Xio 4.70 User Guide

XiO User Guide
XiO version 4.70.00
IMPAC Medical Systems, Inc.

Document ID: LUGXIO0470
Part Number: C#98910
Language: English
Contact Information, Revision History, Trademarks

XiO User Guide
ii
Document Name: LUGXIO0470 (3.0)


XiO User Guide
Revision History
Revision
Date
Changes
LUGXIO0462 (1.0)
LUGXIO0464 (1.0)
LUGXIO0470 (2.0)
LUGXIO0470 (3.0)
01/01/2011
11/15/2011
3/15/2012
05/10/2012
Updated for release 4.62

Revisions to legal entity information.
Trademarks
All terms mentioned in this manual, that are known trademarks, registered trademarks, or service marks have been
appropriately labeled as such. Other products, services, or terms that are referred to in this manual may be trademarks,
registered trademarks, or service marks of their respective owners. IMPAC makes no claim to these trademarks. Use of a
term in this manual should not be regarded as affecting the validity of any trademark, registered trademark, or service
mark.
IMPAC Medical Systems is a registered trademark of Elekta, Inc. Monaco is a trademark of IMPAC Medical
Systems, Inc. XiO is a registered trademark of IMPAC Medical Systems, Inc. Microsoft, Windows, and Windows
NT are registered trademarks of Microsoft Corporation in the United Stated and/or other countries. Adobe, Acrobat,
and the Acrobat logo are trademarks of Adobe Systems Incorporated, which may be registered in certain jurisdictions.
Hewlett-Packard is a trademark of Hewlett-Packard Corporation. Netscape and Netscape Navigator are registered
trademarks of Netscape Communications Corporation in the United States and other countries. Netscape's logos and
Netscape product and service names are also trademarks of Netscape Communications Corporation, which may be
registered in other countries. Red Hat and all Red Hat-based trademarks and logos are trademarks or registered trademarks
of Red Hat, Inc. in the United States and other countries. Copyright 2012 by IMPAC Medical Systems, Inc. All rights
reserved.
Performance characteristics given in this manual are for reference only and are not intended as guaranteed specifications.
XiO
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XiO User Guide
iv
Document Name: LUGXIO0470 (3.0)

Table of Contents
Chapter 1: Introduction to XiO ................................................ 1
Overview ........................................................................................ 1
Intended Users of the XiO RTP System..................................................................... 1
Intended Use of the XiO RTP System ....................................................................... 2
Patient/User Safety and Residual Risk ..................................................................... 2
Training on the XiO RTP System ............................................................................. 3
Using the XiO RTP System ...................................................................................... 3
Program License Agreement .................................................................................. 3
The Basics of a Treatment Plan .............................................................................. 4
Plan Types ........................................................................................................... 4
Patient Data ......................................................................................................... 4
Entering Patient Anatomy Data .............................................................................. 5
Anatomy Data Classifications ................................................................................. 9
Patient Anatomy File Identification ...................................................................... 10
Plan Modes ........................................................................................................ 13
Interest Points and Markers ................................................................................. 13
Calculation Region .............................................................................................. 14
Radiation Source Information .............................................................................. 16
Teletherapy Source Parameters ............................................................................ 16
Source Physics Data ............................................................................................ 17
Wedge and Compensator Information ................................................................... 18
Brachytherapy Source Information ....................................................................... 19
Dose Calculation Algorithms ................................................................................ 19
Chapter 2: XiO Basics ............................................................ 23

Starting XiO ...................................................................................23
Logging into XiO ................................................................................................. 23
XiO Modules ....................................................................................................... 23
Create Login Usernames and Passwords ................................................................ 25
XiO User Utility ................................................................................................... 25
User Definable Setup, Customization, and Preferences ........................................... 27
Create Clinics ..................................................................................................... 28
Window Sizes ..................................................................................................... 28
DICOM RT Plan Import ........................................................................................ 28
DICOM Export Setup and Configuration ................................................................. 28
RTP Link ............................................................................................................ 29
Customizing the Desktop ..................................................................................... 29
Settings ............................................................................................................. 30
PFM and Teletherapy Preferences ........................................................................ 30
Brachytherapy Source Types, Source Templates, and Catheter Types........................ 30
RTOG Protocol Submission Software ..................................................................... 31
VIDAR Film Scanner ............................................................................................ 31
Navigation ......................................................................................................... 31
Limits and Color Definitions................................................................................. 33
General Limitations............................................................................................. 33
IDs, Names, and Descriptions ............................................................................... 35
Brachytherapy .................................................................................................... 35
XiO
Table of Contents
XiO User Guide
Irregular Field Point Dose Calculation ................................................................... 35

