimagesofthe
samemodality.Intheexample,theIDoftheimageseriesisSeries3.
EachimagehasauniqueIDwithinanimageseries.Youcanhave
multipleimageswiththesameID(forexample,CT_1),buttheyall
mustbelongtodifferentimageseries.
Viewing Images
AfteropeningapatientwithimagestotheSelectionWorkspace,view
theselectedimagesintheimageviews.Forinformationonopening
patientfiles,refertotheonlinehelp.
Note: Loadingextremelylargeimagesets(forexample,over400slices)may
causesysteminstabilities.However,intheeventofanabnormaltermination
oftheEclipseapplication,dataintegrityfeaturespreventinconsistentplan
datafrombeingsavedtothedatabase.

A.3DimageB.2Dimage
Figure 28 Image Gallery
TheimagesintheImageGalleryarearrangedbytheirZcoordinatesin
descendingorder(usuallyfromheadtofeet).Theimagescanbe2D
imagesor3Dimages.3Dimagesareidentifiedbythe3dstringunder
thethumbnail.For2Dimages,thedirectionoftheimageplaneis
indicatedbytheirX,YorZcoordinatevaluesunderthethumbnails.If
a2Dimageisnotparalleltoanyofthesethreeaxes,theaxisisreplaced
withd(distancebetweenplanes).
Viewing 4D Images
Afteropeningapatientwith4Dimages,the4Dimageobjectsappear
intheScopewindow.Whena4Dimageobjectisdraggedintothe
imageview,thefirst3Dimageinthe4Dimagingstudyopensinthe
threedifferentorthogonalimageviewsandthedetailedinformation
aboutthe3DimageisdisplayedintheFocuswindow(seeFigure 29
onpage 115).
ThetopmostitemintheFocuswindow,theprimaryimage,isthe
active3Dimagedraggedintotheimageview(ifthe4Dimageobjectis
draggedintotheimageview,thentheprimaryimageisthefirst3D
imageinthe4Dimagingstudy).Youcanshowother3Dimagesofthe
4Dimagingstudyintheimageviewsbyselectingtheirvisibilitycheck
boxes.Whenyousegmentstructuresinavisible3Dimage,the
segmentationisalwayssavedtotheprimaryimage.

TheRegisteredImagesfoldercontainsalltheimagesregisteredwith
theprimaryimage.Theseincludethe3Dimagesinthe4Dimaging
study,andcanalsoincludeother4Dimageobjects.TheIDsofthe3D
imagesarecreatedbasedontheinformationintheimageseries
comments.The3Dimagevalues,definedinthe4DImageProperties
dialogbox,aredisplayedinparenthesesafter3DimageIDs.Youcan
modifyboththeIDsandvaluesofthe3Dimages.
Allthestructuresdefinedforthepatientareshownunderthe
structureseticon.Ifastructurehasnosegmentationinthecurrently
visible3Dimage,itisindicatedwithanemptystructureicon(seeDin
Figure 29onpage 115).Whenyoudefinestructurevisibilityina3D
imagethatispartofa4Dimage,thevisibilitysettingsareappliedtoall
3Dimagesinthe4Dimage.Similarly,ifyoumodifythepropertiesofa
structure,thechangeisappliedtoallimagesunderthepatient.
TheReferencePointsfoldercontainsallthereferencepointsdefined
forthepatient.Whenyouareviewingaplan,theReferencePoints
folderdisplaysthereferencepointsbelongingtotheplan.Ifa
referencepointhasnolocationinthecurrentlyvisible3Dimage,you
cannotselectitsvisibilitycheckbox.

A.PrimaryimageB.4DimageobjectC.3DimagecurrentlyvisibleintheimageviewsD.
Structurethathasnosegmentationinthecurrentlyvisible3DimageE.Foldercontainingallthe
imagesregisteredwiththeprimaryimageF.Allthe3Dimagesinthe4DimagingstudyG.
StructuresetandstructuresdefinedforthepatientH.Referencepointsdefinedforthe
patient/plan
Figure 29 4D Image Visibility in the Focus Window
WhenastructureisselectedintheFocuswindow,inadditionto
showingthecontourorsegmentoftheselectedstructureinthecurrent
3Dimage,theimageviewshowsandhighlightsthecontouror
segmentoftheselectedstructureintheprimaryimage.
Ifyoumodifythewindow/levelsettingsorresizetheVOIforanimage
thatispartofa4Dimage,thechangeisappliedtoallimagesinthe4D
imagingstudy.Thesechangesarealsosavedtothedatabase.
Ifyouzoominorout,panorrotateanimageviewofanimagethatis
partofa4Dimage,thechangeisappliedtoallimageviewsinthe4D
imagingstudy.

To View 2D Images
1. ClickanddraganimagefromtheScopewindowortheImage
Gallerytoanimageview.
Theselected2Dimageopensintheimageview.
2. Toviewanotherimage,dragittoanimageview.
Note: ToremoveimagesfromtheImageGallery,selecttheimageandchoose
File >Close.
Formoreinformationonhowtoviewtheimagesusingdifferent
viewingtools,seeChapter 4,VisualizationofImages,onpage 77.

To View 3D Images
1. DraganimagefromtheScopewindowortheImageGallerytoan
imageview.
Theselected3Dimageopensinthreedifferentorthogonalimage
views.
2. Toviewanotherimage,dragittoanimageview.
Note: ToremoveimagesfromtheImageGallery,selecttheimageandchoose
File >Close.
Formoreinformationonviewingtheimagesusingdifferentviewing
tools,seeChapter 4,VisualizationofImages,onpage 77.

To View 4D Images
1. Draga4DimageobjectfromtheScopewindowtoanimageview.
Thefirst3Dimageintheselected4Dimagingstudyopensinthe
threedifferentorthogonalimageviewsandthedetailed
informationaboutthe3DimageisdisplayedintheFocuswindow
(formoreinformation,seeViewing4DImagesonpage 114).
2. Toviewanother4Dimage,dragittoanimageview.
Viewing DRR images

ADigitallyReconstructedRadiograph(DRR)isanXrayimage,
computedbytheapplication,seenfromthebeamfocus.DRRimages
arefieldspecific.InadditiontodisplayingtheDRRimagesinthe
ModelViewoftheFieldSetupworkspace,theycanbeviewedinthe
Selectionworkspace.FormoreinformationonDRRimages,see
UsingDigitallyReconstructedRadiographImagesonpage 689.
FormoreinformationoncreatingDRRimages,seeChapter 25,Section
ToAddDRRImagesonpage 692.

To View DRR Images in the Selection Workspace
1. IntheObjectExplorer,navigatetothefieldbranchandclickit.
Theselectionishighlighted.TheDRRimagebranchisdisplayedin
therightlistbox.
2. ClicktheDRRbranch.
3. ClickOK.
TheDRRimageobjectappearsintheScopewindowandtheDRR
imageisdisplayedinthe2Dimageviewwiththeedgesofthe
correspondingfield.
ToprintouttheDRRimage,printtheimageviewwhereitis
displayed.Forinstructions,seePrintingtheScreenonpage 725.
To Select the Viewing Direction for Images

Whenviewing3Dimagesintheorthogonalviewstheorthogonal
planesare,bydefault,displayedinthedirectionsoftheirprimaryaxis.
Youcanalsoforcethe3Dimagetobedisplayedinthetransversal
direction.
2. SelecttheSelectionWorkspacetab.
3. CleartheOrthoCubeAdaptstoPlaneNormalcheckbox.
4. ClickOKtoshowthe3Dimageinthetransversaldirection.
Scaling Images
Whenimportingimagesthatdonothaveanycalibrationinformation
orwhosecalibrationinformationisinadequate,youwillneedtoscale
theimages.Thismeansthatyoucalibratethepixelsizeofthedigitized
images.Forexample,tousethemeasurementtools,advancescalingof
theimagesisessential.

To Scale an Image
1. Displaytheimagetoscale.
2. Tomakethecalibrationasaccurateaspossible,maximizethe
image.
3. ChooseEdit >ScaleImage.
Thefollowingdialogboxopens.TheScaleLinetoolappearsinthe
imageview.
A.Dragahandletodefinethelengthofthescalingline.
4. Definethedistancebetweenthetwopointswiththemouse.Move
thelinesothatitcoversalineofaknownlengthinthepatient.
5. EnterthelinelengthintheLengthofscalinglinetextbox.Make
surethattheCurrentImagecheckisselected.
Foraxialimages,thislinelengthistheactuallengthinthepatient.For
filmimages,thelengthdependsontheimagesource.Forstandardfilm
imagesthatcontainamagnificationfactor,thisshouldbethelengthon
thefilm,thatis,multipliedbythemagnificationfactor.Iftheimagehas
beendigitallycapturedandtransferredasasimulatortypeimage,this
lengthisalsotheactuallengthinthepatient,sincetheimagesare
automaticallyrescaledwhenanimaginggeometryisappliedintheEntry
workspace.
6. Toupdatethescalinglinelabel,clickSet.
Thenewlengthappearsinthescalinglinelabel.

7. Calibrateeitherthecurrentimage,ortheselectedimagesandthe
currentimage.Clicktheappropriateoptionbutton.
8. ClickOKtocompletethecalibration.
Youcanscaleallimagesbythesameamount.Placethelineinthecorrect
position,enterthelinelengthononeimageandselecttheSelected
imagesinthegalleryandcurrentimagecheckbox.Thenselectall
imagestobescaledinthegalleryandclickSet.Donotselecttheimages
untilyouhavesetupthescalingline,becausesettingupthelinedeselects
them.
Note: Usefultipsforscaling:
Tomakethescalingasaccurateaspossible,displaythegridorscale,or
usethescaleprovidedonthefilm.
Visuallyverifytheresultofhorizontalandverticalscaling.
Cropping Images
Sometimesanimagemayhaveareasthatmustberemoved.Whenyou
cropanimage,onlythecroppedareaoftheimagewillbesaved.
Note: Imagescanbecroppedonlybeforesavingthemtothedatabase.Crop
imagesbeforeyoucreatea3Dimageandsavethem.
To Crop Images
1. Dragtheimageyouwanttocroptotheimageview.
2. Clickintheimageviewtomakeitactive.
3. ChooseImage >Crop/Extract.

4. Clickintheimageview.
AcropareaappearswhereyouclickedandtheCrop/Extract
dialogboxopens.
5. Inthedialogbox,clicktheCropoptionbutton.
6. Intheimageview,
Toresizethecroparea,dragitshandles.
Tomovethecroparea,movethemousepointerinsideitand
dragittoanewposition.
7. Onceyouaresatisfiedwiththecroparea,clickOK.
8. Tosavethechanges,chooseFile >SaveAll.
9. Tocropsuccessiveimages,clickinthecenteroftheimagetoplace
thecropboxinthesameplaceasthelast.Theabilitytodefinethe
cropareaonlyhappensthefirsttimetheCrop/Extracttoolisused.
Extracting Images
Sometimesimagesareimportedasscannedfilmsconsistingofa
numberofimages.Tobeabletocreate3Dimagesofthesescanned
images,youneedtoextracttheimagesfromthefilms.TheXandY
coordinatesneededforthe3Dimagearedefinedasextraction
parameters.

Extraction Parameters
Whenextractingimages,definetwoparametersintheCrop/Extract
dialogbox:thePositionoftheimagesandtheStepbetweenthe
images.
PositionPositionreferstothecoordinatesoftheimagesonthe
film.Viewthefilmtofindoutthesequenceoftheimagesbefore
beginningtheextraction.
StepStepindicatestheincrementbetweentheimagecoordinates
onthefilm.Onceyouhavedefinedthevalue,thepositionforthe
nextimageiscalculatedautomatically.However,verifyfromthe
filmthattheincrementisconsistentthroughoutthefilmbefore
usingtheautomaticstepcalculation.
To Extract an Image from a Film

1. Importthedesiredscannedfilm.SeeinstructionsinImporting
Imagesonpage 107.
Calibratescannedfilmsbeforedoingtheimageextraction,ifthefilmhas
notalreadybeencalibrated,tomakesurethattheplanningbasedonthe
imagesisaccurate.
2. DragthefilmfromwhichtoextracttheimagesfromtheImage
Gallerytotheimageview.
3. Ifnecessary,enlargetheimage.
Tomagnifythefilmimage,clickZoomIn.
Toenlargethewholeimageview,clicktheMaximize
buttoninitsupperrightcorner.

5. Clickintheimageviewdisplayingthefilmfromwhichtoextract
theimages.
Asquareextractareaappearswhereyouclickedandthe
Crop/Extractdialogboxopens.

A.SelectiontoolB.Crossmarkingthefocalpoint
6. Inthedialogbox,clicktheExtractoptionbutton.
7. Tohavetheselectiontoolmaintaintheshapeofasquare,selectthe
Assquarecheckbox.
8. Intheimageview,
Toresizetheextractarea,dragitshandles
Tomovetheextractarea,pointinsideitanddragittoanew
position
EnsurethattheCTscaleisalsoincludedintheareayouselect.
9. Whentheextractareaisasdesired,makesurethattheextracttool
appearsexactlyinthesameplaceinthenextimage.Findafocal
pointintheimagefilmthatappearsinexactlythesamepositionin
everyimageandrightclickthatpoint.Thispointwillbeusedto
aligntheimageswhencreatingthe3D dataset.
Acrossappearswhereyourightclicked.
10. InthePos[mm]textbox,typethecoordinateoftheimage.This
informationshouldbefoundonthescannedfilm.

11. IntheStep[mm]textbox,typetheincrementbetweentheimage
coordinatesonthefilm.
Makesurethatthisinformationiscorrect,becauseitisusedtogenerate
the3Ddatasetandcannotbechangedafterwards.
12. Ifthedefaultsettingsareinappropriate,definetheorientationof
thepatientintheimagebyclickingOrientation.
Thefollowingdialogboxopens.
A.Forinformationonadvancedimageorientationoptions,seeToChangetheImage
Orientationonpage 136.
13. Toselecttheorientation,clicktheappropriatebutton.
14. ClickOKtoreturntotheCrop/Extractdialogbox.
15. Tocompleteextractingthefirstimage,clickOK.
TheextractedimageopensintheImageGallerywithitsIDand
primaryaxiscoordinate.
16. Tomovetothenextimageonthefilm,chooseView >Pan .

18. Placethemousepointeronthefocalpointintheimageandclick
theleftmousebutton.
Thepreviouslydefinedsquareappearsintheimageview.The
Crop/Extractdialogboxopens.Theimagepositiondatais
automaticallyupdatedinthePositiontextbox.
19. Makesurethatthepositionandstepvaluesarestillcorrect,andto
completeextractingthesecondimage,clickOK.
TheextractedimageopensintheImageGallerywithitsIDand
coordinate.
20. Repeatsteps1619untilyouhaveextractedallthedesiredimages
fromthefilm.
21. Tosavethechanges,chooseFile >SaveAll.
Extending a Scanned Image Set

Selectedimagesetsshouldbelargeenoughtocoveralloftheareasof
interestinthepatient.Thisensuresthatsufficientdataisavailablefor
treatmentplanning,andhelpstoimprovethehandlingoftheimage
setwhenbuildinga3DimageinEclipse.Inthe3Dimage,thepatient
surfaceisnotautomaticallyclosedattheendsoftheimage,sothe
threedimensionalpatientmodelresemblesahollowtubewithopen
ends.Thiscausesinaccuraciesindosecalculationwhenusinglargeor
tangentialfieldsenteringthepatientthroughtheendofthishollow
tube(formoreinformation,seeChapter 11,Fields,onpage 365).
IntheExternalBeamPlanningtask,topreventinaccuracyindose
calculationduetotheopenendsofthe3Dimage,youcancreate
artificialCTslicestobeusedforclosingthe3Dimage.Artificialslices
canbecreatedinEclipseafterimportingthescannedimageset,or
duringpatientimagingintheCTscanner.InEclipse,thesliceaddedto
theslicesetcanbeanartificialslicewithauniformdensityvalueora
copyofanexistingslice.
Note: Alwaysmakesurethattheimagescoverallnecessaryareasofinterestin
thepatient.

To Extend an Image Series with Artificial Slices
1. Opentheimageseriestobeextended,forinstance,aserieswhere
bodypixelvaluescanbefoundonthelastslicesoronewitha
limitednumberofslices.
Besuretoopenallslicesinthescannedimageset.
2. IntheImageGallery,selectoneoftheslices.
Ifyouaregoingtoaddacopyofaslice,selecttheslicetobe
copied.
Ifyouaregoingtoaddanemptyslice,selectanyslice.
3. ChooseImage >Duplicate.
TheDuplicateImage(2D)dialogboxopens.
4. InthePosition<z/y/z/d>box,typethecoordinateoftheposition
alongtheX,Y,Zorobliqueaxistowhichtoaddthenewslice.The
axisshowndependsontheprimaryaxisoftheselectedslice.
Toaddanemptyslice,selecttheFillwithcheckboxandtype
thedesireddensityvaluetobeusedforallpixelsintheslice.
Theunitsofthisvaluedependontheimagemodality(HUfor
CTimages;nounitforMRimages).
Toaddacopyoftheselectedslice,cleartheFillwithcheck
box.
6. ClickOK.
Thenewsliceisaddedtothedefinedpositionontheprimaryaxis.
7. Createa3DimageasinAboutCreating3DImagesonpage 128.
The3Dimageiscreated,includingthenewslicesonthedefined
positionsontheZaxis.
ContinuebycontouringtheBodyandothernecessarystructures.

About Creating 3D Images
3Dimagesarethreedimensionalimagescreatedfrommultiple2D
images.Tocreatea3Dimage,youimportthedesiredimages,orifthis
isalreadydone,openthe2Dimagesofthedesiredpatientinthe
SelectionworkspaceandcontinuebychoosingtheNew3DImage
commandanddefiningthenecessaryparametersforthe3Dimage.
3Dimagescanbecreatedeitherautomatically(usingallthepatients
2Dimages)ormanually(usingarangeofmanuallyselected2D
images).Theapplicationcreates3Dimagesinaccordancewiththe
primaryaxesofthe2Dimages.Themethodofcreatingthe3Dimageis
oneofthefollowing:
IftheImageGallerycontainsimageswithdifferentprimaryaxes
(differentimageorientations),andnoneoftheimagesareselected,
theapplicationattemptstocreatethe3Dimagefromtheimagesin
amajoritythathavethesameorientationandseriesandinthe
ImageGallery.
IfoneimageisselectedintheImageGallery,theapplicationattempts
tocreatethe3Dimageusingtheimagesthathavethesame
orientationandtheseriesastheselectedimage.
Iftheautomaticselectionofthe2Dimagesfails,manuallyselectthe2D
imagesfromwhichtocreatethe3Dimage.Thismaybenecessary
if,forinstance,theImageGallerycontainsimageswiththesame
orientationbutproducedindifferentimagingsessions.However,
usuallytheautomaticallyselectedslicesforcreatingthe3Dimage
aresufficient.
Note: Ifselectingthe2Dimagesmanually:
Makesurethatyouselectasufficientnumberofimages,especiallywhen
usingnoncoplanarfieldsintheExternalBeamPlanningtask.Makesure
thatthe3Dimagecoversthestructuresnecessaryinplanning.
Ifyouneedtocreatea3Dimagebymanuallyselectingslicesfrom
multipleimageserieswhichsharethesamegeometry(frameofreference,
FOR),thesliceswillbecopiedintoanewimageseriesinthedatabase.

About Creating 4D Images
4Dimagesarefourdimensionalimagescreatedfrommultiple3D
imagesthathavethesamecoordinatesystem(DICOMFrameof
Reference)andmodality.4Dimagescanbecreatedeither
automatically(usingallimagesina4Dimagingstudy)ormanually
(usingarangeofmanuallyselected3Dimagesina4Dimagingstudy).
Tocreatea4Dimage,youimportthedesiredimages(formore
information,seeImporting4DImageDataonpage 108),orifthe
imageimportisalreadydone,openthe4Dimagingstudyofthe
desiredpatientandcontinuebychoosingtheNew4DImage
command.
Youcanalsodeletea4Dimage.Whendeletinga4Dimage,onlythe
4DimageobjectisdeletedfromtheContextwindow.Allthe3D
imagesthatwerepartofthe4Dimagearestillpresentandcanbeused
inanew4Dimage.
Parameters Used for Constructing 3D Images

WhenyouselecttheNew3DImagecommandtocreateanew3D
image,theCreate3DImagedialogboxopens.Inthisdialogbox,you
settheparametersforcreatingthe3Dimage.
Note: Normally,theconstructionparametersthattheapplicationsuggestsare
themostappropriateonesfortheselectedsliceset.
First,givethe3DimageyouareconstructinganameandIDand
definethepixelsizeoftheimage.However,normallyyoudonotneed
tochangetheimagesize.Thedefaultsizeisusuallycorrect.
Iftheslicesareunevenlydistributed,selecttheslicestouseinthe
constructionoftheimage,andtheslicethatmustberepresentedasa
planeinthe3Dimage.Youcanalsodefinethecurrentplanesetupby
definingthedesiredseparationbetweentheplanes(incm).The
separationaffectsthenumberofinterpolatedandoriginalplanesin
theimage.Interpolatedplanesareautomaticallycreatedestimatesto
makethe3Dimageascoherentaspossible.
Note: Ifthe3Dimagecontainsinterpolatedplanes,anewimageseriesthat
containstheinterpolatedplanesandcopiesoftheoriginalslicesiscreatedin
thedatabase.Also,ifyoucreatea3Dimagebymanuallyselectingslicesfrom
multipleimageserieswiththesameDICOMFOR(thismaybenecessary,for

example,iftheimagingdevicehascreatedseveralimageseriesduringone
imagingsession),thesliceswillbecopiedintoanewimageseriesinthe
database.
Bydefault,theoriginoftheimagesissettotheDICOMorigin.In
manycases,itismoreusefultosettheoriginsothatithelpsin
identifyinglocationsandvolumesneededintreatment.Forexample,
theorigincouldbeaclearlyvisibleobject,suchasabonestructure,or
alocationeasytouseinpatientmarking.
IftheimagingdevicehashadareversedZaxis(lefthanded
coordinatesystem),youcaninverttheimagesliceorderbefore
creatingthe3Dimage(forinstructions,seeInvertingthe3DImage
SliceOrderonpage 138).
To Create 3D Images
Automatically:ChooseInsert >New3DImage.
Manually:SelecttheimagesfromtheImageGallerybyholding
downCTRLandclickingtheimages.ThenchooseInsert >New
3DImage.
Selectasufficientnumberofimages.
TheCreate3DImagedialogboxopens.
2. TogiveanewIDandnameforthe3Dimage,gotothe
Identificationgroupboxandtypetheinformationinthe
appropriatetextboxes.
3. Tochangethepixelsizeofthe3Dimage,gototheSizegroupbox
andtypethenewsizeintheWidthandHeighttextboxes.
Normallytheconstructionparametersthattheapplicationsuggestsare
themostappropriateonesfortheselectedsliceset.
4. Todefinetheslicethatmustberepresentedasaplaneinthe3D
image,suchastheplanewheretheisocenteristobelocated,
doubleclickthedesiredsliceintheUsableslicesgroupbox.
AnXmarkappearsnexttothesliceyouclicked.
5. Todefinetheseparationbetweentheplanesinthe3Dimage,type
theseparationinthePlaneseparation[cm]listbox.

6. Tocheckthetotalnumberofplanesandthememoryconsumption
ofthe3Dimageinkilobytes,clickUpdate.
IntheCurrentplanesetupgroupbox,thelistboxshowstheuseof
originalslicesandinterpolatedplanesinthe3Dimage.Thetext
boxesshowthenumberofplanesandthememoryusage.
7. Tocreatethe3Dimage,clickOK.
The3Dimagecreationstarts.The3DimageopensintheImage
Gallery,itsthumbnailappearsintheImageGalleryanditsiconin
theFocuswindow.
8. IntheFiletoolbar,clickSavealltosavethechanges.
Continuebyswitchingtothecontouringworkspacefordefiningand
delineatingthestructuresintheimages,ortotheRegistrationworkspace
forregisteringtheimages.
Note: Tochangetheorientationoftheimage,seeChangingtheImage
Orientationonpage 136.
To Create 4D Images
ChooseInsert >New4DImage.
Selectthe3DimagesfromtheImageGallerybyholdingdown
CTRLandclickingtheimages.ThenchooseInsert >New4D
Image.
The4DImagePropertiesdialogboxopens.
2. TypetheappropriateidentificationinformationintheIDtextbox.
3. Tosetorchangetheimagetypeinthe3DImagesIncludedlistbox,
clicktheTypecellofa3Dimageandselectanimagetypefromthe
dropdownlistthatopens.
Onlyphaseimagescanbedisplayedinamovieloop.
4. Todefinetheimagesdisplayedinthemovieloop,selectthecheck
boxesofthe3Dimages.

5. Toadd3Dimagestothe4Dimage,clickAdd3DImages,selectthe
desiredimagesintheAdd3DImagedialogboxthatopens,and
clickOK.
Toselectseveral3Dimages,holddowntheCTRLkeywhileclicking
theimages.
Youcanonlyadd3Dimagesthathavethesamecoordinatesystem
(DICOMFrameofReference)andmodality.Ifyouselect3D
imagesofadifferentmodalityorgeometry,theOKbuttonwillbe
unavailable.
6. Toremove3Dimagesfromthe4Dimage,selectthe3Dimages
fromthe3DImagesIncludedlistboxandclickRemove3DImage.
7. ClickOK.
Thenew4DimageobjectappearsintheScopewindowandthe
MovieControltoolappearsintheimageviews.Formore
informationontheMovieControlbutton,seeUsingtheMovie
ControlToolonpage 92.
To Delete 4D Images
1. IntheScopewindow,selectthe4Dimageobjecttodelete.
3. ClickYesintheconfirmationdialogthatopens.
Theselected4Dimageobjectisdeleted.The3Dimagesit
containedarestillpresentandcanbeusedforanew4Dimagein
theSelectionworkspace.
To Create Phantom Image Sets

1. ChooseInsert >NewPhantomImageSet.
TheSeriesPropertiesdialogboxopens.
2. DefinethepropertiesofthenewimageseriesandclickOK.
TheNewPhantomImagedialogboxopens.

3. Definethesettingsofthephantomimageset.
DefinethesizeoftheimagesetinXandYdirectionsinpixels
andincm.
Ifyouarecreatinga3Dphantomimageset,definethenumber
ofplanesintheimageset,andtheseparationbetweenthe
planes.
4. ClickOK.
TheSelectStructureTemplatedialogboxopens.
5. SelectthedesiredstructuretemplateandclickOK.For
instructions,seeAddingStructuresorStructureGroupson
page 185.
Thenewphantomimagesetiscreated.
6. Continuebycreatingstructuresandstructureoutlinesinthe
phantomimageset.Forinstructions,seeAddingStructuresor
StructureGroupsonpage 185andChapter 8,Segmentation
andContouring,onpage 199.
7. Tocorrectlycalculatethedoseusingthephantom,assignCT
valuesforthestructures.Forinstructions,seeToAssignaCT
ValueforaStructureonpage 186.
Setting the User Origin

TheimagingdeviceusedforpatientimagingsavestheDICOMorigin
totheimagedata.WhentheimagesareimportedintoEclipse,theuser
originiscreatedandpositionedattheDICOMoriginlocation.The
useroriginisshowninthe3Dimagesintheimageviewsandasan
objectintheFocuswindow( ).Whentheviewingplanesare
positionedexactlyontheuserorigin,itishighlighted( )inthe2D
views.
Youcanchangethepositionoftheuseroriginasfollows:
DefinethelocationofthenewuserorigininrelationtotheDICOM
coordinates.
Selectapredefinedlocationfortheuserorigin.
Movetheuseroriginwiththemouse.

Theuserorigincanbeusedforautomaticallycalculatingthecouch
shiftsrequiredfromthesimulationisocenter(fromtheCTscannerora
conventionalsimulator)tothetreatmentisocenterforthepatient
treatment.Thecalculatedcouchshiftscanbeshowninthetreatment
planreportofthecorrespondingplan.Whenimagingthepatient,the
fiducialmarkersareincludedintheimagesproducedbytheCT
scannerorsimulatorandwillshowintheimagesimportedinto
Eclipse.Duringtreatmentplanning,youcansettheuseroriginto
markthelocationofthefiducialsandthencontinuebysettingupthe
fields.Ifthefieldisocentersdonotcoincidewiththesimulation
isocenter,thedifferencebetweenthemcanbeshownasthecouchshift
informationonthetreatmentreport.Formoreinformationon
treatmentreports,seeChapter 26,SectionAboutTreatmentReports
onpage 749.
CAUTION: The user origin must be placed to the simulation isocenter for the
results of the couch shift calculation to be usable and correct for the particular
patient treatment.
To Set the User Origin
1. IntheFocuswindow,rightclickthe3DimageandchooseSetUser
Origin.
TheSetUserOrigindialogboxopens.
2. Todefinethelocationoftheorigin,dooneofthefollowing:
DefinethelocationoftheneworigininrelationtotheDICOM
coordinatesintheappropriatetextboxes.
IntheSettoPredefinedTargetdropdownlist,selectanew
locationfortheorigin,andthenchoosetheappropriatecheck
boxestokeeptheDICOMX,YorZcoordinate,ifdesired.
Thismaybeusefulifyouhaveseveralimagesets,orfilms,forthepatient
andyouwishtomakesurethattheoriginisonaspecificplane,oftenthe
DICOMZplane,inalloftheimagesets.
Movetheoriginwiththemouse.Todothis,movethemouse
pointerontopoftheorigininanimageview(thepointer
changestoacross),rightclickandchooseMovewithMouse.
Whenyoumovetheoriginonasingleplaneinoneofthe2D
imageviews,oneoftheaxesislocked.
3. AddanannotationintheCommenttextboxifdesired.

4. ClickOK.
Theoriginisshowninitsnewlocationintheimageviews.
Toshoworhidetheuseroriginintheimageviews,selectorclearthe
visibilityboxoftheuseroriginobjectintheFocuswindow.
To Move the Viewing Planes to the User Origin
1. IntheFocuswindow,selecttheuserorigin.
2. ChooseView >MoveViewingPlanesto >UserOrigin.
Imageplanesaremovedtointersectattheuserorigin.Theuser
originishighlightedinthe2Dviews( ).
Editing Image Parameters

Sometimesimagingsourcesdonottransferallthenecessary
informationwiththeimages.Inthiscase,edittheimageparameters
separately.
CAUTION: Be especially careful when changing image parameters. Changing
the parameters has far-reaching effects, and making inappropriate changes
may cause serious problems in the system.
ImageparametersaremanagedintheImagePropertiesdialogbox.In
thetabsofthedialogbox,theimagepropertiescanbequickly
reviewedandchangedifneeded.Theinstructionsprovidedhereare
onlyforparametersthatcanbemodified.Foradetaileddescriptionof
thecontentsoftheImagePropertydialogboxes,refertotheonlinehelp.
IntheUsertab,defineanameandstatusfortheimage.Youcanalso
changethehorizontalandverticallabelingoftheimage,andselecta
desiredimagefilter.
IntheCommentsandRemarkstabs,typeadditionalinformationabout
theimagesthatyouthinkisusefulforyourselfandotherusers.New
commentsoverwritetheoldones.Remarksarewrittenintheimage
propertiesandcannotbeoverwritten.Additionalremarkscanbe
madeandappended.

Changing the Image Orientation
Sometimesanimageproducedbyanimagingdevicecanhavean
incorrectpatientorientationindicatorintheimageview.Forexample,
eventhoughthesliceimageisatransversalimagetakenfromthe
directionofthepatientsfeet,thepatientorientationindicatormay
showthattheimagewastakenfromthedirectionofthepatientshead.
Whenyouchangetheimageorientation,anewimageserieswiththe
changedorientationiscreatedinthedatabase.
Itisnotrecommendedtochangetheimageorientationforimages
usedina4Dimageasitmaycauseunpredictableresultsin4Dimage
visualization.
Note: ThePencilBeamConvolution,GeneralizedGaussianPencilBeamand
ElectronMonteCarlocalculationalgorithmsrequirethattheimagesetis
constructedfromtransversalslicesandthattheZaxisofthe3Dimageruns
fromthefeettotheheadofthepatient.Allotherimageorientationsresultin
anerrormessageandabortionofthecalculation.
To Change the Image Orientation
1. IntheImagegalleryorScopeview,selectanimageoranimage
series.
2. ChooseImage >ChangeImageOrientation.
TheChangeImageOrientationdialogboxopens.
3. Selecttheorientationthatmatchestheorientationoftheimage.
Tochangetheorientationandclosethedialogbox,clickOK.
Todefinetheorientationanglesindegrees,clickAdvanced.
TheRotationdialogboxopens.
4. Typetheanglesinthetextboxes.
AlphaistherotationanglearoundtheXaxis.
BetaistherotationanglearoundtheYaxis.
GammaistherotationanglearoundtheZaxis.

5. ClickOK.
Theanglesarechangedandthedialogboxcloses.Ifyouchanged
theorientationofanimageseries,thenewimageserieswiththe
changedimageorientationisshowninthescopewindow.
Note: Toverifythattheimagehasthecorrectorientationassignedtoit,openit
inanimageview.Thepatientorientationindicatornowreflectsthenew
orientationoftheimage.
Note: ChangingtheorientationofPETimagesisnotsupported.
Changing the Patient Imaging Position in Relation to the Couch

Itcanbenecessarytochangethepatientimagingpositioninrelation
tothecouchiftheinformationismissingfromtheslicesortheimage
serieslooksincorrect.
Available Patient Imaging Position Options
Theoptionsforthepatientimagingpositionarethefollowing:
Headfirstsupine
Headfirstprone
Headfirstdecubitusright
Headfirstdecubitusleft
Feetfirstsupine
Feetfirstprone
Feetfirstdecubitusright
Feetfirstdecubitusleft
Facefirstsitting
Whenyouchangethepatientimagingposition,anewimageseriesis
createdinthedatabase.Thepatientorientationindicatorchanges
accordingly.Formoreinformationonthepatientorientationindicator,
seeChapter 4,Section2DViewsonpage 83.

To Change the Patient Position
1. IntheScopeorFocuswindow,selecttheimageseries.
2. ChooseImage >ChangePatientPosition.
3. IntheNewPatientPositiondropdownlist,selectthedesired
patientposition.
4. ClickOKtochangethepatientposition.
Note: ChangingthepatientimagingpositioninPETimagesisnotsupported.
Note: YoucanchangethetreatmentpositionofthepatientinthePlan
Propertiesdialogbox.
Inverting the 3D Image Slice Order

Eclipsearrangestheslicesina3Dimageinaccordancewiththeir
primaryaxes.Forinstance,theZaxisusuallyincreasesfromfeetto
headintheDICOMsystem,andthe3Dimagecreatedinthe
applicationisdisplayedinanuprightposition.Sometimestheoriginal
imagesmayhavehadareversedZaxis,andthe3Dimagecreated
fromtheseimageswillappearupsidedown.Invertingthesliceorder
correctsthisproblembymirroringthe3Dimagealongitsprimary
axis.Whenyouinvertthesliceorder,anewimageserieswiththe
invertedsliceorderiscreatedinthedatabase.

A.OriginalimagesliceorderB.Reversedimagesliceorder
Figure 30 Inverting Slice Order
Note: InvertingthesliceorderofPETimagesisnotsupported.
To Invert the 3D Image Slice Order

1. IntheScopewindow,selecttheimageseries.
2. ChooseImage >InvertSliceOrder.
Youarepromptedtoconfirmthereversal.
3. ClickYestoinvertthesliceorder.
Anewimageserieswiththeinvertedsliceorderiscreated.
Adding Annotations to Images

YoucanaddannotationstoimagesintheContouringworkspace.

To Add Annotations
UsetheAnnotationcommandtoattachcommentstoimages.
1. Selecttheimagetoaddanannotation.
2. ChooseContouring >Draw >Annotation.
ThemousepointerappearsasacrosswiththeletterA.
3. Positionthemousepointerwhereyouwanttoaddtheannotation,
andclick.
TheLabelTextdialogboxopens.
4. Typeyourcomment.
5. ClickOK.
Theannotationappearsintheimageviews.
ThecommentcannotbeeditedafteryouclickOK.
Rotating and Mirroring Images

Sometimesfilmsmaybeaccidentallyscannedinanincorrect
orientation.TheorientationcanbecorrectedwiththeRotate/Mirror
command,whichrotatesormirrorstheimagepixeldata.Theallowed
rotationanglesare90 clockwise,90 counterclockwiseand180.
Imagescanbemirroredverticallyandhorizontally.Youcansavethe
changestotheactiveimageorcreateanewimageandsavethe
changestoit.
To Rotate or Mirror an Image

1. FromtheImageGallery,dragtheimagewiththeincorrect
orientationtoanimageviewandactivatetheimagebyclickingthe
titlebaroftheimageview.
2. ChooseImage >Rotate/Mirror.
TheRotate/Mirrordialogboxopens.

3. Torotatetheimage,selecttheappropriateoptionintheRotate
groupbox.
TheResultboxshowshowtheimagewillberotatedwiththe
selectedoption.
4. Tomirrortheimage,selecttheappropriateoptionintheMirror
groupbox.
TheResultboxshowshowtheimagewillbemirroredwiththe
selectedoption.
Toapplythechangestotheactiveimage,selectModify
OriginalImage.
Tosavethechangestoanewimage,selectCreateNewImage
anddefineanameforthenewimageintheNewIDtextbox.
6. Tofinish,clickOK.
Approving Images
Imagescanhavethefollowingstatuses:New,Reviewed,Action
Required,andApproved.TheReviewedstatusandtheAction
Requiredstatusareindicatedwithablueframearoundtheimageicon
intheScopewindow.Areviewedimagehasabluemark,andan
actionrequiredimagehasaredmarkinthe2Dimageviewsandinthe
ImageGallery.Anapprovedimagehasagreenframearoundthe
imageiconintheScopewindowandagreencheckmarkinthe2D
imageviewsandtheImageGallery.Approvedimagescannotbe
modified.
Note: Imageapprovaldoesnotchangetheapprovalstatusofstructures.
Structuresareapprovedseparatelyfromimages.Formoreinformationon
structureapproval,seeChapter 7,SectionApprovingStructureson
page 195.
Formoreinformationaboutimagestatusesandimageapproval,refer
toOncologyInformationSystemApprovalGuide.

To Approve Images
1. IntheScopewindow,selecttheimage.
2. ChooseEdit >Properties.
3. IntheStatusdropdownlist,selectApproved.
4. ClickOK.
TheAuthorizationforApprovaldialogboxopens.
5. TypethecorrectusernameandpasswordandclickOK.
Thedialogboxcloses.TheimagestatusischangedtoApproved,
andthestatusismarkedintheScopewindowandtheimage
views.
Exporting Images
Youcantransferimagedatatoanothersystem.TheExportwizard
guidesyouthroughtheimageexportprocess
InthedialogboxesoftheExportwizard,usethefollowingbuttons:
ClickCanceltoclosethewizarddiscardingthechanges
To Export Images
1. ChooseFile >Export >Wizard.
TheExportwizardopens.
2. ClickthePlanortheImage(s)optionbuttonandclickNext.

Image(s):Selectthesourceoftheimage(s)andselectwhether
youwishtoincludethestructuresetwiththeimagesandclick
Next.
Plandata:Selectwhatyouwishtoincludeintheplanandclick
Next.
4. SelecttheappropriateexportfilterandclickNext.
5. Inthelistbox,selectthedatatoexport.
6. Ifnecessary,changetheexportdirectoryforalldataorforselected
data:
Tochangetheexportdirectoryforalldata,clickChangeforall
Objectsandselecttheappropriatedirectory.
Tochangetheexportdirectoryforselecteddata,clickChange
forselectedobject(s)andselecttheappropriatedirectory.
SelectedObject(s).
8. Tosavetheselecteddatatothedefinedexportdirectory,click
Finish.

Chapter 6 Image Registration
Registration Workspace
ThischapterdescribesimageregistrationintheRegistration
workspace.Thechapterdescribeshowtheregistrationprocedure
works,andgivesinstructionsonpreparingtheimagesforregistration.
Instructionsareprovidedforregisteringimagesbyusingregistration
points,DICOMcoordinates,imagepixeldata(automaticregistration)
andmanualimageregistrationtools,andforreviewingandadjusting
theresultingregistration.
About Image Registration

Imageregistrationistheprocessofspatiallyaligningtwoimagesby
theircoordinatesystems.Inotherwords,registrationistheprocessof
correlatingtwoimagedatasets,suchasPET,MRandCT3Dimages.
Theimagescanbeofthesamemodalitybutusuallytheyareoftwo
differentmodalities.Thedifferentimagemodalitieshavetheirspecific
benefits,forinstance,differentlevelofanatomicaldetailoraccuracy,
ordifferentdisplayofsoftandnervetissueorbonystructures.These
canbecombinedintreatmentplanningbymeansofimage
registration.
ThecoordinatesystemsoftheimagesareidentifiedbyaDICOM
FrameofReference(FOR),andtheregistrationisdonebetweeneach
FORforeachimageasaspatialtransformation.Imageregistrationis
neededbecausethecoordinatesystemsoftheimages,although
producedfromthesamepatient,alwaysdifferunlesstheysharethe
sameframeofreference.
Ifthepatienthasbeenscannedduringthesameimagingsessionfor
twodifferentimagemodalities(forexample,CTandPET),theimages
havethesameFOR.WhentheimageshavethesameFOR,thereisno
needtoregistertheimages.Eclipseautomaticallyconsiderstheimages
asbeingregisteredwitheachother.
143
Ifthepatientimageshavebeenproducedduringtwodifferent
imagingsessions,theimageshavedifferentFORs.Toenableusing
bothimagesintreatmentplanning,itisnecessarytoregisterthem
together.
Thefollowingdifferencesarecompensatedforduringimage
registration:
Imageanglesinrelationtoeachother(obliquity).Youcancorrect
therelativeimageanglesintheRegistrationworkspace.
Positionofimagesinrelationtoeachother.Youcancorrectthe
relativepositionsoftheimagestoeachotherintheRegistration
workspace.
Note: Theapplicationusesrigidregistration,whichmeansthatgeometric
distortioninimagesofdifferentmodalitiesisnotcorrectedintheapplication.
Youcanalsoregistermultipleimagesofdifferentmodalitieswitheach
other.Ifyouhavetwoimagesthatarealreadyregisteredwitheach
otherandyouregisteroneofthemwithathirdimage,thethirdimage
isalsoautomaticallyconsideredasregisteredwiththeotherimage.In
otherwords,ifyouhave,forexample,CTandPETimagesthatare
alreadyregistered,andyouregistertheCTimageswithanMRimage,
theMRimageisalsoconsideredasregisteredwiththePETimage.
RegisteredimagescanbeviewedinotherworkspacesusingtheBlend
andNormalvisualizationmodes.Whenyouuseregisteredimagesin
otherworkspaces,allchanges,suchascontours,aresavedtothe
primaryimage.Formoreinformation,seeVisualizationMethodsfor
RegisteredImagesonpage 165.Youcanalsosumupplansbasedon
twoormoreregisteredimagesetstoviewthetotaldose.
Registration Methods
Thefollowingimageregistrationmethodsaresupported:
AutomaticimageregistrationusingimagepixeldataSamplesthe
pixeldataandmeasurestheamountofmutualinformationinthe
pixelvaluesoftheset.Automaticimageregistrationsearchesfora
spatialtransformationbetweentheFORsoftheimagesthat
maximizestheamountofmutualinformation.Thegreaterthe

amountofmutualinformation,thebettertheregistrationresult.
Formoreinformation,seeAutomaticImageRegistrationUsing
PixelDataonpage 150.
AutomaticimageregistrationusingDICOMcoordinates
CalculatestheregistrationbyusingtheDICOMcoordinatesystem
dataandtheDICOMFrameofReferenceUniqueIdentifier(UID)
attributefoundintheimagesets.Formoreinformation,see
AutomaticImageRegistrationUsingDICOMCoordinate
Systemonpage 154.
ImageregistrationusingregistrationpointsRequiresthe
identificationofthreeormorecorrespondingpointsoneachimage
set.Formoreinformation,seeImageRegistrationUsing
RegistrationPointsonpage 156.
ImageregistrationusingmanualregistrationtoolsAllows
rotatingandtranslatingtwoimagesetsinrelationtoeachother
manually.Theimagesareshownonsimultaneouslyinthe
verificationview,eitherusingtheSplit,ChessorBlendingview,or
theSpyglasstool.YouusetheRotateandTranslatetoolstochange
thepositionoftheimagesinrelationtoeachother.Youcanfurther
adjusttheregistrationwiththeregistrationfinetuningtools.For
moreinformation,seeImageRegistrationUsingManualTools
onpage 160.
Youcanviewexistingregistrationsandregistrationsdoneinthe
treatmentunit(OBI)inEclipse.RegistrationsdoneintheOBIarein
readonlymodeandcannotbeeditedinEclipse.
Accuracy of Registration
Thereisalwayssomeinaccuracyintheregistrationresult.Itis
importanttobearinmindthatthenatureoftheregistration
determinesitsusefulness.Itisnotunusualforaregistrationtobe
accurateinsomepartsoftheimages,butinaccurateelsewhere.When
definingstructuresandusingregisteredimages,makesurethatthe
registrationisaccuratearoundthestructurethatyouwishtouseand
aroundthecriticalorgans.Whenusingautomaticimageregistration
usingpixeldata,youcanprioritizeastructurevolumetoimprove
registrationaccuracyaroundthestructure.Formoreinformation,see
PrioritizingaStructureVolumeinAutomaticRegistrationon
page 152.
Image Registration 145

Themainreasonsforinaccuracyarethefollowing:
Differencesduetopatientorientation,postureormovement
Finiteslicethicknessandresolution
Imagedistortionorartifacts
Inaccuracyinregistrationpointplacement
Thedistancebetweentheplanesina3Dimageisoneofthemajor
factorsaffectingtheaccuracyofregistration.
Theregistrationresultcanbeeditedforbetteraccuracywiththe
Manualregistrationtools.Theregistrationfinetuningtoolscanbe
usedtochangetheimagepositionbysmallincrements.
Anexampleofaccurateandinaccurateregistrationareillustratedin
Figure 31onpage 148.
A.AccurateregistrationB.Inaccurateregistration
Figure 31 Accurate and Inaccurate Registration
Registering 3D Images
Toregister3Dimages,youmustfirstconstructthemintheSelection
workspace.Afterthisthe3Dimagescanbeopenedtotheimageviews
intheRegistrationworkspace.
Iftheimagestoberegisteredhavebeenscannedfromdifferent
orientations,forexampleoneoftheimagesetshasbeenscannedfeet
firstandtheotherheadfirst,theapplicationrotatesoneofthemsothat

bothimagesareshownfromthesameorientationintheorthogonal
views.Youcanshowtheimagesfromtheiroriginalorientationsby
deselectingtheRegistration >ShowTwinOrthosinSame
Orientationoption.
Note: Whenregisteringimages,noticethefollowing:
Visuallyverifythattheimagesarecorrectlyconstructed.
TotoggletheContextwindowonandoffinordertoviewonlytheleftand
rightimages,chooseWindow >Contextwindow.
Alwaysvisuallyverifyallimageregistrations.
To Load Images for Registration

1. ChooseFile >Open.
ObjectExplorerdialogboxopens.
2. Selectthedesiredpatientandanimageseriesoftheselected
patient.
3. Intheimageseries,selectoneormoreimagesandclickApplyto
opentheimages.
4. Repeatsteps2and3toselectanimagefromadifferentimage
seriesoftheselectedpatient.
5. ClickOKtoshowtheselectedimagesintheScopewindow.
6. Dragtheimagestotheimageviews.
Theimageisdisplayedintheimageviews.
7. Continuewiththedesiredregistrationmethod.
To Show the Images from the Same Orientation

1. Dragtheimagestotheimageviews.
2. Selectthe3Dimageyouwanttobeshowninthesameorientation
astheotherimage.
3. ChooseRegistration >ShowTwinOrthosinSameOrientation.
Both3Dimagesarenowshowninthesameorientation.

Automatic Image Registration Using Pixel Data
Automaticimageregistrationusingthepixeldatasamplesthepixel
dataintheimagesandmeasurestheamountofmutualinformationin
thepixelvaluesoftheimages.Automaticimageregistrationsearches
foraspatialtransformationbetweentheFORsoftheimagesthat
maximizestheamountofmutualinformation.Thegreatertheamount
ofmutualinformation,thebettertheregistrationresult.
TheautomaticimageregistrationinEclipseisarigidregistration.That
is,theregistrationtechniquedoesnotchangethegeometricalaspects
oftheimagesorcorrectgeometricaldistortionsinthem.Ifnoprevious
registrationbetweentheimagesexist,theimagesareprealignedby
placingtheircenterstogether.Ifthereisanexistingregistration
betweentheimages,itisusedasthestartingorientation.The
registrationalgorithmusesamultiresolutionapproach,startingbya
globalmatch,andthenproceedingtofiner,localimagedetails.
Youcanimprovetheregistrationresultbyadjustingthefollowing:
Window/LevelsettingsAutomaticregistrationusesthecurrent
Window/Levelsettingsoftheimages.Thismeansthatthe
algorithmregisterstheimagesbasedonthedatathatisvisibleon
thescreen,andthatthecurrentwindow/levelsettingsaffectthe
registrationresult.Therefore,youshouldadjustthewindow/level
settingsinsuchawaythattheanatomicaldetailsyouwanttouse
duringtreatmentplanningareshownasclearlyaspossible.
PrealignmentofimagesIftheimageshavesubstantially
differentimageareas(forexample,oneoftheimagescoversthe
patientfromheadtowaist,theotherfromheadtochest),you
shouldprealignthemmanuallyusingthemanualregistration
toolssothattheyareroughlyalignedwitheachother.Prealigning
theimagesincreasesthelikelihoodofachievingagoodregistration
result.

Youcanselectwhethertheregistrationalgorithmusesthepixeldatain
thewholeimagesetorinasmallerareawithintheimagesetduring
theregistration.Youhavethefollowingoptionsforlimitingthearea
withinwhichpixeldataissampled:
UseVolumeofInterest(VOI)toolMeasurestheamountof
mutualinformationinsideathreedimensionalVOItool.
PrioritizestructurevolumePrioritizesastructurethathasbeen
definedinoneorbothimages.Youcanselectastructurethatneeds
toberegisteredasaccuratelyaspossible.Thisoptiongiveshigher
prioritytoinformationinsidetheselectedstructurevolume,butit
doesnotexcludeanyinformationoutsidethestructure.
Youcanalsousethesetwooptionssimultaneously.
Forinformationonthealgorithmusedforautomaticregistrationusing
pixeldata,refertoEclipseAlgorithmsReferenceGuide.
Using VOI in Automatic Registration
Youcandefineathreedimensionalvolume(VOI,VolumeofInterest)
tobeusedduringautomaticregistrationbyusingtheRegistrationVOI
tool.TheRegistrationVOItoolallowsa3Dvolume(acube)tobe
defined.TheVOIconsistsofmultipleimageplanes,andspecifiesan
areainwhichdataistobesampled.
WhentheRegistrationVOIisused,automaticregistrationmeasures
onlythepixeldatainsidetheVOI,andalldataoutsidetheVOIis
excluded.TheVOItoolisuseful,forexample,iftheimagesetcontains
afixationdevicethatyouwanttoexcludefromthepixeldatatobe
usedduringtheregistration.

A.VOItoolmovinghandlesB.VOItoolrotationhandleC.Window/levelsliderandimage
histogram
Figure 32 Registration VOI Tool
YoucanadjustthesizeoftheVOIbydraggingitsmovinghandles,or
rotateitbydraggingitsrotationhandle.YoucanshowtheRegistration
VOIbyselectingRegistration >ShowRegistrationVOI .Youcan
resettheVOIbyselectingRegistration >ResetRegistrationVOI .
YoucanalsousethisoptionsimultaneouslywiththePrioritize
StructureVolumeoption.
Prioritizing a Structure Volume in Automatic Registration
Iftheimageshavestructuresdefinedinthem,youcanselecta
structurethatneedstoberegisteredasaccuratelyaspossible,and
prioritizethatstructurevolumeduringtheregistration.Typically,the
structuretobeprioritizedwouldbeverycloseorwithinthetreatment
targetarea.Prioritizingastructurevolumeisuseful,forexample,ifthe
positionofthepatientsbodypartsisdifferentintheimagesets.
Toprioritizeastructurevolumeduringautomaticregistration,the
structuremustbecontouredinatleastoneofthe3Dimages.
YoucanalsousethisoptionsimultaneouslywiththeUseVolumeof
Interestoption.

To Use a VOI in Automatic Registration
IfyouwanttousetheVOItoolinautomaticregistration,youneedto
adjustitssizeandpositionintheimagesetsbeforestartingautomatic
registration.
1. ChooseRegistration >ShowRegistrationVOI .
TheregistrationVOIisdisplayedintheprimaryimageandinthe
imagetoberegistered.
2. ToadjustthesizeoftheRegistrationVOIintheprimaryimage,
clickanddragitsmovinghandles.
3. TorotatetheRegistrationVOIintheprimaryimage,clickanddrag
itsrotationhandle.
4. Repeatsteps2and3fortheotherimageset.
To Automatically Register 3D Images Using Pixel Data
1. Adjustthewindow/levelsettingsfortheimagestoshowthedata
youwanttouseduringregistration.
2. ChooseRegistration >UsePixelData.
TheRegistrationUsingPixelDatadialogboxopens.
3. Selectthevolumeofinteresttobeusedduringtheregistrationin
bothimagesets:
TouseonlythepixeldatainsidetheVOI,selecttheUse
VolumeofInterestcheckbox.
Tomaketheregistrationaroundthestructureyouwanttouse
asaccurateaspossible,selectthePrioritizestructurevolume
checkbox,andselectthedesiredstructurefromthedropdown
list.
Tousethepixeldatainthewholeimageduringregistration,
donotselecteitheroftheseoptions.
YoucanalsousetheUseVolumeofInterestandPrioritizeStructure
Volumeoptionssimultaneously.
4. Toviewtheimagesetfromdifferentdirections,clickTransversal,
SagittalorFrontal.
5. ChoosetheregistrationalgorithmtobeusedintheRegistration
Algorithmdropdownlist.

6. Tostarttheregistration,clickStart.
Duringtheregistration,thepositionsoftheimagesareshownin
theverificationview,theStatusgroupboxshowsstatusmessages,
andtheprogressindicatorshowstheregistrationprogress.
7. Toviewtheregisteredimagesfromdifferentdirectionsduringthe
registration,clickTransversal,SagittalorFrontal.
8. Tointerrupttheregistration,clickStop.
9. Toaccepttheregistration,clickOK.
Theorthogonalverificationviewopensandthepreviouslyused
visualizationmethodisactivated.Theregisteredimageandthe
registrationresultappearunderthe3DimageintheFocus
window.
Automatic Image Registration Using DICOM Coordinate System

Oneimageregistrationmethodistolettheapplicationcalculatethe
registrationbyusingtheDICOMcoordinatesystemdataandthe
DICOMFrameofReferenceUIDattributefoundintheimagesets.
Thisregistrationmethodisdesignedforregisteringimagesthathave
beentakeninthesameimagingdeviceinonepatientorientation.The
registrationisdonebyaligningtheoriginsoftheDICOMcoordinate
systemsavedtotheimagesbytheimagingdevice.Normally,the
DICOMFrameofReferenceUIDattributeisthesameintheseimages.
Whenthisisthecase,theregistrationisdoneautomatically.Some
imagingdevicesproduceimageswithadifferentFrameofReference
UID,butinspiteofthis,theDICOMcoordinatesystemintheseimages
canbeusedtoregistertheimages.
IftherearemultipleimagesthatsharethesameDICOMFrameof
Reference,youcanuseandviewtheminthesamewayasanyother
registeredimages.Youcan,forexample,viewtheseimagesinblend
modeintheContouringworkspace,andcontourstructuresinthem.

To Register 3D Images with the Same DICOM Coordinate System
1. Dragtheimagestotheimageviews.Visuallyverifythatthe
imagesarecorrectlyconstructed.
2. ChooseRegistration> UseDICOMCoordinates.
Theorthogonalverificationviewopensandthepreviouslyused
visualizationmethodisactivated.Theregisteredimageandthe
registrationresultappearunderthe3DimageintheFocus
window.IftheimagessharetheDICOMFORandare
automaticallyconsideredasregistered,noregistrationiconis
shownundertheregisteredimageicon.
Assigning a New DICOM FOR for Re-Registration of Images
Insomecases,imagesthathavebeentakenduringthesameimaging
sessionandsharetheDICOMFrameofReference(FOR)needtobe
reregisteredbecauseofpatientmovementduringtheimaging
session.Toreregistertheimages,youneedtoassignanewDICOM
FORforoneoftheimages.WhenyouassignanewFORforthe
images,theapplicationcreatesacopyoftheselectedimageseries,and
assignsthenewFORforthenewimageseries.
To Assign a New DICOM FOR for Re-Registration of Images
1. OpentheimageseriesforwhichyouwishtocreateanewDICOM
FOR.
2. GototheSelectionworkspace.
3. SelecttheimageseriesyouopenedintheScopewindow.
4. SelectImage >ChangePatientPosition.
TheChangePatientPositiondialogboxopens.
5. SelecttheAssignanewframeofreferenceoption.
6. ClickOKtoclosethedialogbox.
ThenewimageseriesisshownintheScopewindow.Tocontinue,
createanew3Dimageoftheslicesinthisseries.Thenyoucan
registerthenew3Dimagewiththeother3Dimage.

Image Registration Using Registration Points
Toregisterimagesbyusingregistrationpoints,youfirstpositionthe
registrationpointsonanatomicallandmarksoronuserdefined
artificiallandmarksintheimages.Theapplicationthenusesthe
registrationpointstodefinethetransformationfromoneimage
coordinatesystemtoanother.Theimagesusedforregistrationcanbe
3Dimages.Figure 33onpage 156showshowtheuserdefined
registrationpointsareusedtoaligntwo3Dimagestogether.
A.RegistrationpointsinsertedinCTimagesetB.OriginalimagesC.Registeredimages
D.RegistrationpointsinsertedinMRimagesetE.RegistrationpointsalignedfromtheCTand
MRimages
Figure 33 3D Images Registered with Registration Points
Thenumberofdefaultregistrationpointsisfour,andtheminimum
numberofregistrationpointsrequiredtoregistertwoimagesisthree.
Usingmorethanfiveregistrationpointsdoesnotnoticeablyimprove
theaccuracyoftheregistration,butithelpsindetectingerrors.
Theregistrationpointsaredraggedtooneofthe3Dimagesandthen
tothecorrespondingpositionsontheotherimage.Eachimageview
canbeusedforplacingregistrationpoints.Theregistrationpoints
shouldbeplacedthreedimensionally,thatisup,down,rightandleft
oneach3Dimagetogiveagoodthreedimensionalregistrationresult.

Dependingonwhetheryouwanttomakeageneralregistrationora
morespecificregistration,usebones,markersororgansaslandmarks
fortheregistrationpoints.
Note: Theregistrationpointsmaynotformastraightline.Themoreaccurate
thelocationsoftheregistrationpointsareanatomically,thebetterthe
registrationresult.
Registrationpoints( )arestructures,andtheyaredisplayedinthe
FocuswindowbelowtheMatchPointsstructureiconunderthe
structuresetthatbelongstotheselectedimage.
Location of the Registration Points
Differentvisualizationsareusedtoindicatetheplanewhereeach
registrationpointislocated:
Activeregistrationpointlocatedontheactiveviewingplane
Inactiveregistrationpointlocatedontheactiveviewing
plane
activeregistrationpointlocatedbehindtheactiveviewing
plane
Activeregistrationpointlocatedinfrontoftheactiveviewing
plane
Inactiveregistrationpointlocatedinfrontoftheactive
viewingplane
Inactiveregistrationpointlocatedbehindtheactiveviewing
plane
Whenyouselectaregistrationpoint,itistransferredtotheplane
currentlydisplayedintheimageviewwhereyouactivatedthe
registrationpoint.

A
X E
B
X
X
D
C X
A.HighestplaneB.ActiveplaneshowninimageviewC.LowestplaneD.Selectedregistration
pointE.Selectedregistrationpointmovedtotheactiveplane
Figure 34 Lateral View of the Image Planes
Mean Error Indicator
Themeanerrorindicatorisusedonlyinregistrationusingregistration
points.Thegeometricalerrorintheregistrationformedbythe
registrationpointsisdeterminedbycalculatingthemeanerror
betweenthedistancesofregistrationpointpairsdefinedintheimages.
Ifthemeanerrorisunder10mm,themeanerrorindicatorturns
green;iftheerrorexceeds10mm,theindicatorisred.
Note: Thegeometricalmeanerrorismeantasaguidelineonly.Sometimesa
registrationcanserveitspurposewiththemeanerrorexceeding10mm.
A.Meanerrorindicator
Figure 35 Mean Error Indicator

To Register 3D Images Using Registration Points
1. IntheRegistrationworkspace,dragtheimagestotheimageviews.
Visuallyverifythattheimagesarecorrectlyconstructed.
2. Toinsertnewregistrationpoints,dooneofthefollowing:
ChooseInsert > NewDefaultRegistrationPointstoinsertthe
fourdefaultregistrationpoints.
ChooseInsert > NewRegistrationPointtoinsertindividual
registrationpoints.
Theregistrationpoint(s)appear(s)inallimageviewsandthe
Focuswindow.
3. Rotatethe3Dimagessothattheyarebothatthesameanglesto
makeiteasiertolocatethecommonpoints.
4. Movetheimagehandlesorscrollwithyourmousesothatthe
desiredanatomicaltargetisvisible.Toplacetheregistrationpoints
moreaccurately,zoomintotheimageandselectPanfromthe
Viewtoolbartomovetheimageintheimageviewinordertosee
theplaceofinterest.
Theselectedplaneisdisplayedintheimageviews.
5. Dragthenewregistrationpointtothedesiredplace.
Theregistrationpointsmaynotformastraightline.Themoreaccurate
thelocationsoftheregistrationpointsareanatomically,thebetterthe
registrationresult.
TheselectedregistrationpointishighlightedintheFocuswindow.
Intheimageviews,theregistrationpointturnsred.
6. Repeatsteps25untilyouhavedefinedallnecessaryregistration
pointsintheselected3Dimage.
7. Toswitchbetweenthe3Dimages,selectthe3DimageintheScope
windoworgototheimageviewwherethedesiredimageis
displayed.
8. Repeatsteps15onthesecond3Dimage.Trytoplacethe
registrationpointsasclosetothecorrespondingregistrationpoints
onthefirst3Dimageaspossible.
Themeanerrorindicatorturnsgreenifthemeanerrorofthe
registrationislessthan10 mm,evenifithasnotbeenaccepted.

9. Ifyouneedtoaddadditionalregistrationpoints,chooseInsert >
NewRegistrationPoint.
10. Toaccepttheregistration,chooseRegistration >UsePoints.
Adialogboxopens,showingthemeanandmaximumerror
betweentheimagesandpromptingyoutoapprovethe
registration.
11. Toapprovetheregistration,clickYes.Toreadjusttheregistration
pointpositions,clickNo.
Thereisalwayssomeerrorbetweenthegeometriesdefinedbythe
registrationpoints.Theregistrationcanbeadequatedespiteasubstantial
meanerror,whileasmallerrordoesnotnecessarilymeanthatthe
registrationisacceptable.Thebestwaytoverifytheregistrationisto
evaluatetheresultoftheregistrationvisually.
Theorthogonalverificationviewopens.Theregisteredimageand
theregistrationresultappearbelowthe3DimageintheFocus
window.
To Move the Viewing Planes to a Registration Point
UsetheMoveViewingPlanestoRegistrationpointcommandto
examineaselectedregistrationpointinallthreeimageviews.
1. IntheFocuswindow,selectaregistrationpoint.
2. ChooseView >MoveViewingPlanesto >RegistrationPoint >
<registrationpoint>.
Imageplanesaremovedtointersectattheselectedpoint.
Image Registration Using Manual Tools

Imageregistrationwiththemanualtoolsallowsrotatingand
translatingtwoimagesinrelationtoeachothermanually.Bothimages
arevisualizedinthesameverificationview,eitherusingtheSplit,
ChessorBlendingview,ortheSpyglasstool.YouusetheRotateand
Translatetoolstochangethepositionoftheimagesinrelationtoeach
other.
Imageregistrationwiththemanualtoolsisusefulforfurtherediting
registrationsformedbyotherregistrationmethods,forexample,when
preciselocationsarenotfoundinasagittalimageforregistration

pointsinsertedinatransversalimage.Inthiscase,themanualtools
canbeusedtominimizethecoordinatedeviationbetweenthe
registrationpoints.
Manualregistrationtoolscanalsobeusedforprealigningtheimages
toberegisteredautomatically,especiallyiftheyhavesubstantially
differentcoordinatesystems.
To Register 3D Images Using Manual Tools
ChooseRegistration >UseManualTools >Rotate torotate
oneofthe3Dimages.
ChooseRegistration >UseManualTools >Translate to
translateoneofthe3Dimages.
Theorthogonalverificationviewisopenedandaspecialmouse
pointerappears,indicatingtheselectedfunction.Theregistered
imageandtheregistrationresultappearbelowthe3Dimageinthe
Focuswindow.
2. Torotateortranslatetheimage,placethemousepointeroneither
oftheimagesintheSplitview,pressthemousebuttonandmove
thepointer.
Thetwoimagesareconstantlyregisteredasyoumovethemouse
pointer.
3. Toadjustthecenterofrotation,whichisattheintersectionofthe
viewingplanes,pickupandmovethecentralcrossinanyofthe
orthogonalviews.
4. Tostoprotatingortranslating,releasethemousebutton.
5. Tochangetheorientationoftheimages,choose:
Registration >SwitchtoTransversalVerification toviewa
transversalimageintheactiveorthogonalverificationview.
Registration >SwitchtoFrontalVerification toviewa
frontalimageintheactiveorthogonalverificationview.
Registration >SwitchtoSagittalVerification toviewa
sagittalimageintheactiveorthogonalverificationview.
Youcanalsochangetheorientationoftheimagesbyrightclickinginthe
imageviewsandselectingoneoftheoptionsinthemenuthatopens.

6. Toviewthetwoimagesblended,clickBlend onthetoolbar.To
removeblending,clickBlendagain.
7. Tofinishrotatingortranslating,chooseRegistration >Use
ManualToolsandcleartheselection.
Toviewdifferentplanesoftheactive3Dimagesintheorthogonal
verificationview,clickNextPlane andPreviousPlane onthe
toolbar,orscrollwiththemouse.YoucanZoomInandZoomOutthe
registeredimagesbypressingCTRLandscrollingwiththemouse.
Multiple Registrations Between the Same Two Images

Multipleregistrationsbetweenthesameimagesmightbeneeded,for
example,whenthereismorethanonetreatmenttarget,andwhenone
registrationisnotsufficienttoalignallthetargetsaccuratelyenough.
YoucanviewandeditmultipleregistrationscreatedoutsideEclipse,
butyoucannotcreatemultipleregistrationswithit,becauseanew
registrationalwaysreplacesthepreviousone.
Whentherearemultipleregistrationsbetweenthesameimages,the
Focuswindowshowsaseparateregisteredimagesobjectand
registrationobjectforeachregistration.Figure 36onpage 162shows
anexampleofhowmultipleregistrationsareshownintheFocus
window.
Figure 36 Multiple Registrations Shown in Focus Window
Note: Iftherearemultipleregistrationsbetweentheimages:
Copyingandpastingstructuresisnotsupported.
Creatingplansumsisnotsupported.

Registering 4D Images
Registrationofthe3Dimagesusedin4Dimagesisnecessaryifthe3D
imagesdonothavethesameDICOMFrameofReference.However,
youonlyneedtoregisterone3Dimagefromboth4Dimages.Once
thisisdone,theapplicationconsidersallthe3Dimagesinthe4D
imagesasbeingregisteredwitheachother.
To Register 4D Images
1. Openthedesiredpatientandthetwo4Dimagestoregister.
2. Dragone3Dimagefromeach4Dimagetotheimageviews.
Registerthe3Dimagesusingpixeldata.Forinstructions,see
ToAutomaticallyRegister3DImagesUsingPixelDataon
page 153.
Registerthe3Dimagesusingregistrationpoints.For
instructions,seeToRegister3DImagesUsingRegistration
Pointsonpage 159.
Registerthe3Dimagesusingmanualtools.Forinstructions,
seeToRegister3DImagesUsingManualToolsonpage 161.
Youonlyneedtoregisterone3Dimagefromboth4Dimages.Oncethisis
done,theapplicationconsidersallthe3Dimagesinthe4Dimagesas
beingregistered.
Verifying Image Registration

Onceyouhaveregisteredthe3Dimages,youcanevaluatetheresult
visuallyintheorthogonalverificationviewsintheRegistration
workspace.YoucanusetheSplit,ChessorBlendverificationviews,or
theSpyGlasstool.
Theregisteredimagescanbeviewedintransversal,frontaland
sagittalviews.Theverificationviewscanbemaximizedandanyofthe
orthogonalplanescanbeshowninthelargestview.Toviewdifferent
planesofthe3Dimagesintheverificationviews,clicktheNextPlane

andPreviousPlane buttonsonthetoolbar,orscrollwiththe
mouse.YoucanalsouseRotateandZoomIncommandswhen
viewingtheregistration.
TheFocuswindowshowstheregisteredimageobject( )andthe
registrationobject( )belowtheactiveimageasfollows:
IftheimagessharetheDICOMFrameofReferenceUID,and
thereforedonotneedregistration,onlytheregisteredimageobject
isshown.
Iftheimageshavebeenregisteredusingmanualtools,pixeldata
orregistrationpoints,boththeregisteredimageobjectandthe
registrationobjectisshown.
Registeredimagesaredisplayedbyselectingthevisibilityboxofthe
registeredimageobjectintheFocuswindow,andhiddenbyselecting
thevisibilityboxoftheprimaryimage.Theycanalsobedisplayedin
theBlendmodebypressingCTRLandselectingthevisibilityboxofthe
registeredimageobjectintheFocuswindow.
Registeredimagescanalsobeviewedinotherworkspaces.For
instance,tobenefitfromregisteredimagesincontouring,youcan
displaythemintheContouringworkspace.(Fordetailedinstructions
onusingregisteredimagesincontouringandsegmenting,see
CopyingStructurestoRegisteredImagesonpage 189andUsing
RegisteredImagesinContouringonpage 249.)
Note: CTvaluesassignedtostructuresarenotshownintheverificationviews
oftheRegistrationworkspace.

Visualization Methods for Registered Images
Registeredimagescanbeviewedbyusingthefollowingvisualization
methods:
SplitViewShowsrectangularsectionsoftheprimaryimageand
theregisteredimagesimultaneously.Thisvisualizationmethodis
availableintheRegistrationworkspace.
ChessViewShowssmall,rectangularsectionsoftheprimary
imageandtheregisteredimagesimultaneouslyinapattern
resemblingachessboard.Thisvisualizationmethodisavailablein
theRegistrationworkspace.
SpyGlasstoolShowsarectangularregionofinterestinsideof
whichtheregisteredimageisdisplayed.Thisvisualizationmethod
isavailableintheRegistrationworkspace.
BlendmethodTheregisteredimageisshownsimultaneously
withtheprimaryimagewithvariableopacity.Thisvisualization
methodisavailableinallworkspaces.
NormalmethodTheregisteredimageisshowninplaceofthe
primaryimageintheimageviews.Thisvisualizationmethodis
availableinallworkspaces.
Split and Chess Verification Views

TheSplitandChessverificationviewsdisplaytheprimaryimageand
theregisteredimagesimultaneously,showingrectangularsectionsof
bothofthe3Dimagesintheorthogonalverificationviews.

A.SplitviewB.Chessview
Figure 37 Split View and Chess View
TheSplitandChessverificationviewsareopenedbychoosingView >
Verification >SplitorChess .Theviewscanthenbemovedby
pickingupthecentralcross,orthehandleateitherendoftheplanes.
To Use the Split View and the Chess View
1. Afterregisteringtwoimages,theorthogonalverificationview
(SplitvieworChessview)isdisplayedautomatically.
YoucanalsoopentheverificationviewbychoosingView >
Verification >SplitorChess .Theviewscanthenbe
movedbypickingupthecentralcross,orthehandleateitherend
oftheplanes.
2. Chooseoneofthefollowing:
Splitview:Todisplaydifferentpartsoftheregistration,move
thehorizontalandverticalhandles.
Chessview:Tochangethesizeofthechessrectangles,movethe
handle.

4. Youcanalsousethefollowingverificationmethods:
Useadifferentcolormapforoneoftheregisteredimages(for
instance,displayoneimageinyellowbyusingtheView
Parameterscommandandtheotheringrayscale)and
minimizethesquaresintheChessview.
RotatetheimageinSplitviewandevaluatetheregistration
resultondifferentplanes.
5. Iftheregistrationisnotadequate,usetheregistrationfinetuning
toolstoadjusttheimagepositions.
6. Concentrateontheregionofinterest.Whentheregistrationis
adequateonthatregion,accepttheregistration.
AddacommenttotheSpatialRegistrationPropertiesdialogboxstating
theregionofinterestinthisparticularregistration.
7. Tosavetheregistration,chooseFile >SaveAll.
Spy Glass Tool

YoucanusetheSpyGlasstooltoviewaspecificregionofinterestin
theregisteredimages.TheSpyGlasstooldisplaysarectangularregion
ofinterestinsideofwhichtheregisteredimageisdisplayedinthe
orthogonalverificationviews.

Figure 38 Spy Glass Tool
TheSpyglasstoolisopenedbyclickingtheSpyGlass button.You
canmovetheSpyGlasstoolbyclickingitscenteranddraggingwith
yourmouse,andresizeitbyclickinganddraggingoneofitscorners.
WhentheSpyGlasstoolisused,theprimaryimage(thetopmost
imageintheFocuswindow)andtheregisteredimageareshown
simultaneouslyintheverificationviews,theregisteredimageshowing
insidetheSpyGlassbydefault.Youcanselectwhichimageisshown
insidetheSpyGlass.
To Use the Spy Glass Tool
1. ClicktheSpyGlassbutton intheDisplaytoolbar.
TherectangularSpyGlasstoolisdisplayedontheregistered
image.
2. TheregisteredimageisshowninsidetheSpyGlassbydefault.To
showtheprimaryimageinsidetheSpyGlass,clickthevisibility
checkboxoftheregisteredimage,pressCTRLandclickthe
visibilitycheckboxoftheprimaryimage.

3. TomovetheSpyGlass,placethemousepointeroverthecenterof
therectangle,pressthemousebuttonanddragtheSpyGlasstothe
desiredlocation.
4. TochangethesizeoftheSpyGlass,clickanddragoneofits
corners.
5. Tozoominorout,pressCTRLandscrollwithyourmouse.
7. ToclosetheSpyGlasstool,clicktheSpyGlassbuttonagain.
8. Tosavetheregistration,chooseFile >SaveAll.
Blend Verification View

Tobenefitfromthedifferentlevelofanatomicaldetailoraccuracyin
differentimagemodalities,youcanblendtworegistered3Dimages.
TheBlendverificationviewdisplaysboth3Dimagessimultaneously
withselectableopacity.YoucanblendaCTimage,forexample,with
PETorMRimage,anddefinestructuresontheimagethatshowsmore
information.Allsegmentationisalwayssavedtotheprimaryimage
(thetopmostimageintheFocuswindow).
IntheRegistrationworkspace,theimagesareblendedbyclickingthe
Blendbutton .Inotherworkspaces,theimagesareblendedby
pressingtheCTRLkeyandselectingthevisibilitycheckboxesofthe
imagesintheFocuswindow.Whentwoimagesareblended,thetitle
baroftheimageviewdisplaystheIDsoftheblendedimagesandthe
BlendControltoolappearsinthelowerrightcorneroftheimageview
(formoreinformationontheBlendControltool,seeUsingtheBlend
ControlToolonpage 171).
Figure 39onpage 170showsablendedimageintheimageview.

A.TheIDsoftheblendedimagesdisplayedinthetitlebarB.TheIDsoftheblendedimages
displayedintheBlendControltoolC.TheBlendControlToolD.TheMovieControlTool
Figure 39 Blended Images in the Image View
Inthisexample,aCTimage(CT0)isblendedwithanimageof
differentmodality(OT10).TheCTimageisshownusinggrayscale
colormap,whereastheOTimageisshownusingbluegoldcolormap.
YoucanselectthecolormapsbyusingtheViewParameterscommand.
ThevisibilityoftheOTimageisincreasedwiththeBlendControltool.
Whena3Dimagethatispartofa4Dimageisdisplayedintheimage
view,theMovieControltoolisalsodisplayedinthelowerrightcorner
oftheimageview.FormoreinformationontheMovieControltool,
seeUsingtheMovieControlToolonpage 92.
Youcanalsodefinetheopacityoftheregisteredimageblendedover
theprimaryimage.Lowopacityvaluesmaketheregisteredimage
moretranslucent(onlytheprimaryimageisvisible);highopacity
valuesmakeitmoreopaque(onlytheregisteredimageisvisible).
Figure 40onpage 171showsanexampleofdifferentopacityvalues
usedinaregisteredimageintheBlendmode.

A.LowopacityvalueB.IntermediateopacityvalueC.Highopacityvalue
Figure 40 Blended Images with Different Opacity Values
Using the Blend Control Tool
TheBlendControltoolisvisibleintheimageviewonlywhentwo3D
imagesareselectedasvisible.TheBlendControlslidercontrolsthe
visibilitylevelofeachimage.ClickingtheBlendControlmetronome
switchestotheblinkingmodewherethedisplayedimagesalternate.
Youcanadjusttheblinkingspeed.Clickingthemetronomeiconagain
returnstothenonblinkingmode.YoucanusetheBlendControltool
togetherwiththeMovieControltool.
A.TheIDofthefirstimageselectedforblendingB.Metronomeiconforswitchingtotheblinking
modeC.TheIDofthesecondimageselectedforblendingD.Sliderforcontrollingthevisibility
leveloftheblendedimages
Figure 41 Blend Control Tool

To Use the Blend Verification View
1. Afterregisteringtwoimages,clickBlend intheDisplaytoolbar.
TheBlendVerificationviewopensdisplayingtheregistered3D
images,andtheBlendControltoolappearsinthelowerright
corneroftheview.
ForinstructionsonusingtheBlendControltool,seeUsingthe
BlendControlToolonpage 171.
3. Iftheregistrationisnotadequate,usetheregistrationfinetuning
toolstoadjusttheimagepositions.
4. ToclosetheBlendVerificationview,clickBlendagain.

To Blend Images in Other Workspaces
IntheFocuswindow,rightclicktheregisteredimageand
chooseBlendwith<visibleimage>.
IntheFocuswindow,selectthevisibilitycheckboxofthefirst
imagetoblend,pressCTRLandselectthevisibilitycheckboxof
thesecondimagetoblend.
TheselectedimagesareblendedandtheBlendControltoolis
displayedintheimageview.TheIDsoftheblendedimagesare
displayedbothinthetitlebaroftheblendedview,andintheBlend
Controltool.
2. Tocontrolthevisibilityleveloftheimages,movetheBlend
Controlslider.Toincreasethevisibilitylevelofanimage,movethe
slidertowardstheimage.
3. Toviewtheblendedimagesinablinkingmode,clicktheBlend
Controlmetronome.Toreturntothenonblinkingmode,clickthe
metronomeiconagain.
Youcanadjusttheblinkingspeedbyrightclickingthe
metronomeiconandchoosingSlow,MediumorFast.
4. Toexittheblendimagemode,selectthevisibilitycheckboxofthe
imageyouwanttodisplayintheimageviews.
TheBlendControltooldisappearsandonlyoneimageisdisplayed
intheimageview.
Normal Verification Method

WhentheNormalmethodisused,theregisteredimageisshownin
placeoftheprimaryimage(thetopmostimageintheFocuswindow)
byselectingthevisibilitycheckboxoftheregisteredimage.All
segmentationisalwayssavedtotheprimaryimage.
Figure 42onpage 174showsaregisteredimageusingtheNormal
method.

A.PrimaryimageisthetopmostimageinFocuswindowB.Visibilitycheckboxoftheregistered
imageselected
Figure 42 Registered Image using the Normal Method
Inthisexample,CT_1istheprimaryimage,inplaceofwhichthe
registeredimageMR_1isshown.CT_1isnotshownbutallchanges
madetotheimagedata,suchascontours,aresavedtoCT_1.
Modifying the Registration

Youcanmodifytheregistrationresultbyusingthemanual
registrationfinetuningtoolsandrevertregistrationchangesbyusing
theUndocommand.Youcanmodifyanexistingregistrationbyusing
oneoftheregistrationmethods,andeditorviewtheregistration
propertiesdisplayedintheSpatialRegistrationPropertiesdialogbox.

Fine-Tuning Registration Result Manually
Youcanmakefineadjustmentstotheregistrationresultbyusingthe
registrationfinetuningbuttonsavailableintheorthogonalverification
views,orbyusingthenumerickeypadbuttons.Thefinetuning
buttonsareavailableinthetransversal,orthogonalandsagittalviews.
Byusingthefinetuningbuttonsyoucanchangethepositionsofthe
imagesbyrotatingortranslatingtheminsmallincrements.
A.Registrationfinetuningbuttons
Figure 43 Registration fine-tuning buttons
Everytimetherelativepositionsoftheimageschangeduringthe
registration,thechangeisrecordedintheapplicationmemory.You
canundothesechangesonebyonebyusingtheUndocommandorby
pressingCTRL+Z.Youcanredoregistrationchangesyouthatyouhave
revertedbypressingCTRL+Y.Theapplicationremembersthe
registrationchangesuntilyougotoanotherworkspaceorclosethe
patient.

To Fine-Tune Registration Result Manually
1. IntheFocuswindow,selecttheregisteredimage.
2. Switchtheactiveviewtotheimagedirectioninwhichyouwantto
startthefinetuning.
3. ChooseSplitView,ChessViewofSpyGlasstool,dependingon
whichofthemshowsbesttheareayouwishtoconcentrateon
duringfinetuning.
4. Clickthefinetuningbuttonstonudgetheregisteredimagein
smallincrements.
5. Ifyouneedtoundoanyofthemanualregistrationadjustments,
chooseRegistration >Undo,orpressCTRL+Z.
To Undo or Redo Registration Changes

Toundoregistrationchanges:
SelectRegistration >Undo,orpressCTRL+Z.
Toredorevertedregistrationchanges:
PressCTRL+Y.
To Edit an Existing Registration

1. Openthedesiredpatientandtheprimaryimage.
Theprimaryimageisshownintheimageviews.
2. Selectoneoftheverificationviews,forexampleSplitviewor
Chessview,bychoosingView >Verification >Splitor
Chess .
3. IntheFocuswindow,selecttheregistrationobject( )ofthe
registrationthatyouwanttoedit.
Bothimagesareshownsimultaneouslyintheverificationview.

Edittheregistrationusingpixeldata.Forinstructions,seeTo
AutomaticallyRegister3DImagesUsingPixelDataon
page 153.
Edittheregistrationusingregistrationpoints.Forinstructions,
seeToRegister3DImagesUsingRegistrationPointson
page 159.
Edittheregistrationusingmanualtools.Forinstructions,see
ToRegister3DImagesUsingManualToolsonpage 161.
To Modify or Display Registration Properties

1. IntheFocuswindow,selecttheregistrationresult.
2. ChooseEdit>Properties.
TheSpatialRegistrationPropertiesdialogboxopens.
3. TheRegistrationtabcontainsthefollowinginformation:
ID:Identificationfortheregistration.Modifyifneeded.
Instance:Anumberidentifyingtheregistrationinstance.
ContentDescription:Adescriptionoftheregistration.
Add/modifyifneeded.
Algorithm:Algorithmusedinregistration.
Type:Registrationtype(VisualAlignmentorImage
ContentbasedAlignment).
RegisteredFOR:FrameofReferenceUIDfortheregistered
geometry.
TransformationComment:Adescriptionorcommentaboutthe
registration.Add/modifyifneeded.
Matchpointregistrationerrors(mm):Accuracyofthe
registration.
4. TheTechnicaltabshowsthemapping(orientation,rotationand
translation)betweenthecoordinatesofthereferenceand
registeredimages.
5. Toapplyyourchangesandclosethedialogbox,clickOK.

Exporting and Importing a Registration
Youcanexportaregistrationtoanothersystemandimporta
registrationintoEclipse.Forinstructionsonimportingaregistration,
seeChapter 27,SectionToUsetheExport/ImportWizardfor
Importingonpage 774.
To Export a Registration
1. IntheFocuswindow,rightclicktheregistrationresultandchoose
Export.
Thewizardforexportingtheregistrationopens.
3. Ifnotalreadyselected,selecttheregistrationtoexportinthelist
box.
4. Ifnecessary,changetheexportdirectoryfortheselected
registrationbyclickingChangeforSelectedObject(s)and
selectingtheappropriatedirectory.
Finish.

Chapter 7 Structures
Contouring Workspace
Thischapterprovidesinformationaboutstructures,structuresetsand
structuregroups,whichareusedascontainersforthepatient
contours.Thedifferenttypesofstructuresaredescribed,and
instructionsareprovidedforaddingandmodifyingstructuresand
structuregroupsanddefiningthedensityvalueforstructuresto
enablecorrectdosecalculation.Thechapteralsodescribeshow
structurescanbedefinedinregisteredimages.
About Structures
Structuresarepatientwideobjectsthathaveimagespecificgeometric
representations.Structurescanbeanatomicalorgans,treatment
volumesusedtodefinetargetsfortreatment,orotherregionsof
interest.
Structuresareformedbysegmentsdefinedon2Dimagesor3D
images.In2Dimageviews,structuresaregraphicallyrepresentedas
contoursorsegments,whilein3Dimageviewstheycanberendered,
forexample,astranslucentorsolidsurfaces.
Astructureisageometricalrepresentationofapatientvolumeinan
image.Thepropertiesofastructurearedeterminedbythepatient
volumetypeandpatientvolumecodeparameters.Thepatientvolume
codedefineswhichanatomicalstructureofthepatientthestructure
represents.Thepatientvolumetypedefinestheroleofthestructurein
treatment.
Newstructurescanbecreatedonebyone,orbyusingstructure
templates.Allstructurescreatedforapatientbelongtoastructureset.
Structure Set
InDICOM,thestructuresthathavebeendefinedforapatientbelong
toastructureset.Inotherwords,structuresetisacontainerforthe
patientspecificstructures,includinganatomicalorgans,treatment
177
volumesandmarkersaswellassupportstructures.Thestructureset
icon( )isshownintheFocuswindow,andallstructuresthathave
beendefinedforthepatientareshownbelowit.
Youcancreateanewstructuresetinthefollowingways:
WhenyouselectanimageseriesintheObjectExplorer,youcan
createastructuresetandanew3Dimageusingtheimagesinthe
selectedseriesbyclickingCreateNewStructureSet.
YoucancreateastructuresetbyusingtheInsert >NewStructure
Setcommand.
Youcanalsocreateastructuresetsimultaneouslywiththefirst
structureyoucreatebyusingtheInsert >NewStructure
command.
Multipleimageseriestakenduringoneimagingsessioncanalsobe
combinedintoonewhencreatingastructureset.Todothis,select
theseimageseriesinObjectExplorer,andclickCreateNewStructure
Set.Eclipseattemptstocreateanew3Dimageandstructuresetusing
theimagesfromalltheselectedseries.Theslicesusedincreatingthe
new3Dimagewillbecopiedintoanewseriesinthedatabase.
YoucanopenexistingstructuresetsdirectlyfromObjectExplorer.You
cancheckwhichimageastructuresetreferencesbyrightclickingthe
structureseticoninObjectExplorerandselectingProperties.When
youopenastructureset,thereferenced3Dimageisalsoopenedinthe
imageviews.
InDICOMhierarchy,plansreferenceastructuresetandstructuresets
referenceimages.IfastructuresetthathasbeencreatedinEclipseis
goingtobeexportedtoothersystems,youcancheckthatthestructure
setisIHEROcompliant.Formoreinformation,seeExportingPlan
andImageDataonpage 709.
Structure Group
Structuregroupsarepredefinedsetsofstructures,templates,
includingstructurescommonlyusedinsegmentingandcontouring
certainbodypartsandgatheredtogetherinastructuretemplate.The
contentofthestructuretemplatesdependsontheconfigurationof
yoursystem.Astructuregroupcontainsstructuresrelevanttoa
particulartypeofimageset.Forinstance,astructuregroupnamed
PelviccancontaintheBody,PTVandBonestructures,anditcanbeused

foranimagesetconstructedofthepelvicarea.Structuretemplatesare
createdandeditedintheStructureTemplateManager.Formore
information,seeChapter 11,TemplatesandClinicalProtocols,on
page 279.
Patient Volumes
Eachstructureandreferencepointislinkedtoapatientvolume.
Patientvolumesareabstractstructuresbelongingtoapatient,for
instance,LeftLung,andtheyrepresentthesitesoccupiedbythe
structuresinthepatient.Forinstance,theLeftlungpatientvolume
maycorrespondtoslightlydifferingstructuresinaCTandanMR
image.Figure 31onpage 135illustratestherelationbetweenpatient
volumeandstructure.Intheexample,structureAbelongstopatient
volumeA,andithasadifferentrepresentationintheCTandMR
image.ReferencepointAismarkedinboththeCTandMRimage.
Patient
PatientVolumeA
ReferencePointA
ReferencePointA ReferencePointA
StructureA StructureA Location Location
ImageCT ImageMR
Figure 44 Patient Volume and Structure
Structures 179
Patient Volume Codes
Thefollowingvolumecodingsystemsaresupported:
ICDO(InternationalClassificationofDiseasesforOncology,First
Edition)
ICDO2(InternationalClassificationofDiseasesforOncology,
SecondEdition)
ICD9(InternationalClassificationofDiseases,NinthRevision)
ICD10(InternationalClassificationofDiseases,TenthRevision)
Usingthesecodesprovidessuitabledefaultvaluesfortheautomatic
toolsforstructuredefinition.ThecodecanalsobeNone,ifyoudonot
wishtouseanyoftheICDsystems.Thepatientvolumecodesare
configuredintheAdministrationtask.
Patient Volume Types
ThefollowingvolumetypeshaveaninterpretationinARIA
applications:
BODYBodyoutline
CTVClinicalTargetVolume
GTVGrossTargetVolume
PTVPlanningTargetVolume
SupportExternalpatientsupportdevice
ThefollowingDICOMbasedvolumetypescanbeusedforlabeling:
AvoidanceVolumetoavoidintreatment
CavityAnatomicalcavityinpatient
ContrastAgentVolumeinwhichcontrastagentispresent
ControlDoseoptimizationregion(regionofinteresttobeused
ascontrolvolumeindoseoptimizationsandcalculation)
DoseRegionRegionofinteresttobeusedasadosereference
FixationExternalpatientfixationorimmobilizationdevice
IrradVolumeIrradiatedvolume
NoneNotdefined
OrganOrganatrisk
TreatedVolumeTreatedvolume

Body Structure
ThisinformationappliestoEclipseExternalBeamPlanningtask.
TheBodystructuremustbedefinedinallplanes,becausethecontours
formingitareusedtoconstructthe3Dmodelofthepatient.
Target Volumes
Thetargetvolumeconsistsofthedemonstratedtumor(s)andany
othertissuewithpresumedtumor.Thefollowingthreetargetvolume
typesaresupported:
GTV(GrossTumorVolume)AccordingtoICRU50,theGTVis
definedfirst.Thisisamacroscopicvolumewherethetumorcanbe
determinedbymeansofclinicalexamination,radiographic,
radioisotopic,ultrasonicandmicroscopictechniques.
CTV(ClinicalTargetVolume)Includesthemicroscopicspreadof
thetumorcells,andcontainsthetissuestoirradiate.
PTV(PlanningTargetVolume)Includes,forinstance,the
movementsoftissuesduringtreatmentanderrorsinpatient
positioning.Intreatmentplanning,thePTVisthestructureusedto
optimizethetreatment.
StructurescanbelabelledbothwiththeVolumeCodeandVolume
Typeifappropriate,forexamplewhentheGTVisalsoapartofan
anatomicalorgan.
Organs at Risk
Definingcrucialinternalstructures(spinalcord,lungsorliver)in
treatmentplanningisnecessaryinordertoexposethemtoaslittle
radiationaspossible.Thesestructuresarecalledorgansatrisk.
Contouringorgansasorgansatriskisessentialindeterminingthe
correctradiationdosagewiththehelpofdosehistograms.
Structure Properties in Contouring

StructurepropertiesaredefinedintheStructurePropertiesdialogbox.
YoucanmodifythestructurenameandID,volumecodeandtype,
colorandstyleaswellasthecolorandlinestyleusedforthestructure
Structures 181
intheDVHgraph.Thissubsectiononlybrieflydescribesthe
parametersdefinableforstructures.FormoredetailsontheStructure
Propertiesdialogbox,refertotheonlinehelp.
Note: Whenyoumodifythestructurepropertiesofastructure,thechangeis
appliedtoallimagesunderthepatient.
General Structure Properties
Foreachstructure,youneedtodefinethefollowingproperties:
IDStructuresmusthaveauniqueIDwithineachimage.Ifyou
defineavolumecodeforthestructure,thecodeisusedasthe
structureID.EditthevolumecodebasedIDordefineyourown.
NameIfyoudefineavolumecodeforthestructure,thename
linkedtothecodeisusedasthestructurename.Editthevolume
codebasednameordefineyourown.Forinstance,thenamecan
bethenameofananatomicalorgan(forexample,Lung,Kidney)or
thenameofthetreatmentvolume(forexample,UterineCancer,
LungCarcinoma).
VolumeTypeEachstructuremusthaveaVolumeTypedefined.
TheVolumeTypedefinestheroleofthestructureintreatment.
VolumeCodeDefineaVolumeCodeforthestructureorleavethe
structurewithoutaVolumeCode.
ColorandStyleThedefaultcolorandstyleofthestructure
dependsontheselectedvolumetype.IfthevolumetypeisNone,
thedefaultcolorandstyledependsontheselectedvolumecode.
Assign CT Value
Ifnecessary,youcanassignaCTvaluetoastructuretomakeit
unambiguousindosecalculation.Forexample,apelvicCTscanwith
thebladderfullofcontrastcanalterthedosedistributionunlessthe
bladderisassignedaCTvalue.Thestructureisdisplayedwiththe
assignedCTvalueintheimageviews.
Note: InacaseofdeterminingtheCTvaluewhereseveralstructureswith
differentCTvaluesoverlap,thehighestCTvalueisusedwhichisassignedto
anonbodystructure.ApossibleCTvalueassignmentofabodystructureis
alwaysoverriddenbyotherstructureswithassignedCTvalues.

Adding Structures or Structure Groups
Youcanaddnewstructuresonebyone,orusestructuretemplatesto
addstructuregroups.Ifastructuresetdoesnotexistyetforthe
patient,youcancreateitseparately,orcreatesimultaneouslywiththe
firststructureyoucreate.Formoreinformationonaddingstructure
groups,seeChapter 11,SectionToInsertNewStructuresinanImage
fromaStructureTemplateonpage 297.
To Create a New Structure Set

1. ChooseInsert >NewStructureSetcommand.
TheStructureSetPropertiesdialogboxopens.
2. IntheIDandNametextboxes,typeidentificationinformationfor
thestructureset.
3. ClickOK.
ThestructuresetyoucreatedisshownintheFocuswindow.
Note: Ifyoucreateanewstructuresetforanimagethatalreadyhasanexisting
structureset,Eclipsecreatesacopyoftheimage.
To Add a New Structure

Ifastructuresetdoesnotexistyetforthepatient,itiscreated
simultaneouslywiththefirststructureyoucreate.
1. ChooseInsert >NewStructure.
TheStructureSetPropertiesdialogboxopens.
thestructureset.
3. ClickOK.
TheStructurePropertiesdialogboxopens.
thestructure.
Structures 183
5. IntheVolumeTypedropdownlist,selectthevolumetype.
AdefaultcolorisdisplayedintheColorandStylelistbox.Change
it,ifnecessary.
6. Todefinethevolumecode,gototheVolumeCodegroupboxand
clickSearch.
TheSelectCodedialogboxopens.
7. IntheTabledropdownlist,selectthecodesystemtouse.
8. Tofindthedesiredcode,
Scrollthelistbox.
TypeyoursearchcriteriaintheCodeandDescriptiontext
boxesandclickSearch.
9. Inthelistbox,selectthedesiredvolumecode.
10. ClickOK.
TheprogramreturnstothePatientVolumePropertiesdialogbox.
TheTableandCodetextboxesshowthevolumecodeinformation.
11. FromtheDVHgroupbox,selectthedropdownlistoftheline
color,styleorwidth,andchoosethedesiredoption.
12. Continuebydefiningthesearchingoptionsorfinishbyclicking
OK.
Definethecontoursofthestructureintheimages.Forinstructions,see
Chapter 8,SegmentationandContouring,onpage 185.
Note: Insertedstructuresremainactiveforotheractions,butarenotvisiblein
theimagesuntilyouhavedefinedcontoursorsegments.
To Assign a CT Value for a Structure

Note: InacaseofdeterminingtheCTvaluewhereseveralstructureswith
differentCTvaluesoverlap,thehighestCTvalueisusedwhichisassignedto
anonbodystructure.ApossibleCTvalueassignmentofabodystructureis
alwaysoverriddenbyotherstructureswithassignedCTvalues.

1. IntheFocuswindow,selectthestructuretoassigntheCTvalueto.
2. IntheEdit >Properties.
3. SelecttheAssignCTValuetabanddooneofthefollowing:
ToassignaCTvalueforthestructureinthedefinedimage,
selectthecheckboxandgivethedesiredCTvalue.
TousetheCTvaluefromtheCTimage,clearthecheckbox.
IfitisnotpossibletoedittheCTvalue,thereasonforthatisdisplayedon
thetab.
4. ClickOK.
Modifying Structures
Toeditthepropertiesofanexistingstructure,youselectthestructure
intheFocuswindowandedititspropertiesintheStructureProperties
dialogbox.Onlyonestructurecanbeactiveatatime,andtheactive
structureisdisplayedintheimageviews.
Note: Whenyoumodifythestructurepropertiesofastructure,thechangeis
appliedtoallimagesunderthepatient.Theonlyexceptionisassigninganew
CTvalue,asthechangedvalueisappliedonlytotheselectedimage.
To Modify Structures
1. IntheFocuswindow,selectthedesiredstructure.
3. Dothenecessarymodifications.Forinstructions,seeToAdda
NewStructureonpage 139.
Whenyoumodifythestructurepropertiesofastructure,thechangeis
appliedtoallimagesunderthepatient.
4. ClickOKtoupdatethestructureproperties.
Note: Approvedstructurescannotbemodified.
Structures 185
To Measure the Volume of a Structure
1. IntheFocuswindow,selectthestructure.
2. ChooseView >Measure >Volume.
Thestructuresvolumeandequivalentspherediameter(diameter
ofaspherewiththesamevolumeasthestructure)arecalculated
anddisplayedinamessagebox.
3. Toclosethemessagebox,clickOK.
To Clear a Structure from the Current Plane of the Primary Image

1. IntheFocuswindow,selectthestructuretoclear.
2. Displaytheplaneonwhichtoclearthestructure.
3. ChooseEdit >Clear >fromCurrentPlaneofPrimaryImage.
Allcontoursandsegmentsoftheselectedstructurearedeleted
fromthecurrentplaneoftheprimaryimage.
To Clear a Structure from All Planes of the Primary Image or

from All 3D Images in a 4D Image
1. IntheFocuswindow,selectthestructuretoclear.
ChooseEdit >Clear >fromAllPlanesofPrimaryImageto
deleteallcontoursandsegmentsoftheselectedstructurefrom
allplanesoftheprimaryimage.
ChooseEdit >Clear >fromAll3DImagesin4DImageto
deleteallcontoursandsegmentsoftheselectedstructurefrom
allplanesofthe3Dimagesthatarepartofa4Dimage.
To Duplicate a Structure Set

Ifastructuresethasbeenusedasabasisforaplanforwhichdosehas
alreadybeencalculated,thestructurescannotbemodifiedanylonger.
However,ifyouneedtocreateanewplanforwhichyouneedto

modify,forexample,thebodyoutlineorsomeotherstructures,you
canduplicatethestructureset.Youcanthenmodifythestructuresin
thenewstructuresetandcreateanewplanbasedonthem.
1. IntheContouringworkspace,openthestructuresetyouwantto
duplicateandtheaccompanying3Dimage
2. IntheFocuswindow,rightclickthestructuresetandchoose
DuplicateStructureSet.
TheStructureSetpropertiesdialogboxopens.
thestructureset.
4. ClickOK.
Eclipsecreatesacopyoftheimageandthestructureset.
To Delete a Structure
1. IntheFocuswindow,selectthestructuretodelete.
TheDeleteStructuredialogboxopens.
3. Todeletethestructureandthereferencepointsassociatedwiththe
structure,dooneofthefollowing:
ChooseCurrentStructureSetonlytodeletethestructurefrom
thecurrentimage.
ChooseAllStructureSetstodeletethestructurefromthe
currentimageandfromallimages.
4. ClickOK.
Note: Approvedstructurescannotbedeleted.
Copying Structures to Registered Images

Structurescanbetransferredfromone3Dimagetoanother,ortoall
3Dimagesina4Dimage,eitherbycopyingandpastingonestructure
atatimeorbycopyingandpastingtheentirestructureset.
Structures 187
Copying Structure Sets
Youcancopytheentirestructureset(allstructures,includingbolus)
froma3Dimageandpastethemtoanother3Dimage.Thisisuseful
forcopyinginitialstructuresegmentsbetweenasetof3Dimages
representing,forexample,thepatientrespiratorycycle.
Tobeabletocopyandpastethestructures,theimagesmustbe
registered.Forinstructionsonregisteringimages,seeChapter 6,
ImageRegistration,onpage 135.
To Copy Structure Sets from One 3D Image to Another
1. IntheContouringworkspace,opentwoormore3Dimages.
2. IntheFocuswindow,selectthe3Dimagethatcontainsthe
structuresettobecopied.
3. RightclickthestructuresetandchooseCopyallStructures.
IntheScopeorFocuswindow,selectthe3Dimagetowhich
youwishtopastethestructures.
Topastethestructurestoall3Dimagesina4Dimage,selecta
4DimageobjectintheScopeorFocuswindow.
ChooseEdit >PasteStructures.
ChooseEdit >PasteStructurestoImagesin4Dtopastethe
copiedstructurestoall3Dimagesinthe4Dimage.
Ifnostructuresetexistsinthe3Dimage,theStructureSetProperties
dialogboxopens.TypeanIDandanameforthestructureset.
Thestructuresarepastedtotheselected3Dimage.Ifasegmented
structurewithmatchingpatientvolumealreadyexistsinthetarget
image,youarepromptedtoselectwhetheryouwanttoreplaceit
withthecopiedstructure.Ifthematchingstructureisempty,itis
overwritten.

6. Visuallyverifyallcopiedandpastedstructuresandcorrectthem
wherenecessary.
Ifthestructuresetcontainsabolus,andifthe3Dimagetowhichyou
pastethestructuresetalreadyhasthebodystructuredefined,thebolus
maynotbepastedtothecorrectposition.
Copying Individual Structures

Copyingstructurestoaregisteredimagecanbeuseful,forexample,
whenyouwanttodefinethePTVintheMRimage.Ifthetargetimage
alreadycontainsastructurewiththesamenameastheonethatyou
arecopying,theprogramcreatesanewstructurewithanewnameto
thetargetimage.
To Copy Structures from the Original Image

to the Registered Image
1. IntheContouringworkspace,definestructuresinoneofthetwo
3Dimages.
2. IntheRegistrationworkspace,registertheimages.For
instructions,seeChapter 7,ImageRegistration,onpage 151.
Ifthe3Dimagesbelongtothesame4Dimage,Eclipsealreadyconsiders
the3Dimagesasbeingregisteredwitheachother.
3. IntheContouringworkspace,gototheFocuswindowandselect
thestructuretobecopied.
4. Tocopythestructurefortheother3Dimage(forinstance,definea
targetstructureonanMR3DimageandcopyittoaCT3Dimage),
chooseEdit >CopyStructure.
Topastethecopiedstructuretoaregisteredimage,displaythe
targetimageintheMainimageview.
IntheFocuswindow,selecttheregisteredimage.
Topastethestructuretoall3Dimagesina4Dimage,selecta
Structures 189
ChooseEdit >PasteStructuretopastethecopiedstructureto
theselectedimage.
copiedstructuretoall3Dimagesinthe4Dimage.
Note: Whencopyingstructures,payattentiontothefollowing:
Alwaysvisuallyverifytheresult.Minorinaccuraciesmayoccurinthe
copyduetodifferentresolutionsandorientationsoftheimages.
Ifthestructureisamultipartstructurelocatedindifferentareasofthe
images,registereachstructurepartseparately.
Couch Modeling in Eclipse

EclipsecanmodeltheVarianExactandExactIGRTcouches.Acouch
ismodeledasasetofcouchstructures.Thecouchpanelsurfaceand
interior,movablestructuralrailsandgrid(forUnipanelonly)areeach
modeledasseparatecouchstructures.ForanExactcouch,Eclipsecan
modeltheflatpanel,Unipanelandstructuralrails.ForExactIGRT
couch,Eclipsecanmodelathin,mediumandthickpanel.
ThepatientvolumetypeofacouchstructureisalwaysSupport.Couch
structuresaremodeledinsidea3Dimage.Ifthe3Dimageistoosmall,
Eclipsecanenlargetheimagetofitthecouchstructures.
Figure 45onpage 191showscouchstructuresinanimageview.

A.Couchpanel(gridinsidepanel)B.Movablestructuralrails
Figure 45 Couch Structures in 2D View
Youcanmodifycouchstructureswiththesametoolsasother
structures,andshowandhidethemintheimageview.Thereisalsoa
toolformovingallcouchstructuresatthesametime.Formore
informationaboutthetool,seeToMoveAllCouchStructureson
page 148.Couchstructuresaretakenintoaccountindosecalculation.
Ifyoualreadyhavecalculatedthedosedistributionandwantto
removecouchstructuresfromanimage,youneedtofirstinvalidate
thedosedistribution.
Forinformationoncalculationalgorithmsthatsupportcouch
modeling,seeEclipseAlgorithmsReferenceGuide.
Note: Whenworkingwithcouchstructures,notethat:
Alwaysverifythemodeledandactualcouchpositionaswellasthe
positionofmovablerails,andmakesurethatthecorrectcouchprofileand
andcouchaccessoriesareselectedbeforetreatingthepatient.
Couchstructuresdonotautomaticallystayconsistentwithanychanges
inthetreatmentplanwhichaffectthecouchintherealworld.For
example,ifthetreatmentorientationischanged,youneedtochangethe
couchstructuresaccordingly.
Structures 191
Inserting Couch Structures in an Image
YoucaninsertcouchstructuresinanimageintheContouringand
FieldSetupworkspaces.Whentheplanisactive,thetreatment
orientationoftheplanisusedtopositionthecouchstructuresinthe
image.Whentheimageisactive,theimagingorientationisusedfor
that.Ifthe3Dimageistoosmall,Eclipsecanenlargetheimagetofit
couchstructures.
Note: Wheninsertingcouchstructuresinanimage:
Makesurethatyouhaveselectedthecorrectcouchprofile,andthatthe
couchstructuresarepositionedcorrectly.Visuallyverifythecorrectness
ofcouchstructuresineachimageplane.
Ifthe3Dimageistoosmalltofitthecouchstructuresandyouchoosenot
toenlargetheimage,somecouchstructuresmightnotbecreated
completely.Thiscancauseinaccuraciesindosecalculation.
To Insert Couch Structures in an Image
1. Toinsertacouchstructureinanimage,chooseInsert >New
CouchStructures.
TheCreateCouchStructuresdialogboxopens.
2. Selectthecouchprofiletocreatefromthedropdownlist.
3. IntheMovablestructuralrailsgroupbox,selectthelocationforthe
leftandrightrailforExactcouch.
4. IntheCTvaluesgroupbox,ensurethattheHUvaluesaredefined
forthepanelsurface,panelinterior,andmovablestructuralrails.
5. Toinsertthecouchstructuresintheimage,clickOK.

6. Iftheplanningimageistoosmalltofitthecouchstructures,
Eclipsesuggestsenlargingtheimage.
Imageenlargementcannotbeundone.
Dooneofthefollowing:
Toenlargetheimage,clickYes.
Tokeeptheimagesize,butstillinsertthecouchstructuresin
theimage,clickNo.Somecouchstructuresmightnotbe
createdcompletely.
ToreturnbacktotheCreateCouchStructuresdialogbox,click
Cancel.
To Move All Couch Structures
Couchstructurescanbemovedinthetransversalimageview.
1. IntheFocuswindow,selectacouchstructure.
2. OnthePlanningtoolbar,clickMoveSupportStructures .
3. Movethecursorontheselectedcouchstructureandwhenthe
structureishighlighted,dooneofthefollowing:
Tomoveallcouchstructuresfreely,presstheleftmousebutton
downanddragthecouchstructure.
Tomoveallcouchstructuresinverticalandhorizontal
directions,pressSHIFT,presstheleftmousebuttondownand
dragthecouchstructure.
YoucanmoveasinglecouchstructurewiththeMoveStructure
tool.Forinstructionsonusingthetool,seeChapter 8,Section
MovingaStructureonpage 234.
Approving Structures
Individualstructuresorallstructuresinastructuresetcanbe
approvedtopreventfurthermodificationsoraccidentalchangesofa
structureafterithasbeencreated,contoured,andverified.Itis
recommendedthatautomaticallysegmentedstructuresbereviewed
andapprovedbeforebeingusedtoplanatreatment.
Structures 193
Structurescanhavethefollowingapprovalstatuses:
ApprovedThisstatuscanbeusedtoindicatethatsomeonehas
lookedatandanalyzedthestructure,andthenapproveditforuse
intreatmentplanning.Youneedtoenteryourusernameand
passwordtoapprovestructures.Anapprovedstructureis
readonly,anditcannotbemodified.
ReviewedThisstatuscanbeusedtoindicatethatsomeonehas
lookedatandanalyzedthestructure.
UnapprovedThisisthedefaultstatusofastructureafterithas
beencreated.
RejectedThisstatuscanbeusedtoindicatethatsomeonehas
lookedatthestructureandrejectedit,forexample,becausethe
structureneedsfurthermodifications.
Thestatusofanapprovedstructureisshownasaframearoundthe
imageicon( )inthescopewindowandintheObjectExplorer.
Approvedstructurescannotbemodified.Youcanapprovestructures
onebyone,orapproveseveralorallstructuresinastructureset
simultaneously.Theapprovalstatusandapprovalhistoryofa
structureareshowninApprovaltabintheStructurepropertiesdialog
box.
Whenyouapproveaplan,thestructuresbelongingtothestructureset
thattheplanreferencescanbeapprovedsimultaneously,depending
onthesystemconfiguration.Thisoptionisconfiguredinthe
Administrationtask.FormoreinformationontheAdministration
task,refertotheonlinehelp.
To Approve a Structure
1. IntheFocuswindow,rightclickthestructureyouwantto
approve.
2. SelectChangeStructure(s)Statusto >Approved.
TheAuthenticationdialogboxopens.

Thedialogboxcloses.ThestructurestatusischangedtoApproved
andthestatusismarkedintheFocuswindowandinObject
Explorer.
Youcanusethesameproceduretochangethestructuretoanyofthefour
possiblestatuses.
To Approve All Structures in a Structure Set

1. IntheFocuswindow,rightclickthestructureseticon.
2. SelectChangeStructure(s)Statusto >Approved.
TheStructureApprovaldialogboxopens.
3. Allstructuresinthestructuresetareselectedbydefault.ClickOK
tocontinue.
TheAuthenticationdialogboxopens.
5. Thedialogboxcloses.Thestatusofallstructuresischangedto
ApprovedandthestatusismarkedintheFocuswindowandin
ObjectExplorer.
Youcanusethesameproceduretochangethestructurestoanyofthefour
possiblestatuses.
Structures 195
Chapter 8 Segmentation and Contouring
Contouring Workspace, (Field Setup Workspace)
Thischapterdescribestheinterrelationshipsbetweenstructures,
segmentsandcontours,andexplainshowtodefineastructureby
paintingsegmentsordrawingcontoursintheimageviews.
Segmentationcanbedoneautomaticallyormanually,andboth
approachesaredescribedinthechapter.Theautomaticsegmentation
toolsthatallowdefiningsegmentsbothtwoandthreedimensionally
(inimageplanesandvolumesofinterest)includeSearchBody,CT
Ranger,SegmentationWizard,PostProcessing,FloodFill,Crop
Structure,ExtractWall,MarginforStructure,Interpolate,andExtend
Segmentationtools.Themanualsegmentationtoolsthatenablethe
definitionofsegmentstwoorthreedimensionally,orfromfilms
usingadigitizerincludeBrushandFreehand.Thechapteralso
describeshowtheresultingsegmentscanbemodifiedandcopiedas
necessary.Therearealsoinstructionsforusingregisteredimagesin
segmentation.
About Structures, Segments and Contours

Structuresareformedbysegmentsdefinedon2Dimagesor3D
images.Theprocessofdefiningsegmentsiscalledsegmentation(also
referredtoascontouring).Dependingontheselectedlayout,structures
canbedefinedintheMainvieworinaSecondaryviewinthe
Contouringworkspace.IntheFieldSetupworkspaceoftheExternal
BeamPlanningtask,youcandefine,edit,copyanddeletestructures,
clearastructurefromaplaneorfromallplanes,andeditthecolorand
styleofastructure.Youcanalsocreatenewstructuresinthe
transversalimageviewintheFieldSetupworkspace.Thestructure
segmentationisalsoshowninthe3Dview.
Segmentscanbedefinedmanuallyorautomatically.Automatic
segmentationisusefulforstructuresthatextendtoanumberof
planes,forexample,theBodystructurewiththeSearchBodytool,or
thelungswiththeSegmentationwizard.
197
Inthisuserguide,thetermsegmentisusedtorefertoavolumetric
spacethatextendsoverseveralimageplanes.Onasingleimageplane,
asegmentisseenasapaintedarea(forinstance,GTV,CTV,PTV,Body,
orananatomicalorgan).Dependingonthecolorandstylesettingofa
structureandtheactivesegmentationtool,asegmentcanalsobe
displayedasatwodimensionalcontour,andviceversa,intheimage
views.Whencontourisdisplayedassegment,thesegmentmaydiffer
slightlyfromtheoriginalone.Thisisduetothewaytheapplication
calculatestheoutlineofthesegmentanddependsontheresolutionof
theimage.
Figure 46onpage 200showsthevisualizationofasegmentanda
contourdefinedonanimageplane.
A.Visualizationofsegment.B.Visualizationofcontour.
Figure 46 Segment and Contour
Eachcontourbelongstoonestructure,butstructurescancontain
multiplecontours.Figure 47onpage 201displaysanimageplanewith
severalstructuresthataredisplayedascontoursandsegments.

A.Bodystructuredisplayedasacontour.B.Targetstructuredisplayedasacontour.C.Lung
structuredisplayedasasegment.
Figure 47 Example of a Transversal Plane with Structures
Atleastone2Dimageora3Dimageconsistingofseveral2Dplanesis
requiredforsegmentation.
ThesegmentmodelinEclipseisdesignedfordelineatingnaturally
curvedshapes.Themodelisnotoptimalforrepresentingsome
geometricalshapes,suchassharpedgesorminisculestructures.For
instance,whencreatingrectangularsegments,Eclipseroundsthe
cornersoftherectangle(seeDefiningRectangularandElliptical
SegmentsandContoursonpage 232).Theaccuracyofstructure
representationisalsodeterminedbytheCTsliceresolutionandtheCT
slicethickness.
Themainimageviewdisplaysallthestructuresonaplane.Theactive
structureishighlightedinallimageviewsanddisplayedevenifthe
visibilitycheckboxoftheparticularstructureorstructuresetis
clearedintheFocuswindow.Inthetopogramviews,however,only
theactivestructureisvisualized;otherstructuresarenotdisplayed.
Segmentation Methods
Youcandefinesegmentseitherbyusingtheautomaticormanual
segmentationtools.Theautomaticsegmentationtoolsenabledefining
segmentstoasingleplaneortoallplanesina3Dimage.TheCT
Segmentation and Contouring 199

RangertoolsearchesvoxelswiththeCTvalueswithinthedefined
limits,andtheFloodFilltooldefinesasegmentonthebasisofa
usergivenseedpointandtheimagevalues.Youcanletthetools
segmenttheselectedstructureandtheneithermanuallyor
automaticallymodifythestructurewheretheresultisnotthe
expected.
Note: Whenusingautomaticsegmentationtools:
Youcanusethevolumeofinterest(VOI)withallothertools,exceptwith
theInterpolatetool.
YoucanundoasegmentationoperationbychoosingEdit >Undowhilea
dialogofasegmentationtoolisactive.
Alwaysverifytheresultofautomaticsegmentationvisuallyplaneby
planeintheModelview,andcorrecttheresultifnecessary.
Theautomaticsegmentationtoolsincludethefollowing:
SearchBody CreatestheBodystructureandautomatically
findsthebodysegment.Canbeappliedtoall3Dimagesina4D
image.
SegmentationWizard Findsorganspecificsegments
automatically.Canbeappliedtoall3Dimagesina4Dimage.
CTRanger DefinesaCTvaluerangeandthenautomatically
searchesthevoxelswithinthatrange.
Postprocessingtools Groupofautomaticandsemiautomatic
toolsusedtogetherwiththeCTRangerandotherautomatic
segmentationtools,orseparatelyforselectedstructures.
FloodFill FillsanareathatcontainssimilarCTvalueseitherin
2Dor3Dstartingfromaseedpointthatyouhavegiven.Floodfill
operationcanbecontrolledbyagrowingfactor,theeffectofwhich
canbevisuallychecked.
MarginforStructure Addsathreedimensionalmarginaround
adefinedstructurebyexpandingtheselectedstructurewiththe
specifiedmargin.Themargincanbebothsymmetricand
asymmetric.
CropStructure Removesthepartofastructurethatextends
overanotherstructurewithadefinedmargin.
ExtractWall Createsatubular,hollowstructurebasedonan
existingstructure.
ExtendSegmentation Extendsthesegmentationintheactive
planetootherplaneorplanesaccordingtotheselectedmethod.

Interpolate Addsacontourtotheplanesthatnotdoyetcontain
one.Thetoolscanstheplanesbetweenthedefinedtopandbottom
planes,anddefinesthestructurewiththeselectedmethod.Italso
extrapolatesthestructureupanddownifnecessary.TheVOIis
notavailableforinterpolating.
Inmanualsegmentation,asinglesegmentorcontourcanbedefined
forasingleplanemanuallywiththeBrushorFreehandtools,
optionallyusingtheCircleCursortoolasanaid.Thesetoolsarealso
usefulfordefiningthetargetvolumeorredefiningthestructurefor
planeswhoseautomaticsegmentationhasfailed.
Note: YoucanundoasegmentationoperationbychoosingEdit >Undowhile
adialogofasegmentationtoolisactive.
Segmentation and 4D Images

Youcansegmentstructuresina3Dimagethatbelongstoa4Dimage
inthesamewayasyousegmentregular3Dimages.Allsegmentation
isalwayssavedtotheprimaryimage(thetopmostitemintheFocus
window),andthesegmentationtoolsalsousetheimagedatafromthe
primaryimage.Thismeansthatyoucandefinesegmentsontheimage
thatshowsmoreinformation(forinstance,MRorPET),butthe
segmentsarealwayssavedintheprimaryimage.Formore
informationonviewing4Dimages,seeViewing4DImageson
page 114.
Whenyouaddastructuretoa3Dimagethatispartofa4Dimage,the
structureisautomaticallyavailableforsegmentationinalltheimages
underthepatient.Similarly,ifyoumodifythepropertiesofa
structure,thechangeisappliedtoallimagesunderthepatient.
Selecting the Area to Work on in Segmentation

Todefinesegments,youfirstneedtoselecttheareainwhichtheyare
goingtobedefined.Dependingonhowyouwishtowork,definea
threedimensionalvolume(VOI,VolumeofInterest)thatconsistsof
multipleimageplanestolimitthefunctioningofthesegmentation
tools,orselectasingleimageplanetoworkon.