System Color Definitions ...................................................................................... 36
Getting Help ....................................................................................................... 36
Auto-Help/Answer-Help ....................................................................................... 37
Exiting XiO.....................................................................................39
Chapter 3: Patient File Maintenance ...................................... 41
XiO PFM Interface ............................................................................................... 41
The Mode Buttons ............................................................................................... 45
The Submode Buttons ......................................................................................... 45
Chapter 4: Teletherapy .......................................................... 47

XiO Teletherapy Interface .................................................................................... 47
Teletherapy Functionality .................................................................................... 49
The Main Toolbar ................................................................................................ 49
Contour Supporting Toolbar ................................................................................. 50
Beam Supporting Toolbar .................................................................................... 51
Port Supporting Toolbar ...................................................................................... 52
Dose Supporting Toolbar ..................................................................................... 53
Tools Supporting Toolbar ..................................................................................... 54
IMRT Supporting Toolbar ..................................................................................... 55
Teletherapy Features ........................................................................................... 55
Window Format .................................................................................................. 56
Making a Beam Active ......................................................................................... 57
Editing Beam Parameters..................................................................................... 57
Bolus ................................................................................................................. 59
Add/Edit a Contour.............................................................................................. 59
Dose .................................................................................................................. 59
Histogram .......................................................................................................... 61
Multiple Plan Review .......................................................................................... 61
Saving Plans ....................................................................................................... 61
Plan Approval ..................................................................................................... 62
Next Step ........................................................................................................... 62
Index .................................................................................... 65
vi
Chapter 1: Introduction to XiO
Overview
Welcome to XiO! You join thousands of clinicians worldwide who use
XiO to develop treatment plans for cancer patients. As you work with
XiO, you will appreciate the remarkable capability you now have to
create extremely accurate treatment plans in a minimum amount of time.
In this guide, you will read about the underlying concepts that help you
understand the softwares features.
XiO is a combination of two-dimensional, three-dimensional, and IMRT
radiation treatment planning systems, representing thousands of man
years of cumulative research and development by Elektas scientific staff
and academic partners.
While many XiO features are discussed in this guide, some are licensed
individually and it is possible that some topics discussed are not available
to you. XiO is available on Linux systems running either the Fedora Core
2 or the Elekta Linux Distribution (ELD) operating systems. Review your
sales contract to verify the hardware and software features that were
installed at your site and activated by the Elekta technician.
Intended Users of the XiO RTP System

The XiO radiation treatment planning (RTP) system is intended to be
used by qualified individuals. An intended user should be a Certified
Medical Physicist, a Certified Medical Dosimetrist (CMD), or a
Registered Radiation Therapy Technologist (RTT), all under the
direction of the Radiation Oncologist (MD).
They should be knowledgeable in radiation treatment planning
conventions, should be certified by their respective national accrediting
agency, and should hold all appropriate state and federal licenses.
CAUTION: U.S. federal law restricts this device to sale by or on the
order of a physician.
XiO
Introduction to XiO
XiO User Guide
Intended Use of the XiO RTP System

The XiO RTP System is used to create treatment plans for any cancer
patient for whom external beam radiation therapy or brachytherapy has
been prescribed. The system will calculate and display, both on-screen
and in hard-copy, either two- or three-dimensional radiation dose
distributions within a patient for a given treatment plan set-up.
Printing documents formatted for B-size paper to a printing
device that does not support it will produce unpredictable
results. Incorrect scale factors and/or missing data are just
some of the more common results that should be expected.
The XiO online documentation contains detailed information on how
the system is to be used. The XiO Training Guide contains examples that
explain how the system is to be used. You are responsible for ensuring
that you use the system in this manner.
The examples and figures used throughout the XiO online
documentation and XiO Training Guide demonstrate specific aspects of
the XiO RTP system. These figures and examples do not necessarily
reflect what is used in a clinical setting and, as such, should not be used
as models for treatment planning.
Patient/User Safety and Residual Risk

ELEKTA, Business Area Software Systems consciously designs its
products to minimize risk to patient and user safety. ELEKTA, Business
Area Software Systems incorporates extensive precautions to mitigate
potential system hazards. Due to the nature of the product, a low level of
residual risk may exist during use. All residual risks inherent to this
product have been deemed to be as low as reasonably practicable.
ELEKTA, Business Area Software Systems provides training and user
documentation and expects users to operate the system with due
diligence and strictly heed all messages and warnings. Because the
company is unable to protect against all misuses, faults, and device
failures, ELEKTA, Business Area Software Systems maintains that only
personnel who have studied this material are qualified to use this
product. This product shall be used in accordance with all applicable
user, patient and environmental safety guidelines by users with adequate
training, experience, and qualifications.
NOTE: ELEKTA, Business Area Software Systems complies with ISO
14971, Application of Risk Management to Medical Devices.
Introduction to XiO
XiO User Guide
Training on the XiO RTP System