WhenyoudefineaVOIfora3Dimagethatispartofa4Dimage,the
VOIappearsinall3Dimagesinthe4Dimage.
To Select a VOI (Volume of Interest)

2. ChooseContouring >UseVolumeofInterest .
TheVOItoolappearsasarectangleinthe2Dimageviews,andas
arectangularparallelepipedintheModelview.Whenyoudefinea
VOIfora3Dimagethatispartofa4Dimage,theVOIappearsin
all3Dimagesinthe4Dimage.
A.MovehandlestodragtheVOI.
3. ToresizetheVOIasnecessary,dragthemovinghandles.

To Select Individual Planes
1. Ifthepatientdoesnotcontainanystructures,createatleastone.
2. IntheFocusview,selectthedesiredstructure.
A.Dragthelevelindicator.B.TheactivestructureisdisplayedintheSecondaryviews.
3. Toselecttheplanetoworkon,
In2Dviews,dragthelevelindicatorlineorthesliderstoselect
thedesiredplanelevel.
BrowsetothedesiredplanebychoosingView >Previous
Plane orNextPlane ,orscrollwiththemouse.Youcan
definetheplanedistancetomovebackwardorforwardby
typingavalueinthetextboxnexttothebuttons.Bydefault,
theplanedistancevalueis1.Whenscrollingwithmouse,the
planedistancevalueisalways1.
YoucanalsomovetothenextorpreviousplanewiththePageUpand
PageDownkeys,ortothefirstorlastplanewiththeHomeandEndkeys.

Visual Aids for Segmentation
Toaidyouindefiningsegmentsaccurately,showcontoursdefinedin
theplanebelowandabovetheplaneyouareviewing,andusethe
CircleCursortooltodrawsegmentsataspecifieddistancefrom
anotherarea.
To Show the Contours on Other Planes

UsetheContoursonPreviousandNextPlanetoolbarbuttontoshow
thepositionsofcontoursdefinedinthepreviousandnextplanefora
selectedstructure.
2. ChooseContouring >ContoursonPreviousandNextPlane to
showthecontoursdefinedfortheselectedstructureinthe
previousandnextplanes.
A.Pinkline:Contourdefinedonthecurrentlyselectedplane.(Thecontourisdisplayedin
thecolordefinedforthestructure.)B.Violetline:Contourdefinedonthepreviousplane.C.
Greenline:Contourdefinedonthenextplane.
To Use the Circle Cursor

TheCircleCursortoolisasegmentationaid,usedfordrawinga
segmentatadefineddistancefromanotherareaintheimage,for
instance,asegmentat1 cmfromanarea.
1. OntheMeasuretoolbar,clickCircleCursor .
Acircleappearsaroundthemousepointer.

2. InthetextboxnexttotheCircleCursorbutton,definetheradius.
3. Selectthedesiredsegmentationtool.
4. Positionthemousepointersothattheedgeofthecirclecursoris
nexttotheareafromwhereyouwishtostartthemargin.
A.Positionthemousepointerusingthecirclearoundthecursor.B.Drawthecontour.
5. Paintthesegmentwiththeselectedtool.
Segmenting Small Structures Using High Resolution

Somestructureswithsmallvolumescanhavegreatsignificancein
planningorplanevaluation,suchastheopticnerveorartificial
implantsorscrews.Segmentingthemmayrequireusingahigher
segmentationresolutionthanthedefaultresolutionusedinEclipsefor
largerstructures.Youcanmanuallyincreasetheresolutionof
segmentsincaseswheretheimagesizeislargerthan256 256voxels.
Tousethehighresolutionwhensegmentingsmallstructures,you
needtomanuallyselecttheresolutionusingtheHighResolution
Segmentcommand.Youcanonlyuseeitherthehighorthelow
resolutionforsegmentingonestructure,andonceyouhaveincreased
theresolutionofasegment,youcannotgobacktothelower
resolution.

Thecommandincreasestheresolutionofthesegmentontransversal
planesonly.IfyouwishtoincreasetheresolutionalongtheZaxis,you
needtocreateanew3Dimageanddecreasetheplaneseparation
value.Forinformationoncreating3Dimages,seeChapter 5,Section
AboutCreating3DImagesonpage 128.
Theaccuracyofthehighresolutionsufficesforsegmentswithanarea
of2 mm2ontransversalplanes.
Inmostcases,structuresusinghighresolutionaredealtwithinthe
samewasasanyotherstructures.However,thefollowingcasesare
exceptions:
Structuretemplatesuselowresolution.Thismeansthatstructures
aresavedintoatemplateandexportedwithlowresolutionevenif
theyweresegmentedwithhighresolution.
Segmentationtoolsuseeitherloworhighresolution,depending
ontheresolutionofthestructurebeingsegmented.
Exportusesloworhighresolution,dependingontheresolution
usedintheexportedstructures.
Importuseseitherloworhighresolution.Theappropriate
segmentresolutionisdeterminedduringtheimport,andhigh
resolutionisusediftheimportedsegmentscontainverysmall
contours.
Note: Topreventexcesscomputermemoryconsumption,theSegmentation
Wizardisnotavailableforhighresolutionstructures.
TheresolutionofeachstructureisshownintheStructureProperties
dialogbox.
To Increase the Resolution of a Structure

1. Addtherequiredstructuretothestructureset.
2. Tousehighresolutionforthestructure,gototheFocuswindow,
rightclickthestructureandthenchooseHighResolution
Segment.
Thesegmentsareconvertedtousehighresolution.
3. Ifthestructurealreadycontainedsegmentswhentheresolution
wasincreased,visuallyverifythatthesegmentsarecorrect.
Continuecontouringasusual.

Using Automatic Segmentation Tools
Defining the Body Structure

Tobeabletoviewthethreedimensionalmodelofthepatient,you
needtodefinetheBodystructureandthepatientsbodyoutline.The
SearchBodytooldefinesandcreatestheBodystructureandthebody
outlineautomaticallytotheareadefinedbytheVOI.Bydefault,the
VOIcoverstheentire3Dimage.TheSearchBodytoolcanbeapplied
toall3Dimagesina4Dimage.YoucanalsodefinetheBodystructure
manuallyandaddthebodyoutlinemanuallyslicebyslice.
Note: Whenusingthesegmentationtools,payattentiontothefollowing:
AlthoughallowedinEclipse,nevercreatemultipleBodystructures.In
theExternalBeamPlanningtask,multipleBodystructuresprevent,for
instance,thedosecalculationandSSDcalculationsfromworking
properly.
planeintheModelview,andcorrecttheresultifnecessary.
To Define and Segment the Body Structure
1. ChooseContouring >SearchBody .
TheVOItoolappearsinimageviewsandtheSearchBodydialog
boxopens.
2. EdittheVOIareatoremoveunwantedparts,suchasthecouch.
3. Normally,youdonotneedtochangethedefaultvaluesinthe
SearchBodydialogbox,butyoucanchangethemifnecessary.For
instructions,seeToModifytheSearchBodyToolSettingson
page 210.
4. ClickApplytohavetheSearchBodytoolscantheimage.
TheBodystructureappearsintheFocuswindowandtheimage
views.
5. ClickClosetoclosetheSearchBodytool.
Ifyousearchedthebodystructurefroma3Dimagethatispartofa
4Dimage,youareaskedwhetheryouwanttoapplythebodytoall
3Dimagesinthe4Dimage.

To Modify the Search Body Tool Settings
ThedetailedSearchBodytoolsettingsaresimilartothoseofthe
PostProcessingChaintool(seeUsingPostProcessingToolson
page 236).
1. ToopentheSearchBodytool,chooseContouring >SearchBody
.
2. MovetheRangersliderorusethespinboxnexttothesliderto
definethelowerthresholdvalueforthebodysearch.
3. ClickDetailstoexpandthedialogboxtoshowthemodifiable
optionsforsearchingthebody.
4. Definethedetailedsettings:
Toremovesmallparts,selecttheKeepthe<n>largestparts
checkboxanddefinethenumberofpartstokeep.
A.Imagecontainingsmallstructurepartsoutsidebodystructure.B.Onlythelargestpart
is kept.

Todisconnectpartssmallerthanadefinedvaluein
centimeters,selecttheModifyconnectionsbeforeextraction
checkbox,thenselecttheDisconnectoptionanddefinethe
valueintheRadiustextbox.
A.Imagecontainingsmallstructureparts.B.Structurepartssmallerthantheselectedlimit
incentimetersaredisconnectedandremoved.
Tofillcavitiesintheimages,selecttheFillallcavitiescheck
box.
A.Imagecontainingseveralcavities.B.Allcavitiesarefilled.C.Inaddition,thesegment
outlineissmoothedout.

Tocloseopeningssmallerthanadefinedvalueincentimeters,
selectthePreCloseopeningscheckboxanddefinethevalue
intheRadiustextbox.
A.Imagecontainingsmallopenings.B.Openingssmallerthantheselectedlimitin
centimetersareclosed.
Tosmoothoutthesegmentoutline,selecttheSmoothingcheck
boxanddefinethesmoothinglevelinthespinbox.Thehigher
thesmoothinglevelthemoreitsmoothesoutthesegment
outline.
A.Theoutlineofthesegmentiscoarse.B.Segmentoutlineissmoothed.

5. ClickApplytocreatethebodyoutline.
TheSearchBodytoolscanstheimageandthebodystructure
appearsintheFocuswindowandtheimageviews.
Tohavetheapplicationsuggestcertainsettingslater,click
SaveSettingsAsDefault.Thedefaultsettingsarealsoused
whentheBodystructureiscreatedautomaticallyin4Dimage
import.
ContinueworkingwiththeSearchBodytool.
ToclosetheSearchBodydialogboxandcontinuedefining
otherstructures,clickClose.
Segmentation with the Segmentation Wizard

Eclipseprovidespreconfiguredorganspecificsettingsfor
segmentation.Thesesegmentationtoolsuseafloodfillalgorithmand
thekNearestNeighbor(kNN)algorithmtofillconnectedvolumes
withsimilarreferenceimagevaluesandtoclassifyvoxelsintothose
belongingornotbelongingtoasegment.
Thepreconfiguredsegmentationcanbeusedthroughthe
SegmentationWizard toolforthefollowingorgans:
BrainSegmentationstartsbyfindingandselectingbones
resemblingtheskullonplanesinsidethebodystructureusingarea
andmomentumcriteria,andfloodfillisusedtofillthebrain.
LungsSegmentationfirstfindsaslicewithmostairinsidethe
bodystructureintwoconnectedareasandthenusesfloodfillto
fillthelungs.
EyesSegmentationconsistsoftwophases:firstapointinside
eacheyeisfound,andthentheeyesegmentisgeneratedaround
thesepointsusingthefloodfillalgorithm.
SpinalcordSegmentationisbasedonthekNNalgorithm.
BonesSegmentedbyselectingpointswithaCTvaluetypicalof
bonestructures.
Formoredetailsonthesegmentationalgorithms,refertoReference
GuideforEclipseAlgorithms.

TheareawheretheSegmentationWizardworksiseithertheVOI,if
activated,ortheentire3Dimage.Inthecaseofa4Dimage,youcan
havetheSegmentationWizardprocessall3Dimagesinthe4Dimage.
YoumusthavetheBodystructuredefinedbeforeusingthe
SegmentationWizard.
TheSegmentationWizardprovidesNextandBackbuttonsfor
navigatinginthewizard.WhenyouclicktheNextbutton,thewizard
proceedstothenextsegmentationstep.WhenyouclicktheBack
button,thewizardreturnstothepreviousstepandthestructurethat
existedbeforethewizardwasstartedisreturned.IfyouchooseEdit >
Undoafterthis,theresultoftheautomaticsegmentationisreturned.
Thissectiondescribesthesegmentationoptionsspecifictothe
SegmentationWizard.Forinstructionsontheothersegmentation
tools,seethesectionsunderUsingPostProcessingToolson
page 236andUsingtheCTRangerToolonpage 215.
Note: Whenworkingwiththesegmentationwizard:
planeandintheModelview,andcorrecttheresultifnecessary.
Topreventaccidentalchanges,alwaysapprovethestructuresafter
havingdefinedthesegments.Forinstructions,seeApproving
Structuresonpage 195.
To Segment with the Segmentation Wizard
1. DefinetheBodystructure,ifnotalreadydefined.
2. IntheFocuswindow,selectthestructuretodefinewiththe
SegmentationWizard.
3. ChooseContouring >SegmentationWizard .
TheSegmentationWizardopens.
4. Selectthesegmentationmethodfortheactivestructure.
5. ClickNext.
6. Dependingontheselectedsegmentationmethod,forexample,
activatetheVOIormarkthespinalcordononeslice,ifneeded.
7. ClickNext.
Thewizardperformsthesegmentation.

Torepeatthesegmentingoperationtoall3Dimagesinthe4D
image,clickApplytoAll3DImagesina4DImage.
Toreturntothepreviousstep,clickBack.
Toclosethewizard,clickClose.
Using the CT Ranger Tool

TheCTRangertoolisasegmentationtooldesignedforsearching
voxelswiththeCTvalueswithinthedefinedlimits.Itisaccessed
throughtheCTRangerdialogbox.TheCTvaluesintheCTRanger
toolareshownintheunitsdefinedintheimage(forexample,HUsor
pixels).TheCTRangertoolcanbeusedforsegmentingstructuresboth
intheplaneandthevolume.FormoredetailsontheCTRangerdialog
box,refertotheonlinehelp.
To Select a CT Range for Segmentation in the CT Ranger
2. SelectthedesiredplaneorVOI.
3. ChooseContouring >CTRanger .
TheCTRangerdialogboxopens.

4. DefinetheCTrangesettings.
TodefinetheCTrange,
MovetheLowerandUppersliders
Definethevaluesinthespinboxesnexttothesliders
ClickGetfromPaintedtoreadtheCTrangefroma
previouslysegmentedstructure.
Touseasymmetricblurring,selecttheAdvancedcheckbox
andthendefinethevaluestouseforblurringinthe
AsymmetricBlurringspinboxes.
Thisoptioncanbeusefulwhenastructuretodefinehasaspecificand
moreorlessconstantelongationinthe3Dimage,forinstance,thespine.
Tosegmentthestructureintheactiveplane,clickthe2D
optionbutton.
TosegmentthestructureinthedefinedVOIortheentire3D
image,clickthe3Doptionbutton.
Toapplythechangesautomaticallyto2Dviews,selectthe
InteractiveApplycheckbox.
Ifthecheckboxiscleared,clickApplytoupdatethechangesinthe2D
views.
5. ClickApplytohavetheCTRangertoolsegmentthestructure.
6. Tofinish,clickClose.
7. Continuebycorrectingthesegmentationresultwiththe
PostProcessingtoolsormanually.
Using the Flood Fill Tool

TheFloodFilltoolfillsanareathatcontainssimilarCTvalueseitherin
2Dor3Dstartingfromaseedpointthatyouhavegiven.Thefloodfill
operationcanbecontrolledbyagrowingfactor,theeffectofwhichcan
bevisuallychecked.

To Use the Flood Fill Tool
2. Toenhancethevisualizationofthedesiredstructure,changethe
imagebrightnessandcontrast(window/levelsettings).For
instructions,refertotheonlinehelp.
3. SelectthedesiredplaneorVOI.
4. ChooseContouring >FloodFill .
5. PositionthemousepointerintheMainviewwhereyouwantto
starttheautomaticsegmentationandclicktosetthefirstseed
point.
TheFloodFilldialogboxopens.Aseedpointappearsonthe
image.YoucanmovetheseedpointbyclickingagainintheMain
view.
6. Definethevolumegrowingsettings.
Todefinehowintenselythevolumegrows,dragtheVolume
GrowingIntensitysliderandclickApplytoseetheresult.
Togrowthevolumeonthecurrentplane,fromtheMethod
groupbox,clickthe2Doptionbutton.
Togrowthevolumeinthe3Dimage,fromtheMethodgroup
box,clickthe3Doptionbutton.
Tocleartheexistingstructurebeforegrowingthevolume,
selecttheCleartheactivestructurefirstcheckbox.
Tosetmoreseedpoints,pressCTRLandclickontheimagein
theMainview.
TheselectedplaneorallplaneswithinthedefinedVOIare
scanned,andtheareaisfilledaccordingtotheCTvalues.
7. Repeatstep5untilthesegmentcoversthedesiredareaorVOIin
theimageview.
8. ClickClosetoclosethedialogbox.

Interpolating and Extending Segments and Contours
Toaddsegmentsorcontoursforastructuretoplanesthatdonotyet
containone,usetheInterpolatetoolortheExtendSegmentationtool.
Beforedoingthis,youmustdefineastructureandsegmentorcontour
itonatleasttwoplanesintheinterpolationorextendingrange.
About the Interpolate Structure Tool
TheInterpolateStructuretoolscanstheplanesbetweenthedefined
topandbottomplanesanddefinesthestructurewiththeselected
method.Italsoextrapolatesthestructureupanddownifnecessary.
Thefollowinginterpolatingmethodsareavailable:
LinearInterpolationConstructsastraightlinebetweenthedefined
planes.
QuadraticInterpolationConstructsaslightlycurvedlinebetween
thedefinedplanes.
CubicInterpolationConstructsastronglycurvedlinebetweenthe
definedplanes.
Note: TheVOIisnotavailableforinterpolating.
To Use the Interpolate Structure Tool
2. ChooseContouring >Interpolate .
TheInterpolateStructuredialogboxopens.
3. Definetheinterpolationsettings:
Interpolationgroupbox:Todefinetheinterpolationmethod,
clicktheLinear,QuadraticorCubicoptionbutton.
Additionalextrapolationgroupbox:Tospecifythevalues
definingthedistancescannedaboveandbelowtheextrapolate
range,typevaluesintheUpandDowntextboxes.These
valuesareusedtoroundoffthestructure.
4. ClickOK.
Thesegmentsorcontoursareaddedtotheplaneswherethe
selectedstructurehasnotyetbeendefined.

About the Extend Segmentation Tool
TheExtendSegmentationtoolextendsthesegmentationintheactive
planetootherplaneorplanesaccordingtotheselectedmethod.The
tooltakesacontourinthecurrentimageplaneasastartingshapeand
changesittoadapttotheimagedatainotherplanesaccordingtothe
selectedmethod:
AllplanesupExtendsthesegmentationtoallplanesabovethe
currentlyactiveplanethatcontainsimilarCTdata.
OneplaneupExtendsthesegmentationtotheplaneabovethe
currentlyactiveplane.
OneplanedownExtendsthesegmentationtotheplanebelowthe
currentlyactiveplane.
AllplanesdownExtendsthesegmentationtoallplanesbelowthe
currentlyactiveplanethatcontainsimilarCTdata.
TheExtendSegmentationtooloverwritesallexistingpartsofthe
activestructureintheplaneswherethesegmentationisextended.
WhentheExtendSegmentationtoolisactivated,youcanalsoactivate
theBrush,EraserorFreehandtoolandusetheupanddownarrow
buttonsinthekeyboardtoextendthestructureupordownplaneby
planeandsimultaneouslyfinetunethesegmentationwiththemanual
segmentationtools.
To Use the Extend Segmentation Tool
2. ChooseContouring >ExtendSegmentation .
TheExtendSegmentationdialogboxopens.

TheExtendSegmentationtooloverwritesallexistingpartsoftheactive
structureintheplaneswherethesegmentationisextended.
Toextendthesegmentationtoallplanesabovethecurrently
activeplanethatcontainthesimilarCTdata,click .
Toextendthesegmentationtooneplaneabovethecurrently
activeplane,click .
Tostopextendingthesegmentation,click .
Toextendthesegmentationtooneplanebelowthecurrently
activeplane,click .
Toextendthesegmentationtoallplanesbelowthecurrently
activeplanethatcontainthesimilarCTdata,click .
4. Whenready,clickClosetoclosethedialogbox.
Using Manual Segmentation Tools
About the Brush Tool

TheBrushtoolpaintsalineofthedefinedwidth,followingthegrey
scalevaluesontheplanedisplayedintheimageview.Tousethetool,
youcandefinethediameterofthebrushandhavethetool
automaticallyadapttotheCTdataontheactiveimageplane.Youcan
usethe3DBrushtooltodrawsegmentsinallorthogonalimageviews
(transversal,frontalandsagittal).Youcanalsospecifyastructurethat
theBrushtoolwillnotpaintover,eventhoughtheBrushtoolismoved
overthestructure.
Youcandefinewhetherthebrushadaptstotheimagedataonthe
activeimageplanebyusingdifferentBrushtoolmodes.Bydefault,the
Brushtooladaptstothegrayscalevaluesontheimageplaneandthe
brushdiameterchangesaccordingly(inboth2Dand3D).Whenusing
theStaticBrush(inboth2Dand3D),thebrushdoesnotadapttothe
grayscalevaluesintheimageandthebrushdiameterdoesnotchange
whiledrawing.Figure 48onpage 221illustratesthedifference
betweentheadaptiveandstaticbrush.

A.Adaptivebrush:ThebrushadaptstotheCTimagedata.B.Staticbrush:Thebrushdoesnot
adapttotheCTimagedata.
Figure 48 Behavior of the Adaptive and Static Brush
Note: Evenifthecolorandstyleofaselectedstructureisacontour,youcan
paintsegmentswiththeBrushtool.However,onceyoudeactivatetheBrush,
thepaintedsegmentsareshownascontours.Ifyoualwayswanttoviewa
structureassegments,selectasegmentcolorandstylesetting.
3D Brush
Usethe3DBrushtodrawsegmentsonseveralplanessimultaneously.
Thenumberofimageplaneswherethesegmentisdrawndependson
theselectedBrushdiameter.Thelargerthediameteris,themore
planesarecovered.The3Dbrushcanbeusedbothintheadaptiveand
staticmodes.Figure 49onpage 222illustratesasegmentdrawnwith
the3DBrushindifferentimageviews.

A.Segmentdefinedwithoneclickwiththe3DBrushtoatransversalimageB.Theresultin
sagittalimageC.TheresultinfrontalimageD.Theresultin3Dmodel
Figure 49 Segment Drawn with 3D Brush
To Paint Segments with the Brush Tool
2. Toenhancethevisualizationofthestructure,changetheimage
brightnessandcontrast(window/levelsettings).Forinstructions,
refertotheonlinehelp.

3. Selectthedesiredplane.
Toreachgreateraccuracyinthedrawingofthesegment,zoom
inontheimageplane.
4. ChooseContouring >Draw >Brush .
TheBrushdialogboxopens.
5. DefinetheBrushsettings.
TodefinetheBrushdiameter,selectthevalueincentimetersin
thespinbox.
Tousethestaticbrush,selecttheappropriatecheckbox.
Bydefault,theadaptivebrushmodeison.
Tousethethreedimensionalbrush,selectthe3DBrushcheck
box.
Todefineastructuretoavoidpaintingoverwhileusingthe
brush,selectthestructureintheappropriatedropdownlist.
6. DrawthesegmentwiththeBrushtool.
Colorappearsatthemousepointerfollowingthestructureoutline.
To Quickly Erase Part of a Segment
YoucanquicklyerasepartofasegmentwhilepaintingwiththeBrush
tool.
1. WhileusingtheBrushtool,pressSHIFT.
TheBrushtoolchangestotheErasertool.
2. KeeppressingSHIFTandusetheErasertoremovepartofthe
segment.
3. ReleaseSHIFTandthemousebuttontoturntheEraserbackto
Brush.
TheBrushtoolisinuseagain.
About the Eraser Tool

UsetheErasertooltoremovepartsofasegmentinasingleplane.

To Erase a Segment
3. ChooseContouring >Draw >Eraser .
TheEraserdialogboxopens.
4. TodefinetheEraserdiameter,selectthevalueincentimetersinthe
spinbox.
5. Positionthemousepointerwhereyouwanttostarterasingthe
segment.Pressandkeeptheleftmousebuttondownwhile
movingthemousetoerasethesegment.
Theselectedpartofthesegmentiserased.Theworkingareaofthe
eraserisshownasacirclearoundthetipofthemousepointer.
YoucanactivatetheErasertoolalsowhileusingtheBrushtool.For
instructions,seeToQuicklyErasePartofaSegmentonpage 223.
About Freehand Contours and Segments

Freehandcontoursandsegmentscanbedefinedontheactiveimage
planewiththemouseeitherbyclickingthempointbypoint,orby
drawingacontinuouslinewiththeFreehandtool.Contoursand
segmentsononeplanecanalsobemodifiedandoptimizedwiththe
Freehandtool.
Note: IntheExternalBeamPlanningtask,youcanusetheFreehandtoolto
drawandeditcontoursandsegmentsalsointheFieldSetupworkspace.Inthe
FieldSetupworkspacethetoolisactivatedeitherfromthetoolbarbuttonorby
rightclickingthestructureandselectingthetoolfromthedropdownlistthat
opens.

TheFreehandtoolhasthefollowingdrawingmodes:
Smartmode Inthismodetheapplicationdecides,basedonthe
areasinsideandoutsideofthesegment,whichoperationshould
beperformed(seeFigure 50onpage 225).Themodecanbe
selectedfromtheFreehanddialogbox.
Addmode Inthismode,youcanaddasegmenttoastructure.
ThemodecanbeselectedfromtheFreehanddialogbox.
Removemode Inthismode,youcanremoveasegmentfroma
structure.ThemodecanbeselectedfromtheFreehanddialogbox.
Correctmode Inthismode,youcanreplaceacontourofa
segment.ThemodecanbeselectedfromtheFreehanddialogbox.
A.Largersegment.B.Smallersegmentoverlappingthelargersegment.C.Iftheseareastogetherarelargerthan
areaD,segmentBisaddedtosegmentA.D.IfthisareaislargerthanareasCtogether,segmentBisremoved
fromsegmentAcausingsegmentAtobedividedintwo.E.SegmentBisaddedtosegmentA.F.SegmentBis
removedfromsegmentA.
Figure 50 Smart Mode of the Freehand Tool

InalloperatingmodesoftheFreehandtool:
Itispossibletomoveorstretchapartofasegmentoracontour.
Stretchingiszoomdependent:themoreyouzoominbefore
stretchingthesmallerchangeinthesegmentorcontouryoucan
make.Youcanmoveorstretchasegmentoracontourinallmodes
whenthecontourlineishighlighted.
PressingCTRLanddrawingaddsasegmenttoastructureora
contourtoasegment.Asmallplussignappearsnexttothemouse
pointer.
PressingSHIFTanddrawingremovesasegmentfromastructureor
acontourfromasegment.Asmallminussignappearsnexttothe
mousepointer.
Thesegmentonthecurrentimageplaneintheactivestructurecan
bemovedbypressingSHIFTanddraggingthesegment.
Note: Whendrawingcontoursmanually,avoidintersectinglinestomakesure
thatallcontoursarecorrectlyinterpretedbytheapplication.Figure 51on
page 226illustrateshowtheapplicationinterpretsmanuallydrawncontours
thatcontainintersectinglines.
A B
A.ManuallydrawncontoursthatcontainintersectinglinesB.Thesamecontoursinterpretedby
theapplication.
Figure 51 Intersecting Lines Interpreted by the Application

To Draw a Segment Using the Freehand Tool
3. ChooseContouring >Draw >Freehand .
TheFreehanddialogboxopens.
Tousethesmartmode,clicktheSmartmodebutton .
Toaddasegmenttoastructure,clicktheAddmodebutton .
Toremoveasegmentfromastructure,clicktheRemovemode
button .
Toreplaceacontourofasegment,clicktheCorrectmode
button .
5. Positionthemousepointerwhereyouwanttostartdrawing,and
todrawcurvedlines,presstheleftmousebuttonandmovethe
mousepointer.
todrawstraightlines,clickthelinepointbypoint.
6. Toclosetheline:
Movethemousepointerbacktothesamespotwhereyou
starteddrawingthelineandreleasethemousebuttonwhen
theconnectionpointishighlighted.
Rightclickwhenyouareclosetothestartingpoint.The
applicationconnectstheline.
Movingtoanotherplaneclosesthefreehandsegmentdrawnonthe
previousplane.
To Copy a Segment or Contour with the Freehand Tool
1. Drawasegmentoracontouronaplane.
2. Ifnotalreadyusedindrawing,chooseContouring >Draw >
Freehand .
3. RightclickthesegmentorcontourandchooseCopy.
4. Movetoanotherplane.
5. Topastethesegmentorcontourintheactiveplane,rightclickand
choosePaste.

To Copy a Contour to a Structure in Another Image
1. Selectthecontourtocopy.
3. RightclickthecontourandchooseCopy.
4. Displaytheimagewheretopastethecontourandselectthetarget
structure.
5. ChooseEdit >PasteContour.
Thecopiedcontourispastedintotheselectedimage.
Continuebymodifyingthecopiedcontourasneeded.
To Move Contours and Segments with the Freehand Tool

2. Movethemousepointeronthecontourline.
Thecontourlineishighlighted.
3. PressSHIFT anddragthecontourasdesired.
Youcanjointwocontoursbydraggingoneontopoftheother.
To Reshape a Segment or a Contour with the Freehand Tool
Freehand .
3. Movethemousepointeronthecontourline.
Thecontourlineishighlighted.

4. Toreshapethecontour,presstheleftmousebuttondownanddrag
thecontourline.
Toreachgreateraccuracyinthereshapingofthecontour,
zoominontheparticularregionofthecontour.
A.Positionthemousepointeroverthecontourline.B.Dragthecontourline.
To Add or Remove a Part of a Segment or Contour with

the Freehand Tool
1. Selectthedesiredimageplane.
3. Fromthedialogbox,selectthedesireddrawingmodeforthe
Freehandtool.

Toremoveapartofthesegmentorcontour,startandend
drawingoutsidetheexistingsegmentorcontour.
Toaddaparttothesegmentorcontour,startandenddrawing
insidetheexistingsegmentorcontour.
A.Toremoveapart,startandenddrawingoutsidetheexistingsegmentorcontour.B.
Rightclicktoenddrawingandremovethepart.C.Toaddapart,startandenddrawing
insidetheexistingsegmentorcontour.D.Rightclicktoenddrawingandaddthepart.
5. Rightclicktofinishaddingorremovingapart.
To Optimize a Segment or a Contour with the Freehand Tool
Freehand .
3. RightclickthecontourandchooseOptimizeContour.
ThecontourshapeisoptimizedgloballyaccordingtotheCTdata
oftheimage.

To Resize Segments or Contours with the Freehand Tool
Usethisfeaturetoresizeasegmentoracontourinasingleplane.
TheFreehanddialogboxopens.Thereisnoneedtodefinea
drawingmodeforresizingasegmentoracontour.Formore
informationonthedrawingmodes,seeToDrawaSegmentUsing
theFreehandToolonpage 227.
4. Positionthemousepointeronthecontourlinethatyouwantto
resizeormove,rightclickandchooseResize.
Aframeappearssurroundingtheactivestructure.
5. Toresizetheframe,dragasizinghandleuntiltheframeisthesize
youwant.
To Rotate a Segment or a Contour with the Freehand Tool
Usethisfeaturetorotateaselectedcontourorasegmentinasingle
planeofanimage.
drawingmodeforrotatingasegmentoracontour.Formore

4. Positionthemousepointeronthesegmentorcontourlinethatyou
wanttorotate,rightclickandchooseRotate.
Aframeappearssurroundingtheactivestructure.
5. Torotate,pressthemousebuttonanddragarotationhandle.To
finish,releasethemousebutton.
Theselectedstructureisrotated.
To Mirror a Segment or a Contour with the Freehand Tool
Usethisfeaturetomirroraselectedsegmentorcontouraroundits
horizontalorverticalaxisinasingleplane.
drawingmodeformirroringasegmentoracontour.Formore
4. Positionthemousepointeronthesegmentorcontourlinethatyou
wanttomirror,rightclickandchooseFlipLeft/RightorFlip
Up/Down.
Theselectedstructureisdisplayedmirrored.
Defining Rectangular and Elliptical Segments and Contours

InadditiontosegmentsdrawnwiththeFreehandtool,youcandefine
rectangularandellipticalcontoursandsegments.
To Define a Rectangular Segment or Contour
3. ChooseContouring >Draw >Rectangle.
Themousepointerappearsasacross.

4. IntheMainview,presstheleftmousebuttonandmovethemouse
todrawarectangle.
5. Tofinishandfixthesizeoftherectangle,releasethemousebutton.
ThesegmentmodelofEclipsesmoothensthecornersofthe
rectangle.
To Define an Elliptical Segment or Contour
3. ChooseContouring >Draw >Ellipse.
Themousepointerappearsasacross.
4. IntheMainview,presstheleftmousebuttonandmovethemouse
todrawthediameteroftheellipse.
5. Whenthediameteristhedesired,releasethemousebuttontofix
thesizeoftheellipse.
6. Tofurthershrinkorstretchtheellipse,movethemousepointer.
7. Tofinishandfixthesizeoftheellipse,clickintheimageview.
Using Boolean Operators in Segmentation

Booleanoperatorscreatecombinationsofstructures,suchasthepart
ofthelungsthatdoesnotoverlapwiththePTV.Combinedstructures
createdwithBooleanoperatorscanbeusefulin,forexample,DVH
calculation.Thefollowinglogicaloperatorsareusedtocreate
combinedstructures.
Table 3 Boolean Operators
Operator Description
ANDAANDB:thecombinationincludestheareas
thatbelongtobothAandB,thatis,theintersectionofA
andB.
ORAORB:thecombinationincludestheareasthat
belongtoA,Borboth,thatis,theunionofAandB.

XORAXORB:Thecombinationincludestheareas
thatbelongeithertoAorBbutnotbothofthem.
SUBASUBB:thecombinationincludestheareathat
belongstoAbutnottoB.
(Parenthesisstartingaseparatepartinthe
expression.
Forexample:AAND(NOTB)
)Parenthesisendingaseparatepartintheexpression.
NOTNOTA:thecombinationincludestheareathat
coverseverythingelsebutA.
BACKSPACEDeletesthelastaddedlogicaloperator.
To Use Boolean Structures

1. ChooseContouring >BooleanOperators .
TheBooleanOperatorsdialogboxopens.
2. IntheStructureslistbox,selectthestructuretoincludeinthe
Booleanoperation.
TheselectedstructureisshownintheExpressionbox.
3. IntheOperatorsgroupbox,clicktheappropriateoperatorbutton.
TheselectedoperationisshownintheExpressionboxafterthe
structure.
4. Repeatsteps2and3asmanytimesasneededtobuildthedesired
expression.
5. Whentheexpressionisready,clickOK.

Merging 4D Structures
Youcancreatea4Dmergeofastructure,forexample,whenyouwant
toseethestructureinitsmaximumsizeduringarespiratorycycle.The
4Dstructuremergeisproducedfromthecontoursoftheselected
structureintheselectedorall3Dimagesina4Dimage.Figure 52on
page 235displaysamerged4Dstructureinitsmaximumsizeandon
thecurrent3Dimage.
A.Merged4DstructureinitsmaximumsizeB.Mergedstructureonthecurrent3Dimage
Figure 52 4D Structure Merge
To Merge 4D Structures
1. Createanewstructureintowhichthemergedstructurewillbe
saved.
2. IntheFocuswindow,selectthenewstructure.
3. ChooseContouring >4DStructureMerge.
The4DStructureMergedialogboxopens.
4. IntheCreatemergeoflistbox,selectthestructuretomerge.
5. IntheUsingimagesgroupbox,selectthecheckboxesofthe
imagesyouwanttouseinthe4Dstructuremerge.
6. ClickOK.
The4Dmergeissavedintotheselectedstructure.

Using Post-Processing Tools
Thepostprocessingtoolsareagroupofautomaticand
semiautomatictoolsusedtogetherwiththeCTRangerandother
automaticsegmentationtools,orseparatelyforselectedstructures.
ThepostprocessingtoolscanbeselectedinthePostProcessingChain
dialogbox.Thepostprocessingtoolsincludethefollowing:
CleanUpAsemiautomatictoolforremovingdefinedpartsfrom
theactivestructure.Thesepartsaretypicallynotconnectedtothe
mainstructure.Youcanremovepartssmallerthanadefinedsize
insquareorcubiccentimeters,partsselectedwiththemouse,or
overlappingparts.
ExtractionKeepsthedefinedpartsintheactivestructure.You
cankeeppartsselectedwiththemouse,andconnectordisconnect
parts,keepingthepartsexceedingadefinedsizeincentimeters.
Whenconnectingordisconnectingparts,youcutorcreatejoints
betweenseparatesegmentsthatbelongtotheactivestructure.
EnhancementRemovesunwanteddetailsfromtheactive
structure.Youcansmoothoutsmallspikesprotrudingfromor
valleysdippingintothestructure,fillselectedcavitiesinsidethe
structure,fillcavitiesbelowadefinedsizeinsquareorcubic
centimeters.
Thepostprocessingtoolscanbeusedfortheactive2Dimage,all2D
imagesorthe3Dimage.
To Start the Post-Processing Chain

2. ChooseContouring >PostProcessing .
ThePostProcessingChaindialogboxopens.

3. Todefinehowthetoolsshouldwork,clickthe2D,2DAllor3D
optionbutton.
2D:Thepostprocessingoperationsaredoneontheactive
imageplane.
2DAll:Thepostprocessingoperationsaredoneonall2D
imageplanes.Youcanusethisoptiontoremoveanextending
bodypart,forexampleanarm,fromtheimages.
3D:Thepostprocessingoptionsaredonetothewholeimage
volume,includingthevolumebetweenthe2Dimageplanes.
4. Definethepostprocessingtoolandtooloptionstouse.
5. ClickApply.
To Remove Small Structure Parts

WhendefiningstructureswiththeCTRangertool,theendresultmay
containsmallpartsthatdonotbelongtothedesiredstructure.The
PostProcessingtoolsenableremovingallunwantedpartssmaller
thanaspecifiedsizeinsquareorcubiccentimeters.
1. InthePostProcessingChaindialogbox,selecttheCleanUpcheck
box.
2. SelecttheRemovepartssmallerthancheckboxintheCleanUp
groupbox.
3. Definethesizelimitinsquareorcubiccentimetersinthetextbox.
A.Imagecontainingseveralstructureparts.B.Structurepartssmallerthantheselected
limitinsquareorcubiccentimetersareremoved.

To Remove Selected Structure Parts
containpartsthatdonotbelongtothedesiredstructure.The
PostProcessingtoolsenableremovingselectedunwantedpartsfrom
structures.
box.
2. SelecttheRemoveselectedpartscheckboxintheCleanUpgroup
box.
3. ClicktheSelectbutton .
4. MovethemousepointertotheMainviewandclickthepartto
remove.
Asmallcrossmarkstheselection.
Toremoveseveralstructureparts,pressCTRLwhileselectingtheparts.
A.Inthemainview,selectthestructureparttoremove.B.Theselectedstructurepartis
removed.
To Remove Parts Overlapping with Another Structure

Insomecasesyoumayneedtoremovestructurepartsthatoverlap
withanotherstructure.Forexample,astheresultofinterpolation,the
PTVmayextenditselfoutsidetheBodystructure,oritmayextend
outsidetheBodystructureaftera3Dmarginhasbeendefinedforit.
ThePostProcessingtoolsenableremovingstructurepartsextending
outsideanotherstructure.InadditiontothePostProcessingtools,you
canalsousetheCropStructuretoolforremovingstructureparts(for
moreinformation,seeCroppingaStructureonpage 245).

box.
2. SelecttheRemovepartsoutsidecheckboxintheCleanUpgroup
box.
3. Inthedropdownlist,selectthestructure,forexamplebody,with
whichthestructuretoremoveoverlaps.
Theselectionappearsinthelistbox.
A.ThePTVextendsitselfoutsidethebodystructure.B.Thestructureextendingoutsidethe
bodystructureisremoved.
To Keep the Selected Structure Parts

containanumberofpartsthatdonotbelongtothedesiredstructure.
ThePostProcessingtoolsenablekeepingtheselectedpartsand
removingallotherparts.
1. InthePostProcessingChaindialogbox,selecttheExtraction
checkbox.
2. SelecttheKeepselectedpartscheckbox.
3. ClicktheSelectbutton.

4. MovethemousepointertotheMainviewandclicktheparttokeep.
Asmallcrossmarkstheselection.
Tokeepseveralparts,pressCTRLwhileselectingtheparts.
A.Inthemainview,selectthestructureparttokeep.B.Otherstructurepartsareremoved.
To Keep Large Structure Parts

containsmallpartsthatdonotbelongtothedesiredstructure.The
PostProcessingtoolsenablekeepingpartslargerthanaspecifiedsize
incentimetersandremovingallotherparts.
checkbox.
2. Selecttheappropriatecheckbox.
3. Inthetextbox,definethenumberofthelargestpartstokeep.
A.Imagecontainingsmallundesiredstructurepart.B.Onlythedesiredstructurepartis
kept.

To Disconnect or Connect Structure Parts
checkbox.
2. SelecttheModifyconnectionsbeforeextractioncheckbox.
3. Toseparatesmallerpartsfromlargerones,clicktheDisconnect
optionbuttonanddefinetheradiusincentimeters.
A.Imagecontainingstructurepartsofdifferentsize.B.Structureswithjointssmallerthan
theselectedlimitincentimetersaredisconnectedfromlargerparts.
4. Toconnectsmallerpartstolargerones,clicktheConnectoption
buttonanddefinetheradiusincentimeters.
A.Smallstructurepartsareseparate.B.Structurejointssmallerthantheselectedlimitin
centimetersareconnectedtothelargerpart.

To Smooth Out the Segment Outline
1. InthePostProcessingChaindialogbox,selecttheEnhancement
checkbox.
2. SelecttheSmoothingcheckbox.
3. Definethesmoothinglevelinthespinbox.Thehigherthe
smoothinglevelthemoreitsmoothesoutthesegmentoutline.
A.Theoutlinesofthesegmentarecoarse.B.Theoutlinesofthesegmentaresmoothed.
Youcanrepeatsmoothingasmanytimesasneeded.Checkthatthe2D,
2DAllorthe3Doptionisselectedappropriately.
To Fill the Selected Cavities in Structures

TheCTRangertoolmayleavesmallholesinsideastructure.The
PostProcessingtoolsenablefillingtheselectedcavities.
checkbox.
2. SelecttheFillselectedcavitiescheckbox.
3. ClicktheSelectbutton.

4. MovethemousepointertotheMainviewandclickthecavitytofill.
Asmallcrossmarkstheselectedcavity.
Tomarkseveralcavities,pressCTRLwhileselectingthecavities.
A.Inthemainview,selectthecavitytofill.B.Theselectedcavityisfilled.
To Fill Small Cavities in Structures

PostProcessingtoolsenablefillingcavitiessmallerthanaspecified
sizeinsquareorcubiccentimeters.
checkbox.
2. SelecttheFillcavitiessmallerthancheckbox.
3. Definethesizelimitinsquareorcubiccentimetersinthetextbox.
4. Tofillonlycavitiesinsidetheselectedstructure,selectthe
appropriatecheckbox.
A.Segmentcontainingseveralcavitiesofdifferentsize.B.Cavitiessmallerthantheselected
limitinsquareorcubiccentimetersarefilled.

To Fill All Cavities in Structures
PostProcessingtoolsenablefillingallcavities.
checkbox.
2. SelecttheFillallcavitiescheckbox.
3. Tofillonlycavitiesinsidetheselectedstructure,selectthe
appropriatecheckbox.
A.Segmentcontainingseveralcavities.B.Allcavitiesarefilled.
Extracting the Wall of a Structure

Tocreateatubular,hollowstructure,andsaveittotheactivestructure,
usetheExtractWalltool.Youcanusebothpositiveandnegative
valuesindefiningtheinnerandoutermarginsofthewall.InFigure 53
onpage 245,theredlinerepresentsthestructurewhosewallis
extracted,andtheyellowlinesaretheextractedinnerandouterwalls.

A.Theouterwallthicknessissetto1cmandtheinnerwallthicknessto0.5cm.B.Theouterwall
thicknessissetto1cmandtheinnerwallthicknessto0.5cm.
Figure 53 Positive and Negative Values with the Extract Wall Tool
To Extract the Wall of a Structure

1. ChooseContouring >ExtractWall .
TheExtractWalldialogboxopens.
2. IntheExtractthewallfromdropdownlist,selectthestructure
whosewallyouwishtocreate.
3. IntheWallthicknessgroupbox,definetheinnerandouter
marginofthestructurewalltobeextracted.
4. Toconfirmthesettings,clickOK.
Theactivestructureisfirstclearedandthenthespecifiedwallofa
structureisextractedandsavedtotheactivestructure.
Cropping a Structure
Toremovethepartofastructurethatextendsoutsideorinside
anotherstructureandaddadefinedmargin,usetheCropStructure
tool.Forinstance,youmayhavedefinedaPTVthatextendsitself
outsidetheBody,andthenwanttoremovethepartofthePTVthatlies
outsidetheBody,keepingonlythepartinsidetheBodyoutlineasin

A
A.PTVB.MarginC.PartofPTVthatiskeptD.Bodyoutline
Figure 54 Cropping Structure
To Crop a Structure
1. ChooseContouring >CropStructure .
TheCropStructuredialogboxopens.
2. IntheCropstructuredropdownlist,selectthestructuretocrop.
Theactivestructurewillfirstbeclearedandthenthecroppingresultwill
besavedintheactivestructure.
3. Selecttheoptionbuttonoftheappropriatecroppingmethodand
selectthesecondstructureinthedropdownlist.
4. Todefineanadditionalmarginforcropping,typeavaluein
centimetersintheappropriatetextbox.
Thestructureiscroppedasdefined.

Adding a 3D Margin to a Structure
Toaddathreedimensionalmarginaroundadefinedstructure,usethe
MarginforStructuretool.Thetoolexpandstheselectedstructurewith
thespecifiedmargin.Thisisuseful,forexample,ifyouwanttocreatea
PTVfromGTVorCTV.Themargincanbebothasymmetricandan
asymmetricmargin.
In3D,themargingrowsinthedirectionofstructuresurfacenormal.
Becauseofthis,ifyoulookatoneimageplane,themarginwidthmay
differfromwhatwasdefinedwhencreatingthemarginaroundthe
plane(seeFigure 55onpage 247).
E A
B
D
F
C
A.MarginwidthB.MarginwidthasitappearsonasingleimageplaneC.MarginwidthD.
MarginwidthasitappearsonasingleimageplaneE.ImageplaneF.Imageplane
Figure 55 Margin Width
Theaccuracyofthe3Dmarginisdeterminedbytheplaneseparation
usedinthe3Dimage(seeChapter 5,SectionParametersUsedfor
Constructing3DImagesonpage 129ortheonlinehelp).Toincrease
theaccuracyintheZdirection,defineasmallerplaneseparationvalue
forthe3Dimage.

To Add a 3D Margin to a Structure
2. ChooseContouring >MarginforStructure .
TheMarginforStructuredialogboxopens.Theorientationofthe
axesareshownintheimageviews.
3. IntheCreateMarginfromdropdownlist,selectthestructure
fromwhichthemarginiscreated.
4. IntheGeometrygroupbox:
Selecttheappropriateoptionbuttonforcreatinganinneror
outermarginandtypethemarginvaluesincentimetersinthe
textboxes.
Tocreateasymmetricalmargin,selecttheUsesymmetrical
margincheckboxandthentypethemarginvaluein
centimetersinthetextbox.
Toavoidacertainstructurewhencreatingthemargin,select
theAvoidstructurecheckboxandselectastructureinthelist
box.
5. ClickOK.
Theexistingstructureisexpandedwiththedefinedmarginand
theresultisstoredintheactivestructure.
Moving a Structure
Tomoveanentirestructure,usetheMoveStructuretool.Thetoolcan
beusedinthetransversalviewtomoveastructureinXandY
directionsonly.Thetoolmovestheactivestructureinallimageplanes
simultaneously.ThetoolisavailableintheContouringandFieldSetup
workspaces.
Tomoveasegmentofanactivestructureonthecurrentimageplane,
usetheFreehandtool.Forinstructions,seeToMoveContoursand
SegmentswiththeFreehandToolonpage 228.Tomoveallcouch
structuressimultaneously,usetheMoveSupportStructurestool.For
instructions,seeChapter 7,SectionToMoveAllCouchStructures
onpage 195.

To Move a Structure
1. IntheFocuswindow,selectthestructuretomove.
Contouringworkspace:OntheManualContouringtoolbar,click
MoveStructure .
FieldSetupworkspace:OnthePlanningtoolbar,clickMove
Structure .
3. Movethecursoronthestructureandwhenthestructureis
highlighted,dooneofthefollowing:
Tomovethestructurefreely,presstheleftmousebuttondown
anddragthestructure.
Tomovethestructureinverticalandhorizontaldirections,
pressSHIFT,presstheleftmousebuttondownanddragthe
structure.Thestructureismovedtothedirectiondragged
fartherwiththemouse.
Theselectedstructureismovedinallimageplanes.
Using Registered Images in Contouring

Registeredimagescanbeusedintreatmentplanningindifferent
ways,dependingonwhichimagesthestructuresaredefinedtoand
whatthestructuresarelike.
Youcansegmentstructuresusingthefollowingmethods:
Addstructuresandsegmentthemtotheprimary3Dimagewhile
displayingtheregisteredimageintheimageview.Thedefined
structureissavedtotheprimaryimage.Theprimaryimageis
alwaysthetopmostimageintheFocuswindow,andtheimage
viewsalwaysdisplaythestructuresdefinedtothatimage.The

registeredimageisshownundertheprimaryimageintheFocus
window.Theimagedisplayedintheimageviewsistheonewith
thevisibilitycheckboxselected.
Definethetargetstructureontheimagethatshowsmore
information(forinstance,MRorPET)andcopyittotheprimary
CTimage.Thismethodmaybemoreaccurateiftheregistered
imagehashigherresolutionthantheprimaryimage.
Note: Imageregistrationdataisnotusedwhencopyingfields.Confirmthe
correctpositioningofthefieldswhencopyingthembetweenregisteredimage
sets.
To Define Structures to the Original Image

while Showing the Registered Image
1. Displaythedesiredoriginalimage.
2. IntheFocuswindow,expandthetreestructureintheRegistered
Imagesfolderbyclickingtheplussigninfrontoftheimage.
3. Intheimagefolder,findtheregisteredimage andclickthe
visibilitycheckboxinfrontofit.
4. Continuebydefiningcontoursandsegments.
DonotusetheSegmentationWizardandtheFloodFilltoolsfornonCT
images.
5. Tohidetheregisteredimage,clickthevisibilitycheckboxofthe
originalimageintheFocuswindow.
Theregisteredimagedisappearsfromandtheoriginalimage
appearsintheimageviews.Thedefinedcontoursandsegments
arevisibleintheoriginalimage.
Toviewinformationfromboth3Dimages,usetheBlendviewingmode.
Formoreinformation,seeChapter 6,SectionVisualizationMethodsfor
RegisteredImagesonpage 165.
To Copy Structures to a Registered Image

1. IntheContouringworkspace,definestructuresinoneofthetwo
3Dimages.
2. IntheRegistrationworkspace,registertheimages.

3. IntheContouringworkspace,gototheFocuswindowandselect
thestructuretobecopied.
4. ChooseEdit >CopyStructure.
Topastethecopiedstructuretoaregisteredimage,displaythe
targetimageintheMainimageview
IntheFocuswindow,selecttheregisteredimage.
6. ChooseEdit >PasteStructure(s)topastethecopiedstructureto
theselectedimage.
Note: Whencopyingstructures,payattentiontothefollowing:
Alwaysvisuallyverifytheresult.Minorinaccuraciesmayoccurinthe
copyduetodifferentresolutionsandorientationsoftheimages.
Iftherearemultipleregistrationsbetweentheimages,copyingand
pastingstructuresisnotsupported.
Contouring with the Digitizer

Adigitizerenablesmanuallyreplicatingadrawingfromasheetof
paperorfilmintodigitalformonthecomputer.Youcandefineone
closedcontourforasingleplanewithadigitizer.Theitemyouare
digitizingisshownintheactiveimageview.
Note: Verifythatthedigitizeriscorrectlycalibratedtoavoidfaultyscalingand
orientationofdigitizedimages.Forinstructions,seeAppendix Conpage 819.
To Digitize a Contour
1. Insertanewstructureasusual.Forinstructions,seeToAdda
NewStructureonpage 185.
2. IntheFocuswindow,selectthestructuretowhichyouareaboutto
importanoutline.
3. Ifnotselected,chooseContouring >EnableDigitizer.
4. Ifnecessary,calibratethedigitizer.Forinstructions,see
Appendix Conpage 819.

5. OntheDigitizerToolstoolbar,clickDigitizeContour .
TheDigitizingContoursdialogboxopens.
6. Todefinetheoutline,clickthepointsinthefilmwiththedigitizer
mouse.Thepointsareconnectedwithstraightlines
Todeletetheenteredpointsonebyone,selectthepointand
pressBACKSPACEonthekeyboardortheseconddigitizermouse
button.
7. Toclosetheline
PressENDonthekeyboard.
Pressthethirddigitizermousebutton.
8. Whenthecontoursareready,dooneofthefollowing:
ClickStopDigitizingintheDigitizingContoursdialogbox.
DeselecttheDigitizeContourtool.
Thedialogboxcloses.
Youcanenterseveraloutlinesoneafteranother.Thedigitizerremains
usableandthecalibrationisvalidaslongastheselectedstructure
remainsthesame.
Continuebyeditingtheimportedoutlineasusual.Formoreinformation,
seeUsingManualSegmentationToolsonpage 220.
About Isocenter Markers

Isocentermarkerscanbeaddedtopatientimagestomarkthelocation
ofthetreatmentisocentertobeusedduringexternalbeamplanning.If
thepatientimagescontainanisocentermarker,youcanalignafieldto
theisocentermarkerintheFieldSetupworkspace.
Youcanadd,deleteandmodifyIsocentermarkersintheContouring
workspaceandFieldSetupworkspace,withtheexceptionofisocenter
markersthathavebeenapproved.Isocentermarkersareshowninall
workspaces.

Isocenter Marker Visualization
IsocentermarkerdefinedinpatientimagesareshowintheFocus
windowwithaspecialicon( )underthestructureseticon.Youcan
showorhidetheisocentermarkersbyselectingorclearingtheir
visibilitycheckboxesintheFocuswindow.
Figure56IsocenterMarkerinFocusWindow
Isocentermarkersaredisplayedonallimageplanes.Theisocenter
markerthathasitslocationonthecurrentviewingplaneisvisualized
differently.
Figure 57onpage 253showsanisocentermarkerinatransversal
imageina2Dview.
Figure57IsocenterMarkerin2DImageView
IsocentermarkersarealsoshownintheBEVandtheModelview.
Figure 58onpage 254showsanisocentermarkerintheBEV.

Figure58IsocenterMarkerinBeamsEyeView
Figure 59onpage 254showsanisocentermarkerintheModelview.
Figure 59 Isocenter Marker in ModelView
AnisocentermarkermaybeseeminglyinvisibleintheModelview.
Thisisbecausetheyarepositionedrealisticallyin3Dspaceand,
dependingontheviewingangle,maybeobstructedbyastructure.In
theBEV,however,markersarealwaysshownontopofallstructures.

Location of the Isocenter Marker
Differentvisualizationsareusedtoindicatetheplanewherethe
isocentermarkerislocatedinrelationtotheactiveviewingplane:
Activeisocentermarkerlocatedontheactiveviewingplane
Inactiveisocentermarkerlocatedontheactiveviewingplane
Activeisocentermarkerlocatedinfrontoftheactiveviewing
plane
Inactiveisocentermarkerlocatedinfrontoftheactive
viewingplane
Activeisocentermarkerlocatedbehindtheactiveviewing
plane
Inactiveisocentermarkerlocatedbehindtheactiveviewing
plane
Adding Isocenter Markers

YoucanaddnewisocentermarkerswiththeNewIsocenterMarker
command.
To Add an Isocenter Marker
1. SelectInsert >NewIsocenterMarker.
2. DefinetheisocentermarkerID,nameandlocation.Youcanalso
definetheisocentermarkerpositionwiththemouseafterclosing
thisdialogboxorclickingApply.
3. FromtheMoveMarkerorIsocenterMarkertoolbar,clickMove
MarkerorIsocenterMarker .
4. Movethenewisocentermarkertothedesiredlocationwiththe
mouse.
Editing Isocenter Markers

Iftheisocentermarkerpositionneedstobechanged,youcanusethe
MoveMarkerorIsocenterMarkertooltoedittheisocentermarker.

To Edit Isocenter Markers
2. Clicktheisocentermarkerthatyouwishtomovetoanother
location.
Thewayisocentermarkersbehaveinrelationtothecurrentimage
planediffersdependingontheparticularworkspace:
FieldSetupworkspaceClickingtheisocentermarkerwiththe
MoveMarkerorIsocenterMarkertoolfirstmovesthemarker
tothecurrentlyactiveslice.
ContouringworkspaceClickingtheisocentermarkerwiththe
MoveMarkerorIsocenterMarkertoolfirstmovestheimage
planestoshowthelocationoftheisocentermarker.
3. Saveyourchanges.
About Markers
Markers(oftenreferredtoasseeds)placedinsidethepatienthelp
locatethetumorduringthecourseoftreatment.Aparticularuseof
markersintreatmentplanningisinconnectionwithVariansOBI
treatmentunit.OBIiscapableofdetectingmarkersinpatientimages
andsavingtheminastructureset.Thisstructuresetcanthenbe
importedintoEclipseandusedforverifyingthepatientpositioningin
imagesproducedinfurthertreatmentsessions.Youcanalsomodify
markerpositionsinEclipsebetweentreatmentsessionsandthen
reexporttheplantothetreatmentmachine.
Youcanadd,modifyanddeletemarkersintheContouringworkspace
andFieldSetupworkspace,withtheexceptionofmarkersthathave
beenapproved.
Markersareshowninallworkspaces.
Note: YoucanuseapredefinedparametersetforcreatingDRRsthatdisplay
markers.ForinformationonDRRs,seeChapter 25,SectionPredefined
ParameterSetsforDRRCalculationonpage 691.

Marker Visualization
MarkersdefinedtopatientimagesareshownintheFocuswindow
withaspecialicon( )underthestructureseticon.Youcanshowor
hidemarkersbyselectingorclearingtheirvisibilitycheckboxesinthe
Focuswindow.
Figure 60 Markers in Focus Window
Markersaredisplayedonallimageplanes.Markersthatactuallyhave
theirlocationonthatslicearevisualizeddifferently(seeLocationof
theMarkersonpage 259).
Figure 61onpage 258showsmarkersinatransversalimageina2D
view.

Figure 61 Markers in 2D Image View
MarkersarealsoshownintheBEVandtheModelview.Figure 63on
page 259showsmarkersintheBEV.
Figure 62 Markers in Beams Eye View
Figure 63onpage 259showsmarkersintheModelview.

Figure 63 Markers in Model View
MarkersmaybeseeminglyinvisibleintheModelview.Thisisbecause
theyarepositionedrealisticallyin3Dspaceand,dependingonthe
viewingangle,maybeobstructedbyastructure.IntheBEVhowever,
markersarealwaysshownontopofallstructures.
Location of the Markers
markerislocatedinrelationtotheactiveviewingplane:
Activemarkerlocatedontheactiveviewingplane
Inactivemarkerlocatedontheactiveviewingplane
Activemarkerlocatedinfrontoftheactiveviewingplane
Inactivemarkerlocatedinfrontoftheactiveviewingplane
Activemarkerlocatedbehindtheactiveviewingplane
Inactivemarkerlocatedbehindtheactiveviewingplane

Adding Markers
YoucanaddnewmarkerswiththeNewMarkercommand.
To Add Markers
1. SelectInsert >NewMarker.
2. DefinethemarkerID,nameandlocation.Youcanalsodefinethe
markerpositionwiththemouseafterclosingthisdialogboxor
clickingApply.
4. Movethenewmarkertothedesiredlocationwiththemouse.
Editing Markers
Ifmarkerpositionsneedtobechanged,forinstance,between
treatmentsessions,youcanusetheMoveMarkerorIsocenterMarker
tooltoeditthemarkers.
To Edit Markers
1. FromtheMoveMarkerorIsocentermarkertoolbar,clickMove
2. Clickthemarkerthatyouwishtomovetoanotherlocation.
Thewaymarkersbehaveinrelationtothecurrentimageplane
differsdependingontheparticularworkspace:
FieldSetupworkspaceClickingthemarkerwiththeMove
Markertoolfirstmovesthemarkertothecurrentlyactiveslice.
ContouringworkspaceClickingthemarkerwiththeMove
Markertoolfirstmovestheimageplanestoshowthelocation
ofthemarker.
3. Saveyourchanges.

Chapter 9 Courses and Plans
Thischapterprovidesinformationonmanagingplansandcoursesin
theFieldSetupworkspaceanddefinestheconceptsrelatedtoplans.
Instructionsareprovidedforcreatingnewplans,openingexisting
plans,copyingplansandsavingplanstothedatabase.Thechapter
alsodescribestheuseofthePlanOrganizertomanageplans,dose
prescriptionandreferencepoints,anditcontainsstepbystep
instructionsforcreating,opening,andmodifyingcourses.
Plan-Related Concepts
Plan
IntheExternalBeamPlanningtask,aplancomprisesthegeometrical
positioningofthefields,includingallfieldaccessoriesandparameters
(formoreinformation,seeChapter 11,Fields,onpage 365),and
thedoseprescriptiondefinedfortheplan.
Planscanresideindifferentapprovalstatuses.Formoreinformation,
seePlanApprovalStatusesonpage 705.
Fraction
Thetotaltreatmentdosethatwillbeadministeredtothepatientis
normallydividedintoanumberoffractions.Onefractionisthedose
giventoapatientduringonetreatmentsession.
IntheExternalBeamPlanningtask,foratotaldoseof40Gy,for
example,thepatientmayreceive20fractions,eachconsistingof2Gy.
Fractionation
Fractionationisatechniqueofadministeringexternalradiation
therapyinmultipledosesoveranumberofdaysorweekstoachievea
maximumtherapeuticratio.
259
IntheExternalBeamPlanningtask,duringasinglefractionation,the
fractiondoseandweeklydosedonotchange.But,ifmultiple
fractionationsareused,thedosereceivedbythepatientondifferent
daysoftheweekmaydiffer.Multiplefractionationsareshowninthe
PlanOrganizerandtheInfowindow.Anexampleofmultiple
fractionationscouldbeaheadandneckcasewheretheinitialplan
fractionationis54Gyin30fractions,andthenanadditionalplanis
deliveredas18Gyin12fractionsforthelast12daysoftreatment.In
otherwords,twotreatmentsaredeliveredforthelast12days.
Dose Prescription
Thedoseprescriptionreferstotheprocedureofdeterminingthetotal
dosetobeadministeredtothepatient.Thedoseisdetermined
differentlyintheplanningofatreatmentandinfunctionsrelatedto
theactualtreatmentortreatmentscheduling.InEclipse,thedoseis
prescribedtoaspecificisodosepercentageortoareferencepoint.In
ARIAapplications,thedeterminationofthedoseisbasedonlyon
referencepoints.
Dose
Thedosedistributioncalculatedforaplanisrepresentedbyabranch
inthetreestructureintheContextwindow.Thedosedistributionis
indicatedeitherasanabsolute(Gy)orrelative(%)dose,andconveyed
bymeansofisodosesorcolorwashvisualization.Thecheckboxnext
totheDoseiconintheFocuswindowcanbeclearedtohidethedose
distributioninthe2Dand3Dviews.
Plan-Related Concepts and the Context Window in

the External Beam Planning Task
ThedivisionofplanrelatedconceptsisreflectedintheContext
windowasinthefollowingfigure:

A. CourseB ActiveplanC. DosematrixD. Fieldsandfieldaccessoriescontainedintheactive
planE. Plansandplanstatuses,topbottom:Rejected,Reviewed,Unapproved,Planning
Approved,TreatmentApproved,Retired
Figure 64 Plan-Related Concepts in Context Window
Creating New Plans

Planorplansofapatientarealwayscreatedtoacourse,sometimes
multiplecourses,dependingontheclinicalpractices.Beforestartingto
createtheplan,checkwhetherthereareanycoursescreatedfora
selectedpatient,andifthereare,whethertheycanbeusedforthenew
plan.(Forinstance,ifthesamepatienthasbeengivenadifferent
diagnosisthanbefore,youneedtocreateanewcourse.)Foreachplan,
selectthedesiredplantargetandrecordthedoseandfractionations
thatbestcorrespondtothetreatmentprescribedforthepatient.The
plantargetcanbeselectedlateron,butitisrecommendedatthe
creationoftheplan,becausethefieldsare,bydefault,positionedto
thecenteroftheplantargetandfittedtotheplantarget.Inthe
ExternalBeamPlanningtask,areferencepoint(withoutalocation;see
Courses and Plans 261

Chapter 13,ReferencePointsandReferenceLines,onpage 437)is
alsoautomaticallycreatedtoanewplanandconnectedtothetarget
volumeifoneisdefinedfortheplan.Thereferencepointisusedto
transferplanninginformationtoARIAapplicationsandother
recordandverifysystems.
PlanscanbecreatedusingtheInsertNewPlancommandortheInsert
NewPlanfromTemplatewizard.Themethodspromptyoutoeither
selecttherelevantcourseorcreateoneifthepatienthasnocourses.
Theyalsopromptyoutoselecttherelevantphysiciansintent.For
moreinformationoncreatingplansfromtemplate,seeChapter 10,
SectionToCreateaPlanUsingaPlanTemplateintheExternalBeam
PlanningTaskonpage 308.
Youcanalsocreateplansaccordingtoaclinicalprotocol.Formore
information,seeChapter 10,SectionUsingClinicalProtocolsto
CreateNewStructures,ObjectivesandPlansonpage 342.
Note: Beforecreatinganewplan:
Seethatthe3Dimageyouareusingisconstructedofasufficientnumber
ofplanes.Thisensuresthatthe3Dimagecoversallthestructures
necessaryfortreatmentplanning.
Makesurethatthenecessaryclinicalcontoursaredefinedintheimages.
Fordosecalculation,theBodyoutlinemustbedefined.Firstcreateat
leasttheBodyandPTVstructuresfortheselectedpatientbeforecreating
aplan.Formoreinformationoncontouring,seeChapter 8,
SegmentationandContouring,onpage 199.
SometimestheimageandstructureimportthroughDICOMmayresult
inmultiplestructuresmarkedwithBodyVolumeType.Checkthe
propertiesofthesestructuresandeitherdeletetheextraneousonesor
changetheirVolumeType.
Theimagingorientationmustbedefinedintheimages.Formore
information,seeChangingthePatientImagingPositioninRelationto
theCouchonpage 137.
Using Physicians Intents

Aphysiciansintentisawayofcommunicatingdoseprescription
informationfromARIAapplicationstoEclipse.Usingaphysicians
intentallowsthedefinitionofthedoseprescriptionforthetarget,for
instance,bytheoncologistinRTChartbeforestartingtreatment

planninginEclipse.Thephysiciansintentisdefinedforthepatients
course,and,ifrequired,onecoursecancontainseveralphysicians
intents.
Note: Itisnotpossibletoattachaclinicalprotocoltoacoursethathasthe
physiciansintentdefined.
InEclipse,youcanbaseyourplansonphysiciansintentsdefinedin
RTChartbyaddinganewplanusingatemplateorwithoutatemplate
andthenselectingthecoursethathasaphysiciansintentdefined.This
connectsthecreatedplantothephysiciansintent.
Thephysiciansintenticon isshownintheContextwindowunder
thecoursetowhichithasbeendefined.
Thefollowinginformationistransferredfromaphysiciansintenttoa
newplaninEclipse:
Numberoffractions
Prescribeddoseperfraction
Prescribedpercentage
Fractionsperday
Fractionsperweek
Energymodeforeveryfield,ifamatchingmodecanbefoundfor
theselectedtreatmentunit.Thisinformationistransferredonly
whentheplaniscreatedusingatemplate.
To Create a New Plan

1. Ifthepatientfileisnotalreadyopen,usethePatientExplorerand
theObjectExplorertoopenthedesiredpatientandstructureset.
Whenyouopenastructureset,the3Dimagethestructureset
referstoisopenedintheimageviews.The3Dimagecanbelongto
a4Dimage.
Iftherearemultiplestructuresetsor3Dimages,rightclickthestructure
seticonintheleftwindowofObjectExplorerandselectPropertiesto
checkwhich3Dimagethestructuresetrefersto.
ForinformationontheExplorers,seeObjectExploreronpage 72
andrefertotheonlinehelp.
2. ChooseInsert >NewPlan.

3. Whenpromptedtodoso,selectacoursefortheplanorcreatea
newcourse.
IntheAvailableCourseslistoftheSelectCoursedialogbox,
clickthecourseandthenclickNext.
Tocreateanewcourse,clickNewCourseandfollowthe
instructionsinToCreateaNewCourseonpage 276,and
thenclickNext.
4. Ifpromptedtodoso,selectaphysiciansintentfortheplan.
IntheAvailablephysiciansintentslistintheSelect
PhysiciansIntentdialogbox,clickthedesiredphysicians
intentandclickNext.Youcanreviewthepropertiesofthe
selectedphysiciansintentinthePhysiciansintentdetails
groupbox.
ThePlanPropertiesdialogboxopens.
5. IntheIDandNametextboxesofthePlanPropertiesdialogbox,
typetheappropriateplaninformation.
6. Toreviewthepropertiesofthephysiciansintent,clickthe
PhysiciansIntenttab.
7. ClickOK.
Theimagesetselectedfortheplanisopenedintheimageviews
andappearsintheContextwindow.Acourseandtheplanappear
intheScopewindow.IntheExternalBeamPlanningtask,thefirst
fieldiscreatedanditsFieldPropertiesdialogboxopens.
IntheExternalBeamPlanningtask,theprimaryreferencepointisalso
createdforthenewplan.Thepointisconnectedtothetargetvolumeof
theplan,ifthereisonedefined.Ifthepatientalreadyhasreferencepoints
withgeometricallocations,theyareautomaticallytakenintouseinthe
newplan.
IntheExternalBeamPlanningtask,continuebydefiningthefield
propertiesandinsertingthemintheplan.Formoreinformation,see
Chapter 11,SectionAddingStaticFieldstoPlansonpage 383.

To Prescribe the Dose for a Plan in the
External Beam Planning Task
Note: TheMUsarenotavailableintreatmentiftheprimaryreferencepointhas
notbeendefined.
PrescribethedoseforaplanintheDosePrescriptiontaboftheInfo
Window.FormoreinformationonusingtheInfoWindow,seeDose
PrescriptionTaboftheInfoWindowonpage 267.
YoucanalsoprescribethedoseforaplanontheDosetabofthePlan
Propertiesdialogbox,or,inaddition,youcanusethePlanOrganizer
(seeUsingthePlanOrganizeronpage 271).
Dose Prescription Tab of the Info Window

TheDosePrescriptiontabisusedforviewingandsettingthe
prescriptioninformationofaplanorplansum.TheDosePrescription
tabliststhedoserelatedparametervaluesofallthefractionationsof
theselectedplanorplansum.
Table 4 Information in Dose Prescription tab
Column Description
PlanID Foraplansum,IDofeachplaninthesum
FractionationID Foranindividualplan,IDofeachfractionationintheplan
Dose/Fraction Dose/fractioninGy,foreachfractionation
Numberof Numberoffractionsintheplan
Fractions
TotalDose TotaldoseinGy,foreachfractionation
Primary Primaryreferencepointintheplan,foreachfractionation
ReferencePoint
TotalDoseat TotaldoseattheprimarypointinGy,foreachfractionation
Primary
RelativeDoseat Relativedoseattheprimaryreferencepointinpercentage,
Primary foreachfractionation.Cannotbeedited
Prescribed Treatmentpercentageprescribedfortheplan,foreach
Percentage fractionation

Table 4 Information in Dose Prescription tab
Column Description
Plan Plannormalizationusedintheplan.Clicktochangethe
Normalization normalizationmode.
Mode
Plan Plannormalizationvalueinpercentage,foreach
Normalization fractionation.
Value Cannotbeedited
Theprimaryreferencepointandtotaldoseatprimaryreferencepoint
canbeeditedintheInfowindow.Editingthesevalueschangesthe
normalizationoftheplan.Theplannormalizationvaluecannotbe
edited.
Toprescribethedose,editthevaluesinthecells.
Note: InthecaseofanIMRTplan,itisadvisabletoruntheLeafMotion
Calculator(LMC)afterchangesinthedoseprescription.
To Open Existing Plans

1. Ifthepatientfileisnotalreadyopen,usethePatientExplorerto
openthedesiredpatient.
2. IntheObjectExplorer,selectthedesiredplanandclickOK.
Theselectedplanopensinthecurrentworkspace.IntheExternal
BeamPlanningtask,theContextwindowshowstheselected
patient,plan,imageusedfortheplan,andthefieldsaddedtothe
plan.
3. Ifthereareseveralplans,dragthedesiredplanfromtheScope
windowtoanimageview.
Theplanisdisplayedintheimageviews.
IntheExternalBeamPlanningtask,continuebymodifyingthefieldsand
fieldaccessoriesusedintheplan.FormoreinformationseeChapter 11,
Fields,onpage 365.

Saving Plans
IntheExternalBeamPlanningtask,savedplansincludetheimages,
fieldsandfieldaccessories,andthedosedata.
Youarepromptedtosaveyourchangeswhenyoucloseapatientor
openanewplanwhenyouhaveaplanopenedonscreen.
To Save a Plan
ChooseFile >SaveAll.
Copying and Pasting Plans

IntheExternalBeamPlanningtask,youcancopyaplanincludingthe
fieldsetupandfractionationdatatotheselectedcourse.Iftheplan
containsreferenceimages,theycanbeincludedinthecopy.Ifthedose
distributionhasbeencalculatedfortheplan,itisalsocopied.
To Copy Plans in the External Beam Planning Task
1. IntheScopewindow,selecttheplan.
2. ChooseEdit >CopyPlan.
3. Selectthecoursetowhichtopastetheplan.
4. ChooseEdit >PastePlanwithReferenceImages.
5. DefinetheplanpropertiesandclickOK.
Theplaniscopiedundertheselectedcourseandshowninthe
imageviews.
Copying and Pasting Plans between 3D Images in

Planscanbecopiedandpastedtoany3Dimageimportedtothe
database.Thisisuseful,forexample,forcopyingaplanbetweenaset
of3Dimagesrepresentingthepatientsrespiratorycycle.Itispossible
tocopyandpasteaplanregardlessofwhethertheplanisalready
assignedtoastructuresetand3Dimageornot.Iftheplanislinkedto
a3Dimage,thisoriginalimageandtheotherimagemustberegistered

witheachotherorhavethesameimagesizeandresolution.Ifthe
imagesareregistered,theisocenterintheplantobepastedwillbe
placedtothecorrectlocationinthenew3Dimage.
To Copy Plans between 3D Images in

1. Opentheplanyouaregoingtocopytoanother3Dimage.
2. Openthe3Dimagethatyouaregoingtopastetheplanto.
3. Iftheplanalreadyislinkedtoa3Dimagethatisnotregistered
withthenewimageordoesnothavethesameimagesizeand
resolution,gototheRegistrationworkspaceandregisterthe
images.Forinstructions,seeChapter 6,ImageRegistration,on
page 145.
5. ChooseEdit >CopyPlan.
IntheScopewindow,selectthe3Dimagetowhichyouwishto
pastetheplan.
IntheFocuswindow,expandthe4Dimageobject,ifnecessary,
andselectthe3Dimagetowhichyouwishtopastetheplan.
7. ChooseEdit >PastePlan.
Ifimagesareregistered,theisocenterisplacedtothecorrect
locationinthenewimage,otherwiseitisplacedtotheimage
origin.Thepastedplanisshownintheimageviews.

Using the Plan Organizer
ThePlanOrganizerisatoolformonitoringandmanagingthe
planninginformationregardingtheactivecourse.Itdisplaysthedose
valuesforfieldsonly.ThePlanOrganizershowsthefollowing
information:
Planscontainedinthecourse
Dosecontributionoftheplanforeachreferencepoint
IntheExternalBeamPlanningtask,dosedataforeach
fractionationofeachplan,includingtheMUvaluesforeachfield
andthedoseateachreferencepoint
Note: Forexternalbeamplans,usetreatmentapplicationstomonitorthe
actualtreatmentprocess.
About the Plan Organizer

ThePlanOrganizerisadialogboxthatshowsplanninginformation
fortheplansintheactivecourse.IntheExternalBeamPlanningtask,it
isusedformanagingfractionations.Thedialogboxcontainsonetab
showinginformationforallplans,oneshowinginformationforthe
referencepointsintheplans,andonetabforeachfractionationinthe
activecourse.Theinformationinthetabsisshowninatableformat.
Cellscontainingunacceptablevaluesaremarkedwitharedframe.
Figure 65 Plan Organizer
CAUTION: Verify the plan information outside the Plan Organizer before
approving it for treatment, because some of the information may be viewed in
the Plan Organizer only by changing the column widths or by scrolling.

All Plans Tab (Plan Organizer)
TheAllPlanstabsummarizestheplansthatexistcurrentlyinthe
activecourse.Informationaboutplansapprovedfortreatmentcannot
bemodified,andtheirrowsaregrayedout.Youcanmonitorand
definethefollowingfortheplansinthePlanOrganizer:
Changethenameoftheplanandfractionations.
IntheExternalBeamPlanningtask,addanddeletefractionations.
IntheExternalBeamPlanningtask,checkwhichfractionation
belongstoeachplan.
Checkandchangetheprimaryreferencepointthatdescribesthe
prescribeddoseforeachplaninARIAapplications.
Viewthetargetvolumeoftheplan.
Changetheprescribeddosedefinedforeachplan.
Changethefractions/dayandfractions/weekvalues.
Ref. Points Tab (Plan Organizer)
TheReferencePointtabsummarizestheinformationforthereference
pointscontainedintheplansintheactivecourse.Youcandothe
followingforreferencepointsinthePlanOrganizer:
Viewtheplandata:theplanandfractionationIDandthenumber
offractionsforeachplan.
Monitorthedoseperfractionatthereferencepoints.
Sumupthetotaldoseoftheselectedplansatthereferencepoints.
Changethetotaldoseandthedailydoselimitsforthereference
points.
Thecelloftheprimaryreferencepointismarkedwithayellowframe.
Note: Thepatientmayalsohaveotherreferencepointsthatarenotlistedinthis
tab,forexample,referencepointscreatedinARIAapplications.Tohavethese
referencepointsappearinthePlanOrganizer,includethepointsintheplanby
clickingtheEditReferencePointsbutton.Formoreinformationabout
includingreferencepointsintheplan,seeToIncludeReferencePointsin
Plansonpage 445.

Tabs for Individual Fractionations in the Plans
IntheExternalBeamPlanningtask,thetabofeachindividual
fractionationsummarizesthedosedataforthefractionationinthe
activecourse,includingtheMUvaluesforfieldsincludedinandthe
doseforthereferencepointsdefinedforthefractionation.Information
inthistabcannotbemodified.
IntheExternalBeamPlanningtask,youcanmonitorthefollowingfor
individualfractionations:
Fieldsincludedinthefractionation.
Numberofmonitorunits(MUs)foreachfield.
CoefficientMU/GyindicatinghowmanyMUscompriseoneGyat
theprimaryreferencepointforthefield.
Referencepointsincludedinthefractionation.
Thecelloftheprimaryreferencepointismarkedwithayellow
frame.
Fieldspecificdosedataforthereferencepoints:contributionof
onefieldinonefractionatthepoint,doseperfractioninthe
fractionationandtotaldose.
Ifthetotaldosecontributedbythefractionationsincludedinthe
totaldoseexceedsthetotaldoseofareferencepoint,thePlanned
TotalDoseinthecolumnofthereferencepointismarkedwitha
redframe.
Referencedose(Gy)ofthefieldatthedepthofdosemaximum
(dmax)onthefieldcentralaxis.
Modifying Information in the Plan Organizer

Ingeneral,youcanmodifytheinformationingreentablecells.To
modifytheinformation,clickthecelltoactivateitandtheneithertype
thenewinformationorselectitfromalistboxthatappears.

A.Clickacellandtypeavalueinthecell.B.Clickacell,clickthedownarrowthatappearsand
thenselectavaluefromthelistbox.C.VolumeIDofthereferencepoint.
Figure 66 Modifying Information in the Plan Organizer
To Prescribe the Dose in the Plan Organizer

Note: TheMUsarenotavailablefortreatmentiftheprimaryreferencepoint
hasnotbeendefined.
1. ChoosePlanning >PlanOrganizer.
ThePlanOrganizeropens.
2. Tochangethedoseorfractionationsettings,gototheAllPlanstab,
clicktheappropriatecellinthetableandtypethenewvalueinthe
cell.
3. Toincludeaplaninthetotalsum,gototheRef.Pointstaband
selectthecorrespondingcheckbox.
YoucanalsodefinethedoseontheDosetabofthePlanPropertiesdialog
boxwhereyoucangiveprescribeddose/fraction,prescribeddose
percentageandnumberoffractionsfortheplan.
To Add Fractionations to Plans

1. IntheAllPlansorRef.PointstabofthePlanOrganizer,clickthe
rowoftheplantowhichtoaddanewfractionation.
2. ClickAddFractionation.
Anewrowisdisplayedinthefractionationcolumns.

To Delete Fractionations from Plans
1. IntheAllPlansorRef.PointstabofthePlanOrganizer,clickthe
rowofthefractionationtoremove.
2. ClickDeleteFractionation.
About Defining the Primary Reference Point in the Plan Organizer

IntheExternalBeamPlanningtask,theprimaryreferencepoint
specifiesthedosespecifictoeachfield.Youcandeterminewhichofthe
referencepointscontainedinaplanisusedastheprimaryreference
point.Theprimaryreferencepointismarkedwithayellowframein
thePlanOrganizer.TheMUsarecalculatedfortheprimaryreference
point.Itisalsousedinplannormalization,andinthesystemto
indicatetheamountofdosereceivedandtotriggerbreakpointsinthe
treatment.
Formoreinformationaboutreferencepoints,seeChapter 13,
ReferencePointsandReferenceLines,onpage 437.
To Define the Primary Reference Point in the Plan Organizer
2. ClickthePointcellattherowofthedesiredplanandselectthe
primaryreferencepointfromthelistboxthatopens.
YoucanalsoclickEdit Reference Pointsanddefinetheprimaryreference
pointintheReferencePointsdialogbox.IntheExternalBeamPlanning
taskyoucanalsogototheDosePrescriptiontaboftheInfowindowand
definetheprimaryreferencepointthere.
To Evaluate the Planned Dose for the Reference Points
Youcanevaluatetheplanneddoseperfractionateachreferencepoint
forselectedplansinthePlanOrganizer.
2. SelecttheRef.Pointstab.

3. IntheInTotalcolumn,selectthecheckboxforeachplanto
includeintheplannedtotaldose.
Thedoseatthereferencepointsintheincludedplansisdisplayed
intheTotalDoserow.
4. ClickClosetoclosethedialogbox.
Managing Courses
Acourserepresentsthecourseoftreatmentthatapatientwillbegiven.
Everypatientmusthaveacourse,andallplansalwaysbelongtoa
course.Thecoursedescribestheintentandstatusofthetreatment.
Onecoursemaycontainseveralplans,bothapprovedand
unapproved,includingtheirfractionationschemes.Thiswaycourses
canbeusedtogatherupplansthatrepresentdifferentphasesof
treatmentforapatient.
Note: Whenstartingtocreateaplanforapatient,checkwhethertheselected
patienthasanycourses.Ifthepatienthasacourse,checkwhethertheycanbe
used.Forinstance,ifthesamepatienthasbeengivenadifferentdiagnosisthan
before,youneedtocreateanewcourse.Moreover,checkwhichofthecourses
havealreadybeenapprovedfortreatment,ifany.
To Create a New Course

1. ChooseInsert >NewCourse.
TheCoursePropertiesdialogboxopens.
2. Definethecourseproperties.
IntheIDtextbox,adefaultidentificationcodeisdisplayed.If
necessary,typeanewcodeforthecourse.
IntheIntentdropdownlist,selectthepurposeofthecourse.
IntheStarttextbox,typethedateforstartingthetreatment.
3. ClickOKtoaddthecoursetotheContextwindow.
Continuebyaddingaplantothecourse.Forinstructions,seeCreating
NewPlansonpage 263.

To Open a Course
1. ChooseFile >Open.
TheObjectExploreropens.
2. Intheleftlistbox,selectthecourse.
Toopenthecourseandallplansunderit,clickOK.
TheContextwindowdisplaysthecourseandallplans.
Toopenthecourseandaparticularplan,selecttheplaninthe
righthandlistboxandclickOK.
TheContextwindowdisplaysthecourseandtheselectedplan.
Continuebyaddingaplantothecourse.Forinstructions,seeCreating
NewPlansonpage 263.
To Modify Courses
1. IntheScopewindow,selectthecourse.
TheCoursePropertiesdialogboxopens.
3. Modifythepropertiesasnecessary:
IntheIDtextbox,typeanewcodeforthecourse,ifnecessary.
IntheIntentdropdownlist,selectthepurposeofthecourse.
IntheStatusdropdownlist,selectthestatusofthecourse.
IntheStarttextbox,modifythedateforstartingthetreatment.
4. ClickOKtomodifythecourseproperties.
Managing Diagnoses
YoucanaddnewdiagnosesbychoosingInsert >NewDiagnosis.You
thendefinethediagnosisparametersintheDiagnosisProperties
dialogbox.Diagnosesarealsoeditedinthisdialogbox.Youcanalso
attachdiagnosestocoursesintheDiagnosistaboftheCourse

Re-Planning
Insometreatmentplanningcases,itmaybecomenecessarytoedit
existingplanstoreflectchangesduringthepatienttreatment.These
casesincludeplansthatoriginateoutsideEclipsebutarebroughtin
forvolumetricdosecalculation,plansapprovedfortreatmentin
Eclipsethatneedmodificationsduringtreatment,andplansbasedon
4Dimagedatathatrepresentdifferenttimephasesinpatientmotion,
suchasrespirationmotions.
Re-Planning of Approved Plans

Sometimesitmaybenecessarytomakechangesinaplanafterthe
planhasbeenTreatmentApproved,andpatienttreatmenthasalready
beenstarted.Tomakechangestoanapprovedplan(withPlanning
ApprovedorTreatmentApprovedstatus),youcanmakeanewcopy
oftheapprovedplanandeditthecopy.Usingplancopiesisalsoa
goodwayofdistinguishingdosimetricchangesfrompatientsetup
changes.
Thefollowingaretypicalcaseswherepostapprovalchangesmaybe
neededinatreatmentplan:
ApprovedplansoriginatingfromEclipse:Ifthemodificationsrequired
fortheplanaffectthedosimetry,thevolumetricdosemustbe
recalculatedandtheplanreevaluatedinEclipse.
Approvedplansoriginatingfroma2Dplanningapplication,suchasRT
Chart:PlanningiscontinuedinEclipsetoacquirevolumetricdose.
Inthiscase,inadditiontocreatingtheplancopy,thecopymustbe
linkedtoa3DimageinEclipse,tobeabletoperformvolumetric
dosecalculation.Or,ifplanningiscontinuedintheIRREG
Planningtask,areferenceimagemaybeconnectedtotheplan.
Note: IftheplanhasbeenTreatmentApprovedbuttheactualpatienttreatment
hasnotyetbeenstarted,youcanalsomakemodificationstotheplaninEclipse
byopeningtheplanandchangingthestatusoftheplantoUnapproved.
Note: Ifthemodificationsdonotrequirerecalculationofthevolumetricdose,
theplancanbemodifiedoutsideEclipse(forinstance,inRTChart).For
informationonwhatcanbemodified,seePlanApprovalStatuseson
page 705.

InARIAapplications,itisalsopossibletocreatenewrevisionsofplans
inthedatabase.Formoreinformationoncreatingnewplanrevisions,
refertoRTChartReferenceGuide.Newplanrevisionsareexactcopies
oftheoriginalplans,andtheyautomaticallyhavetheUnapproved
status.TheserevisionscanbeopenedandusedinEclipseexactlythe
samewayasanyotherplans.Planrevisionscanbeidentifiedbasedon
theirplanID.TheplanIDofaplanrevisionconsistsoftwoparts
separatedbyacolon,forinstance,Prostate:1,inwhichProstateisthe
planIDoftheoriginalplan,:1marksthecopy.PlanIDsarefreely
modifiable,butitisrecommendedtouseacolonintheIDtoindicatea
planrevision.Ifthepurposeistocreateacompletelynewplanfrom
therevision,itshouldalsobecompletelyrenamedtoavoidconfusion.
Associating Plans with 3D Images

CalculatingthevolumetricdoseforaplanispossibleinEclipseonlyif
theplanhasastructuresetanda3Dimageattachedtoit.Inthecaseof
aplanoriginatingfroma2Dplanningapplication,suchasRTChart,
no3Dimageisnormallyattachedtoit,whichmeansthatthismustbe
doneinEclipse.Thiscanbedonebyeithercopyingtheplantoa3D
imageorattachingadifferent3Dimagetotheplan.
Copying and Pasting Plans between 3D Images
Planscanbecopiedandpastedtoany3Dimageimportedtothe
database.Thisispossibleregardlessofwhethertheplanisalready
assignedtoastructuresetanda3Dimageornot.Iftheplanislinked
toa3Dimage,thisoriginalimageandtheotherimagemustbe
registeredwitheachotherorhavethesameimagesizeandresolution.
Iftheimagesareregistered,theisocenterintheplantobepastedwill
beplacedtothecorrectlocationinthenew3Dimage.Forinstructions
oncopyingandpastingplans,seeCopyingandPastingPlans
between3DImagesintheExternalBeamPlanningTaskonpage 269.
Assigning Patient Images and Structure Sets

to Plans and Plan Copies
Differentpatientimages,including3Dimagesinthedatabaseandthe
structuresetsthatrefertothem,canbeattachedtoaplan.Iftheplan
originatesfromoutsideEclipse,forinstance,fromRTChart,no
isocentermaybepresentintheplan.Whenassigninganimagetoa

plan,Eclipsetriestofindisocentersintheplan.Ifisocentersarefound,
theyremainintheircorrectlocations.Ifisocentersarenotfound,the
fieldisocentersareplacedintheplanbasedonthecouchpositiondata
foundinthefieldsasfollows:
NocouchpositionfoundintheplanIsocenterpositionsofallfields
areplacedtotheimageoriginintheplancopy.
CouchpositionfoundintheplanIsocenterpositionofthefirstfield
isplacedtotheimageorigin.Ifotherfieldshavedifferentisocenter
positions,theyaredefinedinrelationtotheisocenterofthefirst
field.
IftheplancontainsDRRimagescreatedintheEclipseFieldSetup
workspace,theyareautomaticallyrecalculatedwhenthe3Dimageis
changed.ImportedDRRimagesremainastheywereimported.Any
MUvaluesfoundintheplanarecleared,and,ifnotfound,the
primaryreferencepointiscreated(withoutreferencepointlocation).
Allfieldweightvaluesaresetto1,andtheSSDisrecalculatedfor
eachfield.
To Assign a Patient Image and a Structure Set to a Plan
1. Opentheplan.
2. IntheScopeorFocuswindow,rightclicktheplanandchoose
AssignStructureSet.
TheObjectExploreropens,andyoucanselecttheappropriate
structureset.Ifthepatienthasonlyone3Dimage,itopensinthe
imageviews.Thefieldisocentersareplacedtotheimageorigin
dependingonthecouchpositionfoundintheplan.
3. Savetheplan.
Continuebydefiningthefieldgeometryanddoseinformationas
necessary.
Associating Fields with Field Images

Fieldimagesare2Dimagescreatedinthesimulator(including
digitizedfilmimages),DRRimagescreatedinEclipse,orportal
imagescreatedinconnectionwiththepatienttreatment.Eachfieldcan
havemultiplefieldimages,forinstance,oneDRRandonesimulator
image,ofwhichonecanbemarkedasthereferenceimage.The

referenceimagecanbeusedlaterinthetreatmentprocessin,for
instance,4DConsoleandOfflineReviewforcomparingportalimages
withthereferenceimage.
YoucanaddoneorseveralfieldimagestoafieldinEclipse.First,the
imagestobeaddedmustbeimportedandsavedtothedatabase.After
addingafieldimage,youusethefieldimagealignmenttooltoplace
theimagecorrectlyinrelationtothefield.
Therearesomerestrictionsastowhichimagescanbeusedasfield
images.TheimagesmustbeRTimages(projectionimages,suchas
simulationorportalimages),andtheymustbescaledbeforeadding
themtofields.
Note: IfyouusetheVidarscannertoscanimages,defineboththeSADandthe
SIDvaluesfortheimagestoachievecorrectscanresults.
To Add Field Images
1. Opentheplan.
2. IntheScopeorFocuswindow,rightclickthefieldtowhichyou
wishtoaddafieldimageandchooseAddFieldImage.
TheObjectExploreropens,andyoucanselecttheappropriate
image.
3. SelecttheimageandclickOK.
To Align Field Images in the External Beam Planning Task
1. IntheFocuswindow,selectthefieldthatcontainsthefield
image(s)tobealigned.
2. IntheFocuswindow,selectthevisibilitycheckboxofthefield
imagetobealigned.
3. ChooseEdit >AlignImagetoFieldCAX.
TheAlignImagetoFieldCAXdialogboxopens,showingthe
currentlocationofthefieldimage.Thefieldgraticuleisshownin
theBEV.Themousepointerchangestothealignmenttool.
4. IftheimageSADvalueismissing,enterthecorrectvalueinthe
dialogbox.

Tomovethefield,placethemouseinsidethealignmentcircle
anddrag,orclickinsidethecircletomovethefield.
Torotatethefield,placethemouseoutsidethealignmentcircle
anddrag.
A.Tomovethefield,placethemouseinsidethecircleanddrag.B.Torotatethefield,placethe
mouseoutsidethecircleanddrag.
Thepositionofthefieldimageisupdatedinthedialogbox.
6. Whenthefieldimageispositionedasdesired,clickOK.
7. Iftherearemorefieldimages,repeatsteps15foreachimage.
To Show Field Images in the 3D View
IntheFocuswindow,selectthevisibilitycheckboxofthefield
imagetobeshown.
TheselectedfieldimageisshownintheModelviewortheBEV,
dependingonwhichviewisactive.

To Select the Reference Image of a Field in
1. IntheFocuswindow,rightclickthefieldimage(DRRorRT
image)thatyouwishtodefineasthereferenceimageofthefield
andchooseSetImageasReferenceImage.
TheAlignImagetoFieldCAXdialogboxopens,showingthe
currentlocationofthefieldimage.Thefieldgraticuleisshownin
theBEV.Themousepointerchangestothealignmenttool.
2. Verifythefieldalignment,andifnecessary,dragthefieldgraticule
tothedesiredposition.
Thepositionofthefieldimageisupdatedinthedialogbox.
3. Whenthefieldimageispositionedasdesired,clickOK.
Thefieldimageisdefinedasthefieldreferenceimage.The
referenceimageisshownontheReferenceImagetaboftheField
Propertiesdialogbox.IntheFocuswindow,theimageicon
changestoindicatethattheimageisthereferenceimage.
Ifyoumovethefieldafterselectingandaligningthereferenceimage,you
needtorealigntheimagemanually.
Copying Structure Sets between 3D Images

Youcancopytheentirestructureset(allstructures,includingbolus)
froma3Dimageandpastethemtoanother3Dimage.Thisisuseful
forcopyinginitialstructuresegmentsbetweenasetof3Dimages
representing,forexample,thepatientrespiratorycycle.
Tobeabletocopyandpastethestructures,theimagesmustbe
registered.Forinstructionsonregisteringimages,seeChapter 6,
ImageRegistration,onpage 145.
To Copy Structure Sets from One 3D Image to Another
1. IntheContouringworkspace,opentwoormore3Dimages.
2. IntheFocuswindow,selectthe3Dimagethatcontainsthe
structuresettobecopied.
3. RightclickthestructuresetandchooseCopyallStructures.

IntheScopeorFocuswindow,selectthe3Dimagetowhich
youwishtopastethestructures.
Topastethestructurestoall3Dimagesina4Dimage,selecta
ChooseEdit >PasteStructures.
copiedstructurestoall3Dimagesinthe4Dimage.
Thestructuresarepastedtotheselected3Dimage.Ifasegmented
structurewithmatchingpatientvolumealreadyexistsinthetarget
image,youarepromptedtoselectwhetheryouwanttoreplaceit
withthecopiedstructure.Ifthematchingstructureisempty,itis
overwritten.
6. Visuallyverifyallcopiedandpastedstructuresandcorrectthem
wherenecessary.
Ifthestructuresetcontainsabolus,andifthe3Dimagetowhichyou
pastethestructuresetalreadyhasthebodystructuredefined,thebolus
maynotbepastedtothecorrectposition.
Copying Reference Point Locations between 3D Images

Referencepointsandreferencepointlocationscanalsobecopiedand
pastedbetweentworegistered3Dimages.Thisisusefulforcopying
initialreferencepointlocationsbetweenasetof3Dimages
representing,forexample,thepatientrespirationcycle.
To Copy Reference Points from One 3D Image to Another
1. IntheFieldSetuporContouringworkspace,opentwoormore3D
images.
Tobeabletocopyreferencepointlocations,theimagesmustberegistered.
2. Iftheimagesarenotregistered,gototheRegistrationworkspace
andregistertheimages.Forinstructions,seeChapter 6,Image
Registration,onpage 145.

3. IntheScopewindow,selectthe3Dimagethatcontainsthe
referencepointlocationsyouwishtocopy.
4. ChooseEdit >Copy >ReferencePointLocations.
5. Toshowthe3Dimagetowhichthepointswillbecopied,dragit
fromtheScopewindowtotheimageviews.
6. ChooseEdit >PasteReferencePointLocations.
Thereferencepointlocationsarepastedtotheactive3Dimage.Ifa
locationwithmatchingreferencepointalreadyexistsinthetarget
image,thelocationisskipped.

Chapter 10 Templates and Clinical Protocols
Contouring Workspace, Field Setup Workspace
Thischapterprovidesinformationonindividualtemplatesused
regularlyinthetreatmentplanningprocessandintroducesthe
conceptofclinicalprotocol.Clinicalprotocolguidesthetreatment
planningprocesswithpredefinedvalues,thusspeedingupthe
treatmentplanningandeasingtheworkloadofphysiciansand
physicistsintypicaltreatments.
About Templates
Templatesarecollectionsofstructures,objectivesandplanproperties
thatcanbeusedtocreatenewobjectsthatautomaticallypossessthe
propertiessavedinthetemplate,suchasnewplans.Withtemplates
youcansimplifythetreatmentplanningprocessbynothavingto
definethesepropertiesseparatelyforeachcreatedobject.Templates
thatyoucreateareavailabletootherusersofthesystemandprovide
defaultsettingsfortheobjectscreatedbasedonthetemplates.Eclipse
providesyouwithstructuretemplates,objectivetemplatesandplan
templates.
Allusershaverightstoviewtemplates.Dependingonyouruser
rights,youcanalsoedit,approveanddeletetemplates.Ingeneral,if
youhave,forexample,rightstomodifyorapproveplans,youhavethe
samerightsforallitemsundertheplans.Thisdocumentassumesthat
theuserhasfullrights.Formoreinformationonuserrights,referto
OSPApplicationsReferenceGuide.
Structure Templates
Astructuretemplatestoresstructureinformation,suchasthetypeofthe
structurevolumeorthecolorandstyleusedindisplayingthe
structure.Individualstructuretemplatesalwaysbelongtoastructure
templategroup.
285
Astructuretemplategroupconsistsofagroupofindividualstructure
templates.Structuretemplatesstorestructureinformation,for
example,thestructurevolumetypeandcode,thecolorandstyleofthe
structure,theDVHlinecolor,styleandwidthusedtodescribethe
structure,andthesearchingoptionsforthestructure(upperandlower
CTpixelvalues).
Structuretemplatescanalsocontainlayers.Layersareuserdefined
linesonaplanethatareusedastechnicalaids.Layersinclude,for
example,referencelinesandmarkers.
Whencreatingstructuresfromastructuretemplategroup,youfirst
opentheimageorstructuresettowhichyouwanttocreatethe
structures.Thenyoufindthedesiredstructuretemplategroup,select
thestructurestocreateandsegmentthecreatedstructures.
Plan Templates
Aplantemplateisacollectionofstandardplancharacteristics.When
usingatemplatetocreateaplanforapatient,thenewplanisbasedon
theinformationstoredinthetemplate.
IntheExternalBeamPlanningtask,theseplancharacteristicsinclude
informationaboutfieldgeometrysettings,treatmentunitandenergy
modeselection,theuseofwedges,multileafcollimators,blocksand
otheraddons,DRRimagesandfieldalignmentrules.
Whencreatingaplanfromaplantemplate,youfirstfindthedesired
plantemplate.Then,intheExternalBeamPlanningtask,letthe
programcreatetheplanfromtheselectedtemplateandsetupthefield
geometry,fieldmodifiersanddoseprescriptiontotheplan.
Physicians Intent in Plan Templates
Aphysiciansintentisawayofcommunicatingdoseprescription
informationfromARIAapplicationstoEclipse.Usingaphysicians
intentallowsthedefinitionofthedoseprescriptionforthetarget,for

instance,bytheoncologistinRTChartbeforestartingtreatment
planninginEclipse.Thephysiciansintentisdefinedforthepatients
course,and,ifrequired,onecoursecancontainseveralphysicians
intents.
Note: Itisnotpossibletoattachaclinicalprotocoltoacoursethathasthe
physiciansintentdefined.
InEclipse,youcanbaseyourplansonphysiciansintentsdefinedin
RTChartbyaddinganewplanusingatemplateorwithoutatemplate
andthenselectingthecoursethathasaphysiciansintentdefined.This
connectsthecreatedplantothephysiciansintent.
Thephysiciansintenticon isshownintheContextwindowunder
thecoursetowhichithasbeendefined.
Thefollowinginformationistransferredfromaphysiciansintenttoa
newplaninEclipse:
Numberoffractions
Prescribeddoseperfraction
Fractionsperday
Fractionsperweek
Energymodeforeveryfield,ifamatchingmodecanbefoundfor
theselectedtreatmentunit.Thisinformationistransferredonly
whentheplaniscreatedusingatemplate.
Objective Templates
Anobjectivetemplatecontainspredefineddosevolumeobjectivesto
specifytheoptimizationobjectivesofaplan.Theoptimization
objectivesaredefinedbyspecifyingtheobjectivetype(pointorline),
thestructuretowhichtheobjectivelimitsthedose,thedoselimit
(upperorlower),percentageofthestructurevolumetobereceiving
thedose,theintendeddose,andthepriorityfortheobjective.
Templates and Clinical Protocols 287

IntheExternalBeamPlanningtask,ifyouhavemanuallydefined
objectivesforaplanandthendecidetoloadanobjectivetemplateto
theplan,theobjectivevaluesstoredinthetemplateoverridethe
manuallydefinedobjectivevalues.
Note: Inadditiontooptimizationobjectivesthatareusedforanexistingplan,
thereareplanobjectivesthatarepartofaclinicalprotocol.Formore
informationonplanobjectives,seePlanObjectivesinClinicalProtocolson
page 325.
Template Managers
Templatescanbemanagedintemplatemanagers.Structuretemplates
canalsobecreatedintheStructureTemplateManager.Eachtemplate
typehasitsownmanager:StructureTemplateManager,Objective
TemplateManagerandPlanTemplateManager.
TemplatesarestoredinaserverdirectoryinXMLformat.
Note: Sincethetemplatesarestoredinaserverdirectory,theyarenotincluded
indatabasebackups.Tohaveyourtemplatesbackedup,youcanexportthem
onebyoneorcopythedirectorytoadesiredlocation.
Structure Template Manager
TheStructureTemplateManagerdisplaysstructuretemplategroups
aswellastheindividualstructuretemplatesoftheselectedstructure
templategroup.Forastructuretemplategroup,themanagerdisplays
theidentification,approvalstatus,theusersassignedtothetemplate
group,thepossiblediagnosis,treatmentsiteanddescription.Forthe
individualstructuretemplates,themanagerdisplaysthe
identification,structuretype,volumetype,andthecolorandstyleof
thestructure.
YoucansortanycolumnoftheStructureTemplateManagerby
clickingthecolumnheader.Youcancreate,edit,duplicate,delete,
preview,importandexportstructuretemplategroupsintheStructure
TemplateManager.Youcanalsocreatenewstructuresandlayers,and
editanddeleteindividualstructuretemplatesoftheselectedstructure
templategroup.

A.Theapprovalstatusofthedisplayedstructuretemplategroups.B.Typethesearchwordsfor
filteringstructuretemplategroups.C.Theselectedstructuretemplategroup.D.Theindividual
structuretemplatesoftheselectedstructuretemplategroup.E.Actionsavailablefortheselected
individualstructuretemplate.F1andF2.Actionsavailablefortheselectedstructuretemplate
group.
Figure 67 Structure Template Manager
Structure Template Group Properties

TheStructureTemplateGroupPropertiesdialogboxcontainsthe
followinginformation:
AuniqueidentificationforthestructuretemplategroupintheID
textbox.
AdiagnosiscodeorashorttextintheDiagnosistextbox.This
informationisoptional.
TheareatotreatintheTreatmentsitedropdownlist.This
NamesoftheuserstypicallyusingthetemplateintheAssigned
userstextbox.Thisinformationisoptional.

Ashortdescriptionofthestructuretemplategroupinthe
Descriptiontextbox.Thisinformationisoptional.
Youcanusetheinformationineachoftheabovebulletsforfiltering
structuretemplategroupsintheStructureTemplateManager.Formore
informationonfiltering,seeSearchingTemplatesandClinical
Protocolsonpage 358.
TheapprovalstatusofthestructuretemplategroupintheStatus
dropdownlist.
TheHistorytextboxdisplaysinformationontheapprovalstatus
actionsdoneearliertothestructuretemplategroup.
Plan Template Manager
ThePlanTemplateManagerdisplaysplantemplates.Foraplan
template,themanagerdisplaystheidentification,approvalstatus,the
usersassignedtothetemplate,thepossiblediagnosisandtreatment
site,theenergymodeoftheplan,andthetreatmentstyle.A
descriptionoftheselectedplantemplateisshownonthebottomofthe
PlanTemplateManager.
YoucansortanycolumnofthePlanTemplateManagerbyclickingthe
columnheader.Youcanedit,duplicate,delete,preview,importand
exportplantemplatesinthePlanTemplateManager.
A.Theapprovalstatusofthedisplayedplantemplates.B.Typethesearchwordsforfilteringplantemplates.
C.Theselectedplantemplate.D.Informationontheselectedplantemplate.E1andE2.Actionsavailableforthe
selectedplantemplate.
Figure 68 Plan Template Manager

Plan Template Properties
ThePlanTemplatePropertiesdialogboxcontainsthefollowing
information:
AuniqueidentificationfortheplantemplateintheIDtextbox.
AshortdescriptionoftheplantemplateintheDescriptiontext
box.Thisinformationisoptional.
Youcanusetheinformationineachoftheabovebulletsforfilteringplan
templatesinthePlanTemplateManager.Formoreinformationon
filtering,seeSearchingTemplatesandClinicalProtocolsonpage 358.
TheapprovalstatusoftheplantemplateintheStatusdropdown
list.
actionsdoneearliertotheplantemplate.
Objective Template Manager
TheObjectiveTemplateManagerdisplaystheobjectivetemplatesas
wellastheindividualobjectivesofaselectedobjectivetemplate.For
anobjectivetemplate,themanagerdisplaystheidentification,
approvalstatus,theusersassignedtothetemplate,thepossible
diagnosis,treatmentsiteanddescription.
Theobjectivesoftheselectedobjectivetemplatearedisplayedbothin
numericandgraphicform.Inadditiontomodifyingtheobjectivesin
thenumericform,youcanmodifytheminthegraphwiththemouse.

Fortheobjectives,themanagerdisplays:
theobjectivetype(pointorline)andcolor
thestructuretowhichtheobjectivelimitsthedose
thedoselimit(upperorlower)
thepercentageofthestructurevolumetobereceivingthedose
theintendeddose
thepriorityfortheobjective.
Inthegraphicform,thelinetypeobjectivesareillustratedwithsmall
squares,andthepointtypeobjectivesareillustratedwithsmall
arrowheads.
Anobjectivehasanarbitrarycolorintheobjectivetemplate.Whenthe
objectiveisaddedtoaplan,theobjectivecolorchangestothecolorof
thestructuretowhichtheobjectivelimitsthedose.
YoucansortanycolumnoftheObjectiveTemplateManagerby
clickingthecolumnheader.Youcanedit,duplicate,delete,preview,
importandexportobjectivetemplatesintheObjectiveTemplate
Manager.Youcanalsoaddandremovesingleobjectives.
EvenifyoucanseetheobjectivesmeantfortheBrachytherapy
Planningtask,youcannotusethemintheExternalBeamPlanning
task,andviceversa.
InadditiontotheObjectiveTemplateManager,intheExternalBeam
PlanningtasktheobjectivescanalsobeaccessedfromtheOptimizer
dialogbox(seeChapter 14,DoseVolumeOptimization,on
page 449).

A.Theapprovalstatusofthedisplayedobjectivetemplates.B.Typethesearchwordsforfilteringobjective
templates.C.Theselectedobjectivetemplate.D.Theobjectivesoftheselectedobjectivetemplate.E.Clickhere
toaddanewobjective.F.Clickheretoremovetheobjective.G.Clickthedownpointingarrowheadtoopenthe
dropdownmenuforselectinganaction.H.Thegraphicrepresentationoftheobjectivesintheselectedobjective
template.Youcanmodifytheobjectiveswiththemouse.I1andI2.Actionsavailablefortheselectedobjective
template.
Figure 69 Objective Template Manager
Objective Template Group Properties
IntheExternalBeamPlanningtask,theObjectiveTemplateGroup
Propertiesdialogboxcontainsthefollowingtabs:General,Normal
TissueObjective,GEOSandIMRT.

TheGeneraltabcontainsthefollowinginformation:
AuniqueidentificationfortheobjectivetemplategroupintheID
textbox.
Ashortdescriptionoftheobjectivetemplategroupinthe
Descriptiontextbox.Thisinformationisoptional.
Youcanusetheinformationineachoftheabovebulletsforfiltering
objectivetemplategroupsintheObjectiveTemplateManager.Formore
informationonfiltering,seeSearchingTemplatesandClinical
Protocolsonpage 358.
TheapprovalstatusoftheobjectivetemplategroupintheStatus
dropdownlist.
actionsdoneearliertotheobjectivetemplategroup.
TheIMRTtabcontainsthefollowinginformation:
Thedefaultsmoothingvalues.Ahighervaluesmoothesmorethan
alowvalue.
Thedefaultdoseminimization.Ahighervalueminimizesthedose
morethanalowvalue.
Thedefaultoptimizationtype.TheavailabletypesareBeamlet,
FieldweightandNone.
Informationwhetherthefixedcollimatorjawsareusedinthe
treatmentornot.
Themaximumnumberofiterationsatwhichpointthe
optimizationprocessisterminated.
Themaximumtimelimitinminutesafterwhichtheoptimization
isstoppedevenifthemaximumnumberofiterationsisnot
reached.
Informationonhowthefieldfluenceisdisplayed.Theavailable
optionsareUsecolorsandInterpolate.
FormoreinformationonthedefaultvaluesfortheDoseVolume
Optimizer,seeChapter 14,DoseVolumeOptimization,onpage 449.

TheNormalTissueObjectivetabcontainsthefollowinginformation:
UseNormalTissueObjectiveTakestheNormalTissueObjective
intouseorremovesitfromuse
PriorityDeterminestherelativeimportanceoftheNormalTissue
Objectiveinrelationtootheroptimizationobjectives.
DistancefromtargetborderDeterminestheareawherethe
NormalTissueObjectivevaluemustbeconstant.
StartdoseDeterminestherelativedoselevelintheNormal
TissueObjectiveintheareaatthePTVborder.
EnddoseDeterminestherelativedoselevelintheNormalTissue
ObjectiveintheareafurthestawayfromPTVborder.
FalloffDeterminesthesteepnessoftheNormalTissueObjective
curveshape.
FormoreinformationontheNormalTissueObjectiveanditsdefault
values,seeChapter 14,DoseVolumeOptimization,onpage 449or
Chapter 12,BeamAngleOptimization,onpage 423.
TheGEOStabcontainsthefollowinginformation:
InitialfielddistributionDefineswhethertheinitialfield
distributionfortheglobaloptimizationiscoplanaror
noncoplanar.
MinimumnumberoffieldsDefinesthelowestnumberfieldsin
thefieldgeometrycreatedbytheglobaloptimization.
MaximumnumberoffieldsDefinesthehighestnumberfieldsin
thefieldgeometrycreatedbytheglobaloptimization.
MaximumelevationanglefornoncoplanarfieldsControlsthe
maximumelevationfromthecoplanarplaneincasea
noncoplanarinitialfielddistributionisbeingused.
MaximumcollimatorvariationControlshowmuchthe
collimatoranglevaluesareallowedtovaryfromonefieldtothe
closestneighboringfieldintheinitialfielddistribution.
LocalgeometricoptimizationmodeSetsthemodeforthelocal
optimization.
FormoreinformationonthedefaultvaluesfortheBeamAngle
Optimization,seeChapter 12,BeamAngleOptimization,onpage 423.

Creating Templates
IntheExternalBeamPlanningtask,youcancreatealltemplatesinthe
FieldSetupworkspace.Inaddition,youcancreatestructuretemplate
groupsandstructuretemplatesintheContouringworkspace.
Creating Structure Template Groups and Structure Templates

Youcancreatenewstructuretemplategroupsandaddnewstructure
templatesinthembyusingtheStructureTemplateManager.In
addition,youcancreateastructuretemplategroupbasedon
structurescreatedinapatientimage,orduplicateastructuretemplate
group.
To Create a Structure Template Group and a Structure

Template from the Structure Template Manager
Contouringworkspace:ChooseContouring >Templates >
StructureTemplateManager.
FieldSetupworkspace:ChoosePlanning >Templatesand
ClinicalProtocols >StructureTemplateManager.
TheStructureTemplateManageropens.
2. ClickCreate.
TheStructureTemplateGroupPropertiesdialogboxopens.
3. FillinthenecessaryinformationandclickOK.Formore
informationonthecontentsofthedialogbox,seeStructure
TemplateGroupPropertiesonpage 291.
StructuretemplatesareautomaticallysavedwhenyouclickOK(selecting
SaveAlldoesnotaffectstructuretemplates).
4. Toaddastructuretemplatetothenewstructuretemplategroup:
a. ClickNewStructure.
TheStructureTemplatePropertiesdialogboxopens.
b. FillintherequiredinformationandclickOK.
ThenewstructuretemplateappearsintheStructure
Templatestable.

5. Toaddalayertothenewstructuretemplategroup:
a. ClickNewLayer.
TheLayerTemplatePropertiesdialogboxopens.
b. FillintherequiredinformationandclickOK.
ThenewlayerappearsintheStructureTemplatestable.
6. ToclosetheStructureTemplateManager,clickClose.
To Create a Structure Template Group from Image
1. Createanimageforthepatientoropenthedesiredpatientimage
andcreatestructurestotheimage.
CreateStructureTemplatefromImage.
ClinicalProtocols >CreateStructureTemplatefromImage.
TheStructureTemplateGroupPropertiesdialogboxopens.
3. FillinthenecessaryinformationandclickOK.Formore
informationonthecontentsofthedialogbox,seeStructure
StructuretemplatesareautomaticallysavedwhenyouclickOK(selecting
SaveAlldoesnotaffectstructuretemplates).
To Duplicate a Structure Template Group
2. TosearchforastructuretemplategroupintheStructureTemplate
Groupsgroupbox:

a. Selecttheapprovalstatusofthestructuretemplategroupyou
wanttofindfromthefirstdropdownlist.Youcanalsotypea
searchwordintheseconddropdownlist.
b. ClickSearch.
Thestructuretemplategroupsmatchingthesearchcriteriaare
displayedinthetable.Youcansortatablecolumnbyclickingthe
columnheader.
Formoreinformationondifferentsearchoptions,seeSearching
TemplatesandClinicalProtocolsonpage 358.
3. Selectthestructuretemplategrouptoduplicatefromthetable.
4. ClickDuplicate.
ThenewstructuretemplategroupappearsintheStructure
TemplateManager.Thenameofthenewstructuretemplategroup
isappendedwiththe#characterandarunningnumber.
Youcanchangethenametoamoredescriptiveonebyeditingthenew
structuretemplategroup.
Creating Plan Templates

Aplantemplatestoresstandardplancharacteristics.Withplan
templates,youcanquicklycreatenewplansthatarebasedonexisting
plantemplates.
IntheExternalBeamPlanningtask,youcancreatenewplantemplates
intheFieldSetupworkspace.

Plan Geometry and Energy in Templates
for External Beam Plans
Inanewplanbasedonaplantemplate,thefieldgeometryisbasedon
theisocenterpositioning,whichyoucandefinewhilecreatinganew
planfromatemplate.Theisocentercanbeplacedasfollows:
Atfieldtargetmasscenter
Atimageorigin
Atimagecenter
Atviewingplaneintersection
Relativetofieldtargetmasscenter
Relativetoimageorigin
Relativetoimagecenter
Relativetoviewingplaneintersection
Whencreatingaplantemplatefromaplan,theisocenterisplaced
basedontheisocenterlocationintheoriginalplan.Youcanchangethe
placementoftheisocenterasneeded.Thedefaultisocenterpositions
inaplantemplatearethefollowing:
Iftheisocenterofafieldintheoriginalplanisattheimageorigin,
theisocenterisplacedattheimageoriginintheplantemplate.
Ifafieldintheoriginalplanisfittedtoastructure,theisocenteris
placedrelativetothefieldtargetmasscenterintheplantemplate.
Iftheoriginalplancontainsa3Dimage,theisocenterisplaced
relativetotheimagecenterintheplantemplate.
IfaconnectionbetweenanapertureblockoranMLCandastructure
hasbeensavedinthetemplate,theseaddonsarefittedtothe
structuredefinedfortheaddonsbydefault.Youcanalsoselectthefit
structureforeachaddonseparatelyordecidenottofitanyofthem.
Inoneofthestepsforcreatinganewplanonthebasisofaplan
template,selectthetreatmentunittouseforthenewplan.Ifthe
energyordoserateincludedinthetemplatehasnotbeenconfigured
fortheselectedtreatmentunit,theyarechangedtotheclosest
correspondingenergyanddoserate.
Note: Fieldsincludedinthetemplatebutnotallowedintheselectedtreatment
unitarenotverifiedduringthecreationoftheplan.Makesureyouverifythe
fieldgeometrysettingswhentheplaniscompleted.

To Create a Plan Template from a Plan in the
External Beam Planning Task
1. Createaplanandsaveit.
2. ChoosePlanning >TemplatesandClinicalProtocols >Create
PlanTemplatefromPlan.
TheCreatePlanTemplatewizardopens.
3. IntheGeneralgroupbox:
TypetheidentificationforthenewplantemplateintheIDtext
box.
Ifdesired,typethenamesoftheuserstypicallyusingthe
templateintheAssigneduserstextbox.
Selectthetreatmentstylefromtheappropriatedropdownlist.
Ifdesired,typeadiagnosiscodeofashorttextintheDiagnosis
textbox.
Ifdesired,selecttheareatotreatfromtheTreatmentsite
dropdownlist.
Youcanusetheinformationineachoftheabovebulletsforfilteringplan
templatesinthePlanTemplateManager.
4. IntheDescriptiontextbox,modifythedescriptionoftheplan
template,ifnecessary.
Noticethatalthoughyoucanchangetheinformationregardingthefield
geometryparametersintheDescriptiontextbox,theactualfieldsinthe
templatearenotaffected.Forinstance,thegantryanglesofthefieldsare
notchangedevenifyouedittheanglesintheDescriptiontextbox.
5. ClickNext.
6. IntheTemplateitemsgroupbox,selecttheitemstoincludeinthe
plantemplate.
7. InthePrescriptiongroupbox,selecttheIncludeprescriptiondata
checkbox,ifdesired.

8. ClickNext.
A.Selectaniteminthelist.B.Definehowtheselecteditemisplacedduringplancreation.
9. Todecidehowfieldsandaddonswillbeplacedduringplan
creation,selectaniteminthetable,clickthedownpointing
arrowheadthatappearsintheendoftherow,andselectthe
desiredoptionfromthedropdownlist.Formoreinformationon
theplacementoftheisocenter,seePlanGeometryandEnergyin
TemplatesforExternalBeamPlansonpage 301.
10. Whenthenewplantemplateisready,clickFinish.
11. Savethenewplantemplate.
Note: Iftheplanthatthenewplantemplateisbasedoncontainsfield
alignmentrulesorDRRimages,theinformationisalsostoredinthenewplan
template.
To Duplicate a Plan Template
1. ChoosePlanning >TemplatesandClinicalProtocols >Plan

TemplateManager.
ThePlanTemplateManageropens.
2. TosearchforaplantemplateinthePlanTemplatesgroupbox:

a. Selecttheapprovalstatusoftheplantemplateyouwanttofind
fromthefirstdropdownlist.Youcanalsotypeasearchword
intheseconddropdownlist.
b. ClickSearch.
Theplantemplatesmatchingthesearchcriteriaaredisplayedin
thetable.Youcansortanytablecolumnbyclickingthecolumn
header.
3. Selectthetemplatetoduplicatefromthetable.
4. ClickDuplicate.
ThenewplantemplateappearsinthePlanTemplateManager.The
nameofthenewplantemplateisappendedwiththe#character
andarunningnumber.
template.
5. Savethenewplantemplate.
Creating Objective Templates

InExternalBeamPlanningtask,objectivescanbemanagedinthe
ObjectiveTemplateManager(seeObjectiveTemplateManageron
page 293)orthroughtheoptimizationdialogboxes(seeChapter 14,
DoseVolumeOptimization,onpage 449,andChapter 12,Beam
AngleOptimization,onpage 423).
Youmusthaveoptimizationobjectivesdefinedintheplanbeforeyou
cancreateanobjectivetemplate.Formoreinformationondefining
planobjectivesinaplan,seeChapter 14,DoseVolume
Optimization,onpage 449.

To Create an Objective Template from an External Plan
Openanoptimizedplancontainingtheobjectivesyouwishto
saveintoanobjectivetemplateandthenchoosePlanning >
TemplatesandClinicalProtocols >CreateObjective
TemplatefromPlan.
Whileoptimizingaplan,intheoptimizationdialogbox,click
SaveObjectivestotheObjectiveLibrary .
TheObjectiveTemplateGroupPropertiesdialogboxopens.
2. FillinthenecessaryinformationintheGeneraltab.Formore
informationonthecontentsofthedialogbox,seeObjective
3. TosettheEclipseIMRT,selecttheIMRTtabandfillinthe
necessaryinformation.Formoreinformationonthecontentsofthe
dialogbox,seeObjectiveTemplateGroupPropertieson
page 295.
4. ClickOK.
ObjectivetemplatesareautomaticallysavedwhenyouclickOK
(selectingSaveAlldoesnotaffectobjectivetemplates).
To Duplicate an Objective Template
1. ChoosePlanning >TemplatesandClinicalProtocols >Objective

TemplateManager.
TheObjectiveTemplateManageropens.
2. TosearchforanobjectivetemplateintheObjectiveTemplates
groupbox:
a. Selecttheapprovalstatusoftheobjectivetemplateyouwantto
findfromthefirstdropdownlist.Youcanalsotypeasearch
wordintheseconddropdownlist.
b. ClickSearch.
Theobjectivetemplatesmatchingthesearchcriteriaaredisplayed
inthetable.Youcansortatablecolumnbyclickingthecolumn
header.

3. Selectthetemplatetoduplicatefromthetable.
4. ClickDuplicate.
ThenewobjectivetemplateappearsintheObjectiveTemplate
Manager.Thenameofthenewobjectivetemplateisappended
withthe#characterandarunningnumber.
template.
Using Templates to Create New Structures, Objectives

and Plans
IntheExternalBeamPlanningtask,youcanassignalltemplatesinthe
FieldSetupworkspace.Youcanalsoassignstructuretemplategroups
andstructuretemplatesintheContouringworkspace.
Structuretemplatesuseexistingpatientvolumes(seeChapter 7,
SectionAboutStructuresonpage 179andChapter 7,Section
PatientVolumesonpage 181).Whencreatingstructuresusinga
structuretemplate,Eclipsecheckswhetherpatientvolumesalready
existforthepatient,and,iffound,matchestheexistingpatient
volumeswiththoseusedinthetemplate.Aparticularsituation
affectedbythisuseofpatientvolumesischangingstructureIDsina
setupwheretwodifferentimagesetsandonestructuretemplateare
usedforaparticularpatient.Inthissituation,thestructureIDschange
forbothimagesetsbecausetheyarelinkedtotheinternalpatient
volumeIDs.Thisbehavioralsoaffectsreferencepoints,whichare
linkedtopatientvolumes.
Note: Alwaysvisuallyverifytheresultproducedbytemplates.

To Insert New Structures in an Image from a Structure Template
1. Openapatientandanimage.
2. ChooseInsert >NewStructuresfromTemplate.
TheStructureTemplateGroupSelectiondialogboxopens.
Ifyouopenapatientandanimagethatdoesnotcontainstructuresor
referencepointsandthenentertheContouringworkspace,Eclipse
promptsyoutoselectoneofthefollowingprocedures:Attachthepatient
toaclinicalprotocolandcreatestructures(andreferencepoints)fromthe
clinicalprotocoltemplate,createstructuresfromstructuretemplateor
createstructuresmanually.
Groupsgroupbox:
b. ClickSearch.
Thestructuretemplategroupsmatchingthesearchcriteriaare
displayedinthetable.Youcansortanytablecolumnbyclicking
thecolumnheader.
4. Selectthedesiredstructuretemplategroupfromthetable.
Thestructuretemplatesintheselectedstructuretemplategroup
aredisplayedontherightpanelofthedialogbox.
5. Selectthecheckboxesofthestructuretemplatesyouwanttouse
andclickSelect.
Theselectedstructuresarecreatedfromthetemplateand
displayedintheScopewindow.Ifaselectedstructurealready
existsintheplan,itisomittedandamessageisdisplayedstating
thatnotallstructurescouldbecreated.
Continuebysegmentingthecreatedstructures.

To Create a Plan Using a Plan Template in
YoucancreateaplanusingatemplateintheFieldSetupworkspace.
1. ChooseInsert >NewPlanfromTemplate.
2. Ifpromptedtodoso,selectthepatienttowhichtoconnectthenew
plan,andselectastructuresetforthenewplan.
Theimagesthestructuresetreferstoareopenedintheimage
viewsandtheSelectCoursedialogboxopens.
3. Selectacoursefortheplanorcreateanewcourse.
Toconnectthenewplantoanexistingcourse:Selectacoursefrom
theAvailablecourseslistbox.
Toconnectthenewplantoanewcourse:ClickNewCourse,fillin
thecourseinformationintheCoursePropertiesdialogboxthat
opens,andclickOK.
4. ClickNext.
5. Ifpromptedtodoso,selectaphysiciansintentfortheplan(this
willhappeniftheselectedcoursehasphysiciansintentsdefined
forit):
IntheAvailablephysiciansintentslistbox,selectthedesired
physiciansintentandclickNext.Youcanviewtheproperties
oftheselectedphysiciansintentinthePhysiciansintent
detailsgroupbox.
ThePlanTemplateSelectiondialogboxopens.
6. Tosearchforaplantemplate:
b. ClickSearch.
header.
7. Selectthedesiredtemplatefromthetable.

8. Ifdesired,clickPreviewtodisplaytheplantemplateinformation
inthebrowser.
9. ClickNext.
TheConfirmTreatmentUnitSelectiondialogboxopens.
10. FromtheTreatmentunitdropdownlist,selectatreatment
machinetouse.Thedefaultmachineistheoneusedintheplanon
whichthetemplateisbased.
Onlyonetreatmentunitissavedinaplantemplate.
11. ClickNext.
TheReviewPrescriptionParametersdialogboxopens.
12. InthePrescriptiongroupbox:
Typethenumberoffractionsintheappropriatetextbox.
Typethedoseperfractionintheappropriatetextbox.Thetotal
dosebasedonthetwogivenvaluesisdisplayed.
Typetheprescribeddosepercentageintheappropriatetext
box.
Typethenumberoffractionsperdayintheappropriatetext
box.
Typethenumberoffractionsperweekintheappropriatetext
box.
13. ClickNext.
TheReviewMatchingwithCurrentPatientModeldialogbox
opens.
14. Tochangetheplacementofanitem,clicktheappropriatecellin
thetable,clickthedownpointingarrowheadthatappearsinthe
endoftherow,andselectanewplacementfromthedropdown
list.
Toplaceallisocentersatthesamelocation,selectthedesired
locationfromtheIsocenterplacementdropdownlistand
clickSetAllIsocenters.
Toremoveallmodifications,clickResettoDefaults.
Changingtheplantargetvolumechangesthetargetforallfields,butdoes
notaffecttheirfitting.

15. Todefinehowtheaddonsarefittedtostructures:
Tofitalladdons,clickFitAllAddOns.
Toremovefittingfromalladdons,clickUnfitAllAddOns.
Toreturntothedefaultvalues,clickResettoDefaults.
16. ClickNext.
TheReviewMatchedTemplateParametersdialogboxopens
displayinghowtheitemswerematchedagainstthetreatmentunit.
17. VerifytheparametersandclickFinishtocreatethenewplan.
Ifthematchbetweentheselectedtreatmentunitandthefieldaccessories
requiredinthetemplateispartial,therowsoftheaccessoriesare
highlightedintheparametertable.Someparametersarerequiredtomatch
exactly,andifthematchcannotbemade,theFinishbuttonisgrayedout
andanerrormessageisshown.
IntheExternalBeamPlanningtask,areferencepointisalsocreatedfor
thenewplan.Thereferencepointisconnectedtothetargetvolumeofthe
plan,ifthereisonedefined.
18. Savethenewplan.
Note: Iffieldsoraddonsareincorrectlypositionedinrelationtothestructures,
usethefieldgroupingtoolstorepositionthefieldsandrefittheaddons.For
instructions,seeChapter 11,SectionGroupingFieldsonpage 404.
To Insert New Objectives in a Plan from an Objective Template

Openaplancontainingtowhichyouwishtoaddthe
objectivesandthenchooseInsert >NewObjectivesfrom
Template.
LoadObjectivesfromtheObjectiveLibrary .
IntheExternalBeamPlanningtask,objectivescanalsobecreatedinthe
optimizationdialogboxes(seeChapter 14,DoseVolumeOptimization,
onpage 449andChapter 12,BeamAngleOptimization,onpage 423).
groupbox:

b. ClickSearch.
inthetable.Youcansortanytablecolumnbyclickingthecolumn
header.
3. Selectthetemplatethatcontainsthedesiredobjectives.
IntheExternalBeamPlanningtask,youcannotselectanobjective
templatethatismeantfortheBrachytherapyPlanningtask.
TheObjectivesgroupboxliststheobjectivesoftheselected
templateinbothnumericandgraphicform.
4. IntheObjectivesgroupbox,changethestructuretowhichthe
objectiveismatchedintheplan,ifnecessary,byclickingthecellin
theappropriatecolumnandselectinganewstructureinthe
Whenyouchangeastructuretowhichtheobjectiveismatchedinthe
plan,allobjectivesassignedtothesamematchedstructureinthetemplate
changeaccordingly.Ifyouleavethematchedstructurecellempty,the
objectiveisnottakenintoaccount.
5. ClickSelect.
Theselectedobjectivesarecreatedfromthetemplatetotheactive
plan.
Managing Templates
Editing Templates
IntheExternalBeamPlanningtask,youcaneditalltemplatesinthe
FieldSetupworkspace.Youcaneditstructuretemplategroupsand
structuretemplatesalsointheContouringworkspace.
To Edit Structure Template Groups and Structure Templates


Groupsgroupbox:
b. ClickSearch.
Thestructuretemplategroupsandtheirstructuretemplates
matchingthesearchcriteriaaredisplayedinthetables.Youcan
sortanytablecolumnbyclickingthecolumnheader.
Toeditastructuretemplategroup:
SelectthetemplategrouptoeditfromtheStructure
TemplateGroupstable.
ClickProperties.TheStructureTemplateGroupProperties
dialogboxopens.
EdittheinformationasneededandclickOK.
Toeditastructuretemplateinastructuretemplategroup:
Selectthetemplategroupthatcontainsthestructure
templatetoeditfromtheStructureTemplateGroupstable.
SelectthestructuretemplatetoeditfromtheStructure
Templatestable.
ClickProperties.TheStructureTemplatePropertiesdialog
boxopens.
EdittheinformationasneededandclickOK.
Ifyouwanttoeditanapprovedstructuretemplategrouporstructure
template,youfirstneedtochangeitsstatus.Formoreinformation,see
ChangingtheApprovalStatusofTemplates,ClinicalProtocolsand
ClinicalProtocolReferencesonpage 362.
4. ToclosetheStructureTemplateManager,clickClose.
To Edit Plan Templates
Note: Fieldsintheplantemplatecannotbeedited.Ifyouneedtoeditthefields,
createanewplanwithmodifiedfieldsetup,saveitasnewplantemplateusing
adifferentnameastheoriginalplantemplate,deletetheoriginalplantemplate,
andrenamethemodifiedplantemplate.

TemplateManager.
b. ClickSearch.
header.
3. Selectthetemplatetoeditfromthetable.
Ifyouwanttoeditanapprovedplantemplate,youfirstneedtochangeits
status.Formoreinformation,seeChangingtheApprovalStatusof
Templates,ClinicalProtocolsandClinicalProtocolReferenceson
page 362.
4. ClickProperties.
ThePlanTemplatePropertiesdialogboxopens.
5. EdittheinformationasneededandclickOK.
Noticethatalthoughyoucanchangetheinformationregardingthefield
geometryparametersintheDescriptiontextbox,theactualfieldsinthe
templatearenotaffected.Forinstance,thegantryanglesofthefieldsare
notchangedevenifyouedittheanglesintheDescriptiontextbox.
6. ToclosethePlanTemplateManager,clickClose.
7. Saveyourchanges.

To Edit Objective Template Properties
ChoosePlanning >TemplatesandClinicalProtocols >
ObjectiveTemplateManager.
ManageObjectiveSetsintheObjectiveLibrary .
groupbox:
b. ClickSearch.
header.
Ifyouwanttoeditanapprovedobjectivetemplate,youfirstneedto
changeitsstatus.Formoreinformation,seeChangingtheApproval
StatusofTemplates,ClinicalProtocolsandClinicalProtocolReferences
onpage 362.
4. ClickProperties.
TheObjectiveTemplateGroupPropertiesdialogboxopens.
5. EdittheinformationasneededandclickOK.
6. ToclosetheObjectiveTemplateManager,clickClose.

To Edit Objective Templates in the Numeric Form
groupbox:
b. ClickSearch.
header.
onpage 362.
4. Toedittheobjectivesinthenumericform,intheObjectivesgroup
box:
Cellswithsmallarrowhead:Clickthecellandselectanoption
fromthedropdownlistthatopens.
Textboxes:Clickthecellandtypethenewinformation.
Toaddanobjective,clickAdd.
Toremoveanobjective,clickRemove.

To Edit Objective Templates in the Graphic Form
groupbox:
b. ClickSearch.
header.
onpage 362.

4. Toedittheobjectivesinthegraph,dooneofthefollowing:
Dragthelinetypeorpointtypeobjectivewiththemouseas
desired.
Rightclickinthegraphanddooneofthefollowing:
Toaddanewupperobjective,selectAddUpperobjective,
clickinthedesiredlocationinthegraphandmodifythe
newupperobjectivethatappearsinthenumericform.
Toaddanewlowerobjective,selectAddLowerObjective,
newlowerobjectivethatappearsinthenumericform.
Toaddanewlineobjective,selectAddLineObjective,
newlineobjectivethatappearsinthenumericform.
Tomoveanobjective,selectMoveObjectiveanddragthe
linetypeorpointtypeobjectivewiththemouseasdesired.
Tozoominthegraph,selectZoomIn,clickandholddown
theleftmousebutton,movethemousepointertoforma
rectangulararea,andreleasethemousebuttonwhenthe
rectanglecoversthedesiredarea.Youcanrepeatzooming
asmanytimesasneeded.
Tozoomoutthegraph,selectZoomOut.
Tosetthegraphintoitsoriginalscale,selectReset
Geometry.
Tomovethewholegraph,selectPananddragthegraphas
desired.
Deleting Templates
IntheExternalBeamPlanningtask,youcandeletealltemplatesinthe
FieldSetupworkspace.Youcandeletestructuretemplategroupsand
structuretemplatesalsointheContouringworkspace.
Note: Whendeletingtemplates,notethat:
Todeleteanapprovedtemplate,youfirstneedtochangeitsstatusto
Unapproved.
Deletingtemplatesisapermanentoperation,thedeletedtemplatescannot
bereloaded.

To Delete Structure Template Groups and Structure Templates
Groupsgroupbox:
b. ClickSearch.
Thestructuretemplategroupsandtheirstructuretemplates
matchingthesearchcriteriaaredisplayedinthetables.
Todeleteastructuretemplategroup:
Selectthestructuretemplategrouptodeletefromthe
StructureTemplateGroupstable.
ClickDelete.
AnswerYestotheconfirmationmessagethatopens.
Todeleteastructuretemplatefromastructuretemplategroup:
SelectthestructuretemplatetodeletefromtheStructure
Templatestable.
ClickDelete.
Theselectedstructuretemplategrouporstructuretemplateis
deleted.
To Delete Plan Templates

TemplateManager.

b. ClickSearch.
header.
3. Selectthetemplatetodeletefromthetable.
4. ClickDelete.
5. AnswerYestotheconfirmationmessagethatopens.
Theselectedobjectivetemplateisdeleted.
6. Saveyourchanges.
To Delete Objective Templates
groupbox:
b. ClickSearch.
inthetable.
3. Selectthetemplatetodeletefromthetable.

4. ClickDelete.
Theselectedobjectivetemplateisdeleted.
Importing and Exporting Templates

IntheExternalBeamPlanningtask,youcanimportandexportall
templatesintheFieldSetupworkspace.Youcanalsoimportand
exportstructuretemplatesintheContouringworkspace.
To Import Templates
ClinicalProtocols >ObjectiveTemplateManager,Plan
TemplateManager,orStructureTemplateManager.
Thetemplatemanageroftheselectedtemplatetypeopens.
2. ClickImport.
TheOpendialogboxopens.
3. IntheLookinlistbox,selectthedirectoryfromwheretoimport
thetemplate.
4. Selectthetemplatetoimportfromthedirectory.
5. ClickOpen.
Theselectedtemplateisimportedandisvisibleinthetemplate
manager.
IfanidenticaltemplateIDalreadyexistsinEclipse,thetemplatecannot
beimported.Ifthecontrolmechanismthatwasaddedtothetemplate
whenitwasexportednoticesthatthetemplateischangedoutsideEclipse,
awarningisdisplayed.

To Export Templates
2. Tosearchforatemplateinthetemplatemanager:
a. Selecttheapprovalstatusofthetemplateyouwanttoimport
b. ClickSearch.
Thetemplatesmatchingthesearchcriteriaaredisplayedinthe
table.
3. Selectthetemplatetoexportfromthetable.
4. ClickExport.
TheSaveAsdialogboxopens.
5. IntheSaveinlistbox,selectthedirectoryintowhichtosavethe
template.
6. IntheFilenametextbox,defineanameforthetemplate.
7. ClickSave.
ThetemplateisexportedasanXMLfiletothedefinedlocation.A
controlmechanism(checksum)isaddedintheXMLfile.Ifthe
exportedtemplateischangedoutsideEclipse,themechanism
noticesitandawarningisdisplayedwhenthetemplateis
importedbacktoEclipse.

About Clinical Protocols
Aclinicalprotocolconsistsofasetofpredefinedvaluesthatguidethe
treatmentplanningprocess.Itspurposeistospeeduptreatment
planningandtoeasethecliniciansworkloadintypicaltreatments.
Clinicalprotocolsareinsertedtopatientsviaclinicalprotocol
references.Afterinsertingaclinicalprotocolreferencetoapatient,
somevaluesofthereferencecanbeadjustedasnecessaryforthe
particularpatient.Thiswillnotaffecttheoriginalprotocol.
Aclinicalprotocolconsistsofastructuretemplategroup,asetof
protocolplansandreviewsettings(seeFigure 70onpage 324).The
structuretemplategroupcontainsapredefinedsetofstructuresused
incontouringandsegmenting.Protocolplansdefinethedifferent
partsoftheradiationtreatment,forexample,theoriginaltreatment
anditsboost.Reviewsettingscontaintheparametersthatdefinewhat
isincludedintheDVHforselectedstructuresforreviewingpurposes.
Eachprotocolplanconsistsofaplantemplate,planobjectivesand
possiblyanobjectivetemplateforoptimization.Theplantemplate
containsthestandardplancharacteristics.Theplanobjectivesfora
protocolplandefinetheintendeddosedistributionforthetargetand
criticalorgansrealizedbytheplan.Theoverallprescriptionisa
collectionofplanobjectivesthatlimitthetotaldosedistributionforthe
targetandcriticalorgansrealizedbyalltheprotocolplansinthe
clinicalprotocol.Theobjectivetemplatecontainspredefined
dosevolumeobjectivestospecifytheoptimizationobjectivesforthe
dosecalculation.
ClinicalProtocol
StructureTemplateGroup
ProtocolPlans ReviewSettings
andStructureTemplates
PlanTemplate PlanObjectives OptimizationObjectives
Figure 70 Clinical Protocol Structure

Oneclinicalprotocolcancontainbothexternalbeamplansand
brachytherapyplans.Clinicalprotocolscanalsobeincomplete,aseach
elementoftheprotocolisnotrequired.Itispossiblethataclinical
protocolcontainsonlystructures,butnoprotocolplanobjectives.
Allusershaverightstoviewclinicalprotocols.Dependingonyour
userrights,youcanalsoedit,approveanddeleteclinicalprotocols.
Thisdocumentassumesthattheuserhasfullrights.Formore
informationonuserrights,refertoOSPApplicationsReferenceGuide.
Visibility of Clinical Protocol Information in Plans

Foreachcoursethathasaclinicalprotocolattachedtoit,theclinical
protocolreferenceicon( )isshownunderthecourseintheScope
window.Iconsofplansaddedfromtheclinicalprotocolareshown
belowtheclinicalprotocolreferenceicon.
Figure 71 Clinical Protocol in Scope Window
Theplanobjectivesstoredintheclinicalprotocolreferencethatis
insertedtoacourseareshowninthePlanObjectivestaboftheInfo
window(formoreinformationabouttheInfowindow,seeChapter 3,
SectionInfoWindowonpage 75).Thedoseprescriptionis
determinedbytheprimaryplanobjective.Treatmentreportsshowthe
protocolID,phaseandprescriptioninformation(formoreinformation
ontreatmentreports,seeChapter 26,PrintingPlanInformation,on
page 725).
Plan Objectives in Clinical Protocols

Theplanobjectivesforaprotocolplandefinetheintendeddose
distributionforthetargetandcriticalorgansrealizedbytheplan,plus
theplanconformityobjectives.Theoverallprescriptionisacollection

ofplanobjectivesthatlimitthetotaldosedistributionforthetarget
andcriticalorgansrealizedbyalltheprotocolplansintheclinical
protocol.
Thedifferencebetweenplanobjectivesandoptimizationobjectivesis
thatplanobjectivesdefinetheintendeddosedistribution,while
optimizationobjectivestrytomeetthemandinformtheoptimization
algorithmoftheoptimizationconstrains.Withcertainlimitations,plan
objectivescanbeusedasoptimizationobjectiveswhencreatinga
clinicalprotocol.
Oneoftheplanobjectivesisspecifiedastheprimaryplanobjective.In
theExternalBeamPlanningtask,theprimaryplanobjectiveisusedas
thebasisfortheMUcalculationandinfixingtheabsolutedosimetry
fortheplan.
Plan Objectives in the External Beam Planning Task
PlanobjectivesintheExternalBeamPlanningtaskcanbedividedinto
thefollowingtypes:
Objectiveforstructurevolume:Theplanobjectivedefinesthelimit
forthepercentageofthestructurevolumethatreceivesthedose.If
thistypeofplanobjectiveissetastheprimaryplanobjectiveina
clinicalprotocol,plannormalizationmodecanbesetaccordingto
thisplanobjectivewhencreatingtheprotocolplans.
Planobjectivevaluesare:
At least <n> % receives more than <n> Gy/cGy
At most <n> % receives more than <n> Gy/cGy
Minimum dose is <n> Gy/cGy
Maximum dose is <n> Gy/cGy
Objectiveforthemeandose:Theplanobjectivedefinesthelimitfor
themeandosethatthestructurereceives.Ifthistypeofplan
objectiveissetastheprimaryplanobjectiveinaclinicalprotocol,
plannormalizationmodecanbesetaccordingtothisplan
objectivewhencreatingtheprotocolplans.
TheplanobjectivevalueisMean dose is <n> Gy/cGy.
Objectiveforreferencepoint:Theplanobjectivedefinesthelimitfor
thedosethatthereferencepointreceivesifthereferencepointhas
alocationintheimage.Ifthistypeofplanobjectiveissetasthe

primaryplanobjectiveinaclinicalprotocol,plannormalization
modecanbesetaccordingtothisplanobjectivewhencreatingthe
protocolplans.
PlanobjectivevaluesisReference point receives <n> Gy/cGy.
Objectiveforisodoseline:Theplanobjectivedefinesthelimitforthe
dosethatanisodoselinereceives.Thisplanobjectivecannotbe
usedasoptimizationobjective.
PlanobjectivevalueisIsodose <n> % line receives <n> Gy/cGy.
Objectivefordepth:Theplanobjectivedefinesthefieldspecificlimit
forthedoseinacertaindepth.Plannormalizationmodecannotbe
setaccordingtothisplanobjective.Thisplanobjectivecannotbe
usedasoptimizationobjective.
Theplanobjectivevaluesare:
Depth at midpoint receives <n> Gy/cGy
Depth at dmax receives <n> Gy/cGy
Depth at <n> cm receives <n> Gy/cGy
Conformityindex:Theconformityindexisdefinedasthevolume
closedbytheprescriptionisodosesurfacedividedbythetarget
volume.Plannormalizationmodecannotbesetaccordingtothis
planobjective.Thisplanobjectivecannotbeusedasoptimization
objective.
Conformity index is more than <value>
Conformity index is less than <value>
Conformity index is <value>
Gradientmeasure:Thegradientmeasureisdefinedasthedifference
betweentheequivalentsphereradiusoftheprescriptionand
halfprescriptionisodoses.Plannormalizationmodecannotbeset
accordingtothisplanobjective.Thisplanobjectivecannotbeused
asoptimizationobjective.
Gradient measure is more than <value in cm>
Gradient measure is less than <value in cm>
Gradient measure is <value in cm>
Aftertheplanobjectivesarespecified,Eclipsecancalculatetheplan
andnormalizeasspecifiedwithintheclinicalprotocol.Aftertheplan
hasbeencalculated,dosescanbecomparedbetweentheplanand
dosesspecifiedintheobjectiveswithinboththeinfowindowand

DoseVolumehistogramView.Formoreinformation,seePlan
ObjectivesTaboftheInfoWindowonpage 329andToViewPlan
ObjectivesintheDoseVolumeHistogramViewonpage 327.
To View Plan Objectives in the Dose Volume Histogram View
1. Opentheplanwhoseplanobjectivesyouwanttoviewandselect
thePlanObjectivestaboftheInfowindow.
2. Selectthecheckboxnexttothetabname.
TheDoseVolumeHistogramviewisopened,ifnotalready
displayed,andtheplanobjectivelimitsareshowninthegraph.
SelectastructureintheFocuswindow.
SelectastructurefromthePlanObjectivestaboftheInfo
window.
ThearearestrictedbytheplanobjectiveishighlightedintheDose
VolumeHistogramviewandtheplanobjectivetoleranceis
displayedinthegraph.
A.Thearearestrictedbytheplanobjectiveishighlighted.B.Tolerancelimitsfortheplan
objective.C.Planobjectivedefiningthemaximumdosefortheselectedstructure.D.Plan
objectivedefiningtheminimumdosefortheselectedstructure.E.Thearearestrictedbythe
planobjectiveishighlighted.

To Define Plan Objective Tolerance
1. RightclickthenameofthePlanObjectivestabandchooseChange
PlanObjectiveTolerances.
ThePlanObjectiveTolerancesdialogboxopens.
2. IntheToleranceLimitsgroupbox:
TosettheplanobjectivetolerancelimitinGyorcGy,typea
valueintheappropriatetextbox.
Tosettheplanobjectivetolerancelimitinvolumepercentages,
typeavalueintheappropriatetextbox.
3. IntheToleranceColorsgroupbox,selectthedesiredcolorsforthe
doseswithinandoutsidethetolerancelimits.Thecolorsare
displayedintheActualTotalDosecolumnofthePlanObjectives
taboftheInfowindow.
Thissettingisclinicwide;itaffectsallworkstationsthatareconnectedto
thesamedatabase.
Totestthesettings,clickApply.
Toacceptthesettings,clickOK.
Plan Objectives Tab of the Info Window

IntheExternalBeamPlanningtask,thePlanObjectivestaboftheInfo
windowisvisibleintheFieldSetupworkspace.
Thetabisusedforviewingtheplanobjectivesoftheplanderived
fromaclinicalprotocol.Youcannotmodifytheinformationdisplayed
inthetab.
Table 5 Plan Objective Information in the Plan Objectives Tab
Item Description
Primary Definesifaplanobjectiveisspecifiedastheprimary
planobjectiveintheclinicalprotocol.

Table 5 Plan Objective Information in the Plan Objectives Tab
Item Description
Prescription Describestheprescriptionfortheplanobjective
definedintheclinicalprotocol.
Thevaluesare:
At least <n> % receives more than <n> Gy/cGy,
At most <n> % receives more than <n> Gy/cGy,
Maximum dose is <n> Gy/cGy,
Minimum dose is <n> Gy/cGy,
Mean dose is <n> Gy/cGy,
Reference point receives <n> Gy/cGy.
FractionDose ThedoseperfractioninGyorcGyfortheplan
[Gy/cGy] objective.
TotalDose[Gy/cGy] ThetotaldoseinGyorcGyfortheplanobjective.
ActualTotalDose Theactualtotaldosecorrespondingtheplanobjectives
[Gy/cGy] receivedwhentheplaniscalculated.
Table 6 Conformity Objectives in the Plan Objectives Tab
Item Description
Structure Structureforwhichtheconformityobjectiveisdefined.
Index Describestheprescriptionfortheconformityobjective
definedintheclinicalprotocol.
Thevaluesare:
Conformity index is more than <value>
Conformity index is less than <value>
Conformity index is <value>
Gradient measure is more than <value in
cm>
Gradient measure is less than <value in
cm>
Gradient measure is <value in cm>.
Value Numericalvalueoftheconformityobjective.
ActualValue Valueobtainedindosecalculation.
Figure 72onpage 330displaysthePlanObjectivestabintheExternal

BeamPlanningtask.

A.TomaketheInfowindowfloat,pointhereanddragthewindow.B.TodisplaytheplanobjectivesintheDose
VolumeHistogramview,selectthecheckbox.C.Greencolorinthecellsindicatethattheactualtotaldose
respectstheplanobjective.D.Redcolorinthecellindicatesthattheactualtotaldosedoesnotrespecttheplan
objective.
Figure 72 Plan Objectives Tab in the Field Setup Workspace
Optimization Objectives Tab of the Info Window

IntheExternalBeamPlanningtask,theOptimizationObjectivestabis
visibleintheFieldSetupworkspace.Thetabisusedforviewingthe
optimizationobjectives.Ifyouaddnewoptimizationobjectivesforthe
planintheOptimizationdialogbox,thenewobjectivesarealso
displayedintheOptimizationObjectivestab.
Table 7 Information in the Optimization Objectives Tab
Item Description
Plan PlanSumsonly:Indicatesplansthatcontainoptimization
objectives
Type Theobjectivetype(pointorline).
Color Thecolorofthestructure.
Structure Thestructuretowhichtheobjectivelimitsthedose.
Limit Thedoselimit(upperorlower).
Volume[%] Percentageofthestructurevolumetoreceivethedose.
[Gy]or[cGy] TheintendeddoseinGyorcGy.
Priority Theprioritydefinedfortheobjective.
Figure 73onpage 331displaystheOptimizationObjectivestabinthe

ExternalBeamPlanningtask.

A.TomaketheInfowindowfloat,pointhereanddragthewindow.B.Todisplaytheoptimizationobjectivesin
theDoseVolumeHistogramview,selectthecheckbox.
Figure 73 Optimization Objectives Tab of the Info Window
To View Optimization Objectives in the Dose Volume

Histogram View
1. Opentheplanwhoseoptimizationobjectivesyouwanttoview
andselecttheOptimizationObjectivestab.
2. Selectthecheckboxnexttothetabname.
Ifnotalreadydisplayed,theDoseVolumeHistogramviewis
openedandalloptimizationobjectivesareshowninthegraph.
A.Linetypeoptimizationobjectives.B.Pointtypeoptimizationobjectives.

Clinical Protocol Manager
TheClinicalProtocolManagerdisplaysclinicalprotocols.Foraclinical
protocol,themanagerdisplays:
identification
approvalstatus
possiblediagnosisandtreatmentsite
usersassignedtotheclinicalprotocol
description
YoucansortanycolumnoftheClinicalProtocolManagerbyclicking
thecolumnheader.Youcanedit,duplicate,delete,preview,import
andexportclinicalprotocolsintheClinicalProtocolManager.
A.Theapprovalstatusofthedisplayedclinicalprotocols.B.Typethesearchwordsforfiltering
clinicalprotocols.C.Theselectedclinicalprotocol.D1andD2.Actionsavailablefortheselected
clinicalprotocol.
Figure 74 Clinical Protocol Manager
Protocol Properties
ProtocolPropertiesdialogboxisusedwhencreatingnewclinical
protocolsormodifyingexistingprotocols.TheProtocolProperties
dialogboxcontainsthefollowingtabs:General,Structures,Plan
Objectives,PlanSetups,OptimizationObjectives,andReview.Inthe
Generaltabyougiveinformationtoidentifytheprotocolyouare

creating.Therestofthetabscontainthedefaultinformationtaken
fromtheplanonwhichtheprotocolisbased.Youcanacceptthe
informationasitis,orchangeitasneeded.
Creating Clinical Protocols

IntheExternalBeamPlanningtask,youcancreateclinicalprotocolsin
theFieldSetupworkspace.
Creating a Clinical Protocol from a Plan

Whenaclinicalprotocoliscreatedfromaplan,theinformationofthe
activeplaniscopiedtotheProtocolPropertiesdialogbox(Protocol
Propertiesonpage 333),inwhichyoucanacceptinformationor
changeitasneeded.Theclinicalprotocolpropertiestakenfromthe
activeplanarethefollowing:
Structuresdefinedintheplanningimagearesetbydefault.
Protocolplansarecreatedautomatically.Ifaplanisactive,only
oneprotocolplaniscreated.Ifaplansumisactive,aprotocolplan
foreachplanintheplansumiscreated.Protocolplanobjectives
andoptimizationobjectivesaremappedfromtheplansdose
prescription,EclipseIMRTobjectives,andnormalizationmode.
IntheExternalBeamPlanningtask,thedefaultvaluesfor
treatmentstyle,energy,technique,treatmentunit,andfield
geometryarefilledforeachprotocolplanaccordingtotheprotocol
planorplanmapping.
ReviewsettingsarefilledfromtheDVHsettingsoftheactiveplan.
Note: Tocreateaclinicalprotocolthatcontainsmultipleprotocolplans,first
insertaplansumcontainingthecorrespondingplans.

for Creating a Clinical Protocol
ChoosePlanning >TemplatesandClinicalProtocolsandCreate
ClinicalProtocolfromPlan.
TheProtocolPropertiesdialogboxopens.

To Fill in Protocol Information in the General Tab
1. IntheProtocolPropertiesdialogbox,selecttheGeneraltab.
2. IntheIdentificationgroupbox:
TypetheidentificationforthenewplantemplateintheIDtext
box.
Ifdesired,typeadiagnosiscodeofashorttextintheDiagnosis
textbox.
dropdownlist.
clinicalprotocolintheAssigneduserstextbox.
Ifdesired,typeashortdescriptionoftheclinicalprotocolinthe
Descriptiontextbox.
3. IntheApprovalgroupbox:
SelecttheapprovalstatusoftheclinicalprotocolintheStatus
dropdownlist.
Dependingontheselectedapprovalstatusandyouruser
rights,youarepromptedtogiveapasswordwhenyou
clickOK.Formoreinformationontheapprovalstatuses,
seeChangingtheApprovalStatusofTemplates,Clinical
ProtocolsandClinicalProtocolReferencesonpage 362.
TheHistorytextboxdisplaysinformationontheapproval
statusactionsdoneearliertotheclinicalprotocol.
ClickOKandsaveyourchanges,ifyoudonotwishtomake
anymodificationstothedefaultinformationdisplayedinthe
Structures,PlanObjectives,PlanSetups,Optimization
ObjectivesandReviewtabs.
ProceedbymodifyingtheinformationintheStructures,Plan
Objectives,PlanSetups,OptimizationObjectivesandReview
tabs.

To Modify Protocol Information in the Structures Tab
1. IntheProtocolPropertiesdialogbox,selecttheStructurestab.
Thestructuresdefinedintheplanningimagearedisplayedinthe
table.Youcansortanytablecolumnbyclickingthecolumn
header.
2. Toeditastructure:
a. SelectastructurefromtheReferencedStructurestable.
b. ClickPropertiesandmakethemodificationsintheStructure
TemplatePropertiesdialogboxthatopens.
c. ClickOKtoclosetheStructureTemplatePropertiesdialogbox.
3. Tocreateastructure:
a. ClickNewStructureandentertherequiredinformationinthe
StructureTemplatePropertiesdialogboxthatopens.
b. ClickOKtoclosetheStructureTemplatePropertiesdialogbox.
Thenewstructureappearsinthetable.
4. Toduplicateastructure:
b. ClickDuplicate.
Thenewstructureappearsinthetable.Thenameofthenew
structureisappendedwitharunningnumber.
structure.
5. Todeleteastructure:
b. ClickDelete.
Theselectedstructureisdeletedfromtheclinicalprotocol.
Whenastructureisdeleted,theplanobjectivesforthestructure,MLCs
andfieldsfittedtothestructure,theoptimizationobjectivesforthe
structure,andthereviewsettingsforthestructurearealsodeleted.

PlanObjectives,PlanSetups,OptimizationObjectivesand
Reviewtabs.
ProceedbymodifyingtheinformationinthePlanObjectives,
PlanSetups,OptimizationObjectivesandReviewtabs.
To Modify Protocol Information in the Plan Objectives Tab
1. IntheProtocolPropertiesdialogbox,selectthePlanObjectives
tab.
2. InthePlansgroupbox:
Toremoveaplanfromtheprotocol,clickRemoveandanswer
Yestotheconfirmationmessageinformingthatallthe
prescriptionitems,fieldgeometriesandplanobjectivesofthe
planwillalsoberemoved.
Tomodifythefractioninformation,clickacellandaddoredit
theinformationasdesired.
3. InthePlanObjectivesgroupbox:
Toaddanewobjective,clickAddandeditthenewobjectiveas
needed.
Toselectaprescriptionitemastheprimaryprescription,select
thePrimarycheckbox.Formoreinformationontheprimary
planobjective,seePlanObjectivesinClinicalProtocolson
page 325.
Toeditaprescriptionitem:

Structures,PlanSetups,OptimizationObjectivesandReview
tabs.
Setups,OptimizationObjectivesandReviewtabs.
To Modify Protocol Information in the Plan Setups Tab
1. IntheProtocolPropertiesdialogbox,selectthePlanSetupstab.
Toviewthefieldsofaplan,selecttheplan.
Todefinethetreatmenttechnique,clicktheTreatmentStyle
cellandselectanoptionfromthedropdownlistthatopens.
Todefinethedefaulttreatmentunit,clicktheappropriatecell,
clickthedownpointingarrowheadthatappears,andselectan
optionfromthedropdownlistthatopens.
Tospecifythedefaulttreatmentenergy,typethevalueinthe
appropriatetextbox.(IntheExternalBeamPlanningtask
only.)
3. IntheFieldsgroupbox,selectafieldtoviewitsinformation.
4. Forastereotacticplan,selecttheimmobilizationdeviceand
patientlocalizationtechnique.
Structures,PlanObjectives,OptimizationObjectivesand
Reviewtabs.
Objectives,OptimizationObjectivesandReviewtabs.

the Optimization Objectives Tab
1. IntheProtocolPropertiesdialogbox,selecttheOptimization
Objectivestab.
A.Planobjectives.B.Optimizationobjectives.
2. SelectaplanfromthePlanslistbox.
3. IntheDisplaygroupbox:
Todisplaytheplanobjectives,selecttheappropriatecheckbox.
Todisplaytheoptimizationobjectives,selecttheappropriate
checkbox.
Theselecteditemsareshownbothgraphicallyandinthetable.
4. Todefinegeneraloptimizationparametersforallfields:
a. ClickGeneralOptimizationparameters.
b. FilltheObjectiveTemplateGroupPropertiesdialogboxthat
opensandclickOK.

5. Inthetableorgraphshowingplanobjectivesand/oroptimization
objectives:
Toeditanoptimizationobjective:
desired.
Tomoveanobjective,rightclickinthegraph,selectMove
Objectiveanddragthelinetypeorpointtypeobjective
withthemouseasdesired.
Tozoominthegraph,rightclickinthegraph,selectZoom
In,clickandholddowntheleftmousebutton,movethe
mousepointertoformarectangulararea,andreleasethe
mousebuttonwhentherectanglecoversthedesiredarea.
Youcanrepeatzoomingasmanytimesasneeded.
Tozoomoutthegraph,rightclickinthegraphandselect
ZoomOut.
Tosetthegraphintoitsoriginalscale,rightclickinthe
graphandselectResetGeometry.
Tomovethewholegraph,rightclickinthegraph,select
Pananddragthegraphasdesired.
Toaddanobjective,dooneofthefollowing:
ClickAddandmodifythenewobjectivethatappearsinthe
table.
RightclickinthegraphandchooseAddLowerObjective,
AddUpperObjectiveorAddLineObjective,clickinthe
desiredlocationinthegraphandmodifythenewobjective
thatappearsinthetable.
Touseaplanobjectiveinoptimization,clickOptimizewith
this.Theplanobjectiveisaddedasanoptimizationobjectivein
thetable.Formoreinformationonplanobjectives,seePlan
ObjectivesinClinicalProtocolsonpage 325.

Structures,PlanObjectives,PlanSetupsandReviewtabs.
Objectives,PlanSetupsandReviewtabs.
To Modify Protocol Information in the Review Tab
1. IntheProtocolPropertiesdialogbox,selecttheReviewtab.
2. IntheDVHStructuresandExpressionsgroupbox:
SelectthestructuresforwhichtheDVHiscalculated.
Toaddavirtualstructureexpression:
ClickAddexpression.
CreatethestructureintheCreateexpressiondialogbox
thatopens,andclickOK.
Formoreinformationoncreatingvirtualstructures,seeBoolean
OperationsinDVHCalculationonpage 669.
Toremoveavirtualstructureexpression,selecttheexpression
andclickRemoveexpression.
ToselectallDVHstructuresandexpressions,clickSelectAll.
ToclearallselectionsmadeforDVHstructuresand
expressions,clickSelectNone.
3. IntheDVHStatisticsgroupbox,selecttheDVHstatisticscolumns
youwanttodisplayintheDoseVolumeHistogramview.
Structures,PlanObjectives,PlanSetupsandOptimization
Objectivestabs.
Objectives,PlanSetupsandOptimizationObjectivestabs.

Using Clinical Protocols to Create New
Structures, Objectives and Plans
Youcanuseclinicalprotocolstocreatenewstructuresandplans:
Creatingstructuresusingaclinicalprotocolautomaticallyaddsthe
structuresandreferencepointsbasedonthosestructuresfromthe
protocol.
Creatingaplanusingaclinicalprotocolplanautomaticallyadds
theplanobjectivesandtheoptimizationobjectivesoftheplanfrom
theprotocol.
Inserting a Clinical Protocol Reference to a Patient

Tocreatestructuresandplansusingaclinicalprotocolforapatient,
youneedtoinsertaclinicalprotocolreferencetothepatient.
IntheExternalBeamPlanningtask,youcaninsertaclinicalprotocol
referencetoapatientintheContouringandintheFieldSetup
workspaces.
ClinicalprotocolreferencesaredisplayedintheScopewindowunder
acourse.Onecoursecancontainseveralclinicalprotocolreferences.
To Insert a Clinical Protocol Reference to a Patient
1. ChooseInsert >NewClinicalProtocolReference.
TheSelectCoursedialogboxopens.
Toattachaclinicalprotocoltoanewcourse,clickNewCourse,
fillthenewcourseinformationintheCoursePropertiesdialog
boxthatopens,andclickOK.
Toattachaclinicalprotocoltoanexistingcourse,selecta
coursefromtheAvailablecourseslistbox.
3. ClickNext.
TheClinicalProtocolManageropens.
4. TosearchforaclinicalprotocolintheClinicalProtocolsgroup
box:

a. Selecttheapprovalstatusoftheclinicalprotocolyouwantto
b. ClickSearch.
Theclinicalprotocolsmatchingthesearchcriteriaaredisplayedin
header.
5. SelectthedesiredclinicalprotocolfromthetableandclickSelect.
TheclinicalprotocolitemappearsintheScopewindowunderthe
selectedcourse.
Creating Structures According to a Clinical Protocol

Youcancreatestructuresaccordingtoaclinicalprotocolinthe
Contouringworkspace.Inordertodothat,youneedtohaveapatient
withanimageandaclinicalprotocolinsertedtothepatient.
Ifthepatientimagealreadycontainsapreviouslycreatedstructure
withthesamestructureIDasthestructureintheclinicalprotocol,the
existingstructureisnotoverwritten.
IntheExternalBeamPlanningtask,iftheclinicalprotocolcontains
planobjectiveitemsthatusereferencepoints,thereferencepointsare
automaticallycreatedwithoutlocations.Thereferencepointsare
namedaccordingtothestructurenames.Existingreferencepoints
withthesameIDasthosecominginfromtheprotocolarenot
overwritten.
Note: Tobeabletolaterusethereferencepointscreatedusingaclinicalprotocol
forplannormalizationorforevaluatingtheplanagainsttheplanobjectivesin
theprotocol,thepointsmusthavelocationsdefined.Omittingtheuseofa
clinicalprotocolforcreatingstructuresandonlyusingtheclinicalprotocolfor
creatingtheplan(s)willnotcreateanyreferencepointsorreferencepoint
locations,exceptfortheprimaryreferencepoint(thatwillnothavealocation
inthiscase).

To Create Structures According to a Clinical Protocol
1. RightclicktheclinicalprotocolitemintheScopewindowand
chooseCreateclinicalprotocolstructures.
2. Ifnostructuresetexistsinthe3Dimage,theStructureSet
Propertiesdialogboxopens.TypeanIDandanameforthe
structureset.ClickOKtoclosethedialogbox.
TheCreateReferencePointLocationdialogboxopens.
3. IntheReferencepointlocationslistbox,selectthereferencepoint
locationsthatneedtobecreated.
Thereferencepointlocationsarecreatedatthebottomoftheimageview.
Whenyoufinishcreatingthestructuresaccordingtotheclinicalprotocol,
youmustdragthereferencepointlocationstothedesiredplaces.
4. ClickOK.
Ifthereisaconflictinthestructurecreationprocess,theStructure
CreationLogopens.Greenbackgroundinthelogindicatesthatthe
structurewassuccessfullycreated.Redbackgroundindicatesa
conflictinthestructurecreationprocess.
5. Toclosethelog,clickClose.
ThenewstructuresappearintheFocuswindow.
Continuebysegmentingthestructures.
Creating Plans According to Clinical Protocol Plans

IntheExternalBeamPlanningtask,youcancreateplansaccordingto
clinicalprotocolplansintheFieldSetupworkspace.
Inordertodothat,youneedtohaveapatientwithcourseanda
clinicalprotocolreferenceinsertedforthepatient.
Note: Althoughitispossibletoomittheuseofaclinicalprotocolforcreating
structuresandonlyusetheprotocolforcreatingtheplan(s),thisprocedurewill
notautomaticallycreateanyreferencepoints,exceptfortheprimaryreference
point.Thismeansthatallthereferencepointsandreferencepointlocations
usedintheclinicalprotocoldefinitionsforplannormalizationorplan
objectivesmustbemanuallycreatedifclinicalprotocolstructuresarenotused.

Youcannotcreateabrachytherapyplanfromaclinicalprotocolplanin
theExternalBeamPlanningtask,oranexternalbeamplaninthe
BrachytherapyPlanningtask.
Whenyoucreateaplanaccordingtoclinicalprotocolplan,the
applicationcreatesobjectivesforthenewplanusingtheprotocol
objectives.Ifthereisnomatchingstructurefortheoptimization
objectiveintheplanningimage,theobjectiveisnotcreated.The
applicationalsocreatesDVHsettingsforthenewplanaccordingto
thereviewsettingsintheclinicalprotocolinserted.Ifthereview
structuresdonotexist,theyaredropped.
IntheExternalBeamPlanningtask,theplanobjectivesoftheprotocol
planintheclinicalprotocolreferenceareexaminedforplanobjectives
toreferencepoints.Ifthereareany,thereferencepointsnamedbythe
relevantstructuresaremovedtotheplan.Basedontheprimaryplan
objectivecontent,aprimaryreferencepointisassignedintheplan.
Theapplicationalsocreatesadoseprescriptionfortheplanaccording
totheprotocolplanused.Theprimaryplanobjectiveintheplan
objectivesoftheprotocolplanisusedforthispurpose.For
conventionalplans,theplannormalizationmodeisselectedaccording
totheprimaryplanobjective.ForIMRTplansthisisnotdone.
IntheExternalBeamPlanningtask,whenyoucreateallplans
accordingtotheclinicalprotocolatonce,aplansumcontainingthe
protocolplansisalsocreated.
To Create Plans According to Clinical Protocol Plans
1. RightclicktheclinicalprotocolitemintheScopewindowanddo
oneofthefollowing:
Tocreateasingleclinicalprotocolplan:chooseCreateplanand
selectthedesiredplan.
Tocreateallclinicalprotocolplans:chooseCreateallplans.
Thedialogboxforcreatingtheselectedplanorplansopens.
2. IntheMapprescriptioncolumn,selecttheprotocolphasesthat
willbenormalizedwhentheplansarecreated.Thisoptionisnot
availableforIMRTplans.

3. Ifnecessary,youcanchangetheplanIDbytypingthenewID,and
treatmentunitandenergybyclickingthefield,clickingthe
downpointingarrowheadthatappearsandselectinganoption
4. ClickOK.
Iftherewasaconflictintheprotocolplancreationprocess,the
ProtocolPlanCreationLogopens.Greenbackgroundindicates
thattheitemwassuccessfullycreated.Redbackgroundindicatesa
conflictintheprotocolplancreationprocess.
5. ClickClosetoclosetheProtocolPlanCreationLog.
TheselectedprotocolplansappearintheFocuswindow.Inthe
ExternalBeamPlanningtask,theplansumusedtocreatethe
protocolplansisalsodisplayed.
Continuebymodifyingtheplan,ifnecessary,optimizingtheIMRT
plans,calculatingthedoseandreviewingtheplansum.
Changing the Clinical Protocol Reference of a Protocol Plan

Youcanchangetheclinicalprotocolreferenceofaprotocolplaninthe
To Change the Clinical Protocol Reference of a Protocol Plan
1. IntheScopewindow,selecttheprotocolplanwhoseclinical
protocolreferenceyouwanttochange.
3. SelecttheGeneraltab.
4. ChooseProtocolPlandropdownlist,selectthedesiredclinical
protocolreference.
Youcanalsoselectanemptylistitem.Inthatcase,theprotocolplanis
moveddirectlyunderthecourse.
5. ClickOK.
Theprotocolplanappearsunderthenewclinicalprotocol
referenceintheScopewindow.

Deleting a Clinical Protocol Reference from a Course
IntheExternalBeamPlanningtask,youcandeleteaclinicalprotocol
referencefromacourseintheContouringandFieldSetup
workspaces.
Whenaclinicalprotocolreferenceisdeleted,theprotocolplansunder
thereferenceintheScopewindowaremovedundertherelevant
course.
To Delete a Clinical Protocol Reference from a Course
1. FromtheScopewindow,selecttheclinicalprotocolreferenceto
delete.
3. ClickYesintheconfirmationdialogthatopens.
Theselectedclinicalprotocolreferenceisdeletedfromtheplan.
Managing Clinical Protocols

IntheExternalBeamPlanningtask,youcanedit,approveanddelete
clinicalprotocolsintheFieldSetupworkspace.Youcanalsoadaptthe
clinicalprotocolforindividualpatientsbyeditingtheclinicalprotocol
referenceinsertedtothepatient.
Youneedproperuserrightsformanagingclinicalprotocols.
Editing Clinical Protocols

EditingaclinicalprotocolintheClinicalProtocolManagerhasno
effectonthecorrespondingclinicalprotocolreferencesthatare
alreadyusedinapatientplan.
Youcanalsoadapttheclinicalprotocolforindividualpatientsby
editingtheclinicalprotocolreferenceinsertedtothepatient(seeTo
AdapttheClinicalProtocolReferenceforanIndividualPatienton
page 355).Thisdoesnotaffectthecorrespondingoriginalclinical
protocol.

for Editing a Clinical Protocol
1. ChoosePlanning >TemplatesandClinicalProtocols >Clinical

ProtocolManager.
box:
b. ClickSearch.
header.
3. Selecttheclinicalprotocoltoeditfromthetable.
4. ClickProperties.
TheClinicalProtocolPropertiesdialogboxopens.
To Modify Protocol Information in the General Tab
1. IntheProtocolPropertiesdialogbox,selecttheGeneraltab.
2. IntheIdentificationgroupbox:
Typeauniqueidentificationforthestructuretemplategroup
intheIDtextbox.
Ifdesired,typeadiagnosiscodeorashorttextinthe
Diagnosistextbox.
dropdownlist.
clinicalprotocolintheAssigneduserstextbox.
Ifdesired,typeashortdescriptionoftheclinicalprotocolinthe
Descriptiontextbox.

3. IntheApprovalgroupbox:
SelecttheapprovalstatusoftheclinicalprotocolintheStatus
dropdownlist.
TheHistorytextboxdisplaysinformationontheapproval
statusactionsdoneearliertothestructuretemplategroup.
Structures,PlanObjectives,PlanSetups,Optimization
ObjectivesandReviewtabs.
Objectives,PlanSetups,OptimizationObjectivesandReview
tabs.
To Modify Protocol Information in the Structures Tab
1. IntheProtocolPropertiesdialogbox,selecttheStructurestab.
Thestructuresdefinedintheplanningimagearedisplayedinthe
header.
2. Toeditastructure:
b. ClickPropertiesandmakethemodificationsintheStructure
TemplatePropertiesdialogboxthatopens.
c. ClickOKtoclosetheStructureTemplatePropertiesdialogbox.
3. Tocreateastructure:
a. ClickNewStructureandentertherequiredinformationinthe
StructureTemplatePropertiesdialogboxthatopens.
b. ClickOKtoclosetheStructureTemplatePropertiesdialogbox.
Thenewstructureappearsinthetable.
4. Toduplicateastructure:

b. ClickDuplicate.
Thenewstructureappearsinthetable.Thenameofthenew
structureisappendedwitharunningnumber.
structure.
5. Todeleteastructure:
b. ClickDelete.
Theselectedstructureisdeletedfromtheclinicalprotocol.
Whenastructureisdeleted,theplanobjectivesforthestructure,MLCs
andfieldsfittedtothestructure,theoptimizationobjectivesforthe
structure,andthereviewsettingsforthestructurearealsodeleted.
PlanObjectives,PlanSetups,OptimizationObjectivesand
Reviewtabs.
ProceedbymodifyingtheinformationinthePlanObjectives,
PlanSetups,OptimizationObjectivesandReviewtabs.
To Modify Protocol Information in the Plan Objectives Tab
1. IntheProtocolPropertiesdialogbox,selectthePlanObjectives
tab.
Toremoveaplanfromtheprotocol,clickRemoveandanswer
Yestotheconfirmationmessageinformingthatallthe
prescriptionitems,fieldgeometriesandplanobjectivesofthe
planwillalsoberemoved.
Tomodifythefractioninformation,clickacellandaddoredit
theinformationasdesired.

3. InthePlanObjectivesgroupbox:
Toaddanewobjective,clickAddandeditthenewobjectiveas
needed.
Toselectaprescriptionitemastheprimaryprescription,select
thePrimarycheckbox.Formoreinformationontheprimary
planobjective,seePlanObjectivesinClinicalProtocolson
page 325.
Toeditaprescriptionitem:
Structures,PlanSetups,OptimizationObjectivesandReview
tabs.
Setups,OptimizationObjectivesandReviewtabs.
To Modify Protocol Information in the Plan Setups Tab
1. IntheProtocolPropertiesdialogbox,selectthePlanSetupstab.
Toviewthefieldsofaplan,selecttheplan.
Todefinethetreatmenttechnique,clicktheTreatmentStyle
cellandselectanoptionfromthedropdownlistthatopens.
Todefinethedefaulttreatmentunit,clicktheappropriatecell,
clickthedownpointingarrowheadthatappears,andselectan
optionfromthedropdownlistthatopens.
Tospecifythedefaulttreatmentenergy,typethevalueinthe
appropriatetextbox.(IntheExternalBeamPlanningtask
only.)
3. IntheFieldsgroupbox,selectafieldtoviewitsinformation.
4. Forastereotacticplan,selecttheimmobilizationdeviceand
patientlocalizationtechnique.

Structures,PlanObjectives,OptimizationObjectivesand
Reviewtabs.
Objectives,OptimizationObjectivesandReviewtabs.

the Optimization Objectives Tab
1. IntheProtocolPropertiesdialogbox,selecttheOptimization
Objectivestab.
A.Planobjectives.B.Optimizationobjectives.
2. SelectaplanfromthePlanslistbox.
3. IntheDisplaygroupbox:
Todisplaytheplanobjectives,selecttheappropriatecheckbox.
Todisplaytheoptimizationobjectives,selecttheappropriate
checkbox.
Theselecteditemsareshownbothgraphicallyandinthetable.
4. Todefinegeneraloptimizationparametersforallfields:

a. ClickGeneralOptimizationparameters.
b. FilltheObjectiveTemplateGroupPropertiesdialogboxthat
opensandclickOK.
5. Inthetableorgraphshowingplanobjectivesand/oroptimization
objectives:
Toeditanoptimizationobjective:
desired.
Tomoveanobjective,rightclickinthegraph,selectMove
Objectiveanddragthelinetypeorpointtypeobjective
withthemouseasdesired.
Tozoominthegraph,rightclickinthegraph,selectZoom
In,clickandholddowntheleftmousebutton,movethe
mousepointertoformarectangulararea,andreleasethe
mousebuttonwhentherectanglecoversthedesiredarea.
Youcanrepeatzoomingasmanytimesasneeded.
Tozoomoutthegraph,rightclickinthegraphandselect
ZoomOut.
Tosetthegraphintoitsoriginalscale,rightclickinthe
graphandselectResetGeometry.
Tomovethewholegraph,rightclickinthegraph,select
Pananddragthegraphasdesired.
Toaddanobjective,dooneofthefollowing:
ClickAddandmodifythenewobjectivethatappearsinthe
table.
RightclickinthegraphandchooseAddLowerObjective,
AddUpperObjectiveorAddLineObjective,clickinthe
desiredlocationinthegraphandmodifythenewobjective
thatappearsinthetable.
Touseaplanobjectiveinoptimization,clickOptimizewith
this.Theplanobjectiveisaddedasanoptimizationobjectivein
thetable.Formoreinformationonplanobjectives,seePlan
ObjectivesinClinicalProtocolsonpage 325.

Structures,PlanObjectives,PlanSetupsandReviewtabs.
Objectives,PlanSetupsandReviewtabs.
To Modify Protocol Information in the Review Tab
1. IntheProtocolPropertiesdialogbox,selecttheReviewtab.
2. IntheDVHStructuresandExpressionsgroupbox:
SelectthestructuresforwhichtheDVHiscalculated.
Toaddavirtualstructureexpression:
ClickAddexpression.
CreatethestructureintheCreateexpressiondialogbox
thatopens,andclickOK.
Formoreinformationoncreatingvirtualstructures,seeBoolean
OperationsinDVHCalculationonpage 669.
Toremoveavirtualstructureexpression,selecttheexpression
andclickRemoveexpression.
ToselectallDVHstructuresandexpressions,clickSelectAll.
ToclearallselectionsmadeforDVHstructuresand
expressions,clickSelectNone.
3. IntheDVHStatisticsgroupbox,selecttheDVHstatisticscolumns
youwanttodisplayintheDoseVolumeHistogramview.
Structures,PlanObjectives,PlanSetupsandOptimization
Objectivestabs.
Objectives,PlanSetupsandOptimizationObjectivestabs.

Adapting the Clinical Protocol for an Individual Patient
Youcanadapttheclinicalprotocoltobetterfittherequirementsof
eachparticularpatientbyeditingtheclinicalprotocolreference
insertedtothepatient.Editingtheclinicalprotocolreferencedoesnot
affectthecorrespondingoriginalclinicalprotocol.Clinicalprotocols
areeditedthroughtheClinicalProtocolManager.
To Adapt the Clinical Protocol Reference

for an Individual Patient
1. Selecttheclinicalprotocolreference.
TheClinicalProtocolPropertiesdialogboxopens.
3. Modifythepropertiesoftheselectedclinicalprotocolreferencein
thesamewayasthepropertiesofclinicalprotocols.For
instructions,seethetopicsEditingClinicalProtocolsonpage 347
coveringthedifferenttabsinclinicalprotocols.
Rememberthatthesemodificationswillnotaffecttheoriginalclinical
protocol,butonlytheselectedclinicalprotocolreference.
Deleting Clinical Protocols

Youcannotdeleteapprovedclinicalprotocols.Formoreinformation
onapprovalstatuses,seeChangingtheApprovalStatusofTemplates,
ClinicalProtocolsandClinicalProtocolReferencesonpage 362.
IntheExternalBeamPlanningtask,youcandeleteaclinicalprotocol
fromtheClinicalProtocolManagerintheFieldSetupworkspace.
To Delete a Clinical Protocol from the

Clinical Protocol Manager

ProtocolManager.
box:

b. ClickSearch.
header.
3. Selecttheclinicalprotocoltodeletefromthetable.
4. ClickDelete.
Theselectedclinicalprotocolisdeleted.
6. Saveyourchanges.
Importing and Exporting Clinical Protocols

IntheExternalBeamPlanningtask,youcanimportandexportclinical
protocolsintheFieldSetupworkspace.
To Import a Clinical Protocol

ProtocolManager.
2. ClickImport.
TheOpendialogboxopens.
3. IntheLookinlistbox,selectthedirectoryfromwheretoimport
theclinicalprotocol.
4. Selecttheclinicalprotocoltoimportfromthedirectory.
5. ClickOpen.
Theselectedclinicalprotocolisimportedandisvisibleinthe
ClinicalProtocolManager.

To Export a Clinical Protocol
ProtocolManager.
box:
b. ClickSearch.
header.
3. Selecttheclinicalprotocoltoexportfromthetable.
YoucanclickPreviewtoseehowtheclinicalprotocollooks.
4. ClickExport.
5. IntheSaveinlistbox,selectthedirectoryinwhichsavetheexport
file.
6. IntheFilenametextbox,defineanamefortheexportfile.
7. ClickSavetosavetheclinicalprotocoltothedefinedexportfile.
TheclinicalprotocolisexportedasanXMLfiletothedefined
location.Acontrolmechanism(checksum)isaddedintheXML
file.IftheexportedclinicalprotocolischangedoutsideEclipse,the
mechanismnoticesitandawarningisdisplayedwhentheclinical
protocolisimportedbacktoEclipse.

Searching Templates and Clinical Protocols
Templatesandclinicalprotocolscanbesearchedbytheirapproval
status,orbyusingsearchwords.Thesearchisperformedontheitems
visibleintherelevantmanager.Bydefault,theTemplateManagers
andtheClinicalProtocolManagerdisplayapprovedtemplatesand
clinicalprotocolswhenthemanagerisopenedforthefirsttime.The
approvalstatusesthatcanbeusedforsearchingtemplatesandclinical
protocolsareApproved,Unapproved,Reviewed,Retired,andAll.For
moreinformationontheapprovalstatusesoftemplatesandclinical
protocols,seeChangingtheApprovalStatusofTemplates,Clinical
ProtocolsandClinicalProtocolReferencesonpage 362.
Inadditiontotheapprovalstatus,templatesandclinicalprotocolscan
alsobesearchedbyusingsearchwords.Youcanuseoneormore
searchwords.Thesearchesarenotcasesensitive.Whenusingseveral
searchwords,thereisnoneedtotypeandbetweenthewords.For
example,thesearchthoraxbreastgivestheresultswhereeitherofthe
wordsispresent.Theapplicationinterpretsanemptyspace,comma(,)
andcolon(;)asawordseparator.
Youcansearchphrasesbyinsertingquotationmarksaroundthe
searchwords(forexampleJohnDoeorleftbreast).Youcanalso
excludewordsformthesearchresultsbytypingaminussign()
immediatelyinfrontofthewordtoexclude(forexample,thorax).
To Search Templates and Clinical Protocols

ClinicalProtocols >ClinicalProtocolManager,Objective
TemplateManager,PlanTemplateManagerorStructure
TemplateManager.
Theselectedmanageropens.
2. Tosearchforaclinicalprotocoloratemplate:

a. Selecttheapprovalstatusoftheclinicalprotocolortemplate
youwanttofindfromthefirstdropdownlist.Youcanalso
typeasearchwordintheseconddropdownlist.Formore
informationonusingsearchwords,seeSearchingTemplates
andClinicalProtocolsonpage 358.
b. ClickSearch.
Theclinicalprotocolsortemplatesmatchingthesearchcriteriaare
displayedinthetable.Youcansortanytablecolumnbyclicking
thecolumnheader.
Previewing and Printing Templates

and Clinical Protocols
Youcanpreviewandprinttemplatesandclinicalprotocols.The
templatesandclinicalprotocolsarepreviewedintheHTMLformatin
yourdefaultwebbrowser(MicrosoftInternetExplorer5.5orlater
recommended).
Youcanpreviewandprintalltemplatesandclinicalprotocolsfrom
therelevantmanagersintheFieldSetupworkspace.Youcanalso
previewandprintstructuretemplatesintheContouringworkspace.
Youcanpreviewandprintclinicalprotocolreferencesinsertedtoa
patientinbothContouringandFieldSetupworkspaces.
To Preview and Print Template Groups and Templates

2. Tosearchforatemplategrouportemplate:

a. Selecttheapprovalstatusofthetemplategrouportemplate
youwanttofindfromthefirstdropdownlist.Youcanalso
typeasearchwordintheseconddropdownlist.
b. ClickSearch.
Thetemplategroupsandtheirtemplatesmatchingthesearch
criteriaaredisplayedinthetable.Youcansortanytablecolumnby
clickingthecolumnheader.
3. Selectthetemplategrouportemplatetoprevieworprintfromthe
table.
4. ClickPreview.
Informationoftheselectedtemplategrouportemplateis
displayedintheHTMLformatinthedefaultbrowser.
5. Toprintthetemplategroupinformation:
a. Fromthebrowsersmenu,chooseFile >Print.
b. Selecttheprinteranddefinetheprintsettingsasdesired.
c. ClickPrint.
To Preview and Print Clinical Protocols from

the Clinical Protocol Manager
Youcanpreviewandprintclinicalprotocolsandclinicalprotocol
referencesonlyafteryouhaveperformedtheSaveAlloperation.
1. IntheFieldSetupworkspace,choosePlanning >Templatesand
ClinicalProtocols >ClinicalProtocolManager.
box:

b. ClickSearch.
header.
3. Selecttheclinicalprotocoltoprevieworprintfromthetable.
4. ClickPreview.
Informationoftheselectedclinicalprotocolisdisplayedinthe
HTMLformatinyourdefaultwebbrowser.
5. Toprinttheclinicalprotocolinformation:
a. ChooseFile >Print.
c. ClickPrint.
To Preview and Print Clinical Protocol References

Inserted to a Patient
1. IntheScopewindow,rightclicktheclinicalprotocolreference
itemandselectPreviewfromthedropdownlistthatopens.
Informationoftheselectedclinicalprotocolreferenceisdisplayed
intheHTMLformatinyourdefaultwebbrowser.
Youcannotpreviewunsavedclinicalprotocolreferences.
2. Toprinttheclinicalprotocolreferenceinformation:
a. ChooseFile >Print.
c. ClickPrint.

Changing the Approval Status of Templates,
Clinical Protocols and Clinical Protocol References
Youneedproperuserrightstochangetheapprovalstatusof
templates,clinicalprotocolsandclinicalprotocolreferences.
Theapprovalstatusesavailablefortemplates,clinicalprotocolsand
clinicalprotocolreferencesarethefollowing:
UnapprovedThetemplate,clinicalprotocolorclinicalprotocol
referenceisunderconstructionanditcannotbeusedintreatment.
ApprovedThetemplate,clinicalprotocolorclinicalprotocol
referenceisapprovedfortreatment.Youcannotchangeany
informationinanapprovedtemplateorclinicalprotocol.
ReviewedThetemplate,clinicalprotocolorclinicalprotocol
referenceisreviewedbyaphysician.Theinformationinthe
templateorclinicalprotocolcanstillbechanged.
RetiredThetemplate,clinicalprotocolorclinicalprotocol
referenceisnolongerused.
To Change the Approval Status of a Template

1. ChoosePlanning >TemplatesandClinicalProtocols >Objective
TemplateManager,PlanTemplateManagerorStructure
TemplateManager.
Theselectedtemplatemanageropens.
2. Tosearchforatemplate:
a. Selecttheapprovalstatusofthetemplateyouwanttofind
b. ClickSearch.
Thetemplatesmatchingthesearchcriteriaaredisplayedinthe
header.
3. Selectthetemplatetoapprovefromthetable.

4. ClickProperties.
Thedialogboxdisplayingthetemplatepropertiesopens.
5. IntheApprovalgroupbox,selectthedesiredapprovalstatusfrom
theStatusdropdownlist.
Dependingontheselectedapprovalstatusandyouruserrights,
youarepromptedtogiveapasswordwhenyouclickOK.
6. ClickOK.
7. ClickClosetoclosethetemplatemanager.
8. Saveyourchanges.
To Change the Approval Status of a Clinical Protocol

ProtocolManager.
box:
b. ClickSearch.
header.
3. Selecttheclinicalprotocoltoapprovefromthetable.
4. ClickProperties.

6. ClickOK.
7. ClickClosetoclosetheClinicalProtocolManager.
8. Saveyourchanges.
To Change the Approval Status of a Clinical Protocol Reference

1. Selecttheclinicalprotocolreference.
4. ClickOK.

Chapter 11 Fields
ThischapterprovidesinstructionsforworkingwithfieldsintheField
Setupworkspace.Thechapterdescribesthefieldtechniquesavailable
anddifferentfieldvisualizationsinthe2Dand3Dimageviews,and
providesinstructionsforcreatingandmodifyingfields.Fieldscanbe
managedbothgraphicallyandbymodifyingtheirproperties,and
bothapproachesarecovered.Informationisincludedaboutusing
DRRandothertypesoffieldimages.
About Fields
Dependingonthetreatmentmodality(photon,electron,orproton
treatment),thefieldsinthetreatmentplancanbeofdifferentfield
typeandusedifferentfieldtechniques.
Field Types
Thefollowingphotonfieldtypesareusedintreatmentplanning:
Fields Fullymodifiablefieldsthatyouworkwithinthe
ExternalBeamPlanningtask.Youcancalculatethedose
distributionandinsertDRRsforfields.Aftertheplanisapproved
fortreatment,thefieldscanbescheduledinARIAapplications.
Setupfields Fieldsthatareusedformovingthetreatmentunit
tothecorrecttreatmentposition,orforaligningthepatient
correctlyfortreatment.
361
Field Techniques
Twofieldtechniquesareusedforphotonfields:staticfieldsandarc
fields.Oneplancancombinebothfieldtechniques.
Staticfields:
IsocentricfieldsThefieldpositionisdefinedbytheisocenter.
TheisocenterispositionedinthecenterofthePTVbydefault.
FixedSSDfieldsThefieldentrypointdefinesthepositionof
thefield.YoucandefinetheSourceFieldEntryDistance
(SFED)ifnecessary.
TheSFEDisusedfordefiningfieldsthatexceedthemaximum
fieldsizeof40 40cm.
HDTSE(HighDoseRateTotalSkinElectron)fieldsFixed
SSDfieldforhighdosetreatments
TotalbodyfieldsFixedSSDfieldfortotalbodytreatments
Arcfields:Rotational,isocentricfields
StaticarcfieldArcfieldwithastaticMLC
ConformalarcfieldArcfieldwithdynamicMLC
Note: Whendefiningthefieldtechnique,payattentiontothefollowing:
AftercreatinganewtreatmentunitintheAdministrationtask,make
surethattheunithasatleastdefaulttechniqueset,otherwisethelistof
availableenergiesmightbeemptywhenanewfieldiscreatedusingthe
newtreatmentunit.Youcanalsodefinedefaultenergyanddoseratesfor
theunitintheAdministrationtask.
AlthoughthecreationofisocentricelectronfieldsisallowedinEclipse,do
notusethembecauseofpotentialinconsistenciesinthedose
normalization.
TheEclipsecalculationalgorithmsdonotsupporttheuseofelectronarc
fields,althoughitispossibletoselecttheARCfieldtechniqueforan
electronfield.
Electronfieldsarealwaysstaticfields,andbydefaultfixedSSDfields.

1A 2A
2B
1B
1C 2C
2D
1D
1 2
3E
3A
3B
3C
3
3D
1.Isocentricfield1A.Fielddirectionpoint1B.Fieldentrylevel1C.Beamedge1D.Isocenter
2.FixedSSDfield2A.Fieldentrylevel2B.Fieldentrypoint2C.Beamedge
2D. Field direction point
3.Arcfield3A.Fielddirectionpoint3B.Fieldentrylevel3C.Beamedge3D.Isocenter
3E. Rotation span
Figure 75 Photon Field Techniques
Field Visualization
CAUTION: Eclipse does not accurately represent the collimator jaw structure of
Siemens treatment units in dose calculation or the field visualization in the
External Beam Planning task. Eclipse assumes that the field edges in both X
and Y directions are limited by a collimator jaw block, whereas in Siemens
treatment units the MLC device replaces the collimator X jaws.
Fields 363
Field Visualization in 2D Views
Therearetwooptionalfieldvisualizationmodesin2Dviews:cut
modeandprojectionmode.Figure 76onpage 368andFigure 77on
page 369comparethesetwofieldvisualizationmodes.
A. FielddirectionpointB. BeamedgeC. Isocenterandfieldcentralaxisintersectionwiththe

viewD. Fieldedgeontheviewingplane
Figure 76 Isocentric, Non-Coplanar Field in Cut Mode

A. FielddirectionpointB. BeamedgeprojectioninfrontoftheviewingplaneC. Isocenterand
fieldcentralaxisintersectionwiththeviewingplaneD. Fieldedgeontheviewingplane
E. CollimatorjawsatthefielddirectionpointF. Beamedgeprojectionbehindtheviewingplane
Figure 77 Isocentric, Non-Coplanar Field in Projection Mode
Bydefault,fieldpathsaredisplayedin2Dviewsaslinesalongtheir
centralaxes,andthefourcollimatorjawsaredisplayedaslines.The
fieldpathlinesstartoutsidetheactiveplaneandcanbedefinedto
extendthroughitorbecutattheisocenter.Theisocenteralsoservesas
amovinghandle,andfieldscanbemovedbydraggingtheirisocenters
(seeMovingFieldsonpage 400).Inaddition,eachfieldhasa
rotationhandleusedforchangingrotationanglesofstaticandarc
fields(seeRotatingFieldsonpage 406).
Theisocenterismarkedwithacircleusingdifferentcolors,depending
onitspositioninrelationtotheactiveviewingplane:
Ontheviewingplane
Behindtheviewingplane
Infrontoftheviewingplane
Thefieldlinesarealsodisplayedinrelationtotheactiveviewing
plane,usingdifferentlinetypes.Figure 78onpage 370andFigure 79
onpage 370illustratethisfieldvisualization.
Fields 365
A. FieldcentralaxisandisocenterabovetheviewingplaneB. Fieldcentralaxisandisocenteron
theviewingplaneC. Fieldcentralaxisandisocenterbelowtheviewingplane
Figure 78 Field Lines in Relation to Active Viewing Plane (inside Active Field)
A. FieldcentralaxisandisocenterabovetheviewingplaneB. Fieldcentralaxisandisocenter
belowtheviewingplane
Figure 79 Field Lines in Relation to Active Viewing Plane (outside Active Field)
Thevisualizationofthefieldontheactiveviewingplaneisalso
differentdependingonwhetherthefieldisactiveorinactive:
Activefield:Fieldshapeontheviewingplaneisshowninbright
yellow
Inactivefield:Fieldshapeontheviewingplaneisshowninpale
yellow
Note: AfieldismadeactiveeitherbyselectingitintheFocuswindoworby
clickingthefieldlabelina2Dimageview.
Youcanalsodisplayonlythecentralaxis(CAX)offieldsandhidethe
fieldedgesandfieldaccessoriesinthe2DviewsandtheModelview
(seeToShowtheCAXOnlyonpage 378).

Arcfieldsaredisplayedsimilarlytostaticfields,butasanadditional
feature,therotationspanofthefieldisvisualizedwithacurvedline
andanarrowtoindicatetherotationdirection.Theendofthecurved
linemarkstheendoftherotation.Forconformalarcfields,thefield
segmentsareshownalongtherotationspanline.Figure 80on
page 371showsanarcfieldonatransversalplane.
A.FieldrotationhandleB.IsocenterC.Extendedarea.Formoreinformation,seeLimitsinthe
ArcFieldRotationSpanonpage 389D.ArcrotationstopangleE.ArcrotationspanF.Arc
rotationdirectionG.Arcrotationhandle
Figure 80 Arc Field in Transversal Image
Figure 81onpage 371showsaconformalarcfieldonatransversal

plane.
A.Arcrotationspanwithconformalarcsegmentsvisualized.
Figure 81 Conformal Arc Field in Transversal Image
Fields 367
To Change Between the Cut Mode and Projection Mode
TheViewOptionsdialogboxopens.
2. SelectthePlanViewingtab.
ToshowthefieldsintheCutmode,cleartheFieldprojections
checkbox.
ToshowthefieldsintheProjectionmode,selecttheField
projectionscheckbox.
To Show the Field Labels
3. Toshowthefieldlabels,selecttheFieldlabelscheckbox.
To Move the Field Labels
1. Tomoveafieldlabel,pointatthelabelinanimageviewanddrag
ittoanewposition.
2. Toresetthefieldlabelpositions,dooneofthefollowing:
Toresetanindividualfieldlabel,rightclickonit.
Toresetallfieldlabels,clickResetGeometry .
To Cut the Fields at the Isocenter

3. Tocutthefieldedgesattheisocenter,selecttheCutfieldat
isocentercheckbox.
A.FieldprojectionsareshownB.FieldprojectionsarecutattheIsocenter
Field Visualization in the Model View

Bydefault,photonfieldpathsaredisplayedintheModelviewaslines
alongtheircentralaxes,andthefourcollimatorjawsaslines.Thefield
pathlinesstartoutsidethepatientsbodysurfaceandextendthrough
it.Thefieldisocenterismarkedwithasolidyellowsquare.TheSSD
pointismarkedwithasolidwhitesquare.Eachfieldalsohasa
rotationhandle.Inaddition,ifafielddisplayedintheModelviewis
active(selectedintheFocuswindow),theviewcontainsthepatient
orientationindicator,anditshowsthegantryandcouchpositions.
Figure 82onpage 373showsanactivefieldintheModelview.
A.FieldpathB.IsocenterC.Rotationhandle
Figure 82 Active Isocentric Field in Model View
Fields 369
Figure 83onpage 374showsanactivearcfieldintheModelview.
Figure 83 Arc Field in Model View
ArcfieldsaredisplayedintheModelviewsimilarlytostaticfields,but
asanadditionalfeature,therotationspanofanarcfieldisvisualized
withacurvedlineandanarrowtoindicatetherotationdirection.The
endofthecurvedlinemarkstheendoftherotation.
Figure 84onpage 374showsaconformalarcfieldintheModelview.
Figure 84 Conformal Arc Field in Model View
Inadditiontothedefault3Dvisualization,fieldscanalsobedisplayed
astranslucentconesintheModelview,andthefieldshapecanbe
displayedonthesurfaceoftheBodystructure.Formoreinformation

andinstructions,seeToDisplaytheFieldShapesontheBody
Surfaceonpage 376andToShowtheFieldPathsasConeson
page 377.
Youcanalsodisplayonlythecentralaxis(CAX)ofafieldinthemodel
view.Thisisuseful,forexample,iftheplancontainsmultiple
noncoplanarfields.Thisoptionhidesfieldpathsandallfield
accessoriesfromtheModelview.
ThefollowingfigureillustratestheCAXonlyview.
A.ModelViewwithfieldaxesandfieldpathsshownB.ModelViewwithShowCAXOnlyview
Figure 85 Show Central Axis only in Model View
TheShowCAXonlyoptioncanbeusedwhendisplayingfieldsincut
modeorinprojectionmode.Itcanbeusedwhenfieldentryandexit
shapesaredisplayedonthesurfaceoftheBodystructureandwhen
dosecolorwashisdisplayed.TheShowCentralAxisonlyoptioncan
alsobeusedwitharcfields.Forinstructions,seeToShowtheCAX
Onlyonpage 378.
Note: AfieldismadeactiveeitherbyselectingitintheFocuswindoworby
clickingthefieldlabelina2Dimageview.
To Rotate Model View with the Mouse
1. ClickintheModelview.TheRotatetoolisautomaticallyselected
intheModelview.
Becarefulnottoclickonfieldhandlesorthetreatmentunitmodel,
becausethiswillmodifythefield.
Fields 371
2. Dragtorotatetheimage.
A.ClickintheModelviewanywherebutthefieldrotationhandleorthetreatmentunitsymbol.
B.Dragtorotatetheimage.
TopantheimageintheModelview,gototheViewtoolbar,click
Pan ( )anddragtheimagetothedesiredposition.
TozoomintheimageintheModelview,movethemousewheel.
To Display the Field Shapes on the Body Surface
UsetheShowFieldEntryShapeonBodyorShowFieldExitShapeon
Bodycommandstodisplaythefieldoutlinesonthesurfaceofthe
BodystructureintheModelview.Thiscanbeusefulinpositioning
adjacentfieldsseamlesslynexttoeachother.

1. SelectthevisibilitycheckboxoftheBodystructureintheFocus
window,ifnotalreadyselected.
2. IntheModelview,rightclickandchooseShowFieldEntryShape
onBodyorShowFieldExitShapeonBodytodisplaythefield
outlinesonthesurfaceoftheBodystructure.
AllfieldshapesareshownintheBEV.
A.Fieldexitshapeonbody.B.Fieldentryshapeonbody.
To Show the Field Paths as Cones
TodisplaythefieldoutlinesasaconeintheModelview,
IntheModelview,rightclickandchooseShowFieldPathsas
Conestodisplaythefieldpathsastranslucentsurfaces.
Fields 373
To Show the CAX Only
TodisplayonlythecentralaxisforeachfieldintheintheModelview,
IntheModelView,rightclickandchooseShowCAXOnlyto
displayonlythecentralaxisforeachfield.
To Move the Viewing Planes
Tomovetheintersectionpointoftheviewingplanestothecenterof
theselectedstructure,
ChooseView >MoveViewingPlanesto >StructureCenter
<structure>.
Tomovetheintersectionpointoftheviewingplanestotheisocenterof
theselectedfield,
ChooseView >MoveViewingPlanesto >FieldIsocenter/Entry
Point<Field>.
Tomovetheintersectionpointoftheviewingplanestotheselected
referencepoint,
ChooseView >MoveViewingPlanesto >ReferencePoint
<point>.
Field Visualization in the Beams Eye View (BEV)

IntheBeamsEyeView,photonfieldsaredisplayedasrectangleswith
sizinghandlesandfielddimensionlabelsoneachsideoftherectangle.
Thefieldalsohasacollimatorrotationhandle,andtheisocenteris
markedwitharedsquare,whichisalsousedasahandletomovethe
field.Inaddition,theBEVcontainsthepatientorientationindicator
andshowsthegantryandcouchpositions.Youcanalsochooseto
showtheintersectionoftheactivetransversalplaneandtheSAD
planeoftheactivefieldintheBEV.
Figure 86onpage 379showsaphotonfieldintheBEV.

A. PatientorientationlabelsB. FielddimensionlabelC. PatientorientationindicatorD.
RotationhandleE. IsocenterandfieldmovinghandleF. SizinghandleG. Intersectionofthe
activetransversalplaneandtheSADplaneoftheactivefield.H. Gantryandcouchposition
Figure 86 Photon Field in the BEV
ThetitlebaroftheBEVwindowshowstheplanID,planapproval
status,thenameoftheview,viewingdistance,fieldinformationand
structuresetinformation.
YoucanalsoanimatethemovementofanarcfieldintheBEV.For
moreinformation,seeViewingArcFieldMovementonpage 391.
ThetitlebaroftheBEVwindowshowstheplanID,planapproval
status,nameoftheview,viewingdistanceandfieldinformationand
structuresetinformation.
To Show the BEV
OnlytheactivefieldcanbeshownfromtheBeamsEyeView.
ToshowtheBEV,intheContextwindow,rightclickthefieldand
chooseShowBeamsEyeView.
Toswitchtoanotherfield,rightclicktheBEVwindowandchoose
SetBeamsEyeViewto<field>.
To Show the Transversal Plane in the BEV
Fields 375
3. SelecttheTransversalsliceinBEVcheckbox.
TheintersectionoftheactivetransversalplaneandtheSADplane
oftheactivefieldisdisplayedintheBEV.
Field Visualization in the Arc Plane View

TheArcPlaneViewdisplaysareconstructed2Dimageinaplane
paralleltotheArcsrotationandviewedfromadirection
perpendiculartothearcsplaneofrotation.Onlytheactivefieldis
shownintheArcPlaneView.Thestartandstoppositionsofthearc,
thedirectionofthearcsrotationandtheextendedareaareshown.You
canalsoeditthestartandstoppositionsoftherotationintheArc
PlaneView.
Figure 87onpage 380showstheArcPlaneView.
A.FieldrotationhandleB.IsocenterC.ExtendedareaD.ArcrotationstopangleE.Arcrotation
spanF.ArcrotationdirectionG.Arcrotationhandle
Figure 87 Arc Plane View
YoucanzoominandoutintheArcplaneview,andscrollinitwith
yourmouse.Thefieldscanbeshowninprojectionmodeorcutmode,
andtheShowCAXonlyoptioncanbeused.

To Show the Arc Plane View
ToshowtheArcPlaneView,dooneofthefollowing:
RightclicktheModelViewandchooseSetArcPlaneViewto
<field>.
RightclicktheBEVwindowandchooseSetArcPlaneViewto
<field>.
Showing and Hiding Fields

Youcancontrolthevisibilityoffieldsbyselectingorclearingthe
visibilitycheckboxesintheFocuswindow.Youcanshoworhideall
fieldswithasinglecheckboxselection,orapplythecommandona
fieldbyfieldbasis(seeFigure 88onpage 382).Youcanalsoshowor
hidefieldsthatarepartofaplansum.
Theactive(selected)fieldisalwaysdisplayedinallimageviews
regardlessofthesettinginthefieldvisibilitycheckbox.Similarly,if
thefieldaccessoryofahiddenfieldisselectedintheFocuswindow,
theaccessoryisdisplayedintheimageviews.
Fields 377
A.Selectthischeckboxtoshowallfieldsintheimageviews.B.Selectanindividualcheckboxto
showafieldintheimageviews.C.TheaccessoryofahiddenfieldselectedintheFocuswindow
isdisplayedintheimageviews.
Figure 88 Hidden Fields in the Focus Window
Ifyouprintaviewthatcontainshiddenfields,awarningmessageis
includedintheprintout.
To Show or Hide Fields
1. IntheFocuswindow,dooneofthefollowing:
Toshoworhideallfields,selectorcleartheFieldsvisibility
checkbox.
Toshoworhideanindividualfield,selectorclearthevisibility
checkboxofthefield.

Adding Static Fields to Plans
Theinsertionofthefirstfieldisstartedautomaticallywhenyoucreate
anewplan.
ThestructuresdefinedintheimagesintheContouringworkspaceaid
youinpositioningthefields.Fieldscanbemanagedgraphicallywith
themouseandbymodifyingthefieldpropertiesintheField
Note: Beforestartingtosetupfields,makesurethatthe3Dimageyouare
usingcontainsallrelevantstructurestoenableacorrectfieldsetup.
Alsobearinmindthattoenablecorrectdosecalculation,fieldsshould
notintersectthefirstorlastsliceofthepatient,becauseinthiscaseCT
datadoesnotexistaboveorbelowthefield.Thepatientsurfaceisnot
automaticallyclosedattheendofa3Dimage,whichcanbeseeninthe
ModelviewwhenusingSolidorTranslucentrenderingfortheBody
structure:thepatientmodelresemblesahollowtubewithopenends
(Figure 89onpage 384).Ifafieldpassesthroughfromtheendofa3D
imagelikethis,thecalculationalgorithmcannotfindtheintersection
pointofthefanlineandthepatient,andthedosedistributioncannot
becalculatedcorrectly.
Asaworkaround,youcancreateanartificialCTslicetobeusedatthe
endofthe3Dimagetocloseit.ArtificialslicescanbecreatedinEclipse
afterimportingthescannedslices,orduringpatientimagingbefore
importingtheslicesintoEclipse.InEclipse,thesliceaddedtotheslice
setcanbeanartificialslicewithauniformdensityvalueoracopyof
anexistingslice.Formoreinformationonextendinganimageseries
withartificialslices,seeExtendingaScannedImageSetonpage 126.
Note: Whenaddingfields,notethat:
Nowarningisissuedifafieldintersectsthelastsliceofthepatient.
Alwaysmakesurethatyouhaveenoughslicestocovertheentire
treatmentvolume.
Themaximumnumberoffieldsthatshouldnotbeexceededinanysingle
treatmentplaninEclipseis25fields.
Fields 379
Figure 89 Field Direction to Avoid
Default Field Parameters

Whenyouaddnewfieldstoaplan,certaindefaultvaluesareused
unlessotherwisedirectedintheFieldPropertiesdialogbox.
Thedefaultfieldparametersforthefirstfieldaddedtoaplanarethe
following:
FieldsizeDefaultsizedependsontheselectedtreatmentunit.
TreatmentunitsareconfiguredintheAdministrationtask.For
informationonconfiguringtreatmentunits,refertotheonline
help.ForelectronfieldscalculatedwiththeeMCalgorithm,the
electronapplicatordefinesthefieldsizeinsteadofthecollimator
jaws.Theelectronapplicatorsizeisconfiguredinthe
Administrationtask.
Gantry,CollimatorandCouchrotation0(IEC)
IsocenterpositionCenterpointoftheplantargetvolumeselected
inthePlanPropertiesdialogbox,ifdefined;otherwisethecenter
pointoftheimage.
Note: Theinsertionofthefirstfieldisstartedautomaticallywhenyoucreatea
newplan.

Thedefaultparametersforallfieldsaddedtoaplanafterthefirstfield
arethefollowing:
Thetreatmentunit,fieldtechnique,fieldsize,isocenterposition
andfieldsymmetry/asymmetryarecopiedfromthepreviously
insertedfield
Gantry,CollimatorandCouchrotationaresettotheinitialdefault
value
Tolerancetable
Ifanydefaultvalueisoutsidetheallowedlimit,thevalueoftheclosest
limitisused.
Actual and Planned SSD Values
EachfieldhastwoSSDvaluesshownintheFieldPropertiesdialog
box:ActualSSDandPlannedSSD:
PlannedSSDvalueiscalculatedbyEclipsefromthegeometrical
setupofthefield.Thevaluecannotbeedited.
ActualSSDvalueisuserdefinedandindependentoftheplanned
SSDvalue.FornewfieldscreatedintheFieldSetupworkspace,the
actualSSDvalueisempty;forfieldscomingin,forinstance,from
simulation,theactualSSDvalueshowstheSSDvaluemeasuredin
simulation.Thevaluecanbeeditedaftertheplanhasbeen
approvedfortreatment.(Formoreinformationonapprovals,see
Chapter 25,SectionApprovingPlansforTreatmentonpage 704.
Fields Tab of the Info Window

TheFieldstaboftheInfoWindowisvisibleintheFieldSetupandPlan
EvaluationworkspacesoftheExternalBeamPlanningtask.Itisused
forviewingandeditingthepropertiesofthefieldsoftheactiveplan.
Forunapprovedplans,youcaneditthefieldweightsontheFieldstab
oftheInfowindowinthePlanEvaluationworkspace.
TheinformationdisplayedintheFieldstabincludestheparametersof
eachfieldcontainedintheactiveplanorplanscontainedintheactive
plansum.
Fields 381
Table 8 Information in the Fields Tab
Column Description
Group Checkboxesusedtoselectwhichfieldsaregrouped
together.
PlanID Planidentificationcode.Shownforeachfieldinaplansum.
FieldID Fieldidentificationcode.
Technique Fieldtechnique:
STATIC - I=staticfield,isocentric
STATIC - F=staticfield,fixedSSD
ARC - I=arcfield,isocentric
HDTSE - I=HDTSEfield,isocentric
TOTAL - I=totalbodyfield,isocentric
Machine/Energy Nameofthetreatmentunitanditsenergymode.
MLC MLCtype:
Static
DoseDynamic
DoseDynamicArc
FieldWeight Fieldweightofthefield
Scale Treatmentunitscale
GantryRtn Gantryrotationindegrees
[deg]
CollRtn[deg] Collimatorrotationindegrees
CouchRtn[deg] Couchrotationindegrees
RotationA. Chairrotation
[deg]
Wedge Wedgecodeifused.Ifnotinuse,none
FieldX[cm] DimensionFXattheisocenter(isocentricfields)orfield
entrypoint(fixedSSDfields).
X1[cm] ThedisplacementfromthefieldcentralaxistofieldedgeX1
attheisocenter(isocentricfields)orfieldentrypoint(fixed
SSDfields).Editableonlyforasymmetricalfields.Displayed
inbluewithtooltipifusedinafieldalignmentrule.

Table 8 Information in the Fields Tab
Column Description
X2[cm] ThedisplacementfromthefieldcentralaxistofieldedgeX2
FieldY[cm] DimensionFYattheisocenter(isocentricfields)orfield
entrypoint(fixedSSDfields).
Y1[cm] ThedisplacementfromthefieldcentralaxistofieldedgeY1
Y2[cm] ThedisplacementfromthefieldcentralaxistofieldedgeY2
X[cm] Xcoordinateoftheisocenterortheentrypoint
Y[cm] Ycoordinateoftheisocenterortheentrypoint
Z[cm] Zcoordinateoftheisocenterortheentrypoint
SSD[cm] Sourcetoskindistanceincentimeters
MU Monitorunits
MUsaredisplayedonlyafterthedosedistributionhasbeen
calculatedandthedoseprescriptiondefined.MUsare
shownifthereisonlyonefractionation.
Ref.D[Gy] ReferencedoseinGy(orcGy,dependingonthe
configuration)
Referencedoseisdisplayedonlyafterthedosedistribution
hasbeencalculatedandthedoseprescriptiondefined.
Referencedoseisshownifthereisonlyonefractionation.
Fields 383
Thelabelsofthefielddimensions(FieldX,FieldY,X1,X2,Y1,Y2)
usedinthetablearethedefaultlabels.Thelabelscanbeconfiguredin
theAdministrationtask.ForinformationontheAdministrationtask,
refertotheonlinehelp.
Note: Whenshowinginformationofaplancontainingfieldsthatusedifferent
scales,orofaplansumcontainingsuchfields,thecolumnheadersintheInfo
windowshowgenerallabelsforthefieldgeometryinsteadoftheones
configuredintheAdministrationtask.Thisisindicatedwithanadditional
label[IEC1217].However,theactualfieldgeometryvaluesinthecellsare
shownusingtheparticularmachinescaleofeachfield.
To Insert a Static Field

1. ChooseInsert >NewField.
AnewfieldisshowninimageviewsandintheFocuswindow.
2. IntheFocuswindow,selectthenewfield.ChooseEdit >
Properties.
TheFieldPropertiesdialogboxopens.
3. IntheIDtextbox,typeanIDandintheNametextbox,typea
nameforthefield.Otherwise,thedefaultIDandnameareused.
4. IntheMachinedropdownlist,selectthetreatmentunit.
Althoughthecreationofisocentricelectronfieldsisallowed,donotuse
thembecauseofpotentialinconsistenciesinthedosenormalization.
TheEnergylistboxandtheDoseRatetextboxshowthedefault
valuesfortheselectedtreatmentmachine.
WheninsertinganewDoseDynamicArcfield,thedoseratedefinedin
theFieldPropertiesdialogboxwillbethemaximumdoserateusedinthe
arcoptimization.Itisrecommendedtousethehighestdoserateavailable
onthetreatmentunit.
5. IntheEnergydropdownlist,selecttheenergymodeandinthe
DoseRatedropdownlist,selectthedoserateifyoudonotwishto
usethedefaultvalues.
6. SelecttheGeometrytab.
7. IntheTechniquedropdownlist,selectSTATIC.

8. IfyouarecreatingafixedSSDphotonfieldoranelectronfield,do
oneofthefollowing:
FixedSSDfield:GototheSetupdropdownlistbox,select
Fixed SSDandthendefinetheappropriatesourcetofield
entrypointdistanceintheSFEDtextbox.
Electronfield:SelectinganelectronenergyintheEnergy
dropdownlistautomaticallycreatesafixedSSDelectronfield.
Definetheappropriatesourcetofieldentrypointdistancein
theSFEDtextbox.
YoucanchangetheSSDonlyforfieldstobecalculatedwiththeeMC
calculationmodel.
9. Forelectronfields,selecttheAccessoriestabandselectthecorrect
accessorymountfortheelectronapplicator.Thisisamandatory
settingforanelectronfield.
10. ClickOKtoacceptthesettings.
YoucanalsoeditthefieldpropertiesintheInfowindow.
Continuebyresizingandrotatingthefieldandthendefinetheaddonsas
appropriate.
Adding Arc Fields to Plans

Anarcfieldisinsertedtoaplaninthesamewayasstaticfields:you
insertthefieldanddefinethegeneralfieldpropertiesasinToInserta
StaticFieldonpage 388.Afterthis,youdefinepropertiesspecificto
arcfields.
ConformalarcfieldsarecreatedbyaddingDynamicMLCsintoarc
fields.Forinstructions,seeToAddMLCstoArcFieldsonpage 520.
Limits in the Arc Field Rotation Span

Theallowedrotationdirectionofanarcfieldisdeterminedonthe
basisofthestartandstopanglesoftherotationspan.Inthe
configurationofthesystem,youdefineforeachtreatmentunitthe
amountofextendedarcrotation,allowingarcfieldswithanglesinthe
Fields 385
extendedarea.Theextendedareaisshowninthe2Dviews,intheArc
PlaneView,andintheFieldPropertiesdialogbox.Figure 90on
page 390illustratestheextendedarea.
0
270 90
180
A
A.ExtendedareaB.Gantryrotationspan
Figure 90 Extended Area, Clockwise Direction
Forinstance,toachieveafull360rotationintheclockwisedirection,
starttherotationfrom185andstopitat185intheextendedarea.
To Add an Arc Field

1. InsertthefieldanddefinethegeneralfieldpropertiesasinTo
InsertaStaticFieldonpage 388.
3. IntheTechniquedropdownlist,selectARC.
4. IntheGantryRtntextbox,definethestartangleforthegantry
rotation.
5. IntheStopAngletextbox,definetheangleatwhichthearcfield
rotationmuststop.
Ifusedintherotation,theExtendedAreacheckboxbecomes
selectedafterenteringanglesanddirection.TheCW(clockwise)
andCCW(counterclockwise)optionbuttonsareavailable
dependingonthedefinedrotationstartandstopangles.
6. Todefinetherotationdirectionofthearcfield,clicktheCWorthe
CCWoptionbutton.

7. ClickOKtoacceptthesettings.
Thenewarcfieldisshowninimages.
Continuebyresizingandrotatingthefield,andthendefinetheaddonsas
appropriate.
To Add a Conformal Arc Field

AconformalarcfieldiscreatedbyaddingaDynamicMLCintoanarc
field.Forinstructions,seeToAddMLCstoArcFieldsonpage 520.
Viewing Arc Field Movement

Themovementofastaticarcfieldcanbeviewedasananimationin
theBEV.Youcananimatetheentirearcfromthestarttothestopangle
automatically,orviewthemovementin5degreesteps,forwardsand
backwards.Youcanalsodefineanexactgantryanglefromwhichto
viewthearcfieldintheBEV.Thechangingarcangleduringthe
animationisshownonthetitlebaroftheBEVwindow.
Themovementsofconformalarcfields(arcfieldsthatcontaina
DynamicMLC)canalsobeanimated.Forinstructions,seeToView
theMotionsofaDynamicMLConpage 520.
To Animate Arc Fields in the BEV
1. ToshowthearcfieldintheBEV,rightclickintheBEVorModel
View,chooseSetBeamsEyeViewtoandthenselectthearcfield.
TheselectedfieldisshownintheBEV.TheAnimateMLC
SegmentstoolbarappearsabovetheBEV.
2. Toanimatethearcfield:
Toshowtheentiresequenceofarcfieldsegments,click .
Toshowthepreviousorthenextsegment,click or
respectively.
Toshowthefirstorthelastsegment,click or
respectively.
ThearcviewingangleisshownintheBEVtitlebar.
3. Tostoptheanimation,click .
Fields 387
4. Toviewthearcfieldfromaspecificangle,typetheangleinthetext
box inthetoolbar.
Adding Opposing Fields

Opposingfieldscanbecharacterizedasmirrorimagesofexisting
fields.Thefollowingfeaturesoftheoriginalfieldwithchangestothe
gantry,collimatorandcouchpositionsarecopiedtoanopposingfield:
Fieldsize
Fieldtype(isocentricorfixedSSD)
Isocentercoordinates(iftheoriginalfieldisafixedSSDfield,the
isocenterisnotshared,buttheopposingfieldispositionedonthe
patientsskinontheoppositesideoftheoriginalfield)
Wedges(mirroredintheopposingfield).Formoreinformation,
seeWedgesinOpposingFieldsonpage 393andDefiningthe
HardWedgeDirectionintheOpposingFieldonpage 394.
Blocks(mirroredintheopposingfield).Iftheblockintheoriginal
fieldisfittedtoastructure,theshapeoftheblockismirroredinthe
opposingfield,buttheblockisnotautomaticallyfittedtothe
structure.
Multileafcollimators(mirroredintheopposingfield).IftheMLC
intheoriginalfieldisfittedtoastructure,theshapeoftheMLCis
mirroredintheopposingfield,buttheMLCisnotautomatically
fittedtothestructure.
Compensators(mirroredintheopposingfield).Thecompensator
intheopposingfieldisnotcalculated.
Bolus(mirroredintheopposingfield).Thecopiedbolusisnot
linkedtotheopposingfield.
Digitallyreconstructedradiographimage.TheDRRiscreatedfor
theopposingfieldusingtheDRRparametersoftheoriginalfield.
Note: Whenusingopposingfields,notethefollowing:
Ifthepropertiesoftheoriginalfield,copiedtotheopposingfield,arenot
allowedinthetreatmentunit,awarningisdisplayedandthefield
creationiscancelled.
Fieldfluenceisnotcopiedtotheopposingfield.
Themaximumnumberoffieldsthatshouldnotbeexceededinanysingle
treatmentplaninEclipseis25fields.

Asrotatingthecollimatormechanicallytakesalotoftime,the
collimatorrotationisminimizedasmuchaspossiblewhenopposing
fieldsarecreated.Formoreinformation,seeWedgesinOpposing
Fieldsonpage 393.
Figure 91onpage 393showstwoopposingfieldsina2Dview.
Figure 91 Opposing Fields
Wedges in Opposing Fields

Eclipsetriestominimizethecollimatorrotationwhencreatingan
opposingfieldthatcontainsawedge.Withmotorizedwedges,only
onecollimatorrotationangleispossible,asamotorizedwedgecanbe
appliedfromonedirectiononly.Forhardwedges,itispossibleto
definethatthedirectionofthewedgeisnotchangedwhenan
opposingfieldiscreated(formoreinformation,seeDefiningthe
HardWedgeDirectionintheOpposingFieldonpage 394).
ThedirectionoftheDynamicWedgesorEnhancedDynamicWedges
infieldsischangedifminimizingthecollimatorrotationsorequires.If
awedgecannotbeincludedinanopposingfield,awarningmessageis
displayed.
Fields 389
To Insert an Opposing Field
1. IntheFocuswindow,selectthefieldtoaddtheopposingfieldto.
2. ChooseInsert >NewOpposingFieldtoaddtheopposingfieldto
theimageviewsandtheFocuswindow.
Theopposingfieldisshowninimages.
Continuebyresizingandrotatingthefieldandthendefinetheaddonsas
appropriate.
Defining the Hard Wedge Direction in the Opposing Field

Bydefault,Eclipsetriestominimizethecollimatorrotationangle
whencreatingopposingfields.Thisrequiresthatthedirectionofa
hardwedgeischangedintheopposingfield.However,itispossibleto
useaclinicwidesettingthatdefinesthatthedirectionofahardwedge
isnotchangedwhenanopposingfieldiscreated.
To Define the Hard Wedge Direction in the Opposing Field
1. ChooseTools >TaskConfiguration.
TheTaskConfigurationdialogboxopens.
2. SelecttheOpposingFieldtab.
Todefinethatthedirectionofahardwedgeisnotchanged
whenanopposingfieldiscreated,selectthePreservehard
wedgedirectioncheckbox.
Todefinethatthedirectionofahardwedgecanbechanged
whenanopposingfieldiscreated,clearthePreservehard
wedgedirectioncheckbox.
thesamedatabase.
4. ClickOK.

Aligning Fields
Forreachingauniformdosedistributionoverlargevolumes,for
exampleinbreast,andheadandnecktreatments,openfieldscanbe
alignedtoformsmoothjunctionswithotherfields.Youcandefine
fieldalignmentrulesintheFieldAlignmentstaboftheInfowindowin
theFieldSetupworkspace.Figure 92onpage 395showsalignedfields
inabreasttreatment.Thealignedplanesareshowninyellow.Ifthe
ShowFieldPathsasConesoptionisalsoselected,thealignedfields
arevisualizedinlighteryellow.
Figure 92 Aligned Fields
Eachfieldcontains6planes(X1,X2,Y1,Y2,XC,andYC)thatcanbe
alignedwithanotherfieldsplanes.Withthefieldalignmenttool,you
candefinethatcertainplanesoftwofieldsarealwaysalignedwith
eachother.Ifyoumoveafieldthatisincludedinafieldalignment
rule,thegantry,collimatorandcouchrotations,fieldsizes,andeven
theisocenteroftheotherfieldarechangedsothattheplanesstay
alignedaccordingtothedefinedfieldalignmentrule.Figure 93on
page 396showsthefieldalignmentplanesandtheirnormaldirections
viewedfromtheBEV.ThefigureisvisibleintheFieldAlignmentstab
oftheInfowindow.
Fields 391
Figure 93 Field Alignment Planes
Youcandefineamasterfieldforafieldalignmentrule.Themaster
fieldisnotmovedwhenfieldalignmentrulesareapplied.Allother
fieldsareadjustedaccordingtothemasterfield.Ifthemasterfieldis
notdefined,thecurrentlyactivefieldisconsideredasthemasterfield
andallotherfieldsareadjustedaccordingly.
Ifthereareseveralfieldalignmentrules,therulesareappliedinthe
ordertheyaredefined.
Bydefault,whenyoustartEclipsethefieldalignmenttoolisoff.Itis
possibletomodifyfieldalignmentrulesalsowhenthetoolisoff.You
canswitchthetoolonandoffbyselectingthecheckboxintheField
AlignmentstaboftheInfowindow(seeFigure 94onpage 398).When
thetoolisswitchedon,itisactiveuntillyouswitchitofforuntilanew
planisopenedandloadedintoimageviews.
Fieldalignmentrulescanbeappliedtoopenfieldsonly.Theyarenot
availableforprotonfields,plansumsorelectronfields.
Field Alignments Tab of the Info Window

TheFieldAlignmenttaboftheInfoWindowisvisibleintheField
SetupworkspaceoftheExternalBeamPlanningtask.Itisusedfor
viewingandeditingfieldalignmentrules.Fieldalignmentrulesare
appliedwhenthecheckboxintheFieldAlignmentstabisselected.For
instructionsonhowtoaddfieldalignmentrules,seeToDefinea
FieldAlignmentRuleonpage 398.

Table 9 Information in the Field Alignments Tab
Item Description
Field Thefieldusedinthealignmentrule.
Clicktheemptycelltoopenadropdownlistdisplaying
allfieldsinthecurrentplan.
Abluebackgroundintheruleindicatesthattheruleisnot
applied;therulecontainsimpossiblefieldgeometry,orit
violatestreatmentunitlimits.
Edge Theplaneusedinthealignmentrule.
Clicktheemptycelltoopenadropdownlistdisplaying
allsixplanesinthefield(X1,X2,Y1,Y2,XCandYC).For
anillustrationoftheplanes,seeFigure 93.
Abluebackgroundintheruleindicatesthattheruleisnot
applied;therulecontainsimpossiblefieldgeometry,orit
violatestreatmentunitlimits.
Direction Togglebuttonsshowingwhetherthefieldsinthefield
alignmentruleareparalleloropposing.
Fieldsinthefieldalignmentruleareparallel.Clickthe
buttontochangeparallelfieldstoopposingfields.
Fieldsinthefieldalignmentruleareopposing.Clickthe
buttontochangeopposingfieldstoparallelfields.
Deletesthefieldalignmentrule.
Auto Theapplicationfreezeseitherthejawpositionsor
isocentersduringfieldalignment.Iftwofieldshavethe
sameisocenter,theisocentersarefreezed.Otherwise,the
jawpositionsarefreezed.
Keepjaw Freezesfieldsizesduringfieldalignment.Whenthis
positions optionisselected,theisocentersareadjustedinstead.
Theoptionbuttonisautomaticallyselectedwhenelectron
fieldsareused.
Keepisocenters Freezesisocentersduringfieldalignment.Whenthis
optionisselected,thejawpositionsareadjustedinstead.
IfXCorYCisdefinedasanedgeinthefieldalignment
rule,thisoptioncannotbeused.
Fields 393
Table 9 Information in the Field Alignments Tab
Item Description
MasterField Dropdownlistforselectingthemasterfield.Themaster
fieldisnotmovedwhenfieldalignmentrulesareapplied.
Allotherfieldsareadjustedaccordingtothemasterfield.
Ifthemasterfieldisnotdefined,thecurrentlyactivefield
isconsideredasthemasterfieldandallotherfieldsare
adjustedaccordingly.
Showruleorder Opensamessageboxdisplayingtheorderinwhichthe
fieldalignmentrulesareapplied.
ThepictureintherightsideoftheFieldAlignmentstabshowsthe
alignmentplanesX1,X2,Y1,Y2,XCandYCandtheirnormal
directionsviewedfromtheBEV.
A.Whenthecheckboxisselected,thefieldalignmentrulesareapplied.B.Togglebuttonshowingwhetherthe
fieldsintheruleareparalleloropposing.C.Optionsforhandlingisocentersduringfieldalignment.D.Displays
theorderinwhichthefieldalignmentrulesareapplied.
Figure 94 Field Alignments Tab in the Field Setup Workspace
To Define a Field Alignment Rule

1. GototheInfowindowandselecttheFieldAlignmentstab.
2. Todefinethefirstalignmentplaneforthefieldalignmentrule,
clickanemptycellinthefirstFieldcolumn.
Adownpointingarrowhead appearsontherightsideofthe
cell.
3. Clickthearrowhead.
Adropdownlistopensdisplayingallthefieldsinthecurrently
activeplan.
4. Selectthedesiredfieldfromthedropdownlist.

5. ClickanemptycellinthefirstEdgecolumn.
cell.
Adropdownlistopensdisplayingalltheplanesofthefield(X1,
X2,Y1,Y2,XC,andYC).
7. Selectaplaneforthefieldalignmentrule.
TheselectedplaneishighlightedintheModelview.
8. Clickthebuttontoindicatewhetherthesecondfieldinthefield
alignmentruleisparallelwithoropposingtothefirstfieldyoujust
defined.The buttondescribesparallelfieldsandthe
buttondescribesopposingfields.
9. Todefinethesecondalignmentfieldforthefieldalignmentrule,
clicktheemptycellunderthesecondFieldcolumnandselectthe
fieldasbefore.
10. Todefinethesecondalignmentplaneforthefieldalignmentrule,
clicktheemptycellinthesecondEdgecolumnandselecttheplane
asbefore.
11. Repeatsteps210asmanytimesasnecessarytocreateallthefield
alignmentrulesyouneed.
Tokeepthefieldsizesunchangedduringfieldalignment,
selecttheKeepjawpositionsoptionbutton.
TheKeepfieldsizescheckboxisautomaticallyselectedwhenelectron
fieldsareused.
Tokeepthefieldisocentersunchangedduringfieldalignment,
selecttheKeepisocentersoptionbutton.
Tolettheapplicationdecidehowfieldsarehandledduring
fieldalignment,selecttheAutooptionbutton.
13. SelectthemasterfieldfromtheMasterFielddropdownlist.Ifthe
masterfieldisnotdefined,thecurrentlyactivefieldisconsidered
asthemasterfield.
14. Todisplaytheorderinwhichthefieldalignmentrulesareapplied,
clickShowruleorder.
Fields 395
15. Toactivatethefieldalignmentrules,selectthecheckboxinthe
upperleftcorneroftheFieldAlignmentstab.
Theplanesusedinfieldalignmentrulesaremarkedinblueinthe
FieldstaboftheInfowindow.Theyalsohaveatooltipshowing
thefieldalignmentrule.FormoreinformationontheFieldstabof
theInfowindow,seeFieldsTaboftheInfoWindowonpage 385.
To Modify a Field Alignment Rule

1. IntheFieldAlignmentstaboftheInfowindow,clickthefieldor
planetomodify.
cell.
3. Selectthedesireditemfromthedropdownlistthatopens.
4. Tochangeparallelfieldtoopposingandviceversa,clickthetoggle
buttonlocatedbetweenthetwoalignmentplanes.
To Delete a Field Alignment Rule

IntheFieldAlignmentstaboftheInfowindow,clickthe
buttonnexttothefieldalignmentruleyouwanttodelete.
Moving Fields
Movingafieldfromonepositiontoanotherinvolveschangingthe
locationofthefieldsisocenter.Fieldscanbemovedgraphicallywith
themouseandbymodifyingthefieldpropertiesintheField
Moving Handle
Inthe2DviewsandtheModelview,fieldsarerepositionedby
draggingtheirmovinghandles.Whenafieldisactiveitsmoving
handleisdisplayedinthe2DimageviewsandtheModelview.

A.IsocentricfieldB.FixedSSDfieldC.Movinghandle
Figure 95 Field Moving Handle
Youcanalsomovenoncoplanarfieldsin2Dimageviews.In
noncoplanarfields,theisocenterisontheplanedisplayedinthe
current2Dwindowbutthehandlecanbeoutsidethisplane.However,
managingnoncoplanarfieldsintheModelviewortheBEVis
recommended,asthefieldpositionsareshownmorerealistically.In
thecaseofnoncoplanarfields,the2Dimageviewsmainlyfunctionas
referenceimages.
Note: Whenmovingfields,noticethefollowing:
Whentheisocenterisoutsidethepatient,usefixedSSDfieldstomake
surethatthenormalizationusedisfixedSSDnormalization.Using
isocentricfieldswiththeisocenteroutsidethepatientcanresultin
inconsistentnormalizationofthedosedistribution.However,eveninthis
case,theabsolutedosedistributionandMUvaluesarecorrect.
DisplaythefieldoutlinesonthesurfaceoftheBodystructurewhen
positioningadjacentfieldsseamlesslynexttoeachother.Forinstructions,
seeToDisplaytheFieldShapesontheBodySurfaceonpage 376.
To Move the Field Isocenter or Entry Point

Tomovethefieldisocentertothestructuremasscenterpoint,
IntheFocuswindow,rightclickthefield,chooseAlignFieldor
GroupedFieldswith> Structuretoselectthestructuretowhich
thefieldshouldbemoved.
Fields 397
Tomovethefieldentrypointtotheprojectionoftheselectedstructure,
IntheFocuswindow,rightclickthefield,chooseAlignFieldor
GroupedFieldswith> StructureProjectionandselectthe
structureprojectiontowhichthefieldshouldbecentered.
Tomovethefieldisocenterorentrypointtothereferencepoint,
IntheFocuswindow,rightclickthefieldandchooseAlignField >
orGroupedFieldswith >ReferencePoint.
Tomovethefieldisocenterorentrypointtotheintersectionpointofthe
orthogonalplanes,
IntheFocuswindow,rightclickthefieldandchooseAlignField >
orGroupedFieldswith >ViewingPlaneIntersection.
To Move Fields Graphically in the 2D Views

1. IntheFocuswindow,selectthefield.
2. IntheBEVora2Dview,placethemousepointeroverthefields
movinghandleanddragittoanewposition.
Theviewingplaneintersectionfollowstheisocenterorfieldentrypoint.
TheentrypointissnappedontotheBodysurfaceifyoumoveitcloseto
thesurface.
A.Placethemousepointeroverthemovinghandle.B.Dragthefield.
3. Toattachthefieldtoanewposition,releasethemousebutton.

To Move Fields Graphically in the BEV
2. IntheBEV,placethemousepointeroverthefieldisocenterand
dragittoanewpositionwiththemouse.
Theviewingplaneintersectionfollowstheisocenterorfieldentrypoint.
TheentrypointissnappedontotheBodysurfaceifyoumoveitcloseto
thesurface.
A.Placethemousepointeroverthefieldisocenter.B.Dragthefieldtothenewposition.
To Move Fields Graphically in the Model View

2. IntheModelview,pressSHIFTanddragthemovinghandleofthe
field.
A.PressSHIFTanddragthemovinghandle.B.Releasethemousebuttontoattachthefieldtothe
newposition.
Fields 399
To Move Fields by Modifying their Isocenter Coordinates
Inadditiontomovingfieldsgraphically,fieldscanbemovedby
modifyingtheirisocentercoordinates.
3. IntheIsocentergroupbox,typethecoordinatesintheX,Y,andZ
textboxes.
IfthefieldisafixedSSDfield,itsentrypointcoordinatesaredisplayed
insteadofisocentercoordinates.
Ifthefieldisagroupedfield,thefieldcoordinatevaluesare
changedforallfieldsinthegroup.Forinformationongrouping
fields,seeGroupingFieldsonpage 404.
4. ClickOKtomovethefield(s)accordingtothenewcoordinate
values.
YoucanalsoeditthefieldisocentercoordinatesintheInfowindow.For
moreinformationontheInfowindow,seeFieldsTaboftheInfo
Windowonpage 385.
Grouping Fields
Fieldsbelongingtothesameplancanbegroupedtomovetheir
isocenterorentrypointstogether.YoucanalsorefitallMLCsorblocks
inthegroupedfieldsandtheircollimatorjawpositionsatonce.
Isocentricfieldsareinagroupbydefault.Changesmadetoafield
groupingarevalidonlyfortheactiveplaninthecurrentsession.Field
groupscannotbesaved.