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

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

All terms, provisions, and conditions stated in the Program License
Agreement for XiO apply.
Elekta must have a signed program license agreement from you on file
before you can use the software or contents of the XiO documentation.
A copy of your signed agreement can be obtained by contacting your
Customer Support Specialist.
You should not add third party software to the XiO computer.
XiO
Introduction to XiO
XiO User Guide
Virus protection software is not installed on this system, nor has it been
tested on the XiO system. Any virus protection software installed is done
at your own risk.
The Basics of a Treatment Plan

A treatment plan is fundamental when you plan a treatment course for a
cancer patient. It is a collection of data files from which the radiation
dose data is calculated. A treatment plan specifies how radiation sources
are applied to a patient and incorporates these items:
Information about the patient
Information about the radiation sources used (the teletherapy

beams or the brachytherapy source groups)
Information that describes how the radiation is to be applied

to the patient
Plan Types
XiO differentiates between plans that have been created and saved (called
permanent plans) and plans that have not yet been saved (called
temporary plans). When you start a new treatment plan, that plan is
temporary until you actually save it in the XiO database. When you use
or edit a plan that is already permanent, XiO provides a copy instead of
letting you work directly with the permanent plan; this copy is also a
temporary plan. If you edit the temporary plan and then save it, XiO
replaces the original permanent plan with the modified version.
You may have one, two, or three plans open at once. These are the
primary, secondary, and tertiary plans. Most of XiOs commands work
on the primary plan unless you specify otherwise.
Patient Data
XiO maintains demographic and anatomical data for each patient for
whom treatment planning is performed. All patient data is stored under a
unique, user-defined patient ID.
Demographic Data
Patient demographic data about each patient is collected and stored for
use in demographic studies and tumor registry. Typical demographic
Introduction to XiO
XiO User Guide
data includes patient name, address, telephone number, birth date, and
gender.
Anatomy Data
Patient anatomical data identifies the disease sites. XiO categorizes
information about patient anatomy in terms of anatomical sites and
anatomical structure names. These are defined on a clinic-by-clinic basis
and are applied to all patients stored on the system.
Patient anatomy data is physical information about a patient. Patient
anatomy data includes:
Anatomical structure contours
Tissue density of anatomical structures
Entering Patient Anatomy Data

Patient anatomy data can be entered into XiO in two forms: pixel images
and contours.
Pixel Images
Pixel images are images of patient anatomical structures formed using
tissue density information stored in units called pixels. Specifically, a CT
combined with the appropriate electron density conversion file
determines the tissue density of a pixel-size area of patient tissue. MRI
may also be used, but the pixel information does not determine the tissue
density. Using unique shades of color to represent each pixels numeric
value, XiO constructs a patient anatomy image. Five or more parallel,
pixel images in the same orientation comprises a three-dimensional
patient volume. XiO assumes that the images are transverse; if the Image
Orientation Patient data indicates that the image has a gantry tilt, XiO
will still import the images as axial images. Therefore, the user must
determine if the gantry tilt is small enough that it is appropriate to use
these images for treatment planning as axial images. XiO automatically
determines the images positions from the image position patient
(IPP) z-value stored in each image.
Although a CT pixel image inherently contains the tissue density of
many anatomical structures, you must outline the patients external
contour before XiO can use the pixel image data for dose calculation.
XiO
Introduction to XiO
XiO User Guide
Figure 1: Pixel image
Figure 2: Contours
Contours
In XiO, a single CT image is referred to as a cross section. Contours are
connected line segments that outline the individual anatomical structures
within a cross section. Individual structures include such things as the
patient outline, the tumor, individual target regions, and individual
organs (such as the lungs, the heart, or the spinal cord).
You create the contours in the Patient File Maintenance module of XiO
using:
A tablet (digitizer), which is used to trace drawings from graph

paper, a radiograph, or a hardcopy CT image. Contours
Introduction to XiO
XiO User Guide
entered from the digitizer will be assumed to have an axial

orientation with no implied or explicit frame of reference.
A mouse, which is used to either trace a structures contour

directly from the screen or to select an area of the image for
automatic contouring (that is, the automatic generation of
individual contours in a cross section). XiO provides four
methods of automatic contouring:
Auto-by-Threshold XiO draws a contour around the edge of