To Group Fields
1. IntheInfowindow,selecttheFieldstab.
2. Foreachfieldtobegroupedtogether,selectthecheckboxinthe
Groupcolumn.
Totogglethegroupselectionforeachfield,clicktheGrouptitlebar.To
groupallfields,pressSHIFTandclicktheGrouptitlebar.
To Move Grouped Fields

2. Inanimageview,selectoneofthegroupedfieldsanddragittoa
newposition.
Allthegroupedfieldsaremovedwiththeselectedfield.
To Refit Grouped Fields

1. Aftergroupingthefields,intheFocuswindow,rightclicktheplan
containingthefieldsandchooseRefitgroupedfields.
TheRefitAllGroupedFieldsdialogboxopens.Itemsselectedtobe
refittedarehighlighted.
2. Selecttheitemstorefitbyclickingthecorrespondingbuttonsand
clickRefit.
Ifmorethanoneitemisselected,collimatorjawsarealwaysfitted
first,followedbyMLCsandblocks,respectively.
Forinformationonfittingthecollimatorjawstotheselected
structure,seeToResizeFieldsbyFittingtheCollimatorJawstoa
Structureonpage 415.
ForinformationonfittingtheMLC,seeToMoveMLCLeaves
withtheFittoStructureToolonpage 523.
Forinformationonfittingtheblocks,seeToResizeFieldsby
FittingtheCollimatorJawstoaStructureonpage 415.
Fields 401
Rotating Fields
Thefieldangle,thatis,thefieldrotation,canbemodifiedbyrotating
thefieldarounditsisocenter.Todefinethefieldrotation,eithermove
thefieldrotationhandlewiththemouseormodifythefieldproperties
intheFieldPropertiesdialogbox.
Note: Verifyallfieldspriortotransferringtheplantothetreatmenttoavoid
patientandtreatmentunitcollisions.
Rotation Handle
Inthe2DviewsandtheModelview,fieldsarerotatedbymovingtheir
rotationhandles.Whenafieldisactiveitsrotationhandleisdisplayed
inthe2DimageviewsandtheModelview.
A.IsocentricfieldB.FixedSSDfieldC.Rotationhandle
Figure 96 Field Rotation Handle
Noncoplanarfieldscanalsoberotatedin2Dimageviews.In
noncoplanarfields,theisocenterisontheplanedisplayedinthe
current2Dwindowbutthehandlecanbeoutsidethisplane.However,
managingnoncoplanarfieldsintheModelviewortheBEVis
recommended,asthefieldpositionsareshownmorerealistically.In
thecaseofnoncoplanarfields,the2Dimageviewsmainlyfunctionas
referenceimages.

To Rotate Fields Graphically in the 2D Views
2. Ina2Dimageview,dragtherotationhandletorotatethefield
arounditsisocenter.Rotatingafieldinanimageviewrotatesitin
alloftheimageviews.
A.Placethemousepointerovertherotationhandle.B.Dragtherotationhandle.
To Rotate Fields Graphically in the BEV

1. IntheFocuswindow,selectthefieldtorotate.
2. ChooseView >Geometry >Rotate .
3. IntheBEV,pressthemousebuttonandmovethemousepointerto
rotatethebeamarounditsisocenter.
4. Whenthefieldisatthedesiredangle,releasethemousebuttonto
attachthefieldtotheselectedposition.
5. Toinactivatetherotationtool,selectRotateagain.
Fields 403
To Rotate Photon Fields Graphically in the Model View
1. IntheFocuswindow,selectthefieldtorotate.
2. IntheModelview,movethefieldrotationhandletorotatethefield
arounditsisocenter.
A.Pointattherotationhandle.B.Rotatethehandle.
3. Whenthefieldisatthedesiredangle,releasethemousebuttonto
attachthefieldtotheselectedangle.
To Change the Arc Field Rotation Span

1. IntheFocuswindow,selectthearcfield.
2. Inanimageview,movethearcrotationhandlewiththemouseto
thedesiredstopangletoincreaseordecreasetherotationspan.
A.Pointatthearcrotationhandle.B.Increaseordecreasetherotationspan.
Tochangetherotationdirection,pointattherotationhandleand
rightclick.

3. Whenthearcrotationisthedesired,releasethemousebuttonto
fixtherotationspan.
4. Incaseofaconformalarcfield,theMLCleavesareclosedinall
segments.FormoreinformationaboutfittingtheMLCandother
MLCoperators,seeMovingMLCLeavesonpage 521.
Note: YoucanadjustthearcrotationspanalsointheArcPlaneView,which
showstherotationspanofnoncoplanarfieldsmorerealistically.
To Change the Collimator Rotation in the BEV

2. IntheFocuswindow,rightclickthefieldandchooseShowBeams
EyeViewtochangethe3DviewtotheBEV.
3. IntheBEV,movethecollimatorrotationhandlewiththemouseto
rotatethecollimator.
A.Placethemousepointeroverthecollimatorrotationhandle.B.Dragthecollimatorrotation
handle.
4. Whenthecollimatorrotationisasdesired,releasethemouse
buttontofixthecollimatorrotation.
Fields 405
To Change the Rotation Parameters for a Static Field
by Modifying the Field Properties
4. Tochangethegantry,collimatorandcouchrotation,typethe
rotationvaluesintheGantryRtn,CollRtnandCouchRtntext
boxes.
5. ClickOKtorotatetheselectedfieldtothecorrespondingposition
arounditsisocenterorentrypoint.
To Change the Rotation Span Parameters for an Arc Field

by Modifying the Field Properties
4. Tochangethearcrotationspan,typetherotationspanvaluesin
theGantryRtnandStopAngletextboxes.
5. Tochangetherotationdirection,clicktheCW(clockwise)orthe
CCW(counterclockwise)optionbutton.
6. ClickOKtochangetherotationspanoftheselectedfield.
Note: Youalsocanchangethegantry,collimatorandcouchrotationvaluesin
theFieldstaboftheInfowindow.Formoreinformation,seeInfoWindowon
page 75.

Resizing Fields
Tomakefieldsconformbettertothetargetsizeandshape,resizethem
by
MovingthefieldsizinghandleswiththemouseintheBEVimage
view
ChangingthefieldparametersintheFieldPropertiesdialogbox
Fittingthecollimatorjawstoastructure
Resizingisslightlydifferentdependingonwhetherthefieldis
symmetricalorasymmetrical.
Symmetrical and Asymmetrical Fields

Note: Sometreatmentunitsdonotallowasymmetricalfields.
Thenamingofthedimensionsofafielddependsontheconfiguration
oftheselectedtreatmentunit.Thefielddimensionlabelsareshownin
accordancewiththeselectedtreatmentunit.IntheIECsystem,the
fielddimensionsarenamedinfourparts:X1,X2,Y1andY2.Figure 97
onpage 412showsafieldintheBEVimageviewwhen
DimensionlabelingsystemisthatoftheIEC
Gantry,collimatorandcouchrotationis0 (IEC)
Patientorientationindicatorisfrontal(theindicatorisfacingyou).
Asymmetricalfieldscanbedefinedtocorrespondtothetargetvolume
sizemoreaccurately,andifnecessary,twoasymmetricalfieldscanalso
bepositionedseamlesslynexttoeachother.
Fields 407
A.FielddimensionsinIECsystemB.Collimatorrotation0 C.PatientOrientationIndicatorD.
Gantryandcouchrotation0
Figure 97 Field Dimensions
Increaseordecreasethefieldsizebydraggingthesizinghandleson
theXandYaxesintheBEV.Dependingonthefieldsymmetryor
asymmetry,thefieldedgesaremoveddifferently(seeToResize
FieldsGraphicallyonpage 414).
To Define Field Symmetry or Asymmetry

4. DefinethefieldsymmetryorasymmetryintheXdirectionby
clearingtheAsym.Xcheckbox(symmetrical)orselectingit
(asymmetrical).
5. DefinethefieldsymmetryorasymmetryintheYdirectionby
clearingtheAsym.Ycheckbox(symmetrical)orselectingit
(asymmetrical).
FieldsymmetryorasymmetrycanalsobedefinedintheInfowindow.
Formoreinformation,seeInfoWindowonpage 75.

Converting Asymmetrical Fields into Symmetrical Fields
Asymmetricalfieldscanbeconvertedintosymmetricalfieldsto
supportsimulatorworkflowswherethepositionsofthefieldedgesare
locatedfirst,andthentheisocenterpositionedautomatically.The
conversioncanalsobeusefulincaseswheretheimagescontainno
contours.Thetargetcanthenbedefinedasarectanglelimitedbythe
collimatorjaws,andtheisocenterpositionedinthemiddleofthis
rectangle.
Thefieldsizeontheisocenterplaneisnotchangedintheconversion.
Note: Whenconvertingasymmetricalfieldsintosymmetricalfields,noticethe
following:
Groupedfieldsthatsharethesameisocenter:Onlytheselectedfieldis
madesymmetricalbytheconversion.Theisocentersoftheotherfields
containedinthegroupthenfollowtokeeptheisocenterofallthegrouped
fieldsthesame.Thismayleadtounexpectedresultswhenusing,for
instance,opposingfields.
FixedSSDfields:Theisocenterisautomaticallymovedtothesurfaceof
thepatientsskin.
To Convert an Asymmetrical Field to a Symmetrical Field
1. Createafieldandmovetheisocenternearthetargetarea.
2. Adjustthecollimatorjawssothatthetargetareaiscovered.
3. IntheFocuswindow,rightclicktheasymmetricalfieldthatyou
wishtoconvertintoasymmetricalfield,andchooseAlignField
to >SymmetricJaws.Forgroupedfields,chooseAlignGrouped
Fieldsto >SymmetricJaws.
Thefieldpropertiesarechangedintothoseofasymmetricalone.
Theisocentershiftstothefieldmidpointontheisocenterplane.
Tocontinuewithisocentermarkupusingvirtualsimulation,see
ExportingPlanstoVirtualSimulationonpage 709.
Fields 409
To Resize Fields Graphically
EyeViewtochangethe3DviewtotheBEV.
2. Toresizethefieldwiththemouse,dragthesizinghandlesonthe
XandYaxestochangethedimensionofthefield.
A.Symmetricalfield:Placethemousepointeroverasizinghandle.B.Dragthehandletoresizethe
field.
A.Asymmetricalfield:Placethemousepointeroverasizinghandle.B.Dragthehandletoresize
thefield.
To Resize Fields by Modifying the Field Properties


3. IntheGeometrytab,definethefielddimension.
4. ClickOKtochangethefieldsize.
Note: YoualsocanchangethefieldsizeintheFieldstaboftheInfowindow.
To Resize Fields by Fitting the Collimator Jaws to a Structure

1. IntheFocuswindow,rightclickthefieldandchooseFit
CollimatortoStructure.
TheFitCollimatortoStructuredialogboxopens.
2. IntheIDdropdownlist,selectthestructuretowhichtofitthe
collimatorjaws.
3. IntheMargingroupbox,defineawidthforeitheracircularor
ellipticalmargin.
Circularmargin:Typethemarginwidthinthetextbox.
Ellipticalmargin:TypethemarginwidthsintheLeft,Right,Up
andDowntextboxes.
A.Circularmarginusingcollimatorcoordinatesystemandalloptimizationoptions.Themargin
widthis1cm.B.Ellipticalmarginusingcollimatorcoordinatesystemandalloptimization
options.Marginwidths:X1is3cm,X2is1cm,Y1is2cmandY2is1.5cm.
5. Todefinethecoordinatesystem,clickeithertheBEVorCollimator
optionbutton.Foradescriptionofthecoordinatesystems,see
Chapter 16,SectionMLCCoordinateAxisTypesonpage 513.
Fields 411
6. IntheOptionsgroupbox,selectwhethertofitXand/orYjaws
asymmetrically.Selectalsowhethertooptimizecollimator
rotation.
ToviewtheeffectofeachsettinginBEV,clickApply.
Tokeepthechangesandclosethedialogbox,clickOK.
Note: YoucanalsofitafieldwhenaddingablockorMLC.Rightclicktheblock
orMLCandchoosetheOptimizeCollimatorJawsoptionbutton.
Copying Fields
FieldscanbecopiedtotheClipboardandpastedintoaplan.Any
accessoriesaddedtothefieldsarecopy/pastedtogetherwiththe
fields.
Note: Registrationisnotusedwhencopyingfields.Confirmthecorrect
positioningofthefieldswhencopyingthembetweenregisteredimagesets.
To Copy Fields
2. ChooseEdit >CopyFieldtocopythefieldtotheClipboard.
3. IntheFocuswindow,selecttheplantopastethefieldinto.Thereis
noneedtoselecttheplan,ifyouarecopyingandpastingfields
withinthesameplan.
4. ChooseEdit >
PasteFieldtopastethefieldfromtheClipboardtotheselected
plan.
Paste >FieldwithReferenceImagetopastethefieldandthe
referenceimagefromtheClipboardtotheselectedplan.
5. Definethefieldpropertiesandcontinuebymodifyingthefieldas
necessary.

Measuring the Water-Equivalent Depth
Toidentifythewaterequivalentdistancesinapatientimage,youcan
usethefollowingtools:
WEDforFieldtooltomeasurethepathwaylengthfromthebody
outlinetotheselectedpoint.ThetoolshowstheIDoftheactive
fieldandthewaterequivalentdistance(WED),expressedin
centimeterswiththeaccuracyof0.001 cm.Ifthedistancecannotbe
calculated,thetoolshowsahypheninsteadofacalculatedvalue.
Thetooltakesbolusandthecouchsupportstructure,ifany,into
account.
WEDandDistancetooltomeasurethewaterequivalentdistance
andgeometricaldistancebetweentwoselectedpoints.Forarc
fields,theWEDtooldisplaystheaveragevaluecalculatedfromthe
valuesforeachgantryangle.Inadditiontothewaterequivalent
distance,thetoolalsoshowsthegeometricaldistancebetweenthe
points.Thetooltakesbolusandthecouchsupportstructure,if
any,intoaccount.
TheWEDtoolsareavailableintheFieldSetupandPlanEvaluation
workspaces.
Thevaluesshownbythetoolsareupdatedwhenyoumovethe
point(s)inthe2Dimageview,orscrollorrotatetheimageviewing
plane.TheWEDvaluesarealsoincludedintheprintoutoftheactive
viewwherethedistancehasbeenmeasured.
Calculation of Water-Equivalent Depth

Thecalculationofthewaterequivalentdistancesusesthelinear
attenuationcurves.
Thewaterequivalentdistanceofasinglepointiscalculatedalongthe
fanlineofthetreatmentfield,measuredfromthepointwherethe
fanlinecrossesthebodyoutlineorbolustotheselectedpoint.
To Measure the Water-Equivalent Length between Two Points

1. ChooseView >Measure>WEDandDistance .
Themousepointerchangestoalinetool.
Fields 413
2. Tomeasurethewaterequivalentdistancebetweentwopoints,
clickthestartandendpointsina2Dimageview.
Eclipsecalculatesthephysicaldistanceandthewaterequivalent
distancebetweentheselectedpointsforeachfieldandshowsthe
DistanceandWEDvaluesintheimageview.
3. Tochangethedistance,movetheendpointswiththemouse.
TheDistanceandWEDvaluesareupdatedasyoumovethe
mouse.
4. Toinactivatethetool,chooseView >Measure>WEDand
Distance again.
To Measure the Water-Equivalent Depth for a Single Point

1. IntheFocuswindow,selectthefieldforwhichyouwishto
measurethewaterequivalentdepth.
2. ChooseView >Measure>WEDforField .
Themousepointerchangestoapointmeasurementtool.
3. Tomeasurethewaterequivalentdistanceforapoint,clickthe
pointwiththemouse.
Eclipsecalculatesthewaterequivalentdistanceofthepointand
showstheFieldIDandWEDvalueintheimageview.
4. Tochangethelocationofthepoint,moveitwiththemouse.
TheWEDvalueisupdatedasyoumovethemouse.
5. Toinactivatethetool,chooseView >Measure>WEDforField
again.
Changing Treatment Unit

Youcanchangethetreatmentunitindividuallyforeachphoton
planningorsetupfieldinaplanintheFieldPropertiesdialogbox,or
changethetreatmentunitformultipleplanningorsetupfieldsatthe
sametimeusingtheChangeTreatmentUnitscommand.

TheChangeTreatmentUnitscommandcomparestheconfigurationof
thesuggestednewtreatmentunittothetreatmentunitcurrentlyused
inthefieldsandlooksformatchingfieldparameterandaddon
configurations.Ifexactmatchesarefound,thechangeisdonebetween
thetwotreatmentunitswithnochangestothefieldsoraddons.Since
treatmentunitsoftenhavedifferencesinconfigurations,some
modificationsareoftenrequiredinthefieldsandaddonswhen
changingthetreatmentunit.Therequiredmodifications,andthe
fieldsforwhichthechangeisnotpossible,arereportedintheChange
TreatmentUnitdialogbox.
Table 10onpage 419showshowthefieldsandaddonsaredealtwith
ifnoexactmatchesarefoundinthetreatmentunitconfigurations.
Table 10 Field Parameters and Add-ons in Treatment Unit Change
Field
Action
Parameter / Add-on
Fieldtechnique Treatmentunitnotchangedifnomatchisfound
Particletype Treatmentunitnotchangedifnomatchisfound
MLCtechnique Treatmentunitnotchangedifnomatchisfound
Fieldsizelimits Treatmentunitnotchangediffieldsizeexceedsthe
limits
Symmetry/asymmetry Treatmentunitnotchangedifnomatching
configurationisfound
Collimator/Couch/Gant Treatmentunitnotchangediffieldrotationsexceed
ryrotationlimits thelimits
Energy Changedtothenearestcorrespondingenergy
Doserate Changedtothenearestcorrespondingdoserate
Electronapplicatorsize Changedtothenearestlargerelectronapplicatorsize
Wedge Wedgeangleanddirectionmustmatch.Other
(fixed,Enhanced parameterschangedtothenearestcorresponding
Dynamic,motorized) wedgeconfiguration.
Block Materialchangedtothematerialfound.Ifnomaterial
isfound,blocksremaininthefieldsbutareleft
withoutmaterial.
Dosecalculationisnotpossibleforfieldscontaining
blockswithnoblockmaterial.
Fields 415
Table 10 Field Parameters and Add-ons in Treatment Unit Change
Field
Action
Parameter / Add-on
Compensator Materialchangedtothematerialfoundifthe
configuredattenuationfactoristhesame.Ifno
materialisfound,compensatorsremaininthefields
butareleftwithoutmaterial.
Dosecalculationisnotpossibleforfieldscontaining
compensatorswithnocompensatormaterial.
MLC YoucanselecttheMLCtobeusedifthereareseveral
possibleMLCs.
SupportedonlyforVarianMLCs.
DMLC TreatmentunitischangedifDMLCissupportedin
thenewtreatmentunit.FieldscontainingaDMLC
areconvertedifthesameMLCmodelisfound.
Fluence Actualfluencesarealwaysdeleted.
Optimalfluencesremaininfieldswhereamatching
energy,machinemodelorMLCmodelisfound.
DMLCsareremoved.
To Change Treatment Unit for Fields

1. IntheFocuswindow,rightclickafieldoraplanandchoose
ChangeTreatmentUnit.
TheChangeTreatmentUnitdialogboxopens.
2. Tochangethetreatmentunitforallfieldsintheactiveplan,select
theChangefromallfieldsoption.
3. Tochangethetreatmentunitforparticularfields,selectthe
Changefromfieldsusingoption,andthenusethelistboxto
selectthetreatmentunitthatshouldbechangedtoanother.
4. IntheChangetotreatmentunitlistbox,selectthetreatmentunit
thatyouwishtouse.
TheChangelogboxreportsthemodificationsrequiredinthefield
parametersandaddons.
Tosavethetreatmentunitchangelogtext,copyitintheChangelogbox
andpasteittoaseparatedocument.
5. Tochangethetreatmentunit,clickOK.

Chapter 12 Beam Angle Optimization
Field Setup WS
ThischapterdescribesthemainfeaturesofEclipseBeamAngle
Optimization,whichisanoptionfortheEclipsetreatmentplanning
systemdesignedtoselectthebeamanglesforaplanthatbestfulfilthe
dosevolumeobjectivesdefinedfortheplan.
About Beam Angle Optimization

EclipseBeamAngleOptimizationisanintegratedoptimizationoption
fortheEclipsetreatmentplanningsystemandisanessential
componentofeffectiveintensitymodulatedradiotherapy(IMRT).
IMRTisapowerfultechnologyforproducingthreedimensionaldose
distributionshighlyconformaltothePTVwhilesparingnormaltissue.
WhereconventionalIMRTplanningstartswiththeselectionof
suitablebeamanglesfollowedbyanoptimizationoffieldintensities,
theBeamAngleOptimizationselectsthebeamanglesautomatically.It
isdesignedtobeusedtogetherwithDoseVolumeOptimization
(DVO)toenablethecreationofhighlyconformaldosedistributions.
TheBeamAngleOptimizationcanalsomakefieldsetupfasterby
eliminatingtheneedfortrialanderrorwork.
ThegoalofBeamAngleOptimizationistofindanoptimalpositioning
fortreatmentbeamsbyiterativelyoptimizingthebeamanglesto
satisfyasetofuserdefineddosevolumeobjectives.Theoptimalresult
isahomogeneousdosedeliveredtothePTVinaccordancewiththe
doseprescriptionwhileminimizingthedosetothesurrounding
417
normaltissue,especiallytheorgansatrisk.TheBeamAngle
OptimizationisbasedontheEclipseDVOalgorithmandusesthe
sameDVHbasedobjectives.
Note: WhenworkingwiththeBeamAngleOptimization,noticethefollowing:
Theoptimalityoftheplanisdefinedwiththeoptimizationobjectivesthe
BeamAngleOptimizationdoesnotautomaticallyminimizethedoseto
thecriticalstructures.
AlthoughitispossibletousetheBeamAngleOptimizationwithout
fluenceoptimization,thebestresultsareachievedusingitinconjunction
withfluenceoptimization.IftheBeamAngleOptimizationisusedinany
otherway,theoptimalityoftheplancannotbeguaranteed.
TheBeamAngleOptimizationisavailableonlyforphotonplans
consistingofstaticisocentricfieldsthatsharethesameisocenterand
containnofieldaccessories.
Optimizing Beam Angles with the Beam Angle

Optimization
BeamangleoptimizationiscontrolledbytheBeamAngle
Optimizationdialogbox,whereyoudefinetheobjectivesforthe
optimization.
Note: BecausetheDVHbasedconstraintsforthePTVandfororgansatrisk
conveytheoptimizationgoaltotheBeamAngleOptimization,these
constraintsshouldincludeallinformationneededfortheevaluationofthefinal
treatmentplan.Allobjectivesshouldbedefinedandcompletebeforestarting
theBeamAngleOptimization.Toachieveoptimalresults,itisnot
recommendedtoaddorchangeobjectivesduringfluenceoptimization.
Optimization Parameters
Theoptimizationparametersaredefinedinanoptimizationdialog
box.Youdefinetheoptimizationobjectivesforeachsignificantorgan.
Forthetargetstructures,youdefineupperandlowerobjectives.For
otherstructures,youonlydefineupperobjectives.

Inphotonplans,inadditiontotheoptimizationobjectivesforcritical
structures,youcanusetheNormalTissueObjective:
Totakeintoaccountthedecreaseindoselevelasthedistancefrom
targetsisincreased.
Tolimitthedoselevelandpreventhotspotsinhealthytissue.
Forobtainingasharpdosegradientaroundthetargets.
FormoreinformationontheNormalTissueObjective,seeNormal
TissueObjectiveonpage 429.
Thedoseobjectivescanbedefinednumericallybytypingtheobjective
valuesorgraphicallybyclickingtheupperandlowerobjectiveinthe
dialogbox.Youcanalsodefinetheupperobjectivesbydrawingaline
inthedialogbox.
Formoredetailsontheparameters,seeEclipseAlgorithmsReference
Guide.
Structure Model
Structuresaremodeledintheoptimizationasthreedimensionalpoint
clouds.Therespectiveoptimizationdialogboxshowsthenumberand
resolutionofthepointsinthepointclouds.Initially,thenumberof
pointsshownforeachstructureisonlyanestimatebasedonthe
structurevolumeandthepointcloudresolution.Afterthepointcloud
generation,thenumberofpointscandiffersignificantlyfromthe
initialestimate.Thepointcloudgenerationalgorithmplacesmore
pointsclosetothestructuresexternalsurfacetoensureproper
representationofcomplexshapes.Theresolutionofthepointsis
definedastheapproximatedistancebetweenthepoints.Thedefault
valuesusedfortheresolutionandnumberofpointsarechosensothat
theyprovideadequateresultswithouttheneedforchangingthe
values:
Structuresgreaterthan5000 cm3(typicallytheBodystructure)
haveresolutionof4.5 mm
Structures5000 cm3orsmallerhaveresolutionbetween1.0
3.0 mm
Allstructuresmustcontaintheminimumof2000points
Thetotalamountofallpointsinallstructuresmustbelessthan
onemillion
Beam Angle Optimization 419

Ifnecessary,youcanincreaseordecreasethenumberofpointsfor
eachstructurebychangingthepointresolutionvalue.Thisaffectsthe
accuracyoftheoptimization,muchlikeusingdifferentcalculation
gridsindosedistributioncalculation.However,toolargeanumberof
pointsinthepointcloudsslowsdowntheoptimizationandmayeven
preventitcompletelybecauseofhighermemoryconsumption.Evenif
thetotalnumberofpointsisbelowonemillionasyouenterthe
optimizationdialog,itispossiblethatthefinalnumberofpoints
exceedsthislimit.Whenthisisthecase,amessageisshownonthe
screenandyoumustincreasethepointresolutionvalueforcertain
structuresinordertoreducethetotalnumberofpoints.Itis
recommendedtochangethepointresolutionforstructuresoflesser
importanceintheoptimization.
Note: Externalpatientsupportdevices,suchasthecouchsupportstructure
(seeChapter 7,SectionCouchModelinginEclipseonpage 192),arenot
shownintheStructuresandObjectiveslistintheoptimizationdialogbox,and
pointcloudsarenotcalculatedforthem.However,supportstructuresare
accountedforintheoptimization.
Upper and Lower Dose-Volume Objective
UpperobjectiveIsusedtolimitthedoseinagivenstructure(for
example,nomorethan20%ofthestructuremayreceivemore
than25 Gy).
LowerobjectiveIsusedtodefinedesireddoselevelsintarget
structures(forexample,atleast70%ofthestructuremustreceive
atleast20 Gy).
Figure 98onpage 427showsanexampleofanupperandalower
objective,plusaresultingDVHcurveinanoptimizationdialogbox.

A.Atleast50%ofthestructuremustreceiveatleast20 GyB.Nomorethan40%ofthestructure
mayreceivemorethan25GyC.PossibleDVHcurveresultingfromtheobjectives
Figure 98 Upper and Lower Optimization Objectives
Calculation Options for the Beam Angle Optimization
Inadditiontodefiningtheoptimizationobjectives,youcancontrolthe
beamangleoptimizationbydefiningthecalculationoptions.The
calculationoptionsaresettingsfortheBeamAngleOptimization
optimizationalgorithm.thedefaultcalculationoptionsaredefinedin
theBeamConfigurationtask.Thecalculationoptionscontroltheinitial
fielddistribution,optimizationmodes,iterationsandfieldreduction
parameters.
PartofthecalculationoptionsfortheBeamAngleOptimization
algorithmareshownintheBeamAngleOptimizationdialogbox:
Globaloptimizationmode(coplanarornoncoplanar)
Localoptimizationmode(SimplexorPowell)
Minimumnumberoffields(lowestnumberfieldsinthefield
geometrycreatedbytheglobaloptimization)
Maximumnumberoffields(highestnumberfieldsinthefield
geometrycreatedbytheglobaloptimization).

Theseandtherestofthecalculationoptionscanbeaccessedthrough
theBeamAngleOptimizationdialogbox,PlanPropertiesdialogbox
ortheInfowindow.Formoreinformationonchangingcalculation
options,seeChapter 24,SectionCalculationOptionsforExternal
BeamPlansonpage 609.
Formoredetailsonthecalculationoptionsandtheirdefaultvalues,
refertoEclipseAlgorithmsReferenceGuide.
Beam Angle Optimization Modes
Beamangleoptimizationneedsaplancontainingonefieldtobe
started.Theisocenterofthefirstfieldistakentobetheisocenterforall
fieldscreatedbytheBeamAngleOptimization.WhentheBeamAngle
Optimizationisstarted,itoptimizesthebeamanglesintwostages:
Globaloptimization
Localoptimization
Formoredetailsontheoptimizationstages,refertoEclipseAlgorithms
ReferenceGuide.
Global Optimization
Globalbeamangleoptimizationcreatesthenewfieldgeometry,which
canbeeithercoplanarornoncoplanar,dependingonuserdefined
optimizationparameters.Theoptimizationstartsfromasetof
uniformlydistributedfields,andthennarrowsthenumberoffields
downtoasetthatbestfulfilstheoptimizationobjectivesdefinedfor
thepatientstructures.
Thewaynewfieldsarecreateddependsontheselectedglobal
optimizationmode:
CoplanarfieldgeometryCreatesequallyspacedfieldsby
increasingthegantryvalues.Thecouchangleisalwayszero.
NoncoplanargeometryCreatesfieldsbyuniformlypositioning
theminthreedimensionalspace.Theangleofeachfieldtoits
closestneighborisapproximatelythesameforallfields.Opposing
fieldsareavoided.
Note: Fieldsthatenterthepatientthroughtheend(s)oftheCTstackare
excludedbyboththeglobalandlocaloptimizationmodes.

Aftercreatingtheinitialfieldgeometry,theBeamAngleOptimization
startsdecreasingthenumberoffieldsbyiterativelyrankingthefields
basedontherelativeimportanceofeachfield.Thosewithlow
importanceareremoved.Therankingisdoneusinganobjective
function.Youcancontrolthenumberoffieldstobeexcludedafter
eachiterationwithaparametervalue(Fieldreductionrateparameter).
Local Optimization Mode
Thelocalbeamangleoptimizationcontinuesfromtheresultofthe
globaloptimizationbyfinetuningthecouchangles(fornoncoplanar
fieldgeometry)andgantry(forbothcoplanarandnoncoplanarfield
geometries).Thelocaloptimizationdoesnotchangethenumberof
fieldsintheplan,butitcantestanycouchandgantryangle
combinationstofindtheoptimalgeometry.Theprogressofthelocal
optimizationisshownwiththeobjectivefunctioncurveandthe
Numberofiterationsparameter.
Thelocaloptimizationcanbeperformedintwomodesthatare
definedasacalculationoptionforoptimization:theDownhillSimplex
methodandthePowellmethod.Formoreinformationonthese
methods,refertoEclipseAlgorithmsReferenceGuide.Inadditiontothe
mode,themaximumnumberoflocaloptimizationiterationsis
controlledwithacalculationoption.
Thelocaloptimizationcanalsoberunalonewithoutfirstrunningthe
globaloptimization.Thismightbeusefulfortestingpurposes.
However,thebestbeamangleoptimizationresultsareachievedby
runningbothglobalandlocaloptimizations.
Normal Tissue Objective
TheNormalTissueObjectiveisused:
targetsisincreased
Tolimitthedoselevelandpreventhotspotsinhealthytissue
Forobtainingasharpdosegradientaroundthetargets

TheNormalTissueObjectiveisdefinedwiththefollowing
parameters:
DistancefromtargetborderDeterminesthedistancefromthe
targetborderwheretheNormalTissueObjectivevaluemustbe
constant,expressedincentimeters.
TissueObjectiveatthetargetborder,expressedinpercentage.
Objectiveawayfromthetargetborder,expressedinpercentage.
falloff.
Objectiveinrelationtootheroptimizationobjectives.ThePriority
parameterissimilartothatinthedosevolumeobjectives.Toapply
theNormalTissueObjectiveintheoptimization,thePriority
parametermusthaveanonzerovalue.
TheshapeoftheNormalTissueObjectiveiscalculatedasafunctionof
thedistancefromthetargetborder.Figure 99onpage 430showsan
exampleshapefortheNormalTissueObjectivecurveandthe
parametervaluesusedforcalculatingthecurve(distancefromtarget
border = 1 cm,startdose = 105%,enddose = 60%,andfalloff = 0.05).
TheXaxisshowsthedistancefromtargetborder,andtheYaxis
showstherelativedosescale.
Figure 99 Example Shape of Normal Tissue Objective

TheNormalTissueObjectiveisnormalizedbytakinglevel1.0(or
100%)tocorrespondtothelowestupperobjectiveofthetarget.Ifthe
targethasnoupperobjective,level1.0(or100%)correspondstoa
value1.05timesthehighestlowerobjective.
TheNormalTissueObjectivevaluesarecalculatedforallbodypoints.
Iftheplancontainsseveraltargets,theNormalTissueObjectivevalue
foraspecificbodypointiscalculatedfromalltargets,andthehighest
oneisusedintheoptimization.
Table 11onpage 431showsthedefaultparametervaluesforthe
NormalTissueObjective.
Table 11 Default Values for the Normal Tissue Objective
Parameter name Range Default

Distancefromtargetborder[cm] 2020 1.0
Startdose[%] 01000 105
Enddose[%] 01000 60
Falloff 0100 0.05
Priority 01000 150
Beam Angle Optimization Dialog Box
Theprogressoftheoptimizationprocesscanbemonitoredinthe
BeamAngleOptimizationdialogbox,whichshowsaDVHcalculated
foreachstructureaftereachoptimization,thenumberoffieldsleftand
agraphicalmodelofthefieldgeometry.Youcaneasilyevaluatethe
effectivenessofthedoseobjectivesandseewhatthefieldgeometry
willlooklike.Figure 100onpage 432showstheBeamAngle
Optimizationdialogbox.

A. Showsthestructurescontainedintheplan,thevolumesofthestructures,thepointsandpoint
resolutionusedformodelingthestructuresintheoptimization,andthevaluesofthedefined
optimizationobjectives.B. Showthe3Dmodelofeachfieldgeometrysetupcalculatedbythe
BeamAngleOptimizationC. ShowstheoptimizationresultsintheformofDVHcurves,one
curveforeachstructure.D. Showstheselectedcalculationoptionsfortheoptimization,allows
modifyingtheoptions.E. Showstheobjectivefunctionoftheoptimization.F. Automatically
openstheFluenceOptimizationdialogboxoncetheBeamAngleOptimizationiscompleted.
Figure 100 Beam Angle Optimization Dialog Box
ThestatusofthefieldsbeingprocessedbytheBeamAngle
Optimizationaremarkedwithcolorcodinginthe3Dmodelofthe
fieldgeometry:
Red = Originalfieldangles(resultingeitherfromglobal
optimizationormanuallyadded).
Purple = Fieldsbeingprocessed.
Green = Thebestfieldanglesfound.
Oncetheoptimizationiscompleted,allfieldsaremomentarilyshown
ingreen.

Default Optimization Parameters
Theoptimizationdialogboxprovidesyouwithdefaultvaluesforthe
objectivesfortheTargetstructure.
Table 12 Default Optimization Objectives for Target and Calculation Parameters
Objective Default Value/Range

Doseforprimarytarget +1.5%oftheprescribeddose.Forinstance,ifthe
(Upperobjective) prescribeddoseis40Gy,thedefaultmax.doseis
40.6Gy
Doseforprimarytarget 1.5%oftheprescribeddose.Forinstance,ifthe
(Lowerobjective) prescribeddoseis40Gy,thedefaultmin.doseis
39.4Gy
Priorityforallnew 50
objectives
Maximumtime(minutes) Defaultvalue100,range110000minutes
(NotusedinDoseDynamic
ArcPlanning.)
Maximumiterations Defaultvalue1000,range110000iterations
ArcPlanning.)
TheobjectivesforotherstructuresaredrawnintotheDVHgrid
startingfromthecenterofthegridandplacingfurtherobjectives
belowthefirstone.

Figure 101 Example of Default Objectives
Objective Templates
Youcanbuildacustomizedobjectivelibrarytoestablishastarting
pointforoptimizationortodefineasetoftypicaloptimization
solutionsatyourclinic,suchasobjectivesetsforprostateor
nasopharynxcases.
Youcancreateanobjectivelibrarybycreatingobjectivetemplatesof
dosevolumeobjectivesetsthathaveproducedasatisfactory
optimizationresult.Theobjectivesetsaresavedasatemplatewith
userdefinednames.Anysetofobjectivesstoredinanobjective
templatecanbereusedinsubsequentinverseplansandincludedin
clinicalprotocols.Formoreinformationonobjectivetemplates,see
Chapter 10,TemplatesandClinicalProtocols,onpage 287.

To Start the Beam Angle Optimization
1. ChoosePlanning >BeamAngleOptimization.
Ifyouhavenotdefinedthedoseprescriptionearlier,youare
promptedtodoso.Afterdefiningthedoseprescriptionand
restartingtheoptimization,theBeamAngleOptimizationdialog
boxopens.
2. SelectorgansforoptimizationfromtheOrganslistofallthe
volumesdefinedfortheselectedpatientanddefinethe
optimizationobjectivesorloadtheobjectivesfromtheobjective
library.Forinstructions,seeToDefineDoseObjectivesinEclipse
IMRTonpage 465orToInsertNewObjectivesinaPlanfroman
ObjectiveTemplateonpage 310.
Indicatealldesireddosesasunfractionatedtotaldoses.
3. Tochangethefieldgeometrycalculationoptions,clickCalculation
Optionsandthendefinethedesiredoptions.Formoreinformation
onthecalculationoptions,seeEclipseAlgorithmsReferenceGuide.
TheCalculationOptionsdialogboxopens.Forinformationon
howtousethedialogbox,seeCalculationOptionsforExternal
Youcanrotatethegraphicalfieldgeometrymodelduringthe
optimization.
4. Tostarttheoptimization,clickOptimize.Youcanfollowthe
progressoftheoptimizationintheOptimizationdialogbox.
5. Tointerrupttheoptimizationandclosethedialogbox,click
Cancel.
6. Toviewthegraphicalfieldgeometrymodelfromdifferentangles,
dragitwiththemouse.
7. Whentheoptimizationiscompleted,clickOK.
ContinuetoDoseVolumeOptimization.

Chapter 13 Reference Points and Reference Lines
Thischapterprovidesinformationonreferencepoints,andcontains
stepsnecessaryforusingthem.Thechapterdescribesthegeneral
featuresofreferencepointsandtheiruseintreatmentplanning.
Instructionsareprovidedformanagingreferencepoints,the
geographicallocationsofthepoints,anddefiningtheuseofreference
pointsinaplan.
About Reference Points and Reference Lines

Referencepointsareusedfordisplaying,definingandprescribingthe
therapeuticabsorbeddoseatspecificlocations.
IntheExternalBeamPlanningtask,youcanusereferencepointsto:
TransfertheMUsforthetreatmentapplicationsthroughthe
primaryreferencepoint,whichisautomaticallycreatedfornew
plans.TheMUsarecalculatedfortheprimaryreferencepoint.
CalculatedMUsarenotavailableinARIAapplicationsunlessaprimary
referencepointisdefined.
Limitthedoseforspecificorgansbycreatingbreakpointsinthe
treatment
Collectthedosefromdifferentfields
Normalizethedosetotheprimaryreferencepoint
Referencelinescanbeusedtomarkspecificsitesinthepatient
Referencepoints,likestructures,arealwayslinkedtointernalpatient
volumes(seeChapter 7,SectionAboutStructuresonpage 179and
Chapter 7,SectionPatientVolumesonpage 181).Whenusinga
structuretemplatetocreatestructures,theapplicationcheckswhether
patientvolumesalreadyexistforthepatient,and,iffound,matches
theexistingpatientvolumeswiththoseusedinthetemplate.A
particularsituationaffectedbythisuseofpatientvolumesischanging
areferencepointIDinasetupwheretwodifferentimagesetsandone
431
structuretemplateareusedforaparticularpatient.Inthissituation,
thereferencepointIDchangesforbothimagesetsbecauseofthe
linkingtotheinternalpatientvolumeIDs.
Referencepointsaremanagedinthefollowingworkspaces:Field
Setup,PlanEvaluation.Youcanadd,modify,anddeletereference
pointsandreferencelinesinthe2Dimageviewswiththemouseoron
thekeyboard.Eachpointcanhaveauniquename.
Primary Reference Point

Fornewplans,areferencepointisautomaticallycreatedandlinkedto
thetargetvolumeoftheplanandmarkedtheprimaryreferencepoint.
Thisreferencepointdoesnothaveageometricallocation.Ifyoudonot
wishtousethispointastheprimaryreferencepoint,youcandefine
anotherone(seeDefiningtheUseofReferencePointsonpage 444.
Theprimaryreferencepointisusedto:
TransferthecalculatedMUsforARIAapplications
EvaluatethedoseatthispointinthePlanOrganizer
Normalizetheplantothispoint
Thedoseprescribedfortheplaniscalculatedfortheprimaryreference
pointbydividingthetotaldoseintodosecontributionsofeachfield
accordingtothefieldweights.Thetotaldoseandthedoseperfraction
attheprimaryreferencepointareshowninthePlanPropertiesdialog
box.
Reference Points and Geometrical Locations

Areferencepointcomprisesanabstract,conceptualpointwithdefined
doselimits,andcanhaveaseparatelydefinedgeometricallocationin
3Dspace.

Referencepointswithoutageometricallocationinclude
Referencepointscreatedautomaticallywithnewplans.Bydefault,
thesereferencepointsarelinkedtothetargetvolumeoftheplan
andaredefinedprimaryreferencepoints.
Referencepointsdefinedinanexisting3Dimagewhencreatinga
new3Dimageforapatient.Inthiscase,thereferencepointstill
existsforthepatient,butthereferencepointlocationsarenot
includedinthenew3Dimage.
Referencepointswithoutageometricallocationareshowninthe
Focuswindowbutnotintheimageviews.
Referencepointswithageometricallocationnormallyrepresentan
anatomicalstructureorsomeothergeometricalstructureofinterest.
Onereferencepointcanalsobelinkedtodifferentimages,inwhich
caseitcanhaveadifferentgeometricallocationineachimage.Youcan
viewhowthedosedistributionofaplanaffectsthereferencepoints,
andwhenusingmultipleplans,youcanaccumulatedosefrom
differentplanstotheprimaryreferencepoint.
Reference Point Visualization

ReferencepointslinkedtotheactiveplanareshownintheFocus
windowwithaspecialicon(primaryreferencepoint ,other
referencepoints )intheReferencepointsfolder.Ifaplanhasbeen
draggedtotheimageviews,theReferencePointsfolderisshown
underthePlanobject,orifanimagehasbeendraggedtotheimage
views,thefolderisshownundertheImageobject.Foraplansum,
referencepointswithalocationareshownundertheimageinthe
Focuswindow.Youcanshoworhidereferencepointsbyselectingor
clearingtheirvisibilitycheckboxesintheFocuswindow.
Thefollowingfigureshowsreferencepointsinatransversalimageina
2DviewintheExternalBeamPlanningtask.
Reference Points and Reference Lines 433

Figure 102 Reference Points in 2D View (not Selected)
Referencepoints,alongwiththeirIDs,arealsoshownintheBEVand
theModelviewiftheybelongtotheactiveplan(seeDefiningtheUse
ofReferencePointsonpage 444.
Figure 103 Reference Points in Beams Eye View

Figure 104 Reference Points in Model View
ReferencepointsmaybeseeminglyinvisibleintheModelview.Thisis
becausetheyarepositionedrealisticallyin3Dspaceand,depending
ontheviewingangle,maybeobstructedbyastructure.IntheBEV
however,referencepointsarealwaysshownontopofallstructures.
Youcanshoworhidereferencepointsbyselectingorclearingtheir
visibilityboxesintheFocuswindow.
Location of the Reference Points
referencepointislocatedinrelationtotheactiveviewingplane:
Activereferencepointlocatedontheactiveviewingplane
Referencepointlocatedontheactiveviewingplane
Activereferencepointlocatedinfrontoftheactiveviewing
plane
Activereferencepointlocatedbehindtheactiveviewingplane
orinactivereferencepointlocatedinfrontoftheactiveviewing
plane

Adding Reference Points
Afterimportingtheimages,youcancreatereferencepointstothe
areasintheimageswhereyouwishtotrackthecalculateddose.When
youcreateanewexternalplan,onereferencepointisalso
automaticallyaddedandmarkedastheprimaryreferencepoint.
Themodifiablereferencepointparametersarethefollowing:
DailyDoseLimit
TotalDoseLimit
SessionDoseLimit
Volumerepresentedbythereferencepoint
To Insert a Reference Point with a Geometrical Location

1. ChooseInsert >NewReferencePointandLocation.
TheReferencePointPropertiesdialogboxopens.
2. IntheIDtextbox,typeanidentificationforthereferencepoint.
3. IntheNametextbox,typeanameforthereferencepoint.
4. InthePatientVolumedropdownlist,selectapatientvolumethat
thepointwillrepresent.Iftherearenosuitablevolumes,selectthe
volumetypeNone.
5. Todefinethedoselimits,typethevaluesintherespectivetext
boxes.
6. SelecttheLocationtabtodefinethelocationofthereferencepoint
withtheX,Y,andZcoordinates.
Youcanalsodragthepointtothecorrectpositionafteraddingit.
7. Typethecoordinatesintherespectivetextboxes.
8. ClickOK.
Thereferencepointisautomaticallyincludedintheopenplan.Ifthe
patienthasmorethanoneplan,includethereferencepointstothedesired
plans.Formoreinformation,seeToIncludeReferencePointsinPlans

onpage 445.Definealsowhichreferencepointistheprimarypoint.For
moreinformation,seeChapter 9,SectionAboutDefiningthePrimary
ReferencePointinthePlanOrganizeronpage 275.
To Insert a Reference Point without a Geometrical Location

1. Addareferencepointasusual.
2. PressDEL.
TheDeleteReferencePointdialogboxopens.
3. Todeletethegeometricalreferencepointlocationfromthe
currentlyactiveimage,selectCurrentImage.
4. ClickOK.
To Insert a Location for an Existing Reference Point

1. ChooseInsert >NewLocationforExistingReferencePoint.
TheSelectReferencePointdialogboxliststhereferencepointsthat
donothavealocationinthecurrentlyactiveimage.
2. IntheReferencePointsforthePatientlistbox,selectthepointfor
whichtoaddthelocation.
3. ClickOK.
TheReferencePointPropertiesdialogboxopens.
4. SelecttheLocationtabtodefinethelocationofthereferencepoint
withtheX,YandZcoordinates.
5. Typethecoordinatesintherespectivetextboxes.
Youcanalsodragthepointtothedesiredposition.
6. ClickOK.
Adding Reference Lines

Referencelinescanbeaddedbydrawingthemintheimageviews.In
theExternalBeamPlanningtask,referencelinescanbeaddedonlyin
theContouringworkspaceandusedformarkingspecificsitesinthe
patient.

To Add a Reference Line to an External Plan
1. IntheContouringworkspace,chooseInsert> NewReference
Line.
2. IntheIDtextbox,typeanidentificationforthereferenceline.
3. IntheNametextbox,typeanamefortheline.
4. ClickOK.
ThereferencelineiconappearsintheFocuswindowunderthe
structureseticon.TheFreehandtoolisactivated.
5. Continuebydrawingthereferenceline.
Defining the Use of Reference Points

Tobeabletousereferencepointscreatedforapatient,thepointsmust
belinkedtoeachrelevantplan.Thereferencepointautomatically
createdfornewplansisalsoautomaticallylinkedtotheplanand
markedtheprimaryreferencepoint.Ifyoudonotwishtousethis
pointastheprimaryreferencepoint,youcandefineanotherone.If
youdefinereferencepointsforapatientwithanopenplan,thepoints
areautomaticallylinkedtotheopenplan.However,ifyoucreate
multipleplansforthepatient,thereferencepointsarenot
automaticallylinkedtotheplans,andyouneedtoseparatelytakethe
referencepointsintouseintheplans.Oneofthereferencepointscan
bemarkedtheprimaryreferencepoint.
Forinformationontheprimaryreferencepoint,seeAboutReference
PointsandReferenceLinesonpage 437.ForinformationonthePlan
Organizer,seeChapter 9,SectionUsingthePlanOrganizeron
page 271.
Note: MUscalculatedforanexternalplanarenotavailableinARIA
applicationsunlessaprimaryreferencepointisdefined.

To Include Reference Points in Plans
2. Verifythatthereferencepointhasalocationintheimageusedfor
theplan.
3. ChoosePlanning >ReferencePointOrganizer.
YoucanalsoopentheReferencePointOrganizerbyclicking
EditReferencePointsinthePlanOrganizer.
TheReferencepointsforplandialogboxopens.Referencepoints
definedfortheselectedpatientaredisplayedontheleft.Reference
pointsselectedfortheactiveplanaredisplayedontheright.
4. Toincludeapointintheplan,selectitintheleftandclickAdd.
5. Toexcludeapointfromtheplan,selectitintherightlistboxand
clickRemove.
To Define the Primary Reference Point

in the Reference Point Organizer
1. ChoosePlanning >ReferencePointOrganizer.
TheReferencepointsforplandialogboxopens.
2. SelectthepointintheReferencepointsinplanlistboxandclick
Primary.
Thetext[PRIMARY]appearsnexttotheselectedpointtomarkitas
theprimaryreferencepoint.
Eachreferencepointislinkedtoapatientvolume.Thislinkiskeptand
thedefinedpatientvolumeisautomaticallyselected.
Modifying Reference Points or Reference Lines

ReferencepointpropertiescanbeeditedintheReferencePoint
Propertiesdialogbox.Referencelinepropertiescanbeeditedinthe
StructurePropertiesdialogbox.Referencepointscanbemovedto
specific3Dlocationswiththemouseortotheisocenterofafieldby
usingtheMovetoIsocentercommand.

Theexactlocationofareferencepointoneachplanecanbeviewed
withtheMovetoReferencePointcommand.
To Edit Reference Point or Reference Line Properties

1. IntheFocuswindow,selectthereferencepointorthereference
line.
TheReferencePointPropertiesortheStructurePropertiesdialog
boxopens.
3. EditthesettingsasnecessaryandclickOK.Formoreinformation
onthesettings,seeAddingReferencePointsonpage 442and
AddingReferenceLinesonpage 443.
To Move Reference Points

1. IntheFocuswindow,selectthereferencepointtomove.
Thedoseattheselectedpointanditscoordinatesappearnextto
thepoint.
2. Onthetoolbar,clickEditReferencePoints .
3. Movethemousepointertothereferencepointanddragittoanew
position.
Theviewingplanesmovetothereferencepoint.
To Move the Viewing Planes to a Reference Point

1. IntheFocuswindow,selectareferencepoint.
2. RightclickthereferencepointandchooseView >MoveViewing
PlanestoReferencePoint.
To Move a Reference Point to the Isocenter or Entry Point

IntheFocuswindow,rightclickthereferencepointtomoveand
clickMoveReferencePointtoIsocenter.

To Delete Reference Points
1. Selectthepointtodelete.
TheDeleteReferencePointdialogboxopens.
A.Ifthereferencepointisnotpartofthecurrentlyactiveimage,theseoptionsarenotavailable.
B.Ifthereferencepointisnotpartofthecurrentlyactiveplan,theseoptionsarenotavailable.C.
Ifthereareotherreferencepointlocationsdefinedthantheonecurrentlyinuse,thisoptionisnot
available.
Todeletethegeometricalreferencepointlocationfromthe
currentlyactiveimage,selectCurrentImage.
currentlyactiveplan,selectCurrentPlan.
currentlyactiveimageandplan,selectCurrentImageand
Plan.
Todeleteboththereferencepointanditsgeometricallocation,
selectCurrentPatient.
4. ClickOK.
Copying Reference Points between 3D Images

Referencepointsandreferencepointlocationscanalsobecopiedand
pastedbetweentworegistered3Dimages.Thisisusefulforcopying
initialreferencepointlocationsbetweenasetof3Dimages
representing,forexample,thepatientrespirationcycle.

To Copy Reference Points from One 3D Image to Another
1. IntheFieldSetuporContouringworkspace,opentwoormore3D
images.
Tobeabletocopyreferencepointlocations,theimagesmustberegistered.
2. Iftheimagesarenotregistered,gototheRegistrationworkspace
andregistertheimages.Forinstructions,seeChapter 6,Image
Registration,onpage 145.
3. IntheScopewindow,selectthe3Dimagethatcontainsthe
referencepointlocationsyouwishtocopy.
4. ChooseEdit >Copy >ReferencePointLocations.
5. Toshowthe3Dimagetowhichthepointswillbecopied,dragit
fromtheScopewindowtotheimageviews.
6. ChooseEdit >PasteReferencePointLocations.
Thereferencepointlocationsarepastedtotheactive3Dimage.Ifa
locationwithmatchingreferencepointalreadyexistsinthetarget
image,thelocationisskipped.

Chapter 14 Dose Volume Optimization
ThischapterdescribesthemainfeaturesoftheEclipseInteractive
IMRTPlanningoption,whichgeneratesmodulatedfieldfluencesto
createhighlyconformaldosedistributionsinthepatient.The
modulatedfluencesarethenconvertedintoDynamicMultileaf
Collimator(DMLC)sequencesthatareusedtodeliverthecomplex
fields.Inthischapter,youwilllearnhowtooptimizeaplanwith
EclipseIMRT,andviewandedittheresultingoptimizedfluencesin
theEclipseBeamsEyeView.
About Dose Volume Optimization

EclipseIMRTprovidesanintegratedinverseplanningoptionforthe
Eclipsetreatmentplanningsystemandisanessentialcomponentof
effectiveintensitymodulatedradiotherapy(IMRT).EclipseIMRTis
capableofcreatinghighlyconformaldosedistributionsbyiteratively
optimizingthebeamintensitymodulationtosatisfyasetof
userdefineddosevolumeobjectives.
WithEclipseIMRT,itispossibletodeliverarelativelyuniformdose
distributiontoatargetvolumewhilesimultaneouslysparing
surroundinghealthytissue.EclipseIMRTcombinesthefollowingtwo
approachestoaccomplishthisgoal:
IntensityModulationIntensitymodulationistheactofvaryingthe
fluencesofafieldtoshapetheresultingdosedistribution.
AlthoughthedosedistributionofasingleIMRTfieldistypically
nonuniform,thecombinationofseveralIMRTfieldscanresultin
averyuniformtargetdose.
InversePlanningContrarytoconventionaltreatmentplanning,
inverseplanningbeginsbyspecifyingthedesireddosimetric
outcomeofthetreatmentplan.Theinverseplanningengineworks
backwardsfromthedesiredoutcometogenerateasetof
intensitymodulatedfluencematrices.EclipseIMRToptimizesthe
intensitymodulationtoproducedosedistributionsthatconformto
theplanningtargetvolumeascloselyaspossible.
443
Thedifferencebetweenconventionalforwardplanningandinverse
planningiscomparedinFigure 105onpage 450andFigure 106on
page 450.
C
B
A. SetupoffieldgeometrythatconformstothetargetstructureB. Fieldmodifierstoachieve
desiredshapeoffieldsanddosedistributionC. Resultingshapeofdosedistribution
Figure 105 Forward Planning
Traditionalforwardplanningisusuallyatrialanderrorprocess,
wheredifferentfieldandfieldmodifiersetupsaretriedouttosee
whethertheyproduceadosethatcorrespondstothedose
prescription.
A. SetupoffieldgeometryB. Definitionofoptimizationobjectivestoachievethedesireddose
C. ModulatedfluenceresultingfromoptimizationD. Resultingshapeofdosedistribution
Figure 106 Inverse Planning
Inverseplanningdirectlyresultsinoptimalbeamprofilesthatare
producedbytheoptimizationprogramtocorrespondtothedose
prescription(expressedfortheoptimizationasdoseobjectives).

EclipseIMRTcomputesmodulatedfieldfluencesaccordingtoasetof
userdefineddosevolumeobjectives.Thefieldfluencescomputedby
EclipseIMRTareconvertedintoDMLCsequences,andthemodulated
doseisdeliveredwithaDynamicMLC(DMLC)device.Althoughthe
mostimportantroleofEclipseIMRTistosimplifyIMRTplanningby
producingfieldfluences,itcanalsobeusedtoplanoptimalfield
weightsforopenfieldsorfieldscontainingwedgesorstaticMLCs.
Note: EclipseIMRToptimizesthefluences,notthenumberorpositionof
fields.
Inverse Planning and Dose Optimization Process in Eclipse IMRT

TheplanningprocessforinverseplanningforIMRTdiffersslightly
fromtheworkflowfollowedinconventionalplanning.Thelargest
differenceintroducedbyinverseplanningistheuseofdosevolume
objectivesdefinedtospecifytheobjectivesoftheplanbeforethedose
iscalculated.Afterthisoptimizationstageiscomplete,the
conventionalplanningprocessisfollowed.Foracomparisonofthe
inverseplanningandconventionalplanningworkflows,seeChapter 1,
ExternalBeamPlanningWorkflows,onpage 1.
ThealgorithmsusedindoseoptimizationaredescribedinReference
GuideforEclipseAlgorithms.
Preparing the images
Eachinverseplanningsessionbeginsfromselectinga3Dimagefor
contouringanddefiningthetargetvolumeandcriticalorgansinthe
Contouringworkspacejustasinconventionalplanning.However,
sinceIMRTplansproducedosedistributionsthatarehighly
conformedtotheshapesofthetargets,contouringforIMRTplans
typicallyrequiresgreaterprecisionanddefinitionofmorestructures
thanconventionalplanning.Forinstructionsonimageimportand
contouring,seeChapter 5,ImageManagement,onpage 107and
Chapter 8,SegmentationandContouring,onpage 199.
Field setup
Aftertheimagepreparationiscomplete,youpositionthenecessary
fieldssimilarlytoconventionaltreatmentplanning.EclipseIMRTdoes
notautomaticallyselectcorrectfieldanglesforplans.Youcanuse
Dose Volume Optimization 445

Eclipseclinicalprotocolsandplantemplatestoquicklyaddmultiple
fieldscenteredtothetarget,orinsertthefieldsmanually.For
instructionsoninsertingfieldstoaplan,seeChapter 11,Fields,on
page 365.
Dose objectives
Tobegintheactualoptimization,youdefineasetofdosevolume
objectivesforeachtargetandcriticalstructureofconcern.These
objectivesareusedbyEclipseIMRTasthecriteriaforthe
optimization.EclipseIMRTusestwotypesofdosevolumeobjectives:
lowerandupperobjectives.Lowerobjectivesensurethatavolume
receivesaminimumdose.Anystructurewithalowerdosevolume
objectiveisconsideredbyEclipseIMRTtobeatarget.Upper
objectiveslimitthedosetoanystructureandcanbeusedtoenhance
doseuniformityintargetvolumes.
Inadditiontothedosimetricpropertiesoftheplan,youdefinethe
fluencesmoothingparameters,whichhelpinachievingmore
deliverableDMLCsequencesandfewerMUtotreatthefields.The
degreeofthemodulationofthebeamintensityisalwaysreduced
whenfluencesmoothingisapplied.Itisnotrecommendedtoadjust
thesmoothingparameterswithoutagoodunderstandingoftheeffects
ofsmoothingontheoptimizationresults.
Interactive optimization
EclipseIMRTgenerateshighlyconformaldosedistributionsby
iterativelymodulatingthefieldintensitiesuntiltheprescribeddose
objectivesoftheplanareoptimallysatisfied.Theentireoptimization
processisinteractive,allowingyoutochangethedoseobjectives
accordingtotheresultsoftheoptimization.Theinteractive
optimizationofthedosevolumeobjectivesachievesbetterdosimetric
resultsinlesstime.
Optimal fluences
EclipseIMRTgeneratesoptimalfluencesasoutputfromthe
dosevolumeoptimization.Theoptimalfluencesarecreatedby
adjustingtherayweightsusingagradientoptimizationmethod.Each
beamisdividedintosmallelementarypencilbeams,andthedose
contributionsofeachpencilbeamtothetargetandcriticalorgangrid

pointsarecomputed.Theiterationprocesscanbemonitoredduring
thecalculation,andtheobjectiveschangedwhennecessary.The
iterationcanbeinterruptedatanytimeduringtheoptimization
process,orcanbelefttoterminatenaturally.
Theoptimalfluencesrepresenttheidealfieldmodulationinwhichthe
physicalandmechanicalcharacteristicsoftheDMLCdevicehavenot
yetbeentakenintoaccount.Often,theoptimalfluencecannotbe
deliveredinpractice;therefore,itisconvertedintoanactualfluence.
Actual fluences
EclipseIMRTgeneratesasetofoptimalfluencesthatdonotconsider
thelimitationsoftheactualMLC.Theconversionfromoptimalto
actualfluencesisdonebytheLeafMotionCalculator(LMC)program,
whichincorporatesthephysicalcharacteristicsoftheDMLCdevice
andthetreatmentmethodselectedbytheuser.TheLMCdetermines
realisticDMLCleafmotionpatternsandtheircorrespondingactual
fluencesinaniterativecalculationinwhichtheactualfluenceis
determinedfromtheDMLCsequenceuntilmaximumagreement
betweentheactualfluenceandoptimalfluenceisachieved.The
resultingactualfluencematricesareusedbythedosecalculation.
Final dose calculation
AftertheDMLCsequencehasbeengeneratedwiththecorresponding
actualfluence,youcalculatethefinaldosedistributiontoproducea
threedimensionaldosedistributionforfinalevaluation.
Optimizing Plans with Eclipse IMRT

PlanoptimizationiscontrolledbytheOptimizationdialogbox,where
youdefinetheobjectivesfortheoptimization.Youcaneitherdefine
theoptimizationobjectivesforeachplanseparately,orusethe
objectivelibrary,whichstoresobjectivesdefinedearlierforother
plans.

PlanoptimizationwithEclipseIMRTisavailableforopen(unwedged)
photonfieldsonly.Moreover,thetreatmentunitusedintheplanmust
beconfiguredwithadoseenabledMLC.Fieldsthatdonotmeetthese
requirementsaredisabledintheOptimizationwizard.
WARNING: When using plan optimization,

Verify the final plan using DVH analysis inside Eclipse before transferring it
to the treatment unit. For instructions, see Chapter 25, Evaluating Plans,
on page 649.
Evaluate the dose distribution visually.
Perform QA tests to make sure the plan is correctly transferred to the
treatment machine.
Visually verify the shape of the initial DMLC before treating.
Verify the maximum dose inside the irradiated target after dose
calculation, especially in the case of a DMLC plan. You can prevent
unwanted hot spots in the dose distribution by defining suitable values for
the Normal Tissue Objective (see Normal Tissue Objective on page 459),
or reduce hot spots from the resulting dose distribution by adding new
volumes to the hot spot area, defining objectives as you would for critical
organs, and then re-optimizing the plan. For more information on using
the Freehand tool to add new volumes in the Field Setup workspace, see
Chapter 8, Section About Freehand Contours and Segments on page 224.
For more information on contouring and segmenting in the Contouring
workspace, see Chapter 8, Segmentation and Contouring, on page 199.
The optimization uses inhomogeneity correction by default.
Indicate all desired doses as unfractionated total doses.
Note: Ifyouaccidentallydefineatargetstructureoutsidethebodyoutline,the
DVOmayproducehighfluencevaluesforsomefielddirections.Toovercome
theproblem,removethepartsoutsidethebodywithcontouringtools.

targetsisincreased.
inthedialogbox.
Guide.
Structure Model
values:
3.0 mm
onemillion

than25 Gy).
atleast20 Gy).

Time Limit and Iterations
Foreachoptimizationprocedure,youdefinethe
Maximumtimelimit,afterwhichEclipseIMRTstopsthe
optimizationevenifthemaximumnumberofiterationsisnot
reached.Thedefaultvalueis100minutes.
Maximumnumberofiterations,atwhichpointtheoptimization
processisterminated.EclipseIMRTstopstheoptimizationwhenit
hascomputedthemaximumnumberofiterations.Thedefault
valueis1000iterations.
Optimization Parameters for the MLC Device
Foreachfieldincludedintheoptimization,youdefinethefollowing
parametersfortheMLCdevice.
MLC
TheMLCparameterdefineswhichoftheMLCdevicesconfiguredto
thesystemshouldbeusedinthetreatment,ifthereareseveralMLC
devices

Optimization method
Theoptimizationmethodparametersdefinehowtheoptimization
shouldbedone.
BeamletProducesoptimalfluencesforfields.Availableforopen
photonfieldsonly,nofieldaccessoriesallowed.
FieldweightOptimizesthefieldweightsonly,nofluencesare
created.Availableforopenfieldsandfieldscontainingblocksor
staticMLCs.
NoneIgnoresthefieldintheoptimization.Thepossibledose
contributionfromthesefieldsisnotaccountedforduringthe
optimization.Thegivenoptimizationdoseprescriptiondoesnot
takethesefieldsintoaccount.
X smooth and Y smooth
TheXsmoothandYsmoothparameterscontrolthefluenceprofilesby
keepingthemsimpleandeasilytreatablewiththeDMLCdevice.
Removesdrasticchangesinadjacentfluencetransmissionvalues.A
highervaluesmoothesmorethanalowvalue.Typically,thefluence
shouldbesmootherintheXdirectiontoensuretheminimalMU
factorfortheLMC.Thesmoothingparametersareinrelationtothe
priorityvaluesforstructures.Forinstance,whenyouincreasethe
priorityvaluesbutdonotchangethesmoothingparameters,the
resultingsmoothingstrengthswillbelower.Smoothinginthe
Ydirectionhelpsminimizetongueandgrooveeffects.
Minimize Dose
TheMinimizeDoseparameterminimizesthedosereceivedbyorgans
outsidethestructuresforwhichobjectiveshavebeendefined.Ahigh
valueminimizesthedosemorethanalowvalue.Thisisusefulfor
reducinghotspotsinnormaltissue.
ThedefaultvaluesoftheXsmooth,YsmoothandMinimizedose
parametersaredefinedintheBeamConfigurationtaskbydefiningthe
calculationdefaultsfortheoptimizeralgorithm(refertoReference
GuideforBeamConfiguration).

Fixed jaws
Bydefault,theoptimizationfitsthecollimatorjawstoconformtoall
structuresmarkedastargets.TheFixedjawsparameterdefinestheuse
offixedcollimatorjawsinthetreatment.Inthisoption,thecollimator
jawpositionsofthefielddefinedinEclipsearenotchangedduringthe
optimization.Thisoptionmaybeusefulinthecaseof
Amultipletargetplan,whereonefieldisrequiredtoirradiateonly
oneofthetargets.
Irradiatingalargetargetwithtwosmallerandseparatefields
insteadofonelargefielddividedtomultiplecarriagegroupsby
theLMC.Thisallowseffectivepositioningoftheoverlapping
subfieldarea.
Amatchlinedefinedalongonecollimatorjaw(forexample,ina
breastcase)whichshouldberetaineduntilthefinaltreatment.
Youcanalsodefinehowyouwishtoviewthefieldfluenceinthe
Optimizationdialogboxduringtheoptimizationprocess.Thefluence
isupdatedaftereachiteration.Thevisualizationofthefluencecanbe
smoothedout,anditcanbeshownincolorwashorgreyscale.The
fluencepatternhasastrongcorrelationwiththeBEVofeachfield.
targetsisincreased

parameters:
falloff.


Enddose[%] 01000 60
Falloff 0100 0.05
Priority 01000 150
Optimization Dialog Box
Theprogressoftheoptimizationprocesscanbemonitoredinthe
Optimizationdialogbox,whichshowsaDVHcalculatedforeach
structureaftereachiteration,thenumberofiterationsandafluence
mapforeachfield.Fieldweightvaluesareshownforfieldsselected
forfieldweightoptimization.Youcaneasilyevaluatetheeffectiveness
ofthedoseobjectivesand,ifnecessary,modifytheobjectiveswithout
theneedtostoptheoptimization.

A. Showsthestructurescontainedintheplan,thevolumesofthestructures,thepointsandpoint
objectives.B. Showstheresultingfieldfluence.C. Showsthefieldscontainedintheplan,the
smoothingparametersandtheoptimizationmethodforeachfield.D. Showstheoptimization
resultsintheformofaDVH.Allowsgraphicaladjustmentofdosevolumeobjectives.E. Shows
themaximumtimeanditerationsfortheoptimizationprocess.F. Showstheprogressofthe
optimization.
Figure 109 Optimization Dialog Box
Note: TheDVHshownintheOptimizationdialogboxisindicatoryonly.It
mayslightlydeviatefromtheDVHcalculatedforplanevaluationinEclipse.
Alwaysverifytheresultoftheoptimizationbyseparatelycalculatingthedose
andaDVH(usingtheDoseVolumeHistogramcommand).


40.6Gy


39.4Gy
objectives
ArcPlanning.)
ArcPlanning.)
belowthefirstone.

Objective Templates in Eclipse IMRT
nasopharynxcases.
To Start Optimization in Eclipse IMRT

1. ChoosePlanning >Optimize.
promptedtodoso.Afterdefiningthedoseprescriptionand
restartingtheoptimization,theOptimizationdialogboxopens.
2. Selectthecheckboxofthefieldstoincludeintheoptimization.
TheOptimizationdialogboxopens.
3. SelectorgansforoptimizationfromtheOrganslistofallthe
volumesdefinedfortheselectedpatientanddefinethe
optimizationobjectivesorloadtheobjectivesfromtheobjective
library.Forinstructions,seeToDefineDoseObjectivesinEclipse
IMRTonpage 465orToInsertNewObjectivesinaPlanfroman
4. Typethedesiredcalculationparametersinthefollowingtext
boxes:
MaxTime:TimeafterwhichEclipseIMRTstopstheiteration.
Thedefaultvalueis100minutes.
MaxIterations:NumberofiterationsafterwhichEclipseIMRT
stopstheoptimizationprocess.Thedefaultvalueis1000
iterations.

5. IntheFieldslist,selecttheMLCandsmoothingparameters.Click
thecellsinthetableandselectthefollowingparametersinthelists
thatappearateachcell.
TodefinewhichMLCdeviceshouldbeusedinthetreatment,
selectthedesireddeviceintheMLCtypecell.
Todefinehowtheoptimizationshouldbedone,clickthe
Optimizationmethodcellandselectthemethod(Beamlet,
FieldWeightornone).
Toavoiddrasticchangesinadjacentfluencetransmission
values,definetheXsmoothorYsmoothparameterinthe
appropriatecell.
Tominimizethedosereceivedbyorgansoutsidethestructures
forwhichobjectiveshavebeendefined,typethedesiredvalue
intheMinimizeDosecell.
Tousefixedcollimatorjawsinthetreatment,selecttheFixed
Jawscheckbox.
6. SelectthedisplaymodeofthefieldfluenceintheOptimization
dialogbox.
Tosmooththeimageofthefieldfluence,selecttheViewwith
Interpolationcheckbox.
Toshowthefieldfluenceincolor,selectthePseudocolorcheck
box.
7. ClickOptimizetostarttheoptimizationandfollowitsprogress.
Youcanchangethedoseobjectivesduringtheoptimization.
8. Tointerrupttheoptimization,clickStop.
9. Whenthecalculationisfinished,clickOK.
TheLMCprogramautomaticallystartsuptoconverttheoptimal
fluencesintoDMLCmotionpatternsandactualfluences.For
instructions,seeConvertingFieldFluencestoDMLCLeaf
Motionsonpage 540.
To Define Dose Objectives in Eclipse IMRT

Intheoptimizationdialogbox,

1. SelectastructureandclickAddUpperObjective todefinethe
upperdosevolumeobjective.Typethevalueintheappropriate
cellinthestructurelistordragthearrowthatappearsintheDVH
diagram.
A.Pointatanobjectiveanddragittochangetheobjectivevalues.
Indicatealldesireddoseobjectivesasunfractionatedtotaldoses.
2. Iftheselectedstructureisatargetstructure,clickAddLower
Objective todefinethelowerdosevolumeobjective.Typethe
valueintheappropriatecellinthestructurelistordragthearrow
thatappearsintheDVHdiagram.
Youcanadjusttheobjectivesduringtheoptimizationinthe
sameway,eithergraphicallyornumerically.

3. Todrawalinetolimitthedose,clickDrawLine anddrawthe
lineintheDVHbox.
Thesmallsquaresshownatregularintervalsalongtheline
objectivearehandlestochangethelineshape.Theobjectivevalues
areshownintheStructuresandObjectiveslist.
4. Todeleteobjectives,dooneofthefollowing:
Todeleteanindividualdosevolumeobjective,selectthe
objectiveandclickDelete.
Todeletemultipleobjectives,ensurethattheSelectobjectives
tool isactive,drawarectanglethatcoverstheobjectivesto
bedeletedandclickDelete.

Base Dose for Optimization
Insomecases,youneedtakeintoaccountacertainbasedoseforthe
optimization,forinstance,inaboosttreatmentwherethepatienthas
alreadybeentreateduptoacertaindose,andthetreatmentwillbe
continuedwithsomeadditionaldosage.Youcandefinethetotaldose
andlettheoptimizationcreateaplanthatselectivelyincreasesthe
doseofthetreatedplantothedefinedtotaldose.
Thebasedoseplancanbeanytreatmentplan,oraplansum.Ifaplan
sumisusedasabasedoseplan,itcannotcontaintheplanthatis
currentlyunderoptimization.
To Use a Base Dose in Dose Optimization in Eclipse IMRT

Plan1alreadyexists,iscalculatedanditsdoseprescriptionisdefined.
1. Createanewplan,Plan2,togiveadditionaldosetothedose
prescription.
2. ChoosePlanning >Optimizetostarttheoptimization.
3. IntheOptimizationdialogbox,clickSelectnexttotheBasedose
plantextbox.
4. IntheObjectExplorer,selectPlan1tobeusedasabasedoseplan.
5. Definethefinaldosevolumeobjectivesforthesumoftheearlier
plan,Plan1andthenewPlan2.
Forexample,ifthedoseprescriptionforPlan1is50Gyandfor
Plan2itis20Gy,optimizationobjectivesforPlan2areforthetotal
dose(70Gy).
6. ClickOK.
Theoptimizationextractsthebasedosefromthetotaldose
objectiveswhenthedoseobjectivesareevaluated,andreturnsthe
optimalfluenceforPlan2.
7. Calculatethedosedistribution.
EvaluatethefinaldosedistributionbysummingupPlan1andPlan2.

Planning for Aperture Modulated Therapy in Eclipse IMRT
ApertureModulatedRadiationTherapy(AMAT)isasimpleforward
planningIMRTmethodinEclipsewhereyoufirstdefinethefield
aperturesandthenoptimizetheplanusingthefieldweights,without
theuseoffluencesorcollimatorjawoptimization.Themethod
supportstheuseofmultiplefieldaperturesfromthesamedirection.
Fieldweightsaresimultaneouslycalculatedforallfields.MLCsand
blocksareallowedinthefields,buttheirshapesarenotoptimized.
To Use Aperture Modulated Radiation Therapy in Eclipse IMRT

1. Starttheoptimization.
2. Definedosevolumeobjectivesforthepatientstructures.
3. ClickintheMethodcellsandinthedropdownlist,selectField
Weightforeachfieldforwhichyouwishtousethefieldweight
optimization.
4. ClickOptimize.
Displaying and Editing Optimal Fluences in the BEV

Aftercalculatingthedose,youcandisplaytheoptimalfluencematrix
asafluencecolorwash,greyscaleoranisofluenceplotoverlaidonto
theBEVaboveallstructuresofthepatient.Thecommandusedto
displaythefluencematrixalsoopenstheFluenceEditor,atoolthat
allowsyoutomodifythetransmissionvaluesandvisualization(color
range,opacity,isolevels)ofthefluence.
Figure 111onpage 470showsafieldandtheoptimalfluencemap
connectedtothefieldplustheisolevelsofthefieldintheBEVwhen
theFluenceEditorisactive.TheOptimalFluencelegendshowsthe
colorsindicatingdifferenttransmissionfactorsintheoptimalfluence
map.Iftheisolevelsarealsodisplayed,theIsolevelslegendisshown
nexttotheOptimalFluencelegendtoshowthetransmissionfactor
indicatedbytheisolevelcolors.

A. OptimalFluencelegendB. Isolevelslegend
Figure 111 Isofluences and Fluence Map in BEV
Aftereditingthefluence,youcanstarttheLMCtoconvertthe
modifiedoptimalfluenceintoadeliverableactualfluenceandDMLC
leafmotionpattern.
Fluence Editor
TheFluenceEditorenablesyoutomodifythetransmissionvaluesand
visualizationoftheoptimalfluence.Youcandefinethecolorrange
andopacityofthefluencematrix,andshowtheisodoselinesontopof
thematrix.Thetransmissionvaluescanbeincreasedordecreased
withspecialtoolsintheFluenceEditor.
Note: TheFluenceEditorallowseditingtheoptimalfluencematrixonly,and
onlyworksintheBEV.

A.ToolsforeditingthefluenceB.SettingsforthefluenceeditingtoolsC.Fluencevisualization
settings
Figure 112 Fluence Editor
To View a Fluence
1. IntheFocuswindow,rightclickthefluenceyouwishtoeditand
chooseViewfluence.
TheFluenceEditordialogboxopens.
2. IntheMatrixdropdownlist,selectthefluencetypetoview
(optimaloractual).
3. Tomeasuretheselectedmatrixvalueataspecificpoint,clickthe
measurementbutton .
IntheBEVwindow,themousepointerappearsasacrosshair.
Whenyouclickapointinthefluencematrix,itsvalueisdisplayed
intheTransmissionFactortextbox.
4. Withtheslider,adjusttheopacityofthematrixshownintheBEV.

5. Definethefluencedisplayproperties.
Todisplaythefluenceincolor,selecttheUseColorcheckbox
anddefinethetransmissionvaluerangeforthecolorbar.
AreasbelowtheLowervaluearedisplayedastransparent,
verylowvaluesaredisplayedinblue,areasabovetheUpper
valuearedisplayedinpurple.
Todisplaythematrixusingshading,selecttheUseShading
checkbox.
TodisplayisofluencelinesintheBEVwindow,selectthe
Isolevelscheckbox.
Theisofluencesareshowninaccordancewiththetransmission
factorsinthefluence.Foranexampleoftheisolevelsshown,
seeFigure 111onpage 470.
6. Tofinishviewing,clickOK.
To Edit a Fluence
1. IntheFocuswindow,rightclickthefluenceyouwishtoeditand
chooseEditfluence.
TheFluenceEditordialogboxopens.
2. IntheMatrixdropdownlist,selectOptimalfluence.
3. Defineabrushshapeandsize.Thebrushsizerangeis0.1500mm.
Fordescriptionsofthebrushparameters,seeFluenceEditor
BrushParametersonpage 473.
4. Defineatransmissionfactor.Therangeis0100(0 = totalblocking,
100 = openfield).
5. SelectanappropriateFluenceEditortool.Fordescriptionsofthe
tools,seeFluenceEditorToolsonpage 476.
IntheBEVwindow,themousepointerappearsasthebrushofthe
selectedshapeandsize.
measurementbutton .
Whenyouclickapointinthefluencematrix,itsvalueisdisplayed
intheBrushValuetextbox.

8. Definethefluencedisplayproperties.
Todisplaythefluenceincolor,selecttheUseColorcheckbox
anddefinethetransmissionvaluerangeforthecolorbar.
AreasbelowtheLowervaluearedisplayedastransparent,
verylowvaluesaredisplayedinblue,areasabovetheUpper
valuearedisplayedinpurple.
checkbox.
TodisplayisofluencelinesintheBEVwindow,selectthe
Isolevelscheckbox.
Theisofluencesareshowninaccordancewiththetransmission
factorsinthefluence.Foranexampleoftheisolevelsshown,
seeFigure 111onpage 470.
Fluence Editor Brush Parameters

TherearefourBrushheadshapesavailable:square,circular,conical
andgaussian.
Square Brush
ClickinginthefluencewiththesquareBrush drawsasquare,
draggingtheBrushdrawsalinewithasquareshapedend.The
dimensionsoftheclickedareaorlinedependontheBrushsize.The
figureshowstwoexamplesofthesquareBrush.

A.OneclickwiththesquareBrushB.LinedrawnwiththesquareBrush
Figure 113 Square Brush
Circular Brush
ClickinginthefluencewiththecircularBrush drawsacircular
area,draggingtheBrushdrawsalinewithacircularend.The
figureshowstwoexamplesofthecircularBrush.
A.OneclickwiththecircularBrushB.LinedrawnwiththecircularBrush
Figure 114 Circular Brush
Conical Brush
ClickinginthefluencewiththeconicalBrush drawsacirculararea
withlinearcolorgradientsfromthecentertowardstheedgesofthe
Brushtip,draggingdrawsalinewithacircularendandlinearcolor

gradientsfromthecenterofthelinetowardstheedgesoftheline.The
figureshowstwoexamplesoftheconicalBrush.
A.OneclickwiththeconicalBrushB.LinedrawnwiththeconicalBrush
Figure 115 Conical Brush
Gaussian Brush
ClickinginthefluencewiththegaussianBrush drawsacircular
areawithgaussiancolorgradientsfromthecentertowardstheedges
oftheBrushtip,draggingdrawsalinewithacircularendand
gaussiancolorgradientsfromthecenterofthelinetowardstheedges
oftheline.Thedimensionsoftheclickedareaorlinedependonthe
Brushsize.ThefigureshowstwoexamplesofthegaussianBrush.

A.OneclickwiththegaussianBrushB.LinedrawnwiththegaussianBrush
Figure 116 Gaussian Brush
Fluence Editor Tools
Set to Given Value tool
TheSettoGivenValuetool setsthematrixvalueinthepaintedarea
totheselectedbrushvalue.Thearrowshowsthestrokedirection.
Set to Zero tool
TheSettoZerotool setsthematrixvalueintheselectedareato
zero.Thearrowshowsthestrokedirection.

Change above Given Value tool
TheChangeaboveGivenValuetool setsthematrixvaluesthatare
abovethegivenleveltothedefinedvalue.Itaddsonlyonelayeron
eachbrushstrokethuspreventingunwantedresultscausedbyfalse
strokes.Thearrowshowsthestrokedirection.
Change below Given Value tool
TheChangebelowGivenValuetool setsthematrixvaluesthatare
belowthegivenleveltothedefinedvalue.Itsubtractsonlyonelayer
oneachbrushstrokethuspreventingunwantedresultscausedbyfalse

Increase by Defined Value tool
TheIncreasebyDefinedValuetool increasesthematrixvaluesunder
thebrushbythedefinedvalue.Thearrowshowsthestrokedirection.
Decrease by Defined Value tool
TheDecreasebyDefinedValuetool decreasesthematrixvalues
underthebrushbythedefinedvalue.Thearrowshowsthestroke
direction.
Build up Transmission Factors tool
TheBuildupTransmissionFactorstool addsfurtherlayerswiththe
sametransmissionvalueontopofeachotherbypaintingoverthe
alreadypaintedareas.Thearrowshowsthestrokedirection.Usesmall
transmissionvaluesbecauseeachmovementofthemouseremovesa
layerfromthefluence.

Erase Transmission Factors tool
TheEraseTransmissionFactorstool erasesfurtherlayerswiththe
samematrixvaluefromthealreadysubtractedareas.Thearrowshows
thestrokedirection.
Smooth Transmission Factors tool
TheSmoothTransmissionFactorstool smoothsoutsharpchangesin
matrixvaluesandcanbeusedtoremovesmallirregularities.The
arrowshowsthestrokedirection.

Extending Fluence with the Skin Flash Tool
TheSkinFlashtoolcanbeusedtopreventsuddenfluctuations,such
ascoldorhotspots,inthedoseneartheBodyoutline,byextending
theoptimalfluence.TreatmentsusingtangentialIMRTfields(many
breast,headornecktreatments)arepronetofluctuationsintheBody
outlinearea.Deviationsmayalsoarisefrominaccuraciesinpatient
positioning,patientmovement,orasaresultofrespiration.TheSkin
Flashtool,whichvisualizesthefluenceoftheselectedfieldintheBEV,
allowsyoutographicallyextendthefluenceoutsidetheBodysurface
withapaintbrush,makingthefluencesmootherneartheBodyoutline.
Theskinflashfluenceiscalculatedautomatically.
Figure 117onpage 481showsafieldandtheoptimalfluencemap
connectedtothefieldintheBEVwhentheSkinFlashtoolisactive.
TheFluencelegendshowsthecolorsindicatingdifferenttransmission
factorsintheoptimalfluencemap.

A. Fluencelegend
Figure 117 Isofluences and Fluence Map in BEV
To Extend Fluence with the Skin Flash Tool

1. IntheFocuswindow,rightclickthefluencetobeeditedand
chooseSkinFlashTool.
TheSkinFlashTooldialogboxopens.Thefluenceisshowninthe
BEV.
2. TodefinethediameteroftheBrush,typethevalueinmminthe
Brushsizetextbox.
3. IntheFillMethoddropdownlist,selectthedesiredmethod.
4. Todefinetheskinflashparameters,clickinthedesiredcellinthe
tableandtypeinthenewvalue.
Nearestcellmethod:BrushceilingandCutrange
Erosiondilationmethod:Brushceiling,Erosionrangeand
Dilationrange
5. ToactivatetheBrush,clickBrush .
6. Ontheoptimalfluence,painttheareatobemodifiedbytheskin
flashtool.
Whileyoupaintthearea,itisdisplayedingrey,butonceyou
releasethebutton,thepaintedareaisdisplayedwiththecolors
correspondingtothetransmissionfactor.

7. Toviewthetransmissionfactorofanareainthefluence,click
Measure andthenclickatthepointinthefluence.
ThetransmissionfactorisshownintheTransmissionfactorbox.
8. Modifytheskinflasharea,ifnecessary.
Toremovepartsoftheskinflasharea,clickErase .
Toaddtotheskinflasharea,clickBrush.
9. Continuedefiningtheareaandpreviewingituntiltheskinflash
fluenceisacceptable.
10. ClickOK.
11. Moveontoanotherfieldandcontinuedefiningthemodified
fluence.
IfyouwishtoworkonmultiplefieldswhilekeepingtheSkinFlashtool
dialogboxopen,clickApplybeforeselectinganotherfieldtokeepthe
changesmadetothepreviousfield.Moreover,tousemultiplebrushsizes
orotherparametersonthesamefluence,clickApplybeforechangingthe
parameters.
ContinuebyconvertingthefieldfluencestoDMLCmotions.For
instructions,seeConvertingFieldFluencestoDMLCLeafMotionson
page 540.
Skin Flash Dialog Box and Parameters

TheSkinFlashtoolvisualizesthefluenceoftheselectedfieldasa
colorwashareaintheBEV.YouextendthefluencebyusingtheBrush
topainttheextensionwhichisthenfilledwithtransmissionvalues
usingtheselectedfillmethodandBrushparameters.Youcanalso
removepartsoftheskinflashareawiththeEraser ,andmeasure
thetransmissionfactorofanareawiththeMeasuretool .
TheSkinFlashparametersaredefinedintheSkinFlashdialogbox.

Figure 118 Skin Flash Dialog Box
ThesupportedfillmethodsaretheNearestCellandthe
ErosionDilationmethods,andtheBrushparametersincludethe
Brushsize,BrushCeiling,CutRange,ErosionRange,DilationRange,
andTransmissionfactor.
ThissectionbrieflydescribestheSkinFlashtoolparametersandtheir
effectontheextendedfluencewithsomeexamples.However,thebest
waytolearnmoreistoexperimentwiththefluencedataavailableto
you.
Brush Size
TheBrushSizeparameterdefinesthediameteroftheBrushtool
andtheErasertool inmillimeters.
Transmission Factor
TheMeasurementtool measuresandshowsthetransmission
valuesinthefluence.ThevalueisshownintheTransmissionfactor
textbox.Thedefaulttransmissionfactorvalueis1.

Fill Method
TheSkinFlashtoolsupportstwomethodsoffillingtheextensionwith
transmissionvalues:
NearestCellmethodFillstheextensionwiththetransmission
valueofthenearestcellbeyondtheCutRangelimit.
ErosionDilationmethodFillstheextensionwiththetransmission
valuesdefinedbytheErosionandDilationrange.
Brush Ceiling
TheBrushCeilingparameterdefinestheareawhereyoucanpaintthe
extension.TheBrushCeilingdefinestheupperthresholdforthe
extension,thatis,iftheBrushCeilingvalueis0.1,youcannotpainton
fluenceareaswithtransmissionvalues0.1orhigher.
A.StartingpointB.PaintareawithBrushCeilingvalue 0.01C.Holeinthepaintarea,causedby
transmissionvalues(0.017)abovethedefinedBrushCeiling.D.CutRangeof 5 mmE.Paintarea
withBrushCeilingvalue 0.2F.HoledisappearswithnewBrushCeilingvalueG.CutRange
value 5 mm
Figure 119 Examples of Brush Ceiling Values

Intheexample,anextensionwasfirstdrawnusingBrushCeiling
valueof0.01withCutRangeof5 mm.Asaresult,aholeappearedin
theextension,becausethetransmissionvaluesinsidethehole
exceededtheBrushCeilingvalue.Thisholewasfilledbyincreasing
theBrushCeilingvalueslightly(intheexampleitwasincreasedto
0.2).ThediamondlinemarkedwithDandGshowstheCutRange
limit(5 mm)atwhichthetransmissionvaluesaretaken.
Cut Range
TheCutRangeparameterdefinestherangefromwhichthe
transmissionvaluesfortheextensionaretaken,measuredfromthe
edgeoftheBrush.TheSkinFlashtoolgoesthroughallcellsatthe
definedCutRange,forinstance,allcellsat10 mmfromtheedgeofthe
Brush,andassignsthefoundtransmissionvaluestothecellsinthe
paintedextension.AlowCutRangevaluefindstransmissionvalues
fromcellsneartothepaintedextension;ahigherCutRangevalue
findsvaluesfurtherawayfromthepaintedextension.
A.StartingpointB.PaintareawithCutRangevalue 5 mmandBrushCeilingvalue 0.2C.Outer

limitofCutRangeD.PaintareawithCutRangevalue 10 mmandBrushCeilingvalue 0.2E.
OuterlimitofCutRange
Figure 120 Examples of Cut Range Values

Intheexample,afluenceextensionwasfirstpaintedusingaCut
Rangevalueof5 mmwithBrushCeilingof0.2 mm.Theresulting
extensionwasnonuniformbecausethevalueswerepickedupfrom
anareainthefluencewithalotoffluctuations(thediamondline
markedwithCshowstheouterCutRangelimit).Next,theCutRange
(E)valuewasincreasedto10mmtogetthetransmissionvaluesfroma
fluenceareawithlessfluctuations.TheBrushCeilingwaskeptthe
same,butthefluenceextension(D)waspaintedwithmoreoverlap
withtheexistingfluence.
Erosion Range and Dilation Range
BoththeErosionRangeandtheDilationRangeparameters,whichare
usedintheErosionDilationmethodonly,extendhighervaluesinthe
extendedfluence.TheErosionRangeparameterdefinestherangein
millimetersinwhichhighertransmissionvaluesareremovedfromthe
fluencemap.TheDilationRangeparameterdefinestherangeinwhich
highertransmissionvaluesareextendedinthefluencemap.
A.StartingpointB.ErosionRangevalue 1,DilationRangevalue 5,BrushCeiling0.2C.Erosion

Rangevalue 5,DilationRangevalue 10,BrushCeiling0.2D.ErosionRangevalue 10,Dilation
Rangevalue 5,BrushCeiling0.2E.Borderofpaintedextension
Figure 121 Examples of Erosion Range and Dilation Range Values

Reconstructing an Interrupted Treatment
YoucanreconstructpartiallytreatedIMRTorDoseDynamicArcplans
inEclipseforassessingthedosimetricandclinicalimplicationsof
partialtreatments.Intreatmentreconstruction,youcreateapartial
planfromaplanthatcontainsdynamicMLCs.Thepartialplan
containsthedeliveredportionoftheoriginalplan.
Thepartialplanisaverificationplan.Itisacopyoftheoriginalplan
withthefollowingexceptions:
Theactualfluencesandexistingdosedistributionareremoved
Theplanhasonlythedeliveredportionofcontrolpoints
Theplanhasonlyonefraction
ThedosewillbecalculatedusingthedeliverednumberofMUs
Whencreatingapartialplan,youcanchoosetoalsocreateasecond
verificationplanthathasonefractionandfullMUs.Thisplancanbe
comparedwiththepartialplan.Formoreinformationonverification
plans,seeChapter 25,SectionVerificationofTreatmentPlanningon
page 697.
To Create a Partial Treatment Plan

1. ChoosePlanning >CreatePartialTreatmentPlan.
TheCreatepartialtreatmentplanfromoriginalplandialogbox
opensdisplayinginformationontheoriginalplanandthenew
verificationplantobecreated.
2. IntheOriginaltotalMUcolumn,editthenumberoftotalMUs,if
necessary.Bydefault,theMUvalueistheplannednumberofMUs
intheoriginalplan.

3. Forthenewverificationplan,dooneofthefollowing:
DefinethestartandendcontrolpointsintheCPstartandCP
endcolumns.ForDoseDynamicArcplans,thegantrystart
andendvalueschangeaccordingly.ForIMRTplans,the
gantrystartandendvaluesarenotdisplayed.TheMUstart
andMUendvalueschangeaccordingly.
DefinevaluesintheMUstartandMUendcolumns.By
default,theMUendcolumndisplaysthedeliveredMUvalue
obtainedfromthetreatmentrecords.TheCPstartandCPend
values,andthegantrystartandendvalueschange
accordingly.
4. TocreateasecondverificationplanwithonefractionandfullMUs,
selecttheappropriatecheckbox.Thissecondverificationplancan
thenbeusedtocomparetheintendeddosedistributiontothe
partialtreatmentplanandassesstheeffectofthepartialtreatment.
5. Tocreatenewverificationplans,clickOK.
Continuebycalculatingthedosedistributionsandevaluatingthecreated
plans.Verificationplansthatdonotcontainactualfluencesare
automaticallycalculatedusingfixedMUs.Formoreinformationon
calculatingwithfixedMUs,seeChapter 24,DoseCalculationBasedon
MU,onpage 620.

Chapter 15 Dose Dynamic Arc Planning for
RapidArc
ThischapterdescribesthemainfeaturesofDoseDynamicArc
planninginEclipse.DoseDynamicArcplanningistheEclipsefeature
thatsupportsRapidArc.
About Dose Dynamic Arc Planning

InDoseDynamicArcplanning,RapidArctreatmentsareproduced
basedonvolumetricdoseoptimization.RapidArcoffersatreatment
usingasinglegantryrotation,DynamicMLCandvariabledoseper
degree.Variabledoseperdegreeisachievedwithvariabledoserate
andvariablegantryspeed.EclipsesDoseDynamicArcplanning
enableseasyplanningofcomplextreatmentsthatreducethetreatment
deliverytimecomparedtostandardIMRT.Simplicityandefficiencyof
thedeliveryandmanagementofhighlyconformaltreatmentsisalso
improved.
DoseDynamicArcplansforRapidArcarecreatedusingonestaticor
arcfieldastheinputfield.Ifastaticfieldisused,thesystemchangesit
toafullarcfieldduringthearcoptimizationprocess.Thecreatedplan
isthenoptimizedwitharcoptimizationthatfollowsthearcfield
geometryoftheplan.Thearcoptimizationcanoptimizearclengthsof
90359degrees.
Generally,inanarcfield,theMLCcanbe:
Static:TheMLCshapeisstaticduringthebeamon.
ArcDynamic:TheMLCshapeischangeddynamicallyduringthe
beamon.Thedoseperdegreeiskeptconstant.
DoseDynamicArc:TheMLCshapeanddoseperdegreeare
changeddynamicallyduringthebeamon.ThisMLCplantypeis
usedtoidentifyRapidArcfields.
483
Inarcoptimization,theMLCleafpositionsanddoseperdegreeare
calculatedforanumberofcontrolpointsinanarcfield.Theresulting
MLCleafpositionsanddoseperdegreearestoredinanumberof
gantryrotationspecificcontrolpointsinthefield.Thetreatment
machinecontrolsystemdetermineshowthedoserateandgantry
speedneedtobemodulatedinordertodeliverthecontrolpoint
sequenceintheplan.Finally,avolumedoseiscalculatedfortheplan
withaversionoftheAAAdosecalculationalgorithmthatsupports
DoseDynamicArccalculation.Afteroptimization,theMLCtypein
theFieldstaboftheInfoWindowisDoseDynamicArc.DoseDynamic
Arcplanscanbeexported/importedwithDICOM.
Afterarcoptimization,thefinaloptimizedplancanbesavedasa
templateorasaclinicalprotocol.TheMLCtype(DoseDynamicArc)
isnotsavedinthetemplateorclinicalprotocol;thefieldand
optimizationobjectivesaresavedandthearcoptimizationprocess
mustbefollowedwhenthetemplateorclinicalprotocolisused.
Dose Dynamic Arc Planning Process in Eclipse

Theplanningprocessforarcoptimizationdiffersslightlyfromthe
workflowfollowedinIMRTplanning.ForacomparisonoftheDose
DynamicArcplanning,IMRTplanningandconventionalplanning,
seeChapter 2,WorkflowsforExternalBeamPlanning,onpage 47.
ThealgorithmsusedinDoseDynamicArcplanningaredescribedin
EclipseAlgorithmsReferenceGuide.
Preparing the Images
TheplanningsessionforDoseDynamicArcbeginsfromselectinga
3Dimageanddefiningthepatientstructuresandcouchstructuresin
theimage.SinceDoseDynamicArcplansproducedosedistributions
thatarehighlyconformaltotheshapesofthetargets,defining
segments(bothtargetsandavoidancevolumes)fortheplanstypically
requiresgreaterprecisionfromtheclinicianthanconventional
planning.Forinstructionsonimageimportandsegmentation,see
Chapter 5,ImageManagement,onpage 105andChapter 8,
SegmentationandContouring,onpage 197.

Inserting a New Field
Whentheimagepreparationiscomplete,youcancreateaplanand
insertonestaticorarcfieldintheplan.Ifastaticfieldisinsertedinthe
plan,thesystemchangesittoafullarcfieldduringthearc
optimizationprocess.Thestartandstopanglesofthearcfieldmust
notbeinthegantryrotationextendedrange.Ifthestartorstopangles
areintheextendedrange,theywillautomaticallybechangedto0.1
degreefrom180degreeIEC61217.Forexample,ifacounterclockwise
(CCW)arcfieldissetwithstartangleof181Edegreeandstopangleof
182degree(IEC61217),thestartanglewillbechangedto179.9degree
inordertomoveitoutoftheextendedrange.Forinstructionson
insertingfieldstoaplan,seeChapter 11,Fields,onpage 361.
Note: WheninsertingafieldinaDoseDynamicArcplan:
ThedoseratedefinedintheFieldPropertiesdialogboxwillbethe
maximumdoserateusedinthearcoptimization.Itisrecommendedto
usethehighestdoserateavailableonthetreatmentunit.
YoucanletEclipseadjustthefieldgeometryduringthearcoptimization
process.Formoreinformation,seeArcOptimizationDialogBoxon
page 492.
Youcanalsouseaplantemplatetoaddthefieldintheplan.Ifyouuse
atemplatethatcontainsanMLC,theMLCisoverwrittenduringarc
optimization.
Whenselectingthetreatmentunitforthefield,makesurethatyouuse
onethatisabletoproduceDoseDynamicArcbeams.Intheoperating
limitsofthetreatmentunit,themotionmodefortheoperatinglimit
DoseRatemustbesettoDynamic.Thetreatmentunitmustalsohave
eithertheMillenniumMLC120ornewer,orHD120MLC.
Dose Objectives
Tobegintheactualoptimization,youdefineasetofdosevolume
objectivesintheArcOptimizationdialogboxforeachtargetand
criticalstructureofconcern,andstartthearcoptimization.Youcan
alsouseatemplatetoaddtheoptimizationobjectivesintheplan.
Dose Dynamic Arc Planning for RapidArc 485

Interactive Optimization
Arcoptimizationcreateshighlyconformaldosedistributionsby
iterativelymodulatingtheMLCaperturesandcorrespondingdoseper
degreeuntiltheprescribeddoseobjectivesoftheplanareoptimally
satisfied.Theentireoptimizationprocessisinteractive,allowingyou
tochangethedoseobjectivesaccordingtotheresultsofthe
optimization.
Dose Calculation
Afterarcoptimizationisfinished,youcalculatethedosedistribution
toproduceathreedimensionaldosedistributionforfinalevaluation.
SeparateMLCleafmotioncalculationisnotneededbecausearc
optimizationproducestheleafmotiondatadirectly.Dosecalculation
isperformedbasedontheMLCcontrolpoints.Foreachcontrolpoint,
thefluenceusedinthedosecalculationaccountsforleafmotionbased
ontheneighboringcontrolpoints.Thedosecalculationcanalsobe
startedautomaticallyattheendofthearcoptimization,ifdesired.
Optimizing Dose Dynamic Arc Plans

OptimizationofDoseDynamicArcplansiscontrolledbytheArc
Optimizationdialogbox,whereyoudefinethedosevolumeobjectives
fortheoptimization.Youcaneitherdefinetheoptimizationobjectives
foreachplanseparately,oruseanobjectivetemplate.
Arcoptimizationcanbestartedforaplanthatcontainsasinglestatic
orarcfield.Iftheplancontainsastaticfield,itischangedtoafullarc
fieldduringthearcoptimizationprocess.
Theoptimizationprocessisiterative;itproceedsthroughfive
multiresolutionlevels.Duringoptimization,itispossibletodefine
thattheoptimizationprocessstaysonacertainresolutionlevelfora
continuedperiodoftime,inordertoenablemakingchangesbefore
thenextresolutionlevel.Itisalsopossibletoreturntothepreviousor
jumptothenextmultiresolutionlevel,ifneeded.

WARNING: When using plan optimization,
Verify the final plan using DVH analysis inside Eclipse before transferring it
to the treatment unit. For instructions, see Chapter 25, Evaluating Plans,
on page 639.
Evaluate the dose distribution visually.
Perform QA tests to make sure the plan is correctly transferred to the
treatment machine.
Visually verify the shape of the initial DMLC before treating.
Verify the maximum dose inside the irradiated target after dose
calculation, especially in the case of a DMLC plan. You can prevent
unwanted hot spots in the dose distribution by defining suitable values for
the Normal Tissue Objective (see Normal Tissue Objective on page 490),
or reduce hot spots from the resulting dose distribution by adding new
volumes to the hot spot area, defining objectives as you would for critical
organs, and then re-optimizing the plan. For more information on using
the Freehand tool to add new volumes in the Field Setup workspace, see
Chapter 8, Section About Freehand Contours and Segments on page 222.
For more information on contouring and segmenting in the Contouring
workspace, see Chapter 8, Segmentation and Contouring, on page 197.
The optimization uses inhomogeneity correction by default.
Indicate all desired dose objectives and doses as unfractionated total
doses.
targetsisincreased.

inthedialogbox.
Guide.
Structure Model
values:
3.0 mm
onemillion

than25 Gy).
atleast20 Gy).

targetsisincreased
parameters:
falloff.


Enddose[%] 01000 60
Falloff 0100 0.05
Priority 01000 150

MU Objective
TheMUobjectivecanbeusedtoincreaseMUs,whichtendstoadd
modulationintheoptimizationprocess,ortoensurethattheMUsare
keptaslowaspossible,ifclinicallyrequired.
WhenusingtheMUobjective,youneedtodefinethestrength,andthe
minimumandmaximumMUvaluesfortheobjective.Thestrength
valuemustbedefinedbetween0100.Thevalue50isconsideredas
mediumstrength.TheminimumandmaximumMUvaluescanbe
definedbetween010000.ThedefaultminimumMUvalueis0and
maximumMUvalueis2000.
Arc Optimization Dialog Box
Theprogressofthearcoptimizationprocesscanbemonitoredinthe
ArcOptimizationdialogbox,whichshowsaDVHcalculatedforeach
structure.Youcaneasilyevaluatetheeffectivenessofthedose
objectivesand,ifnecessary,modifytheobjectiveswithouttheneedto
stoptheoptimizationprocess.Youcanalsoeasilyshoworhideall
structuresatonceintheDVH.
Eclipseallowsyoutoselectanoptiontoadjustthefieldgeometryof
theDoseDynamicArcfield.Whenthisoptionisselected,Eclipse
automaticallyadjustscollimatorjawsand,ifsodefined,collimator
anglesandisocenterposition,andtriestofindafieldtrajectorywhere
thetargetvolume(s)canbeeasilyirradiatedandcriticalorgans
avoided.Itisrecommendedtoadjustfieldgeometrywhenoptimizing
aplanforthefirsttime.Adjustingfieldgeometryisuseful,for
example,ifthetargetvolumeoftheplanislarge.
IntheArcOptimizationdialogbox,itispossibletoholdthe
optimizationprocessonacertainmultiresolutionlevel,orreturnto
thepreviousorjumptothenextlevel.
Ifyoucanceltheoptimizationprocess,theoptimizationresultswillbe
lost.Youcangetthecurrentoptimizationresultsandendthe
optimizationprocessbyjumpingthroughtherestoftheoptimization
levelsandclickingOK.

Figure 124 Arc Optimization Dialog Box
A.SelectionforNormalTissueobjectiveandMUobjective.B.Showsthestructurescontainedin
theplan(excludingcouchstructures),thevolumesofthestructures,thepointsandpoint
objectives.RightclicktoshoworhideallstructuresintheDVH.C.Showsthestatusofthe
optimizationprocess.D.Clickresolutionlevelbuttonsduringoptimizationtoreturntothe
previousoptimizationlevel,tostayonthecurrentoptimizationlevel,ortojumptothenext
optimizationlevel.E.Clicktoloadobjectivesfromobjectivelibrary,saveobjectivestolibrary,or
manageobjectivesinlibrary.F.ShowstheoptimizationresultsintheformofaDVH.G.Shows
theprogressoftheoptimization.
Note: TheDVHshownintheArcOptimizationdialogboxisindicatoryonly.
ItmaydeviatefromtheDVHcalculatedforplanevaluationinEclipse.Always
verifytheresultoftheoptimizationbycalculatingthedoseandaDVH.



40.6Gy
39.4Gy
objectives
ArcPlanning.)
ArcPlanning.)
belowthefirstone.

Objective Templates in Arc Optimization
nasopharynxcases.
To Start Arc Optimization

1. ChoosePlanning >ArcOptimization.
promptedtodoso.
2. Ifprompted,selecttheMLCdevicetouseandclickOK.
TheArcOptimizationdialogboxopens.
3. SelectstructuresforoptimizationfromtheStructuresand
Objectiveslistanddefinetheoptimizationobjectivesorloadthe
objectivesfromtheobjectivelibrary.Youneedtoaddatleastone
lowerobjectivetobeabletostarttheoptimizationprocess.For
instructions,seeToDefineDoseObjectivesinArcOptimization
onpage 497orToInsertNewObjectivesinaPlanfroman
4. TosetanMUobjective,selecttheUseMUObjectivecheckbox
anddefinethevaluesforstrength,minimumMUsandmaximum
MUs.

5. Toletthesystemadjustthearcfieldgeometry,clickAdjustfield
geometry,selecttheappropriatecheckboxesandclickOK.
Collimatorangle:Allowsautomaticcollimatorrotationfor
tryingtofindagoodrotationangle.
Isocenterposition:Allowsautomaticisocentermovementfor
tryingtofindagoodisocenterposition.
WhenusingtheAdjustfieldgeometrytool,collimatorjawsarealways
optimizedandfittedautomatically.TheProgressiveResolution
Optimizeralgorithmdoesnotmodifytheisocenterposition,collimator
angleorfieldsize.ThoseareonlymodifiedusingtheAdjustField
Geometrybutton.Itisrecommendedtoadjustfieldgeometrywhen
optimizingaplanforthefirsttime.
6. Tocontinueautomaticallytodosecalculationafteroptimization,
selecttheappropriatecheckbox.Bydefault,thecheckboxis
selected.
7. ClickOptimizetostartthearcoptimizationandfollowits
progress.
8. Duringtheoptimizationprocess,youcan:
ShoworhideallstructuresintheDVHbyrightclickinginthe
StructuresandObjectiveslistandselectingShowallstructures
orHideallstructures.
Click tostayonthecurrentmultiresolutionlevel.
Clickthebuttonagaintocontinueoptimization.Whenthe
buttonisclickedon,theLevelHoldtextisdisplayedinthe
optimizationprogresspane.
Click toreturntothepreviousmultiresolutionlevel.
Whenthebuttonisclicked,thePreviuosLeveltextisdisplayed
intheoptimizationprogresspane.
Click tojumptothenextmultiresolutionlevel.When
thebuttonisclicked,theNextLeveltextisdisplayedinthe
optimizationprogresspane.Togetthecurrentoptimization
resultsandendtheoptimizationprocess,jumpthroughthe
restoftheoptimizationlevelsandclickOK.

9. Whenthearcoptimizationprocessisfinished,clickOKtoaccept
theresultoftheoptimization.
Tosavethedefineddoseobjectivesbeforecancellingthe
optimizationprocess,clickApply.
Tostopthearcoptimizationanddiscardalloptimization
results,clickCancel.
Afteroptimization:
TheMLCtypeintheFieldstaboftheInfoWindowisDose
DynamicArc.
TheplantypeintheGeneraltaboftheMLCPropertiesdialog
boxisDoseDynamicArc,andifthedoseiscalculated,the
DetailsbuttonintheDynamictabliststheestimateddoserate
andgantryspeed.
To Define Dose Objectives in Arc Optimization

Intheoptimizationdialogbox,
1. SelectastructureandclickAddUpperObjective todefinethe
upperdosevolumeobjective.Typethevalueintheappropriate
cellinthestructurelistordragthearrowthatappearsintheDVH
diagram.
A.Pointatanobjectiveanddragittochangetheobjectivevalues.
Indicatealldesireddoseobjectivesasunfractionatedtotaldoses.

2. Iftheselectedstructureisatargetstructure,clickAddLower
Objective todefinethelowerdosevolumeobjective.Typethe
valueintheappropriatecellinthestructurelistordragthearrow
thatappearsintheDVHdiagram.
Youcanadjusttheobjectivesduringtheoptimizationinthe
sameway,eithergraphicallyornumerically.
3. Todrawalinetolimitthedose,clickDrawLine anddrawthe
lineintheDVHbox.
Thesmallsquaresshownatregularintervalsalongtheline
objectivearehandlestochangethelineshape.Theobjectivevalues
areshownintheStructuresandObjectiveslist.

4. Todeleteobjectives,dooneofthefollowing:
Todeleteanindividualdosevolumeobjective,selectthe
objectiveandclickDelete.
Todeletemultipleobjectives,ensurethattheSelectobjectives
tool isactive,drawarectanglethatcoverstheobjectivesto
bedeletedandclickDelete.
Base Dose for Optimization

Insomecases,youneedtakeintoaccountacertainbasedoseforthe
optimization,forinstance,inaboosttreatmentwherethepatienthas
alreadybeentreateduptoacertaindose,andthetreatmentwillbe
continuedwithsomeadditionaldosage.Youcandefinethetotaldose
andlettheoptimizationcreateaplanthatselectivelyincreasesthe
doseofthetreatedplantothedefinedtotaldose.
Thebasedoseplancanbeanytreatmentplan,oraplansum.Ifaplan
sumisusedasabasedoseplan,itcannotcontaintheplanthatis
currentlyunderoptimization.
To Use a Base Dose in Dose Dynamic Arc Planning

Plan1alreadyexists,iscalculatedanditsdoseprescriptionisdefined.
1. Createanewplan,Plan2,togiveadditionaldosetothedose
prescription.
2. ChoosePlanning >ArcOptimizationtostarttheoptimization.
3. Ifprompted,selecttheMLCdevicetouseandclickOK.
4. Intheoptimizationdialogbox,clickSelectnexttotheBasedose
plantextbox.
5. IntheObjectExplorer,selectPlan1tobeusedasabasedoseplan.
6. Definethefinaldosevolumeobjectivesforthesumoftheearlier
plan,Plan1andthenewPlan2.
Forexample,ifthedoseprescriptionforPlan1is50Gyandfor
Plan2itis20Gy,optimizationobjectivesforPlan2areforthetotal
dose(70Gy).

7. ClickOK.
Theoptimizationextractsthebasedosefromthetotaldose
objectiveswhenthedoseobjectivesareevaluated.
EvaluatethefinaldosedistributionbysummingupPlan1andPlan2.
Editing Dose Dynamic Arc Plans

ItisnotpossibletoedittheMLCsequenceorgantrystartandstop
anglesinDoseDynamicArcplansbutitispossibletoeditthe
collimatorangleandfieldsize.Makingsuchmodificationstoan
optimizedarcfieldmayproduceresultswhichcausetheplanto
deviatesignificantlyfromthedefinedoptimizationobjectivesandthe
achievedoptimizationresult.
Ifyouchangethedoseprescriptionorplannormalization,validatethe
planwiththeVerifyMLCLeafPositionscommand.Forinstructions,
seeChapter 16,SectionToVerifyandCorrectMLCLeafPositionson
page 526.
Verifying Dose Dynamic Arc Plans

ToverifytheaccuracyofDoseDynamicArcplans,youcancreate
verificationplansusingaphantom.Formoreinformationand
instructions,seeChapter 25,VerificationofTreatmentPlanning,on
page 685.
Reconstructing a Partially Treated Plan

YoucanreconstructpartiallytreatedIMRTorDoseDynamicArcplans
inEclipseforassessingthedosimetricandclinicalimplicationsof
partialtreatments.Intreatmentreconstruction,youcreateapartial
planfromaplanthatcontainsdynamicMLCs.Thepartialplan
containsthedeliveredportionoftheoriginalplan.

Thepartialplanisaverificationplan.Itisacopyoftheoriginalplan
withthefollowingexceptions:
Theactualfluencesandexistingdosedistributionareremoved
Theplanhasonlythedeliveredportionofcontrolpoints
Theplanhasonlyonefraction
ThedosewillbecalculatedusingthedeliverednumberofMUs
Whencreatingapartialplan,youcanchoosetoalsocreateasecond
verificationplanthathasonefractionandfullMUs.Thisplancanbe
comparedwiththepartialplan.Formoreinformationonverification
plans,seeChapter 25,SectionVerificationofTreatmentPlanningon
page 685.
To Create a Partial Treatment Plan

1. ChoosePlanning >CreatePartialTreatmentPlan.
TheCreatepartialtreatmentplanfromoriginalplandialogbox
opensdisplayinginformationontheoriginalplanandthenew
verificationplantobecreated.
2. IntheOriginaltotalMUcolumn,editthenumberoftotalMUs,if
necessary.Bydefault,theMUvalueistheplannednumberofMUs
intheoriginalplan.
3. Forthenewverificationplan,dooneofthefollowing:
DefinethestartandendcontrolpointsintheCPstartandCP
endcolumns.ForDoseDynamicArcplans,thegantrystart
andendvalueschangeaccordingly.ForIMRTplans,the
gantrystartandendvaluesarenotdisplayed.TheMUstart
andMUendvalueschangeaccordingly.
DefinevaluesintheMUstartandMUendcolumns.By
default,theMUendcolumndisplaysthedeliveredMUvalue
obtainedfromthetreatmentrecords.TheCPstartandCPend
values,andthegantrystartandendvalueschange
accordingly.
4. TocreateasecondverificationplanwithonefractionandfullMUs,
selecttheappropriatecheckbox.Thissecondverificationplancan
thenbeusedtocomparetheintendeddosedistributiontothe
partialtreatmentplanandassesstheeffectofthepartialtreatment.

5. Tocreatenewverificationplans,clickOK.
Continuebycalculatingthedosedistributionsandevaluatingthecreated
plans.Verificationplansthatdonotcontainactualfluencesare
automaticallycalculatedusingfixedMUs.Formoreinformationon
calculatingwithfixedMUs,seeChapter 24,DoseCalculationBasedon
MU,onpage 613.

Chapter 16 Multileaf Collimators
Thischapterdescribesthemultileafcollimator(MLC)featuresand
providesinstructionsforaddingMLCstofieldsandmodifyingthem.
ThechapterdescribesthevisualizationofMLCsandthefunctionsand
parametersusedtocontrolanMLCinafield(margin,coordinateaxes,
leaffitandleafbanks).Instructionsareprovidedforaddingand
modifyingMLCstobetterconformtothetargetstructurewithspecial
modificationtools.Thechapteralsocontainsinformationonexporting
andimportingMLCfilestoVarianMLCworkstations.
About MLC Systems

Multileafcollimators(MLC)arethinleafcollimatorsystemsusedto
shapefieldsinconformaltherapy.AllconfigurableMLCsystemsare
supportedforphotonplans,forexample:
VarianMLCsystems
Philips/ElektaMLCsystem
SiemensMLCsystem
BrainLabMLCsystem
MLCleavesarearrangedaroundthetargetstructureautomatically
withthefittingtools,ormanuallybychangingthepositionsof
individualMLCleaves.
TheMLCtransmissionfactorisconfiguredintheBeamConfiguration
Task.TheMLCleafwidth,overtravelandthemaximumbankandleaf
spansaredefinedintheAdministrationtaskandcannotbechanged
duringtreatmentplanning.
503
MLC in Static and Arc Photon Fields
Inastaticfield,theMLCshapeisstaticforeachfieldduringthe
beamon.
Instandardarctreatment,thegantryangleofafieldvariesduringthe
beamonbetweenthestartandthestopangle.IfanMLCisfittedtoan
arcfield,therearetwoMLCoptions:
StaticTheMLCshapeisstaticduringthebeamon.
DynamicTheMLCshapeischangeddynamicallyduringthe
beamontocreateaconformalarcfieldbyrearrangingtheleavesfor
eacharcfieldsegment.
Note: Ifmanualblocksareusedinconformalarcfields,verifytheshieldor
apertureshapesinallsegmentsofthearcfield.
MLC Visualization
WhenyouinsertanMLCtoastaticfield,theMLCicon appearsin
theFocuswindowunderthefield.Ifthefieldisanarcfieldandthe
MLCdynamicMLC,thedynamicMLCicon appearsinstead.
MLC in the Image Views
Inthe2Dviews,MLCsaredisplayedatthefieldendclosertothe
treatmentunit.Theintersectionofthefieldandtheplaneshowthe
MLCshapeasanoutline(Figure 126onpage 510).
A.MLCshapeatthetreatmentmachineendofthefield.B.MLCoutlineattheintersectionofthe
planeandthefield.
Figure 126 MLC in 2D Views

The3Dviews(Figure 127onpage 511)displaytheshapeoftheMLC
apertureontheselectedstructuresandinsidethefieldrectangleatthe
treatmentmachineendofthefield.Ifthefieldisvisualizedasacone,
thesurfaceoftheconeisformedinaccordancewiththeMLCshape.
A.MLCoutline
Figure 127 MLC in Model View
IntheBEV,theMLCleavesaredisplayedandyoucanarrangethe
leaveswiththeFittoStructuretool,ormoveindividualleaveswiththe
mouse.IfyouhaveseveralfieldswithDMLCthathavethesame
isocenter,gantryangle,couchangleandSAD,asinFitandShield
treatments,youcanshowtheMLCshapesfromallcontrolpointsofall
fieldsintheBEV.
Figure 128onpage 511showsanactiveMLCintheBEV.
Figure 128 Active MLC in the Beams Eye View
Multileaf Collimators 505

IfafieldcontaininganMLCishidden,theMLCisalsohiddeninthe
imageviews.However,whentheMLCofahiddenfieldisselectedin
theFocuswindow,theMLCisdisplayedinallimageviews.Formore
informationonhidingfields,seeShowingandHidingFieldson
page 381.
MLC Margin Types

TheMLCmarginisthedistancebetweenthedefinedMLCoutlineand
thetargetoutline.TwotypesofautomaticMLCmarginsareused:
circularandelliptical.Inaddition,youcandefinethemarginmanually
withthemouse.TheautomaticMLCmarginisdefinedintheFitMLC
toStructuredialogbox.
Circular Margin
Inacircularmargin,thedistanceoftheMLCoutlinefromthetarget
volumesurfaceisalwaysuniform.InFigure 129onpage 512,a
circularmarginof1cmisusedwiththeMLC.
A.CircularmarginbetweentargetandMLCleavesB.Target
Figure 129 Circular Margin
Elliptical Margin
Inanellipticalmargin,thedistanceoftheMLCoutlinefromthetarget
volumeoutlinecanbedifferentintwoorthogonaldirections.In
Figure 130onpage 513,themarginisdefinedtobe0.5cmalongtheX1
fieldedge,1.5cmalongtheX2fieldedge,1.0alongtheY1fieldedge,
and2.0alongtheY2fieldedge.