a sharply delineated structure by detecting the abrupt change
in color.
AutoSegmentation XiO draws a contour after analyzing

subtle changes in gray level and intensity taken from a userdefined segment of the image.
Auto Margin XiO draws a second contour around a

structure. XiO also offers three-dimensional variable auto
margin and the ability to draw one contour around a structure
combination.
Interpolation XiO generates contours on cross sections that

lie between the beginning and ending contours that you
specify.
Figure 3: Contour with an automatically generated margin
Contours can be imported along with digital image data in the DICOM
3.0 image format.
Although a contour image contains the contours of many anatomical
structures, it does not contain the tissue density of each structure. You
must enter the tissue density of each structure or use a pixel-by-pixel
calculation instead of assigning a value to a structure before XiO can use
the contour data. XiO prompts you for this information.
XiO
Introduction to XiO
XiO User Guide
Figure 4: Pixel image with contours traced on it
Figure 5: Zoom in on the image to see each of the tiny squares, or pixels, that
make up the image
Introduction to XiO
XiO User Guide
Five or more cross sections in the same orientation comprise a threedimensional patient volume. It is important to remember that at least one
contour in a cross section outline must be the patients external outline
(the skin).
Anatomy Data Classifications

S t u dys e ts
Studysets are sets of cross sections intended for use with a specific
treatment plan. Studysets can be broken down into image-based and
non-image-based studysets. Because isodose treatment plans require at
least one transverse patient cross section, any studyset to be used in an
isodose treatment plan must contain one. Each studyset is referenced by
a studyset ID.
Predefined Anatomy Site
An anatomical site is a description of a particular area of the body (for
example, head and neck, lung, or prostate). In general, these sites
correspond to the anatomy surrounding a specific region of the body.
These sites are user-definable and vary from clinic to clinic.
Anatomical information can be obtained from pixel images or contours.
XiO reconstructs pixel images (such as CT images) from numeric values
captured by the scanner or other imaging machine.
Each anatomical site contains corresponding internal structures
(contours) identified by anatomical structure names. For example, the
anatomical site lung might contain anatomical structures named right
lung, left lung, heart, and spinal cord. These structure names are
also user-definable. Each anatomical structure name has one of three
classification types assigned to it:
General Includes the structure names automatically included in each
anatomical site. General structures are further divided into the following
categories:
XiO
Patient The patients external outline (the skin); this

structure is always required. All other structure definitions are
optional.
Tumor (Tum) The tumor to be treated.
Target Volumes 1 through 5 (TV1, TV2, TV3, TV4, and TV5)

Area defined as the tumor plus a user-defined margin to
Introduction to XiO
XiO User Guide
account for microscopic extensions of the tumor that you

cannot precisely see. This allows for a margin of error in
defining the tumor.
Specific Includes structure names inside of the patient contour other
than the tumor and target volumes.
User-defined Includes all user-defined structure names for individual
sites.
If you do not add a predefined site, you only have general and specific
contour names.
Patient Anatomy File Identification

An anatomy file is identified by its orientation, location, and anatomy
data mode.
Orientation
The orientation of a cross section is determined by its position relative to
the patient coordinate system axes. A cross section can be:
orthogonal (perpendicular to one of the three axes)
semi-orthogonal (at some angle other than 90 to the

axes).
Orthogonal planes are classified as being transverse, sagittal, or coronal.
10
Cross sections or image planes that are perpendicular to the

patient Yp axis are called transverse.

patient Xp axis are called sagittal.

patient Zp axis are called coronal.
Introduction to XiO
XiO User Guide
Figure 6: Patient orientation
Location
The location of each cross section within a patient is also determined by
its reference distance. The reference distance of a cross section specifies
the coordinate where the plane containing the cross section intersects the
patient axis to which it is perpendicular.
XiO
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Introduction to XiO
XiO User Guide
Figure 7: Reference distance
Anatomy Data Mode

The anatomy data mode describes whether contours or pixels are defined
and, for pixel data, what parameter the pixel values denote. The possible
anatomy data modes (and their standard abbreviations) are:
12
Wireframe contours (WC)
Computed tomography (CT)
Electron density converted from CT pixels (EP)
Electron density converted from assigned contour density