A.FieldedgesB.EllipticalmarginbetweentargetandMLCC.Target
Figure 130 Elliptical Margin
Manual Margin
Inamanualmargin,thedistanceoftheMLCleavesfromthetargetis
definedwiththemouse.Figure 131onpage 513showsafreely
varyingmanualmargindefinedinafield.
A.FieldedgesB.TargetC.FreelyvaryingmarginbetweentheMLCleavesandthetarget
Figure 131 Manual Margin
MLC Coordinate Axis Types

Foranellipticalmargin,youalsoneedtoselectaxestouseforcreating
themargin.Theaxesareorthogonalcoordinateaxes,andthey
determinehowthemarginwidthvariesalongtheaxes.Theaxisis

definedintheFitMLCtoStructuredialogbox.Theaxescanbe
determinedeitherbytheBEVcoordinatesorthecollimator
coordinates.
BEV Coordinate Axis
WhentheBEVcoordinateaxisoptionisused,thetwocoordinateaxes
areparalleltothesidesoftheBEVwindow.Foranexampleofan
ellipticalmarginusingtheBEVcoordinateaxis,seeFigure 132on
page 514.Inthisexample,theellipticalmarginis0.5cmalongtheX1
fieldedge,1.5cmalongtheX2fieldedge,1.0cmalongtheY1field
edgeand2.0cmalongtheY2fieldedge.
Figure 132 BEV Coordinate Axis
Collimator Coordinate Axis
Whenthecollimatorcoordinateaxisoptionisused,theaxesare
paralleltothecollimatorjaws.InFigure 133onpage 515,theelliptical
marginisexactlythesameasinFigure 132onpage 514,butthe
coordinateaxisisdifferent.

Figure 133 Collimator Coordinate Axis
MLC Leaf Fit

MLCleavesarearrangedaroundthetargetstructureautomaticallyby
usingthefittingtoolswithoneoftheleaffitmethods,ormanuallyby
changingthepositionsofindividualMLCleaves.TheLeafEdge
ContourMeetPointoptiondetermineswhethertheMLCleavesare
allowedtocrosstheMLCoutlineornot.
Note: AlwayscarefullyverifytheMLCparameterswheneverreapplyingthe
MLCleaffitforacopiedMLC(forinstance,inanopposingfield).
TheLeafEdgeContourMeetPointoptionisdefinedintheFitMLCto
Structuredialogbox.Table 17onpage 515brieflydescribesthe
differentleaffitmethods.
Table 17 Leaf EdgeContour Meet Point Options
Leaf EdgeContour Meet

Description
Point Option
Inside MLCleafedgesareinsideorontheMLCoutline.
ThefinalMLCapertureisslightlysmallerthan
thedefinedMLCoutline.
Outside MLCleafedgesareoutsideorontheMLC
outline.ThefinalMLCapertureisslightlylarger
thanthedefinedMLCoutline.

Table 17 Leaf EdgeContour Meet Point Options
Leaf EdgeContour Meet

Description
Point Option
Middle TheMLCoutlineintersectsthemiddleofthe
MLCleaves.ThefinalMLCapertureis
approximatelythesamesizeasthedefinedMLC
outline.
ThedefaultLeafEdgeContourMeetPointoptionisdefinedinthe
configurationofyoursystem.
Figure 134onpage 516showsanMLCusingthesamesettingsfor
otherparameters,butadifferentLeafEdgeContourMeetPoint
option.
A.InsideB.OutsideC.Middle
Figure 134 Leaf EdgeContour Meet Point Options
MLCleavescanalsobemovedandpositionedalongtheMLCoutline
manually,eitherbymovingtheleaveswiththemouseorbydefining
thecoordinatepositionofeachleafintheMLCPropertiesdialogbox
(forinstructions,seeToMoveMLCLeavesManuallywiththe
Mouseonpage 527).

MLC Leaf Bank
MLCleafbanksarethetwoMLCleafstorageareasonbothsidesofthe
collimator.Theleavesarepushedtowardsthetargetstructurefrom
theleafbankorpulledtowardstheleafbank.Thedefaultnamesfor
MLCleafbanksarebankAandbankB.Theconfigurationofyour
systemcanalsocontainotherleafbanknames.
MLC Leaf and Leaf Bank Maximum Span
ThemovementsofboththeMLCbanksandindividualMLCleaves
arerestrictedbytheirmaximumspanstheMLCbankorMLCleaves
cannotbemovedoverthemaximumspanlimit.Themaximum
distancepastthecentralaxisoftheMLCopeningiscalledtheleaf
overtraveldistance.
Insomesituationsthemaximumspanscanbeaccidentallyexceeded.
IfyoufirstlockanMLCleaforbankandthenusetheFittoStructure
command,thelockedleaforbankmayendupunderthefittedones,
andthemaximumspanisexceeded.Inthesesituations,awarningis
issued.
Closed Leaf Meeting Position
InareasclosingtheMLCaperture,twoMLCleavesfromfacingleaf
banksmeeteachother.Toavoidanydamagecausedbytheradiation
leakagethatalwaysoccursintheseareas,usetheClosedLeafMeeting
PositionoptionstopositiontheMLCleakageareaoutsidethepatients
bodyoutline,forexample.
TheClosedLeafMeetingPositionmethodisselectedintheFitMLCto
Structuredialogbox.TheClosedLeafMeetingPositionoptiondefines
wheretwofacingMLCleavesshouldmeet.Forexample,themeeting
positioncanbedefinedtobeatthemaximumovertraveldistanceof
bankAorB.Figure 135onpage 518illustratesasituationwherethe
closedMLCleavesfrombankBarepushedforwarduptotheir
overtraveldistance.

F
A.MLCleafbankAB.LeakageareaC.MLCleafbankBD.OvertraveldistanceofbankBE.
LeavesmovedtothesideF.Targetstructure
Figure 135 MLC Leaf Banks
Table 18onpage 518describestheavailableClosedLeafMeeting

Positionmethods.
Table 18 Closed Leaf Meeting Positions
Closed Leaf Meeting Description

Position
BankB MLCleavesmeetattheovertraveldistanceforthe
leavesofbankA
Center MLCleavesmeetattheaperturecenter
BankA MLCleavesmeetattheovertraveldistanceforthe
leavesofbankB
Thedefaultmethoddependsontheconfigurationofyoursystem.
Figure 136onpage 519comparestheClosedLeafMeetingPosition
optionswitheachother.

A.BankAB.CenterC.BankB
Figure 136 Closed Leaf Meeting Positions
Adding MLCs
MLCsareaddedwiththeInsert>NewMLCcommand.
Note: IfyouchangethetreatmentunitafteraddinganMLCtoafield,theMLC
typeisconvertedtoonethathasbeenconfiguredforthenewunit.Youare
promptedtoconfirmtheconversion.Verifytheleafpositions.
To Add MLCs to Static Fields

1. IntheFocuswindow,selectthefieldtoaddanMLCto.
2. ChooseInsert >NewMLC.
TheModelviewchangestotheBEV.IfyouhaveseveralMLC
systems,adialogboxforselectingtheMLCtypeopens.
3. Ifnecessary,selecttheMLCtypetouseandclickOK.
TheMLCiconappearsintheFocuswindowandtheleavesare
shownintheBEV.
ContinuebydelineatingtheMLCoutlinebyarrangingtheleaves
automatically,manually,orwithadigitizer.Formoreinformation,see
MovingMLCLeavesonpage 521.

To Add MLCs to Arc Fields
1. Createanarcfield.Forinstructions,seeToAddanArcFieldon
page 390.
3. ChooseInsert >NewMLC.
IfyouhaveseveralMLCsystemsconfigured,adialogboxfor
selectingtheMLCtypeopens.
4. Ifnecessary,selecttheMLCtypeandclickOK.
TheMLCPropertiesdialogboxopens.
5. OntheGeneraltab,typeanIDfortheMLC.
6. DependingonthedesiredMLCtype,intheTechniquedropdown
list,selectStaticorArc Dynamic.
7. ArcDynamicMLC:TodefinethenumberofDMLCsegments,do
oneofthefollowing:
Typeinthedesirednumberofcontrolpoints(segments)
Typeintheanglesbetweenthesegments
8. ClickOK.
TheMLCiconappearsintheFocuswindowandtheleavesare
showninBEV.
ContinuebydelineatingtheMLCoutlinebyarrangingtheleaves
automatically,manually,orwithadigitizer.Formoreinformation,see
MovingMLCLeavesonpage 521.
To View the Motions of a Dynamic MLC

1. IntheFocuswindow,selectthearcfieldcontainingthedynamic
MLC.
2. ShowthefieldinBEV.
IftheMLChasseveralsegments,theanimationtoolbaris
activated.

3. Click .
TheBEVmovesfromthestartangletothestopangle,
consecutivelyshowingthefieldforeachsegment.Thecurrent
gantryangleandsegmentnumberareshowninthetitlebar.
Tostoptheanimation,click .
Toshowtheprevioussegment,click .
Toshowthenextsegment,click .
Toshowthefirstsegment,click .
Toshowthelastsegment,click .
Note: ToeditthesegmentcurrentlydisplayedinBEV,usetheMLCediting
tools;forinstructions,seeMovingMLCLeavesonpage 521.
Moving MLC Leaves

AfteraddinganMLCtoafield,positiontheMLCleavestolimitthe
dosagetothedesiredareasonly.YoucanusetheFittoStructuretool
ordrawtheMLCoutlinewiththeMLCShapertoarrangetheleaves
aroundtheTarget,orusetheFitandShieldtooltoexposetheTarget
whileprotectingcriticalorgans.Iftheresultisnotsatisfactory,youcan
moveindividualMLCleavesintheBEV,andcheckanddefinetheleaf
coordinatesintheMLCPropertiesdialogbox.

WhenmovingMLCleaves,youcandisplaythepreviouslycalculated
dosedistributionandusetheisodoselinesasguidesinmaking
modifications.Formoreinformationondisplayingthepersistentdose,
seeChapter 24,SectionShowingthePersistentDoseonpage 631.
Note: WhenworkingwithMLCfields,payattentiontothefollowing:
AlwayscarefullyverifytheMLCparametersbeforefittingtheMLC,
especiallyforopposedfields.
Ifyouchangethenumberoffieldsegmentsinaconformalarcphoton
field,changethestartorstopanglesofthefield,orrotatethefieldafter
arrangingtheMLCleaves,allleavesareclosed.RefittheMLCleavesto
rearrangethem.
TheFittoStructuretoolmaynotrecognizeverysmallstructures.This
mayaffecttheresultoftheleaffitincaseswherethetargetstructure
consistsoftwopartsofwhichoneisverysmall.
ForDynamicMLCs,theleafpositionscannotbeeditedintheMLC
Propertiesdialogbox.Theleafpositionscan,however,bechanged
graphicallyintheBEV.
About the Fit and Shield Tool

TheFitandShieldtoolallowspositioningMLCleavesaroundthe
targetstructuresothattheapertureformedbytheMLCleavesexposes
thetarget,but,atthesametime,theleavescovercriticalorgans.You
canletthetoolcreatethenecessarynumberoffieldsanddeterminethe
MLCleafpositionsautomatically.Thenumberoffieldscreated
dependsonthenumberofcriticalorgans.Youcanalsomanually
determinethenumberoffieldstobecreated.
WhenusingtheFitandShieldtoolforstaticMLCfields,theproposed
segmentsmaynotbesatisfactory.TheFitandShieldtoolisprimarily
intendedforarctreatments(seeFitandShieldToolinConformalArc
Fieldsonpage 523).
TheFitandShieldtoolletsyouselectthetargetstructureandthe
criticalorgans,anddefinethemarginstobeusedforeachofthe
selectedstructures.Marginsdefinedforcriticalorgansalwaystake
precedenceoverthosedefinedforthetarget.Thefieldsizeis
automaticallypositionedtoconformtothetargetstructure.

TovisuallyevaluatetheMLCsetup,youcansettheBEVtoshowall
MLCshapesthatsharesameisocenter,gantryandcouchangleand
SAD.
Fit and Shield Tool in Conformal Arc Fields
TheFitandShieldtoolcanbeusedinconformalarcfieldsformodified
hollowoutplanning.Thehollowouttechniqueisaconformalarc
treatmenttechniqueinwhichcriticalorgansareshieldedwhilethe
targetisexposed.Hollowouttreatmentsnormallycomprisemultiple
conformalarcfields.TheFitandShieldtoolcanautomaticallycreate
thenecessarynumberofconformalarcfieldsanddeterminethe
correctMLCleafpositions.
Thefollowingpropertiesoftheoriginalconformalarcfieldareused
bytheFitandShieldtoolwhencreatingthenewfields:
Gantry,collimatorandcouchangles
Isocenterposition
Treatmentunitandenergy
TheMLCsegmentsintheoriginalfieldarechangedtosegmentswith
2degreeintervals.Thefieldsizeisautomaticallypositionedto
conformtothetargetstructure.
Note: TheFitandShieldtoolcannotbeusedinconformalarcfieldswithElekta
andSiemensMLCdevices.
To Move MLC Leaves with the Fit to Structure Tool

1. IftheMLCtoolsarenotvisibleinthetoolbar,intheFocuswindow,
rightclicktheMLCandchooseEdit.
The3DviewchangestotheBEVandtheMLCtoolsareactivated.
2. Selecttheleavestoarrange:
Toarrangeallleaves,clickSelectAllLeaves .
Toarrangeseveral,butnotallMLCleaves,clickSelect ,
pressCTRLandclickeachleaf.
ToarrangeanMLCleafrange,clickSelect,pressSHIFTand
clickthefirstandlastleafintherange.

3. IntheFocuswindow,rightclicktheMLCandchooseFitto
Structure .
TheFitMLCtoStructuredialogboxopens.
4. Ifnecessary,intheMLCTargetStructuredropdownlist,selectthe
structuretowhichtheMLCleavesshouldconform.
Ifatargetvolumeoftheplanisdefined,itisselectedbydefault.Ifthere
areseveraltargetvolumes,thefirstinthelistisselected.
YoucanalsofittheMLCtoaselectedisodoselevelthathasbeen
convertedtoastructure.Forinstructions,seeConvertinganIsodose
LeveltoaStructureonpage 638.
5. ClicktheCircularortheEllipticaloptionbuttontodefinethe
margintype.
Circularmargin:Typethemarginwidthinthetextbox.
Ellipticalmargin:TypethemarginwidthsintheLeft,Right,Up
andDowntextboxes.
7. ClicktheBEVortheCollimatoroptionbuttontodefinethe
coordinatesystem.
8. Selectthefollowingasnecessary:
Theleafedgecontourmeetpoint
Theclosedleafmeetingposition
ThecollimatorjawsoptimizationTheapplicationadjuststhe
collimatorjawstobestfittheMLCleavestothestructure.
TheuseoftherecommendedjawpositionsTheapplication
adjuststhecollimatorjawpositionsalongtheMLCaperture
withanadditionalmargin,configuredinthedatabase.
ThecollimatorrotationoptimizationTheapplicationadjusts
thecollimatorangletobestfittheMLCleavestothestructure.
Thecollimatorrotationoptimizationisnotavailableforconformalarc
fields.
9. ClickApplytoarrangetheMLCleaves.
10. Tokeepthechanges,clickOK.

To Fit MLC Outlines to Shield Critical Structures
InsertthefieldsnecessaryasinAddingStaticFieldstoPlans
onpage 383.
InsertanewarcfieldasinAddingArcFieldstoPlanson
page 389.
2. IntheFocuswindow,rightclickeachMLCandchooseFitand
Shield.
TheFitandShieldwizardopens.
3. Inthelistboxes,selectthetargetstructure(s)tobeexposedandthe
criticalstructurestobeshielded.
4. ClickNext.
5. Todefinethedirectionsoftheprotectionmargins,selectthe
MarginsinBEVdirectionsortheMarginsincollimator
directionsoption.
6. Tocreatethesamemarginwidthforallthestructurestobe
radiatedorshielded,selecttheUsethesamemarginsforall
radiatedstructuresortheUsethesamemarginsforallshielded
structurescheckbox.
7. Definewhethertheprotectionmarginswillbesymmetricalor
asymmetrical.
Todefineasymmetricalmarginaroundthestructures,select
theSymmetricmargincheckbox.
Tousedifferentmarginwidthsindifferentdirectionsaround
thestructures,cleartheSymmetricmargincheckbox.
8. Definethewidth(s)ofthemarginsintheappropriatecells.
9. ClickNext.
10. Definethenumberoffieldstobecreated.
Todefinethenumberoffieldstobecreatedbyyourself,select
theDefinetherequirednumberoffieldsoptionandtypethe
numberinthetextbox.
ToletEclipsedeterminethenumberoffields,selectthe
Automaticallydeterminethenumberoffieldsoption.

11. ClickFinish.
StaticMLC:TheMLCleavesarearrangedtoexposethetargetand
shieldtheselectedcriticalorgans.
DynamicMLC:NewconformalarcfieldsarecreatedandtheMLC
leavesarrangedasrequired.Allfieldsaregroupedtogether.All
otherfieldparameters,excepttheMLCshapeandarcdirection,
arethesameasfortheoriginalfields.
To Show Multiple MLC Outlines in the BEV

1. ShowtheappropriatefieldintheBEVasinToShowtheBEVon
page 379.
2. RightclickintheBEVandchooseShowAllMLCAperturesin
BEV.
To Move MLC Leaves Manually with the Shaping Tool

TheMLCShapingtoolenablesyoutodefineavariablemargin
betweenthetargetstructureandtheMLCoutline.
1. IntheFocuswindow,rightclicktheMLCandchooseEdit.Ifyou
alreadyareintheBEV,startfromstep 2.
2. Selecttheleavestomove:
Tomoveallleavestogether,clickSelectAllLeaves .
TomoveseveralindividualMLCleaves,clickSelect ,press
CTRLandclickeachleaf.
TomovearangeofMLCleaves,clickSelect,pressSHIFTand
clickthefirstandlastleafintherange.
3. IntheFocuswindow,rightclicktheMLCandchooseShaper .
TheMLCFitOptionsdialogboxopens.
4. Select
Leafedgecontourmeetpoint
Closedleafmeetingposition
Forinformation,seeMLCLeafFitonpage 515andMLCLeaf
Bankonpage 517.

5. IntheBEV,drawtheMLCoutlinearoundthetargetwiththe
mouseorclicktheoutlinepointbypoint.
UsetheCircleCursortool asanaidtomanuallydrawamarginofa
determinedwidth(formoreinformationontheCircleCursor,see
Chapter 8,SectionToUsetheCircleCursoronpage 206).
A.TheMLCoutlineappearsaroundthetargetasyoumovethemouse.(TheCircleCursortoolis
notusedintheexample.)
6. Whenfinished,rightclickandchooseOKtoclosetheMLCFit
Optionsdialogbox.
To Move MLC Leaves Manually with the Mouse

BotharangeofselectedMLCleavesandallMLCleavescanbemoved
withthemouse.
1. IntheFocuswindow,rightclicktheMLCandchooseEdit.
WhenarrangingDynamicMLCleaves,selectfirstthesegmentwithnext
andpreviousbuttonsavailableintheanimationtoolbar.
2. OntheMLCtoolbar,clickSelect .
3. SelecttheMLCleaforleavestomove:
ToselectseveralindividualMLCleaves,pressCTRLandclick
eachleaf.
ToselectarangeofMLCleaves,pressSHIFTandclickthefirst
andlastleafintherange.
4. Tomovetheselectedleaforleaves,
Pointatthemandmovethemwiththemouse
UsetheMLCShapingtool.FollowinstructionsinToMove
MLCLeavesManuallywiththeShapingToolonpage 526.

5. FinetunetheleafpositioncoordinatesintheMLCProperties
dialogboxifnecessary.Forinstructions,seeToMoveStaticMLC
LeavesManuallywiththeLeafCoordinatesonpage 528.
To Move All MLC Leaves Manually

1. IntheFocuswindow,selecttheMLC.
2. OntheMLCtoolbar,clickSelectAllLeaves .
3. PointattheMLCleavesandmovethemwiththemouse.
4. ToinactivatetheMLCleaves,gototheMLCtoolbarandclick
DeselectAllLeaves .
To Move Static MLC Leaves Manually with

the Leaf Coordinates
TheMLCPropertiesdialogboxopens.
3. SelecttheLeafPositionstab.
4. IntheBankAorBankBbox,selecttheMLCleaftoedit.
ToselectseveralMLCleaves,pressCTRLandclickeachleaf.
ToselectanMLCleafrange,pressSHIFTandclickthefirstand
lastleafintherange.
5. IntheNewLeafPositiontextbox,typethenewvaluefortheMLC
position.
6. ClickApplytodisplaythechangesintheBEV.
7. ToeditanumberofMLCleaves,repeatsteps3to6.
8. Whenyouhavefinished,clickOKtokeepthenewsettings.

To Digitize the MLC Outline
1. InsertanMLCtoafieldasusual.Forinstructions,seeAdding
MLCsonpage 519.
2. IntheFocuswindow,selecttheMLCtowhichtoimportan
outline.
3. ShowthefieldinBEV.
4. Ifnotselected,choosePlanning >EnableDigitizer.
Appendix C.
6. Onthetoolbar,clicktheDigitizeMLCtool .
7. TodefinetheMLCoutline,clickthecornerpointsonthefilmwith
thedigitizermouse.Thepointsareconnectedwithstraightlines.
Todeletetheenteredpointsonebyone,pressBACKSPACEon
thekeyboard,orpresstheseconddigitizermousebutton.
8. Toclosetheoutline
9. IntheMLCLeafFittingOptionsdialogbox,definehowtheMLC
leavesarefittedtotheoutline.
Selectaclosedleafmeetingpoint
Selectaleafedgecontourmeetpoint
ThenewfitisshowninBEV.
10. WhentheMLCcontourisready,clickStopDigitizing.
Thedialogboxesclose.
To Lock the MLC Leaves

PreventaccidentalchangestoMLCleafpositionsbylockingthem.
2. OntheMLCtoolbar,clickLock/Unlock tolocktheMLCleaves.

Converting MLCs into Blocks
Sometimesitmaybenecessarytotransferaplantoatreatmentunit
thatdoesnothaveanMLCdeviceinstalledandconfigured.Inthese
cases,youcanreplacetheMLCsintheplanwithblocksbyusingthe
MLCapertureoutlinefordefininganapertureblock.
To Convert an MLC into an Aperture Block

1. IntheFocuswindow,rightclicktheMLCtobeconvertedintoa
blockandchooseCopytoBlock.
TheCopyMLCtoBlockdialogboxopens.
2. Selectwhetheryouwishtooptimizethecollimatorjawsorthe
collimatorrotation.
OptimizecollimatorrotationEclipserotatesthecollimator
jawsaroundtheselectedstructuretobeabletodecreasethe
fieldsize.
OptimizecollimatorjawsEclipsemovesthecollimatorjaws
asclosetotheselectedstructureaspossibletodecreasethe
fieldsize.
Foradetaileddescriptionoftheoptions,seeChapter 16,Multileaf
Collimators,onpage 509.
3. Tochecktheblockoutline,clickApply.
TheBlockPropertiesdialogboxopens.
4. DefinetheblockpropertiesasinAddingBlockstoFieldson
page 580andclickOK.
TheMLCisconvertedintoablock.
5. VisuallyverifythecreatedapertureblockagainsttheoriginalMLC
apertureintheBEV.

Ifyouarehappywiththeresult,clickOK.
Ifyouwishtochangetheblocksettings,repeatsteps2and3
andclickApply.Youcanrepeatthisasmanytimesasis
necessary.Tofinish,clickOK.
Ifnecessary,youcanedittheblock.Forinstructions,seeChapter 21,
Blocks,onpage 575.
Verifying MLC Leaf Positions

TheMLCleafpositionsofbothstaticandDynamicMLCscanbe
verifiedagainstthephysicallimitationsoftheMLCdeviceafter
manuallymodifyingtheleafpositions.Theverificationisalso
automaticallydonewhenthedoseiscalculatedforaplancontaining
MLCsandwhenaplanisapproved.Eclipseautomaticallycorrectsthe
leafpositionsbyfindingpositionsascloseaspossibletotheinitial
positionwithoutviolatingtheMLCdevicelimitations.
Thefollowinglimitationsareverified:
MLCleafmaximumextendandretractpositions
Maximumleafspan
Minimumleafgap(minimumgaptobemaintainedatalltimes
betweenmovingoppositeDMLCleavesduringthetreatment)
Leafspeed
Interdigitationleafgap(minimumgapfortwodiagonallyadjacent
leaves;verifiedforSiemensandElektaMLCdevices)
ExistenceofcompletelyclosedleafpairsinsidetheMLCaperture
(notallowedinElektaMLCdevices)
ClosedleafpairpositionforElektaMLCdevices
Note: DMLCleafpositionsinconformalarcfieldsforElektatreatmentunits
cannotbeverified.

To Verify and Correct MLC Leaf Positions
1. IntheFocuswindow,selecttheMLC/DMLC.
2. ChoosePlanning >VerifyMLCLeafPositions.
TheVerifyandCorrectMLCdialogboxopens,showingallMLCs
intheplanthatviolatethetreatmentunitlimitations.
3. Toautomaticallycorrecttheleafpositions,clickOK.
About the Field-in-Field Technique

ThefieldinfieldtechniquereferstoamethodofIMRTplanning
wherethecalculateddoseismodifiedincertainareasofthedose
distributionbyaddingnewsegmentsintotheexistingfields.Theaim
isoftentosmoothouthotspotsinthedosedistribution.
InEclipse,thesegmentsareaddedintoexistingfieldsassubfields.You
canusetheisodosevisualizationtoaddthefieldinfieldsubfields.
TheshapeofthesubfieldsisdeterminedwithanMLC.Youcanshow
theprimaryfieldandtheisodosesintheBEVandthenmanuallydraw
theMLCoutlineofthesubfieldbytracingthedesiredisodose,or
convertaselectedisodosesurfacetoastructureandthenfittheMLC
tothatstructure.Theweightsofallsubfieldsandprimaryfieldscanbe
definedasnecessarytocorrectlymodulatetheintensityofthe
radiationineachfield.Afterdefiningthenecessarynumberof
subfields,theyaremergedintooneconformalsegmentalMLCfield.
Note: Fieldintensitymodulationwithsubfieldsisavailableonlyforplans
consistingofphotonfieldscontainingstaticMLCs.Theplancancontain
bolus.However,blocksorwedgesarenotallowed.

Merging Subfields into Segmental MLC Fields
Eachsubfieldinaprimaryfieldistransformedintoastaticsegment
andsavedinanewIMRTplan.Thesubfieldsaremergedinto
segmentalMLCfields(usingtheMultipleStaticSegmentstechnique)
byfollowingcertainrules.Mergedsubfieldsaresubfieldsthathave
thesame
Geometry(gantry,collimatorandcouchrotation,jawpositions,
isocenter)
Treatmentunit(energy,doserate,treatmenttechnique)
MLCdevice
Subfieldsthatcannotbemergedarecopiedintonewfields.Asmany
subfieldsofaprimaryfieldaretreatedusingthesamecarriagegroup
aspossible.Subfieldsthatcannotusethesamecarriagegroupare
furthergrouped,ifpossible,andsavedintonewIMRTfieldsusinga
differentcarriagegroup.
Fieldsandsetupfieldsareincludedinthenewplan.DRRimages
attachedtothefieldsarenotcopiedtothenewplan.
Note: DifferentcollimatorjawpositionsareallowedforElektaMLCdevices.
Thenormalizationmodeofthenewplanisautomaticallychangedto
thePlanNormalizationValueoptionwiththesamenormalization
percentageastheoriginalplan.Forinformationonnormalization,see
PlanNormalizationonpage 643.
Afterthefieldshavebeenmerged,theLeafMotionCalculator(LMC)
isstartedautomaticallytocalculatetheactualfluencesusingthe
physicalMLCleafpositions.Theleafmotioncalculationsupportsthe
useofVarian,ElektaandSiemensMLCdevices.Formoreinformation
ontheLMC,seeDynamicMLCsonpage 537andEclipseAlgorithms
ReferenceGuide.
To Create Subfields (Field in Field)

1. CreatetheprimaryfieldandaddastaticMLCtoit.For
instructions,seeAddingStaticFieldstoPlansonpage 383and
AddingMLCsonpage 519.
3. IntheFocuswindow,selectthestaticMLC.

4. ChooseInsert >NewFieldinField.
AduplicateoftheprimaryfieldappearsintheFocuswindow.The
newsubfieldhaszerofieldweightandinvalidMUvalue.Both
fields,theMLCapertureandthedosedistributionareshownin
theBEV.TheMLCshapingtoolisactivated.TheMLCFitOptions
dialogboxandtheFieldWeightsdialogboxopen.
TheIDofnewsubfieldsisformedfromtheIDoftheprimaryfields
byaddinganincrementaldigittoit,forexample,subfieldsfor
primaryfieldField1willbenamedField1.0,Field1.2,Field1.3
andsoforth.
5. DrawtheMLCapertureintheBEV.
A.DrawtheMLCaperturewiththemouse.Youcantraceanisodosesurfaceifnecessary.
6. IntheMLCFitOptions,definehowtheMLCleavesshouldbe
arrangedaroundthedefinedMLCapertureandclickOK.For
moreinformationaboutthefittingoptions,seeMLCLeafFiton
page 515andMLCLeafBankonpage 517.
TheMLCleavesarefittedtotheMLCaperture.
7. IntheFieldWeightsdialogbox,settheweightsasinUsingField
WeightFactorsonpage 622andclickClose.
8. Recalculatethedoseifnecessary.
9. Repeatsteps36ifnecessary.
To Merge Subfields into a New Plan

1. Createallthenecessaryprimaryfieldsandsubfields,calculatethe
dosedistributionanddefinefieldweightsasinToCreate
Subfields(FieldinField)onpage 533.
2. IntheFocuswindow,selecttheplanthatcontainstheprimary
fieldsandthesubfields.

3. ChoosePlanning >MergeSubfields.
Amessageboxopens,showingthenewplanandfieldsthatwillbe
createdfromtheoriginalplan,primaryfieldsandsubfields.
4. ClickOK.
Thenewplaniscreatedandsavedintotheactivecourse.It
containsthemergedfieldsandcopiesoforiginalfieldsthatcould
notbemerged.TheLeafMotionCalculator(LMC)isstarted
automatically.TheleafmotioncalculationmethodisMultiple
StaticSegments.Asaresultofthemerge,themergedfieldswill
containaDMLCthatconsistsofstaticsegmentsoftheMLCsinthe
originalfields.
5. Thedosecalculationisstartedautomatically.
Evaluatetheplan,approveitandmoveittotreatment.

Chapter 17 Dynamic MLCs
Planning Workspace
ThischapterdescribestheuseofDynamicMultiLeafCollimators
(DMLCs)intreatmentplanning.Thechapterprovidesanoverviewof
howfieldfluencesproducedbyEclipseIMRTareconvertedinto
DMLCleafmotionsbytheLeafMotionCalculator(LMC)program,
andhowtheDMLCleafmotionpatternsproduceintensity
modulationinpatienttreatment.Inthischapteryouwilllearnhowto
converttheoptimizedfluencesproducedbyEclipseIMRTintoDMLC
sequences,andverifytheDMLCsequencesintheEclipseBeamsEye
Viewbeforepatienttreatment.
About Dynamic MLCs

DynamicMultileafCollimators(DMLC)arethinleaf(vane)collimator
systemsusedtoshapefieldsandproducefieldintensitymodulationin
modernconformalradiationtherapy.
DMLCsareusedtomodulatethebeamintensitywhenusing
electroniccompensatorsorIMRTplans.
Note: WhenusingDMLCs,notethat:
TheVarianDMLCsystemsupportsphotonfieldsonly.
DMLCscanalsobeusedtoimprovetheergonomicsandefficacyof
conventionalintensitymodulation(wedgeorcompensator)byreplacing
physicalcompensatingfilters.
TheLeafMotionCalculator(LMC)convertstheoptimalfluencesinto
actualfluences,andcreatestheDMLCmotionpatternsfortheactual
fluence,producingtwokindsofDMLCdataintheconversion:
DMLCmotionsTheLMCaccountsforcertainphysicaland
mechanicalcharacteristicsoftheDMLCdevice,suchasleaf
transmissionvalue,leafedgeshapeandmotionlimitations,which
arenotconsideredwhenproducingintheoptimalfluences.The
531
LMCprogramtakestheselimitationsintoaccount,andcreates
DMLCmotionsthatreproducetheoptimalfluenceascloselyas
possible.
DuetothecharacteristicsofVariansDMLCdevicecontroller,LMC
divideslargefieldsintomultipleMLCcarriagegroups.Depending
onthecapacityofthetreatmentunit(s),thecarriagegroupsina
fieldcanbeeithersavedtoonefieldordividedeachintoaseparate
field.Formoreinformationonmovingplanstotreatmentand
dealingwithcarriagegroups,seeChapter 25,EvaluatingPlans,
onpage 649.
ActualfluencesTheLMCprogramalsoproducesactualfield
fluencesthataccuratelyrepresentthefluencethatwillbedelivered
withtheDMLCmotions.SincetheLMCprogramtakesinto
accountanumberofphysicalandmechanicalparametersofthe
DMLCdevice,theactualfluencesmaydifferfromtheoptimal
fluencescreatedbyEclipseIMRT.Theactualfluencesareusedin
thedosecalculationtoensurethatthecalculatedandthedelivered
dosecorrespondtoeachotherascloselyaspossible.
Note: Actualfluencesareremovedfromfieldscreatedforeachcarriagegroup
inalargeDMLCfield.Thisisindicatedwiththe iconintheFocuswindow
undereachcarriagegroupfield.
EclipseIMRTwillautomaticallyresizetheXandYjawstoframethe
completedirradiatedareaoutline(CIAO)unlessyouchoosetouse
fixedjaws,inwhichcasetheXandYjawsarenotchangedbythe
LMC.
ThecalculatedDMLCleafmotionscanbeexportedtothetreatment
unit.Forinformation,seeExportingandImportingMLC/DMLC
Plansonpage 780.
How a DMLC Produces Intensity Modulation in the Treatment

ThefieldfluencesareproducedbyvaryingthepositionsoftheDMLC
leavesduringtreatment.Asaresult,differentportionsofthefieldare
exposedtoadifferentamountofradiation.Thetotaldosedistribution
istheintegralofthedosedistributionsinallofthesubfieldsor
segments.Twodifferentdeliverytechniquesaresupported:thesliding
windowtechniqueandthemultiplestaticsegments(stepandshoot)
technique.

ThedefaultLMCtechniquetobeusedisconfiguredintheTask
Configurationdialogbox.Formoreinformation,refertoEclipse
AlgorithmsReferenceGuide.
Sliding Window Technique
Intheslidingwindowtechnique,theDMLCleavesmoveinthesame
directionacrossthebeamduringthebeamon.Thesizeandshapeof
theapertureformedbytheleaveschangedynamically.Asaresult,
differentportionsofthefieldareexposedtoadifferentamountof
radiation.Figure 137onpage 539illustratestheslidingwindow
techniqueofproducingthefieldintensities.
A.RadiationsourcefocusB.MovingDMLCleavesC.ChangingaperturebetweentheDMLC
leavesD.TheDMLCleavesmovefromrighttoleftinthisexample.E.Differentfieldfluences
producedbytheDMLC
Figure 137 Field Intensities Produced by DMLC with Sliding Window Technique
Dynamic MLCs 533

Inthisexample,theDMLCleavesmoveinthedirectionindicatedby
thetwoarrows.ThegrayscalegradientsinthefieldbelowtheMLC
leavescorrespondtotheamountofradiationreceived.Thewhiteareas
aremoreexposedthanthegreyareas.
TheslidingwindowtechniqueissupportedonlyforVarianMLC
devices.
Multiple Static Segments Technique
Inthemultiplestaticsegmentstechnique,oftenreferredtoasthe
stepandshoottechnique,theDMLCleavesdonotmoveduring
beamon.Thedeliveryofeachfieldisdividedintosegments.The
beamisturnedoffandtheleafpositionsarechangedbetweenthe
deliveryofeachsegment.
ThemultiplestaticsegmentstechniqueissupportedforbothVarian
andnonVarianMLCdevices.
Converting Field Fluences to DMLC Leaf Motions

Theconversionoftheoptimalfieldfluencesintoactualfieldfluences
andDMLCleafmotionsisautomaticallystartedwhenthe
optimizationiscompleted.Youcanalsodotheconversionseparately,
orlaterreconvertthefluences.Theresultofboththeautomaticand
userinitiatedconversionissavedtothedatabase.DMLCleafmotion
patternscanbeviewedintheBEV.

Theconversionofoptimalfieldfluencestoactualfieldfluencesis
supportedforbothVarianandnonVarianMLCdeviceswhenusing
themultiplestaticsegmentstechnique.
Note: WhenconvertingfieldfluencestoDMLCleafmotionsandactual
fluences:
VerifytheplanwithDVHanalysisbeforetransferringittothetreatment
unit.
Verifythemaximumdoseinsidetheirradiatedvolumeafterthe
volumetriccalculation.Thisisespeciallyimportantforplanscontaining
DMLCs.
Evaluatethedistributionofisodoses.
PerformQAphantomtestingtomakesurethattheplaniscorrectly
transferredtothetreatmentmachine.
VisuallyverifytheshapeoftheinitialDMLCbeforeactualtreatment.
Note: ItisadvisabletoruntheLeafMotionCalculator(LMC)afterchangesin
thedoseprescriptionorplannormalizationofIMRTplans.
ThedefaultLMCtechniquetobeusedisconfiguredintheTask
Configurationdialogbox.Formoreinformation,seeReferenceGuidefor
EclipseAlgorithms.

for Varian DMLC (Interdigitation Allowed)
Ifyouaredoingtheconversionautomatically,theLMC
calculationtoconverttheoptimalfieldfluencestoactualfield
fluencesandDMLCleafmotionsisstartedupaftercalculating
theoptimalfieldfluencesintheOptimizationdialogbox.
IfyouaredoingtheconversionfromfluencestoDMLCleaf
motionsseparately,choosePlanning >CalculateLeaf
Motions.
TheLeafMotionCalculationOptionsdialogboxopens.
Dynamic MLCs 535

2. IntheDeliveryMethodcolumn,clickthecolumnontherowof
eachfieldandselectthebeamdeliverymethodusedduringthe
exposure.
TodeliverthedosewithacontinuouslymovingDMLC
aperture,selectSlidingWindow
TodeliverthedosewithmultiplestaticDMLCsegments,select
MultipleStaticSegments
3. ClickOK.
TheLMCstartsconvertingthefieldfluenceintoDMLCleaf
motions.Ifthefieldisalargeone,theLMCsplitsitintoseveral
fieldsduetolimitationsoftheMLCdevice.
ContinuebyevaluatingtheDMLCmotions.Forinstructions,see
VerifyingtheLeafMotionsonpage 544.

for Non-Varian DMLC (Interdigitation Not Allowed)
Ifyouaredoingtheconversionautomatically,theLMC
calculationtoconverttheoptimalfieldfluencestoactualfield
fluencesandDMLCleafmotionsisstartedupaftercalculating
theoptimalfieldfluencesintheOptimizationdialogbox.
IfyouaredoingtheconversionfromfluencestoDMLCleaf
motionsseparately,choosePlanning >CalculateLeaf
Motions.
TheCalculationOptionsforMSSdialogboxopens.
2. IntheNumberofSegmentscolumn,definehowmanystaticfield
segmentsyouwishtohavecreatedforeachfieldifyoudonot
wanttousethedefaultvalue.
TheNumberofSegmentsvalueisanindicatoryvalueusedintheleaf
positioncalculation;theendresultmaynotnecessarilybeexactlyas
expected.
ThedefaultNumberofSegmentsvalueinaplanisdetermined
fromtheDefaultIntensityLevelsvaluedefinedintheTask
Configurationdialogbox(formoreinformation,seeReference
GuideforEclipseAlgorithms).TheMUfactorsofeachfieldinthe
planaremultipliedwiththeDefaultIntensityLevelsvalue,and

theseproductsarethenadded.TheLMCdistributesthesumfor
specificfieldsbyusinganoptimizationalgorithm.Theresultof
thisoptimizationisshownasthedefaultNumberofSegments
valueintheCalculationOptionsforMSSdialogbox.
3. ClickOK.
TheLMCstartsconvertingthefieldfluenceintoDMLCleaf
motions.Theprogressindicatorshowstheobjectivefunctioncurve
andnumericaldataofthecalculation.
4. Tointerrupttheleafmotioncalculation,clickFinish.
ContinuebyevaluatingtheDMLCmotions.Forinstructions,see
VerifyingtheLeafMotionsonpage 544.
Converting DMLC Leaf Motions to Actual Fluence

ForplansimportedfromanothersystemthatcontainDMLCfilesbut
noactualfluencefiles,youcanregenerateactualfluencesbasedonthe
DMLCfileandtheMUvaluesdefinedfortheplan.
To Convert DMLC to Actual Fluence

1. ImporttheplancontainingtheDMLCfiletobeconvertedintoan
actualfluence.
2. IntheFocuswindow,rightclicktheimportedplanandchoose
GenerateActualFluenceforDMLCFields.
TheCalculateDosewithFixedMUsdialogboxopens.Theoriginal
MUvaluesofthefieldsintheplanareshown(includedareonly
fieldswithDMLCandwithoutactualfluence).Awarningis
showniftheplannormalizationmodeneedstobechanged.
3. DefinethedesiredMUvaluesforeachfieldintheMUcolumn.
4. ToroundtheMUvalueinaccordancewiththeprecisionofthe
selectedtreatmentunit,clickRoundMUstomachineprecision.
5. ToreadthecurrentMUvalueoftheplan,clickGetcurrentMU
values.
Dynamic MLCs 537

6. IntheAbsoluteDosimetrygroupbox,definethedesireddose
values:
Numberoffractions
DoseperfractioninGyorcGy
Plannormalizationvalueinpercentage
7. Togeneratetheactualfluence,clickOK.
TheactualfluenceisgeneratedbasedontheexistingDMLCand
MUvalues.
Verifying the Leaf Motions

Note: IntheverificationofDMLCleafmotions,noticethefollowing:
VerifytheconsistencyoftheDMLCandfluenceusingphantomtestingto
makesurethattheDMLCwillproducetheactualfluencecalculatedby
theLMC.
To View the DMLC Leaf Motions in the BEV

1. ToshowthedesiredfieldintheBEV,rightclickintheBEV,choose
SetBeamsEyeViewtoandthenselectthefield.
TheselectedfieldisshownintheBEV.TheAnimateMLC
SegmentstoolbarappearsabovetheBEV.
2. ToactivatetheDMLCleaves,gototheFocuswindowandselect
theMLCofthefieldshownintheBEV.(TheMLCiconisshown
belowthefluence.Ifnecessary,expandthetreestructureby
clickingthe+signnexttothefluenceicon.)

3. ToanimatethemotionsoftheDMLCleavesinaccordancewiththe
calculatedfieldintensities,
ToshowtheentiresequenceofDMLCmotions,click .
TheBEVmovesfromthefirsttothelastsegment,
consecutivelyshowingtheDMLCapertureforeachsegment.
ThecurrentsegmentandcarriagegroupareshownintheBEV
titlebar.
A.Segment1B.Segment29C.Segment320
Toshowthepreviousorthenextsegment,click or
respectively.
Toshowthefirstorthelastsegment,click or
respectively
Ifthefieldwasalargefieldthatwassplitintoseveralparts,
navigatebackwardsorforwardsthroughthepartsbyclicking
or respectively.
4. Tostoptheanimation,click .
Dynamic MLCs 539

Chapter 18 Electron Field Accessories
ThischapterdescribestheuseofelectronfieldaccessoriesintheField
Setupworkspace.Electronapplicatorsareusedinelectrontreatment
tocollimatethetreatmentareaandtoreducescattering.Youcan
furtherspecifythetreatmentareamorepreciselybydefiningacutout
totheelectronfield.TheuseofbolusisalsosupportedinEclipse.
Instructionsareprovidedforaddingelectronapplicators,electron
cutoutsandbolustoelectronfields.
Electron Applicators
Inelectrontreatment,electronapplicatorsareusedtocollimatethe
treatmentareaandtoreducescattering.InEclipse,anelectron
applicatordefinesthefieldsizeinsteadofthecollimatorjaws.The
electronapplicatorsizeisconfiguredintheAdministrationtask.Inthe
imageviews,thepositionofthecollimatorjawsisnotshown;instead
theoutlineoftheelectronapplicatorapertureisshown.Theapplicator
IDisshownnexttothefieldoutlinedefinedbytheapplicatorinthe
BEV.
Eclipserequiresyoutoaddanelectronapplicatortoeachelectron
field.Theshapeofanelectronapplicatorcanberectangularorcircular.
Tofurtherspecifythetreatmentareamorepreciselyandtoprotect
sensitivetissue,youcandefineelectroncutoutsfortheelectronfield.
TheuseofbolusisalsosupportedinEclipse.
541
Figure 138 Electron Field
Note: Whenworkingwithelectronapplicators,noticethefollowing:
Thesourcetoapplicatorheaddistancemustbedefinedinthe
Administrationtask,otherwisethedosedistributioncalculationcannot
beperformed.
TheGeneralizedGaussianPencilBeamandtheElectronMonteCarlo
algorithmsusetheapplicatorsizefordosedistributioncalculation.The
applicatorsizeisconfiguredintheAdministrationtask.Iftheapplicator
sizehasnotbeenconfigured,thedosedistributioncannotbecalculated.
ThismaybethecasewithVisiondatabasesolderthan7.2.
Verifythattheelectronfieldsizefactorsarecorrectlyconfiguredforeach
electronapplicatorsizeintheBeamConfigurationtasktoensurecorrect
dosecalculation.
Changingtheenergymodeofafieldtoamodenotconfiguredforthe
electronapplicatorinthefieldremovestheapplicator.
To Change an Applicator in an Electron Field

1. IntheFocuswindow,selecttheelectronfield.
3. IntheFieldPropertiesdialogbox,selecttheAccessoriestab.

4. Intheappropriatedropdownlist,selecttheelectronapplicator.
(Thisisamandatorysettingwhenyoucreateelectronfields.)
ApplicatorsizesareconfiguredintheAdministrationtask.Ifthe
collimatorjawsizeissmallerthantheapplicatorsize,dose
calculationwillnotbepossible,andyouwillbepromptedtoverify
theenergyspecificcollimatorsizeconfigurationfortheapplicator
intheAdministrationtask.
5. Intheappropriatedropdownlistbox,selecttheslottowhichthe
electroncutout,ifany,shouldbeinserted.
6. ClickOK.
Cut-Outs in Electron Fields

Cutoutsareusedinelectronfieldstospecifythetreatmentareamore
preciselyandtoprotectsensitivetissue.Theshapeofanelectron
cutoutcanberectangularorcircular.Thecreatedcutoutshapeand
sizeareshownintheBEVandcanbeeditedafteraddingthecutoutto
thefield.
Cutoutsareaddedtoelectronfieldsinthesamewayasblocks.Toadd
acutouttoanelectronfield,youfirstdefinethecutout(block)object
andthendefinethecutoutaperture.Inthecontextofelectron
cutouts,theblockTrayIDparameter(intheBlockPropertiesdialog
box)definestheelectronapplicator,andtheSlotIDparameterdefines
theapplicatorslotintowhichthecutoutshouldbeinserted.
Forinstructionsonhowtoaddblockstofields,seeChapter 21,
Blocks,onpage 575.
Bolus in Electron Fields

Bolusareaddedtoelectronfieldsinthesamewayastophotonfields.
Forinstructionsonhowtoaddblockstofields,seeChapter 23,
Bolus,onpage 601.
Electron Field Accessories 543

Chapter 19 Compensators
Thischapterprovidesbackgroundinformationaboutstandardplane
compensatorsandinstructshowtousetheminfields.The
visualizationofcompensatorsintheimageviewsandtheparameters
usedforcalculatingacompensatoraredescribed,aswellasediting
compensatorsettingsandthecompensatormatrix.
About Compensators
Compensatorsarefieldmodifiersplacedbetweentheradiationsource
andthepatientsskintoachieveauniformdosedistributionona
specificplaneortoshapethedoseonaspecificplane.Standardplane
compensatorsallowdosecompensationonaplaneperpendicularto
thefieldaxisandatagivendistancefromtheisocenter.Youdefinethe
compensationplaneonwhichthedosedistributionshouldbe
uniform,thepenumbramarginandgrid,andtheshapeandthickness
ofthecompensatorpiecearethencalculatedautomaticallyaccording
toyourspecifications.Formoreinformationonthecompensator
parameters,seePhotonCompensatorParametersonpage 552.
Thephotoncompensatorcalculationproducesthetransmissionmatrix
(orthefieldintensitymatrix)ofthecompensator.Thetransmission
matrixisconvertedintothecompensatorthicknessmap,usingthe
linearattenuationfactor.
Thelinearattenuationfactorofacompensatordependsonthe
combinationofthecompensatormaterialandthephotonenergy.The
compensatormaterialsareconfiguredintheAdministrationTask;for
moreinformation,refertotheonlinehelp.Thelinearattenuation
factorofeachcompensatormaterialisdefinedintheBeam
Configurationtask;forinformation,seeReferenceGuideforBeam
Configuration.
Note: Thecompensatortransmissionfactorisnottakenintoaccountinthe
MUcalculation.ToincludethecompensatortransmissionfactorintheMUs,
calculatetheeffectmanuallyand/orusingmeasurements.Thecalculationof
545
thecompensatorcreatesthecompensatortransmissionmatrixthatisconverted
intoathicknessmatrix,usingthelinearattenuationfactorconfiguredforthe
compensatormaterial.
Photon Compensator Parameters
Compensation Plane
Whenaddingacompensatortoafield,youdefinethedistanceofthe
compensationplanefromtheisocenterwiththeCompensator
isocenterdistanceparameter.Thecompensationplanelocationis
perpendiculartothecentralaxisoftheselectedfield.The
compensationplaneisdisplayedintheimageviews.
A.CompensationplaneB.Isocenter
Figure 139 Compensation Plane
Compensator Penumbra Margin
Figure 140showshowthecompensatorcalculationareaisdefinedon
thebasisofthepenumbramarginvalue.

A.MarginbetweenthefieldedgeandthecompensationcalculationareaB.Compensation
calculationareaC.FieldedgeD.TargetE.BlockF.Marginbetweentheblockandthe
compensationcalculationareaG.Marginbetweentheskinandthecompensationcalculation
areaH.Skinsurface
Figure 140 Compensator Penumbra Margin
Compensator Grid
Thegridofacompensatordeterminestheintervalatwhichthe
compensatorthicknessisindicatedforthecompensatorcalculation.
A.Gridsize
Figure 141 Compensator Grid
Compensator Thickness
Themaximumandminimumcompensatorthicknessisdefinedinthe
Administrationtask.Ifthemaximumthicknessisexceeded,the
millingmachinecutsthecompensatorinaccordancewiththeselected
slot.
Compensators 547
Compensator Visualization
Compensator Icons
Whenyoucreateanewcompensator,acalculatedcompensator
icon appearsbelowthefieldintheFocuswindow.Ifyouchangethe
fieldgeometry,thecompensatorisnolongervalid,andtheiconturns
intoaninvalidcompensatoricon .
Compensator in the Image Views
Inall2Dviews,compensatorsinphotonfieldsarevisualizedasa
symboldrawnnexttothefieldentrypoint(Figure 142onpage 554).
Thecompensationplaneisalsovisualized.

A.Compensatorsymbol
Figure 142 Compensator in 2D Views
Inadditiontothesymbolandcompensationplane,theModelview
(Figure 143onpage 555)alsoshowsthecompensatorasa3Dmodel.
Thecompensationplaneandcompensatormodelareshownonly
whenthecompensatorisselectedintheFocuswindow;the
compensatorsymbolisalwaysshown.

A.CompensationplaneB.CompensatorsymbolC.Compensatorsurfacemodel
Figure 143 Compensator in Model View
IntheBEV,compensatorsforphotonfieldsarevisualizedasisolines
indicatingthecompensatorthicknesses.TheCompensatorThickness
legendindicatesthesignificanceofeachisolinecolor(Figure 144on
page 555).
A.CompensatorthicknesslegendB.Compensatorisolines
Figure 144 Compensator Visualization in Beams Eye View
Compensators 549
Ifthedoseisalsoshownintheimageviews,theBEVshowsthe
compensatorforphotonfieldsontopofthedosevisualization.The
Isodoseslegendindicatesthesignificanceofeachcolorinthedose
visualization(Figure 144onpage 555).
A.IsodoseslegendB.CompensatorthicknesslegendC.Compensatorisolines
Figure 145 Compensator and Dose Visualization in Beams Eye View
WhentheCompensatorEditorisactive,theisolevels(transmission)of
acompensatorcanbevisualizedingreyscaleorcolorwashwithor
withoutisolevellines(seeFigure 146onpage 557).

A.CompensatorfluenceingreyscaleB.Grayscalecompensatorfluencewithisolevellines.C.Compensator
fluenceincolorwashD.ColorwashcompensatorfluencewithisolevellinesE.Compensatortransmission
legendF.Isolevellinelegend
Figure 146 Compensator Isolevel Visualization (Greyscale, Color wash and Lines)
Ifafieldcontainingacompensatorishidden,thecompensatorisalso
hiddenintheimageviews.However,whenthecompensatorofa
hiddenfieldisselectedintheFocuswindow,thecompensatoris
displayedinallimageviews.Thiscanbeusefulforhidingdistracting
fieldgraphicswhenviewingcompensatorfluence.Formore
page 381.
Compensators 551
Adding Compensators
Note: Compensatorscannotbeaddedtoarcfieldsorelectronfields.
To Add a Plane Compensator to a Photon Field

1. Checkthatyouhavetheappropriatecalculationoptionsselected
forthecompensator.Forinformationondefiningcalculation
options,seeChapter 24,SectionCalculationOptionsforExternal
2. IntheFocuswindow,selectthephotonfieldintowhichtoadda
standardplanecompensator.
3. ChooseInsert >NewCompensator.
4. TheCompensatorPropertiesdialogboxopens.
5. DefineanIDforthenewcompensator.
6. IntheDosimetricMaterialgroupbox,selectthecompensator
material.
TheavailablecompensatormaterialsareconfiguredintheAdministration
Task.Formoreinformation,refertoonlinehelp.Thelinearattenuation
factorofeachcompensatormaterialisconfiguredintheBeam
Configurationtask.Forinformation,seeReferenceGuideforBeam
Configuration.
7. Definethecompensatorgeometry:
InthePenumbramarginbox,definethewidthofthemarginto
excludefromthecompensationcalculation.
IntheGridsizebox,definetheintervalatwhichtoindicatethe
compensatorthickness.
Notallcompensatoralgorithmssupportdifferentgridsizes.
Specifythedistancebetweentheisocenterandthe
compensationplane.
8. IntheTraygroupbox,selectthecompensatortray.
TheCustomCodeboxdisplaysacodebywhichthetreatmentunit
identifiesthecompensator,ifconfigured.

9. Ifnecessary,intheSlotIDdropdownlist,selectthetrayslotto
useforthecompensator.
10. ClickOKtostartthecalculation.
Note: Ifyouchangeafieldafteraddingacompensatortoit,theoriginal
compensatormatrixisinvalidated.ThisisindicatedbyaredXattachedtothe
compensatoricon .Torecalculatethecompensator,gototheFocuswindow,
rightclickthecompensatoriconandchooseRecalculate.
Editing Compensators
Normally,thethicknessandshapeofthecalculatedcompensatorare
acceptable.Ifnecessary,youcandominoralterationsontheshapeof
thecompensatorwiththeCompensatorEditortools.Mostlikely,some
alterationsareneededifthecalculatedphotoncompensatorcouldnot
beproducedinamillingmachine.
Tochangehowthecompensatormatrixisvisualized,editthe
compensatorisolevels.
Wheneditingacompensator,youcandisplaythepreviously
calculateddosedistributioninpersistentdosemodeandusethe
isodoselinesasguidesinmakingmodifications.Formoreinformation
ondisplayingthepersistentdose,seeChapter 24,SectionShowing
thePersistentDoseonpage 631.
Compensator Editor
TheCompensatorEditorshowsthecalculatedcompensatormatrixas
acolored2DsurfaceintheBEV,inwhichthematrixcanbemodified
pointbypoint.Thecompensatorsurfaceisdrawnontopofallother
structures.Thecolorrangeandopacitycanbeadjusted.Isothicknesses
andotherisocurvesaredisplayedontopofthetexture.
Note: TheCompensatorEditorallowseditingthecompensatormatrixinthe
BEVonly.
Compensators 553
A.ToolsforeditingthephotoncompensatormatrixB.Settingsforthephotoncompensator
matrixeditingtoolsC.Photoncompensatormatrixvisualizationsettings
Figure 147 Compensator Editor
To Edit the Compensator Matrix

1. IntheFocuswindow,selectthecompensatoryouwishtoedit.
2. ChoosePlanning >EditCompensator.
TheCompensatorEditordialogboxopens.
3. IntheMatrixdropdownlist,selecteitherTransmissionor
Thickness.
Onlythetransmissionmatrixiseditable.Formoreinformationabout
calculatingcompensatormatrices,refertoReferenceGuideforEclipse
Algorithms.
4. Defineabrushshapeandsize.Thebrushsizerangeis0.1500mm.
Fordescriptionsofthebrushparameters,seeCompensatorEditor
BrushParametersonpage 561.
5. Definethetransmissionfactorforthebrush.Therangeis01,0
beingequivalenttonocompensatormaterial.

6. SelecttheappropriateCompensatorEditortool.Fordescriptions,
seeCompensatorEditorToolsonpage 564.
IntheBEV,themousepointerappearsasthebrushoftheselected
shapeandsize.
measurementbutton .
Whenyouclickapointinthematrix,itsvalueisdisplayedinthe
Transmissionfactorbox.
9. DefinethevisualizationofthecompensatormatrixintheBEV.
Todisplaythematrixincolor,selecttheUseColorcheckbox
anddefineacolorrangeintheLowerandUpperboxes.
AreasbelowtheLowervaluearedisplayedinblue;areas
abovetheUppervaluearedisplayedinpurple.
checkbox.
TodisplayisothicknesslinesintheBEVwindow,selectthe
Isolevelscheckbox.
Theisothicknessesareshowninaccordancewiththe
transmissionfactorsinthecompensatormatrix.
Toviewisothicknesslinesonly,movetheOpacityslidertotheleft.
Compensator Editor Brush Parameters

TherearefourBrushheadshapesavailable:square,circular,conical
andgaussian.
Square Brush
ClickinginthefluencewiththesquareBrush drawsasquare,
draggingtheBrushdrawsalinewithasquareshapedend.The
figureshowstwoexamplesofthesquareBrush.
Compensators 555
A.OneclickwiththesquareBrushB.LinedrawnwiththesquareBrush
Figure 148 Square Brush
Circular Brush
ClickinginthefluencewiththecircularBrush drawsacircular
area,draggingtheBrushdrawsalinewithacircularend.The
figureshowstwoexamplesofthecircularBrush.
A.OneclickwiththecircularBrushB.LinedrawnwiththecircularBrush
Figure 149 Circular Brush
Conical Brush
ClickinginthefluencewiththeconicalBrush drawsacirculararea
withlinearcolorgradientsfromthecentertowardstheedgesofthe
Brushtip,draggingdrawsalinewithacircularendandlinearcolor

gradientsfromthecenterofthelinetowardstheedgesoftheline.The
figureshowstwoexamplesoftheconicalBrush.
A.OneclickwiththeconicalBrushB.LinedrawnwiththeconicalBrush
Figure 150 Conical Brush
Gaussian Brush
ClickinginthefluencewiththegaussianBrush drawsacircular
areawithgaussiancolorgradientsfromthecentertowardstheedges
oftheBrushtip,draggingdrawsalinewithacircularendand
gaussiancolorgradientsfromthecenterofthelinetowardstheedges
oftheline.Thedimensionsoftheclickedareaorlinedependonthe
Brushsize.ThefigureshowstwoexamplesofthegaussianBrush.
Compensators 557
A.OneclickwiththegaussianBrushB.LinedrawnwiththegaussianBrush
Figure 151 Gaussian Brush
Compensator Editor Tools
Set to Given Value tool
TheSettoGivenValuetool setsthematrixvalueinthepaintedarea
totheselectedbrushvalue.Thearrowshowsthestrokedirection.
Set to Zero tool
TheSettoZerotool setsthematrixvalueintheselectedareato
zero.Thearrowshowsthestrokedirection.

Change above Given Value tool
TheChangeaboveGivenValuetool setsthematrixvaluesthatare
abovethegivenleveltothedefinedvalue.Itaddsonlyonelayeron
eachbrushstrokethuspreventingunwantedresultscausedbyfalse
Change below Given Value tool
TheChangebelowGivenValuetool setsthematrixvaluesthatare
belowthegivenleveltothedefinedvalue.Itsubtractsonlyonelayer
oneachbrushstrokethuspreventingunwantedresultscausedbyfalse
Compensators 559
Increase by Defined Value tool
TheIncreasebyDefinedValuetool increasesthematrixvaluesunder
thebrushbythedefinedvalue.Thearrowshowsthestrokedirection.
Decrease by Defined Value tool
TheDecreasebyDefinedValuetool decreasesthematrixvalues
underthebrushbythedefinedvalue.Thearrowshowsthestroke
direction.
Build up Transmission Factors tool
TheBuildupTransmissionFactorstool addsfurtherlayerswiththe
sametransmissionvalueontopofeachotherbypaintingoverthe
alreadypaintedareas.Thearrowshowsthestrokedirection.Usesmall
transmissionvaluesbecauseeachmovementofthemouseremovesa
layerfromthefluence.

Erase Transmission Factors tool
TheEraseTransmissionFactorstool erasesfurtherlayerswiththe
samematrixvaluefromthealreadysubtractedareas.Thearrowshows
thestrokedirection.
Smooth Transmission Factors tool
TheSmoothTransmissionFactorstool smoothsoutsharpchangesin
matrixvaluesandcanbeusedtoremovesmallirregularities.The
arrowshowsthestrokedirection.
Compensators 561
To Select the Compensator Isolevels
1. IntheFocuswindow,selectthecompensator.
2. ChoosePlanning >CompensatorIsolevels.
TheThicknessIsolevelEditordialogboxopens.
3. IntheThicknesscolumn,thecalculatedthicknessofeachisolevelis
shown.Ifnecessary,editthethicknesses.
4. IntheColorandStylecolumn,thecurrentcolorsforeachisolevel
areshown.Tochangethecolor,clickthecellandselectanewcolor
fromthelistbox.
Toaddanewisolevel,clickAddlevelandthenfillinthecells
asappropriate.
Todeleteanisolevel,selectitbyclickingtheleftmostcolumn
(themousepointerappearsasablackrightarrow),andthen
clickDeletelevel.
6. Toacceptthechanges,clickOK.
Thedialogboxcloses.

Chapter 20 Electronic Compensators
Thischapterbrieflydescribestheelectroniccompensatorfunctionality
inEclipse,providingabriefoverviewtothemethodofcalculating
electroniccompensatorsandstepbystepinstructionsforaddingan
electroniccompensatortoafield.
About Electronic Compensators

Anelectroniccompensatorisafieldmodifierimplementedbymeans
ofaDynamicMLC(DMLC,seeChapter 17,SectionAboutDynamic
MLCsonpage 537)thatreplacesamechanicalcompensator.
Electroniccompensatorscanspeedupthetreatment,andalsoreduce
skindose,sincetheydonotexposethepatienttoelectron
contaminationfromthecompensatormaterialorfixedwedgefilters.
Moreover,electroniccompensationdoesnotrequirethehighoverhead
inproductionthatispresentinmechanicalcompensators,and
multibeamtreatmentsaremuchfasterbecausethereisnoneedto
installadifferentphysicalcompensatorbeforeeachtreatmentbeam.
Electronic Compensator Calculation

ElectroniccompensatorsareaddedtoaplaninEclipsebyfirst
insertingastandardplanecompensatorintheplanandthen
convertingitintoanelectroniccompensator.Thecompensation
methodusedisplanecompensation.Formoreinformationonthe
calculationofthecompensationplane,seeChapter 19,
Compensators,onpage 551.
Theconversionofastandardplanecompensatorintoanelectronic
compensatorcreatesanoptimalfluence,accordingtoyourcalculation
parameters.Thecalculationisdoneforeachfieldbyscanningall
pointswithinthefieldontheselectedplane.Thecompensator
calculationbeginsattheuserdefineddistancefromtheedgeofthe
patienttangentialborder.Theoptimalfluencesareconvertedinto
actualfluencesandapatternofDMLCleafmotionsbytheLeaf
563
MotionCalculator(LMC).Forinformationonactualfluences,DMLC
motionsandtheLMCprogram,seeChapter 17,SectionConverting
FieldFluencestoDMLCLeafMotionsonpage 540.Whentheplan
andtheDMLCmotionsarecompleted,theDMLCleafmotionfilecan
beexportedtothetreatmentunit.ForinformationonexportingDMLC
files,seeChapter 27,SectionExportingandImportingMLC/DMLC
Plansonpage 780.
Theuniformdosedistributioniscomputedusingthedose
backprojectionmethod,inwhichtheoptimalfluencesaredefined.
Thedosebackprojectionisdoneinthedivergingfieldcoordinate
system.
Using Electronic Compensators
Availability of Electronic Compensation

Electroniccompensationisavailableforopencoplanarphotonfields.
Youcannotaddanelectroniccompensatortoanelectronfield,and
electroniccompensatorscannotbeusedforarcfields.Moreover,one
fieldmaynotcontainbothaphysicalplanecompensatorandan
electroniccompensator.
Note: Whileusinganelectroniccompensator,notethat:
Addinganelectroniccompensatortoaplanzeroesthetotaldose
distribution.
unit.
Verifythemaximumdoseinsidetheirradiatedvolumeafterthe
volumetriccalculation.Thisisespeciallyimportantforplanscontaining
DMLCs.
Eclipseisnotabletoconvertastandardcompensatorintoanelectronic
compensatoriftheisocenterofthefieldisnotinsidethefieldaperture(one
ofthefieldedges,orcollimatorjaws,extendsoverthefieldcentralaxis).
Evaluatethedistributionofisodoses.
PerformQAphantomtestingtomakesurethattheplaniscorrectly
transferredtothetreatmentmachine.

To Add an Electronic Compensator
Note: Makesurethatyoudonotneedtomakeanyotherchangesintheplan.
Ifyoumodifytheplanafteraddinganelectroniccompensator,thecompensator
maynotworkasexpected.
1. IntheFocuswindow,selectthefieldintowhichtoaddan
electroniccompensator.
2. ChooseInsert >NewCompensator.
3. DefinethecompensatorpropertiesasinstructedinChapter 19,
Compensators,onpage 551.
4. IntheFocuswindow,rightclickthecompensatorandchoose
ConverttoElectronicCompensator.
Theplanecompensatorisconvertedintoanoptimalfluence.
5. ConverttheoptimalfluenceDMLCmotions.Forinstructions,see
ConvertingFieldFluencestoDMLCLeafMotionsonpage 540.
About Irregular Surface Compensators

Irregularsurfacecompensatorisanelectroniccompensatordesigned
forcreatingacurvedcompensationsurfaceasopposedtoastraight
compensationplaneintraditionalphysicalcompensatorsandnormal
electroniccompensators.
Usingacurvedcompensationsurfaceprovidesbetterdose
distributionsincaseswheretheshapeofthetargetvolumeisrounded,
suchasbreasttreatments.Inbreastcases,traditionalcompensators
oftencreatehotspotsinthebaseofthebreastneartheskin,butthis
canbeavoidedwithirregularsurfacecompensation.
Theshapeoftheirregularcompensationsurfaceisalwaysspecificto
theshapeofeachpatientsBodyoutline.Thepositionofthedesired
irregularcompensationsurfaceisdefinedbyspecifyingthedesired
penetrationdepth.Thepenetrationdepthisthepercentageofthe
penetrationoftheradiationalongeachfanlineraythroughthepatient;
calculatedaspath length = exit point - entry point.The
penetrationdepthrangeis0100%,where0% = entrypoint;
100% = exitpoint.Apenetrationdepthof50%createsacompensation
surfacethatrepresentsthemidpointofeveryray.Figure 152on
Electronic Compensators 565

page 572showsschematicallywhattheirregularcompensation
surfacewouldlooklikeforacurvedstructure,usingpenetrationdepth
of50%.
C
B
A.RadiationfocusB.Pathoftheirregularcompensationsurface,50%penetrationdepthC.
Fanlinerays
Figure 152 Penetration Depths, Medial 50% Penetration
Theuseofdifferentpenetrationpercentagesaffectsthefluence.The
largerthepenetrationdepthpercentage,themorefluencedifference
therewillbebetweenthinandthickpartsofthepatient.Avalueclose
tobutsmallerthan50%workswellforbreastcases.
Note: Afteraddinganirregularsurfacecompensator,usetheSkinFlashtoolto
viewthefluenceinthepenumbraareaandbalanceitifnecessary.For
informationontheSkinFlashtool,seeChapter 14,SectionExtending
FluencewiththeSkinFlashToolonpage 480
Thecalculationoftheirregularsurfacecompensatorisperformedwith
theDoseVolumeOptimizeralgorithmusingsmoothingoptions.The
resultisanoptimalfluence,whichcanbeconvertedintoanelectronic
compensator.
Irregular Surface Compensator Algorithm

Theirregularsurfacecompensationcalculationisperformedwiththe
DoseVolumeOptimizeralgorithm,whichusesthegradientmethod.
Thealgorithmconstructsanirregularlyshapedsurfacecorresponding
tothepenetrationdepthsofthefanlineraystracedthroughthe
patient.Thealgorithmmodulatestheintensityofeachbeamletto
achieveauniformdoseonthecompensationsurface.Theirregular
surfaceautomaticallyincludestheeffectsofbeamdivergenceinboth
theXandYdirections.Patientgeometryisconsideredindetermining

thecompensationsurface,butheterogeneityisaccountedforinthe
fieldfluencecalculation,notindeterminingtheirregularsurface.
Smoothingoptionscanbesetforthealgorithm.
FormoreinformationontheDoseVolumeOptimizeralgorithmand
theirregularsurfacecompensationcalculation,refertoReferenceGuide
forEclipseAlgorithms.
To Add an Irregular Surface Compensator to a Field

1. Intheactiveplan,insertthenecessaryfieldsandfieldaccessories.
2. Ifdesired,calculatethedosedistribution.
3. IntheFocuswindow,rightclickafieldandchooseNewIrregular
SurfaceCompensator.
YouarepromptedtoselecttheMLCdevice,ifthereareseveralof
themconfiguredtoyoursystem.TheIrregularSurface
Compensatordialogboxopens.
4. Tospecifythedesiredpositionoftheirregularsurfaceforthe
compensationalongeachfanline,typethePenetrationDepthand
clickOK.
Therangeofpossiblevaluesis0100%penetration(0% = entry
point,100% = exitpoint).Thedefaultvalueis50%.
Theirregularsurfacecalculationisstarted.Thefluenceappearsin
theFocuswindowundertheselectedfield.
5. Recalculatethedosedistribution.
TheLeafMotionCalculatordialogboxopens.
6. DefinetheLMCsettingsasinChapter 17,DynamicMLCs,on
page 537.
TheleafmotionsarecalculatedandMLCsappearunderthe
fluenceintheFocuswindow.
UsetheSkinFlashtooltoviewthefluenceinthepenumbraareaand
balanceitifnecessary.ForinformationontheSkinFlashtool,see
Chapter 14,SectionExtendingFluencewiththeSkinFlashToolon
page 480.
Electronic Compensators 567

Chapter 21 Blocks
Thischapterdescribestheblockfeaturesandprovidesinstructionsfor
addingblockstoplansandmodifyingthem.Thechapterdescribesthe
block,marginandaxistypesavailableinthesystemandthe
visualizationofblocks.Instructionsareprovidedforaddingblocksto
fields,modifyingtheblockoutlinesandmovingtheblocks.Blockscan
beaddedbydrawingtheblockoutlinemanuallyordefiningit
automaticallyaroundthetargetstructure,orbyusingadigitizer.All
approachesarecoveredinthischapter.
About Blocks
Blocksarephysicaldevicesmadeofhighdensitymaterial,usually
withalowmeltingpoint.Theyareusedtopreventcriticalorgansor
otherareasoutsidethetargetstructurefrombeingexposedto
radiation.Theblockshapecanbedefinedeithermanuallyor
automatically.
Theblockmaterialparametersaredefinedinthetreatmentunit
configuration,andcannotbechangedduringtreatmentplanning.The
blockparametersincludetheblockmaterial,blockthickness,base
platethickness,transmissionfactor,trayfactor,useoftheblockand
thetreatmentunitsallowingtheuseoftheblock.Theconfigurationis
doneintheAdministrationtask.Formoreinformationontheaddon
materialconfigurationintheAdministrationtask,refertoonlinehelp.
Blockscanbemirrored,rotatedandmoved.Theblockcoordinate
systemisfixedtothatofthetreatmentunit,inotherwords,rotating
thecollimatoralsorotatestheblocks.
Note: Ablockisautomaticallyaddedtoaprotonpatchfieldiftheprimaryfield
containsablock.
569
Block Types
Thefollowingtypesofblocksareused:
ShieldingblocksPiecesofblockmaterialthatshieldthearea
withintheblockoutline.Onefieldcancontainanynumberof
shieldingblocks.
ApertureblocksPiecesofblockmaterialthatleavetheinside
areaoftheblockopen,thatis,theblockhasanaperture.Theshape
oftheapertureiseitherregular(acircularorrectangularstandard
apertureblock)ordefinedtosurroundtheexposedareawitha
specifiedmargin(acustomapertureblock).Therecanbeonlyone
apertureblockperfield.
Block Visualization
Whenyoucreateanewblock,theblockiconoftheapertureblock or
shieldingblock appearsintheFocuswindowunderthefield.
Block in the Image Views
The2Dviewsdisplayblocksatthefieldendclosertothetreatment
unit.Thefieldandplaneintersectionshowstheactualblockshapeas
outlines.
A.Blockshapeattreatmentmachineend.B.Blockshapeatfieldandplaneintersection.
Figure 153 Blocks in 2D View

The3Dviewsshowtheshapeofthefieldcontainingablockatthe
treatmentmachineendofthefieldandattheendofthefield
visualization.ThefieldshapecanalsobeshownontheBodysurface.
Ifthefieldlinesarevisualizedassurfaces,thesurfaceisformedin
accordancewiththeblockshape.
Ifthe3DviewisintheBEVmode,individualblocksarevisualized,
andtheblockcontourscanbereshapedwiththecontouringtools.
Areascontainingblockmaterialareshadedtodistinguishthemfrom
theopenareas.
Figure 154 Shielding Blocks in BEV
IfablockisselectedintheFocuswindow,allthecontoursthatdefineit
areshownintheBEV.Ifseveraloverlappingblockoutlineshavebeen
drawnintooneblockobject,alltheoutlinesaredisplayed.However,if
thefieldcontainingtheblockisselectedintheFocuswindow,onlythe
netoutlineformedbytheoverlappingoutlinesisshown(see
Figure 155onpage 577).Forapertureblocks,theindividualblock
outlinesareexported.Forshieldingblocks,thenetoutlineisexported.
Indosecalculation,overlappingblockoutlinesaretakenintoaccount
iftheybelongtoseparateblocks.Iftheoverlappingoutlinesbelongto
oneblock,thenetoutlineisusedindosecalculation.
Figure 155 Individual Overlapping Block Outlines and the Net Outline
Blocks 571
Ifafieldcontainingablockishidden,theblockisalsohiddeninthe
imageviews.However,whentheblockofahiddenfieldisselectedin
theFocuswindow,theblockisdisplayedinallimageviews.Formore
page 381.
Block Margin Types

Thetargetoutlineandtheblocksinneroutlineareseparatedbya
userdefinedmargin.Themargintypecanbecircularorellipticaland
tiedtothecollimatorrotationortheBEVwindow.
Circular Margin
Inacircularmargin,thedistanceoftheblocksinneroutlinefromthe
targetvolumeoutlineisuniform.
Figure 156 Aperture Block with a Circular Margin
Elliptical Margin
Inellipticalmargins,thedistanceoftheblocksinneroutlinefromthe
targetvolumeoutlinediffersintwoorthogonaldirections.Inthis
example,themarginisdefinedtobe0.5cmalongtheX1fieldedge,1.0
cmalongtheY2fieldedge,and1.5cmalongtheX2fieldedgeand2.0
cmalongtheY1fieldedge.

Figure 157 Aperture Block with an Elliptical Margin
Block Coordinate Axis Types

Forapertureblockswithellipticalmargins,youalsoneedtoselectthe
axistouseforcreatingthemargin.Theaxesareorthogonalcoordinate
axes,andtheydeterminehowthemarginwidthvariesalongtheaxes.
TheaxiscanbedeterminedeitherbytheBEVcoordinatesorthe
collimatorcoordinates.
BEV Coordinate Axis
WhentheBEVcoordinateaxisoptionisused,themarginaxesare
paralleltothesidesoftheBEVwindow.
Figure 158 Aperture Block, BEV Coordinate Axis
Blocks 573
Collimator Coordinate Axis
Whenthecollimatorcoordinateaxisoptionisused,themarginaxes
areparalleltothecollimatorjaws.
Figure 159 Aperture Block, Collimator Coordinate Axis
Adding Blocks to Fields

Toaddablocktoafield,youfirstdefinetheblockobjectandthen
delineatetheblockoutlinesforthestructureintheBEV.
Note: Blockscanbeaddedonlyifablockaddonmaterialhasbeenconfigured
fortheselectedtreatmentenergy.
To Add the Block Object

1. IntheFocuswindow,selectthefieldtowhichtoaddablock.
2. ChooseInsert >NewBlock.
TheBlockPropertiesdialogboxopens.
3. IntheIDtextbox,typeanidentificationfortheblock.
4. IntheDosimetricMaterialgroupbox,selectthematerialforthe
block.
TheBlocktransmissionboxdisplaysthefactorconfiguredinthe
BeamConfigurationtask.

5. ClicktheApertureorShieldingoptionbuttondependingonthe
desiredblocktype.
6. Tohavetheblockcutalongthefanlineofthebeam,selectthe
Divergingcutcheckbox.
7. IntheTraygroupbox,selecttheblocktrayintheIDlistbox.
Inanelectronfield,TrayIDdefineswhichelectronapplicatorisused.
TheCustomcodeboxdisplaysthecodeusedbythetreatment
unittoidentifytheaddon(ifcustomcodingisconfiguredfor
thetreatmentunit).
TheTraytransmissionboxdisplaysthefactorconfiguredin
theBeamConfigurationtask.
IntheSlotgroupbox,theIDlistboxdisplaystheslot
configuredfortheselectedtray.
Inanelectronfield,SlotIDdefinestheslotintowhichanelectroncutout
shouldbeinserted.
8. ClickOKtoaddtheblock.
Continuebydefiningtheblockoutlinesautomaticallyormanually.
Delineating Block Outlines

Inshieldingblocks,theblockoutlineisdrawnwiththemouse,andthe
areaclosedbytheoutlineisfilledwiththeblockmaterial.Inaperture
blocks,closedblockoutlinesofcustomizedorstandardshapeare
placedaroundthetargetvolumecontainedintheselectedfield.The
inneroutlineoftheblocksurroundsthetargetvolumewitha
userdefinedmargin,andtheouterblockoutlinefollowsthefield
outline.Theblockoutlinesarethenfilledwiththeblockmaterial.
Whendelineatingblockoutlines,youcandisplaythepreviously
calculateddosedistributionandusetheisodoselinesasguidesin
makingmodifications.Foremoreinformationondisplayingthe
persistentdose,seeChapter 24,SectionShowingthePersistentDose
onpage 631.
Note: Afieldcancontainonlyonestandardapertureblock.Addingastandard
apertureblocktoafieldclearstheexistingblockaperturefromthefield.
Blocks 575
To Delineate the Block Outlines Automatically
1. IntheFocuswindow,rightclicktheblockandchooseFitto
Structure .
TheFitBlocktoStructuredialogboxopens.
2. IntheBlockTargetStructuregroupbox,selectthestructure
aroundwhichtocreatetheblock.
Youcanfittheblockalsotoaselectedisodoselevelthathasbeenconverted
toastructure.Forinstructions,seeConvertinganIsodoseLeveltoa
Structureonpage 638.
3. Definethemargintypeandwidth.
CircularMargin:Definethewidthofthemargin.
EllipticalMargin:Definethewidthofthemarginforeachedge
intheX1,X2,Y1andY2textboxes.
4. ClicktheBEVortheCollimatoroptionbuttontodefinethe
margincoordinatesystem.
5. SelecttheOptimizeCollimatorJawsortheOptimizeCollimator
Rotationcheckbox,ifdesired.
Theoptimizationofthecollimatorrotationturnsthecollimator
jawsaroundtheselectedstructuretobeabletodecreasethe
fieldsize.Theoptimizationofthecollimatorjawsmovesthe
collimatorjawsasclosetotheselectedstructureaspossibleto
decreasethefieldsize.
Theseoptionsareavailableforapertureblocksonly.
6. TodisplaytheblockinBEV,clickApply.
7. Tokeepthesettingsandclosethedialogbox,clickOK.
To Add a Standard Aperture Block

1. AddablockobjecttothefieldasinToAddtheBlockObjecton
page 580.
2. IntheFocuswindow,rightclicktheblockstructureandchooseSet
BlockShape.
TheSetApertureBlockdialogboxopens.

Tocreateacircularaperture,selectCircularanddefinethe
diameterofthecutoutapertureintheDiameterbox.
Tocreatearectangularaperture,selectRectangularanddefine
thesidelengthsoftheapertureintheXsizeandYsizeboxes.
4. ClickOK.
To Delineate the Block Outlines Manually

1. IntheFocuswindow,rightclicktheblockanddooneofthe
following:
IftheBEVisnotdisplayed,chooseEdit.
The3DviewchangestotheBEVandtheblocktoolsare
activated.
OntheBlockToolstoolbar,clicktheFreehandtool .
IftheBEVisalreadydisplayed,chooseFreehand.
2. Usingtheselectedtool,drawtheblockoutlineeitherasa
continuouslineorbyclickingitpointbypoint.
UsetheCircleCursor toolasanaidtomanuallydrawamarginofa
determinedwidth.Formoreinformationonthecirclecursor,seeVisual
AidsforSegmentationonpage 206.
Blocks 577
3. Toclosetheoutline,movethemousepointerbacktothesamespot
whereyoustarteddrawingthelineandreleasethemousebutton
whentheconnectionpointishighlighted.
Theoutlineisclosed.Dependingontheselectedblocktype,the
areabetweentheblockoutlineandthefieldoutlinesorthearea
enclosedbytheblockoutlineisfilledwithblockmaterial.
A.Finishtheoutline.B.Apertureblock:Theareabetweentheblockoutlineandthefieldoutlines
isfilledwithblockmaterial.C.Shieldingblock:Theareaenclosedbytheblockoutlineisfilled
withblockmaterial.
4. Todelineateanotherareawhichispartofthesameblock,repeat
steps23.
To Digitize the Block Outline

1. InsertablocktoafieldasinToAddtheBlockObjecton
page 580.
2. IntheFocuswindow,selecttheblocktowhichyouareaboutto
importanoutline.

3. ShowtheappropriatefieldinBEV.
4. Ifnotselected,choosePlanning >EnableDigitizer.
Appendix Conpage 819.
6. Onthetoolbar,clicktheDigitizeBlocktool .
Thefollowingdialogboxopens.
7. Todefinetheoutline,clickthepointsonthefilmwiththefirst
buttonofthedigitizermouse.Thepointsareconnectedwith
straightlines.
Todeletetheenteredpointsonebyone,selectthepointand
pressBACKSPACEonthekeyboardortheseconddigitizer
mousebutton.
8. Toclosetheline
9. Toedittheoutline,usetheblockeditingtools.Formore
information,seeModifyingBlocksonpage 585.
10. Whentheblockcontourisready,deselecttheDigitizeBlocktool.
Youcanenterseveraloutlinesoneafteranother.Thecalibrationisvalidas
longastheselectedfieldremainsthesame.
11. Todisablethedigitizer,choosePlanning >EnableDigitizeragain.
Modifying Blocks
Theoutlinesofallblocktypes(shielding,apertureandstandard)can
beeditedwiththeblocktoolsintheBEVafterinitiallydefiningthem.
Inadditiontomodifyingtheblockoutline,youcanrescale,move,
rotate,andmirrorblocks,copyandpasteblocksbetweenfields,
convertblocksintoMLCs,andclearblockoutlines.Forinstructions
anddetailsonhowtousetheFreehandtool,seeAboutFreehand
ContoursandSegmentsonpage 224.
Blocks 579
Whenmodifyingblocks,youcandisplaythepreviouslycalculated
dosedistributionandusetheisodoselinesasguidesinmaking
modifications.Formoreinformationondisplayingthepersistentdose,
seeShowingthePersistentDoseonpage 631.
To Reshape the Block Outline

Toredrawapartoftheblockoutline,eitheraddasectiontotheblock
orremoveasectionfromtheblock,usetheFreehandtool.Whenyou
reshapeablockoutline,drawanewoutlinesectionovertheexisting
outlinewiththemouse.Thenewoutlinereplacestheoldoutline.For
moreinformationontheFreehandtool,seeAboutFreehandContours
andSegmentsonpage 224.
IntheFocuswindow,rightclicktheblockandchooseEditto
opentheBEV.
OntheBlockToolstoolbar,clickFreehand andselectthe
drawingmodefortheFreehandtoolfromthedialogboxthat
opens.
Toaddasectiontoablock,drawthenewoutlinesectionby
beginningandendinginsidetheexistingblockoutline.
Rightclicktofinishthenewoutline.
Toremoveasectionfromablock,drawthenewoutlinesection
bybeginningandendingoutsideoftheexistingblockoutline.
Rightclicktofinishthenewoutline.
Startdrawingthecorrectionrelativelyclosetotheoutline.
A.Toaddtotheblock,startdrawingfrominsidetheexistingblock.B.Toremoveapartfromthe
block,startdrawingfromoutsidetheexistingblock.

3. Rightclickandchooseoneofthefollowing:
Tocutoraddanewpart,chooseCorrect
Todeletethelargerareaenclosedbyacontour,chooseCorrect,
RemoveLarger
To Edit Standard Aperture Blocks

1. IntheFocuswindow,rightclicktheblockandchooseSetBlock
Shape.
TheSetApertureBlockdialogboxopens.
2. Tochangetheshapeoftheaperture,selectCircularor
Rectangular.
3. Tochangethesizeoftheaperture,definethenewsizeinthe
Diameter(forcircularaperture)ortheXsizeandYsizeboxes(for
rectangularaperture).
4. ClickOK.
To Move Blocks
opentheBEV.
IntheFocuswindow,rightclicktheblockandchooseSelect
.
2. IntheBEV,placethemousepointerontheblock.
Awhitecrossappearsnexttothemousepointer.
Blocks 581
3. Pressthemousebuttonanddragtomovetheblock.
A.MovingablockwiththeSelecttool.
To Rotate Blocks by Degrees

1. IntheFocuswindow,rightclicktheblockyouwishtorotateand
chooseRotateBlock.
TheRotateBlockdialogboxopens.
2. IntheRotationAngletextbox,definethedesiredangleofthe
rotation.Thedefaultvalueis90degrees.
3. Todefinethedirectionoftherotation,clickClockwiseor
Counterclockwise.
4. Torotatetheblock,clickApply.
Theblockisrotatedaroundtheisocenteroftheactivefieldbythe
defineddegreevalue.
Torotatetheblockbysmallincrements,forinstance,5degreesatatime,
definethevalueofoneincrementintheRotationangletextboxandthen
clickApplyseveraltimesuntilyouhavereachedthedesiredangle.
5. ToclosetheRotateBlockdialogbox,clickClose.

To Mirror Blocks
opentheBEV.
OntheBlockToolstoolbar,clickMirrorL/R orMirrorU/D
tomirrortheblock.
Patientorientationhasaneffectonhowtheblocksaremirrored.
A.OriginalblockB.Blockmirroredleft/rightC.Blockmirroredup/down
To Copy Blocks
1. IntheFocuswindow,selecttheblocktocopy.
2. ChooseEdit >CopyBlocktocopytheselectedblocktothebuffer.
3. IntheFocuswindow,selectthefieldtocopytheblockto.
4. ChooseEdit >PasteBlocktopastetheselectedblocktothe
selectedfield.
Blocks 583
Converting Blocks into MLCs
Sometimesitmaybenecessarytotransferaplanfromatreatmentunit
thatdoesnothaveanMLCdeviceinstalledandconfiguredtoa
treatmentunitthathasone.Inthesecases,ifblockswereusedto
modifythefieldshape,youcanreplacetheblocksintheplanwith
MLCsbyusingtheblockapertureoutlineforpositioningtheMLC
leavesaroundthetarget.
To Convert an Aperture Block into an MLC
1. IntheFocuswindow,rightclicktheblocktobeconvertedand
chooseCopytoMLC.
TheCopyBlocktoMLCdialogboxopens.
2. DefinetheMLCfittingoptionsasdesired.
Theleafedgecontourmeetpoint
Theclosedleafmeetingposition
ThecollimatorjawsoptimizationEclipseadjuststhe
collimatorjawstobestfittheMLCleavestothestructure.
TheuseoftherecommendedjawpositionsEclipseadjusts
thecollimatorjawpositionsalongtheMLCaperturewithan
additionalmargin,configuredinthedatabase.
ThecollimatorrotationoptimizationEclipseadjuststhe
collimatorangletobestfittheMLCleavestothestructure.
Fordetaileddescriptionoftheoptions,seeChapter 16,Multileaf
Remembertocheckthatanyotherfieldmodifierfitsifyouareusing
collimatorrotationoptimization.
3. ClickApplytoarrangetheMLCleavesinaccordancewiththe
fittingoptions.
4. VisuallyverifytheMLCapertureagainsttheoriginalblock
apertureintheBEV.
5. Ifnecessary,changetheMLCleaffittingoptionsandclickApply.
Youcanrepeatthisasmanytimesasnecessary.

6. Tokeepthechanges,clickOK.
Ifnecessary,youcanedittheMLC.Forinstructions,seeChapter 16,
MultileafCollimators,onpage 509.
To Delete Block Outlines

1. Iftheblocktoolsarenotactivated,intheFocuswindow,rightclick
theblockandchooseEdittoopentheBEV.
2. Todeleteblockoutlines,selectRemoveallcontours .
Allblockcontoursareremoved.
Blocks 585
Chapter 22 Wedges
Thischapterdescribesthewedgefeaturesandprovidesbackground
informationnecessaryforworkingwithwedges.Thewedge
parametersaredescribed(direction,width),aswellasthecalculation
ofmotorizedwedgesandthevisualizationofwedgesintheuser
interface.Instructionsareprovidedforaddingandmodifyingwedges
infields.
About Wedges
Fourtypesofwedgesaresupported:standard,Dynamic,Enhanced
Dynamic,andmotorizedwedges.
StandardwedgeAstandardwedgeisaphysicalpieceofmaterial
withananglethatisstaticduringtreatment.
DynamicwedgeDynamicWedgesareformedbyamovingjawof
astandardcollimatorduringirradiation.
EnhancedDynamicwedgeEnhancedDynamicWedgesaresimilar
toDynamicWedges,buttheyfeaturemorewedgeanglesthan
simpleDynamicWedges.
MotorizedwedgeMotorizedwedgesarestandardwedgesplaced
inthefieldforauserdefinedfractionofthetotaltreatmenttime.
AllwedgepropertiesareconfiguredintheAdministrationtask;for
moreinformation,refertoonlinehelp.
Note: Thewedgetypesavailabledependontheconfigurationofyourdatabase
andthecurrenttreatmentunit.If,forinstance,DynamicWedgesarenot
configuredtoyourdatabase,youcannotinserttheminfields.
Wedge Directions
Fourdifferentwedgedirectionsaresupported,asshowninTable 19
onpage 594.Asthewedgedirectionisalwaysdefinedinrelationtoa
collimatorangleof0(IEC),thelistassumesthatthecollimatorangleis
587
0 (IEC)andthatthepatientorientationindicatoronscreenisfacing
you.InTable 19onpage 594,thewedgedirectionisexpressedin
relationtothepatient,inaccordancewithIEC61217.
Table 19 Wedge Directions in Relation to the Patient (Assuming Collimator
Rotation 0 in IEC 61217 and Patient in the Head-First Supine Position)
Direction
Meaning Illustration
IEC 61217 Eclipse
0 In Thesharpedge(toe)ofthe
wedgepointsSuperior.
Defaultvalue.
270 Left Thesharpedge(toe)ofthe

wedgepointstothepatients
left.
180 Out Thesharpedge(toe)ofthe

wedgepointsInferior.
90 Right Thesharpedge(toe)ofthe
wedgepointstothepatients
right.
Changingthecollimatorangleresultsinachangeintheactualwedge
direction,asthewedgeisfixedtothecollimator.However,inrelation
tothecollimator,thewedgedirectionalwaysremainsthesame.
Wedge Width
Wedgesaredefinedintheconfigurationofyoursystem,formore
informationrefertotheonlinehelp.Thewedgeparametersspecified
intheconfigurationmaysetlimitsforthefieldsizeandwedge
direction.

Calculation of Motorized Wedges
Weight Factor for Motorized Wedges

Thewedgeweightfactorisaparameterusedformotorizedwedgesto
indicatethedosepercentageofthewedgedandopenpartofafield
containingawedge.Theweightfactorsrangefrom0to1.0,andthe
factorindicatesthefollowing:
0fullyopenfield
1fullywedgedfield
Othervaluespartlywedgedfield.
Forexample,aweightfactorof0.5fora60motorizedwedgeis
approximatelyequivalenttoafieldcontaininga30standardwedge.
YoudefinethewedgeweightfactorintheAccessoriestaboftheField
Propertiesdialogbox(seeAddingWedgesinFieldsonpage 598).
ThecoefficientindicatingtheMUsofthewedgedandopenpartofthe
fieldiscalculatedasinfollows:
Eq. 1 MU wedge MU wedge

D = --------------------
- = -----------------------------------------------
-
MU total MU open + MU wedge
Dose Distribution for Motorized Wedges

Thedosedistributionoffieldscontainingamotorizedwedgeis
calculatedonthebasisoftheweighteddosepercentagesforthe
wedgedandopenpartsofthefield.TheFieldstaboftheInfoview
displaystheMUvaluesandreferencedoseforboththeopenand
wedgedpartofafieldcontainingamotorizedwedge.
Wedges 589
Wedge Visualization
Wedgesaredisplayedinallimageviews.Thewedgeoutlinesare
indicatedinorange,andthewedgespointintheselecteddirection.As
thewedgedirectionisalwaysindicatedinrelationtoacollimator
angleof0,theactualdirectionofthewedgedependsonthecollimator
angle.
Wedge Icon
Whenyouinsertawedgetoafield,thewedgeicon appearsinthe
Focuswindowunderthefield.
Wedges in the Image Views

Inthe2Dviews,thewedgeisdisplayedrealistically,meaningthatthe
wedgeoutlinesymbolisshownasseenfromdifferentangles,
dependingonthegantry,collimator,andcouchrotation.Figure 160on
page 596presentswedgesinatransversalimage.
Figure 160 Wedge in a Coplanar and Non-coplanar Field, Transversal Image
IntheBEV,thewedgeisalwaysindicatedasatrianglefixedtothe
collimatorjaws.Figure 161onpage 597showsawedgeintheBEV.

Figure 161 Wedge in a Field, BEV
IntheModelview,thewedgeisdisplayedrealistically,meaningthat
thewedgeoutlinesymbolisshownasseenfromdifferentangles,
dependingonthegantry,collimator,andcouchrotation.Figure 162on
page 597showswedgesintheModelview.
Figure 162 Wedges in Model View
Ifafieldcontainingawedgeishidden,thewedgeisalsohiddeninthe
imageviews.However,whenthewedgeofahiddenfieldisselectedin
theFocuswindow,thewedgeisdisplayedinallimageviews.For
moreinformationonhidingfields,seeShowingandHidingFields
onpage 381.
Wedges 591
Adding Wedges in Fields
Youcanaddawedgesimultaneouslywithaddingafieldinaplanor
lateron,afterpositioningthefieldasdesired.Ifyouareattachinga
wedgetoafieldcreatedearlier,youmustfirstselectthefieldtowhich
youareaddingthewedge.Ifyouareinsertingawedgetoafieldwhile
creatingit,thefieldyouareworkingonisactive.
To Add a Wedge
1. IntheFocuswindow,selectthefieldtoaddthewedgeto.
3. SelecttheAccessoriestab.
Standardwedge:SelecttheIDofthedesiredwedgeinthe
<Accessory>listbox.
Dynamicormotorizedwedge:IntheWedgeIDdropdownlist,
selectthedesiredwedge.
5. Motorizedwedge:IntheWeightFactor,definetheweightofthe
wedgedpartofthefield.
Afterthedosecalculation,theWedgeDoseboxshowsthe
coefficientusedtoindicatetheMUsofthewedgedandopenpart
ofthefield.
6. Iftheselectedtreatmentunithasmultipleslots,selectthe
accessoryinthe<slot>listboxes.
7. ClickOKtoaddthewedgetothefield.
Modifying Wedges
ThewedgepropertiesaremodifiedintheFieldPropertiesdialogbox.

To Modify Wedges in Fields
1. IntheFocuswindow,selectthefieldcontainingthewedgeto
modify.
3. IntheAccessoriestab,changethesettingsasnecessary.For
instructions,seeAddingWedgesinFieldsonpage 598.
4. ClickOK.
To View the Physical Wedge Properties
Note: ThewedgepropertiesareconfiguredintheAdministrationtask.This
functiononlyallowsyoutoviewtheproperties.
1. IntheFocuswindow,selectthewedge.
TheWedgePropertiesdialogboxopens,showingthewedge
properties.
Wedges 593
Chapter 23 Bolus
Thischapterprovidesinformationonworkingwithbolusstructures.
Thechapterdescribesthebolusproperties,thevisualizationofbolus
intheuserinterface,andhowbolusistakenintoaccountinthedose
calculation.Instructionsareprovidedforaddingandmodifyingand
deletingbolusstructurestoimagesandforlinkingthemtofieldsfor
dosecalculation.
About Bolus
Abolusisapieceoftissueequivalentmaterialplaceddirectlyonthe
patientsskintoprovideadditionaltissueandbringthemaximum
doseclosertotheskinsurface.Bolusstructuresaremanagedas
imagespecificstructures,notasfieldspecificaddonslikeblocksor
compensators.Consequently,whenafieldcontainingabolusiscopied
fromonephotonplantoanother,thebolusisnotcopied,butwhenan
entireplaniscopied,theboluscontainedinafieldorseveralfieldsis
alsocopied.
Bolus Visualization
Bolusstructuresaredisplayedinthe2Dimageviews,theModelview
andtheBEV.TheyarealsoshownintheFocuswindowsimilarlyto
otherstructuresandreferencepoints.
Bolus Icons
Whenyoucreateanewbolus,thebolusstructureicon appearsin
theFocuswindowunderthestructureseticon.Whenyoulinkabolus
toafield,thelinkedbolusicon appearsunderthefield.
595
Bolus Structures
Youcanselectthecolorandstyleforeachbolus.Formoreinformation,
seeUsingColorandStyleintheImageViewsonpage 94.
The2Dimageviewsdisplaybolusstructuresasoutlinesasin
A.Bolus
Figure 163 Bolus in 2D Image View
TheModelview(seeFigure 164onpage 602)displaysbolusstructures

inthesamewayasotherstructures,forexample,assolidsurfaces.
A.Bolus
Figure 164 Bolus in Model View
TheBEVdisplaysthebolusstructure(s)linkedtotheactivefieldon
topofotherstructurescontainedintheimageandbelowthefield
outlines.YoucannoteditabolusintheBEV.

Dose Calculation and Bolus
Tocalculatethedosedistributionforaplancontainingabolus,you
firstcreateabolusstructureandthenlinkittotheappropriatefields.
Thedoseisthencalculatedinsidethebolus.
Note: Thedosecalculationonlytakesintoaccountbolusstructureslinkedto
thefieldsinaphotonplan.
Adding Bolus
BolusstructureandmaterialareaddedonthesurfaceoftheBody
structurewithaspecialtool.Youfirstcreatethebolusstructure,define
theCTvalueofthebolusmaterial,outlinetheareainimageviews
wherethebolusshallcoverthepatientsskinanddefinethethickness
ofthebolusstructure.Thenyoulinkthestructuretoappropriatefields
forplandosedistributioncalculations.Thebolusstructureappearson
thepatientskininthe2DimageviewsandtheModelview.
Youcanaddseveralboluslayersofdifferentthicknessesontopofeach
other.However,noticethatthethicknessofoverlappinglayersisdealt
withinaspecialway:Theeffectivebolusthicknesswherelayers
overlapismeasuredfromtheskinsurfacetotheuppersurfaceofthe
topmostlayer(seeFigure 165onpage 604).
Bolus 597
A.Effectivethicknessoflayer2.B.Thicknessoflayer1.
Figure 165 Bolus Layers
Note: Dosecalculationresultswhenusingboluscanresulttoslightinaccuracy
iftherearemultiplebolusgeometricallyontopofeachother,orifthesame
bolusislinkedtomultiplefields.Itisrecommendedtouseonlyonebolusper
fieldandcreateanindividualbolusforeachfieldinsteadoflinking.
Note: Insomerarecases,creatingabolusinEclipsecanresultina
disconnectedobject:Ifthedistancebetweentheplanesinthevolumeimageis
largeandtheBodyoutlinechangesaresharpunderthebolus(thatis,theBody
outlinedeviatesmorethanthethicknessofthebolusbetweentwoplanes),the
resultingbolushasaholebetweenthosetwoplanes.Insuchsituations,usea
smallerplanedistancewhencreatingthevolumeimage.
To Create the Bolus Structure

1. ChooseInsert >NewBolus.
2. TheBolusPropertiesdialogboxopens.
3. Typeaname,ID,andCTvalueforthenewbolusstructure.The
defaultCTvalueis0(waterinHounsfieldunits).
CTvaluesarecalibratedtocorrespondtoelectrondensitiesintheBeam
Configurationtask.Formoreinformation,refertoReferenceGuidefor
BeamConfiguration.
4. ClickOK.
TheVOI(VolumeofInterest)toolappearsinallviewsandtheEdit
Bolusdialogboxopens.

5. UsetheVOItooltodefinetheareaofthebolusontheBody
surface.FormoreinformationonusingtheVOItool,see
Chapter 8,SectionSelectingtheAreatoWorkonin
Segmentationonpage 203.
TheVOItoolrestrictsthebolussizethreedimensionally.Toenable
correctdosecalculationtakingthebolusintoaccount,makesureyou
placetheedgesoftheVOItoolappropriately.Forinstance,ifthethickness
ofabolusis4cm,placetheedgesoftheVOIatleast4cmfromthesurface
oftheskin.
6. IntheEditBolusdialogbox,typeathicknessforthenewbolus
structure.
7. ClickOK.
ThebolusoutlineiscreatedontheBodyinsidethearearestricted
withtheVOItool.IntheModelview,a3Dmodelofthebolusis
shown.In2Dviews,thebolusisshownascontours.
Linking Bolus to Fields

Toincludetheeffectofthebolusinthedosecalculation,youmustlink
thebolustoafieldintheplan.
Youcanlink
Multiplebolustoasinglefield
Onebolustoseveralfields
To Link a Bolus to a Field
1. Tolinkabolustoafield,
IntheFocuswindow,rightclickthefieldandchooseLinkto
Bolus<BolusID>.
Alinkedbolusiconappearsunderthefield.
2. Toremovethelink,
IntheFocuswindow,rightclickthefieldandchooseRemove
linktoBolus<BolusID>.
Thelinkedbolusicondisappears.
Bolus 599
Modifying Bolus
Afterdefiningabolustoapatientimage,youcanmodifythebolus.
Thefollowingcanbechanged:
SizeoftheareainwhichthebolusisdrawnwiththeVOItool,
whichmodifiesthebolusthreedimensionally.Youcanalsodefine
anewthicknessforthebolus.
ShapeofthebolusoutlinewiththeFreehandtool.Formore
informationontheFreehandtool,seeAboutFreehandContours
andSegmentsonpage 224.
Note: Whendoingmodificationstobolus,noticethefollowing:
IfyoumodifytheBodystructureaftercreatingabolus,recreatethebolus
tohaveEclipserecalculateit.Thebolusisnotautomaticallyrecalculated
afterchangestotheBodystructure.
Ifyoumodifyaboluslinkedtoanumberoffields,awarningisdisplayed:
changingthebolusalsoaffectsalltheinactivefieldstowhichthebolusis
linked.
Youcannoteditabolususedinanapprovedplan.
To Edit the Bolus Shape and Thickness with the VOI Tool
1. IntheFocuswindow,rightclickthebolusandchooseEditBolus.
TheVOItoolappearsinalltheviewsandtheEditBolusdialogbox
opens.
2. Intheimageviews,defineanewbolusshapebydraggingthe
handleswiththemouse.
3. TypeathicknessintheEditBolusdialogbox.
4. ClickOK.
Thebolusisupdatedintheviews.

To Edit the Bolus Outlines with the Freehand Tool
2. IntheFocuswindow,rightclickthebolustobeeditedandchoose
Freehand.
3. SelectthedrawingmodefortheFreehandtool.Formore
informationontheFreehanddrawingmodes,seeAboutFreehand
ContoursandSegmentsonpage 224.
Toaddaparttothebolus,startandenddrawinginsidethe
existingboluscontour.
Toremoveapartofthebolus,startandenddrawingoutside
theexistingboluscontour.
Tomovepartoftheboluscontour,movethemousepointeron
theboluscontourlineandwhenthecontourishighlighted,
presstheleftmousebuttondownanddragthecontourline.
Tomovethewholebolus,movethemousepointeronthebolus
contourlineandwhenthecontourishighlighted,pressSHIFT
anddragthecontourasdesired.
To Delete a Bolus
Whenyoudeleteafieldcontainingalinkedbolus,onlythelinkis
actuallyremovedwiththefield.Thebolusstructureremainsinthe
image.Whenyoudeleteapatient,theentirebolus(bothlinksand
structures)isremoved.
1. IntheFocuswindow,breakallthelinkstothebolusyouwishto
delete.Forinstructions,seeToLinkaBolustoaFieldon
page 605.
2. IntheFocuswindow,selectthebolus.
Bolus 601
4. ThebolusicondisappearsfromthestructuresetintheFocus
window.Thebolusstructureisclearedfromallimageplanes.
Note: Youcannotdeleteabolusifitis
Partofanapprovedplan
Linkedtoafield

Chapter 24 Dose Calculation
Thischapterdescribesthedosecalculationtoolsandoptionsthatare
availableintheExternalBeamPlanningtask.Instructionsare
providedfordefiningthecalculationoptionstouse(calculation
settings,calculationmodels),thesizeofthecalculationvolumeand
dosematrix,fieldweightfactorsanddosenormalization.Thechapter
alsodescribeshowthecalculateddoseisvisualizedandhowyoucan
changethevisualization.ForinformationontheDistributed
CalculationFramework,refertoBeamConfigurationReferenceGuide.
TheExternalBeamPlanningtasksupportstheuseofanumberof
algorithms,whichcanbeconfiguredintheBeamConfigurationtask.
Forinformationonconfiguringthetreatmentplanningsysteminthe
BeamConfigurationtask,refertoBeamConfigurationReferenceGuide.
Foradescriptionofthecalculationalgorithmssupported,referto
EclipseAlgorithmsReferenceGuide.
Calculation Options for External Beam Plans

Forphotonplans,youcanselectandchangethecalculationmodeland
calculationoptionsforthefollowing:
Compensator
Volumedose
Beamangleoptimization
Irregularsurfacecompensator
Optimization
Pointdose
Portaldoseimageprediction
Forelectronplans,youcanselectandchangetheoptionsfor
calculatingthefieldvolumedose.
Youcanuseadifferentcalculationmodelforeachoftheseitems,for
instance,useonecalculationmodelforcompensatorcalculationand
anotherforfieldvolumedosecalculation.Ifyoudonotdefineany
particularcalculationoptionsforaplan,thedefaultsettingsdefined
603
fortheDistributedCalculationFrameworkareused.Formore
informationontheDistributedCalculationFramework,seeBeam
ConfigurationReferenceGuide.
Ifyouhaveaplanthatincludescalculationoptionsdefinedinan
earlierversionofEclipse(beforetheDistributedCalculation
Framework),youcanseetheOldCalculationOptionstabinthePlan
Propertiesdialogbox.Thetabliststheearlierselectedcalculation
options.Nocalculationmodelisselectedfortheplan.Assoonasyou
defineacalculationmodelfortheplan,theOldCalculationOptions
tabdisappearsfromthePlanPropertiesdialogbox.Forinstructionson
definingthecalculationmodel,seeToSelecttheCalculationModel
forExternalBeamPlansonpage 611.
Calculation Models Tab of the Info Window

IntheFieldSetupworkspace,theCalculationModelsTaboftheInfo
windowliststheselectedparticles(photon,electronorproton),
calculationtypes,calculationmodelsandcalculationalgorithmsfor
externalbeamplans.Theinformationdisplayedinthetabdependson
theglobalorlocalcalculationsettings.Youcansortthedisplayed
informationbyclickinganycolumnheader.Youcanchangethe
calculationmodelintheintheModelcolumnbyclickingthecelland
selectinganewmodelfromthedropdownlistthatopens,andeditthe
calculationoptionsofacalculationmodelbyclickingtheEditbutton.
A.TomaketheInfoWindowfloat,pointhereanddragthewindow.
Figure 166 Calculation Models Tab
YoucanalsoedittheinformationintheCalculationModelstabofthe
PlanPropertiesdialogboxorintheBeamConfigurationtask.
Formoredetailedinformationonthecalculationalgorithms,referto
EclipseAlgorithmsReferenceGuideandProtonBeamPlanningReference
Guide.

To Select the Calculation Model for External Beam Plans
1. IntheInfoWindow,selecttheCalculationModelstab.
2. Tochangethecalculationmodel,clickthecellintheModelcolumn
andselectthecalculationmodelyouwishtousefromthe
Thenewcalculationmodelandalgorithmaredisplayedinthe
CalculationModelstab.
Youcanselectonlyonecalculationmodelforeachparticlecalculation
typecombination.Youcanalsochangethecalculationmodelinthe
CalculationModelstabofthePlanPropertiesdialogbox.
To Clear All Calculation Model Selections

from an External Beam Plan
1. IntheScopewindow,selecttheplanforwhichtoclearall
calculationmodelselections.
3. SelecttheCalculationModelstab.
4. Toclearallcalculationmodelselectionsofthecurrentcalculation
model,clickClearallselections.
Aconfirmationmessageopensstatingthatifyouproceed,all
calculateddosedistributionswillbeinvalidated.
5. ClickYes.
Allcalculationmodelselectionsarecleared.Youneedtodefinea
calculationmodelbeforeyoucancalculatethedosedistribution.
Formoreinformation,seeToSelecttheCalculationModelfor
ExternalBeamPlansonpage 611.
To Select Default Calculation Models for an External Beam Plan
1. IntheScopewindow,selecttheplanforwhichtosetthedefault
calculationmodels.
Dose Calculation 605

3. SelecttheCalculationModelstab.
4. Tosetthedefaultcalculationmodels,clickSelectdefaults.
Aconfirmationmessageopensstatingthatifyouproceed,all
calculateddosedistributionswillbeinvalidated.
5. ClickYes.
ThedefaultcalculationmodelsdefinedintheBeamConfiguration
taskareselectedfortheplan.
To Change the Plan-Specific Calculation Options

for an External Beam Plan
1. IntheScopewindow,selecttheplanforwhichtochangethe
calculationoptions.
2. IntheInfoWindow,selecttheCalculationModelstab.
3. ClicktheEditbuttonontherowofthecalculationmodelwhose
calculationoptionsyouwishtochange.
YoucaneditthecalculationoptionsalsointheCalculationModelstabof
thePlanPropertiesdialogbox.
TheCalculationOptionsdialogboxopensshowingthecurrent
optionsfortheusedcalculationalgorithm.
A.Theselectedcalculationmodel.B.Calculationoptionsoftheselectedcalculationmodel.
C.Calculationoptionvalues.Clickthedownpointingarrowheadtochooseanewvalue,or
typeanewvalueinthetextbox.D.Informationontheselectedcalculationoption.

4. Selectthedesiredcalculationoptiongroupontheleftsideofthe
CalculationOptionsdialogbox.
5. Todefinethecalculationoptionsforthecalculationmodel,click
theoptiontodefineintheAttributesgroupboxanddooneofthe
following:
Clickthedownpointingarrowheadandchooseanewvalue
forthecalculationoption
Typeanewvalueforthecalculationoptioninthetextbox.
7. Tosavethenewcalculationoptionsinthedatabase,savetheplan.
Dose Matrix
Thedosematrixisathreedimensionalmatrixwithinwhichthedose
distributioniscalculated.Thedosematrixsizeisdeterminedbythe
sizeoftherectangularcalculationvolume,whichisdefinedbysetting
thelengthsofthevolumesides.Theresolutionofthedosematrixis
determinedbydividingitintosmallerelements:Thesmallerthe
elements,thefinertheresolution.Thesizeoftheseelementsis
determinedbydefiningtheirsidelengths.
A.DosematrixdimensionsB.Resolution
Figure 167 Dose matrix and resolution
Thedefaultcalculationvolumeisequaltothesizeoftheimage
volume.
Note: Whenmakingchangestothecalculationvolume,becarefultocheckthat
itcoversthevolumeofinterest.

To Edit the Calculation Volume for External Beam Plans
1. IntheFocuswindow,rightclickthedoseandchooseEdit
calculationvolume .
Thedimensionsofthecalculationvolumeappearintheimage
views.
2. Dragthecornerpointsofthedimensionstoresizethecalculation
volume.
Themodifiedvolumeisshowninallimageviews.
Themaximumsizeofthecalculationvolumedependsonthealgorithm
selectedforfieldvolumedosecalculationandthecalculationgridsizethat
hasbeendefinedforthatalgorithminplancalculationoptions.The
smallerthecalculationgridsize,thesmallertheallowedmaximumsizeof
thecalculationvolume.
3. Toinactivatethecalculationvolume,gototheFocuswindow,
rightclickthedoseanddeselectEditcalculationvolume.
To Reset the Calculation Volume for External Beam Plans

IntheFocuswindow,rightclickthedoseandchooseReset
calculationvolume .
Thecalculationvolumeisresettothedefaultsize.
To View Dose Matrix Properties for External Beam Plans

1. IntheFocuswindow,selectthedose.
TheDoseMatrixPropertiesdialogboxopens.
3. IntheGeometrygroupbox,
Positiontextboxesshowthecoordinatesofthecenterpointof
thevolume.
Sizetextboxesshowhowmanysmallparallelepipedsthe
volumecontainsineachdirection.
Resolutiontextboxesshowthelengthsofthesidesofthesmall
parallelepipeds.

Dose Distribution Calculation for
External Beam Plans
ThedosedistributioncanbecalculatedintheFieldSetupworkspace
forbothindividualplansandplansumscontaininganumberofplans.
Formoredetailsondosecalculationforplansums,seeSumming
Plansonpage 678.
Theaccuracyofthedosecalculationforphotonfieldsinatypical
clinicalsetupis23%.Theaccuracyofphotonbeamreconstruction
modelis+/ 1%forrectangularfieldsand+/2%forirregularfields,
theobliquecorrectionbeingwithin12%.Forelectronfieldsin
inhomogeneousmaterial,thedosecalculationaccuracyis
+/ 5% or +/ 5 mm.
Theaccuracyofthedosecalculationdependsonmultiplethings,the
mostnotableofwhicharepatientimageresolutionandaccuracy,
treatmentplangeometry,theaccuracyofbeamdatameasurements
andbeamdataconfiguration,andthecalculationalgorithmused.For
moreinformationoncalculationalgorithms,seeEclipseAlgorithms
ReferenceGuide.
CAUTION: To include the compensator transmission factor in the MUs for
photon fields, calculate the effect manually and/or using measurements,
because the compensator transmission factor is not automatically taken into
account in the resulting MU values. Some calculation algorithms do not
calculate MUs for fields that contain a compensator. For more information on
calculation algorithms, see Eclipse Algorithms Reference Guide.
Note: Whencalculatingthedosedistribution,noticethefollowing:
Verifydosecalculationsusingmanualcalculations.Forinformationon
thecalculationalgorithms,refertoEclipseAlgorithmsReferenceGuide.
ThetreatmenttimeisexpressedassecondsforCobaltunitsintheuser
interfaceandprintouts.However,theunitofthetreatmenttimeis
MUinsteadofSeconds.TheshuttertimedefinedintheBeam

Configurationtaskisnottakenintoaccount.Toincludetheshuttertime
inthetreatmenttimeforCobaltunits,additmanuallytothereported
treatmenttime.
Notethatthecalculateddoseisinvalidatedifyouchangethefield
geometryorfieldaccessorysettings.
Allbeamdatausedindosecalculationcontainchecksums.When
calculatingthedose,Eclipserecalculatesthechecksumvaluesand
comparesthemwiththeoriginalones.Ifdifferencesarefound,youare
promptedtogototheBeamConfigurationtasktoverifyandrevalidate
thebeamdata.Thisensuresthatthecorrectbeamdataisusedfordose
calculations.
Thedetailsofthecalculationandpossiblecalculationerrorsor
warningsarerecordedinacalculationlogshownontheCalculation
taboftheFieldPropertiesdialogbox.Iftherewasanerrorduring
calculation,onlyfieldsthatwerecalculatedcorrectlyhavedoseandno
plandoseisshown.
Image Requirements for Planning

Toensurethattheimagesusedfortreatmentplanningareproperly
preparedtoachieveacceptableresultsindosecalculation,makesure
thattheimagesfulfillthefollowingrequirements:
Allnecessaryclinicalcontourshavebeendefined.InEclipse,at
leasttheBodystructuremustbedefinedfordosecalculation.
MakesurethattheCTscanneriscorrectlyconfigured(for
instructions,refertotheonlinehelporBeamConfigurationReference
Guide).TheimagesmustbeCTimageswithavalidmappingfrom
pixelvaluestoHUvalues.Normally,thismappingiscorrectin

DICOMimages.Ifyouuseimagesofsomeothermodalitythan
CT,definetheBodystructureandassignaCTvalueforitto
indicatetheHUvaluesforthedosecalculation.
Ifyouareusingimagesproducedwithcontrastagent,bearin
mindthatthisaffectstheresultofdosecalculationand
inhomogeneitycorrection.
Eachimageusedforaphotonplanmusthaveanelectrondensity
lookuptable.ThelookuptableisdefinedintheSeriesProperties
dialogboxbyselectingtheappropriateCTimagingdevice.Ifyou
wishtouseMRimagesfordosecalculation,linktheCTscannerto
theimagesbyhandintheSeriesPropertiesdialogbox,andassign
abulkCTvalueforthestructures.
InacaseofdeterminingtheCTvaluewhereseveralstructures
withdifferentCTvaluesoverlap,thehighestCTvalueisused
whichisassignedtoanonbodystructure.ApossibleCTvalue
assignmentofabodystructureisalwaysoverriddenbyother
structureswithassignedCTvalues.
Thecalculationalgorithmsrequirethattheimagesetisconstructed
fromtransversalsliceswithnogantrytilt.Allotherimage
orientationsresultinanerrormessageandabortionofthe
calculation.
Calculation Progress Indicator in the External Beam Planning Task
Acalculationprogressindicatorisdisplayedduringdosecalculation.
TheprogressindicatorshowsthefieldIDsofthefieldstobe
calculated,calculationservantsusedforeachfield(formore
informationrefertoBeamConfigurationReferenceGuide),
colorindicatedprogressofthecalculationofeachfieldinpercentages,
andthestateofthecalculation.ThecolorsintheProgresscolumn
indicatethefollowing:
Blue=processingdata
Green=completed
Red=resultedinanerror

A.Clickthebuttonstodisplaycalculationmessagesorerrorsandwarnings,andtoreturntothe
progressindicatorB.FieldIDsofthefieldstobecalculatedC.Showsarunningnumberwhen
calculationofonefieldisdistributedtoseveralcalculationservantsD.Calculationservants
performingdosecalculationE.ProgressofthecalculationofeachfieldinpercentagesF.Stateof
calculationindifferentservantsG.StateoftheoverallcalculationH.Selecttodefinewhetherthis
dialogboxisclosedaftersuccessfulcalculationI.Progressbarshowingtheoverallprogressof
dosecalculation
Figure 168 Calculation Progress Indicator
YoucanstopthecalculationatanytimebyclickingAbort,ordisplay
calculationmessagesbyclickingMessages.TheMessagesbuttonis
blinkingifthereisunreadinformationinthemessagespane.Ifthere
areerrorsorwarningsinthedosecalculation,theerrorandwarning
messagesaredisplayedautomaticallyafterthedosecalculationis
done.WhenthedosecalculationisperformedintheDistributed
CalculationFramework,youcanviewthestatusofthedistributorby
clickingViewDistributorStatusPage.Ifcalculationservantsareset
toprovideinformationduringthecalculationprocess,youcanviewit
byclickingDebug.FormoreinformationontheDistributed
CalculationFramework,refertoBeamConfigurationReferenceGuide.
To Calculate the Dose Distribution

1. FromtheScopewindow,dragtheplantoanimageview.Theplan
isnowactiveanditsdetailsaredisplayedintheInfowindow.
2. Ifnecessary,definethecalculationvolume.Forinstructions,see
ToEdittheCalculationVolumeforExternalBeamPlanson
page 614.