(EC)
Introduction to XiO
XiO User Guide
Plan Modes
A treatment plan can be two-dimensional or three-dimensional (2D or
3D), based on the nature of the studyset. The plan mode affects how the
plan appears on the screen, how the plan is set up, and how the dose is
calculated.
If the plan has a studyset with fewer than five transverse cross
sections, the planning mode is set to 2D. In this mode, only
individual cross sections are displayed on the screen.
Representations of beams and treatment aids are displayed in
two dimensions.
If the plan uses five to 30 transverse cross sections, you can set
up the treatment plan as 2D or 3D.
If you have more than 30 cross sections, you can display

individual cross sections or a patient volume constructed from
several cross sections in 3D.
Intensity Modulated Radiation Therapy

When creating a 3D treatment plan, you also have the option of Intensity
Modulated Radiation Therapy (IMRT). In IMRT, rather than
manipulating beam parameters to achieve a suitable dose distribution,
you reverse the process by defining the clinical goals first and then
allowing the optimization algorithm to find the best configuration of
beam intensities.
Interest Points and Markers

Optional interest points and markers can be defined on each cross
section. Interest points are used to obtain dose calculations at specific
points in a cross section. Markers are used to mark specific points in
anatomical structures. Dose is not calculated at markers.
Interest points and markers are defined in two places within XiO:
In the actual studyset, while entering cross sections. These

points are available in any treatment plan containing this cross
section.
While you are setting up the treatment plan. These points are
available only for this treatment plan.
Interest points and markers are affected by the treatment planning mode:
XiO
13
Introduction to XiO
XiO User Guide
Interest points and markers in three-dimensional planning

mode can be defined, moved, or added to anywhere in the
patient including between cross sections.
Interest points and markers in two-dimensional planning

mode must be located on individual cross sections in the
orientation in which the point was originally defined. In other
words, a point originally defined on a transverse cross section
can be relocated only to relevant transverse cross sections and
cannot be located between cross sections.
In XiO, interest points and markers are displayed using the same symbol
(+), but in different colors.
Calculation Region
The calculation region is that region in the patient anatomy for which
the radiation dose will be calculated. Only points inside (including on the
edge) of this region are used during dose calculation. Outside of the
calculation volume, the dose is set to zero.
The type of calculation region used in the treatment plan is called the
calculation mode. The calculation area and region are specified by their
x, y, and z coordinates. The possible modes include:
Volume Available only for three-dimensional plans, a calculation
volume consists of user-definable, equally spaced calculation points along
each dimension of the volume. You may specify the volumes size, its
center position, and the number of points in each dimension or grid
spacing to place calculation points. The system calculates the radiation
dose for each point in the matrix, along with any interest points you have
specified.
For the Clarkson photon dose calculation algorithm and the electron
pencil beam algorithm, dose is calculated to a distance of 4 cm from the
beams nominal field size edge. Outside this distance, the dose is set to
zero.
For the Convolution and Superposition algorithms, dose is calculated
throughout the entire calculation volume. The system calculates both a
primary and a scatter component for dose points that lie within the
beams collimator and for a defined distance in centimeters outside the
beam collimators, known as the Maximum Terma Extent. This value is
set during beam modeling by the medical physicist responsible for this
treatment machine model. For dose points that lie beyond this
14
Introduction to XiO
XiO User Guide
maximum terma extent, the system calculates only the scatter

component to the dose point.
Selected Planes Available when two- or three-dimensional treatment
plans are used, this method calculates dose for an area on user-selected
cross sections. This area is divided into a series of equally spaced
calculation points along the two dimensions of the area. You may specify
the orientations and reference distances for each cross section, the
dimensions along two of the axes that apply to the plane, two center
coordinates of the calculation area, and the number of points in each
dimension or grid spacing to place calculation points. The system
calculates the radiation dose for each point in the matrix, along with any
interest points you have specified.
Interest Points Only This mode is available when interest points are
defined in the treatment plan. Each calculation point is defined by its
coordinates in the patient coordinate system. The system calculates the
dose only at the specified interest points.
Figure 8: 3D calculation region
Figure 9: 2D calculation region
Tissue Density Heterogeneities

Tissue density heterogeneities are tied to the calculation region and may
be either included or excluded in dose calculation.
When the heterogeneities are not considered in the dose calculation, the
entire volume inside the patient surface is calculated as homogeneous
water. The relative electron densities of the anatomical structures and
tumors will be ignored.
Use heterogeneity corrections to account for innate variability in the
anatomy, density, and geometry of individual patients.
XiO
15
Introduction to XiO
XiO User Guide
When the heterogeneities are considered in the dose calculation, two

different methods of deriving the tissue densities (relative electron
densities) inside the patient exist. These are:
For non-image-based and image-based cross sections, the

method uses user-assigned relative electron densities, which
assume that the entire region inside each user-defined contour
is homogeneous with one relative electron density.
For over lapping contours, the density will be set by the last
entered contour having the same region.
For image-based cross sections, the pixel values used to

generate the image are used to determine density values within
a contour.
Even when heterogeneity corrections are turned off, XiO converts the
patient data to an electron density matrix. When calculating with a
homogeneous patient, the electron densities of the pixels inside the
patient wire contour are set to 1.0 and outside are set to 0.0.
Radiation Source Information

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

Source parameters are all of the treatment beam constraints that specify
how radiation sources are applied to the patient in the treatment plan. In
teletherapy plans, these determine how individual beams are positioned
on the patient.
16
Introduction to XiO
XiO User Guide
This data is supplied by the machine manufacturer or is determined

from clinical measurements. The system uses this data to determine the
limits for treatment setups.
XiO requires these parameters for each energy of the machine:
The modality (photon, electron, or proton)
Energy
Machine reference distance (source-to-isocenter distance,

where the field size readout on the machine is defined)
Machine setup (source-to-axis distance, source-to-skin

distance, rotational arc, or symmetric or asymmetric beam)
Collimator settings and angle (including asymmetric jaw

parameters or multileaf collimators)
Gantry settings, angles, and degrees of rotation
Couch settings and angle
Isocenter/beam entry point location
Placement of treatment aids (wedges, ports, and compensating

filters)
Beam weighting settings
Normalization method and settings
Source-to-skin distance (which varies for each treatment plan)
Source Physics Data

Source physics data consists of the following tables or parameters used to
calculate the radiation dose. From the following list of data tables, photon
machines maintain internal tables for BSF, PSCF, TAR, TPR, OCR
(aligned and diagonal), PDD, dose outputs, and irregular field data.
Electron machines maintain tables for PDD and cone parameter data.
Not all tables listed exist for all machines. The data required by radiation
dose calculation varies with the calculation algorithms. These parameters
determine the range of values, which can be used when positioning
individual beams in a treatment plan. Source physics data consists of a
subset of the following tables or parameters used to calculate dose:
XiO
Backscatter factors (BSF)

Phantom scatter correction factors (PSCF)
Tissue-air ratios (TAR)
Tissue-phantom ratios (TPR)
17
Introduction to XiO
XiO User Guide
Aligned and diagonal off-center ratios (OCR/OCD)

Percent depth doses (PDD)
Dose outputs
Cone parameters
Irregular field parameters
Penumbra modeling parameters
Machine energy spectra
Collimator, MLC transmission parameters
Machine non-scanned data (geometry and other information)
Wedge and Compensator Information

Wedge data consists of the wedge type and all parameters required for
the wedge correction and attenuation. The wedge types available with
XiO are:
Physical wedge
Motorized wedge A wedge angle synthesized from a wedge that is in
place for a specified fraction of the treatment and then removed for the
remaining portion.
Enhanced dynamic wedge A software simulated wedge for Varian
linear accelerators.
Virtual wedge A software simulated wedge for Siemens linear
accelerators.
Compensating filter (or compensator) data consists of the compensating
filter type and all parameters required for the addition of a compensating
filter to a treatment plan. A compensating filter attenuates the radiation
beam before the radiation reaches the patient. The purpose is to provide
an even dose distribution to the patient at the required depth in the
presence of patient irregularities (surface shape or internal densities).
The compensating filters available with XiO are:
1D 1D compensators provide one-dimensional compensation. Onedimensional filters are constructed by stacking thin sheets of attenuating
material of different lengths in stepwise fashion, only over the area
requiring compensation. You can send 1D compensating filter data to a
plotter.
Ellis Ellis compensators provide two-dimensional compensation. Ellis
filters are attached to a mounting tray and constructed with aluminum or
18
Introduction to XiO
XiO User Guide
brass blocks that correspond to the irregular surface or internal

inhomogeneities. You can send Ellis compensating filter data to a plotter.
Milling machines XiO supports Huestis and Par Scientific milling
machines. Milling machines are linked to the planning system in order to
automate the construction of compensators, which can be constructed
with a variety of materials of different mass densities. These include wax,
plastic, aluminum, brass, and a gypsum/steel mixture. You can send the
data for Huestis and Par Scientific filters to the milling machines.
.decimal These compensating filters are built using data files you send
to .decimal via email. The .decimal compensating filter is made using
special CADCAM software on a computer networked to a computerized
milling machine. The standard .decimal compensator is machined from
aluminum, however brass may also be used. The .decimal compensator
is shipped with a quality assurance report.
Brachytherapy Source Information