Tocalculate2Ddoseinthedirectionoftheprimaryimaging
plane,gototheimageplaneforwhichtocalculatethedoseand
choosePlanning >Dose Calculation >CalculatePlane .
Tocalculate3Ddose,choosePlanning >Dose Calculation >
CalculateVolume .
Duringthecalculation,aprogressindicatorisdisplayed.Ifyouare
calculatingthedosedistributionforaplansum,theprogress
indicatorisdisplayedforeachplanintheplansumseparately.For
moreinformationontheprogressindicator,seeCalculation
ProgressIndicatorintheExternalBeamPlanningTaskon
page 618.Whenthecalculationiscompleted,thedosedistribution
isdisplayedintheimageviews.Iftherewasanerrorduring
calculation,onlyfieldsthatwerecalculatedcorrectlyhavedose
andnoplandoseisshown.
Continuebyevaluatingthedosedistributionwiththeevaluationtools;
forinstructions,seeChapter 25,EvaluatingPlans,onpage 649.
Dose Calculation Based on MU

TheCalculateVolumewithFixedMUstoolenablesyoutoregenerate
volumetricdosedistributionbasedonexistingMUvalues,orto
generatethedesireddosedistributiontoareferencepoint.Thetool
rememberstheoriginalMUvaluesduringthecurrentapplication
session.
ThisisusefulincaseswheretheMUhasbeenenteredmanuallyand
thereisnovolumetricdosedistribution,orifaplanisfirstcreatedor
modifiedinRT Chart,IRREGPlanningtaskorSimulation,andthen
openedinEclipseforreplanning,volumetricdosecalculationand
DVHevaluation.Thismaybenecessaryinthecaseofanemergency
treatmentwithnoprevious3Dplanning,ormistreatment(too
many/notenoughMU)thatneedstobecompensatedforbycreatinga
newplanbasedonthetreatedMU.Also,whendosedistributionsare
calculatedforverificationplansthatdonotcontainactualfluences,the
calculationisautomaticallydoneusingfixedMUs.
MUvaluescalculatedforaplanarealsoclearedasaresultofanumber
ofactions,anditmaybenecessarytorecalculatethedoseusingthe
previousMUvalues.

EclipsecalculatesMUvaluestogreaterprecisionthanthetreatment
unitisabletoproduce.Thismayleadtominordiscrepanciesin
calculatedanddelivereddosedistributions.TheCalculateVolume
withFixedMUstoolalsoallowsrecalculatingthedoseusingtheMU
precisionofthetreatmentunitinsteadoftheEclipseinternalprecision.
NoticethattheInfowindowalwaysdisplaystheMUvaluesinthe
precisionofthetreatmentunit.ToviewtheexactMUvaluecalculated
byEclipse,placethemousepointeroverthecellsintheMUcolumn
andviewtheMUvalueinatooltip.
Note: TobeabletocalculatethevolumetricdosebasedonfixedMUvalues,the
plannormalizationmodemustbesettoNoNormalizationorPlan
NormalizationValue.Moreover,theplanmaynotcontainmorethanone
fractionation.
To Calculate the Dose Distribution Based on MU
1. Openthedesiredplan.
2. FromtheScopewindow,dragtheplantoanimageview.
TheplanisnowactiveanditsdetailsaredisplayedintheInfo
window.TheoriginalMUvaluesaresavedtemporarily.
3. Iftheplanhasnoimageassociatedwithit,
a. RightclicktheplanintheFocuswindowandchooseAssign
PatientImage.
For2Dplans,theimageselectionalsosetsfieldweights.
b. Adjusttheisocenterlocations.
Thevolumetricdosedistribution(imageviews)andtheMU
values(Infowindow)disappear.
4. Ifnecessary,definethecalculationvolume.Forinstructions,see
ToEdittheCalculationVolumeforExternalBeamPlanson
page 614.
5. ChoosePlanning>Dose Calculation> CalculateVolumewith
FixedMUs.
TheCalculateDosewithFixedMUsdialogboxopens.Theoriginal
MUvaluesoftheplanareshown.Awarningisshowniftheplan
normalizationmodeneedstobechanged.
6. DefinethedesiredMUvaluesforeachfieldintheMUcolumn.

7. Todefinethedesireddoseforareferencepoint,selecttheUse
checkbox,selectthereferencepointintheIDcolumn,anddefine
thedesireddoseintheDosecolumn.
8. ToshowtheMUvalueintheprecisionoftheselectedtreatment
unit,clickRoundMUstomachineprecision.
9. ToreadthecurrentMUvalueoftheplan,clickGetcurrentMU
values.
10. IntheAbsoluteDosimetrygroupbox,definethedesireddose
values:
Numberoffractions
DoseperfractioninGyorcGy
Plannormalizationvalueinpercentage
11. Tocalculatethedose,clickOK.
Thevolumetricdoseiscalculatedforallfieldsandthefield
weightsareadjustedtoretaintheoriginalMUvalues.
Using Field Weight Factors

Field Setup Workspace, Plan Evaluation Workspace
Thetotaldosedistributionofaplaniscalculatedbyaddingthe
individualfielddosedistributions.Beforedoingthis,thedose
distributionsofeachfieldaremultipliedwiththerespectivefield
weights,whichindicatetherelativeweightofeachfieldinaplan.How
thefieldweightsaffectthedosedistributionisdeterminedbythe
selectedfieldnormalizationmethod.
Eclipseenablesyoutochangethefieldweightsinteractivelyto
finetunedosedistributions,forinstance,inplansusingthe
fieldinfieldtechnique(seeAbouttheFieldinFieldTechniqueon
page 532).Achangemadeinthefieldweightsautomatically
normalizesthedose(usingthecurrentdefaultnormalizationmethod)
anddisplaysthenewdosedistributiononscreenwithouttheneedfor
recalculation.Forinformationonplannormalization,seePlan
Normalizationonpage 643.Forinformationonfieldnormalization,
refertoEclipseAlgorithmsReferenceGuide.

Fieldweightsofallfieldsincludedintheactiveplanorplansumcan
beviewedandchangedintheFieldWeightsdialogbox.Inthisdialog
box,youcanchangethe
Individualfieldweights(changesthetotalsum)
Totalsumofallweights(changestheindividualweights)
Dosepercentageofeachfield,calculatedfromthetotalweightsum
(modifiestheindividualfieldweightbutdoesnotaffectthetotal
sum)
ThetotalsumisalwaysthesumofthefieldsshownintheField
Weightsdialogbox,notnecessarilythetotalsumofallfieldsinthe
activeplan.
Youcanalsolocktheweightsofthefieldstokeepthemthesamewhile
changingtheotherweights.Lockingafieldweightalsolocksthetotal
weightsum.However,thelockingisvalidonlywhiletheField
Weightsdialogboxisopen.Itisalsopossibletosettheweightsofall
fieldsthathavenotbeenlockedtothesamevalue.
Note: Whenworkingwithfieldweights,noticethefollowing:
Youcannotchangetheweightfactorofafieldthatbelongstoanapproved
plan.
FieldweightscanalsobeeditedintheFieldPropertiesdialogboxandthe
FieldInfoview,butyoucanlockfieldweightsonlyintheFieldWeights
dialogbox.ThelockingisnotvalidoutsidetheFieldWeightsdialogbox.

To Change the Field Weight Factors
1. Opentheplanorplansum.
2. ChoosePlanning >FieldWeight.
TheFieldWeightsdialogboxopens.
Ifthedialogboxobstructsyourviewtotheplan,resizeitbydraggingthe
bottomrightcornerofthedialogbox.
A. FieldIDs(readbytheIDfilter)B. CurrentfieldweightsC. Typethenewfieldweights

hereD. TypethedesiredsumofthefieldweightshereE. Typethenewfieldweightasa
percentageofthesumoffieldweightshereorusethesliders.F. Selectthesecheckboxesto
locktheweightsofindividualfieldsandthesumofthefieldweights.G.Toresizethedialog
box,dragthecornerofthedialogbox
3. Toviewonlyparticularfieldsinthedialogbox,typeyourfiltering
criteriaintheIDFilterboxandpressENTER.Forinstance,youcan
showonlysomespecificfieldsfromtheactiveplanorinaspecific
planinaplansum.Ifyouhavethreeplansintheplansum(Plan1,
Plan2,andPlan3)andonlywishtoseethefieldsinPlan2,type
plan2asthecriteria.Thefilteringiscaseinsensitive.
4. Tochangethedesiredsumofthefieldweights,typeinthenew
valueintheTotalrow.Thischangeaffectsonlyunlockedfield
weights.
5. Tochangetheweightsofindividualfields,dooneofthefollowing:
TypeinthedesiredweightintheWeightcolumn.Therangeis
0100.
Typeinthedesiredpercentageinthe%column.Thisisthe
percentageofthefieldweightofthetotalsumoftheweights.
Movethesliderhandleswiththemouse.Thischangesthefield
weightpercentage.

6. Tolocktheweightofafieldorfields,selectthecheckboxofeach
fieldintheLockcolumn.
Tolock/unlockallfields,clicktheLockcolumntitle.
Thetotalsumofthefieldweightsisalwayskeptstaticunlessyou
specificallychangeitbytypinginanewvalue.
7. Tosetallthefieldweightsthathavenotbeenlockedtothesame
value,clickEqualize.
8. Tokeeppreviewingtheeffectofchangingthefieldweights,select
theInteractiveapplycheckbox.
9. Topreviewtheeffectofchangingthefieldweights,clickApply.
10. Toclosethedialogbox,clickClose.
Managing the Dose Visualization

Aftercreatingaplanandcalculatingthedosedistributioninthe
ExternalBeamPlanningtask,youcandisplaythedosedistributionin
the2Dimageviews,theArcPlaneView(iftheplancontainsarcfields)
andtheModelview.
Thedosedistributioninformationisindicatedeitherasanabsolute
(Gy)orarelative(%)dose,andvisualizedrespectively.IntheExternal
BeamPlanningtask,theabsolutedosedistributionsareshownonly
whenthedoseprescriptionhasbeendefined.Theabsolutedose
shownisalwaysthetotaldose,iftherearemultiplefractionations.
Youcanchangethevisualizationmodeasnecessaryanddefinehow
thedosevaluesaredisplayedasfollows:
Showthedoseintheisodoseorcolorwashmodein2Dimageviews;
orinthedosecloudmodeorsurfacedosemodeinModelview.
Selecttheisodoselevelsshown,anddisplayonlythemost
significantdoselevels,dependingonwhatisappropriateineach
situation.
Showthepersistentdoseintheimageviews,whentheplanhas
beenchangedafterthedoseiscalculated.
ModifytheisodosecolorandstyleusedinModelview(contour,
translucent,segment).
Showorhidetheisodoselabelsandthedosemaximumpoint.
Showorhidethedosestatisticsinthe2Dimageviewsandthe
Modelview.

Onlyonevisualizationmodecanbeusedatatime.Youcannotdisplay
thedoseasisodoselinesinone2Dimageviewandinthecolorwash
modeinanother.
Note: IntheExternalBeamPlanningtask,duetointerpolationinthedose
visualization,thedosedistributionmayextendoutsidetheBodystructure,
especiallywhenyouuselargecalculationgridsizes,forinstance,10mm.
Note: Forphotonandelectronplans,thedoseiscalculatedontransversal
planesonly.Whenviewingthedoseonsagittalorfrontalreconstructions,or
intheArcPlaneView,thedosedisplayedisaninterpolationofthedose
calculatedonthetransversalplanes.Toincreasetheaccuracyinviewingthe
interpolateddose,useaplanedistancesmallerthan5mm.Theplanedistance
isdefinedintheCreate3DImagedialogboxwhichopenswhenyoucreatea
new3DimagewiththeInsert>New3DImagecommand.
Isodoses in the External Beam Planning Task

Bydefault,theimageviewsdisplaytheresultingdoseasisodoses.The
followingfigureshowsanexampleofthedosedisplayedasisodoses.
Figure 169 Isodoses in 2D View and Model View
Inthisvisualizationmode,theselectedisodosesaredisplayedas
coloredcontoursinthe2Dimageviews,theArcPlaneView(ifthe
plancontainsarcfields)andtheModelview.Alegendintheupperleft

corneroftheimageviewsshowsthecolorusedforeachisodoseand
thedosevalueseitherinrelative(%)orabsolute(Gy)mode,
dependingontheselection.Theabsolutedosedistributionsareshown
onlywhenthedoseprescriptioniscompleted.Absolutedoseis
displayedasthetotaldoseforthefractionsand/orfractionations
definedforthedoseprescription.
Note: Youcanviewonlysignificantisodoselevelsinthe2Dimageviewsin
particulartreatmentcasesbyusingpredefinedisodosesets.Theisodoselevels
includedineachsetaredefinedintheAdministrationtask.
Color Wash in the External Beam Planning Task

Inthedosecolorwashvisualizationmode,thedoseisdisplayedwitha
continuouscolormapinthe2DimageviewsandintheArcPlane
View,andasadosecloudorsurfacedoseintheModelview.
Figure 170onpage 628showsanexampleofadosedistribution
displayedinthecolorwashmodeina2Dview.Forclarity,thefields
arehiddeninthefigure.
Figure 170 Dose Color Wash in 2D View
Figure 171onpage 628showsanexampleofadosedistribution

displayedinthecolorwashmodeintheArcPlaneView.

Figure 171 Dose Color Wash in Arc Plane View
Figure 172onpage 629showsanexampleofthedosevisualizedasa

dosecloudandasurfacedoseonthesurfaceoftheselected,visible
structure.Inthesurfacedose,onlythedosefortheselectedstructureis
shown.
Figure 172 Dose Cloud and Surface Dose in Model View
Inboth2DviewsandtheModelview,theleftcorneroftheview
containsthedosecolorwashslider,whichshowstherangeofdose
levelsdisplayedandisusedtoselectthedoselevelsdisplayed.The

slideralsoshowstheuseofrelative(%)orabsolute(Gy)dosevalues.
Theabsolutedosedistributionsareshownonlywhenthedose
prescriptionisdone,andtheabsolutedoseisalwaysthetotaldose,if
therearemultiplefractionations.
Defining the Dose Levels Displayed in the Color Wash Mode

Bydefault,thecontinuouscolormapusedinthecolorwashdose
visualizationmodecontainsalldosevaluesinthedefineddoserange.
Youcaneithershowthewholedosedistributionfromtheminimumto
themaximumdoseorlimitthevisualizationtoviewonlythe
significantpartofthedosedistributionby
Numericallydefiningupperandlowerdosevaluestobeshown
Definingtheupperandlowerdosevaluestobeshownbymoving
thehandlesonthedosecolorwashsliderwiththemouse
Definingthelowerdosevaluetothetargetminimumandthe
upperdosevaluetothetargetmaximum
Usingthelowestandhighestisodoselevelintheselectedisodose
levelsetasthelowerandupperdosevalue
Thewholespectrumofthecontinuouscolormapisstretchedor
compressedbetweenthedefinedupperandlowerdosevalue.
Ifsomedosevaluesfalloutsidetherangewhenusingthecolorwash
slidertodefinethedoserange,theyarevisualizedinaparticularway.
Inasingleplan,dosevaluesexceedingtherangeareshownwitha
specialcolor,butdosevaluesbelowtherangearenotvisualized.Ina
summedplan(inthePlanEvaluationworkspace),bothdosevalues
aboveandbelowtherangeareshownwithspecialcolors.
Figure 173onpage 631showshowthedoseaboveandbelowthe
defineddoserangearedisplayedintheExternalBeamPlanningtask.

A.Dosevaluesabovethedefinedrangeinasingleexternalbeamplan.B.Dosevaluesabovethe
definedrangeinasummedexternalbeamplan.C.Dosevaluesbelowthedefinedrangeina
summedexternalbeamplan.
Figure 173 Visualization of Dose outside Defined Range in External Beam Plans
Note: Toviewonlysignificantisodoselevelsinthe2Dimageviewsin
particulartreatmentcases,youcanalsousepredefinedisodosesets.The
isodoselevelsincludedineachsetaswellasthedefaultisodoseleveltemplate
fortheExternalBeamPlanningtaskaredefinedintheAdministrationtask.
Showing the Persistent Dose

Forexternalbeamplans,youcandefinethattheapplicationshowsthe
previouslycalculated,outdateddosedistributioninallimageviewsin
theFieldSetupworkspace.Thisisuseful,forexample,ifyouneedto
modifyblocks,MLCs,fluencesorcompensatorsafterreviewingthe
calculateddosetoimprovetheoveralldosedistribution.Whenthe
persistentdoseisdisplayed,youcan,forexample,followanisodose
linetoeditablockaperture.
WARNING: Be careful not to make any treatment decisions based on the

outdated, weighted or not fully visualized dose for any plans or plan sums.

Whentheoptionforshowingthepersistentdosedistributionis
selected,awarningmessagepromptingtorecalculatethedoseis
displayedinallimageviewsiftheplaninformationischangedafter
thedosedistributionfortheplaniscalculated(seeFigure 174on
page 632).
Figure 174 Visualization of Persistent Dose in External Beam Plans
Whenthepersistentdoseisdisplayed,thePointDoseandDoseProfile
tools,referencepoints,andtheDoseVolumeHistogramviewdonot
showanydoseinformation.Modifyingthefieldweight,dose
prescription,fractionation,oraddingordeletingfieldshasnoeffecton
thepersistentdose.Itisnotpossibletochangethedosemodefrom
relativetoabsoluteorviceversawhenthepersistentdoseisdisplayed.
Awarningmessageisdisplayedifyoutrytoapproveaplan,printor
useDICOMprint,approveaplanfortreatment,normalizeaplan,
exportaplan,saveaplan,orchangethecalculationareawhenthe
persistentdoseisdisplayed.Ifyouacceptthewarningmessagestating
thatthedosedistributioniscleared,youcancontinueperforming
theseoperations.Ifyoudonotacceptthatthedosedistributionis
cleared,youarenotallowedtoperformtheaboveoperations.
Ifyoucopyaplan,thepersistentdosedistributionisclearedfromthe
copiedplan.Thepersistentdoseisalsocleared,ifyouchangethesize
ofthecalculationvolume.

To Show the Persistent Dose
2. SelectthePersistentDosetab.
Todefinethatthepersistentdoseisvisualizedintheimage
views,selecttheUsepersistentdosecheckbox.
Todefinethatthepersistentdoseisnotvisualizedintheimage
views,cleartheUsepersistentdosecheckbox.
thesamedatabase.
4. ClickOK.
Showing the Absolute or Relative Dose

IntheExternalBeamPlanningtask,tobeabletoshowtheabsolute
doseonscreen,youmustfirstdefinethedoseprescription.Ifthedose
prescriptionisnotdefined,therelativedoseisalwaysdisplayed,even
iftheabsolutedoseisselected.Theabsolutedoseisalwaysthetotal
dose,iftherearemultiplefractionations.
To Show Absolute or Relative Dose
1. IntheFocuswindow,rightclickthedose.
Todisplaytheabsolutedose,makesurethattheAbsolute
Dosemenucommandisselected(hasacheckmark).
Todisplaytherelativedose,makesurethattheAbsoluteDose
menucommandisnotselected(thereisnocheckmark).

To Show the Dose as Isodoses or in the Color Wash Mode
1. IntheFocuswindow,rightclickthedose.
Todisplaythedoseinthecolorwashmode,chooseDose
ColorWash >ShowDoseinColorWash(acheckmark
appearsnexttothecommand).
Todisplaythedoseasisodoselines,cleartheShowDosein
ColorWashmenucommand(thecheckmarkdisappears).
Bydefaultthesliderisdisplayedonlyinone2DviewintheExternal
BeamPlanningtask.Youcanshowthehiddensliderintheotherimage
viewsbymaximizingtheview.
To Show the Surface Dose in the Model View

IntheFocuswindow,rightclickthedesiredstructureandchoose
ShowSurfaceDose.
Thesurfacedoseisdisplayedandthesliderappearsintheupper
leftcorneroftheview.
To Select the Dose Color Wash Levels in the 2D Image Views

Todefinetheupperandlowerdoselevelshownwiththecolor
washslider,dragthesliderhandles.
Inthisoption,thecolorwashmapisnotcompressedbetweentheupper
andlowerdoselevel.
Toshowthedosedistributionbetweentheisodoselevelsdefined
bythepositionsofthecolorwashsliderhandles,dragtheslider
handlestothedesiredlevels.ThengototheFocuswindow,
rightclickthedose,chooseDoseColorWash >Rangebetween
SliderHandles.
Todefinetheupperandlowerdoselevelnumerically,inthetext
boxesbelowandabovetheslider,typethelevelvaluesandpress
ENTER.
Toshowthedosedistributionbetweenthetargetminimumdose
andthetargetmaximumdose,gototheFocuswindowand
rightclickthedose.ChooseDoseColorWash >Rangefrom
TargetDoseMinimumtoMaximum.

Tousethelowestandhighestisodoselevelintheselectedisodose
levelset,gototheFocuswindowandrightclickthedose.Choose
DoseColorWash >RangebetweenIsodoseSetLevels.
Toreturnthecolorwashtothedefaultstate,intheFocuswindow,
rightclickthedose,chooseDoseColorWash >ResetColorWash.
Thefollowingfiguresshowtheslider.
A.Pointatahandleinthecolorwashslider.B.Movetheslider.
To Select the Isodose Levels Displayed in the Model View

1. ChoosePlanning >IsodoseLevels.
Dependingontheselecteddosedisplaymode,eithertheRelative
DoseIsolevelEditorortheAbsoluteDoseIsolevelEditoropens.If
thedosedisplayedisabsolute,theunitintheDosecolumnisGy.If
thedosedisplayedisrelative,theunitintheDosecolumnis
percentage.
Inthe3Dcolumn,selectthecheckboxoftheisodoselevelyou
wishtoshow,orclearthecheckboxtohidetheisodoselevel.
2. ClickOK.
To Select a Predefined Isodose Set

TheAbsolute/RelativeDoseIsolevelEditordialogboxopens.
2. InCopyLevelsfromdropdownlist,selecttheisodoseset.
3. ClickOK.
Theisodoselevelsetissavedwiththeplan.

To Modify the Isodose Levels in an Isodose Set
Tochangetheisodoselinewidth,clickthecellintheLine
widthcolumnandtypethewidthinthecell.
Tochangeanisodoselevel,clickitscellintheDosecolumn
andtypethenewisodosevalueinthecell.
Tochangetheisodosecolorandstyle,clickthecellintheColor
andStylecolumn,andselectthedesiredsettinginthelistbox.
Toshowthenewisodoselevelinthe3Dmodel,selectthe
checkboxinits3Dcolumn.
3. ClickOK.
Themodifiedisodoselevelsetissavedwiththeplan,however,theisodose
linethicknessissavedusingthedefaultvalue.
To Add Isodose Levels to an Isodose Set

2. Toaddanisodoselevel,clickAddlevel.
3. EditthecellsasinToModifytheIsodoseLevelsinanIsodoseSet
above.
4. Toshowthenewisodoselevelinthe3Dmodel,selectthecheck
boxinits3Dcolumn.
5. ClickOK.
To Delete Isodose Levels from an Isodose Set

TheDoseIsolevelEditordialogboxopens.

Todeleteoneisodoselevel,clickoneofthecellsintherow.
Todeleteseveralisodoselevels,pressthemousebuttonwhile
pointingatthefirstonetodelete,andkeepingthemouse
buttondown,movethemousepointertothelastonetodelete.
3. ClickDeletelevel.
Youarepromptedtoconfirmthedeletion.
4. Toconfirmthedeletion,clickYes.
Theselectedisodoselevel(s)aredeleted.
5. ClickOK.
Converting an Isodose Level to a Structure

Tomake,forexample,thefieldinfieldplanninglesstimeconsuming
andmoreaccurate,youcanfitfieldapertures(MLCsandBlocks)toa
selectedisodoseleveloftheexistingdosedistribution.Beforeyoucan
fitafieldaperturetoanisodoselevel,youmustconverttheisodose
leveltoastructure.
To Convert an Isodose Level to a Structure
1. Ifnotalreadydone,calculatethedosedistributionfortheactive
plan.
2. IntheFocuswindow,rightclickDoseandchooseConvertIsodose
LeveltoStructure.
TheConvertIsodoseLeveltoStructuredialogboxopens.
3. IntheIsodoseLeveltextbox,typetheisodoselevelinpercentages
toconverttoastructure.
4. ClickOK.
5. Fillinormodifytheinformationasneeded.Formoreinformation,
seeToAddaNewStructureonpage 185.
6. ClickOKtoclosetheStructurePropertiesdialogbox.
Theselectedisodoselevelisconvertedtoastructureandthenew
structureisdisplayedintheFocuswindow.

Dose Statistics
Apartfromthevisualrepresentationofthecalculateddose
distribution,thefollowinginformationisalsoshownintheimage
views:
Locationofthedosemaximum(Dmax)point
Dosestatistics
Dose Maximum (Dmax) Point
Youcanshowthelocationofthedosemaximum(Dmax)inaplan.The
2DimageviewsshowthelocationoftheDmaxontheactiveviewing
plane;theModelviewandtheBEVshowthelocationofthe3Ddose
maximuminsidethethreedimensionalcalculationmatrix.TheDmax
canbeshownintheFieldSetupworkspaceandthePlanEvaluation
workspace.
Thedosemaximumpointisshownasareddotaccompaniedwiththe
dosevalueatthepointasinFigure 175onpage 639.
Figure 175 Dose Maximum Point in 2D Image View, Model View and BEV
The3DdosemaximumpointmaybeseeminglyinvisibleintheModel
view.Thisisbecauseitispositionedrealisticallyin3Dspaceand,
dependingontheviewingangle,maybeobstructedbyastructureor
anisodosevisualization.IntheBEVhowever,the3Ddosemaximum
pointisalwaysshownontopofallstructures.

TheDmaxpointlocatedattheintersectionoftheviewingplanesis
shownhighlightedinthe2Dimageviews(Figure 176onpage 640).
Moreover,ifaviewingplaneshowninoneofthe2Dimageviewsin
theFieldSetupworkspaceintersectswiththelocationofthe3Ddose
maximumvaluepoint,thedosemaximumpointishighlightedonthat
viewingplane.
Figure 176 Highlighted Dose Maximum Point in 2D Image View
Statistical Dose Information
The2Ddosestatisticscanbeshowninevery2Dviewasadifferential
2Ddoseareahistogram(DAH).TheDAHisshownfortheactive
structure.Ifnostructureisactive,theDAHisdisplayedfortheTarget
VolumedefinedinthePlanPropertiesdialogbox.TheDAHshowsthe
minimum,maximumandmeandosevaluesforthestructure.Youcan
showorhidetheDAHasisconvenient.TheDAHisavailableinthe
FieldSetupworkspaceandthePlanEvaluationworkspace.
Note: TohaveEclipseworkfaster,hidetheDAHwheneveryoudonotneedto
view2Dstatisticaldoseinformation.
Figure 177onpage 640showstheDAHofanexternalbeamplanina
2DimageviewintheFieldSetupworkspace.
Figure 177 Dose Area Histogram in Field Setup Workspace

The3DdosestatisticscanbeshownintheModelview.Thestatistics
showthedosevaluesinsidetheentirecalculationvolume.The
informationdisplayedincludesthe3Ddosemaximumvalue,and
maximum,meanandminimumdoseintheplanTargetVolume.You
canshoworhidethe3Ddosestatisticsasisconvenient.3Ddose
statisticsareavailableintheFieldSetupworkspaceandthePlan
Evaluationworkspace.
Note: Inthecaseofaplansum,the3Ddosestatisticsshowstatisticaldose
informationforthetargetvolumeofthefirstplaninthelistoftheplans
includedintheplansum.
Figure 178onpage 641showsthe3Ddosestatisticsofanexternal
beamplanintheModelviewintheFieldSetupworkspace.
Figure 178 External Beam Plan Dose Statistics in the Model View
Inasituationwherea2DviewismaximizedintheExternalBeam
Planningtask,and3DdosestatisticsisselectedinViewOptions,the
3Ddosestatisticsareshowninthe2Dviewsidenexttothedose
statisticsofthe2Dimageview.
Figure 179 3D Dose Statistics and DAH in a 2D Image View
To Show or Hide the Dose Statistics


3. IntheDosegroupbox,dooneofthefollowing:
ToshowthestatisticaldoseinformationintheModelview,
selectthe3DStatisticscheckbox.
Toshowthestatisticaldoseinformationinthetopleft2D
imageview,selectthe2DStatistics(DAH)checkboxandthe
Inprimaryviewoption.
Toshowthestatisticaldoseinformationinall2Dimageviews,
selectthe2DStatistics(DAH)checkboxandtheInallviews
option.
Tohidethestatisticaldoseinformation,cleartheappropriate
checkbox.
4. ClickOK.
To Show or Hide the Dose Maximum Point

3. Toshowthedosemaximumpoint,selecttheShowDMAXcheck
box.
Tohidethepoint,clearthecheckbox.
4. ToseethecoordinatesoftheDmaxpointmovetheviewingplanes
totheGlobalDoseMaximum(seeToMoveViewingPlanestothe
Doseonpage 643)andcheckthecoordinatesatthebottomof
eachimageview.
To Move Viewing Planes to the Dose

1. GototheFieldSetuporPlanEvaluationworkspace.
2. ChooseView >MoveViewingPlanesto >Doseandselect
GlobalDoseMaximum,tomovetheintersectionpointofthe
viewingplanestothepointthatreceivesthemaximumdosein
theplan
TargetDoseMaximum,tomovetheintersectionpointofthe
viewingplanestothepointthatreceivesthemaximumdosein
thetargetstructure
TargetDoseMinimum,tomovetheintersectionpointofthe
viewingplanestothepointthatreceivestheminimumdosein
thetargetstructure.

Plan Normalization
Inplannormalization,totaldosedistributionsarenormalizedto100%
ataselectedvalueorpoint,ortoaselecteddosepercentageofa
selectedpercentageofapatientstructure.
Eclipsesupportstwotypesofplannormalization:
Defaultplannormalization,whichisaclinicwidenormalization
usedforallnewplans
Planspecificplannormalization,whichcanbeselectedtooverride
thedefaultnormalizationmethodifyoudonotwanttousethe
defaultplannormalization
Thenormalizationoptionssupportedinthesetwotypesarethesame.
Theselectednormalizationmethod,itsparametersandthe
coordinatesofthenormalizationpointareshowninthePlan
Propertiesdialogbox.Inaddition,theresultingplannormalization
valueisshownintheInfowindowandinprintouts.Formore
informationontheInfowindow,seeChapter 3,SectionInfo
Windowonpage 75.Formoreinformationonprintouts,see
Chapter 26,PrintingPlanInformation,onpage 725.
Whenchangesaremadetotheactiveplan,itisautomatically
renormalizedusingtheselectedmethod.Thereisnoneedto
manuallyrenormalizetheplan.Automaticrenormalizationisdone
when
Thedoseisrecalculated
Thefieldweightingischanged
Thereferencepoint,primaryorother,selectedfornormalizationis
modifiedormovedtoanotherlocation
Thetargetstructureischanged,ifatargetrelatednormalization
methodisselected
Afieldisremovedfromtheplan
Thenormalizationmodeischanged
Amotorizedwedgecontainedintheplanismodified
Note: Theplandoesnotnecessarilycontainanysinglepointthatwould
exactlycorrespondtothedefinednormalizationpercentage.
Note: InthecaseofanIMRTplan,itisadvisabletoruntheLeafMotion
Calculator(LMC)afterchangesintheplannormalization.

Fortheequationforcalculatingthedosedistributionwithaplan
normalizationvalueintheExternalBeamPlanningtask,seeUsing
FieldWeightFactorsonpage 622.
Plan Normalization Options

Boththedefaultplannormalizationmethodandtheplanspecificplan
normalizationusethefollowingnormalizationoptions.
Table 20 Plan Normalization Options
Option Description
100%atBody Themaximumdosevalueinthebodyisnormalized
maximum to100%.
100%atTarget Themaximumdosevalueintheplantargetvolume
maximum isnormalizedto100%.
100%atTarget Theminimumdosevalueintheplantargetvolumeis
minimum normalizedto100%.
100%atTargetmean Themeandosevalueintheplantargetvolumeis
normalizedto100%.
<n>%covers<n>%of Thedoseintheuserdefinedamountoftheplan
targetvolume targetvolumeisnormalizedtotheuserdefineddose
percentage.
100%atPrimary Thedosevalueatthereferencepointmarkedasthe
referencepoint primaryreferencepointisnormalizedto100%.
100%atFieldIsocenter Thedosevalueattheisocenteroftheselectedfieldis
normalizedto100%.
Plannormalization Theplanisnormalizedaccordingtotheuserdefined
value normalizationvalue,forinstance,200%
Nonormalization Theplanisnormalizedaccordingtothe
normalizationtypedefinedforthecalculationmodel
inuse.
Inadditiontotheseoptions,planscanalsobenormalizedto100%at
theselectedreferencepoint.However,thisoptioncannotbe
configuredasthedefaultnormalizationoption.

To Normalize the Plan
1. ChoosePlanning >PlanNormalization.
ThePlanNormalizationdialogboxopens.
2. Toselectthenormalizationmethod,selecttheappropriateoption
button:
100%atBodyMaximum
100%atTargetMaximum
100%atTargetMean
100%atTargetMinimum
<n>%Covers<n>%ofTargetVolumeandthendefinethe
percentageofthedoseandthetargetvolumeinthetextboxes
100%atPrimaryReferencePoint
100%atReferencePointandthenselectthereferencepointin
thedropdownlistbox.
Whennormalizingthedosetoareferencepoint,checkthatthepointisnot
placedinalowdosearea.
100%atFieldIsocenterandthenselectthefieldinthe
dropdownlistbox
PlanNormalizationValueandthendefinethevalueinthe
textbox
NoPlanNormalization
3. ClickOK.
To Define the Default Plan Normalization Method

2. SelecttheDefaultPlanNormalizationModetab.

3. Toselectthenormalizationmethod,selecttheappropriateoption
button:
100%atBodyMaximum
100%atTargetMaximum
100%atTargetMean
100%atTargetMinimum
<n>%Covers<n>%ofTargetVolumeandthendefinethe
desiredpercentageofthedoseandthetargetvolumeinthe
textboxes
100%atPrimaryReferencePoint
100%atFieldIsocenter
PlanNormalizationValueandthendefinethevalueinthe
textbox
NoPlanNormalization
4. ClickOK.

Chapter 25 Evaluating Plans
Field Setup Workspace, Plan Evaluation Workspace
Thischapterdescribeshowtousetheplanevaluationtools.Thetools
forviewingthepointdosesanddoseprofilesaredescribed.
Stepbystepinstructionsareprovidedforcomparingplansvisually,
usingdosevolumehistogramsforevaluatingasingleplanand
multipleplans,aswellasforsummingupplanstocompareand
evaluatealternativeplanscreatedforapatient.Instructionsfor
approvingplansfortreatmentarealsoincluded.
About Evaluating Plans

Eclipsecanevaluateplansasfollows:
Visuallybyreviewingandcomparing3Ddosedistributionsto
decidewhichofthealternativeplanswillbeusedfortreatment
InthePlanEvaluationworkspace,youcannotchangeanyparameters
thatwouldinvalidatethedosecalculation.
Quantitativelybyusingthedosemeasurementtoolspointdose
valueanddoseprofile
Reductivelybyusingdosevolumehistogramsthatsummarizethe
overalldosereceivedbystructures.Thedosevolumehistogram
informationcanalsobeviewedinstatisticalformat,togetherwith
doseconformalityvalues.
Summingplanstomakesurethatthedelivereddoseisacceptable
ifthetreatmentconsistsofmultipleplans
Point Dose Value and Dose Profile

Field Setup Workspace and Plan Evaluation Workspace
Usethemeasurementtoolstogetherwithisodosesandcolorwashto
verifythedosedistribution.Thepointdoseandlinedosetoolsenable
studyingthedoseatonelocationordosegradientsatparticular
criticallocations,respectively.
639
Displaying the Point Dose
Thepointdoseisthedosecalculatedforapointthatyouclickona
planedisplayedinanimageview.Forinstance,usepointdosesfor
definingthenormalizationvalueusedfornormalizingthedose
distributiontoaselectedpointorforcheckingthedosevaluesata
criticalpoint.Youcandisplayseveralpointdosesatthesametimeand
dragthepointstothedesiredlocations.
IntheExternalBeamPlanningtask,thepointdoseinformation
includesthefollowing:
Absolutedose:ThetotaldoseinGyorcGytotheselectedpoint
brokendownintotheabsolutedosecontributionfromthe
individualfields
Relativedose:Thetotaldoseasapercentageoftheplan
normalizationvalueaswellasthenormalizedand
nonnormalizedrelativedosecontributionfromeachfield
Pointcoordinates:The(x,y,z)coordinatesofthepointexpressed
incentimeters
A.PointDosedialogboxshowingabsolutedoseB.Dosecontributionofeachfieldattheselected
pointC.TotalabsolutedosetotheselectedpointD.PointDosedialogboxshowingrelativedose
E.DosecontributionofeachfieldattheselectedpointF.Totalpercentualdosetotheselected
point
Figure 180 Point Dose Dialog Box in External Beam Planning Task, Absolute
and Relative Dose

To Display the Dose at the Selected Point
1. ChooseView >Measure >PointDose .

2. Inanimageview,clickapointofinteresttoshowthepointdose
information.
ThePointDosedialogboxopens,displayingthedoseatthe
selectedpointcontributedbyeachfieldseparately.
Creating a Dose Profile

Createadoseprofiletoderiveadditionalinformationfromtheisodose
plotofthedosedistribution.Thedoseprofileisusefultoviewthedose
ordosegradientsatcriticallocationsintheplan.Thefollowing
informationisdisplayedfortheselectedline:
Graphofthedosealonganarbitrarylinethroughtheplan
Graphofthedosecontributionfromeachfield
Startandendpointsofthedoseprofileline
Dosesamplingstepsandthestepsize
Maximumdosealongthelineinpercentageoftheprescribedtotal
doseorinabsolutedose(GyorcGy)
Figure 181onpage 652showsanexampleofalineprofile.
Figure 181 Dose Line Profile Dialog Box
Evaluating Plans 641

To Display the Dose Along a Line
1. ChooseView >Measure >DoseProfile .
2. Inanorthogonalview,clickthestartingpointofthedoseprofile.
TheDoseLineProfiledialogboxopens.
3. Movethemousetowhereyouwishtoendtheline.
Thedoseprofileisshownandchangesasyoumovethemouse.
4. Clicktheendpointoftheline.
Thedoseprofileshowsthedoseintensityalongtheline.
Youcanmovethelineintheimageviewbyusingthepantoolorby
draggingthehandlesateitherendoftheline.Toconstrainthemovement
toverticalandhorizontaldirections,pressSHIFTwhendragging.Youcan
maximize,minimizeorresizethedoselineprofiledialogboxasnecessary
andprintthedoseprofile.
5. Todisplaythedosevalueanddistanceatanypointalongtheline
profile,placethemousepointerinthegraph.
Thevalueanddistanceatthatpointaredisplayedinlabels.
To Export the Dose Profile

1. Tosavethedoseprofileasatextfile,clickExportintheDoseLine
Profiledialogbox.
TheExportDoseProfilesdialogboxopens.
2. IntheExportDoseProfilesdialogbox,selecttheprofilestoexport
andclickOK.
3. IntheSaveAsdialogbox,selectthedirectoryintowhichtosave
theexportfile,typeanamefortheprofileandclickSave.
Theprofileissavedinthedefineddirectory.
To Print out the Dose Profile

1. Toprintthedoseprofile,clickPrintintheDoseLineProfiledialog
box.
ThePrintdialogboxopens.
2. Selectthedesiredprinterandnumberofcopiestobeprinted.
3. ClickOK.

Dose-Volume Histogram
Field Setup Workspace and Plan Evaluation Workspace
Adosevolumehistogram(DVH)displaysthecomplex3Ddose
distributioninatwodimensionalgraph.TheDVHrevealsthedose
uniformitythroughoutstructuresandisanexcellenttoolfor
evaluatingdosedistributionsfromvariousplans.
Thedosevolumeinformation,togetherwiththedoseconformity
values,canalsobeviewedinstatisticalformatinthetheDoseStatistics
taboftheInfoWindow.
ThefunctionoftheDVHalgorithmisbasedoncalculateddose
distributionsandashapebasedinterpolationmodelforvolumes,
whichroundsstructureedgestobetterreproducetheshapesof
biologicalstructures.Theroundingeffectisstrongestinthe
Zdirection.Thesameshapebasedmodelisalsousedinvolume
calculationand3Dvisualization.Formoreinformationonvolume
modellinginDVH,refertoReferenceGuideforEclipseAlgorithms.
Viewing the DVH Graph

ADVHgraphcanbedisplayedintheModelviewinsteadofasolid3D
oraBEVimageofthepatient.TheDVHgraphshowsthedoseforthe
selectedstructuresinoneplanormultipleplans.Formoreinformation
oncalculatingtheDVHgraphs,seeToDisplayaDVHforOnePlan
onpage 661,ToDisplayaDVHforMultiplePlansintheFieldSetup
Workspace(ExternalBeamPlanningTask)onpage 665andTo
DisplayaDVHforMultiplePlansinthePlanEvaluationWorkspace
onpage 666.

Note: WhenusingaDVH,notethefollowing:
Youcandisplaythestructure,course,plan,doseandtheequivalent
spheredepthrelevanttopointsalongahistogramcurvebyactivatingthe
Crosshairtool,movingthemousepointeronthecurveandclicking.
BeforecreatingtheDVH,prescribethedosefortheplan.
DosestatisticsshownforstructuresintheDoseVolumeHistogramview
maydifferfromdosestatisticsshownelsewhere.Thisisduedifferent
modelingofthestructure.Formoreinformationonvolumemodellingin
DVH,refertoReferenceGuideforEclipseAlgorithms.
YoucanalsocalculateDVHsforstructurecombinations;formore
information,seeBooleanOperationsinDVHCalculationonpage 669.
Incaseswhereadefinedstructureisverysmall,thespatialresolutionis
differentforthedosematrixandthedefinedstructure.Thisleadstoa
situationwherethesamplingcoverageoftheDVHisnot100%,andthe
DVHcurveandstatisticsmaynotbefullyaccurate.Formore
information,seeAccuracyoftheDVHonpage 676.
TheDVHcanbeprintedanditcanbeexportedinASCIIformat.The
exporttextfilecontainstherowandcolumnvaluesofthehistogram.
Note: DVHcanalsobeexportedinDICOMformatwiththedosedatausing
theExport/Importwizard.Formoreinformation,seeChapter 27,Exportand
Import,onpage 765.
To View the DVH Graph
ToswitchtotheDoseVolumeHistogramView,dooneofthe
following:
ChoosePlanning >ShowDoseVolumeHistogramView.
RightclickintheModelviewandchooseShowDoseVolume
HistogramView.
TheDoseVolumeHistogramviewopensandtheDoseStatistics
taboftheInfowindowisdisplayed.Formoreinformationonthe
DoseStatisticstaboftheInfoWindow,seeDoseStatisticsTabof
theInfoWindowonpage 658.

Available DVH Types
DVHsformultiplestructuresfromasingleplancanbeplottedonthe
samegraph(singleplanDVH).Likewise,DVHcurvesformultiple
structuresfromseveraldifferentplanscanbeplottedonthesame
graph(multiplanDVH).Adoseareahistogramforanyimageplane
canbecalculatedfromwithintheExternalBeamPlanningtask.
TheavailableDVHtypesare
Cumulative
Differential
Natural(availableforBrachytherapyplansonly)
Formoreinformation,seeDVHforaSinglePlanonpage 660and
DVHforMultiplePlansonpage 662.
Cumulative DVH
ThecumulativeDVHgraphdisplaysthepercentage(relative)or
volume(absolute)ofstructuresthatreceiveadoseequaltoorgreater
thanadefineddose.Itisparticularlyusefulforsummarizingthedose
deliveredtoatargetstructure.Figure 182onpage 656illustratesa
cumulativeDVHgraph.
A.Forexample,thispointindicatesthat100%ofthestructurereceivesatleast87%ofthe
prescribeddose(orabout34Gy).B.Thesharperthecurvefallsbetweentheindicatedpointsthe
moreuniformisthedosedistribution.
Figure 182 Cumulative DVH Graph

InthecumulativeDVHgraph,theYaxisrepresentstheproportionof
thetotalvolumeofthestructuresreceivingaparticulardose.The
proportionofthevolumeisindicatedinpercentageorcm3.Thelower
Xaxisrepresentsthedoseindicatedeitherinpercentagesorin
absolutedosebetweenthedoserangevaluesdefinedintheDose
VolumeHistogramview.TheupperXaxisrepresentsthedose
indicatedinabsolutedose.
Ifbothrelativeandabsolutedosecannotbedisplayed,thelower
Xaxisrepresentsthecurrentlyavailabledosemode.Forplansums,
theonlyabsolutedosecanbedisplayed.Ifaplanhasnoprescription,
onlytherelativedoseisdisplayed.
Differential DVH
ThedifferentialDVHdisplaystheshareofthetotalvolumein
structuresreceivingacertaindoseasafunctionofequivalentdose
intervals.Itisusefulforsummarizingthedosedistributiontonormal
tissue.Figure 183onpage 657illustratesadifferentialDVHgraphfor
astructure.
A.Thewiderthepeak,thelessuniformisthedosedistribution.
Figure 183 Differential DVH Graph
InthedifferentialDVHgraph,theYaxisrepresentstheshareofthe
totalvolumeofthestructuresreceivingthedose.Thevolumeis
indicatedincm3/Gy,cGyor%.ThelowerXaxisrepresentsthedose

intervalswiththedoseindicatedeitherinrelativedoseorinabsolute
dose,andtheupperXaxisrepresentsthedoseintervalsinabsolute
dose.
Ifbothrelativeandabsolutedosecannotbedisplayed,thelower
Xaxisrepresentsthecurrentlyavailabledosemode.Forplansums,
theonlyabsolutedosecanbedisplayed.Ifaplanhasnoprescription,
onlytherelativedoseisdisplayed.
Natural DVH
ThenaturalDVHtypeisspecificallydesignedforevaluating
brachytherapyplans.ThisDVHtypedisplaystheshareofthetotal
volumeofstructuresreceivingacertaindoseagainstasetof
nonequidistantdoseintervals.Formoreinformationonthenatural
DVH,refertoReferenceGuideforBrachytherapyPlanning.
Dose Statistics Tab of the Info Window

IntheExternalBeamPlanningtask,theDoseStatisticstaboftheInfo
WindowisvisibleintheFieldSetupandPlanEvaluationworkspaces.
Thetabisusedforviewingtheselecteddosestatisticsandeditingthe
DVHgraph.YoucansortacolumnintheDoseStatisticstabby
clickingthecolumnheader.Formoreinformationondisplayingthe
DVHgraphs,seetheSectionsToDisplayaDVHforOnePlanon
page 661andToDisplayaDVHforMultiplePlansintheFieldSetup
Workspace(ExternalBeamPlanningTask)onpage 665.
Table 21 Information in the Dose Statistics Tab
Item Description
View ShowsifthestructureisincludedintheDVHgraph.
DVHline ThelinestyleusedforthestructureintheDVHgraph.
Structure Structuresfromeachimageoftheplanorplansumthat
isdisplayedintheviews.
ApprovalStatus Theapprovalstatusofthestructure.
Plan Theplanthatproducedthedoseforthestructure.
Course Thecoursethatcontainstheplanthatproducedthedose
forthestructure.

Item Description
Volume[cm3] Thevolumeofthestructureincubiccentimeters.
DoseCoverage[%] Thepercentageofthestructurevolumecoveredbythe
dosematrix.
SamplingCoverage Thepercentageofthestructurevolumeusedforthe
[%] DVHcalculation.
MinDose[%] Theminimumdoseinpercentages.
MaxDose[%] Themaximumdoseinpercentages.
MeanDose[%] Themeandoseinpercentages.
Modal Themodaldoseinpercentages.
Median Themediandoseinpercentages.
STD[%] Thestandarddeviationinpercentages.
Equiv.Sphere Equivalentspherediameterofthestructure,thatis,
Diam.[cm] diameterofaspherewiththesamevolumeasthe
structure.
ConformityIndex Doseconformityindexvalue(thevolumeclosedbythe
prescriptionisodosesurfacedividedbythetarget
volume).Reportedonlyfortheplantargetvolume,and
calculatedonlyiftheDVHcoverageoftheBody
structureintheplanimageisaccurateenough.
GradientMeasure Dosegradientvalueincentimeters(differencebetween
[cm] theequivalentsphereradiusoftheprescriptionand
halfprescriptionisodoses).
Reportedonlyfortheplantargetvolume,andcalculated
onlyiftheDVHcoverageoftheBodystructureinthe
planimageisaccurateenough.

Item Description
Displaysthedropdownlistcontainingthefollowing
menuitems:
ViewColumns:OpenstheDVHColumnSelection
dialogboxfordefiningthecolumnsthatarevisibleinthe
DoseStatisticstab.
Properties:OpenstheStructurePropertiesdialogboxof
thestructureinquestion.
AddExpression:OpenstheExpressionPropertiesdialog
boxforaddingvirtualstructurestotheDVHgraph.The
structuresarenotsavedinthedatabase,theyexistonly
aslongastheplanisopen.
Remove:RemovesavirtualstructurefromtheDose
Statisticstab.
A.TheselectedstructuresareincludedintheDVHcalculation.B.Thelinestyleusedforthe
structureintheDVHgraph.C.OpensthedialogboxfordefiningthecolumnsvisibleintheDose
Statisticstab.D.Opensthedialogboxforeditingstructurepropertiesofthestructurein
question,oraddingvirtualstructuresintheDVHgraph.
Figure 184 Dose Statistics Tab of the Info Window
DVH for a Single Plan

UseasingleplanDVHtocomparethedosereceivedbyseveral
structuresinoneplan.TocreateaDVHforoneplan,youselectthe
structurestoincludeintheDVHintheDoseStatisticstaboftheInfo
window,andtheprogramcalculatestheDVHstructurebystructure.
YoucanthendefinehowtoviewandscaletheDVH,andselectthe
DVHtype.
AsingleplanDVHcontainstheXandYaxisinformationasindicated
inAvailableDVHTypesonpage 656.Thecurveforastructureinthe
DVHgraphisdrawninthecolorselectedintheStructureProperties
dialogbox.

ForanexampleofacumulativesingleplanDVH,seeFigure 182on
page 656.ForanexampleofadifferentialsingleplanDVH,see
To Display a DVH for One Plan

1. ToswitchtotheDoseVolumeHistogramView,dooneofthe
following:
ChoosePlanning >ShowDoseVolumeHistogramView.
RightclickintheModelviewandchooseShowDoseVolume
HistogramView.
TheDoseVolumeHistogramviewopensandtheDose
StatisticstaboftheInfowindowisdisplayed.
2. FromtheDoseStatisticstaboftheInfoWindow,selectthecheck
boxesofthestructurestobeincludedintheDVH.
TheDVHiscalculatedautomaticallyforeachselectedstructure.
ThefinishedDVHgraphappearsintheDoseVolumeHistogram
view.TheDVHlineofthestructurethatislastselectedintheDose
StatisticstaborwiththeCrosshairtoolishighlighted.
AnotificationtextisdisplayedatthebottomoftheDoseVolume
Histogramviewandtherelevantcellishighlightedinredinthe
Infowindow,ifthedosecoverageislessthan100%andthe
samplingcoveragelessthan90%forastructure.
3. ToclosetheDVHgraph,rightclickintheDoseVolumeHistogram
viewanddeselectShowDoseVolumeHistogramView.
TheModelviewisdisplayedinsteadoftheDVHgraph.
ForinstructionsonusingthetoolsforviewingtheDVHgraph,seeTo
UsetheDVHToolsonpage 666.
Note: WhenusingDVHcalculation,noticethefollowing:
Ifthetargetstructureexceedstheselectedcalculationvolume,theDVHis
partiallycalculatedandamessageisdisplayed.Thismayoftenbethecase
fortheBodystructurebecausethedosecalculationandthevolume
calculationinterpretthevolumedifferently.IfthePartialcalculation
percentagestatediscloseto100%fortheBodystructure,themessageis
notcritical.
DosestatisticsshownforstructuresinDVHdialogboxmaydifferfrom
dosestatisticsshownelsewhere.Thisisduetodifferentmodelingofthe
structure.

DVH for Multiple Plans
AmultiplanDVHshowstheDVHcurvesformultiplestructuresfrom
severaldifferentplansonthesamegraph.UseamultiplanDVHin
theFieldSetuporinthePlanEvaluationworkspacetocomparethe
absolutedosereceivedbyoneorseveralstructuresincludedina
numberofplansorsummedplans.Theplanscanbelongtodifferent
courses.
ThecurvesinamultiplanDVHaredifferentiatedfromeachother
usingdifferentsymbolsforeachgraph.TheDVHcurvesforthesame
structurehavethesamecolorinallplans,iftheplansusethesame
image.Differentplansareindicatedwithdifferentsymbols.
TocreateamultiplanDVH,firstopentheplansyouwishtocompare.
IntheFieldSetupworkspace,startthecomparisonbyselectingthe
relevantplanstoincludeintheDVHinthePlanComparisonDVH
Propertiesdialogbox.InthePlanEvaluationworkspace,startthe
comparisonbydraggingtherelevantplansintheviewsetand
activatingtheDoseVolumeHistogramview.Thenselectthestructures
toincludeintheDVHcalculationandtheapplicationcalculatesthe
DVHfortheselections.YoucanalsocreateBooleanstructuresfora
multiplanDVH(seeBooleanOperationsinDVHCalculationon
page 669).
Note: WhenusingaDVH,notethefollowing:
Youcandisplaythestructure,course,plananddoserelevanttopoints
alongahistogramcurvebyactivatingtheCrosshairtool,movingthe
mousepointeronthecurveandclicking.
BeforecreatingtheDVH,prescribethedosefortheplan.
DosestatisticsshownforstructuresintheDoseVolumeHistogramview
maydifferfromdosestatisticsshownelsewhere.Thisisduetodifferent
modelingofthestructure.Formoreinformationonvolumemodelingin
IftheplansforthemultiplanDVHcontainsaplansumandaplan
withoutprescription,theDVHcannotbedisplayed.
Theplansmustusethesamedoseunits(percentages,GyorcGy)orhave
thesameprescriptionorplannormalization,otherwisetheDVHcannot
bedisplayed.
Iftheplanscontaindifferentprescriptions,youcanchoosetodisplaythe
DVHeitherinabsoluteorinrelativedose.NotethattheDVHgraphs
mightlooksimilarwhenviewedinrelativedose,butverydifferentwhen
viewedinabsolutedose.

Figure 185onpage 664showsanexampleofacumulativemultiplan
DVH:
A.CumulativeDVHcurvesforstructureAintwoplansB.CumulativeDVHcurvesforstructure
Bintwoplans.
Figure 185 Cumulative Multi-Plan DVH
Figure 186onpage 664showsanexampleofadifferentialmultiplan

DVH:
A.DifferentialDVHcurvesforstructureAintwoplansB.DifferentialDVHcurvesforstructure
Bintwoplans.
Figure 186 Differential Multi-Plan DVH

Field Setup Workspace (External Beam Planning Task)
1. ChoosePlanning >CreatePlanComparisonDVH.
ThePlanComparisonDVHPropertiesdialogboxopens.
2. SelecttheplanstoincludeinthemultiplanDVH.
3. ClickOKtodisplaythemultiplanDVH.
ThePlanComparisonicon appearsintheScopewindow,the
PlanComparisonDVHisdisplayedintheDoseVolume
HistogramviewandtheDoseStatisticstaboftheInfowindowis
displayed.TheDVHlineofthestructurethatislastselectedinthe
DoseStatisticstaborwiththeCrosshairtoolishighlighted.
IftheDoseVolumeHistogramviewisnotactivated,rightclickin
theModelviewandchooseShowDoseVolumeHistogramview
fromthedropdownlistthatopens.Ifnotalreadyselectedinthe
individualplans,selectthedesiredstructurestocompareinthe
DVHintheDoseStatisticstaboftheInfoWindow.
AnotificationtextisdisplayedatthebottomoftheDoseVolume
Histogramviewandtherelevantcellishighlightedinredinthe
Infowindow,ifthedosecoverageislessthan100%andthe
samplingcoveragelessthan90%forastructure.
ForinstructionsonusingthetoolsforviewingtheDVHgraph,seeTo
UsetheDVHToolsonpage 666.
Note: NotethefollowingwhendisplayingthemultiplanDVH:
YoucandisplayamultiplanDVHalsobyshowingasingleplanDVH
intheDoseVolumeHistogramviewanddragginganotherplanontopof
it.
DosestatisticsshownforstructuresinDoseVolumeHistogramview
maydifferfromdosestatisticsshownelsewhere.Thisisduedifferent
modelingofthestructure.Formoreinformationonvolumemodelingin

1. Toselecttheappropriateviewlayout:
a. ChooseWindow >ViewLayouts.TheSwitchlayoutdialog
boxopens.
b. SelectthedesiredlayoutandclickOK.
2. FromtheScopewindow,dragtheplanstoincludeinthe
multiplanDVHintotheplanevaluationviewsets.
3. ChooseEvaluation >ShowDoseVolumeHistogramview.
TheDoseVolumeHistogramViewisdisplayed.
4. Ifneeded,definethestructuresthatareincludedintheDVHgraph
byselectingthemintheDoseStatisticstaboftheInfowindow.
To Use the DVH Tools
YoucanusethefollowingtoolstoviewtheDVHgraph.
Note: YoucansetmostoftheDVHoptionsthatappearintherightclickmenu
ontheDoseVolumeHistogramviewalsointheDVHOptionsdialogbox.
DVH Type
TodefinetheDVHtype,rightclickintheDoseVolumeHistogram
viewandchooseCumulativeGraph orDifferentialGraph
orNaturalGraph .
Absolute/Relative Mode
Toviewtheabsolutedoseinformationforeachstructure,
rightclickintheDoseVolumeHistogramviewandchoose
AbsoluteDose.
Volume Scale
Toviewthedosedistributioninthetotalstructurevolume,
rightclickintheDoseVolumeHistogramviewandchoose
Absolutevolume.
Bydefault,thevolumescaleissettorelativevolume.

Zooming
1. TozoomintoadefinedareaintheDVHgraph,rightclickinthe
DoseVolumeHistogramviewandchooseZoomRegion.
Asmallmagnifyingglassappearsnexttothemousepointer.
2. PlacethemousepointeronthedesiredpointintheDVHgraph
anddooneofthefollowing:
Tozoomarectangularregion:
a. Clickandholddowntheleftmousebutton.
b. Movethemousepointertoformarectangulararea.
AredrectangleisdrawnontheDVHgraph.
c. Releasethemousebuttonwhentherectanglecoversthe
desiredareaoftheDVHgraph.Youcanrepeatthezoomingas
manytimesasneeded.
Toscrollandzoom,pressCTRLandmovethemousescroll
wheel.
3. Toresetthezoomtotheoriginaldisplay,rightclickintheDose
VolumeHistogramviewandchooseZoomReset.
Panning
1. Firstzoominthedesiredarea.
2. Topanthezoomedarea,dooneofthefollowing:
ChooseView >Pan anddragthezoomedareaasdesired.
Onthescrollmouse,pressthescrollwheelanddragthe
zoomedareaasdesiredwhileholdingthescrollwheeldown.
YoucanpanwithinthelimitsoftheunzoomedDoseVolumeHistogram
view.
Dose Along a DVH Line
1. ToviewthedoseinacertainpointoftheDVHline,rightclickin
theDoseVolumeHistogramviewandchooseShowCrosshair .
2. ClickthedesiredpointintheDVHline.
TheDVHgraphdisplaysthestructure,courseID,planID,thedose
attheselectedpointandtheequivalentspherediameterofthepart
ofthestructurevolumecoveredbytheselecteddoselevel.The

structureandtheisodoselevelcorrespondingtothepointthatyou
clickedintheDVHviewarehighlightedintheimageviews,and
thestructureisactivatedbothintheFocuswindowandInfo
window.
Grid
ToshowagridintheDVHgraph,rightclickintheDoseVolume
HistogramviewandchooseShowGrid .Thegridisshownby
default.
Dose Levels
1. TodisplaydoselevelsintheDVHgraph,rightclickintheDose
VolumeHistogramviewandchooseShowDoseLevels .
Dependingonthedosevisualizationmode,eithertheisodoselines
ordosecolorwashcolorsareshownintheDVHgraph.
2. Tochangethedisplayeddoselevels,switchtodosecolorwash
visualizationandspecifythedesireddoselevelswiththedose
colorwashslider.Formoreinformation,seeDefiningtheDose
LevelsDisplayedintheColorWashModeonpage 630.
Note: IftheDVHgraphcontainsplansthathavedifferentdoselevels,thedose
levelscannotbedisplayedintheDVHgraph.
DVH Graph Background
TochangetheblackbackgroundoftheDVHgraphtowhite,
rightclickintheDoseVolumeHistogramviewandchooseShow
GraphonWhiteBackground .
DVH Scale
1. TosetthescalefortheDVHgraph,rightclickintheDoseVolume
HistogramviewandchooseDVHOptions .
TheDVHOptionsdialogboxopens.
2. IntheScalegroupbox,definethedesiredminimumand
maximumvaluesforthedoseandvolumeinformation.
3. Totestthesettingswithoutclosingthedialogbox,clickApply,and
toacceptthesettings,clickOK.

DVH Columns
1. TochangetheDVHcolumnsthatarevisibleintheDoseStatistics
taboftheInfowindow,rightclickintheDoseVolumeHistogram
viewandchooseSelectStatisticsColumns.
TheDVHColumnSelectiondialogboxopens.
2. Selectthecheckboxesofthecolumnsyouwanttoview.
TheVolume,DoseCoverage,andSamplingCoveragecolumnsarealways
displayed.
3. ClickOK.
To Calculate a DVH for Summed Plans
1. CreateaplansumasinSummingPlansonpage 678.
2. ShowtheDoseVolumeHistogramView.
3. FromtheDoseStatisticstaboftheInfoWindow,selectthecheck
boxesofthestructurestobeincludedintheDVH.
TheDVHiscalculatedautomaticallyforeachselectedstructure.
Duringthecalculation,aprogressindicatorisdisplayed.The
finishedDVHgraphappearsintheDoseVolumeHistogramview.
TheDVHlineofthestructurethatislastselectedintheDose
StatisticstaborwiththeCrosshairtoolishighlighted.
Note: Thedosemodeforsummedplansisalwaysabsolute.
Boolean Operations in DVH Calculation

Booleanoperatorscreatecombinationsofstructures,suchasthepart
ofthelungsthatdoesnotoverlapwiththePTV.Combinedstructures
createdwithBooleanoperatorscanbeusefulin,forexample,DVH
calculation.Thefollowinglogicaloperatorsareusedtocreate
combinedstructures.

ANDAANDB:thecombinationincludestheareas
thatbelongtobothAandB,thatis,theintersectionofA
andB.
ORAORB:thecombinationincludestheareasthat
belongtoA,Borboth,thatis,theunionofAandB.
XORAXORB:Thecombinationincludestheareas
thatbelongeithertoAorBbutnotbothofthem.
SUBASUBB:thecombinationincludestheareathat
belongstoAbutnottoB.
(Parenthesisstartingaseparatepartinthe
expression.
)Parenthesisendingaseparatepartintheexpression.
NOTNOTA:thecombinationincludestheareathat
coverseverythingelsebutA.
BACKSPACEDeletesthelastaddedlogicaloperator.
To Create Boolean Structures for DVH Calculation
1. IntheDoseStatisticstaboftheInfowindow,clickthedown
pointingarrowheadintheendofthestructurerowandselectAdd
Expressionfromthedropdownlistthatopens.
TheExpressionPropertiesdialogboxopens.
2. IntheStructureslistbox,selectthefirststructuretoincludeinthe
newcombinedstructure.
TheselectedstructureisshownintheExpressionbox.

3. IntheOperatorsgroupbox,clicktheappropriateoperatorbutton.
TheselectedoperatorisshownintheExpressionboxafterthe
structure.
4. Repeatsteps2and3asmanytimesasneededtobuildthedesired
expression.
5. IntheDVHgroupbox,selectthedropdownlistofthelinecolor,
styleorwidth,andselectthedesiredoption.
6. Whentheexpressionisready,clickOKtoclosethedialogbox.
ThenewstructureisaddedintheDoseStatisticstaboftheInfo
WindowanditisdisplayedintheDVHgraph.
Thecombinedstructuresaretemporary,andtheyarenotsavedintothe
database.YoucanonlyusethemtoevaluateplanswithDVHs.
Toeditacombinedstructure,clickPropertiesintheendofthe
combinedstructurerowintheDoseStatisticstaboftheInfo
Window,andmodifythestructureintheExpression
Propertiesdialogboxthatopens.
Toremoveacombinedstructure,clickthedownpointing
arrowheadintheendofthecombinedstructurerowinthe
DoseStatisticstaboftheInfoWindow,andselectRemove
Modifying the Style of a DVH Line

Youcanmodifythecolor,styleandwidthofaDVHline.Tomodify
thestyleofaDVHline,youselectthestructureintheDoseStatistics
taboftheInfoWindowandmodifyitsDVHlineintheStructure
To Modify the Style of a DVH Line
1. IntheDoseStatisticstaboftheInfowindow,clickthe
downpointingarrowheadintheendoftherowofthestructure
whoseDVHlineyouwanttomodifyandchoosePropertiesfrom
thedropdownlistthatopens.

2. IntheDVHgroupbox,selectthedropdownlistofthelinecolor,
styleorwidth,andselectthedesiredoption.
3. ClickOK.
ThenewDVHlinelayoutisdisplayedintheDoseVolume
HistogramviewandintheDoseStatisticstaboftheInfoWindow.
Exporting DVHs
TheDVHscanbeexported,orsavedasatextfilewhichcanbe
opened,forexample,inaspreadsheetprogramforfurtheranalysis.
Note: NoticethefollowingaboutDVHexport:
OnlythevalueswithinthedoserangesetintheDVHgraphareexported.
DVHcanalsobeexportedintheDICOMformatwiththedosedatausing
theExport/Importwizard.Formoreinformation,seeChapter 27,Export
andImport,onpage 765.
About the DVH Export File
TheexportfunctionsavestheDVHtoanASCIIfile.Theexportfileof
bothasingleplanandmultiplanDVHcontainsthefollowing
information:
NameandIDofthepatient
Exportdateandtime
DVHtype(cumulative,differentialornatural)
IDofthecourse
IDoftheplan(s)
IDoftheselectedstructure(s)
Approvalstatusoftheselectedstructure(s)
Structureinformationinnumericalformat(percentageofvolume
calculated,volumeofthestructure)
Doseinformationinnumericalformat(prescribeddose,treatment
percentage,doseminimumandmaximum,dosemean,median
andmodal,standarddeviation,equivalentspherediameter,
conformityindex,gradientmeasure)
DVHgraphinformationinnumericalformat,dependingonthe
typeoftheDVH(cumulative,differentialornatural)

TheDVHinformationforasingleplanDVHissavedintheexportfile
inthefollowingformat:
Patient Name : <name of the patient
Patient ID : <identification of the patient>
Comment : <user-defined comment>
Patientinformation Date : <dd.mm.yyyy> <hh:mm:ss>
Type: <Cumulative/Differential/Natural> Dose Volume Histogram
Description : <description of the DVH type exported>
Plan: <ID of the plan>

Doseinformation Prescribed dose [Gy] : <dose in Gray>
% for dose (%) : <treatment percentage>
Structure: <ID of the structure>

Approval status: <Approved/Reviewed/Unapproved/Rejected>
Course: <ID of the course>
Volume [cm]: <volume>
Structure Dose Cover. [%]: <percentage of the dose coverage>
information Sampling Cover. [%]: <percentage of the structure volume used in
DVH calculation>
Min Dose [%]: <dose minimum>
Max Dose [%]: <dose maximum>
Mean Dose [%]: <dose mean>
Modal Dose [%]: <dose modal>
Median Dose [%]: <dose median>
STD [%]: <standard deviation>
Equiv. Sphere Diam. [cm]: <equivalent sphere diameter value>
Conformity Index: <conformity index value>
Gradient Measure [cm]: <gradient measure value>
Dose [Gy] Relative Dose[%] Ratio of Total Structure Volume(%)

<dose in Gray> <percentage> <percentage>
Thestructureinformationiswrittenforeachstructureincludedinthe
DVH.
TheDVHinformationforamultiplanDVHissavedintheexportfile
inthefollowingformat:

Patient Name : <name of the patient
Patient ID : <identification of the patient>
Comment : <user-defined comment>
Patientinformation
Date : <dd.mm.yyyy> <hh:mm:ss>
Type: <Cumulative/Differential/Natural> Dose Volume Histogram
Description : <description of the DVH type exported>
<Plan ID>:
Prescribed dose [Gy] : <prescribed dose in Gray>
Plananddose % for dose (%) : <treatment percentage>
information
<Plan ID>:
Prescribed dose [Gy] : <prescribed dose in Gray>
% for dose (%) : <treatment percentage>
Structure: <ID of the structure>

Approval status: <Approved/Reviewed/Unapproved/Rejected>
Course: <ID of the course>
Volume [cm]: <volume>
Dose Cover. [%]: <percentage of the dose coverage>
Sampling Cover. [%]: <percentage of the structure volume used
in DVH calculation>
Min Dose [%]: <dose minimum>
Structureinformation Max Dose [%]: <dose maximum>
Mean Dose [%]: <dose mean>
Modal Dose [%]: <dose modal>
Median Dose [%]: <dose median>
STD [%]: <standard deviation>
Equiv. Sphere Diam. [cm]: <equivalent sphere diameter value>
Conformity Index: <conformity index value>
Gradient Measure [cm]: <gradient measure value>
Dose [Gy] Ratio of Total Structure Volume(%)

<dose in Gray> <percentage>
Thestructureinformationiswrittenforeachstructureincludedinthe
DVH.
To Export a DVH
1. DisplaytheDVHgraphintheDoseVolumeHistogramview.
2. SettheDVHgraphtodisplaythedoserangeyouwanttosavein
theexportfile.

3. Tochangetheintervalatwhichthedosevaluesareprintedtothe
exportfile,definethedesiredvalueintheStepsizetextboxofthe
DVHOptionsdialogbox.(Toopenthedialogbox,rightclickinthe
DoseVolumeHistogramviewandchooseDVHOptions.)
4. ToexporttheDVH,dooneofthefollowing:
RightclickintheDoseVolumeHistogramviewandchoose
ExportDVH.
ChooseFile >Export >ExportDVH.
5. IntheSaveinlistbox,selectthedirectoryintowhichtosavethe
exportfile.
6. IntheFilenametextbox,defineanamefortheexportfile.
7. ClickSavetosavetheDVHtothedefinedexportfile.
DVH Print-Outs
BothsingleplanandmultiplanDVHscanbeprinted.
FormoreinformationonprintingDVHs,seeChapter 26,SectionTo
PrintaDVHonpage 736andChapter 26,SectionUsingPrint
Templatesonpage 744.
Inbothcases,theDVHprintcontainstheDVHgraph,andunderit,
thefollowinginformation,dependingonthetypeoftheDVH:
NameandIDofthepatient
DVHtype(cumulative,differentialornatural)
DVHlinetype(s)andID(s)oftheselectedstructure(s)
ID(s)oftheselectedplan(s)
Planapprovalstatus(es)
ID(s)ofthecourse(s)
Approvalstatusoftheselectedstructure(s)
Structureinformationinnumericalformat(coverage,volume)
Doseinformationinnumericalformat(min.,max.,mean,modal,
median,standarddeviation,naturaldoseratio,equivalentsphere
diameter,conformityindex,gradientmeasure)
Userdefinedcomment,ifany
Printdateandtime

DVHsareprintedusingtheDVH.tmltemplatefile.Formore
informationontreatmentreporttemplatefiles,seeAppendix Eon
page 827.
TheDVHgraphinaDVHprintoutissimilartothatdisplayedinthe
DoseVolumeHistogramview.Thefollowingfigureshowsanexample
ofaDVHprintout.
Figure 187 DVH Print-Out
Accuracy of the DVH

SomecompromisesareinevitableregardingtheaccuracyofaDVH,
becausetheDVHalgorithmperformsinterpolationandsamplingto
combinethedoseandstructuresetdata.Interpolationandsampling
areneededbecauseofthedifferencesinthespatialresolutionand
positionofthedosematrixandthe3Dimage(thedosematrixusually
hascoarserresolutionthanthestructuresinthe3Dimage).The
structureshapesaresampledandinterpolatedfromtheimagestothe
dosematrices,andvolumemodelingusestheinterpolatedstructure
shapes.ThecumulativeDVHisgeneratedasanintegralofthe
sampleddoseovertheinterpolatedstructures.

Thisprocessinterpolationandsamplingleadstoinaccuracyofthe
volumeinthedosespace.Theinaccuraciesaremostpronouncedin
verysmallstructures,whereaminorerrorinthevolumeestimation
canbealargefractionofthestructurevolume.Theeffectisalso
amplifiedifthedosecalculationplanesarefarapartfromtheimage
planes.
ThestatisticalparametersareextractedfromthecalculatedDVH
curve.Thevolumesofstructuresarecalculatedmoreaccuratelyfrom
theoriginalstructuredataintheimagetoallowverifyingthe
parametersandtheaccuracyofthevolumemodeling.
ThevolumeinaccuracyisshownintheDoseStatisticstaboftheInfo
Window,whichdisplaysthepercentageofeachstructuresvolume
coveredbythedosematrix(DoseCoverage)andthepercentageofthe
structuresvolumeusedfortheDVHcalculation(SamplingCoverage)
(seeDVHforaSinglePlanonpage 660).
Comparing Plans Visually

Whenyouhavecalculatedthedosedistributionforatleasttwoplans,
comparethemvisually.
To Compare Plans Visually

1. Opentheplanstocompare.
TheplansareshownintheScopewindow.
2. ChooseWindowandselectaviewlayout:
TwoOrthogonalViews2Dimagesofbothplans.
TwoModel/BEVViews3Dimagesofbothplans.
MultiplePlaneViewsOneviewsetconsistingofnine
transversalviewsdisplayingadjacentimageplanes.
OrthoviewsandBEVOneviewsetconsistingofthree2D
views(transversal,frontalandsagittal)anda3Dview.
MultiplePlansSixtransversal2Dviews.

3. Dependingontheselectedwindowlayout,dragtwoormoreplans
totheimageviewsforcomparison.
4. ToconnectviewsbasedonthesameCTimageseries,selectthe
LinkViewGeometriestool .
Whenthetoolisselected,changestotheviewgeometryoftheleft
viewsetarealsoappliedtorightviewsetandviceversa.Thisway
youcanautomaticallyseethesamelocationinbothplans.
Viewthedosedistributionwiththeviewingtools(Zoom,Pan,
Reset,Nextplane,Previousplane,Rotate;formore
information,seeChapter 4,VisualizationofImages,on
page 77).
Evaluatethedosewiththedosemeasurementtools(Point
dose,Doseprofile).Forinstructions,seePointDoseValueand
DoseProfileonpage 650.
6. Toviewthedoseondifferentplanes,usetheplaneslider,the
mousescrollwheel,thePGUPandPGDOWNkeys,ortheNextPlane
andPreviousPlanetoolbarbuttons.Forinstructions,see
Chapter 4,SectionSelectingtheViewingPlaneDisplayedinthe
2DViewsonpage 86.
Summing Plans
Field Setup and Plan Evaluation Workspace
Thedosedistributionfromseparateplanscanbecombinedtoforma
compositeplan,suchasatreatmentanditsboost,oracombinationof
photonandelectrontreatmentsinamammarycase.Eachplaninthe
sumcanhaveitsownprescriptionpoint.Summingplansispossibleif
theplansarebasedonthesame3Dimageandstructureset.Ifthe
plansusedifferent3Dimages,theimagesmustfirstberegistered.The
plansumimagescanbeprintedoutlikeanyotherplanimages.
Treatmentreportsalsocontaininformationontheplansum.Formore
informationandinstructionsonimageregistration,seeChapter 6,
ImageRegistration,onpage 145.Forinformationonprintouts,see
Chapter 26,PrintingPlanInformation,onpage 725.

Youcancreateaplansumby:
Includingexistingplansinanewplansum.
Creatinganewplansumandnewplanssimultaneously.
Creatinganemptyplansumandaddingnewplanstoitlateron.
ExternalbeamplanscanbesummedbothintheFieldSetup
workspaceandthePlanEvaluationworkspace.Theplansdonotneed
tohaveadoseprescriptionandthedosedoesnotneedtobecalculated
beforesummingthem.Thedosecanalsobecalculatedforthe
completedplansumintheFieldSetupworkspace.Inthiscase,the
doseiscalculatedtoallfieldsandplansinaplansumthatdonothave
calculateddose.Whencalculatingthedosedistributionforaplansum,
thecalculationprogressindicatorisdisplayedforeachplanintheplan
sumseparately.Ifaplansumcontainsplanswithoutdose
prescription,thedosefortheplansumisnotvisualizedintheimage
views.
Youcanmodifythefieldgeometryandfieldaccessoryoftheexternal
beamplansincludedinaplansum.Thedosemustberecalculatedfor
modifiedfields.Themodificationscanbedoneeitherthroughthe
individualplansorthroughtheplansum.Modificationsdonethrough
theindividualplansarereflectedintheplansum,andviceversa.
Youcanalsomodifythenormalization,doseprescription,
fractionation,andplanandfieldweightofeachplanwhiletheplan
sumisactiveintheFieldSetupworkspace.Thesechangescanbemade
withoutdraggingtheindividualplansintotheimageviews.
Note: Youcannotaddorchangethepatientimageofaplanthatisincludedin
aplansum.
IntheExternalBeamPlanningtask,plansumscanbecopied,pasted,
modifiedanddeletedintheFieldSetupworkspace.Youcan,for
example,maketwoormoresimilartrialsofaproposedtreatment
plan.
YoucanalsocomparetwoormoreplansumssidebysideinthePlan
Evaluationworkspace,andevaluateplansumsusingDVH
calculations.Whenyouapproveaplansumfortreatment,allthe
individualplansintheplansumareapprovedatonce.
Summedplanscanalsobeexported.Tobeabletoexportaplansum,
youneedtosetallplanweightsto1.00anddisplayalldose
distributionsintheimageviews.

Inadditiontosummingplans,youcanalsosubtractplans.Unlike
summedplans,subtractedplanscannotbeapprovedfortreatmentor
exported.SubtractedplanscanbeviewedonlyinthePlanEvaluation
workspace.
Dose Matrices in Summed Plans

Thecalculationvolumeforthedoseintheplansumencompassesthe
totalirradiatedvolumeofallfieldsintheplansum.Thiswaythedose
contributionsfromallfieldsaretakenintoaccountforallregions
coveredbytheplansum.Iftheoriginaldosematriceshavedifferent
resolutions,awarningmessageisdisplayedwhenthedoseforthe
plansumiscalculated.
Iftheoriginaldosematricesareofdifferentsize,theapplication
displaysawarningmessagewhenthedoseforaplansumis
calculatedand,ifsochosen,resetsthedosematricestothelargest
possiblesizetocoverallthevolumesinthesum.Thiswarningisalso
displayedwhenaplansumcontainingdosematricesofdifferentsize
isapproved.
Forthesummedplan,theDVHiscalculatedonlyforthoseareasofthe
originalplanmatricesthataresharedbyalltheplans.
Plan Sum Tab of the Info Window

ThePlanSumtaboftheInfowindowisvisibleintheFieldSetupand
PlanEvaluationworkspaces.Thetabisusedforviewingandediting
thepropertiesoftheplansum.Whenyoueditthepropertiesofthe
plansuminthetab,theplansumisupdatedaccordinglyintheimage
views.Thistabalsoshowsthetypeofsumming(adding/subtracting).
ThePlanSumtabliststheparametersrelatedtothesummation
procedureandthedoseprescribedfortheplans.
Table 23 Information in Plan Sum Tab
Column Description
InTotal Checkboxesusedtoselectwhetherthedosedistribution
ofaplanisvisualizedintheimageviews.
PlanID IDofeachplanincludedinthesum.

Table 23 Information in Plan Sum Tab
Column Description
CourseID IDofthecoursetowhicheachplaninthesumbelong.
Cannotbeedited.
Operation Indicateswhethertheplanissummedwith(+)or
subtractedfrom()theotherplansinthesum.
PlanWeight Weightofeachplanincludedinthesum.
Target Targetvolumeofeachplanincludedinthesum.Target
volumesofexternalbeamplanscanbeeditedonlyinthe
FieldSetupworkspace.
Prescribed Prescribeddosepercentageofeachplanincludedinthe
Percentage sum.
Dose/Fraction DoseperfractioninGyofeachplanincludedinthesum.
Numberof Numberoffractionsofeachplanincludedinthesum.
Fractions
TotalDose TotaldoseinGyofeachplanincludedinthesum.
PlanNormalization Plannormalizationmodeusedforeachplaninthesum.
Mode
FieldID Externalbeamplanning:IDofeachfieldintheplans
includedinthesum.
MU Externalbeamplanning:Monitorunitsofeachplan
includedinthesum.Cannotbeedited.
IfthecalculatedMUsareoutsideoftheoperatinglimits
ofthetreatmentmachine,theMUsareshowninred.
FieldWeight Externalbeamplanning:Fieldweightofeachfieldinthe
plansincludedinthesum.
Plan Sum Visualization

Externalbeamplansumscanbecreatedandviewedintheimage
viewsintheFieldSetupandPlanEvaluationworkspaces.TheFocus
windowshowstheexternalbeamplans,fieldsandfieldaccessories
includedinplansum.

A.Individualplansusedtoformtheplansum.B.Plansum.C.Plansandfieldsincludedinthe
plansum.D.Ahiddenfieldnotvisibleintheimageviews.Ifthefieldaccessoryofthehidden
fieldisselectedintheFocuswindow,theaccessoryisdisplayedintheimageviews.
Figure 188 Plan Sum in Focus Window
Toviewaplansumintheimageviews,dragittoanimageviewfrom
theScopewindow.The3Dimageusedforandthegeometryofthe
plansumisshowninallimageviews.Whenviewingexternalbeam
plansumsintheFieldSetupworkspace,thesumisshownbothin2D
imageviewsandtheModelview.Thedosedistributionisalso
displayedinallimageviews.Noticethatyoucansumexternalbeam
planswithoutcalculateddosedistributions,andthencalculatethe

dosefortheplansum.Ifaplansumcontainsaplanwithoutadose
prescription,thedoseoftheplansumisnotvisualizedintheimage
views.
Note: Inthecaseofaplansum,the3Ddosestatisticsshowstatisticaldose
informationforthetargetvolumeofthefirstplaninthelistoftheplans
includedintheplansum.
Youcancontrolthevisibilityoffieldsintheplansumbyselectingor
clearingthefieldvisibilitycheckboxesintheFocuswindow.The
active(selected)fieldisalwaysdisplayedinallimageviewsregardless
ofthesettinginthefieldvisibilitycheckbox.Similarly,ifthefield
accessoryofahiddenfieldisselectedintheFocuswindow,the
accessoryisdisplayedintheimageviews.Youcanalsoquicklyshow
orhideallthefieldsandDRRsofaplansumintheimageviews.In
addition,youcanusethePlanSumtaboftheInfowindowtocontrol
howplansumsarevisualizedintheimageviews.
Figure 189 Plan Sum in Field Setup Workspace
Themotionofstaticanddynamicarcfieldsincludedintheplansofthe
plansumcanbeanimatedintheBEV.Forinstructions,seeViewing
ArcFieldMovementonpage 391andToViewtheMotionsofa
DynamicMLConpage 520.

Figure 190onpage 684comparesthedosedistributionsofindividual
externalbeamplansincludedinaplansumandthecombineddose
distributionoftheplansum.
A.Dosedistributionofplan1B.Dosedistributionofplan2C.Combineddosedistributionoftheplansum
Figure 190 Individual Plans and Plan Sum on Transversal Plane
ProjectionsofallthefieldsontheBodysurfaceofaplansumcanbe
shownintheModelview(seeFigure 191onpage 684).
Figure 191 Plan Sum and Field Shapes Shown on Body Surface in Model View
To Sum and Subtract Plans

1. Openthepatientandallthecoursesthatincludeplanstobe
summed.
TheplansareshownintheScopewindow.
2. ChooseInsert >NewPlanSum.

3. Ifprompted,selectacourseorcreateanewcoursefortheplan
sum.Ifonlyonecourseisopen,theplansumisautomatically
createdinthatcourse.
TheInsertNewPlanSumdialogboxopens.
4. InthePlanSumID,typeanidentificationforthenewplansum.
5. IntheImagedropdownlist,selecttheimagetobeusedinthe
plansum.
Ifyouaresummingplansthatarebasedonregisteredimages,selectthe
imageonwhichyouwishtodisplaythesum.
Toincludeaplaninthesum,selectthecheckboxinfrontofit.
Toexcludeaplanfromthesum,clearthecheckboxinfrontof
it.
Tosumaplan,doubleclickintheOperationcolumnandselect
+
Tosubtractaplan,doubleclickintheOperationcolumnand
select
8. ModifytheplanID,planweight,plantarget,prescribeddose
percentage,fractiondose,numberoffractions,totaldoseandplan
normalizationmode,ifnecessary.
9. ClickOK.
Theimageselectedfortheplansumandthefieldsincludedinthe
plansumareshownintheimageviews.Aplansumicon
appearsintheScopewindow.
10. Tosavetheplansum,chooseFile >SaveAll.
Continuebyevaluatingtheplansumwiththedoseevaluationtools.For
moreinformation,seeDoseVolumeHistogramonpage 654.

To Create a New Plan Sum and New Plans Simultaneously
1. ChooseInsert >NewPlanSum.
2. Ifprompted,selectacourseorcreateanewcoursefortheplan
sum.
TheInsertNewPlanSumdialogboxopens.
3. InthePlanSumID,typeanidentificationforthenewplansum.
4. IntheImagedropdownlist,selecttheimagetobeusedinthe
plansum.
Ifyouaresummingplansthatarebasedonregisteredimages,selectthe
imageonwhichyouwishtodisplaythesum.
5. Toaddanewplanintheplansum,clickAddNewPlanandfillin
thenecessaryinformation.
6. ClickOK.
Theimageselectedfortheplansumandtheplansumareshown
intheimageviews.Aplansumicon appearsintheScope
window.
7. Tosavetheplansum,chooseFile >SaveAll.
Continuebymodifyingtheplansintheplansum,ifnecessary.Youcan
alsocreateanemptyplansumandaddplanstoitlateron.
Reference Points in Plan Sums

Youcanaddnewreferencepointsinaplanthatisincludedinaplan
sumwhentheplansumisdisplayedintheimageviews.Youcanadd
referencepointsdirectlytoindividualplansintheplansum,ortothe
plansumimageandthenassignthemtothedesiredplanusingthe
ReferencePointOrganizer.
Youcanalsomoveallthereferencepointsincludedintheplansum.If
aplanintheplansumisnormalizedtoareferencepointandthedose
distributioniscalculated,thereferencepointcanbemovedonlyinthe
FieldSetupworkspace.Ifthesamereferencepointisusedinplan
normalizationoutsideplansum,youcannotmovethereferencepoint.

To Insert a Reference Point in a Plan Sum
1. Showtheplansumintheimageviews.
Toaddareferencepointdirectlytoaplanintheplansum,
rightclicktheplanandchooseNewReferencePointand
Location.
Toaddareferencepointtoaplansumimage:
RightclicktheReferencePointsfolderandchooseNew
ReferencePointandLocation.
Thenrightclickthedesiredplanintheplansum,choose
ReferencePointOrganizerandassignthereferencepoint
totheplan.
Continuebymovingthereferencepointasneeded.Formoreinformation
onreferencepoints,seeChapter 13,AboutReferencePointsand
ReferenceLines,onpage 437.
Evaluating and Editing Plan Sums

Youcanevaluatethesummeddosedistributionwithviewingtools
anddosemeasurementtools.Inaddition,youcanusethePlanSum
taboftheInfoWindowfordefininghowplansumsarevisualizedin
theimageviews,andforeditingplansums.Youcanspecify,for
example,whichdosedistributionsofindividualplansarevisualized
intheimageviews,andchangeplanweightsanddoseprescriptions.If
youhaveaplansumthatcontainsbothexternalbeamplansand
brachytherapyplans,youcannotusethePlanSumtabtoedit
brachytherapyplansintheExternalBeamPlanningtaskandvice
versa.FormoreinformationonthePlanSumtab,seePlanSumTabof
theInfoWindowonpage 680.
Youcanalsoeditplansumsbyaddingorremovingfieldsfromplans
includedinaplansum,andaddingorremovingplansfromaplan
sum.

To Evaluate the Plan Sum
1. Evaluatethesummeddosedistributionwithviewingtoolsand
dosemeasurementtoolsasusual.Formoreinformation,seePoint
DoseValueandDoseProfileonpage 650andDoseVolume
Histogramonpage 654.
2. Toedittheplansum,gotothePlanSumtaboftheInfoWindow.
3. Tocomparetwoormoreplansumsvisually,dragtheplansum
iconsfromtheScopewindowintotheimageviewsinthePlan
Evaluationworkspace.
To Show or Hide Fields and DRRs in the Image Views
1. ToshowthefieldsandDRRimagesofallplansintheplansum
simultaneouslyintheimageviews,rightclickaplansuminthe
ContextwindowandselectShowfieldsandDRRs.
2. TohidefieldsandDRRimagesfromtheimageviews,rightclick
theplansumanddeselectShowfieldsandDRRs.
To Add Plans to a Plan Sum (External Beam Planning)
1. Showtheplansumyouwanttoaddaplantointheimageviews.
2. ChooseInsert >NewPlantoPlanSum.
3. DefineacoursefortheplanandclickNext.
4. FillintheplanpropertiesandclickOK.
5. FillinthefieldpropertiesandclickOK.
ThenewplanappearsintheFocuswindowundertheplansum
andisshownintheimageviews.
To Remove Plans from a Plan Sum
1. IntheContextwindow,selecttheplantoremovefromtheplan
sum.
2. ChooseEdit >DeletePlanfromPlanSum.
Theplanisdeletedfromtheplansum,butexistsstillasan
individualplanintheContextwindow.

Copying and Pasting Plan Sums
YoucancopyandpasteplansumsintheFieldSetupworkspace.When
aplansumiscopied,alltheindividualplanswithfieldsandfield
accessoriesarecopiedinthenewplansum.Thecopiedplansare
renamedtoavoidconfusionwiththeoriginalplans.Itisalsopossible
tocopyfieldsandplansinsideplansums.
To Copy and Paste a Plan Sum
1. Openthepatientandthecoursethatcontainstheplansumtocopy.
2. IntheScopewindow,selecttheplansumtocopy.
3. ChooseEdit >CopyPlanSum.
4. Topastetheplansum:
a. IntheScopewindow,selectthecourseintowhichtopastethe
copiedplansum.
b. ChooseEdit >PastePlanSum.
Theplansumandtheindividualplansformingtheplansumare
copiedtotheselectedcourse.Iftheplansumispastedintothe
samecoursewiththeoriginalplansum,thenewplansumandthe
individualplansformingtheplansumarerenamed.
Using Digitally Reconstructed Radiograph Images

ADigitallyReconstructedRadiograph(DRR)isanXrayimage,
computedbytheapplication,seenfromthebeamfocus.ThefinalDRR
imageisaweightedcompositionofDRRlayers.Therecanbeoneto
threelayersintheDRRimage.TheDRRimageisdisplayedintheBEV
ortheModelview.DRRimagesarefieldspecific.Youcanshowor
hidetheDRRimageindividuallyforeachfield.
Figure 192onpage 690showsaDRRimageintheBEV.

Figure 192 DRR Image in BEV
Thefieldcanberotatedandmovedasusual,andtheDRRimageis
recalculatedandupdatedaccordingly.
Figure 193onpage 690showsDRRimagesgeneratedfortwofieldsin
theModelview.
Figure 193 DRR Image in Two Fields in Model View
ADRRimageisdisplayedwhenitsvisibilitycheckboxintheFocus
windowisselected.Ifyoublendtwo3Dimagesthatbelongto4D
images,theDRRimagesarenotvisibleintheimageviewseven
thoughtheirvisibilitycheckboxesareselected.

EnhancedDRRimagescanalsobegeneratedbyusingweightedCT
values.Theapplicationprovidesthefollowingcalculationoptionsfor
DRRimages:
Calculatingbasedonthewholeorpartialimagevolume
DefiningtheCTvaluerangetotakeintoaccount
Usingpredefinedparametersetsandcreatingandsavingnewsets
OnceyouhaveaddedoneDRRimagetoaplanusinga3Dimagethat
ispartofa4Dimage,youcandisplaytheDRRimagesofall3Dimages
inthat4DimageautomaticallybyclickingthePlaybuttonofthe
MovieControltoolonthelowerrightcorneroftheimageview.You
canalsoselectthevisibilitycheckboxesofthe3Dimagesina4D
imageonebyonetoshowtherelevantDRRimage.TheDRRimages
displayedthiswayusethesameparametersthatwereusedinthe
originalDRRimage.TheseDRRimagesarecalculatedfortemporary
useandtheyarenotsavedinthedatabase.ManuallycreatedDRR
imagesaresavedinthedatabase.
Predefined Parameter Sets for DRR Calculation

Thesystemfeaturesthepredefinedcombinationsofdetailed
calculationsettingsfortheparametersetspresentedinthetablebelow.
Table 24 Predefined DRR Parameter Sets
Parameter Set HU Values

Weight Description
Name from to
Abdomen.dps 2.0 16 126 Layer1:(Softtissue)
10.0 100 1000 Layer2(Bones)
Airway.dps 1.0 999 918
Bones.dps 1.0 100 1000
Breast.dps 5.0 100 1000 Layer1(Bones)
0.2 450 150 Layer2(Softtissue)
100.0 1600 3000 Layer3(Metalstructures)

Table 24 Predefined DRR Parameter Sets
Parameter Set HU Values

Weight Description
Name from to
Chest.dps 0.6 999 0 Layer1(Air/lungtissue)
1.0 100 1000 Layer3(Bones)
Lungs.dps 1.0 1000 700
OBI 1.0 2000 3000

markers.dps
Pelvis 10.0 300 1500 Layer1(Bones)

Lateral.dps
10.0 1600 3000 Layer3(Metalstructures)
SoftTissue 1.0 450 150
To Add DRR Images

1. IntheFocuswindow,selectthefieldtowhichaDRRimagewillbe
added.
2. ChooseInsert >NewDRR.
TheDRROptionsdialogboxopens.
3. Selectasuitableparameterset.Forexample,toexaminebonesin
theDRR,selectBones.dps.Thepredefinedsetsaredescribedin
PredefinedParameterSetsforDRRCalculationonpage 691.
Inadditiontothepredefinedparametersets,youcancreatecustomized
sets.Forinstructions,seeToManageDRRParameterSetson
page 695.
4. Todefinemoredetailsforthecalculation,adjustthesettings
manually.Forinstructions,seeToUseDetailedCalculation
ParametersforDRRImagesonpage 693.
5. Tocalculatetheimage,clickApply.
TheDRRimageappearsintheBEVortheModelview.TheDRR
iconappearsintheFocuswindow.

6. ToclosetheDRROptionsdialogbox,clickClose.
7. Ifdesired,settheDRRasthefieldreferenceimage(seeinstructions
inChapter 9,SectionToSelecttheReferenceImageofaFieldin
theExternalBeamPlanningTaskonpage 283).
8. Iftheplanimageispartofa4Dimage,youcanviewtheDRR
imagesforall3Dimagesinthat4DimagebyclickingthePlay
buttonoftheMovieControltoolonthelowerrightcornerofthe
imageview,orbyselectingthevisibilitycheckboxesofthe3D
imagesonebyone.
TheDRRimagescreatedthiswayusetheparametersettings
definedintheabovesteps.TheseDRRimagesarecalculatedfor
temporaryuseandarenotsavedtothedatabase.
Note: Inthecaseofarcfields,theDRRimageiscalculatedforthestartangle
only.
To Use Detailed Calculation Parameters for DRR Images

1. ToopentheDRROptionsdialogbox,chooseInsert >NewDRR.
Thedetailedparameteroptionsaredisplayedinthedialogbox.
2. IntheParametersgroupbox,selectonetothreelayerstobeused
ingeneratingtheDRRimage.
3. SpecifytheDRRlayerweightfactortousefortheselected
parameter.Theweightfactordetermineshowtheimagesare
composedtogether.Negativeweightvaluesubtractstheimage
fromotherDRRlayerimages.
4. DefinetherangeofCTwindowvaluesinHUtouseforgenerating
theDRRimage.CTwindowvaluesareusedinthegraylevels
varyingfromblacktowhite.
TheFromvaluedeterminesthedarkerendoftheCTwindow.
TheTovaluedeterminesthelighterendoftheCTwindow.
ChangingtheFromandTovaluesinvertsthegrayvaluesofthe
projectedimage.

5. TodefinethescopeoftheDRRimage,dooneofthefollowingin
theParametersgroupbox:
TobasetheDRRcalculationtofullimagevolume,leavethe
Clipping[cm]optionunselected.Bydefault,theDRRis
calculatedtofullimagevolume.
TobasetheDRRcalculationtopartialimagevolume,selectthe
Clipping[cm]optionanddefinethedistancerangefromthe
isocenterwiththeFromandTovalues.
A.UpperandlowerlimitofthedistancerangeofapartialDRR.
6. IntheDRRsize[cm]box,definetheresolutionoftheDRRimage.
Thedefaultvalueis50cm.
DecreasingthesizeoftheDRR(typeanewvalueintheDRR size [cm]
box)effectivelyincreasestheresolutionoftheDRR.
7. ClickApplytocalculatetheDRRimage.
TheDRRimageappearsintheBEVortheModelview.TheDRR
iconappearsintheFocuswindow.
Note: Tochangethecalculationparameters,rightclicktheDRRintheFocus
windowandchooseEditDRR.

To Manage DRR Parameter Sets
Tocreateanewparameterset,definethedetailsasinstructedin
ToUseDetailedCalculationParametersforDRRImageson
page 693andclickSaveset.Typeanameforthesetinthe
ParameterSetNametextbox.
Tospecifyadefaultparametersetthatisautomaticallyselected
whentheNewDRRdialogisopened,selectitfromtheParameter
setslistboxandclickSetasdefault.
Tomodifyaparameterset,definethedetails,typethenameofthe
setintheParameterSetNametextbox,clickOK,andclickYesto
overwritetheoldset.
Toremoveaparameterset,selectitfromtheParameterSetslist
boxandclickDelete.
Printing DRR Images

ThesimplestwaytoprintoutDRRimagesistoprinttheBEV.For
instructions,seeToPrinttheBeamsEyeViewonpage 735.
YoucanprintoutDRRimagesbydisplayingtheminanimageviewin
theSelectionworkspaceandthenprintingtheviewwheretheDRR
imageisdisplayed.Forinstructions,seePrintingImageandPlan
Informationonpage 725.
Displaying Field Images in the BEV or Model View

DRRimages,simulationimagesandportalimagescanbedisplayedin
theBEVandModelviewifthefieldshavebeenlinkedtogetherinthe
RelatedFieldstabofthePlanPropertiesdialogbox.
AsimulationimagecanbeviewedintheBEVandtheModelview
similarlytoDRRimagesifthesimulationimageandthesimulation
fieldhavebeencorrectlyaligned.
YoucanalsostorethedefinedstructuresaslayersintheDRRand
showthemasoutlines,alongwithafieldgraticule,intheBEVinthe
FieldSetupandPlanEvaluationworkspaces.Structureoutlinesare
shownasontheSADplane.Thevisualizationofthegraticuleisalso
availableintheIRREGPlanningtask,butnotthestructureoutlines.

YoucancontrolthestructurevisibilityintheFocuswindowby
selectingorclearingthevisibilitycheckboxes.Ifyouchangethefield
geometry,thestructureoutlinesareupdatedaccordingly.
Thefieldgraticuleshowsthefieldwitharesolutionof1 cmforsmaller
fields,and5 cmforlargerfields.Ifyouchangethecollimatorangle,
theSADorsomeotherpartsofthefieldgeometrythataffecttheBEV,
orselectanotherfield,thegraticuleisupdatedaccordingly.The
graticuleisnotstoredwhentheplanissaved.
Figure 194 Structure Outlines and Field Graticule in BEV
To Display Field Image
1. IntheFocuswindow,selectthefieldforwhichyouwishto
computetheDRRimage.
2. IntheFocuswindow,displaythesubbranchesoftheselectedfield.
3. ClickthecheckboxinfrontoftheDRRbranchtoviewtheDRR
imageanddisplayitintheBEVortheModelview.
To Display Structure Outlines in a DRR Image
1. IntheBEVwindow,rightclickandchooseShowStructure
OutlinesinBEV.
AllstructureoutlinesappearintheBEV.
2. Toshoworhidestructures,clicktheirvisibilitycheckboxesinthe
Focuswindow.

To Display the Graticule in a DRR Image
IntheBEVwindow,rightclickandchooseShowGraticulein
BEV.
ThegraticuleappearsintheBEV.
Verification of Treatment Planning

Toverifytheaccuracyoftreatmentplanningbeforegoingtoactual
treatmentofapatient,youcancreateverificationplansfromplansin
Eclipse.Verificationplansarecreatedusingeitherofthefollowing
methods:
Verificationusingaphantom
Verificationusingportaldoseprediction
Thefieldscontainedinaverificationplanhavethesamegeometryand
accessoriesastheircounterpartsintheoriginalplan.TheMUs,actual
fluences(forIMRTplans)andDMLC(dynamicMLC)motionsinthe
fieldsinaverificationplanareidenticaltotheircounterpartsinthe
originalfields.Thedosedistributionisinvalidatedintheverification
plan,andreferencepointsarenotcopiedfromtheoriginalplantothe
verificationplan.
Foreachverificationplan,youdefinewhetherallthefieldsarestored
tothesameverificationplanoreachfieldtoaseparateverification
plan,andwhetheryouwishtooverridetolerancetablesandthe
gantry,collimatorandcouchangles.
Theverificationplanandtheoriginalplanareseparatefromeach
other,thatis,changesmadetotheoriginalplanarenotreflectedinthe
verificationplan.Moreover,thetreatmentunit,energyanddoserate
cannotbemodifiedinaverificationplan.Changesmadetothefield
geometryintheverificationplandonotaffecttheactualfluencesor
theDMLCmotions.
Note: Ifyouchangethetreatmentunitorenergyintheoriginalplan,theactual
fluence,DMLCmotionsandMUsintheverificationplanarenolongervalid.
VerificationplansareshownintheFocuswindowwithaspecialicon
( ).

Verification with Phantom
Averificationplanthatusesaphantomcanbeconnectedtoa
verificationstructuresetandimage,(normallyanartificialora
scannedphantomimage).Theselectedstructuresetandimageare
copiedtotheactivepatientiftheydonotalreadybelongtotheactive
patient.Referencepointlocationsaretransferredtotheverification
plan.Referencepoints(namedVerification <number>)areadded
duringthecreationoftheverificationplanandconnectedtoapatient
volumenamedPhantomwiththetypeNone.ThePhantom
patientvolumecanbesharedbetweentheplansifseveralverification
planshavebeencreatedforthepatient.
Verificationplansthatdonotcontainactualfluencesareautomatically
calculatedusingfixedMUs.Formoreinformationoncalculatingwith
fixedMUs,seeChapter 24,SectionDoseCalculationBasedonMU
onpage 620.
Verification with Portal Dose Prediction

Verificationplansusingportaldosepredictionarenotconnectedtoany
referenceimage.Aftertheverificationplaniscreated,theportaldoses
foreachfieldarecalculatedautomatically.Thecalculationoftheportal
dosetoafieldalsoaddsdataabouttheportalimagingdevicedistance
atwhichthedosepredictioniscalculatedforeachfield.Theportal
dosesarecopiedtothegeneratedfields,andthecorrectportalimaging
devicedistanceismarkedtothefieldstoenabletheuseofthe
verificationplaninPortalImaging.
DuetothecharacteristicsofVariansDMLCdevicecontroller,large
fieldscontainingDynamicMLCsaresplitintosmaller,deliverable
subfieldswhentheplansaremovedtotreatment.Likewise,large
DMLCfieldsaresplittosubfieldswhencreatingaverificationplan.
Youcanchoosetosaveeachfieldandsubfieldeitherintotheirown,
separateverificationplans,orsaveallfields,includingsubfields,into
thesameverificationplan.
Note: Portaldosepredictioncanbeusedonlyforcomparingthecalculated
relativedosedistributionwiththemeasureddoseintheportalimage.

Portal Dose Prediction Calculation
PortaldosepredictioninEclipseenablesyoutopredicttheportaldose
ofatreatmentplanforpretreatmentverificationwithoutusing
patientdata,whichisespeciallyusefulinthecaseofIMRTplans.The
patientorthecoucharenotmodeledinthepredictionunlessthey
havebeenincludedasastructure.Portaldosepredictioncanbe
calculatedinconnectionwithcreatingaverificationplan,or
separately.
Aportaldoseisa2Ddosedistributiongiventothedetectionplaneof
anelectronicportalimagingdevice.Theimagingdeviceisusedto
produceaportaldoseimageduringtheirradiationforthe
measurementofthedose.Themeasuredandcalculateddosescanthen
becomparedinPortalImaging,whichreadsthepredictedportaldose
fromthedatabase.Themeasuredportaldoseisstoredtothedatabase
withverificationfielddata.
PortaldosepredictioninEclipsesupportsMLCs,fluencesandblocks,
andbothrelativeandabsolutedosescanbeusedinPortalImaging.
Thealgorithmusedfortheportaldosepredictioncalculationis
automaticallyselectedbyEclipse.Theconfigurationofthealgorithm
isdoneintheBeamConfigurationtask.Formoreinformationabout
thealgorithm,refertoEclipseAlgorithmsReferenceGuide.For
informationaboutusingtheBeamConfigurationtask,refertothe
onlinehelporBeamConfigurationReferenceGuide.
To Create a Verification Plan Using a Phantom

Beforeyoubegin,checkthatyouhaveanimageofthewaterphantom
youaregoingtouseforverifyingtheplan.
1. ChoosePlanning >CreateVerificationPlan.
TheCreateVerificationPlanSelectaCoursedialogboxopens.
2. Selectthecourseorcreateanewcourse.
ThesecondpageoftheCreateVerificationPlanwizardopens.
3. SelectthePhantomoptionbutton.

4. Selecttheverificationstructureset.
Toconnecttheselectedstructuresetandimagetoevery
verificationplan,clickSetasDefault.
ToselectthestructuresetfromtheObjectExplorer,click
Select.
Thefirstfieldisocenterispositionedtothecenteroftheimagethat
thestructuresetrefersto.Iftheselectedimagehasauserorigin
defined,thefirstfieldisocenterispositionedtotheuserorigin.
Otherisocentersarepositionedinrelationtothefirstisocenter.
5. ClickNext.
Thethirdpageofthewizardopens.
6. Todefinetheplangenerationmethod,selectthedesiredoptions
amongthefollowing:
Placeallfieldsintosameverificationplan
Spliteachfieldintoseparateverificationplan
Splitsubfieldsintoseparatefields
7. Todefinethefieldgeometry,selecttheappropriatecheckbox(es)
andthendefinethegantry,collimatorandcouchresetanglesinthe
textboxes.
8. Todefinethetolerancetable,selecttheUsetolerancetablecheck
boxandthenselectthetablefromthelistbox.
9. ClickNext.
Thelastpageofthewizardopens.
10. Reviewtheverificationplanparameters.
11. ClickFinish.
TheverificationplanisshownintheContextwindowandthe
imageviews.
Calculatethedosedistributionfortheverificationplan.Verificationplans
thatdonotcontainactualfluencesareautomaticallycalculatedusing
fixedMUs.Thenmovetheverificationplantotreatment,scheduleand
treatitusingthewaterphantom.Measurethedoseinthewaterphantom
andcomparethedosewiththecalculateddosedistribution.

To Create a Verification Plan Using Portal Dose Prediction
1. ChoosePlanning >CreateVerificationPlan.
TheSelectaCoursefortheNewPlandialogboxopens.
2. Selectthecourseorcreateanewcourse.
ThefirstpageoftheCreateVerificationPlanwizardopens.
3. SelectPortalDosePrediction.
4. DefinetheSourceImagerDistanceinthetextbox.Thedefault
valueisreadfromtheoperatinglimitsoftheselectedtreatment
unit(configuredintheAdministrationtask).
5. ClickNext.
Thesecondpageofthewizardopens.
6. Todefinetheplangenerationmethod,selectthedesiredoptions
amongthefollowing:
Placeallfieldsintosameverificationplan
Spliteachfieldintoseparateverificationplan
Splitsubfieldsintoseparatefields
7. Todefinethefieldgeometry,selecttheappropriatecheckbox(es)
andthendefinethegantry,collimatorandcouchanglesinthetext
boxes.
8. Todefinethetolerancetable,selecttheUsetolerancetablecheck
boxandthenselectthetablefromthelistbox.Forinstance,usea
tolerancetablethatallowsverificationwiththeportalimaging
devicewithoutthecouch.
9. ClickNext.
Thelastpageofthewizardopens.
10. Reviewtheverificationplanparameters.
11. ClickFinish.
TheverificationplanisshownintheContextwindowandthe
imageviews.
Movetheverificationplantotreatment.Exporttheplantotheportal
imagingdeviceandexposetheportalimagingdeviceusingthe
verificationplan,butwithoutthecouch,patientdataandphantomdata.

ComparethepredictedandmeasureddoseinPortalImaging.Ifthereis
goodagreementbetweenthepredictedandmeasureddose,theoriginal
plancanbeapprovedfortreatment.
Verifying the DMLC Leaf Motions

TheDMLCleafmotionscanbeverifiedbyusingarbitrarytestfluences
orbyusingaregeneratedDMLC.
To Verify the Leaf Motions Using Test Fluences

1. Createaplanforthewaterphantom.
2. Importthedesiredarbitrarytestfluenceintotheplan.
3. CalculatetheleafmotionswiththeLMC.
5. Movetheplantotreatment,scheduleandtreatitusingthewater
phantom.
6. Comparethemeasureddoseagainstthecalculateddoses.
7. EvaluatetheLMCconversion.
ComparetheoptimalfluencewithBEVprintoutscontaining
thetotalactualfluenceinEclipse
CompareBEVprintoutscontainingtheoptimalfluencewith
fieldimagesonfilm
Comparetheoptimalfluenceswiththetotalactualfluencesin
theASCIIformat
To Verify the Leaf Motions Using a Re-Generated DMLC

1. Createanoptimizedplan.
2. Exportthetotalactualfluence.
3. Importthetotalactualfluenceasoptimalfluence.
4. StarttheLMCtoregeneratetheDMLCmotionpatterns.
5. ComparetheDMLCmotionpatternswiththosecreatedbythe
originaloptimization.

Creating Setup Fields
Setupfieldsareusedformovingthetreatmentunittothecorrect
treatmentposition,orforaligningthepatientcorrectlyfortreatment.
Eclipseprovidesthefollowingmethodstocreatesetupfields:
CreatesetupfieldsfromoriginalfieldsintheFieldSetup
workspace.Theoriginalfieldremainsintact,whilethecreated
setupfieldisanexactcopyoftheoriginal,excludingthedoseand
includingtheDRRandfieldaccessories.Iftheoriginalfield
containedaDRR,theDRRislinkedtothesetupfieldasareference
image.
Insertnewsetupfieldsinaplanusingthedefaultfieldsettings(see
Chapter 11,SectionDefaultFieldParametersonpage 384).
Setupfieldsresultingfrombothmethodscanberotatedasnecessary.
Theoriginalfieldsarenotupdatedinaccordancewithchangesmade
insetupfields.
YoucangenerateaDRRforeachsetupfieldifnecessaryandsetthe
DRRasareferenceimage(forinformation,seeUsingDigitally
ReconstructedRadiographImagesonpage 689).Referenceimages
canbeused,forinstance,inXimatronDigitalImagingandPortal
Imaging.Ifrequired,youcanaddfieldaccessoriestothesetupfields.
Thedosedistributionisnotcalculatedforsetupfields,andtheycannot
beusedforpatienttreatment.Aplancancontainbothnormalfields
andsetupfields.
Setupfieldicons areshownintheFieldsfolderintheFocus
windowintheFieldSetupandPlanEvaluationworkspaces.TheDRR
andfieldaccessoryiconsareshownundertheparticularsetupfield.
Note: Ifyouhaveadatabaseupgradedfrom7.3to8.0,setupfieldscreated
beforetheconversionarenotvisualized.
To Generate Setup Fields

IntheFocuswindow,rightclickthefieldandchooseNewSetup
FieldfromSelectedField.
Asetupfieldiscreatedfromtheselectedfieldandshowninthe
imageviewsandFocuswindow.

To Create New Setup Fields
IntheFocuswindow,selecttheplantowhichyouwishtocreatea
newsetupfieldandchooseInsert >NewSetupField.
ThenewsetupfieldisshownintheimageviewsandFocus
window.
Approving Plans for Treatment

TobeabletoviewaplanorplansuminAriaapplicationsandlater
approveitforactualpatienttreatment,theplanmustbeapprovedfor
treatmentinEclipse.ThisisdonewiththePlanningApprovalwizard,
whichchangestheapprovalstatusoftheplantoPlanningApproved
inthedatabase.
Youcanperformthefollowingactionsinthewizard:
CreateDRRimagesforeachfieldthatdoesnotyethaveone.The
DRRisusedasareferenceimageforthefieldifnoreferenceimage
hasbeendefinedforitbefore,andisautomaticallyaligned
correctly.
IncludetheoutlinesofselectedstructuresintheDRRimages.The
structureoutlineswillbevisibleinARIAapplications.
DefinetheactualSSDforthefieldsintheplan.
Calculatethetreatmenttimeforthefieldsintheplan(see
CalculationoftheTreatmentTimeonpage 708).
SplitlargeIMRTfieldscontainingmultiplecarriagegroupsinto
smallerfieldsorretainthemassinglefields,dependingonthe
treatmentunit.
GranttheplanthePlanningApprovalstatus.
Iftheplancontainsmultiplefractionations,allfractionationsare
includedintheplanningapproval.
Whenyouapproveaplan,thestructuresbelongingtothestructureset
thattheplanreferencescanbeapprovedsimultaneously,depending
onthesystemconfiguration.ThisisconfiguredintheAdministration

task.FormoreinformationontheAdministrationtask,refertothe
onlinehelp.Formoreinformationonstructureapproval,see
Chapter 7,SectionApprovingStructuresonpage 195.
Note: Whenapprovingplansorplansumsfortreatment,noticethefollowing:
AlwaysverifyplanswithDVHanalysis.
PlanswithTreatmentApprovalcannotbemodifiedintheExternalBeam
PlanningtaskortheIRREGPlanningtask.ToedittheseplansinEclipse,
makeacopyofitandeditthecopy(seeChapter 9,SectionRePlanning
onpage 278).
MakesurethattheEclipsetreatmentplanningsystemiscorrectly
configuredandthattheconfigurationreflectsthepropertiesofthe
treatmentunit.
ForDMLCplans,alwaysmakesurethat:
AqualifiedpersonverifiestheplanontheMLCviewingstation,ordo
phantomtestingbeforestartingthetreatment.
Youusethesametreatmentunitfortreatingapatientasyouusedfor
creatingtheplan.
Plan Approval Statuses

Dependingontheirapprovalstatuses,plansaredealtwithindifferent
ways.
Thissectionbrieflydescribestheplanapprovalstatusesusedinthe
ExternalBeamPlanningtask.Formoredetailsonotherapprovals,
refertoOncologyInformationSystemApprovalGuide.
Unapproved Status
TheUnapprovedplanstatusofaplan referstoaplanusedfor
planningthetreatmentofapatient.Unapprovedplansareunlockedin
thedatabase,whichmeansthattheyarefullymodifiableinthe

Rejected Status
TheRejectedstatusofaplanreferstoaplanthathasbeencreatedasa
potentialcandidatebutrejectedforactualuseintreatment.Similarly
toUnapprovedplans,Rejectedplansareunlockedinthedatabase,
whichmeansthattheyarefullymodifiableintheExternalBeam
Planningtask.
Reviewed Status
TheReviewedstatusofaplanreferstoaplanthathastypicallybeen
initiallyverified,butstillrequiresfurtherapprovals.Similarlyto
PlanningApprovedplans,Reviewedplansarelockedinthedatabase,
whichmeansthattheycannotbechangedintheExternalBeam
PlanningtaskwithoutfirstchangingtheplanstatustoUnapprovedor
makingacopyandeditingthecopy.
Planning Approved Status
ThePlanningApprovedstatusofaplan referstoaplanapprovedby
aqualifiedspecialistthatisintendedtobeusedforthetreatmentofa
patient.Planningapprovalisusedtoidentifytheplanthatisintended
tobeusedforactualpatienttreatment.Theplanmustfurtherbegiven
theTreatmentApprovalstatusinRTCharttobeabletouseitfor
schedulingthetreatment.
PlanningApprovedplansarelockedinthedatabase,whichmeans
thattheycannotbechangedintheExternalBeamPlanningtask
withoutfirstchangingtheplanstatustoUnapprovedormakinga
copyandeditingthecopy.
Alldoserelevantpropertiesbecomeunmodifiablewhenyougivea
planthePlanningApprovedstatus.Propertiesthatdonotaffectthe
dosecanbemodified.Inaddition,thefieldapertureoverlayand
digitalgraticuleareaddedautomaticallytoreferenceimagesoutside
Eclipse.
Sometimesfieldgeometryordosechangesarecalledforinaplan
alreadybeingtreated,especiallyintheadaptivetreatmentplanning
process.Itispossibletochangecouchandimagerpositions,field
setupnotes,andplanandimageschedulingforTreatmentApproved
plansoutsideEclipse.Foranyotherchanges,theTreatmentApproval

hastobecancelledoranewcopycreatedoftheplan.Forinformation
onhowthesechangesaredone,seeChapter 9,SectionRePlanning
onpage 278.
Note: IfyoucreateanewplanrevisionofatreatedplaninARIARadiation
Oncologyapplicationsor4DTreatmentConsole,thestatusoftheoriginalplan
isautomaticallysettoRetired.InEclipse,thenumberoffractionsdisplayed
forRetiredplansistheoriginallyplannednumberoffractions,notthe
deliverednumberoffractions,asisdisplayedinRTChart.IfaRetiredplanis
usedasabasedoseplanforIMRToptimizationorinaplansum,its
contributionwillbetheoriginallytotalplanneddose,notthedelivereddose.
EachphotonfieldhastwoSSDvalues:actualSSDandplannedSSD
(formoreinformationonactualandplannedSSD,seeChapter 11,
SectionActualandPlannedSSDValuesonpage 385).Whengivinga
planthePlanningApprovedstatus,thesevaluesaretreatedina
particularway:theplannedSSDvaluesareeithercopiedtotheactual
SSDvaluesandyoucanacceptthemortypeinnewvalues,orfor
fieldsthathaveanactualSSD,youarepromptedtoconfirmwhetherit
shouldbekept.
Large DMLC Fields and Approving Plans for Treatment

DuetothecharacteristicsofVariansDMLCdevicecontroller,theLMC
divideslargeDMLCfieldsintomultipleMLCcarriagegroups(for
moreinformationontheLMC,seeChapter 17,DynamicMLCs,on
page 537).Dependingonthecapacityofthetreatmentunit(s)usedina
plan,thecarriagegroupsinfieldsaredealtwithasfollows:
TreatmentunitcanhandlefieldswithmultiplecarriagegroupsYou
canchoosetoretaincarriagegroupsasonefieldorsplittheminto
smallerfields(defaultsettingforthisoptionisdefinedinTask
Configuration,seeDefiningDefaultFieldSplitOptionforLarge

IMRTFieldsonpage 708).ThecollimatorXjawsandMLCbanks
moveonlyduringbeamhold,otherwisetheyremainstationary.
Photonplansaresupported.
Treatmentunitcannothandlefieldswithmultiplecarriagegroups
Carriagegroupsaresplitintoindividualfieldsandsavedtoanew
copyoftheoriginalplan,whichwillhavetheRetiredstatus.The
newcopywillhavethePlanningApprovedstatus.Photonplans
aresupported.
TwodifferenttreatmentunitsusedinaplanCarriagegroupsare
splitintoindividualfieldsandsavedtoanewcopyoftheoriginal
plan,whichwillhavetheRetiredstatus.Thenewcopywillhave
thePlanningApprovedstatus.Photonplansaresupported.
Defining Default Field Split Option for Large IMRT Fields
2. SelecttheLargeFieldIMRTtab.
3. TosplitlargeIMRTfields(containingmultiplecarriagegroups)
intosmallerfieldswhentheplanisapprovedfortreatment,select
theSplitlargeIMRTfieldsinEclipsecheckbox.Toretainlarge
IMRTfields,clearthecheckbox.
Calculation of the Treatment Time

ThetreatmenttimeofaplaniscalculatedfromtheMUsandthedose
rateoftheplan,usingatreatmenttimefactor:
Eq. 2 MU
Treatment time = Treatment time factor --------------------------------
Dose rate
Thetreatmenttimefactorisparticularlyusefulintreatmentswhere
thedoserateisvariable,suchasDMLCtreatments.