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

A dose calculation algorithm is a set of principles, models, and formulas
used to calculate the dose throughout the calculation area, volume, or set
of interest points.
Algorithms available are:
XiO
Clarkson
Fast Fourier Transform (FFT) Convolution
19
Introduction to XiO
XiO User Guide
20
Superposition
Fast Superposition
Electron 3D Pencil Beam
Electron Monte Carlo
Proton Broad Beam, Pencil Beam, and spot scanning
Introduction to XiO
XiO User Guide
XiO
21
Chapter 2: XiO Basics
Starting XiO
1. Connect the XiO system to the proper power outlets.
2. Turn on power to all of the devices attached to the workstation.
3. Turn on the power to the workstation. A login prompt appears.
Logging into XiO

1. At the login prompt, type your user name and press Enter.
2. At the password prompt, type your password and press Enter.
If you have added the XiO icon to the desktop, click the XiO
icon. XiO opens automatically.
If you have not added the XiO icon to the desktop, do the
following:
a. Close the Start Here window.
b. Open a terminal window. Right-click on the desktop and
select New Terminal from the drop-down menu.
c. In the terminal window, type xio and press Enter. The
main XiO window displays.
XiO Modules
Select the module you want to use. The most commonly used modules
are selectable from the initial screen. Select the other modules from the
Run drop-down menu.
XiO
M o du le
D es cr ipt ion
Patient File
Maintenance
(main screen)
The Patient File Maintenance (PFM) module is used

to maintain all patient data, including:
o
Patient demographic data
Anatomy data, including anatomical structure

contours and tissue density of anatomical
structures
23
XiO Basics
XiO User Guide
M o du le
D es cr ipt ion
Teletherapy
(main screen)
The Teletherapy planning module is used to

develop and evaluate treatment plans, including
the production of the dose matrix and generation
of isodose surfaces or isodose curves.
Several features are available only when special
licenses for them have been purchased. If you see
a Help topic for a feature that you do not have at
your clinic, check with your system administrator
to see if your XiO system is licensed for that
feature.
Source File
Maintenance
(main screen)
The Source File Maintenance (SFM) module is used

to enter and maintain data that defines the
characteristics of radioactive sources. The data is
used to set up treatment plans and to calculate
dose.
Data for each source, such as a teletherapy
machine, is saved under a directory identified by a
unique source ID. For teletherapy machines, this ID
is also called the machine ID.
Irregular Field
(Run menu)
The Irregular Field Point Dose Calculation module

allows dose calculations to be performed for
specific points in a patient.
Plans are created, saved, recalled, and modified in
Irregular Field Point Dose Calculation in a way
similar to the Teletherapy planning module, but
with the following differences:
Brachytherapy
(Run menu)
Patient surface topology and density variation

information are represented differently. They
are represented in Teletherapy planning by
entering CT scan data or digitizing wire
contours to which you assign densities. The
Irregular Field Point Dose Calculation module
assumes a 1.0 homogeneous density.
The Clarkson algorithm, used to perform dose

calculations, is implemented differently in that
the user must provide the point depths and
distance to surface since CT data and contours
are not used.
The Brachytherapy planning module is used to

develop and evaluate treatment plans utilizing
brachytherapy, including the localization of seed
sources, production of the dose matrix, and
generation of isodose surfaces or isodose curves.
The Brachytherapy planning module is organized
into a large set of global and local functions.
Data Export
(Run menu)
24
The Data Export module is used to create data files

for use on record and verify systems.
XiO Basics
XiO User Guide
M o du le
D es cr ipt ion
RTOG Submission
(Run menu)
The RTOG Submission module is used to submit

data to the RTOG 3D Quality Assurance (QA) Center.
Transfer Data to Focal

PC
(Run menu)
The Transfer Data to Focal PC module is used to

send data to a Focal system.
Film Digitizer
(Run menu)
The Film Digitizer System module is used to

connect to the VIDAR Film Digitizer. This enables
you to:
o
Scan films from an x-ray, CT, or MRI scan
Extract individual images from the scanned

film
Manipulate the images for the best possible

quality
Export the images to the DICOM 3.0 Secondary

Capture format
The individual images can then be imported into

XiO, where they can be used to create contours and
treatment plans.
Create Login Usernames and Passwords

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

Run the XiO user utility on a workstation when you want to add a
dedicated user, remove a user, or change a users password. If a user has
an account on more than one workstation on your network, you must
run this utility on each workstation.
Before running this utility, verify that:
You are not running NIS, shadow passwords, or any other

automatic configuration utility.
No one is modifying the password file.
Add a user through XiO:

1. Open the XiO Online Help.
2. On the Contents tab, click the Utilities book.
3. Click the Utilities Table of Contents topic.
XiO
25
XiO Basics
XiO User Guide
4. Click the Manage User Accounts link.