To Approve External Plans for Treatment
1. IntheScopewindow,selecttheplanorplansumtobeapproved
fortreatment.
2. ChooseEdit >PlanApproval >PlanningApproved.
ThePlanningApprovalwizardopens.Iftheplanningis
incomplete,thePlanningApprovalwizardpromptsyoutoadd
andverifymissingitems.
3. IntheProjectedStructuresinReferenceImageslistbox,selecteach
structurewhoseoutlinesyouwishtobeaddedtoDRRsifyouare
goingtocreatethem.
4. TocreateaDRRimageforeachfield,selecttheGenerateDRRs
intoFieldscheckbox.
5. Tocalculatethetreatmenttimeforthefields,selecttheCalculate
TreatmentTimescheckboxanddefinethetreatmenttimefactorin
theMultiplywithFactorbox.Therangeofthefactoris1.00to5.00.
6. TosplitlargeIMRTfieldsintosmallerfieldsiftheselected
treatmentunitcannotprocessthem,selectSplitlargeIMRTfields
inEclipse.
ThedefaultvalueforsplittinglargeIMRTfieldsisdefinedin
TaskConfiguration.
7. TogranttheplanPlanningApproval,typeyourinformationinthe
UsernameandPasswordboxesandclickFinish.
Exporting Plans to Virtual Simulation

Virtualsimulationusinglaseralignmentsystemsprovidesaccurate
patientpositioningandmarkup.Fieldcoordinatescanbemarkedon
thepatientsskinwiththehelpofthelaseralignmentsystem,andthe
CTscannercanbeusedforsimulationinsteadofaconventional
simulator.EclipsesupportsexportingfieldcoordinatestoLAP,
GammexandA2Jlaserpositioningsystems.Thelaserpositioning
systemtobeusedintheexportisselectedandconfiguredintheTask
Configurationdialogbox(selectfromtheToolsmenu).Fordetailson
theTaskConfigurationdialogbox,refertotheonlinehelpsystem.

Thereferenceplaneforvirtualsimulationcanbedefinedintwoways
forlasersystemswiththreemovinglasers:theCTzeroplanecanbe
usedasthereferenceplane,orthereferenceplanecanbedefinedin
theVirtualSimulationwizard.
About Virtual Simulation with Gammex

WhenusingaGammexlaseralignmentsystem,noticethefollowing:
Thedevicedoesnothave3Dcapability.
Thedevicecannotshowpointsonthepatientsback(insupine
orientation).Becauseofthis,thefieldcoordinatestobemarked
mustbefrontal.
TheCTscannercouchpositionisalwayssetmanuallybymoving
theCTcouchtothecorrectpositioninrelationtoallfield
coordinatepoints.
EclipsenowsupportsthenewGammex5.0fileformat.Inthis
format,thecoordinatesareexpressedinmillimetersinsteadof
centimeters.
About Virtual Simulation with LAP

WhenusingaLAPCT4laseralignmentsystem,noticethefollowing:
Thedevicecannotshowpointsonthepatientsback(insupine
orientation).Becauseofthis,thefieldcoordinatestobemarked
mustbefrontal.
Thetransversallaserscanonlymove60 cm,andthedevicecannot
showpointslocatedfurtherthan60cmfromthefirstscanned
image.Usingfieldsexceedingthisdistancemayresultina
warningmessage.
TheCTcouchmustbemanuallymovedtothepositionindicated
bythefieldcoordinatesonthefirstslice.Forsubsequentpoints,
theCTcouchmovesautomatically.
Eclipsecalculatesallvirtualsimulationcoordinatesusingthe
referenceplaneposition,whichistakentobethefirstCTimage
regardlessofwherethefirstCTimageislocatedintheimagedCT
set.Thismeansthatitisnolongernecessarytomanuallymovethe
CTcouchtothefirstimageslicepositiontodefinethereference
planeforLAPCT14.Notethatsincethemovementspanofthe

transversallasersis60cminLAPCT14,thedevicecannotshow
pointslocatedoutsidethisspan.Usingfieldsexceedingthisspan
mayresultinawarningmessage.
About Virtual Simulation with AJ2

WhenusingaA2Jlasersystem,noticethatEclipsedoesnotconvey
whetherthepointsarelocatedontheleftorrightsideofthepatient.
Whenmarkingskinpoints,alwayscheckthegreenceilinglaserto
makesurewhichsideofthepatientthepointsare.
General Virtual Simulation Process in Eclipse

ThedatacommunicationbetweenEclipse,thelaseralignmentsystem
andtheCTscannerisbasedonthedefinitionofafixedreferenceplane
inthepatient.Thereferenceplaneusuallymarksananatomically
meaningfulareainthepatient,oritcanalsomarkthefirstslicetobe
scanned.Thepositionofthereferenceplaneisknownwhenscanning
thepatient,whenexportingtheplantovirtualsimulationandwhen
doingthepatientmarkup.
Thereferenceplaneisusuallydefinedtobethezeroplane.Depending
ontheequipmentusedforscanningandCTsimulation,thisisdone
eitherinrelationtotheCTcouchorfixedtothegantryoftheCT
scanner.
Thereferenceplaneisoften,butnotalways,markedonthepatient
skinwithfiducialmarkers,usuallywithatleasttwomarkersforthe
transversalandfrontalposition.Thefiducialsareplacedtothelaser
intersectionsofthelaseralignmentsystem.
Table 25 Virtual Simulation Process in Eclipse
Step Action
DefinethereferenceplaneforthelaseralignmentsystemandtheCTscanner.
1. PositionthepatientontheCTscannercouch.
2. Movethecouchsothatthelasersofthelaseralignmentsystempointto
thedesiredlocationinthepatient.Zerothelasers.
Ifdesired,locatetheplaneonthepatientwithfiducialmarkers.

Table 25 Virtual Simulation Process in Eclipse
Step Action
3. TogivethereferenceplanezerocoordinatesalongtheYaxisoftheCT
scanner,either
ZerotheCTcouchin/outposition(Siemenstypescanners),or
MovetheCTcouchsothattheCTzeroplane(GEtypescanners)
pointsatthereferenceplane.
Scanthepatient,withthereferenceplaneincluded.
4. Dependingontheclinicalpractices,thepatientgoeshomeorwaitsonthe
couch.
CreateaplanwiththerequiredfieldsandfieldaccessoriesinEclipse.
PerformvirtualsimulationinEclipse.
5. PositionthepatientontheCTcouch.
6. TostarttheplanexporttovirtualsimulationinEclipse,chooseFile >
Export >VirtualSimulation.
7. MovetheCTcouchsothatthereferenceplaneisalignedwiththelasersof
thelaseralignmentsystem.Then,dependingontheCTscanner,either
ZerotheCTcouchpositions,or
TypetheCTscannercouchpositionsinEclipse.
8. ReviewthefieldmarkingstobeexportedinEclipse,thenexportthem.
Marktheexportedpointsonthepatientsskin.Ifrequiredbythelaser
alignmentsystem,movethecouchmanuallybetweeneachpoint.
Processing of Data in the Export to Virtual Simulation

TheExporttoVirtualSimulationfunctiongeneratesthecoordinatesof
theisocenter,fieldapertureandMLCapertureoftheselectedfield(s)
intheactiveplanandsavesthecoordinatestoanexportfileorfiles,
whicharetransferredtothelaseralignmentsystemandusedtomark
thefieldcoordinatesonthepatientsskin.

Thecoordinatesystemsusedintheexporttovirtualsimulation
dependonthelaseralignmentsystemasfollows:
3adjustablelaseraxes:Allpointsarerelativetotheoriginofthelaser
alignmentsystem.NoCTcoordinatesystemcorrectionsaredone
fortheY and Z (IEC 61217)axes.
PointsotherthantheisocentercanbemarkedonlyinLAPCT14.
2adjustablelaseraxes:Theselectedisocenterpointsareexported.
TheY coordinates(IEC61217)oftheisocenterpositionsare
exportedinthecoordinatesystemoftheCTscanner;theX and
Z coordinates(IEC 61217)arerelativetotheoriginofthelaser
alignmentsystem.
1adjustablelaseraxis:Theselectedisocenterpointsareexported.
TheY andZ coordinates(IEC61217)oftheisocenterpositionsare
exportedinthecoordinatesystemoftheCTscanner;theX
coordinates(IEC 61217)arerelativetotheoriginofthelaser
alignmentsystem.
Marking the Field Coordinates in the

Virtual Simulation Export
Thecoordinatesofthefieldisocenter,fieldaperture,andfieldcentral
axisonthepatientsskinaremarkedwithpointsbyusingalaser
alignmentsystemasfollows:
Theisocenterisshownformarkupfirstusingalllasers.Afterthat,
thelasersshowthesubsequentpoints,eitheroneatatimeorallat
thesametime,dependingonthelaseralignmentsystem.
Staticfields:Eachcornerformedbythefieldapertureismarked
withapoint,altogetherfourpoints(seeFigure 195onpage 714),
andthefieldcentralaxisonthepatientsskinismarkedwithone
point.Youcanchoosetousenoneorallofthesepointstomarkthe
field.
Arcfields:Thefieldaperturesatarcanglesdefinedintheexportare
marked(at,forinstance,10,20,30and40degrees).

A.Pointsusedtomarkstaticfield.
Figure 195 Field Coordinate Points for Static Fields
Note: TheuseoftheGammexsystemisrecommendedonlyformarkingthe
isocenteronthepatientsskin,becauseitdoesnotacceptlasercontrol
information.However,ifyouwishtousetheGammexsystemfordisplaying
skinpoints,manuallyturnoffalllasersexceptthegreenonewhileviewingthe
Reviewdisplay.
Somelaseralignmentsystemssortthefieldcoordinatesintheexport
fileanddothemarkupinaparticularway,dependingonthevirtual
simulationinterface.Thefieldcoordinatesaresortedaccordingtothe
isocentersandsavedeitherinonesingleexportfileormultipleexport
files.Inlaseralignmentsystemsthatsavetheisocentercoordinatesin
separatefiles,thefieldsaresortedaccordingtotheisocenterssothat
fieldswiththesameisocenterareconsecutive.Interfacesthatrequire
movingtheCTtablemanuallyintheYaxisdirectionfurthersortthe
pointsineachfieldbytheYaxisdirection.
Marking the MLC Aperture in the Virtual Simulation Export
MLCaperturesaremarkedwithfourpointsthatmarktheintersection
pointsofthebeamandthepatientsskinatthecornersoftheMLC
apertureasfollows:
Staticfields:Forthefirstandlastopenleafpair(seeFigure 196on
page 715).
Staticarcfields(staticMLC):Atarcanglesdefinedintheexport(at,
forinstance,10,20,30and40degrees).
Conformalarcfields(DynamicMLC):Foreachsegmentofthe
conformalarcfield.ThenumberofsegmentsisdefinedintheMLC

A.PointsusedtomarkanMLC.
Figure 196 MLC Points in Field Coordinate Export
Reviewing the Laser Markings in the Virtual Simulation Export

Youcanreviewthelaserbeamsassimulatedprojectionsandthecross
lasersmarkingeachpointonthepatientmodelintheModelview
beforestartingtheexporttovirtualsimulation.Thelaserbeamsare
shownintheModelviewusingspecialcolorcoding.
IntheVirtualSimulationwizard,youcanalsoreviewalltransferred
pointstogetherwiththefieldandaperturedata,theactivelasersused
todisplaytheskinpoints,andthecoordinatesofthetransferred
points.Figure 197onpage 716showsthepageoftheVirtual
Simulationwizardwhereyoucanreviewthelasermarkingsbeforethe
export.

A. IsocentergroupstobeexportedB.Selecttherowofagrouptoviewitsinformationinthe
tableC. Field(s)fromwhichthepointsintheselectedgrouporiginateD. Characterizationofthe
points(isocenter,FCA = fieldcentralaxisonskin,fieldaperturecorner)E. Diagramshowingthe
directionsofthecoordinateaxesonthecurrentCTdeviceF. Laser(s)tobeactivatedtoshoweach
pointG. CoordinatesofthepointsontheX,YandZaxisH. Selecttherowofapointtoview
thefieldandthecrosslasersforthepointintheModelview
Figure 197 Virtual Simulation Wizard Point Review Page
Isocentergroupingisonlyshownforlaseralignmentsystemsthatsort
fieldinformationperisocenterintheexportfile.Theinformationin
thecolumnsoftheaxesalongwhichthecouchmustbemoved
manuallyisshowninred.
Youcanalsoreviewandsimulatethelasersaftertheexportis
complete.
Figure 198onpage 717andFigure 199onpage 717showthelaser
projectionsintheModelview.

Figure 198 Isocenter Cross Laser and Laser Beam Review in Model View
Figure 199 Field Aperture Cross Laser and Laser Beam Review in Model View
ThefollowingcolorcodingisusedintheModelView:
Red:Activelasers
Atthelaseralignmentsystem,onlyoneofthelasersisactivatedfor
markingtheskinpoints,butalllasersareactivatedformarkingthe
isocenters(orentrypointsforfixedSSDfields).
Yellow:Inactivelasersthatintersectthepatientsskininan
unacceptablepositioninrelationtothepointbeingdisplayed
Orange:Lasersmadeinactivebecausetheyintersectthepatients
skinatanexcessivelynarrowangle(under45)

Configuring the Laser Alignment System
LaseralignmentsystemsandCTscannerareconfiguredinTask
Configuration.Theconfigurationparametersdependonthetypeof
laseralignmentsystemandCTscannerinuse.
To Configure the Laser Alignment System and CT Scanner
2. SelecttheVirtualSimulationtab.
3. Selectthelaseralignmentsystemtobeconfiguredfromthe
dropdownlist.
4. Todefinetheparametersfortheselectedlaseralignmentsystem,
clickConfigure.
The<Name>Configurationdialogboxopens.
5. Definethedesiredlaseralignmentsystemparametersandclick
OK.Forinstructionsontheparameters,seeLAPLaserAlignment
SystemParametersonpage 718orGammexLaserAlignment
SystemParametersonpage 719.
6. Todefinetheparametersfortheselectedlaseralignmentsystem,in
theVirtualSimulationHardwaregroupbox,clickConfigure.
7. TodefinetheparametersfortheCTscannerdevice,intheCT
Scannergroupbox,clickConfigure.
TheCTScannerConfigurationdialogboxopens.
8. DefinethedesiredCTscannerparametersandclickOK.For
instructionsontheparameters,seeCTScannerParameterson
page 720.
LAP Laser Alignment System Parameters
LAPdevicesallowtransferofdataeitherviaFTP,shareddirectoriesor
aserialport.Theshareddirectoriesmethodisrecommended.
However,ifFTPdatatransferisselected,theEclipseworkstationmust
beconfiguredasanFTPserver.TheFTPservicemustbeenabledwhen
Eclipseisrunning.

Table 26 Configuration Parameters for LAP
Parameter Description
SerialPort Definesaserialportasthemethodofdatatransferfrom
EclipsetoLAPSelectionactivatesadropdownlistfor
selectingortypinginthenameoftheserialport.Theserial
portcanbeoneofthepredefinedselectionsCOM1COM4or
anyotherport.
File DefinesafileasthemethodofdatatransferfromEclipseto
LAPSelectionactivatesatextboxfordefiningthedirectory
pathandfilenameandtheBrowsecommandbuttonfor
navigatingtothelocationofthefile.Thedefaultfilenameis
LAPDATA.LAP.
DataInterface SelectstheinterfacetotheLAPsystem.
Gammex Laser Alignment System Parameters
Dialogboxforconfiguringthevirtualsimulationinterfacewhenusing
Gammexlaseralignmentsystems.
Table 27 Configuration Parameters for Gammex
DefaultExport Definesthepathofthedirectorywheretheexported
Directory fieldcoordinatesaresaved.IfyouselecttheStart
lasersautomaticallycheckbox,thefilenameisfixedto
beAUTORUN.CTS,otherwisethefilenameis
promptedforduringtheexportprocess.
Browse Navigatestothelocationofthedirectorywherethe
exportedfieldcoordinatesaresaved.
Markup Definestheintervalatwhichthelasersaremovedto
Markupdelay<n> showeachexportedpoint.Value0indicatesthatlaser
seconds(0=manual) positionsarechangedmanually.
Startlasers Turnsthelasersonautomaticallyafterthefield
automatically coordinateexport.
DataInterface SelectstheinterfacetotheGammexsystem.

CT Scanner Parameters
DialogboxforconfiguringtheCTscannerpropertiesforvirtual
simulation.
Table 28 Configuration Parameters for CT Scanner
CTIsocenter DefineshowtheCTisocenterXZprojection(IEC
61217)isdetermined.Theisocentercanbeprojectedto
theimageslicemidpoint(Definedbypixeldatacenter
option)ortoDICOMposition(0,0)(Definedby
DICOMoriginoption).
CTTable DefinestheCTcouchsettings.
Tablein/outdirection Definesthein/outreadoutoftheCTcouchtoincrease
increasestowards whenthecouchismovedtowardsthegantryoftheCT
gantry/ scanner,ortheup/downreadoutoftheCTcouchto
increasewhenthecouchismovedupwards.
Tableup/down
directionincreasesup
Tablein/outdirection SpecifieswhethertheCTdevicesupportszeroingthe
canbezeroed/ in/outortheup/downreadoutoftheCTcouch.
Tableup/down
directioncanbe
zeroed
Unitoftableposition SelectstheunitofCTcouchpositionreadoutsonthe
display displaypanel(s).Possiblevaluesaremmorcm.
PatientReference Referenceplaneisthetransversalzeroplanecheckbox
Plane forspecifyingthattheYcoordinatesoftheimageslice
atthereferenceplaneiszero.
VirtualSimulation DistancebetweenlasersandCTimagingplane<n>mm
HardwarePosition textboxfordefiningthedistanceofthereferenceplane
fromthezeropositionoftheCTdevice.

with Three Moving Laser Axes
1. Opentheplanthatyouwishtoexportforvirtualsimulation.
2. Ifrequiredbyyoursystem,convertasymmetricalfieldsinto
symmetricalonesasinConvertingAsymmetricalFieldsinto
SymmetricalFieldsonpage 413.
3. TobeabletobetterreviewthelasersprojectedontheBodysurface,
maximizetheModelview.
4. ChooseFile >Export >VirtualSimulation.
ThefirstpageoftheVirtualSimulationwizardopens.
5. Tospecifythepositionofthereferenceplane,movetheCTcouch
totheinitialpositionasfollows:
a. Positionthepatientreferenceplanetotheoriginofthelaser
alignmentsystem.
b. ZerotheCTtablein/outpositionorenterthecurrentCTin/out
reading,dependingontheconfigurationoftheCTdevice.
c. Definethereferenceplanepositionifthereferenceplaneisnot
thezeroplaneoftheCTdevice.
6. ClickNext.
ThenextpageoftheVirtualSimulationwizardopens.
7. Dooneorbothofthefollowing:
Toselectthefieldswhosecoordinatesyouwishtoexport,click
eachfieldintheFieldslist.
Toselectthesegmentsofaconformalarcfield,clickeach
segmentintheFieldslist.
Toselectmultiplefieldsorconformalarcfieldsegments,pressSHIFTor
CTRLandclickthedesireditems.
8. Todefinethestaticarcfieldanglesfromwhichtopickupthe
pointstobeexported,firstselectthearcfieldinthelist,thenclick
ArcFieldandinthedialogboxthatopens,
TochangetheangleshownintheFieldslist,typethedesired
valueintheAngleboxandclickOK.
Todefinenewangles,typethedesiredvalueintheAnglebox
andclickNew.Repeatforeachnewangle.

9. Toexportthecornersofthefieldapertureformarkuponthe
patientsskin,selecttheIncludeaperturecornerscheckbox.
ToexportthecollimatorcornersoftheMLCaperture,selectthe
UsecollimatorcornersforMLCcheckbox.
10. Toexportthecentralaxisofthefieldformarkuponthepatients
skin,selecttheIncludecentralaxisonsurfacecheckbox.
11. IntheCommenttextbox,typeyourcommentifnecessary.
12. Tocorrectfordeviationscausedby,forexample,CTcouch
bending,gototheTableDeviationgroupboxanddefinethe
patientspecificdeviationfromXandZdirectionsinmm.Thisis
notpossibleinalllaseralignmentsysteminterfaces.
13. ClickNext.
InLAPCT4,transversallaserscanonlymove60cm,anditcannotshow
pointslocatedfurtherthan60cmfromthefirstimage.Usingfields
exceedingthisdistancemayresultinawarningmessage.
ThenextpageoftheVirtualSimulationwizardopens.Formore
informationonthepage,seeReviewingtheLaserMarkingsinthe
VirtualSimulationExportonpage 715.
14. ToviewthelaserbeamsintheModelview,selecttheDisplaylaser
beamsinModelviewcheckbox.
15. ToviewthecrosslasersmarkingeachpointontheBodysurfacein
theModelview,selecttherowofeachpointinthetable.
IfthewizardobstructsyourviewtotheModelview,moveitbydragging
itbyitstitlebar.
Thelasersofthepointthatyoudoubleclickareshowninthe
Modelview,colorcodedasdescribedinReviewingtheLaser
MarkingsintheVirtualSimulationExportonpage 715.
16. Afteryouhavereviewedallthenecessarypoints,clickExportto
continue.
Thecoordinatesofthefieldsarecomputedandsavedtotheexport
fileorsenttothelaseralignmentsystem,dependingonthe
configurationofyoursystem.Allpointsareexportedrelativeto
theoriginofthelaseralignmentsystem.ThereisnoCTcoordinate
systemcorrectionfortheYandZ(IEC 61217)axes.

with One or Two Moving Laser Axes
1. Opentheplanthatyouwishtoexportforvirtualsimulation.
2. Ifrequiredbyyoursystem,convertasymmetricalfieldsinto
symmetricalonesasinConvertingAsymmetricalFieldsinto
SymmetricalFieldsonpage 413.
3. TobeabletobetterreviewthelasersprojectedontheBodysurface,
maximizetheModelview.
4. ChooseFile >Export >VirtualSimulation.
ThefirstpageoftheVirtualSimulationwizardopens.
5. SetuptheCTcouchtospecifythepositionofthereferenceplaneas
follows:
a. Positionthereferenceplanetotheoriginofthelaseralignment
system.
b. ZerotheCTcouchin/outandup/downposition(dependingon
theconfigurationofthesystem).
ThereferenceplanewillbetheplanethathaszeroYcoordinatesinthe
coordinatesystemoftheCTscanner.
6. ClickNext.
7. Dooneorbothofthefollowing:
Toselectthefieldswhosecoordinatesyouwishtoexport,click
eachfieldintheFieldslist.
Toselectthesegmentsofaconformalarcfield,clickeach
segmentintheFieldslist.
Toselectmultiplefieldsorconformalarcfieldsegments,pressSHIFTor
CTRLandclickthedesireditems.
8. Todefinethestaticarcfieldanglesfromwhichtopickupthe
pointstobeexported,firstselectthearcfieldinthelist,thenclick
ArcFieldandinthedialogboxthatopens,
TochangetheangleshownintheFieldslist,typethedesired
valueintheAngleboxandclickOK.
Todefinenewangles,typethedesiredvalueintheAnglebox
andclickNew.Repeatforeachnewangle.
9. IntheCommenttextbox,typeyourcommentifnecessary.

10. ClickNext.
ThenextpageoftheVirtualSimulationwizardopens.Formore
informationonthepage,seeReviewingtheLaserMarkingsinthe
VirtualSimulationExportonpage 715.
11. ToviewthelaserbeamsintheModelview,selecttheDisplaylaser
beamsinModelviewcheckbox.
12. ToviewthecrosslasersmarkingeachpointontheBodysurfacein
theModelview,selecttherowofeachpointinthetable.
IfthewizardobstructsyourviewtotheModelview,moveitbydragging
itbyitstitlebar.
Thelasersofthepointthatyoudoubleclickareshowninthe
Modelview,colorcodedasdescribedinReviewingtheLaser
MarkingsintheVirtualSimulationExportonpage 715.
13. Afteryouhavereviewedallthenecessarypoints,clickExportto
continue.
14. Ifpromptedtodoso,definethefilenameandthedirectorytosave
thefiletoandclickOK.
Thecoordinatesofthefieldsarecomputedandsavedtotheexport
fileorsenttothelaseralignmentsystem,dependingonthe
configurationofyoursystem.
Twomovinglaseraxes:TheYcoordinates(IEC61217)ofthe
isocenterpositionsareexportedinthecoordinatesystemoftheCT
device.TheXandZcoordinates(IEC61217)oftheexportedpoints
arerelativetovirtualsimulationsystemorigin.
Onemovinglaseraxis:TheYandZcoordinates(IEC61217)ofthe
isocenterpositionsareexportedinthecoordinatesystemoftheCT
device.TheXcoordinates(IEC61217)oftheexportedpointsare
relativetovirtualsimulationsystemorigin.

Chapter 26 Printing Plan Information
Thischapterdescribeshowplaninformationcanbeprintedout.
Informationisprovidedonprintingimageviewsasscreenimagesand
onprintingtreatmentreports,whicharedescriptionsoftheplanin
textualformat.Itisalsopossibletouseprinttemplatestoproduce
differenttypesofprintoutsfromasingledialogbox.Youcaninclude
textualandgraphicaldatainbothscreenprintoutsandtreatment
reports,andinstructionsareprovidedforbothapproaches.The
chapterdescribesthelayoutofandtheinformationcontainedinboth
typesofprintouts.Treatmentreportscanalsobemodified,and
instructionsforthiswithexamplesareprovidedinAppendix Eon
page 827.
Printing Image and Plan Information

Youcanprintanyapplicationscreenorwindowasanimageinoneor
multiplecopies,oranyactiveimageviewontheselectedprinter.In
ExternalBeamPlanning,DICOMprintsareavailableforfieldsand
setupfieldsintheFieldSetupandPlanEvaluationworkspaces.
Printing the Screen

Anyapplicationscreenorwindowcanbeprintedoutasanimagein
oneormultiplecopiesontheselectedprinter.Bydefault,onecopyis
printedonthedefaultprinter,whichisdefinedintheconfigurationof
youroperatingsystem.Printoutsoftheapplicationscreencanbe
used,forinstance,intreatment,fortreatmentverificationand
713
validation,andasaplanarchivalmethod.Apartfromthegraphical
information,thescreenprintoutsalsoindicatetheprintdateandtime,
andtheuserwhohasloggedin.
CAUTION: When printing screens, note that:
Do not use screen print-outs for conveying any planning information to

treatment as some of the information may be viewed only by changing the
column width or by scrolling it on screen. For example, in the External
Beam Planning task, this is the case with Info window (visible in the Field
Setup and Plan Evaluation workspaces).
Before printing the screen, display the viewing scale on screen to have
it included in the print-out.
You can also print plan reports. For a description and examples of a plan
report, see About Treatment Reports on page 749.
To Print Screens and Windows
1. ChooseFile >Print >PrintScreen.

ThePrintdialogboxopens.
2. IntheNamedropdownlist,selectthedesiredprinter.
3. Toprintoutmultiplecopies,gototheCopiesgroupboxand
definethedesirednumberintheNumberofcopiesspinbox.By
default,onecopyisprinted.
4. ClickOKtoprintthescreenontheselectedprinter.
Theresultingprintoutisnottoscale.
Printing the Active Image View

Apartfromtheentireapplicationscreen,anyactiveimageviewcanbe
printed.Printoutsoftheactiveviewcontaingraphicalandtextual
informationabouttheitemsvisibleintheviewatthemomentof
producingtheprintout.Thecontentoftheprintoutsdependon
whichwindowisactive.Largescaleimagescanbeprintedonseveral
pages,ifnecessary.

Print Settings for Active Image Views
Whenprintingimagesfromthesystem(eitherwithorwithoutprint
templates),youcandefinevarioussettingsforeachprintitem.These
settingsareavailable(viatheFile >Printmenu)foreachprintitem
bothwithandwithoutatemplate.
DVHsettings
BEVsettings
ArcPlaneviewsettings
Modelviewsettings
2Dviewsettings
DICOMsettings
TheprintsettingsofaplanreportaredescribedinTreatmentReport
PrintSettingsonpage 750.
Withprinttemplates,printerspecificsettingslikethenumberof
copiesetc.,aredefinedinaspecificprintsetupdialogbox.Formore
information,seePrintSetupDialogBoxonpage 746.
DVH Settings for Printing

PrinttemplatesareavailableintheFieldSetupworkspace.
Table 29showstheprintsettingsofaDVHprintout.
Whenprintingwithoutatemplate,thesesettingsinclude,forexample,
thepossibilitytodefinethenumberofcopiestobeprinted.Whena
templateisnotused,thenumberofcopiescanbedefinedbyclicking
thePropertiesbuttonoftheprintingdialogbox.Withprinttemplates,
however,thenumberofcopiescanonlybedefinedthroughthe
PropertiesbuttoninthePrintSetupdialogbox.
Table 29 DVH Settings
Item Option Description

Layout Printingwitha Printingwithatemplate:Checkthata
template:Various suitablereporttemplateisselected.
options. Printingwithoutatemplate:The
selectionisalwaysdisabled.
Description Thisboxisalwaysdisabled.
Printing Plan Information 715

Table 29 DVH Settings

Printcomment Adescriptionshownintheupper
partoftheprintout(belowpatient
information).
BEV Settings for Printing
Table 30showstheprintsettingsofaBEVprintout.
PropertiesbuttonPrintSetupdialogbox.
Table 30 BEV Settings

Fields(onlyavailable Selectedfield PrintstheBEVimageofthe
withprinttemplates) selectedfieldonly.
Allfields PrintstheBEVimageofall
fields.
Plotdistancefrom SourcetoSkin Printstheimageto1:1scaleat

focus Distance(SSD) theSSD.
SourcetoAxis Printstheimageto1:1scaleat
Distance(SAD) theSAD.
Sourcetoblock Onlyavailablewithprint
distance(SBD) templates:Printstheimagein
1:1scaleattheSBD.
Other(cm) Printstheimagein1:1scaleat
theuserdefineddistance
(definethedistanceinthetext
box).

Table 30 BEV Settings

Pagelayout UseX Xpages Definethenumberofpages
usedhorizontallyand
vertically.Forexample:
Entering1 2producesa
separateheaderpageand
twoimagepagesas
follows:
twoimagepagesas
follows:
Automatically Letstheapplicationdecidethe
arrangeon numberofpagesused
multiplepages (producesaseparateheader
pageanddividestheimageon
severalpages).
Includeinprint Drawlinesas Printslinesblack,forexample,

black fieldlines.
Separatepagefor Printsthetextualinformation
header andtheimageonseparate
pages.
Printcomment Adescriptionshowninthe
upperpartoftheprintout
(belowpatientinformation).
Arc Plane View Settings for Printing
Table 31onpage 730showstheprintsettingsofanArcPlaneview

printout.

Table 31 Arc Plane view settings

Fields(onlyavailable Selectedfield(only PrintstheArcPlaneviewof
withprinttemplates) availableiftheactive theselectedfieldonly.
fieldisanarcfield)
Allfields PrintstheArcPlaneviewofall
fields.
Scale Fittopage Lettheapplicationzoomthe

imageontheselectednumber
ofpages.
Scale(%) Definethezoomratio(%).
Pagelayout UseXXpages Definethenumberofpages

usedhorizontallyand
vertically.Forexample:
twoimagepagesas
follows:
twoimagepagesas
follows:

Table 31 Arc Plane view settings

Automatically Lettheapplicationdecidethe
arrangeon numberofpagesused
multiplepages (producesaseparateheader
pageanddividestheimageon
severalpages).
Includeinprint Fieldsummary Printsfieldinformationlines

abovetheimage.
3Dimage Currentlynotinuse(although
possibletoselect).
Usewhite Currentlynotinuse(although
background possibletoselect).
Drawlinesas Printslinesinblack,for
black example,fieldlines.
Separatepagefor Printsthetextualinformation
header andtheimageonseparate
pages.
Printcomment Adescriptionshowninthe
upperpartoftheprintout
(belowpatientinformation).
Model View Settings for Printing

Table 32showstheprintsettingsofamodelviewprintout.

Table 32 Model View Settings

imageontheselectednumberof
pages.
Pagelayout UseXXpages Definethenumberofpagesused

horizontallyandvertically.For
example:
separateheaderpageandtwo
imagepagesasfollows:
arrangeon numberofpagesused(produces
multiplepages aseparateheaderpageand
dividestheimageonseveral
pages).

abovetheimage.
Drawlinesas Printslines,forexamplefield
black lines,inblack.
Separatepagefor Printsthetextualinformationand
header theimageonseparatepages.
partoftheprintout(below
patientinformation).

2D View Settings for Printing
Table 33showstheprintsettingsofa2Dviewprintout.
PropertiesbuttonPrintSetupdialogbox.
Table 33 2D View Settings

Views(only Selectedview Printsa2Dimageoftheselected
availablewithprint viewonly.
templates)
Alldisplayed Printsa2Dimageofalldisplayed
views viewsseparately.

pages.
Pagelayout UseXXpages Definethenumberofpagesused

horizontallyandvertically.For
example:

Table 33 2D View Settings

arrangeon numberofpagesused(producesa
multiplepages separateheaderpageanddivides
theimageonseveralpages).

abovetheimage.
Drawlinesas Printslines,forexamplefield
black lines,inblack.
Separatepagefor Printsthetextualinformationand
header theimageonseparatepages.
3Dimage PrintsaCTimageintheactive
view.
Usewhite Printstheimageonawhite
background background.
partoftheprintout(below
patientinformation).
To Print 2D Views, the Model View or the Arc Plane View
1. Toactivatetheviewtobeprintedout,clickitstitlebar.
2. ChooseFile >Print >View.
ThePrintViewdialogboxopens.
3. Definetheprintertouse.
IntheNamedropdownlist,selecttheprinter.
Todefinetheprinterproperties,clickProperties.
4. UsetheNumberofcopiesspinboxtodefinehowmanycopiesto
printout.
5. InthePrintcommenttextbox,typeyourcommenttoshowonthe
printout.
6. Toprintthefieldinformationlinesabovetheimage,selectField
summary.

7. Toprinttheimageintheactive2Dview,select3Dimage.
8. Toprintthetextualinformationandtheimageonseparatepages,
selectSeparatepageforheader.
9. Toprinttheimageonawhitebackground,selectUsewhite
background.
10. Toprintlinesblack,selectDrawlinesasblack.
11. InthePagelayoutgroupbox,definethepagelayoutforthe
printout:
Todefinethenumberofpagesusedhorizontallyand
vertically,clickUseandtypethenumbersofpagesinthetext
boxes.
Tolettheprogramdeterminethenumberofpagesused,click
Automaticallyarrangeonmultiplepages.
12. IntheScalegroupbox,definethezoomfactor:
Todefinethezoomratio,clickScaleandtypethezoomratioin
thetextbox.
Tolettheprogramzoomtheimageontheselectednumberof
pages,clickFittopage.
Toseeapreviewoftheprintout,clickPreview.ClickPrintin
thepreviewwindowthatopens.
ClickOKtoprinttheactivewindowtotheselectedprinter.
Note: IfyouselectAutomaticallyarrangeonmultiplepages,thefirst
previewpageillustratestheorderinwhichtheimagepartswillbeprinted.
To Print the Beams Eye View
1. ToactivatetheBEV,clickitstitlebar.
2. ChooseFile >Print >View.
ThePrintBEVdialogboxopens.
3. Definetheprintertouse:
IntheNamedropdownlist,selecttheprinter.
Todefinetheprinterproperties,clickProperties.

4. UsetheNumberofcopiesspinboxtodefinehowmanycopiesto
printout.
5. InthePrintcommenttextbox,typeyourcommenttoshowonthe
printout.
6. Toprintthetextualinformationandtheimageonseparatepages,
selectSeparatepageforheader.
7. Toprintlinesblack,selectDrawlinesasblack.
8. InthePagelayoutgroupbox,definethepagelayoutforthe
printout:
Todefinethenumberofpagesusedhorizontallyand
vertically,clickUseanddefinethepagesinthetextboxes.
Tolettheprogramdecidethenumberofpagesused,click
Automaticallyarrangeonmultiplepages.
9. InthePlotdistancefromfocusgroupbox,definethescaleofthe
BEVimageontheprintout:
Toprinttheimagein1:1scaleattheSSD,clickSSD.
Toprinttheimagein1:1scaleattheSAD,clickSAD.
Toprinttheimagein1:1scaleatauserdefineddistance,click
Otheranddefinethedistanceinthetextbox.
Toseeapreviewoftheprint,clickPreview.ClickPrintinthe
previewwindowthatopens.
ClickOKtoprinttheactivewindowtotheselectedprinter.
To Print a DVH
1. DisplaytheDVHgraphintheDoseVolumeHistogramview.
2. RightclickintheDoseVolumeHistogramviewandchoosePrint
DVHReport.
ThePrintTreatmentReportdialogboxopens.
3. IntheNamedropdownlist,selecttheprintertouse.
4. IntheNumberofcopiesspinbox,selectthedesiredvalue.
5. InthePrintcommenttextbox,typeacommentfortheDVH,if
desired.

6. Topreviewthegraphbeforeprinting,clickPreview.
7. ToprinttheDVHgraph,clickOK.
Information in Print-Outs of Active Views

Theprintoutsofactiveviewscontaintextualandgraphical
informationabouttheitemsvisibleintheviewatthemomentof
producingtheprintout.Inaddition,printoutsdoneintheFieldSetup
orPlanEvaluationworkspacealsocontainfieldinformation.Ifthe
activeviewcontainshiddenfields,acautionisincludedinthe
printoutstatingthatthehiddenfieldandfieldaccessoryoutlinesare
notincludedintheprintout(seeTable 34onpage 737).Youcan
displaythefieldaccessoryofahiddenfieldbyselectingtheaccessory
intheFocuswindow.
Textual Information in Print-Outs of Active Views
Thetextualinformationintheprintoutofanactiveviewdependson
theworkspacefromwhichitisproduced.
Table 34 Textual Information in Header
Information printed Workspace

Patientsnameandidentificationcodes All
1and2
Hospital All
Lastmodificationdateandtimeofthe All
planandthenameofthemodifier
Imagecomment: All
TexttypedintheCommenttabofthe
ImagePropertiesdialogbox.
Comment: All
TexttypedinthePrintViewdialogbox
PlanComment: ExternalBeamPlanning:FieldSetup,
TexttypedintheCommenttabofthe PlanEvaluation
PlanPropertiesdialogbox BrachytherapyPlanning:Planning,
PlanEvaluation

Table 34 Textual Information in Header

Caution:Hiddenfieldandfield ExternalBeamPlanning:FieldSetup,
accessoryoutlinesnotincludedinthe PlanEvaluation
printout!
Courseidentificationcode ExternalBeamPlanning:FieldSetup,
PlanEvaluation
BrachytherapyPlanning:Planning,
PlanEvaluation
Planidentificationcode ExternalBeamPlanning:FieldSetup,
PlanEvaluation
PlanEvaluation
Imageseriesname Selection,Registration,Contouring
Imageidentificationcode All
Visibleimageidentificationcode ExternalBeamPlanning:Selection,
Contouring,FieldSetup,Plan
Evaluation
BrachytherapyPlanning:Selection,
Contouring,Planning,Plan
Evaluation
Plannormalizationvalue ExternalBeamPlanning:FieldSetup,
PlanEvaluation
Calculationgrid ExternalBeamPlanning:FieldSetup,
PlanEvaluation
PlanEvaluation
Maximumdoseintheplan(if ExternalBeamPlanning:FieldSetup,
calculated) PlanEvaluation
PlanEvaluation
MaximumandminimumdoseinPTV ExternalBeamPlanning:FieldSetup,
(ifcalculated) PlanEvaluation
PlanEvaluation
MeandoseinPTV(ifcalculated) ExternalBeamPlanning:FieldSetup,
PlanEvaluation
PlanEvaluation

Table 35 Textual Information in Footer

Patientsnameandidentificationcode All
Courseidentificationcode ExternalBeamPlanning:FieldSetup,
PlanEvaluation
BrachytherapyPlanning:Planning,Plan
Evaluation
Plannameandidentificationcode ExternalBeamPlanning:FieldSetup,
PlanEvaluation
Evaluation
Imageseriesname Selection,Registration,Contouring
Imageidentificationcode Selection,Registration,Contouring
Printedimageplane(notshownin All
ModelvieworBEVprints)
Plottingdistance(shownonlyinBEV ExternalBeamPlanning:FieldSetup
prints)
Arcviewingangle ExternalBeamPlanning:FieldSetup,
PlanEvaluation
Scalingfactor All
Patienttreatmentorientation All
Offsetoftheimageuseroriginfrom All
theDICOMoriginanduserorigin
comment,ifdefined
Applicationnameandversion All
Dateandtime All
Pagenumber All
Gridsize(ifgridison) All
Graphical Information in Print-Outs of Active Views
Printoutsproducedofanactiveviewcontainthesamegraphical
informationasonscreen.Itemsnotvisibleonscreenarenotincluded
intheprintouts.

Table 36 Graphical Information in Image View Print-Outs
Graphical Information Workspace

Patientorientationindicator All
Coordinateaxesindicator All
Imagescaleindicator All
Orientationlabels All
Grid(ifgridison) All
Structureoutlines All
Imageorigin All
Referencepoints All
Markers All
Fieldoutlines ExternalBeamPlanning:FieldSetup,
PlanEvaluation
Fieldisocenter(coplanarfields)or ExternalBeamPlanning:FieldSetup,
fieldcentralaxisviewingplane PlanEvaluation
intersection(noncoplanarfields)
Arcangleindicator ExternalBeamPlanning:FieldSetup,
PlanEvaluation
Wedgeindicator ExternalBeamPlanning:FieldSetup,
PlanEvaluation
Bolus,block,andMLCprojections ExternalBeamPlanning:FieldSetup,
PlanEvaluation
Compensator ExternalBeamPlanning:FieldSetup,
PlanEvaluation
Isodosecurvesorcolorwash ExternalBeamPlanning:FieldSetup,
PlanEvaluation
Evaluation
Dosemaximumpoint ExternalBeamPlanning:FieldSetup,
PlanEvaluation
Structure3Dmodels ExternalBeamPlanning:FieldSetup,
PlanEvaluation

Field Information in Print-Outs of Active Views
IftheFieldsummarycheckboxisselectedinthePrintViewdialog
box,thefieldinformationlinesareprintedbetweentheheaderandthe
image.Alsothefieldinformationofthehiddenfieldsisincludedinthe
printoutwhentheactiveviewcontainshiddenfields.
Table 37 Textual Information in Field Information Lines, External Beam
Planning Task
Print-Out Text Description

FieldID Fieldidentificationcode
Technique Fieldtechnique
Machine Treatmentunitname
Scale Treatmentunitscale
Energy Treatmentunitenergymode
WedgeID Wedgeidentificationcode
Weight Fieldweight
X1[cm]X2[cm] FieldsizeinXdirection;ifsymmetric,onlyonenumberis
shown
Y1[cm]Y2[cm] FieldsizeinYdirection;ifsymmetric,onlyonenumberis
shown
GantryRtn[deg] Gantryrotationangle
CollRtn[deg] Collimatorrotationangle
CouchRtn[deg] Tablerotationangle
X[cm] Isocentric:IsocenterXcoordinate
FixedSSD:Fieldentrypoint
Y[cm] IsocenterYcoordinate
Z[cm] IsocenterZcoordinate
SSD[cm] SourcetoSkinDistance
MU MonitorUnits;iftherearetwoormorefractionations,the
fieldisempty.

DICOM Print
InExternalBeamPlanning,DICOMprintsareavailableforfieldsand
setupfieldsintheFieldSetupandPlanEvaluationworkspaces.
DICOMprintsarescalabletoallowfilmcomparisononthelightbox
(comparisonofDRRimagewithsimulationorverificationimage).
DICOMprintscontainbothtextual/numericaldataandgraphicaldata.
Thefollowinginformationisprintedintextualornumericalformat:
PatientnameandID
CourseID
PlanID
FieldID
Printdate
Collimator,gantryandcouchsettings
Thefollowinginformationisprintedingraphicalformatasoverlays,if
selectedtobeprinted:
Collimatorjaws
Fieldaccessories(compensators,blocks,wedges,MLCs,DMLCs)
Structureoutlines
Fieldgraticule
Layersinthereferenceimage(DRR),ifany
TheDICOMprintercanbeconfiguredasnecessary.Formore
information,refertotheonlinehelp.
FormoreinformationonprintingDICOMprintouts,seeInformation
inPrintOutsofActiveViewsonpage 737andUsingPrint
Templatesonpage 744.
Note: WhenusingDICOMprinttheprinterneedstobecarefullyconfigured
inordertoprintimagesincorrectscale.Checktheprinterconfigurationby
printingatestimagewithanobjectofknowndimensionsinXandY
directions.
DICOM Settings for Printing

Table 38showstheprintsettingsofaDICOMprintout.

Whenusingaprinttemplate,settingslikethename,thenumberof
copiesandmargindefinitionscanbefoundinthePrintSetupdialog
box.Formoreinformation,seePrintSetupDialogBoxonpage 746.
Note: WhenusingDICOMprinttheprinterneedstobecarefullyconfigured
inordertoprintimagesincorrectscale.Checktheprinterconfigurationby
printingatestimagewithanobjectofknowndimensionsinXandY
directions.
Table 38 DICOM Settings

Fields Selectedfield PrintsaDICOMimageofthe
selectedfieldonly.
Allfields PrintsaDICOMimageofall
displayedfieldsseparately.

pages.
Pagelayout Variousoptions Definehowtheimagewillbe

dividedonpages.
Includeinprint Fieldsummary Printsfieldspecificinformation.
Jawsandwedges Showsthepositionofjawsand
drawstheoutlineofpossible
wedges.
Graticule Drawsthegraticuleintheimage.
Planinfo Printsplanspecificinformation,
forexample,planID,fieldID,
fieldname.
Aperture(MLC, ShowstheapertureofMLCand
blocks) theoutlineofpossibleblocks.
Structureoutlines Printstheoutlineofthedefined
structures.
Printcomment(only Adescriptionshownintheupper
availablewithprint partoftheprintout(below
templates) patientinformation).

To Use DICOM Print
1. ChooseFile >Print >DICOMPrint.
2. Definetheprintsettingsasnecessary.
Formoreinformationonprintsettings,seeDICOMSettingsfor
Printingonpage 742.
3. ClickOK.
Using Print Templates

Youcanproducedifferenttypesofprintouts(DVH,planreport,BEV,
Modelview,2Dview,andDICOMprintouts)fromasingledialogbox
intheFieldSetupworkspace.Youcansaveyourprintsettingsasa
templateafterwhichthesesettingswillbeavailableforall
workstations.Youcanalsomodifyexistingprinttemplates,delete
themfromtheserver,anddefineadefaulttemplateforyour
workstation.
Note: Whenusingprinttemplatesnotethat:
Atleastoneprintermusthavebeendefinedforyourworkstation.
Printtemplatesarenotavailableforplansums.
Theprintsettingsofeachtemplateincludebothitemspecificprint
settingsaswellasprinterspecificoptions.
Foremoreinformationonprintitemspecificsettings,seePrint
SettingsforActiveImageViewsonpage 727.Formoreinformation
onprinterspecificoptionsofatemplate,seePrintSetupDialogBox
onpage 746.
To Access Print Templates

1. Toopentheprinttemplatesdialogbox,chooseFile >Print >Using
TemplatesintheFieldSetupworkspace.
ThePrintUsingTemplatesdialogboxopens.

2. Ifthisisthefirsttimetheprinttemplatesareused,thePrint
templateslistisempty.Forinstructionsoncreatinganew
template,seeToCreateaNewPrintTemplateonpage 747.
Ifsomeonehasalreadysavedtemplatesintothesystem,the
templatesareshowninthePrinttemplateslist.
Whenyouselectatemplateinthelist,thePrintitemslistdisplays
itemsthatareincludedinthetemplate(forexampleDVH,plan
reportand2Dview).Whenyouselectaprintiteminthelist,its
settingsaredisplayedinthelowerpartofthedialogbox.
To Print Images Using a Template

1. IntheFieldSetupworkspace,chooseFile >Print >Using
Templates.
2. FromthePrintTemplateslist,selectthetemplatethatbestsuits
yourneeds.
ThePrintItemslistindicateswhichitemsareselectedforprinting
(checkboxselected).Whenyouclickaprintitem,itssettingsare
displayedinthelowerpartofthedialogbox.
Formoreinformationonprintitemsettings,seePrintSettingsfor
ActiveImageViewsonpage 727.
IftheapplicationshowsUnknown PrinterinthePrintercolumnofa
printitem,youcannotprinttheitemsincetheprinterisnotaccessibleat
themoment.Tobeabletoprinttheitem,definenewprintersettings
throughthePrintSetupdialogbox.
3. Toviewprinterspecificinformationoftheselectedprintitem,
clickPrintSetup.
Formoreinformationonprintsetupinformation,seePrintSetup
DialogBoxonpage 746.
4. Toproduceaprintoutwiththedefinedinformation,clickPrint.

Print Setup Dialog Box
DVH, Plan Report, BEV, Model View, 2D View

and Arc Plane View Prints
InthePrintSetupdialogboxyoucanselecttheprintertouseand
definesomeprinterspecificsettings,forexamplethepapersizeand
orientation.ThedialogisaccessedbyclickingthePrintSetupbutton
inthePrintUsingTemplatesdialogbox.
Youcandefinemoreadvancedsettingsfortheprinterbyclickingthe
Propertiesbutton.Thesettingsvarydependingontheselectedprinter.
Youcan,forexample,definethenumberofcopiestoprintandthe
papersize.Notethattheselectedprinterandprinterdriverdetermines
wherethesesettingsarechanged.
Note: Thefinalappearanceoftheprintoutisdeterminedbycombinationof
printeroptionsyouselectbothfromthePrintSetupdialogbox(forexample,
scaling)andfromtheprinterspecificsettings(forexample,pagespersheetor
scaling).Forexample,ifyouselect50%scalinginthePrintSetupdialogbox
andthen50%scalingintheprinterspecificsettings,theimagesizeonthe
finalprintoutwillbeonefourth(1/4)oftheoriginal.
Note: Whenprintingtreatmentreports,thepapersizeisdefinedbythe
treatmentreporttemplate.Inotherwords,thepapersizedefinitionsyoumake
inprintersettingswillbeignoredbytheapplication(excluding,forexample,
thesituationswheretheprintercannotsupporttheA3papersize).Ifyou,for
example,wanttoprintatreatmentreportusingtheFull.tmllayoutandyou
setA3asthepapersizeinprintersettings,theapplicationwillprintthereport
intheA4sizesincethishasbeendefinedasthepapersizetobeusedinthe
treatmentreporttemplate.
DICOM Prints
WhenyouselecttheDICOMprintiteminthePrintUsingTemplates
dialogboxandclickthePrintSetupbutton,thePrintSetup:DICOM
dialogboxopens(dedicatedtoDICOMprintsonly).Inthedialogbox,
youcansetmarginsforyourprintoutsanddefinethenumberof
copiestobeprinted.
PrintoutsareprintedtoaspecificprintersupportedbytheDICOM
protocol.TheprintersshownintheNameboxmusthavebeen
configuredbeforehand(Tools>DICOMPrintConfiguration).

To Create a New Print Template
Templates.
Iftherearenotemplatesdefinedinthesystem,thePrint
Templateslistisemptyandyoucandirectlystartselecting
printitemsandtheirsettingsinthePrintitemslist.
IftherealreadyaretemplatesinthePrintTemplateslist,select
atemplatethatsuitsyourneedsandmodifyitssettings.
2. InthePrintItemslist,definetheprintitem(s)andtherelated
settingsforthenewtemplate.
Example:IfyouwanttocreateatemplatethatproducesaDVH
printoutandusesalocalprinter,selecttheDVHcheckboxinthe
printitemslistandclickPrintSetup.InthePrintSetupdialogbox
thatopens,selectthedesiredprinterandclickOK.Checkthat
otherprintitemsettingsalsosuityourneeds.
Formoreinformationonprintitemspecificsettings,seePrint
SettingsforActiveImageViewsonpage 727.
3. Tosavethesesettingsasatemplate,clickSaveas.
ThePrintTemplate:Saveasdialogboxopens.
4. Giveanameforthetemplateandenteradescriptionintothe
Commentbox(forexample,indicatewhichlocalprinteryou
selectedforthistemplate).
TheLocationandModifiedfromboxesindicatewherethis
informationwillbesavedandfromwhichworkstationthechanges
weremade.
5. ClickOK.
6. ThetemplateyoucreatedappearsinthePrinttemplateslist.
Otherusersarenowabletousethistemplate,tomodifyand
overrideitssettings(Save)ortocreateanewtemplatebasedon
thesesettings(Saveas).
Note: Ifyoucreatedanewtemplatebasedonanexistingone,itnowseemsin
thePrintUsingTemplatesdialogboxasifthesettingsoftheoriginaltemplate
werechanged,too.Thisis,however,notthecase.WhenyouclickCancelto

closethedialogboxandopenitagain,youcanseethatthesettingsofthe
originaltemplateremainedunchangedandthenewtemplatenowcontainsthe
settingsyousaved.
To Modify a Print Template

Templates.
2. FromthePrintTemplateslist,selectthetemplatethatyouwantto
modify.
3. Selectorclearthecheckboxoftheprintitemandmodifythe
settingsasneeded.Afterthatdooneofthefollowing:
Toprintwithoutsavingthechanges,clickPrint.The
applicationwillnotstorethechangedsettings.
Tooverridethecurrentsettingsandtosavethechangesprior
toprinting,clickSave.Thenprinttheimage(s)withthenewly
definedsettings.
Tocreateanewtemplatebasedonthechangesyoumade,click
Saveas.Thenprintthedefinedinformation.Formore
informationoncreatinganewtemplate,seeToCreateaNew
PrintTemplateonpage 747.
Notethatsavingthenewtemplatewithanexistingfilenamewill
overridetheexistingtemplate.
To Set a Default Print Template

Templates.
2. Todefineatemplateasthedefaulttemplateforyourworkstation,
selectaprinttemplatefromthePrinttemplateslistandclickSetas
Default.
Thedefaulttemplateisnowindicatedwith(Default)nexttoits
nameinthePrinttemplateslist.

Afterthis,whentheprinttemplatedialogboxisopenedonthis
workstation,thistemplatewillbeselectedbydefault.
To Delete a Print Template

Note: Thetemplateisdeletedfromtheserver,notonlyfromyourworkstation.
Carefullyconsiderdeletingtemplates,sinceotherusersmaystillbeusing
them.
Templates.
2. Todeleteatemplate,selectitfromtheprinttemplateslistandclick
Delete.
Notethattheapplicationdoesnotwarnyouaboutdeletingthetemplate.
About Treatment Reports

Atreatmentreportisadescriptionofaplanorplansumintextual
format,containingalltherelevantinformationofthepatient,theplan
orplansincludedinthesum,andallfieldsintheplanorplansumin
textualform.
Theinformationisprintedinascalespecifictothetreatmentunit,
usingtreatmentunitspecificlabelsiftheyhavebeendefined.
Theapplicationcontainsafewreadymadetreatmentreport
templates,determiningthelayoutofandtheinformationincludedina
treatmentreport.Whenprintingoutatreatmentreport,youcanselect
thelayouttouse.Youcanalsodefinethelayoutofthetreatmentreport
accordingtoyourneeds,andincludeonlytheinformationrelevantin
yourenvironment.Formoreinformationabouteditingreport
templates,seeAppendix Eonpage 827.
Note: Whenworkingwithplansums,notethat:
Treatmentreporttemplatesarenotavailableforplansums.
Tobeabletoprintatreatmentreportforaplansum,alldose
distributionsmustbedisplayedandallplanweightsmustbesetto1.
TreatmentreportscanbeprintedfromtheFieldSetupworkspace.

Treatment Report Print Settings
Table 39showstheprintsettingsofatreatmentreportprintout(plan
report).
Table 39 Treatment Report Settings

Layout Variousoptions Selecthereasuitablelayout
option.
partoftheprintout(belowpatient
information).
Inaddition,adescriptionisdisplayedifdefinedinthetemplatefile.
To Print Treatment Reports

Note: Youcanalsouseprinttemplatesforprintingtreatmentreports.Formore
information,seeUsingPrintTemplatesonpage 744.
1. ChooseFile >Print >PrintReport.
ThePrintTreatmentReportdialogboxopens.
2. IntheLayoutdropdownlist,selectalayouttemplateforthe
report.
TheDescriptionboxdisplaysacomment,ifdefinedinthe
templatefile.
3. InthePrintcommenttextbox,typeyourcommenttoaddonthe
report.
4. Toincludethecouchshiftinformationonthetreatmentreport,
selectthePrintcouchshiftcheckbox.Formoreinformationabout
thecouchshift,seeChapter 5,SectionSettingtheUserOriginon
page 133.
Toseeapreviewofthereport,clickPreview.
Toclosethepreviewwindowandcanceltheprintoutaction,
clickClose,ortoprinttheview,clickPrint.
ClickOK.Thetreatmentreportisprintedontheselected
printer.

Content of Treatment Reports for External Beam Plans
Layout of Information on a Default Treatment Report

for an External Beam Plan
Theinformationonthefulltreatmentreporttemplate(Full.tml)is
organizedaspresentedinFigure 200onpage 752.Alltheitemsare
listedanddescribedinthetables.
TreatmentReportLayout:A.Header,B.Form,C.Footer,1.PatientInformation,2.Clinical
ProtocolInformation,3.CourseandPlanInformation,4.ImageInformation,5.Treatment
Information,6.CalculationInformation,7.FieldSpecificInformation,and8.ReferencePoint
Information.
Figure 200 Treatment Report Layout

Information Entries on a Full Treatment Report
Theheadercontainsthenameandversionofthesoftware,andthe
nameofthehospital.Thefootercontainsthenameofthepatient,the
dateandtimeofprinting,andidentificationcodesforthecourseand
plan.Themaintext,form,containsinformationconcerningthepatient,
course,plan,image,possibleclinicalprotocol,prescribedtreatment,
calculationmethods,fieldsandreferencepoints.
Thefollowingtableslisttheinformationintheheader,formand
footer.
Table 40 Patient Information
Report Text Description

Birthdate Patientsdateofbirth.
IDs Identificationcodesofthepatient.
Name Nameofthepatient.
PatientComment Userdefinedcommentaboutpatient.
PrimaryOncologist Identificationoftheoncologistassignedtothe
patient.
ReportComment Userdefinedcommentaboutreport.
Sex Patientssex.
Table 41 Course and Plan Information

CourseComment Userdefinedcommentaboutcourse.
CourseID Identificationcodeofthecourse.
CourseIntent Intendeduseofthecourse.
PlanComment Userdefinedcommentaboutplan.
PlanID Identificationcodeoftheplan.
PlanName Nameoftheplan.
PlanCreated Dateandtimewhentheplanwasfirstcreated,
userwhocreatedtheplan.

Table 41 Course and Plan Information

PlanLastModified Dateandtimewhentheplanwaslastmodified,
userwhomodifiedtheplan.
PatientTreatment Intendedpatientorientationduringbeamon
Orientation
Table 42 Clinical Protocol Information

FractionsperDay Numberoffractionstoapplyinonedayduring
thetreatment.
FractionsperWeek Numberoffractionstoapplyinoneweekduring
thetreatment.
ImmobilizationDevice Immobilizationdeviceofthepatientinthe
treatment.
Index Conformityobjectivesforstructuresintheplan
(structureID,objectivetype(Conformity
Index,Gradient Measure),valueofthe
objective).
LocalizationTechnique Localizationtechniqueofthepatient.
Prescriptions Doseprescriptionoftheprotocolplan.
ProtocolID Identificationcodeoftheclinicalprotocol.
ProtocolPlanID Identificationcodeoftheplanintheclinical
protocol.
Status Statusoftheclinicalprotocol.
TotalFractions Totalnumberoffractionsintheprotocolplan.
Table 43 Image Information

ContrastAgentIngredient Contrastagentusedduringimaging,ifany.

Table 43 Image Information

ImageApproval Dateandtimewhentheimagewasapproved,
userwhoapprovedtheimage.
IftheimageisinsomeotherstatethanApproved,
printsIMAGE NOT APPROVED.
ImageComment Userdefinedcommentaboutimage.
ImageID Identificationoftheactiveimage.
ImageModality Modalityoftheimage.
ImageName Nameoftheactiveimage.
ImageOrigin Imageorigincoordinates.
Iftheoriginhasbeenmoved,thelinereadsUser
originDICOMoffset=(<n>cm,<n>cm,<n>cm).
ImageOriginComment Userdefinedcommentaboutimageorigin.
ImageSeriesID Identificationoftheimageseries.
ImagingDevice Model:
Manufacturer:
SerialNumber:
PatientImaging Patientorientationusedduringimaging.
Orientation
PatientTreatment Intendedpatientorientationduringtreatment.
Orientation
PlanningCoordinate Identificationcodeofaxisorientationusedin
System planning.
SeriesComment Userdefinedcommentabouttheimageseries.
Table 44 Structure Information

ApprovalStatus Approvalstatusofthestructure
CTValue SourceoftheCTvalueofthestructure.
ID Identificationofthestructure.

Table 44 Structure Information

Name Nameofthestructure.
StructureComment Userdefinedcommentaboutthestructure.
StructureSetComment Userdefinedcommentaboutthestructureset.
StructureSetID Identificationofthestructureset.
Type Volumetypeofthestructure.
Table 45 Couch Shift Information

WARNING AlwaysprintsVERIFY THAT USER ORIGIN IS
SET CORRECTLY BEFORE USING COUCH
SHIFT INFORMATION.
UserOrigin Userorigincoordinates
Iftheoriginhasbeenmoved,thelinereadsUser
originDICOMoffset=(<n>cm,<n>cm,<n>cm).
CouchShiftViewing AlwaysprintsFrom foot of couch looking

Direction toward gantry.
Field<n>: Foreachisocentercontainedintheplan:
<FieldID>ofeachfieldusingtheisocenter.
CouchShiftfromUserOrigin:
Shift[cm]:Couchshiftneededtocorrectlyplace
theisocenter.
Direction[cm]:Directionofthecouchshiftin
relationtothegantry.
Right Graphicprintedoutif
thecouchistobe
movedtotheright.
Up Graphicprintedoutif
thecouchistobe
movedup.

Table 45 Couch Shift Information

Left Graphicprintedoutif
thecouchistobe
movedtotheleft.
Down Graphicprintedoutif
thecouchistobe
moveddown.
In Graphicprintedoutif
thecouchistobe
movedtowardsthe
gantry.
Out Graphicprintedoutif
thecouchistobe
movedawayfromthe
gantry.
Table 46 Dose Prescription Information

Fractionation <FractionID>:Identificationcodeofthe
fractionation.
Prescribeddose
DoseinPrimaryReferencePoint
NumberofFractions:Numberoffractionstowhich
thetreatmentisdivided.
IntervalDays:Numberofintervalsinthe
treatmentindays.
FractionsperDay:Numberoffractionstoapplyon
onedayduringthetreatment.
FractionsperWeek:Numberoffractionstoapplyin
oneweekduringthetreatment.
StartDelay:Delayuntilthestartingdayofthe
treatment.
NumberofFractionations Numberoffractionations.
PlanNormalization Normalizationmethodoftheplan.
Method

Table 46 Dose Prescription Information

PlanNormalizationPoint Coordinatesofthereferencepoint(primaryor
other)usedforplannormalization.
PlanNormalizationValue Normalizationvalueoftheplan.
PrescribedDose Prescribeddosepercentage.
Percentage
PrimaryReferencePoint Primaryreferencepoint.
RelativeDoseinPrimary Relativedoseinprimaryreferencepoint.
ReferencePoint
TargetVolume Targetofthedose;forexample,ptv.
Table 47 Calculation Options Information

ElectronAlgorithm Nameofelectroncalculationmodelused.
CalculationGrid:Calculationgrid.
FixedSSDNormalization:Normalizationmethod
forfixedSSDfields.
NumberofFractionations Numberoffractionations
PhotonAlgorithm Nameofphotoncalculationmodelused.
CalculationGrid:Calculationgrid.
InhomogeneityCorrection:Useofinhomogeneity
correction.
StdArcCalculationSegments:Numberofstandard
(nonDMLC)arcfieldsegments.
ArcNormalization:Normalizationmethodforarc
fields.
IsocentricNormalization:Normalizationmethod
forisocentricfields.
FixedSSDNormalization:Normalizationmethod
forfixedSSDfields.
PrimaryReferencePoint Primaryreferencepoint
TargetVolume Targetofthedose;forexample,ptv.

Table 48 Field-Specific Information

<Field> Identificationcodeandnameofeachfield.
Block Block:Identificationcodeofblock.
Type:Typeofblock.
Material:Blockmaterial.
TransmissionFactor:Transmissionfactorofblock
material.
Tray:Trayonwhichtheblockisplaced.
TrayTransmissionFactor:Transmissionfactorof
blocktraymaterial.
Slot:Slotinwhichthetrayisplaced.
Bolus Bolus:Identificationcodeofbolusstructure.
Name:Nameofthebolusstructure.
MaterialCTValue:CTvalueofthebolusmaterial.
SourcetoBolusDistance(SBD).
Calculated Dateandtimeofcalculation.
CalculationErrors Shownonlyincaseofcalculationfailure.
CalculationNotes Detailedcalculationinformation.
CalculationWarnings Showniftheentiredosecalculationdoesnotfail.
CollimatorAngle Collimatorrotationangle.
Compensator Compensator:Identificationcodeofcompensator.
Type:Typeofcompensator.
PenumbraMargin.
DistancefromIsocentertoCompensationPlane.
Material:Materialofthecompensator.
LinearAttenuationFactor.
Tray:Trayonwhichthecompensatorisplaced.
TrayTransmissionFactor:Transmissionfactorof
compensatortraymaterial.
Slot:Slotinwhichthetrayisplaced.


DoseforFractionation<n>
MonitorUnits MUvalue,ifcalculatedforthefractionation(two
valuesshown,ifmotorizedwedge).
MonitorUnitsperGy MU/Gyvalue,ifcalculatedforthefractionation.
ReferencePoints ID:Identificationcodeforthepoint.
FractionDose:Dosedeliveredtothepoint.
Pointtype:Doseprescriptionpointorcalculation
point.
PSSD:(PointSourcetoSkinDistance)Distance
fromthesourcetothesurfacealongthefanline
fromthesourcetothereferencepoint(forarc
fields,calculatedatstartanglebyaveragevalues),
takingbolusintoaccount.
Depth:Distancefromthesurfacetothereference
pointalongthefanlinefromthesourcetothe
referencepoint(forarcfields,calculatedatstart
anglebyaveragevalues),takingbolusinto
account.
Eq.PathLength:Thedistancefromthesurfaceto
thereferencepointalongthefanlinefromthe
sourcetothereferencepoint(forarcfields,
calculatedatstartanglebyaveragevalues),taking
electrondensityandbolusintoaccount.
DoseRate Doserateofthetreatmentunit
EnergyMode Identificationcodeoftheenergymodeusedinthe
treatmentunit.
EntryPoint Pointinspacethatdefinesthefieldlocation.
ShownonlyforfixedSSDfields.
FieldNormalization Identificationcodeofthenormalizationmethod
Method used.
FieldNormalization Fieldnormalizationvalueatnormalizationpoint.
Value
FieldSize FieldsizeatSADincm.
GantryAngle Gantryrotationangle.
Isocenter Pointinspacethatdefinesthefieldlocation.Not
shownforfixedSSDfields.
MachineID Identificationcodeforthetreatmentunit.


MachineModel Modelofthetreatmentunit.
MachineScale Scaleofthetreatmentunit.
MLC MLC:IdentificationcodeofMLC.
Manufacturer:ManufactureroftheMLC.
Model:ModelnameoftheMLC.
Rotation:Collimatorrotation.
Material:MaterialoftheMLC.
TransmissionFactor:TransmissionfactorofMLC
material.
MLCPlanType:TypeoftheMLC(static,dose
dynamic,ordosedynamicarc).
NumberofBlocks Numberofblocksinthefield.
Numberofbolus Numberofbolusinthefield.
NumberofWedges Numberofwedgesinthefield.
ReferenceImage IdentificationcodeofasimulatorimageorDRR
image.
SBD SourcetoBolusDistance.
SFED SourceFieldEntryDistanceincm.
SourceAxisDistance SourcetoAxisDistanceincm.
(SAD)
ActualSSD ActualSSDincm(notforarcfields).
(SourcetoSkinDistance)
PlannedSSD PlannedSSDincm.
(SourcetoSkinDistance) Forarcfields,plannedSSDforstartandstop
angles,averageSSDandrotationdirectionofthe
field.
SPD SourcetoPhantomDistanceincm.
TableAngle Tablerotationangle.
Technique Fieldtechnique.


Wedge Wedge:Identificationcodeofwedge.
Type:Typeofwedge.
Angle:Wedgeangle.
Direction:Wedgedirection.
WedgeFactor:Wedgefactorofthefield.
Material:Wedgematerial.
Slot:Identificationcodeoftheslotinwhichthe
wedgeisinstalled.
MotorizedWedgeWeightFactor:Weightfactorof
motorizedwedge.
MotorizedWedgeMUFactor:MUfactorof
motorizedwedge.
WeightFactor Weightfactorofthefield.
Table 49 Reference Point Information

3DCoordinates X,YandZcoordinatesofeachreferencepoint.
FractionationID Identificationcodeofthefractionation.
FractionDose Doseinafraction.
PointID Identificationcodeofthereferencepoint.
PrimaryPoint Referencepointselectedtobetheprimarypoint.
TotalDose Totaldosedeliveredateachreferencepoint.
VolumeID Identificationcodeofthepatientvolumeto
whichthereferencepointislinked.
Information Entries on a Plan Sum Report Cover Page
Intreatmentreportsprintedforplansums,thefirstpageofthereport
isthePlanSumReportcoverpage,whichisfollowedbyanormal
treatmentreport.
TheheaderofthePlanSumReportcoverpagecontainsthenameand
versionofthesoftware,andthenameofthehospital.Thefooter
containsthenameofthepatient,thedateofprinting,andnameofthe

plansum.Themaintext,form,containsinformationconcerningthe
patient,plansincludedintheplansum,andprescribeddoseinthe
plans.
Thefollowingtableliststheinformationintheheader,formandfooter
oftheplansumreportpage.
Table 50 Information in Plan Sum Report Page

Course Courseoftheplansum
Date Dateofcreatingtheprintout
DoseatPrimary Doseattheprimaryreferencepointineachplan
ReferencePoint includedinthesum,expressedinGy
FractionationID Identificationsoffractionationsineachplan
includedinthesum
NbrofFractions Numberoffractionsineachplanincludedinthe
sum
Patient Nameofthepatient
PatientIDs Identificationcodesofthepatient
PlanID Identificationofeachplanincludedinthesum
PlanName Nameofeachplanincludedinthesum
PlanSumID Identificationoftheplansum
PlanSumName Nameoftheplansum
PrescriptionDose Prescribeddoseofeachplanincludedinthesum,
expressedinGy

Chapter 27 Export and Import
All Workspaces
Thischapterprovidesinformationnecessaryforexportingand
importingplanningobjects,suchasimages,structures,plans,plan
sums,fieldfluencesandDMLCpatternstoothersystemsforfurther
use.BriefinstructionsareprovidedforusingtheImportandExport
wizard.ThechapterdescribeshowtheDICOMstandardissupported
intheexportfunction,andprovidesinstructionsforexporting
planningdatathroughDICOM,eithertobeusedinothersystemsorto
besenttotheAdvancedTechnologyConsortium(ATC).Theprocesses
ofexportingfluencesinDICOMfilesandimportingfluencesinASCII
filesarecovered,withstepbystepinstructionsincluded.Instructions
arealsoprovidedfortransformingfluencesintheDICOMRTformat
totheASCIIformat.Thechapteralsodescribeshowplanscontaining
DMLCscanbeexportedoutsidethesystem.
Exporting Plan and Image Data

Tobeabletoexportdatatoanothersystem,configureexportfiltersfor
alldataformatsyouneedtouse,forinstance,DICOM.For
instructions,seeAppendix Bonpage 815.
UsetheExport/Importwizardtotransferdata,suchasimages,
structuresets,plans,plansums,anddosedata,toothersystemsfrom
Eclipse.
Note: Beforeexportingdata:
Verifyalldatabeforeexportingit.
YoucancheckthatthestructuresetisIHEROcompliant(Integrating
theHealthcareEnterpriseRadiationOncology).TochecktheIHERO
complianceofastructureset,rightclickthestructureseticoninthe
ContouringworkspaceandselectCheckIHEROCompliance.
YoucancheckthattheplanisacompliantIHEROgeometricplan.To
checktheIHEROcomplianceofaplan,rightclicktheplaniconinthe
FieldSetupworkspaceandselectCheckIHEROGeometricPlan
Compliance.
751
About Export Options
Thissectiononlydescribessomeoftheexportoptions.Fora
descriptionofallexportoptions,refertotheonlinehelp.
Export as IHE-RO Geometric Plan
EclipsefulfilstherequirementsforIHEROGeometricPlanner,and
youcanexportExternalBeamPlansasIHEROGeometricPlans.This
optionisavailableonlyiftheplanyouareexportingisIHERO
compliant.Iftheplanisnoncompliantoriftheplantypeisnot
supported,thisoptionisgrayedout.Formoreinformation,see
ExportingIHEROCompliantPlansonpage 769.
Include Structure Set
Youcanselectwhethertoincludethestructuresetintheexported
plan.
Include Reference Images in Export
Oneoptionforfielddataintheexportiswhethertheexportfiles
shouldincludereferenceimages(suchasDRRs)linkedtofieldsinthe
plan.Youcanalsochoosetoincludestructureoutlines,generated
duringtheexport,withthereferenceimage.
Dose Export
Youcanexportthefollowingtypesofdosedata:
Totalplan(volumetric)doseExportedseparatelyorwithotherplan
data
DosedistributionontheactiveplaneExportedseparatelywiththe
ExportDosePlanecommand.AvailableintheFieldSetupand
PlanEvaluationworkspace.
Inbothcases,thedoseisexportedeitherasabsoluteorrelativedose,
andinaccordancewiththeDICOMstandard.

Planar Dose Details in Export
Thedoseontheviewingplanecurrentlyshownintheactiveimage
viewcanbeexportedeitherintheabsoluteorrelativemode.The
exportisdoneinaccordancewiththeDICOMstandard.
Theresolutionofthedoseisdeterminedbydefiningthelengthsofthe
sidesofthedosematrixinXandYdirectionsandthenumberofpixels
insidethedosematrix.
Forexternalbeamplans,youselectthefieldwithwhichthedose
matrixisaligned.Ifthefieldcentralaxis(CAX)isnotparalleltothe
activeimageview,thecenterofthematrixisplacedtotheintersection
ofthefieldCAXandtheimageview.Iftheimageviewandthefield
CAXareparallel,thecenterofthematrixispositionedtothe
projectionofthefieldisocenter.
Youcanalsomarkthecornersoftheimagewithhighdosepixelsfor
correctalignmentofthedoseimage.
DVH Export Details
ADVHisexportedinaccordancewiththeDICOMstandard,along
withthevolumetricdoseandtheplan.Thefollowingareamongthe
exportoptionsforDVHexport:
DVHStructuresStructuresforwhichyouwishtohavetheDVH
calculatedandexported.Youcanalsoincludeoromitstructures
forwhichtheDVHhasbeenpartiallycalculated.Bydefault,the
DVHiscalculatedforallstructures,andallstructuresareincluded
intheDVHexport.
DosebinwidthResolutionoftheDVH,expressedinGyfor
absolutedoseandinpercentageforrelativedose.Therangefor
thisvalueis010exclusive.Bydefault,thedosebinwidthis0.1.
Formoreinformation,seeDVHDoseBinWidthParameteron
page 768.
VolumeunitUnitofmeasurementinwhichthevolumeofthe
structuresincludedintheDVHareexpressed.
Note: TheDVHcanbeexportedonlywiththevolumetricdose.
Export and Import 753

DVH Dose Bin Width Parameter
Thedosebinparameterdefinedintheexportexpressestheresolution
oftheDVHcalculatedduringtheexport.Theparameterisdefinedin
Graysorpercentage,dependingonthedosemode.
Forexternalbeamplans,thedosebinintervalisequidistantforthe
entireDVHcurveasshowninthefigurebelow.
B
{
C
A.VolumeaxisB.DosebinwidthC.Doseaxis
Figure 201 Dose Bin Width Parameter for External Beam Plans
To Use the Export/Import Wizard for Exporting

Note: ForDoseDynamicArcplans,makesurethatyouselecttheCompatible
toVarianTreatmentConsolecheckboxinthewizard.
2. DefinewhatyouwishtoexportandclickNext.
3. DefineotherexportparametersinthewizardandclickNext.
Thewizardproceedstothenextstep.Thenumberofsteps
dependsontheselectedobjectstobeexported.
5. Checktheitemstobeexported.

SelectedObject(s).
Finish.
To Export the Dose Plane

1. Inanimageview,displaythedesiredviewingplane.
2. IntheFocuswindow,rightclickthedoseandchooseExportDose
Plane.
3. DefinethedoseexportoptionsandclickNext.
6. Tosavethedoseplanedatatothedefinedexportdirectory,click
Finish.
Performfilmdosimetry.Youcanalignthedoseimagewiththefilmusing
thecornermarks.
Exporting IHE-RO Compliant Plans

IHERO(IntegratingtheHealthcareEnterpriseRadiationOncology)
isaninitiativethatpromotestheintegrationofhealthcaresystems.
EclipsefulfilstherequirementsforthefollowingIHEROactors:
contourer,geometricplanner,dosimetricplanneranddosimetric
displayer.Beforeyouexportstructuresetsandplans,youcancheck
thattheyareIHEROcompliant.

WhenyouchecktheIHEROcomplianceofastructureset,Eclipse
verifiesthat:
Thestructuresetisdefinedinanimagethatdoesnothave
interpolatedimageplanes.Iftheimagehasinterpolatedplanes,a
newstructuresetandimagewithnointerpolatedplanesare
created.
ThestructuresetisdefinedonCTslices.
AllthestructureshaveRTROIinterpretedtypesset.
Allthestructureshavetheirgenerationalgorithmset.Ifthe
algorithmismissingfromastructure,itissettoManual.
Noneofthestructuresisempty.
Noneofthestructureshasmorethan100contoursperplane.If
necessary,thenumberofcontoursisreducedto100.
WhenyouchecktheIHEROcomplianceofageometricplan,Eclipse
verifiesthat:
Theplanisnotabrachytherapyorprotonplan.
Theplanhasastructuresetassigned.
Noelectronenergiesareused.
NoneofthefieldshaveMUsorreferencepointdosesdefined.
Nowedges,compensatorsorbolusesareused.
Noneofthefieldsisanarcfieldorhasmorethantwocontrol
points.
Alltheblocksaredivergentandtheoutlineshavebeendefined.
Noneofthefieldshasmorethanoneapertureblockoutline.
Allfieldshavesetuptechniquedefined.
FormoreinformationonEclipseIHEROsupport,seeIHERO
IntegrationStatementdocument.Formoreinformationonexporting
plandata,seeExportingPlanandImageDataonpage 765.
Exporting Data with DICOM

EclipseusesthemethodologydefinedintheDICOM(DigitalImaging
andCommunicationsinMedicine)standardtotransferimage,
structure,plan,doseandDVHdatatoanothersystem.Thepurposeof

thestandardistostandardizethecommunicationoftherapeutic
information,suchasradiotherapyimagesandtherapyplans,between
devicesthatproducedifferentimageformats.
HowEclipseconformstothestandardisdefinedinVarianSystem
ServerDICOMConformanceStatement.
Thetransferreddataincludesthefollowing,dependingontheplan:
Fielddata
Isocenterpositions
Fieldaccessories(MLCs,blocks,wedges,compensators,bolus,
applicator)
Gantry,collimatorandcouchangles
Vertical,longitudinalorlateralpositionofthecouch
Fieldfluences
TreatmentunitID
Dosedata
Relativeorabsolutefielddoses,orrelativeorabsoluteplan
dose
DVHdataforselectedstructures
Structuresetdata
Structuresetincludesphysicalstructures,markers,the
isocentermarker,andregistrationpoints.
Imagedata.TheimportedDICOMimagescanbelinkedto
differenttypesoffieldsinanexternaltreatmentplanasfollows:
PortalimagesTosessionfieldsorfields
DRRimagesTofields
Note: WithDICOM,notethattoachieveareliableresultinthetransfer,the
treatmentunitconfigurationmustbeexactlythesameinboththesourceand
destinationsystem.

Transforming DICOM Files to ASCII Files
FilesexportedfromEclipseforphotonplansintheDICOMformatcan
beconvertedintotheASCIIformatusingtheDcm2Ascii.exe
application,whichsavestheconvertedfilestothedefinedfolder,over
thenetworkorlocally.TheinputfilemustbeintheImplicitVRLittle
EndianUncompressedformat,whichistheformatusedinEclipse.
Note: Dcm2Ascii.execannotbeusedtoreaddatathatusestheExplicitVR
LittleEndianUncompressedformat.
To Transform DICOM Format Files to the ASCII Format
1. TostarttheASCIIconverter,navigatetothedirectorythatcontains
theDcm2Ascii.exefile.
2. Doubleclickthefile.
3. Selecttheinputfile,outputoptionsandoutputdirectory.
4. ClickApply.
Exporting Plan Data to the ATC

TheATC(AdvancedTechnologyConsortium)isamultiinstitutional
cooperativeorganizationforcancerresearchthatcollectstreatment
historiestobeusedasthebasisofanalysesandreportsfromthe
members.
YoucanexportRTdata(imageandplandata)fromEclipseto
participateintheATCstudies.Tobeabletocompletetheexport,you
needtheITCDICOMpilerapplication.TheexportfromEclipseisdone
intheDICOMformat,andthedataisthenmodifiedfortheATCin
DICOMpiler,whichcreatestheDICOMfilesetrequired.Totransfer
theDICOMfileset,thedatamustbecopiedtoatransfermedium(CD
orFTPserver).YoualsoneedtoconfiguretheDICOMStorageService
SCUfilter(forinstructions,seeAppendix Bonpage 815andreferto
theonlinehelp).
FormoreinformationontheITCDICOMpilerapplication,referto
VarianInstallationInstructions,ITCDICOMpilerSoftwareInstallation
GuideandITCDICOMpilerQuickStartGuide.TheITCDICOMpiler

documentationisavailableattheITCwebsite(http://itc.wustl.edu).
ForanFTPaccount,[email protected]
theATCwebsiteortheITCwebsite.
TheATCsetsthefollowingrestrictionsforplansandimagesexported
forATCstudies:
ImageorientationmustbeHFS(headfirstsupine).
Contoursmustbeclosed.Pointcontoursoropenendedline
contoursarenotsupported.
Plansmustcontainaprimaryreferencepointwithalocation,the
volumetricdosemustbecalculated,atleastonevaliddose
prescriptionandvalidplantreatmentpercentagemustbefoundin
theplans.
Iftheserestrictionsarenotfulfilledintheplanandimagestobe
exported,theExportwizardshowswarningsconcerningthe
unacceptableparts.
Note: UltrasoundimagesorBooleanstructurescannotbeexportedforthe
ATC.
To Export Planning Data for the ATC in DICOM Format
1. MakesurethatyouhavetheDICOMpilerprograminstalledand
thatitisrunning.
IfDICOMpilerisnotrunning,startitbydoubleclicking
ITC_DICOMpiler.exe.IntheITCDICOMpilerwindow,startthe
ReceiverbyclickingRunDICOMReceiver.
2. InEclipse,chooseFile >Export >ATCDICOMExport.
3. Todefinewhethertoexporttheplanortheimages,selectthe
appropriateoptionbuttonandclickNext.
4. DefinetheexportoptionsandclickNext.
5. CheckanyremarksabouttheexportandclickNext.
6. IntheConfiguredExportFilterslistbox,selecttheappropriate
filterfortheexportandclickNext.

SelectedObject(s).
Finish.
10. TransferyourfilestotheATCviaaninternetbasedtransfer,such
asFTP.
Importing Plan and Image Data

Tobeabletoimportdatafromanothersystem,configureimportfilters
foralldataformatsyouneedtouse,forinstance,DICOMandVidar
scanners.Forinstructions,seeAppendix Bonpage 815.
UsetheExport/Importwizardtoimportobjects,suchasplansand
structuresets,fromothersystemsintoEclipse.
Note: Whenimportingstructuresorstructuresets,thestructuresthatarenot
compatiblewiththeEclipseinternaldatamodelarediscarded,whichcancause
missingstructures(forinstance,structuresdefinedonnonequidistantslices
oroutsidetheimagearea,orminisculestructures).Itisrecommendedtouse
equidistantslicesinimaging,andalwaysvisuallyverifyanyimported
structures.
Note: WhenimportinganIHEROgeometricplan,itispossiblethatthe
treatmentunitdataforsomefieldsismissing.Inthiscaseavirtualtreatment
unitisusedforthatfieldinEclipse.Forthispurpose,onetreatmentunitcan
bemarkedasavirtualtreatmentunitintheAdmintask.Notethataplanwith
avirtualtreatmentunitcannotbeapproved.
Note: ActualfluencesareremovedfromimportedDMLCdata.Thisis
indicatedwiththe iconintheFocuswindowundereachrelevantfieldin
theimportedplan.Youcanupdatethedosecalculationbyconvertingthe
DMLCmotionsintoactualfluences.Forinformation,seeChapter 17,Section
ConvertingDMLCLeafMotionstoActualFluenceonpage 543.
To Use the Export/Import Wizard for Importing

1. ChooseFile >Import >Wizard.
TheImportwizardopens.

2. SelecttheappropriateimportfilterandclickNext.
Selectthedatatobeimportedfromthedefaultdirectory.
Touseanotherdirectory,clickChangeDirectory,selectthe
appropriatedirectory,clickOpen,andthenselectthedatato
beimportedfromthelistdisplayedinthewizard.
4. ClickNext.
Thewizardproceedstothenextstep.TheSourcePatient
Informationboxdisplaysthepatientinformationfoundinthe
data.
5. Selectthetargetpatienttowhomtoimportthedata.Thedetailed
informationabouttheselectedpatientwillbedisplayedinthe
SelectedTargetPatientgroupbox.
SelectapatientsuggestedbythewizardintheClosest
MatchesinDatabasebox.
Toimportthedatatothepatientcurrentlyopen,clickTask
Patient.
ToopenthePatientExplorerandimportthedatatoapatient
existinginthedatabase,clickOpen.
Tocreateanewpatienttoimportthedatato,clickNew.
Youcanconnecttheimagestotheobjecthierarchyunderthe
selectedpatienteitherautomaticallyorbyhand.Toletthe
wizardautomaticallyimportthedatatotheselectedpatient,
selecttheTryautomaticimportcheckbox.
6. ClickNext.
Automaticimport:Thewizardclosesaftertheautomaticimportis
completed.
Importbyhand:Thewizardproceedstothenextstep.
Ifthedatahasgrayindicatorsinthetreestructuresinthe
ImportDataandARIADatapanes,youneedtoconnectthe
datatotheobjecthierarchyundertheselectedpatient.Todo

this,dragthedatafromtheImportDatapanetoanappropriate
placeunderthepatientintheARIADatapane.ClickFinishto
closethewizard.
Ifthedatahasgreenindicatorsinthetreestructure,click
Finish.
Exporting and Importing Fluences
Exporting and Importing Fluences in DICOM Files

FluencesareexportedintheDICOMformatalongwithotherdata
exportedthroughtheDICOMexport,usingtheExportwizard.This
sectiondescribestheDICOMfluenceexportandimportfiles,and
shortlydescribestheexportoffluencesusingtheExport/Import
wizard.FormoreinformationontheExport/Importwizard,referto
theonlinehelp.
AlldatainthefluenceexportisstoredasdistinctDICOMfiles,one
mainfilecontainingreferencestotheotherfiles.Theexportfilescanbe
convertedintotheASCIIformatusingtheRT2ASCIIconverterforuse
bywordprocessingorspreadsheetapplications.TheseparateASCII
filecontainingthefluencecanbeimportedbackintoEclipse.
OptimalfluencescanalsobeimportedintotheactiveDMLCfieldin
ASCIIformat.Iftheactivefieldcontainsanoptimalfluence,itis
replacedbytheimportedfluence,andtheMLCplanincluding
actualfluencesintheactivefield,ifany,isremoved,andthedoseis
invalidatedfortheactivefield.TheMLCtypeissavedinthecontext
detailsoftheoptimalfluence.
Note: WhentransferringDMLCplanstotreatment,
Alwaysmakesurethataqualifiedpersonverifiestheprescriptionsonthe
MLCviewingstation,ordophantomtestingbeforestartingthe
treatment.
unit.
Alwaysmakesurethatyouusethesametreatmentunitfortreatinga
patientasyouusedforcreatingtheplan.

DICOM Fluence Export File
Forallfieldsincludedintheexportedplan,thefollowinginformation
isincludedintheDICOMexportfile:
Optimalfluences
Totalactualfluence
DMLCparameters(bothDMLCandconformalarctreatments),
collimatorjawsettings,collimatorrotation,andgantryrotation
Portaldoseprediction
Dynamictoleranceinformation
Note: Whenexportingfluences,notethat:
Planspecificvolumeoptimizationobjectivesarenotincludedinthe
DICOMexportfile.
ThefluencedataisexportedusingtheDICOMCompensatordefinition
withanextensiontotheCompensatorTypeattribute.
Carriagegroupinformationisnotincludedintheexportfile.
DICOM Fluence Import File (ASCII)
Theimportformatfortheoptimalfluenceisthefollowing.
Table 51 Fluence Import File
Header Meaning
SizeX NumberoffluenceelementsinfieldXdirection
SizeY NumberoffluenceelementsinfieldYdirection
SpacingX ResolutionofthefluenceelementsinfieldXdirection,inmm
SpacingY ResolutionofthefluenceelementsinfieldYdirection,inmm
OriginX LocationofthefirstfluenceelementcenterinXdirectionin
relationtothefieldcentralaxis,inmm.Xpositioncoordinates
increasetowardsX2jaw.
OriginY LocationofthefirstfluenceelementcenterinYdirectionin
relationtothefieldcentralaxis,inmm.Ypositioncoordinates
increasetowardsY2jaw.

Table 51 Fluence Import File
Header Meaning
Data Fluencevaluesforeachelement.Valuesareseparatedbyspaces,
tabsornewlinecharacters.Fluencevaluesarelistedfor
increasingXandsecondlyforincreasingYpositions.Positionof
thenthfluenceelementcenterpointinrelationtothefieldcentral
axisexpressedinmillimetersis:
PosX = OriginX + SpacingX * [(n-1) mod SizeX]

PosY = OriginY - SpacingY * [(n-1) div SizeX)]
BelowisanexampleoftheASCIIformatfluenceimportfiledefining
1.0 1.0 cm2unityfluenceonfieldcenter.
#Central 16 fluence elements

#
OptimalFluence
SizeX 10
SizeY 10
SpacingX 2.50
SpacingY 2.50
OriginX -11.25
OriginY 11.25
Values
0.00.00.00.00.00.00.00.00.00.0
0.00.00.00.00.00.00.00.00.00.0
0.00.00.00.00.00.00.00.00.00.0
0.00.00.01.01.01.01.00.00.00.0
0.00.00.01.01.01.01.00.00.00.0
0.00.00.01.01.01.01.00.00.00.0
0.00.00.01.01.01.01.00.00.00.0
0.00.00.00.00.00.00.00.00.00.0
0.00.00.00.00.00.00.00.00.00.0
0.00.00.00.00.00.00.00.00.00.0
Figure 202 Example of Optimal Fluence Import File
To Export Fluences with DICOM
ClickNexttoproceedaftereachstepintheExportwizard.

2. ClickthePlanoptionbutton.
3. SelecttheIncludefluencescheckbox.
4. SelecttheDICOMMediaFileExportfilter.
5. ClickFinishtocompletetheexport.
Importing Fluences in ASCII Files

Youcanimportafluencefilethathasbeencreatedearlierforapatient
totheselectedfield.Importedfluencefilescanbeusedtoverifythe
dosimetryofindividualDMLCfieldsinaphantom.
Note: Whenimportingfluences,notethat:
Theplancontainsonefractionation.
TheoptimalfluencefileformatiscommadelimitedASCII.
TheoptimalfluencedoesnotcontaininformationaboutMLCtypeusedto
generateit.
ThefluencesandDMLCsinotherfieldsintheplanareunaffected.
To Import Fluences in ASCII Files
ClickNexttoproceedaftereachstepintheImportwizard.
1. IntheFocuswindow,rightclickthefieldtowhichtoimportthe
fluenceandchooseImportOptimalFluence.
TheImportOptimalFluencedialogboxopens.
2. NavigatetothelocationoftheASCIIfilecontainingtheoptimal
fluenceandclickOpen.
To Transform the DICOM format to ASCII
1. TostarttheASCIIconverter,navigatetothedirectorythatcontains
theDcm2Ascii.exefile.
2. Doubleclickthefile.
3. Selecttheinputfile,outputoptionsandoutputdirectory.
4. ClickApply.

Exporting and Importing MLC/DMLC Plans
InadditiontotheDICOMexportandimport,theMLCorDMLCdata
canalsobeexportedandimportedbyusingtheExportMLCPlan
command,forinstance,ifyouhaveacompletelyseparatesystem
whichisnotconnectedtoARIAatall.
Exporting MLC/DMLC Plans

TheMLCPlanexportstorestheMLCorDMLCleafdatainanASCII
exportfilewhichcanthenbetransferredtoVarianMLCworkstations.
EachexportfilecancontainoneDMLCcarriagegroup.Thedefault
exportfolder(thefolderinwhichtheexportfileissaved),theformat
ofthefileaswellasthedefaultMLCrevisionandexportscaleare
definedintheAdministrationtask.
Note: WhenexportingMLCorDMLCdata,notethat:
StructuresarenotexportedwiththeMLC.
AlwaysverifytheMLCbeforeexportingit.
DMLCscancurrentlybeexportedonlytoVarianMLCsystems.
Note: WhenapprovingDMLCplansfortreatment,
treatment.
unit.
To Export MLC or DMLC Files
1. IntheFocuswindow,selecttheMLCorDMLCtoexport.
2. ChooseFile >Export >ExportMLCPlan.
TheExportMLCPlan(s)dialogboxopens.
3. Ifnecessary,intheExportDirectorybox,definewherethe
MLC/DMLCexportfilemustbesaved.

4. IntheFileNamePrefixbox,typeanewnamefortheMLCfileif
necessary.
5. IntheMLCRevisiongroupbox,selecttheappropriaterevision.
6. IntheScalegroupbox,selecttheappropriatescale.
7. ClickOKtosavetheMLCexportfiletothedefinedexportfolder.
Importing MLC/DMLC Plans

TheMLCorDMLCdatatobeimportedmustexistintheVarianMLC
fileformat(refertoMLCFileFormatDescriptionfortheMultileaf
Collimator).ThedefaultimportfolderandthedefaultMLCrevision
andimportscalearedefinedintheAdministrationtask.
Note: ActualfluencesareremovedfromtheimportedDMLCdata.Thisis
indicatedwiththe iconintheFocuswindowundereachrelevantfield.You
canupdatethedosecalculationbyconvertingtheDMLCmotionsintoactual
fluences.Forinformation,seeChapter 17,SectionConvertingDMLCLeaf
MotionstoActualFluenceonpage 543.
Note: WhenapprovingDMLCplansfortreatment,
treatment.
unit.
To Import MLC or DMLC Files
Thedefaultimportfolder(thefolderinwhichtheMLCorDMLCfiles
tobeimportedarelocated)isdefinedintheconfigurationofyour
system.
1. IntheFocuswindow,selectthefieldtowhichtheMLCorDMLC
willbeimported.
2. ChooseFile >Import >ImportMLCPlan.
AdialogboxforselectingtheMLCtypeopens.

3. SelecttheappropriateMLCtypeandclickOK.
TheImportMLCFiledialogboxopens.
4. Ifnecessary,intheLookindropdownlist,selectthefolderwhere
theimportfileislocated.
5. Ifnecessary,inthefolderslistbox,selectthesubfolderwherethe
importfileislocated.
6. Inthelistbox,clicktheMLCfiletobeimported.
7. IntheImportScaledropdownlist,selectthescaletouseforthe
MLCfile.
8. ClickImporttoaddtheMLCtotheplan.

Appendix A Using Patient Explorer
PatientExplorer(seeFigure 203)isanapplicationmoduleused
throughouttheARIAsoftwaresuite.PatientExplorerconsistsofa
twotabwindowyouusetofindpatientrecords;specifictypesof
images,treatmentplans,orarchiveddataattachedtothoserecords;or,
addanewpatientwithminimalinformation.Onceyoulocatean
existingpatientrecordyoucanmakechangestosomeofthecontents
ofthatfoundpatientrecordbyselectingEditfromtheSearchtab.To
makemajorchangestoapatientrecord,usePatientManager.
SelectingtheNewtabofthePatientExplorerwindow,youcanadda
recordforanewpatient.Creatinganewpatientrecordrequiresonlya
minimumofinformation.
Clickoneoftwobuttonsto Typeinbasicpatientsearch Thelistdisplayspatients

SearchandNew
showspecialitypatient criteriatolimitthelistof foundthatmeetthe
patienttabs
searchcriteria patientsdisplayed criteriayoulist
Figure 203 Patient Explorer Window
769
Adescriptionofthethreetabsandtheirusefollows:
SearchtabOffersseveralleftframetextandcheckboxesyou
canusetosearchtheVariansystemdatabasefortheexisting
recordofapatient.
NewtabDisplaysadataentryformyouusetoaddinformation
totheVariansystemdatabaseforanewpatient.
EdittabOnceyoufindarecord,clickingEditopensthatrecord
intheEdittab,allowingyoutomakesomechangestoinformation
inthatpatientrecord.Tofullyreviewandupdateapatientrecord,
usePatientManager.
Searching for Records

YouusetheSearchtabofthePatientExplorerwindowtolocatethe
followingtypesofinformationintheVariansystemdatabaseor
archivedfiles:
Patientrecords
Imagesassociatedwithpatientrecords
Treatmentplansassociatedwithpatientrecords
Archivedpatientrecords
Asearchcanbeaquick,usinglimitedvariablestoyieldmanyresults;
or,thesearchcanbepreciseusingmultiplevariablestoyieldlimited
results.Thegenericsearchprocess,andadditionallimits,are
describedinthenextfewsections.
Patient Record Searches

Whethersearchingforasinglepatientrecord(activeorarchived),or
allpatientrecordsofaspecificcategory,youmakeselectionsfromthe
leftpaneoptionsoftheSearchtab.Whensearchingforarecordyou
canlimityoursearchesusingoneormoreofthoseoptions.
Note: TheoptionsofthePatient,Advanced,andStatusfiltersectionsare
shownas(AND)or(OR).Thesearelogicalsearchoperatorsindicating
conditionstotheoptionsyouselecttolocatepatientrecordsasfollows:
ANDAllvaluesmustbetruewhenfindingrecords
OROnlyonevaluemustbetruewhenfindingrecords

Thebasicprocesstosearchforapatientrecord(activeorarchived)or
allpatientrecordsthatcontainimages,ortheplanofaspecific
categoryisasfollows:
1. OpenPatientExplorer.(Maybeopenedusingmenuortoolbaricon
optionsdependingupontheapplication.)
2. Typeinformationinoneormoreofthefourtextboxesofthe
PatientFilters(AND)groupintheleftpaneoftheSearchtab:
LastNameAllowsforsearchingonthesurnameorpartofa
surnameofapatient.
FirstNameSearchesrecordsbypatientgivenname,listing
allrecordsfoundwiththesamename.
SSNUsesaSocialSecurityAccountNumbertolocatea
patientsrecord.
ID1Limitstherecordsearchforapatientbyidentifyinga
primary,secondaryorotherpatientidentification(See
IdentifyingaPatientIDonpage 785).
3. (Optional)ClickShowAdvancedFilters(seeSearchUsing
AdvancedFiltersonpage 787)orShowStatusFilters(see
SearchUsingStatusFiltersonpage 789)andselectadditional
options.
4. ClickSearchtodisplaypatientsrecordsthatmeetthecriteriayou
identifiedinyoursearch.
5. Ifmorethanonerecorddisplays,selectapatientfromthelistin
therightpaneusingoneofthefollowingmethods:
Doubleclicktherecordyouwishtoopen.
SelecttherecordyouwishtoopenandclickOK.
Identifying a Patient ID
Formerly,ARIAlimitedpatientidentificationtotwooptionsID1and
ID2.Now,youcanassignmultipleidentificationstoyourpatients.
Thoseidentificationsmaybeusedacrossallhospitals,clinics,and
departmentsinyoursystem(identifiedasglobal),orthe
identificationscanbelimitedtoonlypatientsinonedepartment
(identifiedasinstitutional).
Using Patient Explorer 771

YousetupglobalandinstitutionalpatientIDsinDataAdministration.
InDataAdministration,selectSetuptab>Systemtabandselectthe
PatientIdentifiesicon(shownatleft)todisplaythePatientIDslist.
WhenyouusePatientExplorertosearchforandlocateapatientrecord,
youcanuseanyoftheassignedpatientidentificationIDs.Toselecta
patientidentificationotherthanID1,dothefollowing:
1. Fromtherightendofthepatientidentificationtextbox,clickthe
Ellipsisbutton(seeFigure 204).
ClicktheEllipsisbuttontoopenthe
patientidentificationselectiondialog
Figure 204 Default Patient Identification Text Box
2. ToselectapatientidentifierotherthanID1,clickonaglobalor
institutionalpatientidentificationshownintheopenPatientID
Typeswindow(seeFigure 205).
SelectapatientIDfromthe
availablelistwithintheglobal
category
SelectapatientIDfromthe
institutionallistofavailableIDs
Onceselected,clickOKto
identifyyourselectioninthe
Figure 205 Select The Primary Patient ID
3. ClickOKtoclosethePatientIDTypeswindow.Theselectedglobal
orinstitutionalpatientidentifierbecomesthenameofthepatient
identifiertextboxforyoursearch.

Afteryouchangeuponwhichglobalorinstitutionalpatientidentifier
PatientExploreruses,yoursearchforpatientrecordswillfindthe
specificrecordyouseek.
Search Using Advanced Filters

TheShowAdvancedFiltersbuttonontheleftpaneoftheSearchtab
offersnineadditionalsearchoptionswhenselected(seeFigure 206on
page 787).Youcanusetheseadvancedsearchoptionsaloneorwith
thebasicsearchoptionstolocatetherecordforasinglepatientora
groupofrecordsthatmeetsspecificcriteria.
Note: Theoptionsoftheadvancedfiltersectionareshownas(AND).These
arelogicalsearchoperatorsindicatingAND(allvaluesmustbefoundina
record)conditionstotheoptionsyouselecttolocatepatientrecords.
ShowAdvancedFilters(or
HideAdvancedFilters)offers
alistofsearchoptionstouse
inlocatingpatientrecords
Searchforpatientrecords
withcoursescompleted.Limit
thepatientrecordsearchtoa
daterange.
Selectoneormoreofthesix
optionstolimityoursearch
forpatientrecords
Figure 206 Advanced Patient Record Search Options
TheadditionalsearchoptionsfoundwhenyouselecttheShow
AdvancedFiltersbuttonareasfollows:
Course/TxstatusLimitsthelistofpatientrecordsfoundtoonly
thosepatientswithtreatmentcoursesorwithtreatmentsmeeting
theselectioncriteria.
Thelistofavailableselectioncriteriaisasfollows:
None
Coursescompletedindaterange
Coursescompletedinlast2weeks
Coursescompletedinlastweek

Ptstreatedindaterange
Ptscompletedinlast2weeks
Ptscompletedinlastweek
ActiveCoursesindaterange
DaterangeAfterselectedfromtheCourse/Txstatuslist,ifadate
rangeisactive,usethetwodatetextboxestospecifyastartand
enddatewhenlocatingpatientrecords.Youcaneithertypein
dates(twodigitmonth/twodigitday/fourdigityear),orclickthe
arrowtodisplayacalendar(shownatleft).
Selectdatesfromthecalendarasfollows:
LeftorRightArrowsClickanarrowtomovetothe
previousornextmonthrespectively.
NameofMonthClickthenameofthemonthinthecalendar
headertoshowandselectfromalistofmonthsfortheselected
year.
YearClicktheyear.Typeinanewyear,orclicktheupor
downarrowsattherightendofthedatetomoveforwardor
backthroughyears.
DayonCalendarClickadateonacalendartoselectthat
specificdayforthedisplayedmonthandyear.
HospitalOffersaselectionlistofhospitalsaddedtoyour
VariansystemdatabasethroughDataAdministration.
DeptSelectfromalistofdepartments,basedupontheselected
hospital,addedtoyourVariansystemdatabasethroughData
Administration.
MachineIdentifiesthetreatmentmachinesavailableatyour
facility.Selectoneofthosemachinesfromthelisttoidentify
patientsdesignatedasscheduledfortreatmentonthatmachine.
OncologistProvidesalistofOncologistsfromwhichyoucan
selectonetolistthepatientsofthatdoctor.Thenamesofthe
OncologistsincludesthosedoctorsyouaddthroughData
Administration.
StatusOffersapatientrecordsearchbaseduponwhetherthe
patientrecordismarkedneworpriorpatient.Theoptionsoffered
fromthelistareNone,NewPatient(NP),orPreviousPatient(NOP).
Noneidentifiesthatthepatientrecorddoesnotindicatethe
patientsstatus.

CategoryIdentifieswhetherthepatientishospitalized.The
optionsofferedfromthelistareBoth,Inpatient,orOutpatient.
TypeIndicateswhetherthepatientiscurrentlybeingtreated,or
therecordshavebeenarchived.Theoptionsofferedfromthelist
areNone,ActivePatient,orArchivedPatient.Noneindicatesthatthe
patientrecorddoesnotidentifythestatusofthepatientsrecords.
Search Using Status Filters

SelectingtheShowStatusFiltersbutton(seeFigure 207)displaysa
seriesofoptionsthatpermityoutosearchforimagesandtreatment
plansattachedtopatientrecords.Tomodifysuchasearch,youcan
alsolimittheimagesorplansfoundbyidentifyingthestatusofthe
foundimagesorplans.
ShowStatusFiltersbuttonopens
selectionsforsearchofimagesand
treatmentplans
Offersoptionsandstatusforsearch
forpatientimages
Patientplans,treatmentstatus,and
treatmentapprovalarealsooffered
assearchoptions
Findspatientrecordswherethe
treatmentsaremarkedapproved
Figure 207 Search For Patient Images and Plans
IntheImageStatusFilters(OR)groupareacheckboxmatrixofnine
imagetypesandfivestatus.Byselectingoneormoreoftheimagetype
andstatuscheckboxes,PatientExplorerwillsearchtheVariansystem
databaseforimagesthatmeetthosecriteria.
Note: Theoptionsofthestatusfiltersectionareshownas(OR).Theseare
logicalsearchoperatorsindicatingOR(onlyonevaluemustbefoundtomake
thesearchtrue)conditionstotheoptionsyouselecttolocatepatientrecords.
Theimagetypesforwhichyoucansearchare:
Simul.Searchesforpatientrecordsthatincludesimulation
images.
TxkVIdentifiesPortalorOnBoardImagertreatmentimages
forofflinereviewasasearchcriteria.Suchasearchwillidentify
patientrecordsthatcontainPortalorOnBoardImagertreatment
images.

TxMVSeekspatientrecordsthatincludePortalorOnBoard
Imagertreatmentimagesforofflinereview.
CTIncludesinasearchpatientrecordsthatincludeCTscans.
MRISearchesforpatientrecordsthatincludemagnetic
resonance images (MRI).
PETIdentifiespositron-emission tomography (PET) images as a
search criteria. Such a search will identify patient records that
contains PET images.
FCSearchesforanddisplaysalistofpatientrecordsthat
includefluoroscopy/cine images (FC).
PDSeekspatientrecordsthatincludePortal Dosimetry(PD)
imagesandinformation.
OtherSearchespatientrecordsinyourVariansystemdatabase
thatincludesimagesotherthanthetypesspecificallyidentified.
Image Status
Thestatusoftheimagesinpatientrecordsforwhichyouaresearching
canbeidentifiedasApproved,Unapproved,New,Reviewed,orActionReq.
Youcanselectoneormoreofthecheckboxes.
Plan and Treatment Status Filters
Treatmentstatusandplansinpatientrecordsarefoundusingfour
checkboxesinthePlanandTreatmentStatusFilters(OR)group.Those
checkboxoptionsareNew,Reviewed,Completed,andApproved.Select
oneormoreofthecheckboxestotheleftoftheoptionforwhichyou
wishtosearch.
Treatments Approved Status
Thefinalcheckboxofthisgroupofsearchfilters,theTreatment
Approvedcheckbox,limitssearchesforapprovedtreatmentsas
identifiedonpatientrecords.

Other Display Options
TheleftpaneSearchtabincludesfourbuttonsthatperformspecial
functions.
Show Recent Patients
ClickingtheShowRecentPatientsbuttonfromtheleftpaneofthe
Searchtabdisplaysalistofpreviouslyfoundpatientrecords.Those
recordsdisplayintherightpaneoftheSearchtab.
Search
ClickingtheSearchbuttonfromtheleftpaneoftheSearchtabbegins
thesearchforpatientrecordsafteryouidentifythecriteriaofyour
search.Ifanychangesshouldhaveoccurredtothoserecords,selecting
Searchagainupdatestheinformationdisplayed.
Clear Filters
SelectingtheClearFiltersbuttonfromtheleftpaneoftheSearchtab
clearsthepatientrecordscontainedinthesearchqueryandcachefiles,
whileresettingallsearchfilterstothedefaultforeachfilter.Bothfiles
holdpatientrecordstopermityoufastersearcheswhenpreviously
foundrecordswillbeviewedagain.
Restore Filters
SelectingtheRestoreFiltersbuttonfromtheleftpaneoftheSearch
tabreturnsallsettingsyouchangedinPatientExplorersinceopening
thewindow.PatientExplorersavesallsortoptionsandfiltersettings
whenyouclosetheapplication.UponrestartingPatientExplorerthe
applicationopenswiththoselastsavedsettings.Ifafterchanging
varioussettingsandfiltersduringuseyouwishtoreturntothesame
settingsyouhaduponopeningPatientExplorer,clickRestoreFilters.

Found Patient Records
TherecordsfoundbyPatientExplorerdisplayinalistintherightpane.
Thefollowinginformationdisplays(ifincludedinanindividual
record)foreachpatientrecordfound:
PatientIdLimitsthedisplaytothepatientwiththeselected
identification.
LastNameListsthesurnames(ifbypartialsurnamesearch)of
thepatientrecordsfound.
MiddleNameDisplaysthesecondgivennameofapatient.
FirstNameListspatientrecordsbygivenname,listingallwith
thesamename.
TypeIdentifieswhetherapatientisneworapriorpatient.The
optionsofferedfromthelistareNone,NewPatient(NP),orPrevious
Patient(NOP).Noneidentifiesthatthepatientrecorddoesnot
showthepatientsstatus.
LastSimulIdentifiesthelasttreatmentsimulationdateofa
patientasshowninthepatientsrecord.
LastPortProvidesthedateofthepatientslastportalfilm.
LastOtherFromapatientsrecord,identifiesthedateofthelast
othertreatmentreceivedbythepatient.
DateofBirthIdentifiesthebirthdateofeachpatientinthe
foundrecords.Thedigitaldatedisplaysasmonth,day,andyear.
Patient List Right-Click Menu

Ifyourightclickontheheaderofthepatientlist(notthepatient
recordsdataarea)PatientExplorerdisplaysaspecialmenu(see
Figure 208).Themenuoptionsselected(notecheckmarkstotheleftof
amenuoption)changethedatadisplayedinthepatientlist.
Sortsorfiltersdatacontainedinthepatientlist
Removesaselectedcolumnfromthepatientlist.The
columnisavailablefromtheColumnChooserlist
OpenstheColumnChooserlistfromwhichyoucan
selectandaddadditionalcolumns,ifavailable,tothe
patientlist
Offersautomaticormanualresizingofcolumnsinadata
table
DisplaysaPrintPreviewwindowofthedatacontained
inthepatientlist
Figure 208 Patient List Right-Click Menu Options

Print Preview Toolbar Controls
ThetoolbarcontrolsonthePrintPreviewwindowconsistofnine
icons,withnamesofthoseiconcontrols(seeFigure 209)shownbelow
theicon.Youusethesecontrolstosetupandviewpatientrecords
foundanddisplayedinalist.
Figure 209 Print Preview Window Controls
Printed Patient Search List

WhenyouselectthePrintoptionfromtherightclickmenu,Patient
Explorerdisplaysthepatientlist.ThePrintPreviewwindowdisplays
thatlist(seeFigure 210)inthewindowcenter,withreportdisplay
controlsalongtheupperleftofthatwindow.
Toolbarcontrolsassociatedwiththelistdisplay Listoffoundpatientrecordsdisplayasalist
Figure 210 Patient List

Thenineicons,alongwiththeirnamesanddescriptions,ofthePrint
PreviewwindowareshowninTable 52.
Table 52 Print Preview Controls
ActualSizeDisplaysthewindoworreportinactual
size.
CloseWhenselected,closesthePrintPreviewwindow.
OnePageShowsthecurrentsinglepageofthedisplay
orreport.
PageSetupOpensthePageSetupdialogbox.Itisfrom
thisdialogboxthatyoudefinepaper,orientation,
margins,andprinterfortheprintedresults.
TrackerSetupOpenstheTrackerPageSetupdialog
box.Thisdialogboxcontainsasingleoption,theFit
Columntextbox,fromwhichyoucanselectNoScaling,Fit
allcolumnsinonepage,orResizecolumnsforthedisplay.
PreviousPageMovesthedisplaytothepreviouspage
oftheinformationorreport.
PrintSendsthedisplayorreporttothedefaultprinter.
NextPageMovesthedisplaytothenextpageofthe
informationorreport.
Editing a Patient Record

Inadditiontosearchingforrecordsofexistingpatients(seeSearching
forRecordsonpage 784)andcreatinganewpatientrecord(see
RecordingNewPatientDataonpage 796),youcanchangesome
patientinformationfromwithinPatientExplorer.Makingchangestoa
patientrecordassumesyouhavetheappropriateusersecurityrights
toviewandchangeapatientrecord.

TochangeinformationinapatientrecordfromwithinPatientExplorer,
dothefollowing:
1. Searchforthepatientrecordtowhichyouwanttomakechanges
(seeSearchingforRecordsonpage 784).
2. FromtheSelectapatientlist,selectthemedicalrecordofthepatient
forwhomyouwanttochangeinformation(seeFigure 211)and
clickEdit.
Typeinformationorselectsearchoptionsto
Onceyouidentifya
displayalistfromwhichtofindthepatientrecord
patientrecord,clickEdit
forwhichyouwanttochangeoraddinformation
Figure 211 Find And Select A Patient Record
3. TherecordfortheselectedpatientdisplaysintheEdittab(see
Figure 212onpage 796).
4. Changeoraddinformationtothepatientrecord(seeAddinga
NewPatientRecordonpage 797).

5. ClickOK.PatientExplorerclosesandtheARIAapplicationyou
wereusingdisplaystheselectedpatientrecordwiththechanged
oraddedinformation.
Changeoraddinformation Whenfinishedaddingor
tothepatientrecord changingdata,clickOK
Figure 212 Add Or Change Data In the Open Patient Record
Recording New Patient Data

Inadditiontosearchingforpatientrecords(activeorarchived),orall
patientrecordsthatcontainimagesorplansofaspecificcategory,you
canusethePatientExplorerwindowtoaddnewpatientstoyourVarian
systemdatabase.SelectingtheNewtabfromthePatientExplorer
windowdisplaysapatiententryform(seeFigure 213onpage 797).

Identifiesthetextboxeswhich,ataminimum,mustbefilledinto
createanewpatientrecord
Figure 213 Adding A New Patient Record
Adding a New Patient Record

WhenusingthePatientExplorerwindowtoaddanewpatient,you
mightbeseeingthatpatientonawalkinoremergencybasis.Youcan
beginthenewpatientrecordwithonlytwoitemsofinformation:
LastNameRecordsthesurnameofapatient.
PatientIDIdentifiesoneormorepatientIDs(globalor
institutional)whichmustbeaddedwhencreatinganewpatient
recordfortheselectedhospital.

Withthosetwoitemsofpatientinformationinplace,clickOKtosave
thatminimalrecordandworkwiththepatient.Oncethepatienthas
beenseenortreated,ARIAattachestheinformationdescribingthe
examinationortreatmenttothepatientrecordandfullidentifying
informationaboutthepatientcanbeadded.
Theprocesstoaddanewpatientrecordisshowninthefollowing
overview:
1. OpenthePatientExplorerwindowandselecttheNewtab.
2. (Required)TypeinthenewpatientsLastName.
3. (Required)Ifnotdisplayed,clickthePatientIDstab.InthePatient
IDlist,identifyglobalandinstitutionalidentificationsasneededin
textboxesshowninorange(seeAddingPatientIDsonpage 801
fordetails).
4. (Optional)Typeinorselectadditionalpatientinformationinthe
textboxorlistsofthePatientPersonalgroup.(SeeAddingPatient
PersonalDataonpage 799fordetails.)
5. (Optional)Selectoneormoreoftheaddresstabs(HomeAddress,
Prim.ResidenceAddress,orSec.ResidenceAddresstab)andadd
informationforthenewpatient.(SeeRecordingPatient
Addressesonpage 804fordetails.)
6. (Optional)ClicktheReferringtabandidentifythenewpatients
doctorintheReferringPhysiciangroup.(SeeIdentifying
Providersonpage 805fordetails.)
7. (Optional)ClicktheReferringtabandselectthenewpatients
oncologistintheOncologistgroup.(SeeAddingthePatients
Oncologistonpage 810.)
8. (Optional)Identifythestatusofthepatient.FromtheStatustext
boxlist,selectNone,NewPatient(NP),orPreviousPatient(NOP).
9. (Required)Ifnotalreadyidentified,selectthenameofthehospital
fromtheNametextboxlist.
10. (Optional)Selectdepartmentswithinthehospitalwherethe
patientreceivestreatment(SeeSelectingTreatmentDepartments
onpage 813).
11. ClickOK.TherecordofthenewpatientisaddedtotheVarian
systemdatabase.

Adding Patient Personal Data
Apatientspersonalinformationcanbeaddedatthetimeyoustarta
newpatientrecord,oraddedlater.Ifyouaddinformationafterthe
initialtreatment,searchforthenewpatientusingthenameorpatient
IDcodetolocatethespecificrecordinyourVariansystemdatabase.
BeyondtheLastNametextboxrequiredpatientdataentry,addthe
followinginformationtoanewpatientrecord:
WiththeNewtabofthePatientExplorerwindowopen,adddatato
anyofthefollowinginthePatientPersonalgroup(seeFigure 214
onpage 800):
Note: YoumanagethosetextboxesthatofferlistsinDataAdministration.
Youcanacceptthedefaultentriesineachlistoraddyourownadditionstoa
listinDataAdministration.
FirstNameThegivennameofthenewpatient.Youcanuse
thistextboxinformationwhensearchingforpatientrecords.
MiddleNameThesecondgivennameofapatient.
MaidenNameIffemale,thebirthsurnameofapatientwho
hasmarried.
MothersMaidenNameThebirthsurnameofthepatients
mother.
ID1(ReadOnly)Identifiestheprimaryidentificationcode
usedforapatient.
ID2Asecondaryidentificationcodeassignedtothepatient.
Youcanusethistextboxinformationwhensearchingfor
patientrecords.
UniversalIDAnidentificationcodeassignedtothepatient
byagovernmentotherthantheUSA.
SSNASocialSecurityAccountNumberassignedtothe
patientbytheUSAgovernment.Youcanusethistextbox
informationwhensearchingforpatientrecords.
BirthDateThedateofbirthofthepatient.Youcaneither
typeindates(twodigitmonth/twodigitday/fourdigityear),
orclickthearrowtodisplayacalendar(shownatleft).

Selectdatesfromthecalendarasfollows:
LeftorRightArrowsClickanarrowtomovetothe
previousornextmonthrespectively.
NameofMonthClickthenameofthemonthinthe
calendarheadertoshowandselectfromalistofmonthsfor
theselectedyear.
YearClicktheyear.Typeinanewyear,orclicktheup
ordownarrowsattherightendofthedatetomove
forwardorbackthroughyears.
DayonCalendarClickadateonacalendartoselectthat
specificdayforthedisplayedmonthandyear.
Theminimumdata
requiredtobeginandsave
anewpatientrecord
includesthistextbox
Typeinformationin
theothertextboxesor
selectoptionsfromthe
listtocompletethe
patientinformation
yourequire
Figure 214 Patient Personal Data
Age(ReadOnly)Whenyouidentifythedateofbirthfora
patient,PatientExplorercalculatesanddisplaysthecurrentage
ofthepatient.
BirthCountryOffersalistofcountrynamesfromwhichto
selectthepatientscountryofbirth.

CitizenshipAlistofferscountrynamesfromwhichyou
selectthepatientscurrentcountryofcitizenship.
MaritalStatusAlistofferssixdifferentstatusdesignations.
YoucanselectfromNone,Divorced,Married,Single,Unknown,
orWidowed.
RaceOffersalistofnationalitydesignationsfromwhich
youselecttheidentificationthatappliestothenewpatient.
SexAlistthatincludessevendesignationsfromwhichto
select.YoucanselectfromNone,Female,Male,NotStated,Other
(Hermaphrodite),Transsexual,orUnknown.
LanguageOffersatextboxintowhichyoucantypethe
primarylanguageofthepatient.
PassportNumberIfthepatienthasapassport,typethe
identificationofthatpassportintothistextbox.
EmailAddressDoesthepatienthaveaprimaryemail
address?Ifso,typethatemailaddressintothistextbox.
Home/CellPhoneInsertthepatientsprimarycontact
telephonenumber,homeorcellphone,inthistextbox.
WorkNumberTypethepatientsworktelephonecontact
numberinthistextbox.
PagerNumberIfthepatientpossesatelephonepager,type
thatnumberintothistextbox.
ClinicalTrialAcheckboxthatidentifieswhetherthe
patientisincludedinaclinicaltrial.
Adding Patient IDs

Afteraddingthelastnameofanewpatient,andanyadditional
optionaldata,youmustidentifytherequiredpatientIDsinthePatient
IDlist(seeFigure 215onpage 802).
InthePatientIDlist,DataAdministration(Setup>System>PatientID
icon),youidentifyglobalandinstitutionalpatientIDs.ThePatientID
listoffersnineoptionsyoucanselectforeachpatientID.Thepatient
IDsyoumarkasrequired,PatientExplorersNewtabshowsinorange.
YoumustaddpatientIDsinthosetextboxesfornewpatients.

IdentifiesglobalpatientIDs Orangetextboxesshow Identifiesinstitutional
requiredinformation patientIDs
Figure 215 Selecting Patient IDs
ThePatientIDstabincludesthefollowingoptionsanddatacolumns:
HospitalAtextboxthatidentifiesthecurrentlyselected
hospital.Tochangetheselectedhospital,clickonthedownarrow
andselectadifferenthospitalfromthedisplayedlist.
ShowHistoryWhenselected,PatientExplorershowsany
patientIDwhichhavebeenmarkedasError(seePatientIDs
MarkedErroronpage 803fordetails)andallnoncurrentpatient
IDs.
PatientIDThecolumnlistsallpatientIDs,bothglobaland
institution,fromDataAdministration,PatientInformationlist,which
aremarkedasVisible.
ValueThedatacolumnacceptsentriesyoutypeinfordifferent
namedpatientID.Orangecellsinthecolumnidentifyrequired
patientIDs.
Note: Ifeditinganexistingpatientrecord,PatientExplorercopiestherowto
maintainarecordofpriorvalues,markingthepriorvalueasnotcurrent.
EnteredOn(ReadOnly)Thecolumnidentifiesthedatewhen
youenteredthepatientID.
ExpiryDate(ReadOnly)IdentifiesthepatientIDasActive.If
youchangeapatientID,thedateandtimethepatientIDceasesto
beactivedisplays.

Patient IDs Audit History
IfyourightclickonapatientIDinthePatientIDlistandclickAudit,
thePatientKeysAuditReportdialogbox(seeFigure 216)displays.
ThedialogboxidentifiesallactionstakenwiththeselectedpatientID.
Thethreecolumnsofthatdialogboxareasfollows:
ActionNamestheactiontakenforeachinstanceofchangeofa
patientID.
UserIdentifiesthelogonusernameoftheindividualtakingan
actionwithapatientID.
Date/TimeListsthedate(month,day,andyearformat)and
date(hour,minute,andwhetherAMorPM)foreachactiontaken
forapatientID.
Displaystheaction,user,alongwith
dateandtimeofallactionsassociated
withthepatientIDyouselectedfrom
thePatientIDlist.
Figure 216 Patient ID Audit History
Patient IDs Marked Error
IfyoucreatedapatientIDinerror,orwishtoremoveapatientIDfrom
thedisplayedlist,youcanmarkapatientIDasError.Justselecta
patientID,rightclick,andselectError.MarkingapatientIDasError
removesthatpatientIDfromtheregulardisplay.
TodisplaypatientIDsmarkedasErrorforapatient,selecttheShow
HistorycheckboxattheupperrightendofthePatientIDstab(see
Figure 217onpage 804).

PatientIDsmarkedasErrorarecrossedout TodisplaypatientIDsmarkedError,select
theShowHistorycheckbox
Figure 217 Patient ID Marked As An Error
Recording Patient Addresses

WhenaddinganewpatientrecordtoyourVariansystemdatabase,
youcanincludeuptothreeseparateaddressesforthatpatient.Each
addressisseparatelyrecordedondifferenttabsofthePatientExplorer
window,Newtab(seeFigure 218onpage 804).
Thosethreetabsare:
HomeAddress
Prim.LocalResidence
Sec.LocalResidence
Thepatientaddresstabs
ofanewpatientrecord
allowadditionofupto
threeaddresses
Informationforone
addressoftheselected
patient
Figure 218 Maintaining Patient Addresses

Torecordapatientaddresstooneofthethreetabs,dothefollowing:
1. FromtheNewtabofthePatientExplorerwindow,selectoneofthe
threepatientaddresstabs.
2. Addinformationtotheseventextboxesandonelistoftheselected
addresstab:
StreetAddress1Identifiesthenumberandstreetofthe
patientaddress.
StreetAddress2Ifneeded,offersasecondlineonwhichto
recorddetailsofapatientsaddress.
CityListsthecityinwhichthepatientaddressisfound.
StateRecordsthestate,aseitheracodeorspelledout,in
whichthecityofthepatientsaddressisfound.
PostalCodeAtextboxintowhichyoucantypeapostal
codeofanyformthatisassociatedwiththepatientsaddress.
CountyIdentifiesthenameofthegeographicaldesignation,
betweencityandstate,inwhichthepatientsaddressisfound.
CountryOffersalistfromwhichyoucanselectthecountry
associatedwiththepatientaddress.
PhoneInthetextbox,typethetelephonenumber,including
areacode,associatedwiththepatientsaddress.
3. (Optional)Ifyouwishtorecordanotheraddressforthepatient,
clickonadifferentaddresstabandrepeatstep2.
Identifying Providers
ToidentifyareferringphysicianorOncologistforapatient,youdoso
fromtheProviderstab.SelectingtheProviderstabdisplaystwolists,
oneforReferringPhysicianandoneforOncologist(seeFigure 219on
page 806).
Referring Physician
Yournewpatientrecordalsoidentifiesoneormorereferring
physicians.Thereferringphysiciancouldbethepatientsprimarycare
doctor,aspecialistworkingwiththeprimarycaredoctor,orboth.If
youlistmultiplereferringphysicians,youcanonlymarkoneofthose
physiciansastheprimaryphysician.

Identifiestheprimary Clicktosetuporselectthe Identifiestheprimary
referringphysician referringphysiciansor Oncologistforthe
forthepatient Oncologistsforthepatient patient
Figure 219 Identifies A Patients Providers
Toselectoneormorephysiciansasthepatientsreferringphysician,
dothefollowing:
1. FromtheNewtabofthePatientExplorerwindow,clickthe
Providerstab.
2. OntheProviderstab,clickAssign/DetachfromtheReferring
Physiciangroup.
3. TheSelectPhysiciansdialogboxopens(seeFigure 220on
page 807).Tosearchforanexistingphysicianrecord,type
informationinoneormoreofthethreeSearchCriteriagrouptext
boxesasfollows:
LastNameSearchforprimaryphysicianusingdoctors
surname.
FirstNameUsegivennametosearchforadoctor,oraddas
asecondsearchcriteriatolimitthesearch.
SpecialtySearchforaprimaryphysicianbylistingall
doctorsofaparticularspecialty
4. Select(andhighlight)adoctorfromtheAvailablePhysicianslist.
Note: Ifthedoctoryouwantisnotlisted,addanewdoctor.(seeAddingA
PrimaryCarePhysicianonpage 808).
5. Clickthedownarrowbutton(shownatleft)tomovetheselected
doctortotheSelectedPhysicianslist.

Searchforaphysician Selectthepatientsphysician Clickthedownarrowtomove
usingoneorallofthe fromthenamesdisplaying theselectedphysiciantothe
threeoptions inthelist SelectedPhysicianslist
Figure 220 Select An Existing Physician
6. ClickOK.ARIAtransfersthedoctoryouselectedandmovedto
theSelectedPhysicianslistontotheReferringPhysicianlistofthe
Newtab,PatientExplorerwindow(seeFigure 221).
7. Ifthisdoctoristheprimaryreferringdoctor,selectthecheckboxin
thePrimarycolumn.
Onceselected,thenameofthe
referringphysiciandisplaysinthelist
onthenewpatientrecord
Toidentifythepatientsreferring
physician,clickAssign/Detachto
opentheSelectPhysiciansdialogbox
Figure 221 Adding The Referring Physician

Adding A Primary Care Physician
Ifthenewpatientsprimarycarephysicianisnotincludedinthelist
shownontheSelectPhysiciansdialogbox,youcanaddthatdoctor.
Youmustadddatatoaminimumoffiverequiredtextboxesonthe
Physiciantab,PhysicianDetaildialogboxtoaddanewdoctortothe
listofprimarycarephysicians.
Toaddanewprimarycarephysician,withtheSelectPhysiciansdialog
boxopendothefollowing:
1. FromtheAvailablePhysiciansgroup,clicktheNewbutton.
2. OnthePhysiciantab,PhysicianDetaildialogbox(SeeFigure 222),
typeinformationintherequiredtextboxes.
PhysicianID(Required)Liststheidentificationcode
assignedbyyourhospitaltotheprimarycarephysician.
DisplayName(Required)Thenameoftheprimarycare
physicianasthatdoctorappearsinlists.
LastName(Required)Thesurnameoftheprimarycare
physician.
FirstName(Required)Thegivennameoftheprimarycare
physician.
Specialty(Required)Identifiesthemedicalspecialityofthe
primarycarephysician.
Typeindataabout
thedoctorusingthe
fiverequiredand
extratextboxes
SelectthePhysiciantab
toaddinformation
aboutthepatients
primarycaredoctor
Figure 222 Adding Physician Details

3. Therearesevenoptionaltextboxesintowhichyoucanadd
informationthatfurtheridentifiestheprimarycarephysician.
MiddleNameThesecondoradditionalgivennameofthe
primarycarephysician.
HonorificAtitleorotheridentificationusedbytheprimary
carephysician.
NameSuffixAnadditionalendtagforaname,forexample
juniororIII.
InstitutionIdentifiesthehospitalorclinicwherethe
primarycarephysicianworks.
CommentAcceptsashortnotefortherecordoftheprimary
carephysician.
FaxNumberTheareacodeandtelephonenumbertowhich
Faxmessagescanbesenttotheprimarycarephysician.
EmailAddressAnInternetmailaddress,typicallythrough
thehospitalorclinic(Institution),wheretheprimarycare
physicianreceiveselectronicmessages.
4. Afteraddingpersonalinformationabouttheprimarycare
physician,clicktheAddresstab(seeFigure 223onpage 810)to
openandrecordthedoctorsaddress.
StreetAddress1Identifiesthenumberandstreetofthe
doctorsofficeaddress.
StreetAddress2Ifneeded,offersasecondlineonwhichto
recorddetailsofthedoctorsofficeaddress.
CityListsthecityinwhichthedoctorsofficeaddress.
StateRecordsthestate,aseitheracodeorspelledout,in
whichthecityofthedoctorsofficeaddressisfound.
PostalCodeAtextboxintowhichyoucantypeapostal
codeofanyformthatisassociatedwiththedoctorsoffice
address.
CountyIdentifiesthenameofthegeographicaldesignation,
betweencityandstate,inwhichthedoctorsofficeaddressis
found.
CountryOffersalistfromwhichyoucanselectthecountry
associatedwiththedoctorsofficeaddress.
PhoneInthetextbox,typethetelephonenumber,including
areacode,associatedwiththedoctorsofficeaddress.

SelecttheAddresstab
toidentifytheprimary
carephysicians
businessoffice
Alltextboxesandthe
listareoptional.Usethe
Addresstabtoidentify
theofficeinformation
fortheprimarycare
physician
Afteraddingaddress
informationforthe
primarycarephysician,
clickOKtosavethat
data
Figure 223 Adding A Physicians Address
5. ClickOKtosavethenewprimarycarephysiciandata.Thename
ofthenewlyaddeddoctorappearsintheAvailablePhysicianslist.
Adding the Patients Oncologist
Thenewpatientrecordalsoidentifiesoneormoreoncologistsasbeing
associatedwiththepatient.Ifmorethanoneoncologistwillbe
involvedinthepatientstreatment,selectboth.However,onlyonecan
beidentifiedasprimary.
Toselectoneormoreoncologiststoidentifyasthepatientsoncologist,
dothefollowing:
Providerstab.
2. OntheProviderstab,clickAssign/DetachfromtheOncologist
group.
3. TheSelectOncologistsdialogboxopens(seeFigure 224on
page 811).TosearchforanOncologist,typeinformationinoneor
moreofthefourSearchCriteriagrouptextboxesasfollows:
LastNameSearchforanoncologistusingdoctorssurname.
FirstNameUsegivennametosearchforadoctor,oraddas
asecondsearchcriteriatolimitthesearch.

SpecialtySearchforanoncologistbylistingalldoctorsofa
particularspecialty
HospitalFromthelist,selectthehospitaltowhichthe
oncologistisassociated.
Searchforan Selectthepatients Clickthedownarrowtomovethe

oncologistusingoneor oncologistfromthenames selectedoncologisttotheOncologistslist
allofthethreeoptions displayinginthelist
Figure 224 Identify The Primary Oncologist For A Patient
4. Select(andhighlight)adoctorfromtheAvailableOncologistslist.
doctortotheSelectedOncologistslist.
6. ClickOK.ThedoctoryouselectedandmovedtotheSelected
OncologistslistmovestotheOncologistlistoftheNewtab,Patient
Explorerwindow(seeFigure 225onpage 812).
7. Ifthisdoctoristheprimaryoncologist,selectthecheckboxinthe
Primarycolumn.

Onceselected,thenameofthe
oncologistdisplaysintheliston
thenewpatientrecord
Toidentifythepatientsreferring
physician,clickAssign/Detachto
opentheSelectOncologistdialog
box
Figure 225 Listing The Oncologist For A Patient
Adding Department and Patient Status

Youalreadyidentifiedthehospitalwhenstartinganewpatientrecord.
FromtheHospitaltab,younowidentifythestatusofthepatientand
thedepartmentsthatwillprovidecaretothepatient.
Toidentifydepartmentandstatusinformationforthenewpatient,do
thefollowing:
Hospitaltab.
Hospitalproviding
treatmenttothepatient
Identifiesthepatients
status,eithernewor
returning
Listsdepartmentinthe
hospitalthatprovide
treatmenttothepatient
Figure 226 Adding Hospital And Department For A Patient
2. OntheHospitaltab,selectoptionsforthispatient(Figure 226on
page 812).
NameOffersalistofhospitalandclinicnamesassociated
withyourlocation.Selectthenameofthefacilityatwhichthe
newpatientwillhaveappointments.

StatusIdentifiesthestatusofthenewpatient,listingthe
patientasNone,NewPatient(NP),orPreviousPatient(NOP).
3. Toadddepartmentswithinthehospitalwhoareproviding
treatmenttothepatient,seeSelectingTreatmentDepartmentson
page 813.
Selecting Treatment Departments

Youcanaddoneprimaryandmultiplesecondarydepartment
associationstoanewpatientrecord.TheDepartmentgroupdisplays
thehospitaldepartmentsyouselectforapatient.However,onlyoneof
thelisteddepartmentscanbeidentifiedasprimary.
Toidentifytheprimaryandsecondarydepartmentassociationsfora
patient,dothefollowing:
Hospitaltab.
2. AtthebottomoftheHospitaltab,clickAssign/Detachfromthe
Departmentgroup.
3. TheSelectDepartmentsdialogboxopens(seeFigure 227on
page 814).FromtheHospitallist,selectthenameofthefacilityfrom
whichthenewpatientreceivestreatment.
4. Select(andhighlight)adepartmentfromtheAvailableDepartments
list.
departmenttotheSelectedDepartmentslist.
Note: Youcanselectandtransfermorethanonedepartmentfromthe
AvailableDepartmentslisttotheSelectedDepartmentslist.Each
departmentmustbetransferredseparately.YoucanalsochangetheHospital
designationtoselectandtransferdepartmentsfromdifferenthospitallists.
6. IftheSelectedDepartmentslistcontainsmorethanonedepartment,
selectthecheckboxinthePrimarycolumnoftheprimary
departmentforthenewpatient.Asonlyonedepartmentcanbe
designatedasprimary,allotherdepartmentswillbeidentifiedas
secondary.

Selectthehospital
fromwhichyou
willselect
Departmentnames
fromtheselected
hospitaldisplay.
Highlighta
departmentname
toselectthe
department
Usethearrowkeys
toaddorremove
departmentsfrom
theSelected
Departmentslist
Listsallselected
departmentsfor
thenewpatient
Allowsselection
ofonlyone
primary
Figure 227 Select Departments Dialog Box
7. ClickOKtoclosetheSelectDepartmentsdialogbox.Theselected
primaryandsecondarydepartmentsnowdisplayinthe
Departmentlist(SeeFigure 228)oftheNewtab,PatientExplorer
window.
Selectedprimaryandsecondary
listofdepartments
ClicktoopentheSelect
Departmentsdialogbox
Figure 228 Department List

Appendix B Import and Export Filters
All Workspaces
ThisAppendixbrieflydescribeshowtoconfigurenewimportand
exportfiltersforyoursystemorremovingfilters.
Configuring Import and Export Filters

Importandexportfiltersareneededfortransferringinformationwith
differentfileformatsfromvarioussourcesandtoanumberof
destinations.Generally,thefiltersareconfiguredduringsystem
configuration.Fordetailedinstructions,refertotheonlinehelp.
Note: YouneedsufficientuserrightstoconfigureImportandExportfilters.
To Add New Import and Export Filters

Theproceduresforaddinganimportorexportfilterareidentical.In
thefollowing,animportfilterisaddedtothesystem.
1. ChooseTools >Import/ExportConfiguration.
TheImport/ExportConfigurationdialogboxopens.
2. ClickAdd.
TheAddNewFilterdialogboxopens.
3. Tosavethefilterparametersinaserverregister,selecttheGlobal
AccessFiltercheckbox.
Modificationsmadetoaglobalaccessfilterinoneworkstationchanges
thefilterparametersinalltheworkstationsusingthefilter.
4. SelecttheappropriatefilterandclickAdd.
Therelevantfilterconfigurationdialogboxopens.Thecontentsof
thedialogboxdependontheselectedfilter.
5. Ifnecessary,typeanewnameintheIDtextbox.
6. Definetheparametersofthefilter.
801
7. ClickOKtoaddthefilter.
Note: Notethattherecanbevariousconfigurationsforaparticularimport
filter.ForexampleyoucanmaketwodifferentconfigurationsforaDICOM
MediaFileFilterwithdifferentimportdirectoriesbydefiningadifferentname
andparametersforthetwofilters.Namethefilterswitheasilyrecognizable,
descriptivenames.
To Modify the Import/Export Filter Configuration

Inthisexample,thefiltermodifiedistheDicomMediafilefilter.
2. Selectaninstalledfilter.
3. ClickConfigure.
TherelevantFilterParametersdialogboxopens.
4. Definethenecessarymodificationsfortheselectedfilter.
5. ClickOK.
6. ContinuetoconfiguremorefiltersorquitbyclickingExit.
Note: Notethattherecanbevariousconfigurationsforaparticularimport
filter.ForexampleyoucanmaketwodifferentconfigurationsforaDICOM
MediaFileFilterwithdifferentimportdirectoriesbydefiningadifferentname
andparametersforthetwofilters.Namethefilterswitheasilyrecognizable,
descriptivenames.
To Delete Import/Export Filters

TheproceduresforremovinganImportorExportfilterareidentical.
InthefollowingsteplistanImportfilterisremovedfromthe
registry.
2. SelectthefilterandclickRemove.
Youarepromptedtoconfirmthedeletion.
3. ClickOK.

Appendix C Calibrating the Digitizer
Thisappendixprovidesinformationaboutcalibratingadigitizerfor
definingoutlinesforstructures,blocks,andMLCsandfordefining
referencepointlocations.
About Digitizers
Adigitizerisanelectronicdevicethatenablesyoutomanually
replicateadrawingfromasheetofpaperorfilmintodigitalformon
thecomputer.Theequipmentconsistsofaflatsurface(sometimes
backlit),onwhichthesourceimagecanbefixed,andapointingdevice
withwhichthepositionofapointintheimagecanbeprecisely
measuredandsenttoacomputer.Severaldigitizermodelsare
supported.
InContouring,2Dcontourscanbedelineatedforpatientswithouta
3DCT/MRimage.Forexample,apatientbodyoutlineisdefinedon
threeplanesusingsomeothermeansthanaCToranMR.These
outlinesaredigitizedintotheapplicationandusedtodefinea3D
bodystructure.Formoreinformationonplanningwithouta3Dimage
andtheuseofdigitizerincontouringworkspace,refertoIRREG
Planning.
IntheFieldSetupworkspaceoftheExternalBeamPlanningtask,a
blockorMLCoutlinecanbedrawnonasimulatorimagewitha
digitizer.Insomecases,youcanplantheblockshapedirectlytothe
simulatorimage,eitherwithapenorusingstandardblockshape
shieldsavailableonthesimulator.Totransferthisshapeintothe
treatmentplanningsystem,scaneitherthewholesimulatorimage,or
digitizejusttheblockoutline.
Theitemyouaredigitizingisshownintheactiveimageview.Inthe
ExternalBeamPlanningtask,forblocks,youcandefinemultiple
contours,startinganewcontourwhentheoldoneisclosed.Foran
MLC,youcandefineonlyonecontour.Formoreinformationon
digitizingblockoutlines,seeChapter 21,Blocks,onpage 575.For
informationondigitizingMLCoutlines,seeChapter 16,Multileaf
803
To Configure a Digitizer
2. SelecttheDigitizertab.
3. IntheCOMPortlistbox,selecttheporttowhichthedigitizeris
connected.
4. IntheTypegroupbox,selectthedesireddigitizermodel.
5. Tosetthedigitizerresolution,clickConfigureDigitizer
Resolution,anddefinethescalelinelengthandthedigitizer
resolutioneitherindpiorbydrawingalinewiththedigitizer.
6. ClickOK.
Calibrating Digitizers
Inordertoconvertapointdefinedindigitizercoordinatesintoapoint
onthecomputerscreenorinpatientcoordinates,youhavetocalibrate
thedigitizerfirst.Theminimumrequirementisthatacommonorigin
isdefinedinallcoordinatesystems.Ifthesourceimageisrotatedin
respecttothedigitizeraxesordefinedinsomeotherscalethan1:1,
youhavetogiveatleastoneadditionalpoint.
InContouringworkspace,thedigitizeriscalibratedforoneplane
(transversal,sagittal,orfrontal)atatime.Youcanselecttheorigin
arbitrarilywithintheimagearea.
IntheFieldSetupworkspaceoftheExternalBeamPlanningtask,the
digitizeriscalibratedtoworkwithonefieldatatime.Theselected
fieldisshownintheBEV.Thecalibrationisvalidforthisfielduntilthe
digitizeriscalibratedforsomeotherfieldortheworkspaceisclosed.
Theoriginisapointthatexistsbothintheimagetobedigitizedandin
theimageview.IntheExternalBeamPlanningtask,intheBEV,you
canfixtheorigintothefieldisocenter,andhavetheXYplaneofthe
digitizerrepresentthefocalplane.InCTimages,theorigincanbethe
corneroftheimageareaorthestartpointofthescalingvector,andthe
XYplaneofthedigitizerrepresentsthetransversalplane.

Thebaselinethatdefinestherotationofthesourceimagecanbeany
lineeitherintheXortheYdirection.Ifthebaselinestartsfromthe
origin,onlyoneadditionalpointisrequiredtodefineit.
Thescalingfactorcanbedefinedeitherfromthebaseline,orsome
othertwopointswhenthedistancebetweenthemisknown.
Alternatively,youdeterminethescalingfactorbyenteringa
FilmtoFocusdistance.
DigitizersarecalibratedwiththeDigitizerCalibrationwizard.Inthe
dialogboxesoftheDigitizerCalibrationwizard,usethefollowing
buttons:
ClickCanceltoclosethewizardanddiscardthechanges
Note: Thecalibrationisvalidforoneimageonthedigitizertableatatime.
To Calibrate a Digitizer for Contouring

1. Openthepatientandtheplanthatincludesthestructuretowhich
youareabouttoimportanoutline.
3. ChooseContouring >EnableDigitizer.
TheDigitizerToolsbuttonsappearinthetoolbar.Ifa
calibrationisrequired,allbuttonsexceptCalibrateDigitizer
aredimmedanddisabled.
ThefirstwindowoftheDigitizerCalibrationwizardopens.
Ifthedigitizerisalreadyenabled(acheckmarkisshowninthe
Contouringmenu),clickCalibrateDigitizerinthetoolbartoopenthe
dialogbox.
Calibrating the Digitizer 805

4. Todefinetheimageorigin,selectanappropriateoptionbutton:
ImagecenterMarktheimagecenterinthefilmwiththe
digitizer.
SelectedpointSelectClickpointonscreenandthenclickon
theselectedpointinthemainview.Thenmarkthesamepoint
onthefilmwiththedigitizer.
5. FollowtheonscreeninstructionsandclickNext.
Thesecondwindowofthewizardopens.
6. Todefinetheimagescale,selectanappropriateoptionbutton:
GiveFilmtoFocusdistance
GiveFilmscaling
GivescalelineonthedigitizerTypefirstthelengthofthe
scalelineandthenmarkthestartandendpointsoftheline
withthedigitizer.
Thelastwindowofthewizardopens.
8. Todefinetheimagerotation,selectanappropriateoptionbutton:
Filmiscorrectlyaligned
Giverotationangle
Clickhorizontal/verticallineondigitizerMarkthestartand
endpointsofthelinewiththedigitizer.
9. Followtheinstructionsinthewizardand,toacceptthecalibration,
clickFinish.
Thedigitizerisnowcalibratedforusewiththisimage.
To Calibrate a Digitizer in the BEV for External Beam Planning

1. Openthepatientandtheplanthatincludesthefieldtowhichyou
areabouttoaddafieldaccessory.
EyeView.

3. ChoosePlanning >EnableDigitizer.
TheDigitizerToolsbuttonsappearinthetoolbar.Ifa
calibrationisrequired,allbuttonsexceptCalibrateDigitizer
aredimmedanddisabled.
ThefirstwindowoftheDigitizerCalibrationwizardopens.
Ifthedigitizerisalreadyenabled(acheckmarkisshowninthePlanning
menu),clickCalibrateDigitizerinthetoolbartoopenthedialogbox.
4. Todefinetheimageorigin,selectanappropriateoptionbutton:
FieldisocenterMarkthefieldisocenteronthefilmwiththe
digitizer.
SelectedpointSelectClickpointonscreenandthenclickon
theselectedpointinBEV.Thenmarkthesamepointonthe
filmwiththedigitizer.
Thesecondwindowofthewizardopens.
6. Todefinetheimagescale,selectanappropriateoptionbutton:
GiveFilmtoFocusdistance
GiveFilmscaling
GivescalelineonthedigitizerTypefirstthelengthofthe
scalelineandthenmarkthestartandendpointsoftheline
withthedigitizer.
Thelastwindowofthewizardopens.
8. Todefinetheimagerotation,selectanappropriateoptionbutton:
Giverotationangle
Clickhorizontal/verticallineondigitizerMarkthestartand
endpointsofthelinewiththedigitizer.
9. Followtheinstructionsinthewizardand,toacceptthecalibration,
clickFinish.
Thedigitizerisnowcalibratedforusewiththisimage.
Calibrating the Digitizer 807

Appendix D Keyboard Shortcuts
Thisappendixliststhekeyboardshortcutsavailable.
Table 53 Keyboard Shortcuts
Shortcut Action
ALT+1 Switchbetweentasks
ALT+2
ALT+3
ALT+4
ALT+ENTER OpensthePropertiesdialogboxoftheactiveobject
CTRL+C Copiestheactiveobject
CTRL+N Createsanewpatient
CTRL+O OpenstheObjectExplorer.Whenthereisnoactivepatient,
opensthePatientExplorer.
CTRL+P Printstheactivewindow
CTRL+S Savesalldatatothedatabase
CTRL+V Pastesthecopiedobject
CTRL+W AutomaticallyadjuststheWindow/Levelsettings
CTRL+Y Activatesthestructurespecificredooperation
CTRL+Z Activatesthestructurespecificundooperation
CTRL+1 Switchbetweendifferentworkspaces
CTRL+2
CTRL+3
CTRL+4
CTRL+5
DEL Deletestheactiveobject
F1 Openstheonlinehelp
F3 OpenstheFieldWeightdialogbox
F5 Calculatesthedosedistributionwithinthecalculation
volume
F6 Calculatesthedosedistributionontheactiveplane
809
Table 53 Keyboard Shortcuts
Shortcut Action
F7 OpenstheOptimizationdialogbox
F8 Createsanewplan
F9 Createsanewfield
F10 Createsanewopposingfield
F11 CalculatestheMLCleafmotions
PAGEDOWN Showsthepreviousimage
PAGEUP Showsthenextimage
SHIFT+CTRL+1 Changeimageviewlayouts
SHIFT+CTRL+2
SHIFT+CTRL+3
SHIFT+CTRL+4

Appendix E Editing Report Templates
Editing Report Templates

Reportsareprintedonpredefinedlayoutsthatarecalledtemplates.
Thetemplatesare.tmlfilesstoredtoaReportTemplatesDirectory.
YoucancheckthelocationoftheReportTemplatesDirectoryandthe
templatesbychoosingHelp> About.SelectSystemInfofromthe
dialogboxthatopens,andthelocationofthetemplatesisdisplayedin
theSystemInfodialogboxafterReportTemplatesDirectory.
TheavailabletemplatesareFull.tml,DVH.tml,ShortSummary.tml
andShortSummaryTabular.tml.
Youcancustomizethetemplatefilesorcreatenewtemplatesinatext
editor.IfyouedittheDVH.tmltemplatefile,youmustsaveitusingthe
originalfilename.TheFull.tmltemplateincludesthebasic
instructionsonhowtoeditthetemplates.
CAUTION: To avoid loss of data, always make a backup copy of the template
files before editing them.
Note: Thetemplatefilescontainsymbolsforvariables.Eachofthesevariables
beginwiththesymbol$.Donotuseanyvariablesotherthanthoselistedinthis
appendix.Thesoftwareonlyrecognizesthelistedvariables.Ifanunknown
variableisusedinthetemplate,thetextundefinedvariablenameisprinted
inthereport.
811
Report Template File Structure
Eachtemplatefilecontainsthreemainsections:Header,Footer,and
Form(whichisthereportbody).
IntheHeadersection,youdefinethespacereservedforthe
header.Next,youdefinethefont,placeandcontentofeachtext
lineprintedintheheaderofeachreportpage.
IntheFootersection,youfirstdefinethespacereservedforthe
footerandthenthefont,placeandcontentofeachtextlineprinted
inthefooterofeachreportpage.
IntheFormsection,youdefinethefont,placeandcontentofeach
textlineprintedinthereport.
Thetemplatefilesconsistoflines.Eachlinecomprisesacommand
followedbyanequals(=)signandparametervalue(s).The
parametertypesallowedforeachcommandarelistedinReport
TemplateCommandsonpage 828.
Alldimensions,includingfontsizes,aregivenin1/10millimeters.For
example,2000standsfor200 mmor20 cm.Fontweights,inturn,can
havevaluesranging1to999.
Note: Youcanalsoincludecommentlinesinthetemplatefilebyinsertinga
pound(#)signatthebeginningofthecommentline.
Report Template Commands

Note: Avoidlongprinttextlines.Theprintoutswillincludeonlytextthatfits
ononelinewhenusingtheselectedpapersizeandfont.
Section=Header|Footer|Form
Definesthetemplatesection(Header,Footer,orForm)towhichthe
formattingcommandsapply.
Height=Y
Definestheheightofthesection.Thecommandisonlyvalidforthe
HeaderandFootersections.Theheightisdefinedin1/10millimeters.
Forexample,Height=400definesaheaderheightof4centimeters.

LineSpacing=X.x
Definesthemultiplierforlinespacingbetweentheprintedlines.The
linespaceequalstoLineSpacingtimestheheightofthecurrentfont.
Forexample,LineSpacing=1.5definesalinespaceofonehalfofthe
heightofcharacterMinthecurrentfont.
Description=string
Atextlinedescribingthetemplatefile.ThisisshowninthePrint
Reportdialogboxtoassistinselectingacorrecttemplatefilefor
printingoutreports.
Note: Wheneditingreporttemplates,noticethefollowing:
Typethedescriptionononeline.Thelengthofadescriptionlineisnot
limited.
SuccessiveDescriptioncommandsoverridepreviousones.
Forexample:
Description=This report will print out all blocks

in all files
#string
The#characteratthebeginningofalinedefinesthelineasacomment
line.Commentlinesdonotappearintheprintedreport.Forexample:
Font=40;400;Arial
Text=Hello
printsoutas Hello
#Text=Good Bye
Editing Report Templates 813

Move=X[;Y]
MovesthestartinglocationofthenexttextstringXunitsrightandY
unitsdownmeasuredfromtheleftandtopedgesoftheform,
respectively.NegativeXandYvaluesaremeasuredfromtherightand
bottomedges,respectively.Yisoptional.Oneunitis1/10millimeters.
X+
Y+
Forexample:
Move=100;100 Tolocation(100,100)
Move= 200 Tolocation(200,100)
Move=-200 Tolocation(1800,100)
Move= 100;-200 Tolocation(100,2700)
RelativeMove=X[;Y]
unitsdownmeasuredfromthecurrentposition.Yisoptional.One
unitis1/10millimeters.Forexample:
Move=100;100 Tolocation(100,100)
RelativeMove=100;200 Tolocation(200,300)
RelativeMove=-200 Tolocation(0,300)
RelativeMove= 100;-200 Tolocation(100,100)
MoveText= X[;Y]
MovesthestartinglocationofthenexttextstringX unitsrightand
Y unitsdownmeasuredfromtheleftandtopedgesoftheform,
respectively.NegativeXandYvaluesaremeasuredfromtherightand

bottomedges,respectively.Y isoptional.Oneunitinthehorizontal
directionisthewidthoftheletter Musingthecurrentfont.Inthe
verticaldirection,oneunitistheheightofoneline.Forexample:
Font=100;400;Arial
LineSpacing=1.5
MoveText=1;2 Tothesecondlineofthefirstcolumn
MoveText=-2 Tothesecondlastcolumn,firstline
MoveText=3;-2 Tothethirdcolumn,secondlastline
RelativeMoveText= X[;Y]
unitsdownmeasuredfromthecurrentposition.Yisoptional.One
unitinthehorizontaldirectionisthewidthoftheletterMusingthe
currentfont.Intheverticaldirection,oneunitistheheightofoneline.
Text=string
Printsthegivenstringstartingfromthecurrentlocationandendingat
alinebreak.Afterthecommand,thecursormovesonelinedownand
returnsbacktotheXlocationwhereitwasbeforeexecutingtheText
command.
Thetextstringcanincludevariablesthatarereplacedwiththecorrect
valueswhenprintingthereport.Allvariablesarenamedas$<name>.
Formoreinformationonvariables,seeReportTemplateVariables
onpage 839.
Note: Toprintaspaceafteravariablevalue,typetwospacesinthecommand
line.
Forexample:
Font=100;400;Arial
Text=This is a text line
Move=100
Text=This line is indented
Text=This one also

Move=0
Text=This is not anymore
Text=Patient: $PatientFirstName $PatientLastName
Text=Patient: $PatientFirstName $PatientLastName
printsoutas
This is a text line

This line is indented
This one also
This is not anymore
Patient: Test Patient
LineText=string
Printsthegivenstringstartingfromthecurrentlocation.After
executingtheLineTextcommand,thecursorremainsattheendofthe
string.Forexample:
Font=100;400;Arial
Move=100
LineText=One
LineText=Two
Text=Three
Text=This is even more indented
Move=0
LineText=Patient:
LineText= $PatientFirstName

Text= $PatientLastName
printsoutas
This is a text line

OneTwoThree
This is even more indented
This is not anymore
TextRight=string and TextLineRight=string
PrintthegivenstringasText=stringandLineText=stringcommands
butendingthestringonthecurrentcursorposition.Allowsadjusting
texttorightonanycolumn.Forexample:
Font=100;400;Arial
Move=0
Text=This is written to the left edge of the page.
Move=-1
TextFromRight=This is written to the right edge of the page.
Move=1000
Text=This starts from the middle.
Move=1000
TextFromRight=This ends in the middle.
printsoutas
This is written to the left edge of the page.

This is written to the right edge of the page.
This starts from the middle.
This ends in the middle.

TextCenter=string and LineTextCenter=string
PrintthegivenstringasText=stringandLineText=stringcommands
butthemiddlepointofthestringisatthecurrentcursorposition.
Allowscenteredtextonanycolumn.
Margin=X
SetstheleftmargintoagivenpositionX.Allhorizontalmovement
fromhereonisdoneinrelationtothemargin.
Font=100;400;Arial
Margin=0
Margin=100
Move=100
Text=This one is even more indented
Move=0
Text=Back to here
Margin=0
printsout
This is a text line

This one is even more indented
Back to here
This is not anymore

Font=size;stroke;name
DefinesthefonttobeusedfromthispointonuntilthenextFont
command.Thesizeofthefontisgivenin1/10millimeters.Thestroke
isavaluerangingbetween1and999.Thefollowinglistssome
commonstrokevalueswithcorrespondingnumericvalues:
100Thin
300Light
400Normal
700Bold
900Heavy
Thenameofthefontisastring.Thedefaultfontis3mmhighnormal
TimesNewRoman,forexample:
Font=100;400;Arial
Text=This is 1cm high Arial
Font=60;700;Times New Roman
Text=This is 6mm high bold Times New Roman
printsout
This is 1cm high Arial

This is 6mm high bold Times New Roman
HorizontalLine=X1;X2
DrawsathinhorizontallinefrompositionX1topositionX2.
PageBreak=X.x
Insertsapagebreakintoareport.Avaluecanbegiventomakethe
pagebreakoptionaldependingonhowmuchpagespacehasbeen
used.Thegivenvaluecanrangefrom0.0to1.0.Forexample,ifthe
valueissetto0.8itmeansthatwhenapageis80%full,apagebreakis
inserted.Value0.0forcesthepagebreakalwayswhile1.0doessoonly

ifthepageiscompletelyfull.Thiscommanddoesnotaffectautomatic
paging;anautomaticpagebreakisinsertedalwayswhenapageis
full.ValidonlyintheFormsection.
PaperOrientation=<keyword>
Definesthepaperorientationusedforthereport.Availablekeywords
areportraitandlandscape.Thedefaultkeywordisportrait.
PaperSize=<keyword>
Definesthepapersizeusedforthereport.AvailablekeywordsareA4,
A3,legal,letterandtabloid.ThedefaultkeywordisA4.
Report Template Syntax
Loop=<keyword>
EndLoop
Oneplancancontainseveralfields,fractionations,referencepointsetc.
Furthermore,onefieldcancontainseveralblocksorwedgesetc.
Toprintoutthesekindofmultipleitemlistsyouneedtospecifyaloop
intothereporttemplate.AllthecommandsbetweenLoopand
EndLooparerepeatedasmanytimesasthereareobjectsdefinedbythe
keywordintheplan.Forexample,iftheplancontainsthreefields,the
Fieldsloopisrepeatedthreetimes.

Availableloopkeywordsarelistedbelow:
Fields
Listsfielddata(variableslistedfromTable 63onpage 846to
Table 70onpage 853)
Fractionations
Listsgeneralfractionationdata(variableslistedinTable 60on
page 844)
Structures
Listsstructuredata(variableslistedinTable 58onpage 843)
RefPoints
Listsreferencepointdata(variableslistedinTable 71on
page 853)
PhotonAlgOptions
Listsphotondosecalculationalgorithmoptions(variables
$AlgOptionNameand$AlgOptionValue)
ElectronAlgOptions
Listselectrondosecalculationalgorithmoptions(variables
$AlgOptionNameand$AlgOptionValue)
Fields,FractionationsandRefPointsloopscanbeusedinsideeach
othertolistdifferentvariables.
RefPointsloopinsideFieldsloop
Listsfielddependentreferencepointdata(variableslistedin
Table 70onpage 853)
RefPointsloopinsideFractionationsloop(orviceversa)
Listsreferencepointdependentfractionationdata(variables
listedinTable 71onpage 853)
FractionationsloopinsideFieldsloop(orviceversa)
Listsfractionationdependentfielddata(variableslistedin
Table 62onpage 846)
Forexample,AlgOptionName and AlgOptionValueloopsinsidea
PhotonAlgOptionsloopcanbeusedtoprintoutthepropertiesofthe
photoncalculationalgorithmselectedfortheplan:

Loop=PhotonAlgOptions Printsoutthenamesandvaluesof
alltheoptionsinthecalculation
Move=100
algorithmselectedfortheplan.
LineText=$AlgOptionName
Move=600
Text=$AlgOptionValue
EndLoop
ThefollowingloopscanbeusedonlyinsideFieldsloop:
Blocks(variableslistedinTable 68onpage 852)
Wedges(variableslistedinTable 65onpage 849)
Bolus(variableslistedinTable 69onpage 852)
Referencepoints(variableslistedinTable 71onpage 853)
CalculationWarnings
Listswarningsfromdosecalculationsforthisfield(variable
$FieldCalculationWarning)
CalculationErrors
Listserrorsfromdosecalculationsforthisfield(variable
$FieldCalculationError)
CalculationInfos
Listsinformationmessagesfromdosecalculationsforthisfield
(variable$FieldCalculationInfo)
CalculationNotes
Listsnotesfromdosecalculationsforthisfield(variable
$FieldCalculationNote)
If=[$<variable>]
Else
EndIf
ThecommandsbetweenIf andElse (orIfandEndIf,ifnoElse

branchisused)areprocessedonlyifthevariablehasadefined
nonemptyandnonzerovalue.TheElsebranchisprocessedifthe
valueisnotdefined,emptyorzero.
Forexample:

If=$ImageApprovalDate Iftheimageis
approved,printsout
LineText=Image Approval:
theapprovaldateand
Text=$ImageApprovalDate by $ImageApprover approver
Else
Text=IMAGE NOT APPROVED
EndIf
Image Approval: Wednesday, October 31, 2007 1:57:20 PM by Mr Smith
otherwiseprintsout:
IMAGE NOT APPROVED
Report Template Variables

Informationprintedonreportsastextstringsisdeterminedwith
variables.Eachvariableisreplacedwiththecorrectvaluewhen
printingthereport.
Thissectionlistsvariablesavailableforreporttemplates.
Note: Theunitsofmeasurementshowninthereportsdependonthe
configurationofthesystem.
Note: Donotuseanyvariablesotherthanthoselistedhere.Thesoftwareonly
recognizesthelistedvariables.Ifanunknownvariableisusedinthetemplate,
thetextundefinedvariablenameisprintedinthereport.
Formoreinformationonprintingreports,seeChapter 26,Section
PrintingPlanInformationonpage 725.
Table 54 Patient Variables
Variable Description
$Comment TexttypedintheCommentboxofthePrint
TreatmentReportdialogbox.
$PatientComment TexttypedintheCommenttabofthePatient

Table 54 Patient Variables
$PatientDateOfBirth DatetypedintheBirthDateboxoftheNametabof
thePatientPropertiesdialogbox.
$PatientFirstName TexttypedintheFirstNameboxoftheNametabof
$PatientId IdentificationofthepatienttypedintheID1boxof
theNametabofthePatientPropertiesdialogbox.
$PatientId2 IdentificationofthepatienttypedintheID2boxof
theNametabofthePatientPropertiesdialogbox.
$PatientLastName TexttypedintheLastNameboxoftheNametabof
$PatientMiddleName TexttypedintheMiddleNameboxoftheNametab
ofthePatientPropertiesdialogbox.
$PatientSex TextselectedintheSexlistboxoftheNametabofthe
PatientPropertiesdialogbox.
$PrimaryOncologist Identificationoftheoncologistselectedinthe
AssignedDoctorstabofthePatientPropertiesdialog
box.
Table 55 Protocol Variables
$ImmobilizationDevice Immobilizationdeviceofthepatientinthe
treatment.
$IndexModifier Criterionfortheindex.Canhavevaluesis
more than,is less thanoris.
$IndexStructure Nameofthestructurefortheindex.
$IndexType Nameoftheindex.Canhavevalues
Conformity IndexorDose Measure [mm].
$IndexValue Indexvalue.
$IsPlanPhase Printsclinicalprotocolinformationinsidethe
Phasesloop.

Table 55 Protocol Variables
$LocalizationTechnique Localizationtechniqueofthepatientinthe
treatment.
$PhaseFractionsPerDay Numberofdailyfractionsintheclinical
protocolplan.
$PhaseFractionsPerWeek Numberofweeklyfractionsintheclinical
protocolplan.
$PhaseId Identificationoftheclinicalprotocolplan.
$PhaseTotalFractions Numberoftotalfractionsintheclinical
protocolplan.
$PrescriptionDose Thedoseformedbythenumberoffractions
andthefractiondoses.
$PrescriptionModifier Canhavevalues:At least,At most,Minimum

dose,Maximum dose,Mean pointor
Reference point.
$PrescriptionText Thevaluedependsonthevalueofthe
$PrescriptionModifiervariable.
Canhavevalues: % receives more than,is
orreceives.
$PrescriptionType Nameofthestructurefortheprescription.
$ProtocolId Identificationoftheclinicalprotocol.
$ProtocolStatus Statusoftheclinicalprotocol.
Table 56 Course and Plan Variables
$CourseComment TexttypedintheCommenttaboftheCourse
$CourseId IdentificationofthecoursetypedintheIDboxof
theGeneraltaboftheCoursePropertiesdialog
box.
$CourseIntent TextselectedintheIntentlistboxoftheGeneral
taboftheCoursePropertiesdialogbox.

Table 56 Course and Plan Variables
$IsIRREGPlan PrintsdatawhenaplanisanIRREGplan.
$PlanComment TexttypedintheCommenttabofthePlan
$PlanCreationDate Datewhentheplanwassavedforthefirsttime.
$PlanCreator Nameoftheuserthatsavedtheplanforthefirst
time.
$PlanId IdentificationoftheplantypedintheGeneraltab
ofthePlanPropertiesdialogbox.
$PlanModificationDate Datewhentheplanwassavedforthelatesttime.
$PlanModifier Nameoftheuserthatsavedtheplanforthelatest
time.
$PlanName NameoftheplantypedintheGeneraltabofthe
PlanPropertiesdialogbox.
Table 57 Image Variables
$ImageApprovalDate Datewhentheimageusedintheplan
wasapproved.
$ImageApprover Identificationoftheuserwhoapproved
theimage.
$ImageComment TexttypedintheCommenttabofthe
ImagePropertiesdialogbox.
$ImageContrastBolusAgentIngre ContrastAgentingredientshowninthe
dient ContrastAgenttaboftheImage
$ImageId Identificationoftheimage.
$ImageModality Modalityoftheimage(CTorMR).
$ImageName Nameoftheimage.
$ImageSeriesComment TexttypedintheCommenttabofthe
SeriesPropertiesdialogbox.

Table 57 Image Variables
$ImageSeriesId Identificationoftheseriesthattheimage
belongsto.
$ImageUserOrigin Coordinatesoftheuserdefinedimage
origin.
$ImageUserOriginComment TexttypedintheOrigintaboftheImage
$ImagingDeviceId Identificationofthedevice(scanneretc.)
usedtoscantheimagesintothesystem.
$ImagingDeviceManufacturer Manufacturerofthedeviceusedtoscan
theimagesintothesystem.
$ImagingDeviceModel Modelofthedeviceusedtoscanthe
imagesintothesystem.
$ImagingDeviceSerialNumber Serialnumberofthedeviceusedtoscan
theimagesintothesystem.
$PatientImagingOrientation PatientpositionshownintheGeneraltab
oftheSeriesPropertiesdialogbox.
$PatientTreatmentOrientation Treatmentorientationthatcanbe
selectedontheGeneraltabofthePlan
$PlanningCoordinateSystemName Nameofthecoordinatesystem.
Table 58 Couch Shift Variables
$TableShift PrintstheCouchShiftsectionintreatment
reportsifthePrintcouchshiftoptionisselected
intheprintdialogbox.
$ImageUserOrigin Coordinatesoftheuserdefinedimageorigin.
CouchShiftTable Commandthatprintsthetableshowingthe
requiredcouchshiftsingraphicalandnumerical
format.

Table 59 Structure Variables
$IsStructureCTValue Printsthecontentsofthe$StructureCTValue
variable.IfnoCTvalueassigned,printsfrom
image.
$StructureComment CommenttypedintheCommenttabofthe
StructurePropertiesdialogboxwhenthe
structurewascreated.
$StructureCTValue CTvalueassignedforthestructure,ifany.
$StructureId Identificationofthestructure.
$StructureName Nameofthestructure.
$StructureSetId Identificationofthestructureset.
$StructureSetComment CommenttypedintheCommenttabofthe
StructureSetPropertiesdialogboxwhenthe
structuresetwascreated.
$StructureStatus Structureapprovalstatus.
$StructureType Patientvolumetype.
Table 60 Dose Prescription Variables
$DoseInPrimaryRefPoint Calculateddoseinprimary
referencepoint.
$DosePerFractionInPrimaryRefPoint Calculateddoseperfractionin
primaryreferencepoint.
$Fractionations Numberoffractionationsinthe
plan.
$FractionationId Identificationofthefractionation.
$FractionIntervalDays Numberofintervaldays.
$Fractions Numberoffractions.
$FractionsPerDay Numberofdailyfractions.

Table 60 Dose Prescription Variables
$FractionsPerWeek Numberofweeklyfractions.
$FractionStartDelay Numberofdaysasessionstartis
delayed.
$PlanNormMethod Plannormalizationmethod.
$PlanNormPointX Plannormalizationpoint,
Xcoordinate.
$PlanNormPointY Plannormalizationpoint,
Ycoordinate.
$PlanNormPointZ Plannormalizationpoint,
Zcoordinate.
$PlanNormValue Normalizationvalue.
$PrescribedDose PrescribedtotaldoseinGy.
$PrescribedDosePerFraction PrescribedfractioninGy.
$PrescribedDosePercent Prescribeddosepercentage.
$PrimaryRefPointId Identificationoftheprimary
referencepoint.
$RelativeDoseInPrimaryRefPoint Relativedoseintheprimary
referencepoint.
$TargetVolume Targetvolume.
Table 61 Calculation Variables
$AlgOptionName Nameofcalculationalgorithmoption.
$AlgOptionValue Valueofcalculationalgorithmoption.
$ElectronAlg Nameofelectronalgorithm.
$PhotonAlg Nameofphotonalgorithm.
$ProtonAlg Nameofprotonalgorithm.

Table 62 Field Fractionation Variables
$FieldMonitorUnits CalculatedMUvalueforthefield.
$FieldMonitorUnitsPerGy CalculatedMU/Gyvalueforthefield.
$FieldRefDose Calculatedreferencedose[Gy].
Table 63 Field Variables
$FieldActualSSD Sourcetoskindistancesavedtothe
database.
$FieldCalculationError Errorissuedduringthelatestcalculation.
$FieldCalculationInfo Informationissuedduringthelatest
calculation.
$FieldCalculationNote Noteissuedduringthelatestcalculation.
$FieldCalculationTimestamp Timeofthelatestcalculation.
$FieldCalculationWarning Warningissuedduringthelatestcalculation.
$FieldCarriageGroup IdentificationoftheDMLCcarriagegroup.
$FieldCollimatorAngle Collimatorrotationangle.
$FieldCPX1 Distancebetweenisocenterandcollimator
jawX1intheDMLCcarriagegroup.
$FieldCPX2 Distancebetweenisocenterandcollimator
jawX2intheDMLCcarriagegroup.
$FieldCPY1 Distancebetweenisocenterandcollimator
jawY1intheDMLCcarriagegroup.
$FieldCPY2 Distancebetweenisocenterandcollimator
jawY2intheDMLCcarriagegroup.
$FieldDoseRate Doserateofthetreatmentmachine
[MU/min].

$FieldEnergyMode Energymodeofthetreatmentmachine.
$FieldGantryAngle Gantryrotationangle.
$FieldGantryRotationDir Gantryrotationdirection:CW,CCW,none.
$FieldGantryStopAngle Gantrystopangle.
$FieldId Identificationofthefield.
$FieldImageId Identificationoftheimageattachedtothe
field.
$FieldImageName Nameoftheimageattchedtothefield.
$FieldIsocenterX FieldisocenterXcoordinate.
$FieldIsocenterY FieldisocenterYcoordinate.
$FieldIsocenterZ FieldisocenterZcoordinate.
$FieldName Nameofthefield.
$FieldMachineId Identificationofthetreatmentmachine.
$FieldMachineModel Modelofthetreatmentmachineusedinthe
field.
$FieldMachineScale Scaleofthetreatmentmachine.
$FieldNominalEnergy Nominalenergyoftheprotonfield.
$FieldNormFactor Normalizationfactor.
$FieldNormMethod Normalizationmethod.
$FieldSAD SourceAxisDistance.
$FieldSFED SourceFieldEntryDistance.
$FieldSizeX FieldwidthindirectionX.
$FieldSizeY FieldwidthindirectionY.
$FieldSSD SourcetoSkinDistance.
Forarcfields,SSDatthestartangle.
$FieldSSDAtStopAngle SourcetoSkinDistanceatthestopangleof
anarcfield.

$FieldSSDAverage AveragefieldSourcetoSkinDistanceofan
arcfield.
$FieldSymmetry Canhavevalues:Symmetric,Asymmetric X,
Asymmetric YorAsymmetric.
$FieldTableAngle Couchrotationangle.
$FieldTechnique Techniqueoftheplanningfield.
$FieldWeightFactor Weightofthefieldwhensummingplans.
$FieldX1 Ifthefieldisasymmetric,horizontaldistance
betweenisocenterandcollimatorjawX1.
$FieldX2 Ifthefieldisasymmetric,horizontaldistance
betweenisocenterandcollimatorjawX2.
$FieldY1 Ifthefieldisasymmetric,verticaldistance
betweenisocenterandcollimatorjawY1.
$FieldY2 Ifthefieldisasymmetric,verticaldistance
betweenisocenterandcollimatorjawY2.
$IsFieldFixedSSD PrintsdatawhenafieldhasfixedSSD.
$IsFieldIMRT PrintsdatawhenafieldisanIMRTfield.
$IsFieldSymmetric PrintsfieldsizeXandfieldsizeYfora
symmetricfield.
$IsSetupField Printsdatawhenafieldisasetupfield.
$LmcCalculationError ErrorissuedduringthelatestLMC
calculation.
$LmcCalculationInfo InformationissuedduringthelatestLMC
calculation.
$LmcCalculationNote NoteissuedduringthelatestLMC
calculation.
$LmcCalculationTimestamp TimeofthelatestLMCcalculation.
$LmcCalculationWarning WarningissuedduringthelatestLMC
calculation.
$VirtualSADx Virtualsourceaxisdistance,Xcoordinate.

$VirtualSADY Virtualsourceaxisdistance,Ycoordinate.
Table 64 Electron Applicator Variables
$ApplicatorId Identificationoftheelectronapplicator.
Table 65 Wedge Variables
$MotorizedWedgeMUFactor MonitorUnitfactorofthewedge.
$MotorizedWedgeWeightFactor Weightofthewedge(ranging01).
$WedgeAngle Angleofthewedge.
$WedgeDirection Directionofthewedge.
$WedgeFactor Dosimetricwedgefactor.
$WedgeId Identificationofthewedge.
$WedgeMaterialId Identificationofthedosimetricmaterialthat
thewedgeismadeof.
$WedgeMaterialName Nameofthedosimetricmaterialthatthe
wedgeismadeof.
$WedgeSlot Identificationoftheslotinwhichthewedge
isinstalled.
$WedgeType Typeofthewedge.

Table 66 MLC Variables
$DosimetricLeafGap DosimetricleafgapofconfiguredforDMLC
fieldsinthesystem,usedforaccountingfor
dosetransmissionthroughtheroundedMLC
leaves.
$IsMLCPlanStatic Printsthevalueofthe$MLCPlanSegments
variable.
$MinDoseLeafDynamicLeafGap Minimumgaptobemaintainedatalltimes
betweenmovingDMLCleavesduringthe
treatment.ConfiguredforallDMLCfieldsin
thesystem.
$MLCId IdentificationoftheMLC.
$MLCManufacturer NameofthemanufactureroftheMLC
hardware.
$MLCMaterialId Identificationofthedosimetricmaterialthat
theMLCleavesaremadeof.
$MLCMaterialName Nameofthedosimetricmaterialthatthe
MLCleavesaremadeof.
$MLCModel ModelnameoftheMLChardware.
$MLCPlanSegments NumberofsegmentsindynamicMLC.
$MLCPlanType CanhavevaluesStatic,Dose Dynamicor

Dose Dynamic Arc.
$MLCRotation MLCrotationangleconfiguredinthe
Administrationtask.
$MLCSerialNumber MLCserialnumberconfiguredinthe
Administrationtask.
$MLCTransmissionFactor TransmissionfactoroftheMLCmaterial.

Table 67 Compensator Variables
$CompensatorBorderSmoothing Thecompensatorborder
smoothingvalueoftheproton
field,expressedincm.
$CompensatorCentralAxisThickness Thicknessofthecompensatorat
thefieldcentralaxisontheskin.
$CompensatorId Identificationofthecompensator.
$CompensatorLinearAttenuationFactor Linerattenuationfactorofthe
compensatormaterial.
$CompensatorMaterialId Identificationofthedosimetric
materialthatthecompensatoris
madeof.
$CompensatorMaterialName Nameofthedosimetricmaterial
thatthecompensatorismadeof.
$CompensatorPenumbraMargin Widthofthecompensatormargin
[cm].
$CompensatorPlaneDistance Distancebetweenthe
compensationplaneandthe
isocenter.
$CompensatorSlot Identificationoftheslotinwhich
thecompensatortrayisinstalled.
$CompensatorSmearingMargins Smearingmarginoftheproton
field.
$CompensatorStoppingPowerRatio Stoppingpowerratioofthe
protoncompensatormaterial.
$CompensatorTray Identificationofthetrayonwhich
thecompensatorisinstalled.
$CompensatorTrayTransmissionFactor Transmissionfactorofthetray.
$CompensatorType Typeofthecompensator.

Table 68 Block Variables
$BlockDivergence Valueiftheblockcutisdiverging,
otherwiseprintsas -.
$BlockId Identificationoftheblock.
$BlockMaterialId Identificationofthedosimetricmaterial
thattheblockismadeof.
$BlockMaterialName Thenameofthedosimetricmaterialthat
theblockismadeof.
$BlockSlot Identificationoftheslotinwhichtheblock
trayisinstalled.
$BlockTransmissionFactor Transmissionfactoroftheselected
material.
$BlockTray Identificationofthetrayonwhichthe
blockisinstalled.
$BlockTrayTransmissionFactor Transmissionfactoroftheselectedtray.
$BlockType Typeoftheblock:shieldingoraperture.
$FieldBlocks Numberofblocksinthefield.
Table 69 Bolus Variables
$BolusId Identificationofthebolus.
$BolusMaterialCTValue CTvalueofthebolusmaterial[HU].
$BolusName Nameofthebolus.
$FieldBoluses Numberofbolusesinfield.
$FieldCAXPLB Centralaxispathlengthinbolus.
$FieldSBD SourcetoBolusDistance.

Table 70 Field Reference Point Variables
$FieldCarriageGroup IdentificationoftheDMLCcarriagegroup
$FieldDose Fielddosetoareferencepointfroma
fraction.
$FieldRefPointDepth Depthofthereferencepointalongfanline
fromsourcetoreferencepointforexternal
beamplanning.
$FieldRefPointEffectiveDepth Effectivedepthofthefieldreferencepoint.
$FieldRefPointPSSD PerpendicularSourcetoSkinDistance
alongfanlinefromsourcetoreference
point.
$FieldRefPointSSD SourcetoSkinDistanceofthereference
point.
$FieldRefPointType Canhavevalues[dose prescription]

or[calculation]inIRREGplan.
$FieldRefPointX Locationofthereferencepointindirection
XinIRREGfield.
$FieldRefPointY Locationofthereferencepointindirection
YinIRREGfield.
$MU_CarriageGroup MUfortheDMLCcarriagegroup.
$RefPointId Identificationofthereferencepoint.
$RefPointType Canhavevalues[primary]oremptyline.
Table 71 Reference Point Variables
$IsPrimaryRefPoint Canhavevalues[primary]oremptyline.
$RefPointId Identificationofthereferencepoint.
$RefPointPatientVolumeId Identificationofthepatientvolumewherethe
referencepointislocated.

Table 71 Reference Point Variables
$RefPoints Numberofreferencepointsinplan.
$RefPointTotalDose Totaldoseatthepoint[Gy].
$RefPointTotalDosePerFraction Totaldoseperfractionatthepoint[Gy].
$RefPointX PointlocationXcoordinate.
$RefPointY PointlocationYcoordinate.
$RefPointZ PointlocationZcoordinate.
Table 73 Miscellaneous Variables
$ApplicationName Nameoftheapplication.
$CurrentDateShort Dateandtimeofproducingtheprintout
(DD.MM.YYYYhh:mm).
$Hospital NameofthehospitalselectedintheNametabofthe
PatientPropertiesdialogbox.
$IsAllMUperGyValid Printsawarningifallfieldsintheplandonothave
validMU/Gyvalues.
$IsPlanModified Printsawarningiftheplanhasbeeneditedafterit
waslastsavedtothedatabase.
$PageNumber Pagenumber.
$PlanningApprovalDate Datewhentheplanwasapprovedforplanning.
$PlanningApprover Nameoftheuserwhoapprovedtheplanfor
planning.
$TaskName Nameofthecurrenttask(ExternalBeamPlanning
etc.).
$TaskVersion Versionnumberofthecurrenttask.
$TreatmentApprovalDate Datewhentheplanwasapprovedfortreatment.
$TreatmentApprover Nameoftheuserthatapprovedtheplanfor
treatment.

Table 73 Miscellaneous Variables
$UserId Identificationoftheuserloggedinthesystem.
Table 74onpage 855liststheDVHspecificvariablesusedintheDVH

reporttemplate(dvh.tml).InadditiontotheDVHspecificvariables,
thedvh.tmlcontainsothervariablesalsousedintreatmentreports.
Formoreinformationonprintingreports,seeChapter 26,SectionTo
PrintaDVHonpage 736.
CAUTION: Edit the DVH Report template with caution. Before editing the
template file, always make a backup copy of it. Save the edited template using
the original file name. It is not recommended to make other changes than add
or remove DVH-specific variables.
Table 74 DVH-Specific DVH Report Variables
$DVHConformity Conformityindexofthestructure(reportedonlyfor
thetargetstructureoftheplan)
$DVHESD Equivivalentspherediameterofthestructure
$DVHGradient Gradientindex(reportedonlyforthetarget
structureoftheplan)
$DVHMax Themaximumdoseinpercentages.
$DVHMean Themeandoseinpercentages.
$DVHMedian Themediandoseinpercentages.
$DVHMin Theminimumdoseinpercentages.
$DVHModal Themodaldoseinpercentages.
$DVHNDR Naturaldoseratio(BrachytherapyPlanning).
$DVHStdDev Thestandarddeviationinpercentages.
Notincludedinthedvh.tmlbydefault.
$DVHStructure Structure(s)forwhichtheDVHhasbeencalculated.

Table 74 DVH-Specific DVH Report Variables
$DVHVolume Thevolumeofthestructureincubiccentimeters.

Index
Symbols extractingbeforecreating120
interpolatedplanes127
invertingsliceorder136,137
orientation126
Numerics primaryaxes136,137
2Dimage registration143,154
addingslicestoimageset124 reversedZaxis136
usingtoconstruct3Dimages77 selectingsufficientnumberofslices124,
viewing114 126
Seealsoimage usableslices127
2Dplane.Seeplane verifyconstructionbeforeplanning262
2Dview verifyZcoordinatesinregistration147
axes84 viewing115
block570 3Dmargin
bolus596 addingtostructure246
colorwash620 variationsinwidth245
compensator548 3Dmodel77
contours197 3Dimage77
directions84 forming77
Dmax630 imageset77
dose619,620 3Dview
dosestatistics630 BEV374
fieldvisualization364 Modelview369
MLC504 modelview85
overview83 overview85
planesandslices83 4Dimage
printsettings721 andsegmentation201
printing722 blending167,171
segments197 creating127,129
selectingplanedisplayed86 deleting130
sliders86 importingdata106
wedge590 mergingstructures233
3Dimage77 MovieControltool92,93
blending167,171 registering161
constructionfrom2Dimages77 types79
copyingstructuresfromslices127 viewing111,116
creating126,128 visibilitysettings112
creatingphantom130 4Dmodeling78
defaultparameters127
directionofZaxis127
distancebetweenplanes127
A
accuracy
841
meanerrorindicator156 Brachytherapyplans697
registrationresult145 Externalplans697
actualfluence447,563 approvingstructures193
ActualSizeicon780 arcfield
actualSSD381,695 adding386
adaptiveBrush218 addingconformal385
addinganewpatient769,782 animatingintheBEV387
addinganewpatientrecord784 CCW(counterclockwise)386
addingaprimarycarephysician794 changingrotationspan406
addingpatientpersonaldata785 CW(clockwise)386
addingpatientpersonaldataprocedure extendedarea385
785 FitandShieldtool516
additionaldocuments,ordering45 limitsinrotationspan385
addressesofapatient784 rotationspan406
Agetextbox786 rotationstopangle404
algorithm,configuration603 viewingmovement387
aligning visualizationinArcPlaneView376
fieldwithreferencepoint397 ArcPlaneView
fieldwithstructure397 printsettings717
fieldwithstructureprojection397 printing722
aligningfields391 ASCIIfluencefile
anatomicallandmark154 convertingDICOMtoASCII765
annotation,addingtoimage133,138 import765
ApertureModulatedRadiationTherapy Assign/Detachbutton792,796,799
463 asymmetricalfield
applicationinstance convertingtosymmetrical409
startingmultiple62 defining408
startingthefirst61 automaticcontouringandsegmentation
approval Bodystructure207
QAbeforeapprovingplans693 croppingastructure243,244
approvalstatus extendingsegmentation217
ofplans693 extractingwallofstructure242,243
PlanningApproved694 interpolation216
Unapproved693 multipleplanes211
ofstructures194 overview197
Approved194 automaticsegmentation.Seeautomatic
Rejected194 contouringandsegmentation
Reviewed194 AvailableDepartmentslist799
Unapproved194 AvailableOncologistslist797
oftemplatesandclinicalprotocols358 AvailablePhysiciansgroup794
Approved358 AvailablePhysicianslist792
Retired358 axis
Reviewed358 3Dimage136
Unapproved358 reversedZaxis136
approvingplansfortreatment692
842 INDEX
B copying583
ballshapedBrush219 definingoutline575
basedose462,499 digitizing578
inEclipseIMRT462 electronfield543
BeamAngleOptimization icon570
calculationoptions421 in2Dview570
defineallobjectivesbeforestarting418 inBEV570
definingobjectives429 inModelview570
excludedfields422 margintype572
globaloptimizationmode422 material569
localoptimizationmode423 mirroring583
modes422 shielding570,575
overview417,418 types570
preconditions418 visualization570
startingoptimization429 blockcoordinateaxis
Seealsooptimization BEV573
BEV(BeamsEyeView) collimator574
block570 blockmargintype
bolus596 circular572
collimatorrotation405 elliptical572
compensator548 blockoutline
displayingsimulationimage683,684 definingautomatically576
Dmax(ExternalBeam)630 definingmanually577
dosestatistics(ExternalBeam)630 deleting585
fieldvisualization374 reshaping580
fluence463 blocktype
graticule683,685 aperture570
measurementsin100 inner570
MLC504 outer570
printsettings716 shielding570
printing723 bodymaximum
showing375 normalizationofplanto636
BEVcoordinateaxis Bodystructure181
block573 displayingfieldson372
MLC508 boldtextinuserguide40
BirthCountrylist786 bolus595
BirthDatelist774,786 adding597
BlendControltool,using169,171 breakinglinktofield599
blendingimages167,169,171 deleting601
block569 editing600
adding574 icons595
aperture570 in2Dview596
configuringaddonmaterial574 inBEV596
coordinateaxis573 indosecalculation597
inModelview596
INDEX 843
linkingtofield599 604
visualization595 calculationoptions
Booleanoperators BeamAngleOptimization421
andDVH657 changingforplan606
incontouring231,232 forexternalbeamplans603
insegmentation231,232 calculationprogressindicator611
brightness calculationvolume
changing96,97,98 editing608
imagehistogram96 resetting608
Brush calibration
adaptive218 digitizer804
ballshaped219 Categorylist775
overview218 CCW(counterclockwise),arcfield386
paintingsegments220 changingapatientrecord770
static218 checkboxes
usingwithEraser221 ShowHistory788
buttons TreatmentApproved776
Assign/Detach792,796,799 circlecursor204
ClearFilters777 circularmargin
downarrow792,797,799 block572
Ellipsis772 fittingcollimatortostructure411
HideStatusFilters775 MLC506
PrintPreview779 Citizenshiplist787
RestoreFilters777 Citytextbox791,795
Search771,777 ClearFiltersbutton777
ShowAdvancedFilters771 clinicalprotocol
ShowRecentPatients777 andcoursewithphysiciansintent263,
ShowStatusFilters771,775 287
approvalstatuses358
C Approved358
Retired358
calculating
Reviewed358
dosebasedonMU613,614
Unapproved358
dosedistribution609,612
changingapprovalstatus359,360
calculation
containingmultipleprotocolplans330
actualfluences563
creating330
treatmenttime696
creatingfromplan330
calculation(ExternalBeam)
creatingobjectivesfrom338
bolus597
creatingplansfrom338,340,341
calculationalgorithm,configuration603
creatingstructuresfrom338,339,340
calculationmodel
deleting351
clearingallselections605
editing343,351
selecting605
exporting352,353
selectingdefaults605
importing352
CalculationModelstaboftheInfoWindow
insertingreferencetopatient338
844 INDEX
manager329 Modelview620
managing343 selectingdisplayeddoselevels622
overview320 selectingdisplayedlevels626
planobjectives321 surfacedose620
previewing355,356 columns
printing355,356 DateofBirth778
properties329,330,344,351 FirstName778
Generaltab331,344 LastName778
Optimization Objectives tab 335, LastOther778
348 LastPort778
PlanObjectivestab333,346 LastSimul778
PlanSetupstab334,347 MiddleName778
Reviewtab337,350 PatientID788
Structurestab332,345 PatientId778
searching354 Primary793,797,799
visibilityinplans321 Type778
clinicalprotocolreference combinedstructure.SeeBooleanoperators
changing342 command
deleting343 inreporttemplates812
insertingtopatient338 Commenttextbox795
overview338 comment,addingtoimage133,138
previewing357 comparingplansvisually665
printing357 compensator545
ClinicalTargetVolume.SeeCTV 2Dviews548
ClinicalTrialtextbox787 adding552
clipping,viewingplanes103,104 brushparameters555
clockwise(CW),arcfield386 editing553
Closeicon780 electronic563
closedMLCleafmeetingposition511,512 icons548
collimatorcoordinateaxis isolevels562
block574 Modelview548
illustration508 overview545
MLC508 selectingisolevels562
collimatorrotation visualization548
changing402,405,406 CompensatorEditor553
default380 brushparameters555
colorandstyle94 tools558
availability95 compensatorisolevels
overview94 modifying562
selecting95 selecting562
usinginsurfacemodels94 compensatormatrix,editing554
colorwash620 compensator,electronic.Seeelectronic
2Dviews620 compensator
definingdoserange622 configuration
dosecloud620 addingfilter
INDEX 845
export801 Seealsosegmentandstructure
import801 contouring
digitizer804 andstructures177
modifyingfilter automatictools211
export802 Bodystructure207
import802 Booleanoperators231,232
removingfilter circlecursor204
export802 croppingastructure243,244
import802 deleting
conformalarcfield contours186
addingtoaplan385 segments186
contactinformationforproductsupport45 editingcontours185
Contextwindow extractingwallofstructure242,243
Focuswindow69 Freehand222,225
Scopewindow69 interpolating216
visibilitycheckbox70,72 intersectinglinesinmanualcontouring
contour 224
adding manually218
automatically207 Planeview197
manually218 requirementsfordosecalculation610
overview197 SegmentationWizard211
addingpartwithFreehand227 usingcopiedstructures187
connectingparts239 usingregisteredimages247
copyingwithFreehand225 visualaids204
deleting186 Contouringworkspace
digitizing249 imageviewlayouts65
disconnectingparts239 layoutoptions65
drawing218 navigatingin65
elliptical230,231 overview59
Freehand222,225 contrast
geometrical230 changing96,97,98
interpolating216 imagehistogram96
intersectinglinesinmanualdefinition controls
224 PrintPreviewreport779
mirroring230 coordinateaxis
movingwithFreehand226 BEV508,573
optimizingwithFreehand228 block573
printing713 collimator508,574
rectangular230 MLC507
removingpartwithFreehand227 coordinatesystem
reshapingwithFreehand226 DICOM82
resizingwithFreehand229 IEC6121781
rotatingwithFreehand229 standard80
showingpreviousandnext204 userdefined81
viewingassegment219 couchmodeling
846 INDEX
insertingcouchstructuresinanimage CTV(ClinicalTargetVolume)181
192 cubicinterpolation,contours216
overview190 cumulativeDVH645
couchrotation cutout
changing402,406 electronfield543
default380 CW(clockwise),arcfield386
couchstructures
insertinginanimage192 D
moving193
DateofBirthcolumn778
counterclockwise(CCW),arcfield386
default
Countrylist791,795
fieldparameter,firstfield380
Countytextbox791,795
fieldparameter,subsequentfields380
course
defaultregistrationpoint154
changing275
Departmentlist800
creating274
departments
definition274
selectingtreatment799
monitoringplans269
Deptlist774
opening275
diagnosis
referencepoints269,270
adding275
Course/Txstatusoption773
editing275
criticalpoint,doseat640
dialogboxes
cropping
Hospitaltab798
availability119
PatientExplorer790,792,796,799
images119
PatientManager771
CTfilm.SeeCTimage
PhysicianDetail794
CTimage
PrintArchiveList779
cropping119
SelectDepartments799
extendingimageset124
SelectOncologists796
extracting120
SelectPhysicians792,794
imagecoordinates121
TrackerPageSetup780
imageposition121
DICOM
importing105
assigninganewFORforimages153
requirementsfordosecalculation611
convertingtoASCII765
scaling117
coordinates152
step121
defininguseroriginfor3Dimages132
Ctimagetype776
exporting,images756
CTnumber,measuringinimage100
fluenceexportfile763
CTrange
fluenceimportfile763
CTRangeroptions213
FrameofReferenceUID152
definingforsegmentation213
importing,images756
usingCTRanger213
printsettings730
CTscanner,avoidingmirroredimages106
printerconfiguration730
CTvalue
printing730,732
assigningforstructure184
DICOMcoordinatesystem82
requirementsfordosecalculation611
INDEX 847
DICOMcoordinates insteadofphysicalwedge531
useforimageregistration152 leafmotions447
DICOMfluenceexportfile763 overview531
DICOMfluenceimportfile763 producingmodulation532
DICOMFrameofReferenceUID107,127, verifymaximumdose535,564
130,143 verifyvisually535,538,564
DICOMimage DMLCleafmotions563
requirementsfordosecalculation611 verifying690
DICOMRT withregeneratedDMLC690
compensator545 withtestfluences690
differentialDVH646 dose
DigitallyReconstructedRadiograph.See absolute625
DRR calculating609,612
digitizer calculatingbasedonMU613,614
calibrating804 contouringrequirementsfor
overview803 calculation610
digitizing CTimagerequirementsforcalculation
block578 611
contours249 CTvaluerequirementsforcalculation
MLC523 611
display imageorientationrequirementsfor
brightness96 calculation611
contrast96 movingviewingplanesto633
imagehistogram96 relative625
movingvisibleplane100 viewingproperties608
window/level96 dose(ExternalBeam)
zooming98,99 2Dview619
DisplayNametextbox794 atciriticalpoint640
displayingpreviouslyfoundpatient changingprescription270
records777 definition260
distance,measuringinanimage101 doseprofile641
Dmax(dosemaximum) exporting752,753
showingin2Dviews630,633 extendingoutsideBodystructure619
showinginBEV(ExternalBeam)630 monitoringinplans269
showinginimageviews630,633 persistentdose623,625
showinginModelview630,633 pointdose640
DMLC prescribing265,272
largefields695 primaryreferencepoint270,438
DMLC(DynamicMultileafCollimator) referencepoint432
availablefieldtypes531 with10mmgridsize619
exporting766 dosecloud620
fieldfluences447 DoseDynamicArcplanning
importing767 ArcOptimizationdialogbox492
inIMRT443 basedosein499
insteadofphysicalcompensator531 defaultoptimizationparameters493
848 INDEX
definingdoseobjectives497 showingrelative625
dosecalculation486 surfacedose620
doseobjectives485 dose,point640
insertingnewfield485 DoseVolumeHistogram.SeeDVH
MLCtypes483 dosevolumeoptimization.SeeBeamAngle
objectivetemplatesin495 Optimization,EclipseIMRT,
optimizationparameters487 optimization,protonoptimization
optimizingplans486 doublequotationmarksinuserguide40
overview483 downarrowbutton792,797,799
preparingimagesfor484 DRR
processinEclipse484 showingmarkers254
starting495 DRR(DigitallyReconstructed
dosematrix Radiograph)
definition607 calculating680
properties608 creating(ExternalBeam)680
size607 detailedparameters681
dosemaximum.SeeDmax displaying680
dosenormalization.Seenormalization,plan displayingstructureoutlinesin684
doseobjective.Seeobjective managingparametersets683
doseplane,exporting752,753 overview677
doseprescription260 predefinedparametersets679
doseprofile641 printing683
displaying642 showinginBEV683,684
exporting642 showinginModelview683,684
informationin641 viewing116,117
savingastextfile642 duplicating
doserange,definingforcolorwash622 objectivetemplate303
dosestatistics plantemplate301
DoseStatisticstab647 structureset186
showingin2Dviews630,632 structuretemplate297
showinginBEV(ExternalBeam)630 DVH(DoseVolumeHistogram)643
showinginModelview630,632 accuracy(ExternalBeam)664
dosevisualization andverysmallstructures644
changingmode625 Booleanoperators657
colorwash620 calculating
dosecloud620 formultipleplans653,654
doserange622 foroneplan650
interpolationofdoseonreconstructed forsummedplans657
slices619 creatingBooleanstructures658
isodoses619 cumulative645
outdateddose(ExternalBeam)623,625 differential646
persistentdose(ExternalBeam)623,625 dosebinwidthparameter(export)754
showingabsolute625 dosestatisticsdifferences644,650,651
showingasisodoses626 doseunitsinmultipleplans651
showingincolorwash626 exportedvalues660
INDEX 849
exporting660,662,753 iteration446
inOptimizationdialogbox456 overview443
modifyinglinestyle659 starting458
multiplan651 startingoptimization458
natural647 targetvolume445
overview643 usingbasedose462
printsettings715 workflow445
printing724 Seealsooptimization
printout,informationin663 Edittab770
saving660 editingapatientrecord769,780
singleplan649 editingpatientrecordsprocedure781
types645 electrondensity
viewing643,644 requirementsfordosecalculation611
DVHexportfile660 electronfield
DVHtools accessories541
changingbackgroundcolor656 block543
changingcolumnsintheDoseStatistics bolus543
tab657 cutout543
changingscale656 electroniccompensator
Crosshair655 actualfluences563
DVHmode654 adding565
DVHtype654 addingtoafield565
panning655 availability564
showingdoselevels656 calculationprocess563
showinggrid656 compensationmethod563
using654 dosebackprojection563
volumescale654 effectofaddingondose564
zooming655 effectofnewonexistingone564
DVHview644 optimalfluence563
optimizationobjectivesin328 overview563
planobjectivesin324 Ellipsisbutton772
DynamicMLC.SeeDMLC ellipticalmargin
DynamicWedge587 block572
fittingcollimatortostructure411
E MLC506
EmailAddresstextbox795
EclipseIMRT
Emailaddresstextbox787
actualfluences447
EnhancedDynamicWedge587
ApertureModulatedRadiation
entrypoint
Therapy463
aligningwithreferencepoint397
basedose462
aligningwithstructureprojection397
DMLC443
aligningwithviewingplane
fluences446
intersection397
intensitymodulation443
movingreferencepointto440
inverseplanning443
Eraser
850 INDEX
deletingsegments222 parameters121
usingwithBrush221 step121
Errormarking788
export F
clinicalprotocol353
FaxNumbertextbox795
DICOMfluenceexportfile763
FCimagetype776
DICOMprotocol756
field
DICOM.SeeDICOM
2Dviews364
DMLC766
actualfluence447,531,563
dosedata752,753
addingtoaplan379,384
doseplane752,753
aligning391
doseprofile642
approvingplansfortreatment692
DVH660,662,753
arc362
DynamicMLC766
asymmetrical407
exportoptions752
BEV374
export/importwizard751
breakinglinktobolus599
fieldcoordinates697
changingtreatmentunit414,416
fluenceexportfile763
conformity443
fluences762,764
convertingtosetupfield691
IHEROcompliantgeometricplans752
coordinates,exporting697
IHEROcompliantplans755
copying412
images140,756
dimensions407
includingreferenceimages752
displaying
includingstructureset752
onbodysurface372
registration176
pathsascones373
template319
DRRimage680
virtualsimulation697
electron541
volumetricdose752,753
exportingcoordinates697
exportfilter
exportingtovirtualsimulation697
adding801
FieldinFieldtechnique526
differentconfigurations802
fitting
modifying802
grouped401
naming802
tostructure411
removing802
fixedSSD362
extendedarea,arcfields385
fluence446
extendingsegments217
Seealsofluence
externalcrossreferencesinuserguide41
grouping400,401
extraction
HDTSE362
3Dimage120
hiding377,378
calibratescannedfilms121
importingfluence765
image
intensitymodulation443
calibration121
isocentric362
coordinates121
labels368
position121
largeDMLCfields695
images120
INDEX 851
Modelview369 fielddimension
moving396 changing407
grouped401 coordinates407
in2Dview398 default380
inBEV399 fieldfluence.Seefluence
inModelview399 fieldlabel
movinghandle396 moving368
opposing388 showing368
optimalfluence446 fieldrotation
resizing407 byparameters406
fittingcollimatortostructure411 changingbyparameters406
graphically410 changinggraphically403
modifyingfieldproperties410 handles402
rotating402 in2Dviews403
rotatingin2Dviews403 inBEV403
setupfields691 Modelview404
showing377,378 overview402
static362 stopangle(arcfield)404
symmetrical407 FieldSetupworkspace(ExternalBeam)
technique362,382 navigatingin66
totalbody362 fieldsize.Seefielddimension
types361 fieldsymmetry407
visualization364,369 defining408
weightfactor615 fieldvisualization
fieldaccessory Cutmode368
block569 cuttingatisocenter368
bolus595 Projectionmode368
compensator545 showingCAXonly371,374
MLC503 FieldinFieldtechnique526
wedge587 filedalignment
fieldalignment391 deletingrule396
definingrule394 filmscanner,avoidingmirroredimages
modifyingrule396 106
FieldAlignmenttaboftheInfowindow findingpatientrecords769
392 FirstNamecolumn778
fieldasymmetry407 FirstNametextbox771,785,792,794,796
defining408 FitandShieldtool516
fieldcoordinates FitColumntextbox780
couchmovementsafterexport698 fixedSSDfield362
exporting698 FloodFilltool214,215
exportingtovirtualsimulation697 fluence
exporting,overview697 actual447
markingfieldaperture701 DICOMexportfile763
markingisocenter701 DICOMimportfile763
markingMLCaperture702 displaying463
852 INDEX
DMLC534 moving401
EclipseIMRT446 refitting401
editing463 groups
electroniccompensator563 AvailablePhysicians794
extending474,475 Oncologist784
FluenceEditor464 PatientFilters(AND)771
importing765 PatientPersonal784
optimal446 ReferringPhysician784,792
FluenceEditor464
inktypes470 H
modifyingtransmissionvalues464
HideStatusFiltersbutton775
foundpatientrecords778
hiding
fraction259
objectsinimageviews70,72
fractionation259
hidingfields377,378
Freehand
highresolutionsegment205
addingpartofsegmentorcontour227
histogram
contouring225
image96
copyingcontourorsegment225
HomeAddresstab782,790
drawingmodes223
Home/CellPhonetextbox787
mirroringcontourorsegment230
Honorifictextbox795
movingcontoursorsegments226
Hospitallist774,797,799
optimizingcontoursorsegments228
hospitalname784
overview222
reshapingcontoursorsegments226
resizingcontoursorsegments229 I
rotatingcontourorsegment229 ICD10(InternationalClassificationof
frontalview,axes84 Diseases,10thRevision)180
ICD9(InternationalClassificationof
G Diseases,9thRevision)180
ICDO(InternationalClassificationof
Gammex
DiseasesforOncology)180
couchmovementsafterexport698
ICDO2(InternationalClassificationof
marking
DiseasesforOncology,2ndEdition)
fieldaperture701
180
isocenter701
Icons
MLCaperture702
OnePage780
gantryrotation
icons
changing402,406
ActualSize780
default380
Close780
globaloptimizationmode422
NextPage780
globalpatientIDs771,783,784
PageSetup780
grayscale96
PatientIdentifiers772
grid,inscaling119
PreviousPage780
groupedfield
Print780
creating401
TrackerSetup780
INDEX 853
ICRU50 imageset77
CTV181 importing105,107
GTV180,181 invertingsliceorder136,137
PTV181 loadingforregistration147
Report50,Prescribing,Recording,and measuring
ReportingPhotonBeamTherapy CTnumber100
180 distances101
ID1textbox771,785 pixelvalue100
ID2textbox785 scalingimage101
identifyingapatientID771 volume186
identifyingareferringphysician791 mirroring138
identifyingareferringphysicianprocedure modality143
792,796 orientation134
identifyinganoncologist796 panning100
identifyingpatientstatusanddepartment positiononCTfilm121
treatingpatientprocedure798 properties133
IECcoordinatesystem81 registration143
IHERO removingunnecessaryareas119
checkingcompliance751 reversingsliceorder136
compliancecheckforgeometricplan rotating138
755 scaling117,118
compliancecheckforstructureset755 usingregisteredimages247
exportingcompliantplans755 verifyingorientation135
exportinggeometricplan752 view82
importinggeometricplans760 viewing110,111,114,116
supportedactors755 viewingdirection117
image whentocrop119
3Dimage126,128 zooming98,99
accuratescaling119 imageexport
addingannotation138 DICOM756
addingcomment133 ImageGallery
approving139,140 2Dand3Dimages110
blending167 deletingimages114,115
calibrating121 imageorientationof3Dimage126
changingproperties,effectoferrors133 imagehistogram
coordinatesystem79 displaying96
coordinatesonCTfilm121 grayscale96
correlating143 in2Dview96
cropping119 imageimport
deleting4D130 verifyimageaspectratio106
deletingfromImageGallery115 verifyimagingdevicecalibration106
exporting140 verifyimagingdeviceconfiguration
extending124 106
extracting120,121 imagemodality143
Gallery63,110 imageorientation
854 INDEX
changing134 DICOM.SeeDICOM756
mirroring138 DMLC767
requirementsfordosecalculation611 DynamicMLC767
rotating138 fluence762
showingfromoneforregistration147 fluenceimportfile763
verifying135 fluencetofield765
imageplane fluencesinASCII765
markerlocations257 images105,107,760
imageplane,locationsofregistration MLCfiles767
points155 plans760
imageproperties template318
changing133 importfilter
changing,effectof133 adding801
overview133 differentconfigurations802
verifying133 modifying802
imageset77 naming802
extending124 removing802
imagetypes importing760
CT776 IMRT(IntensityModulatedRadiation
FC776 Therapy).SeeEclipseIMRTandproton
MRI776 optimization
Other776 inaccuracy,registrationresult145
PD776 InfoWindow
PET776 CalculationModelstab604
Simul775 DoseStatisticstab647
TxkV775 Fieldstab381
TxMV776 inFieldSetupWS75
imagetypestosearchfor775 inPlanEvaluationWS75
imageview MUvalue383
2Dview83 OptimizationObjectivestab327
3Dview85 PlanObjectivestab325
changingoptions102 PlanSumtab668
planesandslices83 referencedose383
printsettings715 screenprintouts75
printing714 technique382
images viewinginformation75
searchingfor775 informationontreatmentreport(External
statustosearchupon776 Beam)739
typestosearchfor775 InsertNewRegistrationPoint158
imagingorientation135 Institutiontextbox795
import institutionalpatientIDs771,783,784
4Dimagedata106 intensitymodulation443
clinicalprotocol352 conversionoffluencestoDMLC
datawithExport/Importwizard760 motions532
DICOMRT763 DMLC447,531
INDEX 855
electroniccompensator563 addingisodoselevels628
fieldfluence446 deletingisodoselevels628
planoptimization443 modifyingisodoselevels628
internalcrossreferencesinuserguide40 selecting627
interpolation selectingisodoselevelsin2Dviews623
availabilityofVOI216 italicsinuserguide41
contours216 iteration
cubic216 maximumnumberof451
increating3Dimage127 iterations451
linear216
quadratic216 L
segments216
Languagetextbox787
inverseplanning.SeeEclipseIMRT
LAP
isocenter
couchmovementsafterexport698
aligningwithreferencepoint397
marking
aligningwithstructure397
fieldaperture701
aligningwithviewingplane
isocenter701
intersection397
MLCaperture702
default380
LastNamecolumn778
markinginGammex701
LastNametextbox771,783,784,792,794,
markinginLAP701
796
movingbycoordinates400
LastOthercolumn778
movingreferencepointto440
LastPortcolumn778
isocentermarker
LastSimulcolumn778
adding253
leafedgeshape(DMLC)531
editing253
LeafMotionCalculator.SeeLMC
locationsonimageplanes253
leaftransmissionvalue(DMLC)531
overview250
linearinterpolation,contours216
visualization251
lists
isocentricfield362
AvailableDepartments799
isodose
AvailableOncologists797
selectingdisplayedlevelsinModel
AvailablePhysicians792
view627
BirthCountry786
isodose(ExternalBeam)619
BirthDate774,786
2Dviews619
Category775
colorwash620
Citizenship787
Modelview619
Country791,795
Seealsocolorwash620
Department800
isodoselevel
Dept774
addingtoisodoseset628
Hospital774,797,799
convertingtostructure(ExternalBeam)
Machine774
629
managingdata785
deletingfromisodoseset628
MaritalStatus787
modifyinginisodoseset628
Name798
isodoseset
856 INDEX
Oncologist774,797 MLC
PatientID783,784 circular506
PatientIDs772 elliptical506
Race787 manual507
ReferringPhysician793 margin,addingautomatically245,246
SelectedDepartments799 MaritalStatuslist787
SelectedOncologists797 markedasError788
SelectedPhysicians792 marker
Sex787 adding258
Status774,799 editing258
Type775 locationsonimageplanes257
LMC(LeafMotionCalculator) overview254
actualfluences531 showinginDRRs254
conversionoffluencetoDMLC447,534 visualization255
DMLCmotionfiles531 matchedimage.Seeregisteredimage
fieldaperture531 matching.Seeregistration
limitationsofDMLCdevice531 material.Seecolorandstyle
starting534 matrix,dose608
localoptimizationmode423 maximumiterations451
locatingpatientrecords770 meanerrorindicator156
LucidaConsolefontinuserguide40 measuring
CTnumber100
M distance101
distance,convertingtocontour102
Machinelist774
pixelvalue100
MaidenNametextbox785
scalingimagesbefore101
managingdatelists785
volume186
manualmargin
merging4Dstructure233
block577
MiddleNamecolumn778
MLC507
MiddleNametextbox785,795
manualregistrationtools158
minimalnewpatientdata783
margin
mirroring
block572
blocks583
fieldfitting407
contour230
MLC506
images138
segments211
segment230
structure245
MLC(MultileafCollimator)503
margintype
adding513
block572
availablefieldtypes503
circular572
axis507
elliptical572
changing515
manual572,577
coordinateaxis507
collimatortostructure
digitizing523
circular411
export766
elliptical411
exporting766
INDEX 857
FieldinFieldtechnique526 block570
FitandShieldtool516 bolus596
importing767 colorwash620
leafbank511 compensator548
leaffit509 displayingCAXonly374
leakagearea511 displayingfieldpathsascones373
margin506 displayingfieldsonBody372
margintype506 displayingsimulationimage683,684
markingapertureinGammex702 displayingviewingplanes102
markingapertureinLAP702 Dmax630
movingleaves515 dose619,620
supportedtypes503 dosestatistics630
verifyingleafpositions525 fields369
visualization504 isodoses619
MLCcoordinateaxis507 measurementsin100
BEV508 MLC504
collimator508 overview85
MLCexport766 printsettings719
revision766 printing722
MLCimport767 rotating371
MLCleaf rotatingfields404
fittingtostructure517 wedge590
locking523 MothersMaidenNametextbox785
maximumspan511 motorizedwedge587
meetingpositionforclosedleaves511 calculation589
moving515 dosedistribution589
bycoordinates522 weightfactor589
manually520 MovieControltool,using92,93
withMLCShapingtool520 movinghandle396
withmouse521 MRimage,registration143
movingall522 MRIimagetype776
movingwithleafcoordinates522 MU
movingwithShapingtool520 calculatingdosebasedon613,614
verifyingpositions525 MU(MonitorUnit)
MLCleafbank511 coefficientforGyorcGy271
autofit511 PlanOrganizer271
leakage511 MUvalue
overtraveldistance511 inInfowindow383
MLCleaffit509 MultileafCollimator.SeeMLC
tostructure517 multipleapplicationinstances62
MLCmargin
circular506 N
manual507
Namelist798
modalityofimages143
NameSuffixtextbox795
Modelview
858 INDEX
Nametextbox784 creating302
naturalDVH647 creatingIMRTobjectivetemplatefrom
navigating plan303
inContouringworkspace65 deleting317
inFieldSetupworkspace66 duplicating303
inPlanEvaluationworkspace68 editingingraphicform314
inRegistrationworkspace64 editinginnumericform313
inSelectionworkspace63 editingproperties312
newpatient insertingobjectivesfrom308
addingpersonaldata785 manager291
minimaldata783 overview287
recordingdata783 properties293
newpatientrecord(overview)procedure oncologist
784 identifyingreferring796
Newtab770,782,790,792,796,798,799 Oncologistgroup784
NextPageicon780 Oncologistlist774,797
nonormalizationforplan636 OnePageicon780
normalization opposingfield
definingdefaultmethod636 adding388,390
normalization,plan634 hardwedgedirectionin390
definednormalizationpercentagein parameterscopiedfromoriginal388
plan634 wedgesin389
nonormalization636 optimalfluence446,563
options635 creating445
tobodymaximum636 displaying463
toprimaryreferencepoint636 editing463
toselectedvalue636 optimization
totargetmaximum636 defaultparameters427,456,493
totargetmean636 iterationsforEclipseIMRT451
totargetminimum636 NormalTissueObjective423,453,490
parameters418,448,487
O phantomtesting535,564
startingBeamAngleOptimization429
ObjectExplorer,overview72
structuremodelparameters419,449,
objective
488
definingforBeamAngleOptimization
timelimitforEclipseIMRT451
429
verifyDMLCvisually535,538,564
dosevolume420,450,489
verifymaximumdose535,564
Lowerdosevolumeobjective420,450,
SeealsoBeamAngleOptimization,
489
EclipseIMRT,protonoptimization
Upperdosevolumeobjective420,450,
optimizationobjective
489
andplanobjective288
objectivelibrary(EclipseIMRT)428,458,
definingforEclipseIMRT458,459
495
tabinInfoWindow327
objectivetemplate428,458,495
viewinginDVHview328
INDEX 859
optimizationobjective.Seeobjective PatientIDlist783,784
options PatientIDTypeswindow772
Course/Txstatus773 patientidentificationselectionwindow
orderingadditionaldocuments45 772
organatrisk181 PatientIdentifiersicon772
orientation90 patientIDs
changingforimages134 global771,783,784
image134 identifying771
mirroring138 institutional771,783,784
rotating138 settingup772
verifyingforimages135 PatientIDslist772
origin,definingfor3Dimages132 PatientIDstab784
orthogonalplane patientimagingposition
and3Dview91 availableoptions135
showingin3Dview102 changing135,136
orthogonalverificationview161 patientlistrightclickmenu778
orthogonalview.See2Dview PatientManagerdialogbox771
Otherimagetype776 patientorientationindicator90
PatientPersonalgroup784,785
P patientrecord
addinganew784
PageSetupicon780
editing769
PagerNumbertextbox787
patientrecords
painting
addinganew782
adaptiveBrush220
changing770
ballshapedBrush219
displayingpreviouslyfound777
Brush220
finding769
segment218
found778
staticBrush220
newpatient769
panning100
recordingaddresses790
PassportNumbertextbox787
refreshingthedisplay777
patient
searchingfor770
imagingposition135
patientstatus784
orientation90
PatientVolume
orientationlabels90
codes180
treatmentposition136
overview179
patientaddresses784
types180
PatientExplorer769
PC,sharinginformationwithUNIX751,
editingrecords780
755
PatientExplorerdialogbox790,792,796,
PDimagetype776
798,799
PencilBeamConvolutionalgorithm563
PatientFilters(AND)group771
PETimagetype776
patientID771
phantom,creatingphantomimageset130
PatientIDcolumn788
Phonetextbox791,795
PatientIdcolumn778
physician
860 INDEX
identifyingreferring791 planexport
minimumrequireddatatoadda794 treatmentunitconfiguration757
primaryreferring791 verifyingplans751,756
PhysicianDetaildialogbox794 plannormalization634
PhysicianIDtextbox794 planobjective
Physiciantab794 andoptimizationobjective288
physiciansintent262 creatingfromplan303
andplantemplates286 definingtolerance325
pixel inclinicalprotocol321
measuringvalueinanimage100 insertingfromobjectivetemplate308
pixeldata overview(ExternalBeam)322
useforimageregistration148,151,158 tabinInfoWindow325
plan viewinginDVHview324
addingfields379 PlanOrganizer
approvingfortreatment692 contentofplans269
comparingvisually665 modifyinginformationin271
copying267,278,279,280,281 prescribeddose269
between3Dimages267,268 prescribingdose272
creating263 referencepoints270
creatingclinicalprotocolfrom330 verifyplansbeforetreatment269
creatingnew261 planreport.Seetreatmentreport
definition259 plansum
opening266 copying677
physiciansintent262 dosematrix668
prescribingdose265 evaluating666,675,676
printing713,730,737 pasting677
saving267 PlanSumtaboftheInfoWindow668
savingastemplate300 printing666
includedinformation301 visualization669
subtracting666,672 plantemplate
summing666,672 creating298
verifybeforeapprovingfortreatment creatingfromplan300
402 includedinformation301
verifyfromsimulationortreatment262 creatingplanfrom306
plan(ExternalBeam) repositioning fields and addons
PlanOrganizer269 308
planapprovalstatus693 deleting316
PlanningApproved694 duplicating301
Unapproved693 editing310
planevaluation geometryandenergy299
overview639 manager290
PlanEvaluationworkspace68 overview286
subtractingplans666,672 physiciansintentin286
summingplans666,672 properties291
visual665 planverification
INDEX 861
portaldoseprediction686 smoothingoutsegments240
usingphantom686 starting234
plane PreviousPageicon780
changingorder136,137 Prim.LocalResidencetab782,790
clipping103,104 Primarycolumn793,797,799
definingstructures197 primarydepartmentselection799
inrelationto3Dmodel84 primaryreferencepoint
moving100 defining273
reversingorder136,137 definingpointas439
selecting201,203 normalizationofplanto636
selectingin2Dview86 primaryreferringphysician791
showingcoordinates102 PrintArchiveListdialogbox779
showingpreviousandnextcontour204 Printicon780
slidersin2Dviews86 PrintPreviewbutton779
transversal197 PrintPreviewreportcontrols779
plannedSSD381,695 PrintPreviewreports779
planningapproval692 PrintPreviewwindow779
planningcoordinatesystem79 printsettings
PlanningTargetVolume.SeePTV 2Dview721
plans ArcPlaneView717
searchfortreatment776 BEV(ExternalBeam)716
pointdose640 DICOM(ExternalBeam)730
displaying640,641 DVH715
informationin640 Modelview719
portaldoseprediction overview715
calculationof687 treatmentreport738
overview687 printtemplate
portalimage accessing732
displayinginBEVorModelview683, creating735
684 defaultprinttemplate736
PostalCodetextbox791,795 definingprinters732
postprocessing deleting737
connectingsegmentparts239 modfying736
CTRanger213 overview732
disconnectingsegmentparts239 Printsetupdialogbox734
fillingallcavities242 appearanceofprintout734
fillingselectedcavities240 papersizeofreporttemplates734
fillingsmallcavities241 unknownprinter733
keepinglargeparts238 using733
keepingselectedparts237 printing
overview234 2Dviews722
removingpartsoverlappingwith activeimageview714
anotherstructure236 BEV723
removingselectedparts236 clinicalprotocol355,356
removingsmallparts235 contours713
862 INDEX
DICOM(ExternalBeam)732 R
doseprofile642 Racelist787
DRRs683 recordingnewpatientdata783
DVH724 recordingpatientaddressesprocedure791
fieldinformationinprintouts729 recordssearchprocedure770
graphicalinformationinprintouts727 referencedose,inInfoWindow383
informationinprintouts725 referenceline
Modelview722 editingproperties440
overview713 inserting437
screen713 managing433
template355 modifying439
textualinformationinprintouts725 overview431
treatmentreports738 referencepoint
usingprinttemplates732 definingasprimarypoint439
workspace713 deleting441
procedures dose432
addingaprimarycarephysician794 editingproperties440
addingpatientpersonaldata785 geometricallocation432
editingpatientrecords781 inPlanOrganizer270
identifyingareferringphysician792, includingpointstouse439
796 inserting436
identifyingpatientstatusand insertinglocationfor437
departmenttreatingpatient798 managing433
newpatientrecord(overview)784 modifying439
recordingpatientaddresses791 moving
searchingforrecords770 toentrypoint440
selectingpatientIDs772 toisocenter440
proceduresinuserguide41 viewingplanesto440
productsupport overview431
additionaldocuments45 primary438
intheWeb46 referencepointlocation,adding437
sendingemail46 referringphysician
telephone45 identifying791
profile,dose641 primary791
propertiesdialogboxes74 ReferringPhysiciangroup784,792
protonoptimization ReferringPhysicianlist793
UpperandLowerdosevolume refreshingpatientrecordsdisplay777
objectiveparameters420,450,489 registeredimage
Providerstab792,796 accuracy145
PTV(PlanningTargetVolume)181 copyingstructureto187
displayingwhencontouring247
Q usingincontouring247
quadraticinterpolation,contours216 usinginplanning247
verifyZcoordinates147
INDEX 863
viewing161 useforregistration154
registration registrationresult
3Dimages143,154 meanerror156
acceptingaregistration157,174 verifying147
accuracy145 Registrationworkspace
anatomicallandmarks154 navigatingin64
availableimages154 overview59
correctionsmade143 reloadingobjectfromdatabase74
DICOMcoordinates152 remark,addingtoimage133,138
editing174 reporttemplate
exporting176 commands812
finetuningresultsmanually173 editing811
inaccuracy145 filestructure812
indicationoferror156 structures820
loadingimages147 variables823
manualtools158 report.Seetreatmentreport
meanerror156 reports
meanerrorindicator156 PrintPreview779
modifying172,175 RestoreFiltersbutton777
multiplebetweensameimages160 rightclickmenu
pixeldata148,158 patientlist778
prioritizingastructurevolume150,151 rotatingimages138
redoingchanges174 rotation
registrationpoints154 collimator,changing402
showingimagesfromoneorientation collimator,fieldparameter380
147 couch,changing402
showingproperties175 couch,fieldparameter380
undoingchanges174 field402
usingDICOMcoordinates153 gantry,changing402
usingmanualtools159 gantry,fieldparameter380
usingpixeldata148,151,158 stopangle(arcfield)404
usingregistrationpoints157,174 rotationhandle402
verifyimageconstruction147 collimator405
verifyresult147 rotationspan
verifystructures190,249 changing406
visualizationmethods163 extendedarea385
withregistrationpoints154,157,174
registrationpoint154 S
colors155
sagittalview,axes84
default154
saving
erroringeometries157,174
all73
inserting154
DVH660
location157,174
scale,treatmentunit382
meanerror156
scaling
movingviewingplanesto158
864 INDEX
achievingaccuracy119 all242
grid119 selected240
images117 small241
overview118 highresolution205
scalingimages interpolating216
scalealloftheimagesthesameamount keepinglargeparts238
119 keepingselectedparts237
scanning,avoidingmirroredimages106 mirroring230
screen,printing713 movingwithFreehand226
SearchBodytool207 optimizingwithFreehand228
changingsettings208 overview197
Searchbutton771,777 painting218
searchforplans775 postprocessing234
searchfortemplatesandclinicalprotocols removingpartwithFreehand227
354 reshapingwithFreehand226
searchfortreatmentplans776 resizingwithFreehand229
Searchtab770,771,777 rotatingwithFreehand229
searches smoothingoutoutline240
plans775 startingpostprocessingtool234
searchingforrecords770 verifyautomaticsegmentation200,212
Sec.LocalResidencetab782 viewingascontour219
secondarydepartmentselection799 segmentation
segment addingsegmentstoseveralplanes211
adding and4Dimages201
automatically211,214 automatictools211
manually218 Bodystructure207
overview197 Booleanoperators231,232
toseveralplanes211,214 circlecursor204
addingpartwithFreehand227 croppingastructure243,244
connectingparts239 CTrange213
copyingwithFreehand225 extendingsegmentation217
definition197 extractingwallofstructure242
deleting186 FloodFill214,215
deletingparts highresolutionsegments205
overlapping with another struc interpolation216
ture236 manualtools218
selected236 SegmentationWizard211
small235 smallstructures205
deletingwithEraser222 usingSegmentationWizard212
disconnectingparts239 visualaids204
editing185 SegmentationWizard
erasing222 overview211
erasingpart221 using212
extending217 SelectDepartmentsdialogbox799
fillingcavities SelectOncologistsdialogbox796
INDEX 865
SelectPhysiciansdialogbox792,794 startingapplication
SelectedDepartmentslist799 firstinstance61
SelectedOncologistslist797 multipleinstances62
SelectedPhysicianslist792 Statetextbox791,795
selectedvalue,normalizationofplanto636 staticBrush218
selectingapatientIDprocedure772 Statuslist774,799
selectingitems,inObjectExplorer72 statusofimagestosearchfor776
selectingtreatmentdepartments799 Statustextbox784
Selectionworkspace StreetAddress1textbox791,795
navigatingin63 StreetAddress2textbox791,795
overview58 structure
viewingimages110,111 adding183
settinguppatientIDs772 fromtemplate305
setupfield adding3Dmargin246
convertingfromfields691 aligningfieldwith397
creating691,692 approving194
Sexlist787 assigningCTvaluefor184
SFED362 clearing
sharinginformationbetweenPCand activeplane186
UNIX751,755 all4Dphases186
shieldingblock575 allplanes186
ShowAdvancedFiltersbutton771 contouringsmallstructures205
ShowHistorycheckbox788 copyingonregisteredimage248
ShowRecentPatientsbutton777 copyingtoregisteredimage187
ShowStatusFiltersbutton771,775 createfromisodoselevel(External
showingobjectsinimageviews70,72 Beam)629
Simulimagetype775 cropping243,244
simulationimage,displayinginBEVor definingonregisteredimage247
Modelview683,684 definingtotheoriginalimagewhile
SkinFlash474 showingregisteredimage248
using475 definition177
Soc.LocalResidencetab790 deleting186,187
SourceFieldEntryDistance362 deletingparts
SourcetoSkinDistance362 overlapping with another struc
Specialtytextbox792,794,797 ture236
SPECTimage,registration143 selected236
SpyGlasstool small235
verifyingregistration165 editing181,185
SSD extractingwallof242,243
actual381,695 fillingcavities
planned381,695 all242
SSD(SourcetoSkinDistance)362 selected240
SSNtextbox771,785 small241
standardcoordinatesystem80 fittingMLCleavesto517
standardwedge587 highresolution205
866 INDEX
inreporttemplates820 symmetricalfield
information181 defining408
insertingfromstructuretemplate305
keepinglargeparts238 T
keepingselectedparts237
tabas
margin245
Prim.LocalResidence782
measuringvolume186
tabs
modifying185
Edit770
onplanes197
HomeAddress782,790
overview177
Hospital798
properties182
New770,782,790,792,796,798,799
savingastemplate297
PatientIDs784
smallstructures205
Physician794
type177
Prim.LocalResidence790
verifycopiedstructures190,249
Providers792,796
visibility184
Search770,771,777
volumecode182
Sec.LocalResidence782
structureproperties
Soc.LocalResidence790
colorandstyle182
targetmaximum,normalizationofplanto
editing185
636
overview181
targetmean,normalizationofplanto636
structureset177
targetminimum,normalizationofplanto
copyingtoregisteredimages188,281
636
creating177,183
targetvolume
duplicating186
overview181
openinginObjectExplorer263
types181
structuretemplate
technique,field362
creating296
template
creatingformmanager296
approvalstatuses358
creatingfromimage297
Approved358
deleting316
Retired358
duplicating297
Reviewed358
editing309
Unapproved358
insertingstructuresfrom305
changingapprovalstatus358
manager288
creating296
overview285
deleting315
properties289
editing309
subfield,FieldinFieldtechnique526
exporting318,319
summedplan.Seeplansum
importing318
support
makingbackups288
additionaldocuments45
managers288
contactingbytelephone45
managing309
intheWeb46
objectivetemplate287
sendingemail46
overview285
surfacedose,showing626
INDEX 867
plantemplate286 UniversalID785
previewing355 WorkNumber787
printing355 timelimit451
searching354 TrackerPageSetupdialogbox780
structuretemplate285 TrackerSetupicon780
usingtocreatenewstructures, transmissionvalue,fluence
objectivesandplans304 modifying464
template,printtemplate.Seeprinttemplate transversalplane197
template,treatmentreports.Seereport transversalview,axes84
template TreatmentApprovedcheckbox776
textboxes treatmentplan
Age786 verifybeforeediting262
City791,795 treatmentplans
ClinicalTrial787 searchfor776
Comment795 searchingfor775
County791,795 treatmentreport
DisplayName794 informationentries740
EmailAddress795 layout(ExternalBeam)739
Emailaddress787 overview737
FaxNumber795 printsettings738
FirstName771,785,792,794,796 printing738
FitColumn780 treatmentreport(Brachytherapy)
Home/CellPhone787 template,backupsof840
Honorific795 treatmenttime
ID1771,785 calculation696
ID2785 treatmentunitconfiguration
Institution795 planexport757
Language787 treatmentunit,changingforfields414,416
LastName771,783,784,792,794,796 treatmentsapprovalstatus776
MaidenName785 TxkVimagetype775
MiddleName785,795 TxMVimagetype776
MothersMaidenName785 Typecolumn778
Name784 Typelist775
NameSuffix795
PagerNumber787 U
PassportNumber787
UniversalIDtextbox785
Phone791,795
UNIX,sharinginformationwithPC751,
PhysicianID794
755
PostalCode791,795
URL,toproductsupport46
Specialty792,794,797
userguide
SSN771,785
boldtextin40
State791,795
doublequotationmarksin40
Status784
externalcrossreferencesin41
StreetAddress1791,795
internalcrossreferencesin40
StreetAddress2791,795
868 INDEX
italicsin41 referencepoint374
LucidaConsolefont40 registrationpoint158,174
programmingitemsin40 structurecenter374
visualcues40 targetdosemaximum633
warningsin39 targetdoseminimum633
userorigin userorigin133
movingviewingplanesto133 virtualsimulation
userorigin,definingfor3Dimages132 exportingfieldcoordinatesto697
userdefinedcoordinatesystem81 Gammex698
usingPatientExplorer769 generalprocess699
LAP698
V markingMLCapertureinexport702
reviwinglasermarkingsinexport703
variables,inreporttemplates823
virtualsimulationexportfile700
verification
visibilitycheckbox70,72
creatingphantomimageset130
visualcuesinuserguide40
DMLCleafmotionswithregenerated
visualization
DMLC690
markers255
DMLCleafmotionswithtestfluences
VOI(VolumeofInterest)
690
availabilityforinterpolating216
planningdata685
selecting201,202
registration147
usinginregistration149,151
verificationplan
volume
portaldoseprediction686
code177
usingphantom686
colorandstyle182
verificationtools,registration
volumecode180,182
Blendmethod167
volumetype180
Chessview164
volumetype177
Normalmethod171
Bodystructure181
Splitview163
organatrisk181
SpyGlasstool166
targetvolume181
Vidarfilmscanner,avoidingmirrored
volume,measuringforstructure186
images106
viewoptions
changing102 W
showingorthogonalplanesin3Dview warningsinuserguide39
102 Web,productsupport46
viewingdirection,selectingforimages117 wedge
viewingplane adding592
clipping103,104 availabletypes587
displayinginModelview102 configurationandfieldsizes588
movingto direction587
fieldentrypoint374 in2Dview590
fieldisocenter374 inModelview590
globaldosemaximum633 inopposingfield389
INDEX 869
modifying593 PrintPreview779
overview587 WorkNumbertextbox787
restrictiononusing587 workspace
standard587 Contouring59
type587 PlanEvaluation639
viewingproperties593 printing713
visualization590 Registration59
width588 Selection(ExternalBeam,
wedgedirection587 Brachytherapy)58
default588
down588 Z
left588
Zaxis,reversed136
relationtocollimator587
Zcoordinate,verifyingforregistration
relationtopatient588
147
right588
zooming
up588
canceling99
wedgetype587
in98,99
Dynamic587
out99
EnhancedDynamic587
motorized587
standard587
wedgewidth588
weightfactor
fieldsinanapprovedplan616
forfields615
formotorizedwedge589
WHO(WorldHealthOrganization)
ICD9180
ICDO180
ICDO10180
ICDO2180
patientvolumetypes180
window
changinglayout65
windowrange,changing97
window/level
automatic98
changing96,97,98
imagehistogram96
manual98
parameters96
windows
PatientIDTypes772
patientidentificationselection772
PringPreview779
870 INDEX

External Beam Planning RG

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External Beam Planning

CAUTION: US Federal law restricts this device to sale by or on the order of

CHAPTER 2 WORKFLOWS FOR EXTERNAL BEAM PLANNING ............................... 47

CHAPTER 3 GETTING FAMILIAR WITH EXTERNAL

6 External Beam Planning Reference Guide

CHAPTER 4 VISUALIZATION OF IMAGES................................................................77

CHAPTER 5 IMAGE MANAGEMENT ......................................................................105

8 External Beam Planning Reference Guide

CHAPTER 6 IMAGE REGISTRATION ....................................................................... 143

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CHAPTER 8 SEGMENTATION AND CONTOURING ................................................ 197

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CHAPTER 9 COURSES AND PLANS ....................................................................... 259

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CHAPTER 10 TEMPLATES AND CLINICAL PROTOCOLS........................................... 285

16 External Beam Planning Reference Guide

18 External Beam Planning Reference Guide

CHAPTER 11 FIELDS ................................................................................................. 361

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CHAPTER 12 BEAM ANGLE OPTIMIZATION............................................................ 417

CHAPTER 13 REFERENCE POINTS AND REFERENCE LINES ...................................... 431

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CHAPTER 14 DOSE VOLUME OPTIMIZATION ........................................................ 443

CHAPTER 15 DOSE DYNAMIC ARC PLANNING FOR RAPIDARC............................. 483

24 External Beam Planning Reference Guide

CHAPTER 16 MULTILEAF COLLIMATORS................................................................ 503

CHAPTER 17 DYNAMIC MLCS.................................................................................. 531

26 External Beam Planning Reference Guide

CHAPTER 18 ELECTRON FIELD ACCESSORIES.......................................................... 541

CHAPTER 19 COMPENSATORS ................................................................................545

CHAPTER 20 ELECTRONIC COMPENSATORS.......................................................... 563

CHAPTER 21 BLOCKS .............................................................................................. 569

28 External Beam Planning Reference Guide

CHAPTER 23 BOLUS................................................................................................ 595

30 External Beam Planning Reference Guide

CHAPTER 25 EVALUATING PLANS.......................................................................... 639

32 External Beam Planning Reference Guide

CHAPTER 26 PRINTING PLAN INFORMATION ........................................................ 713

34 External Beam Planning Reference Guide

CHAPTER 27 EXPORT AND IMPORT........................................................................ 751

APPENDIX A USING PATIENT EXPLORER ............................................................... 769

36 External Beam Planning Reference Guide

APPENDIX B IMPORT AND EXPORT FILTERS.......................................................... 801

APPENDIX C CALIBRATING THE DIGITIZER............................................................ 803

APPENDIX D KEYBOARD SHORTCUTS .................................................................. 809

APPENDIX E EDITING REPORT TEMPLATES ............................................................ 811

38 External Beam Planning Reference Guide

About This Manual

Before You Begin

Who Should Read This Manual

WARNING: Before or when using the Eclipse Treatment Planning System

CAUTION: A caution describes actions or conditions that could result in minor or

WARNING: A warning describes actions or conditions that could result in

40 External Beam Planning Reference Guide

Couch ExactandExactIGRTcouchescannowbe Chapter 8,Section

Enhanced Eclipsecontainsanenhanceddialogboxfor Chapter 24,Section

Enhanced YoucannowuseaVolumeofInterest(VOI) Chapter 6,Section

42 External Beam Planning Reference Guide

Improved TheDICOMstandardconformanceofEclipse Chapter 8,Section