5. When prompted, enter the root password. Continue with the
system prompt in step 3 below.
Add a user through a system prompt:
1. Log in as the root user.
2. Enter the following, pressing Enter at the end of each line:
cd /
/FOCUS/bin/xio_user
3. Enter the number for the Add an XiO User option and press
Enter. This option sets up the login ID to be a dedicated XiO
user. When you select this option, the following is displayed:
Add an XiO User
---------------Enter a valid XiO login ID:
ID must be unique, 8 characters or less, and
may contain the characters, A-Z, a-z, or the
numbers 0-9 only.
Enter a blank line to return to the previous
menu.
NOTE:
The system does not allow uppercase A-Z characters.
4. Enter an ID and press Enter. When you enter a valid ID, the
following is displayed:
Enter user identification:
User identification should include the name of
the user and any other demographics desired but
may not contain a :.
5. Enter a description for the ID to identify the user and press

Enter.
6. Enter a password and press Enter.
7. Enter the password again to confirm and press Enter. After
entering a valid password, the following is displayed:
User [login id] was successfully added.
Press ENTER to continue.
8. Press Enter.
9. Enter the number for the Exit option and press Enter to return
to the User Utility menu.
User Authorization
To set up user access privileges, follow the steps below.
26
XiO Basics
XiO User Guide
1. Open XiO.
2. On the main window, go to the Settings menu and select
Installation followed by User Authorization. The System User
Access Preferences dialog box displays.
3. Complete the fields according to the definitions below for each
user. Click OK when finished
F ie ld
D e f in it ion
Login Name
Enter an eight-character user name that has been previously

defined in the operating system. Login names may consist of
numbers or letters only.
Admin
Enter Yes to grant administrator privileges. Enter No to

deny administrator privileges. This privilege allows other
users to access all areas in Settings.
Physicist
Enter Yes to grant physicist privileges. Enter No to deny

physicist privileges. This privilege allows access to the
following areas of XiO:
Treatment
Planner
Plan Approval
Source File Maintenance
Settings (only Anatomical Sites, Calculation Defaults,

CT/MRI Interface Defaults, and Display/Plotter Defaults)
Enter Yes to grant treatment planner privileges. Enter No to

deny treatment planner privileges. This privilege allows
access to the following areas of XiO:
o
Teletherapy
Irregular Field
Patient File Maintenance
Settings (only Anatomical Sites and CT/MRI Interface

Defaults)
Enter Yes to grant plan approval privileges. Enter No to

deny plan approval privileges, but allow the user to enter
comments for plan review. This privilege allows access to
the following areas of XiO:
o
SF8 APPROVAL (Irregular Field)
Teletherapy
User Definable Setup, Customization, and Preferences

After your new XiO system is installed and before you begin planning,
you may need to setup specific features and/or customize your planning
system using the Settings menu on the XiO main window. This section
will help you get your clinics up and running by providing the location of
specific documentation that covers the listed topics. If you have further
questions regarding these topics or have trouble finding the information,
XiO
27
XiO Basics
XiO User Guide
you may contact Elekta Customer Support and they will help you get set
up.
Create Clinics
XiO requires that you create at least one clinic in which all your patient
data will be stored. If you plan for multiple hospitals/clinics, this provides
an easy way to subdivide your patients into various virtual clinics. For
more information, see the XiO Online Help.
Window Sizes
The Window Size drop-down box on the main window displays. It
displays the current window size for Teletherapy and PFM. The default is
the highest resolution available that fits within the current screen
resolution. Any Teletherapy or PFM window launched after you change
the size will open with the new setting.
DICOM RT Plan Import

If you intend to import images, structure sets, and plan data from
another vendor that has DICOM export capability, you will need to
customize and map XiO identifiers with the system that is sending plan
information to XiO. Setup is only required if you meet the following
criteria:
You have purchased this feature.
XiO installation is complete.
A DICOM network has been established and tested between

XiO and the system (i.e., other vendors CT simulation
workstation, other vendors TPS) that will be sending the
DICOM plan information.
The XiO DICOM Conformance Statement can also be found on the

Elekta web site.
DICOM Export Setup and Configuration

If you intend to export images, structure sets, dose, and plan/ion plan
data to a receiving system, you will need to map XiO identifiers with a
receiving systems identifiers. Setup is only required if you meet the
following criteria:
28
XiO Basics
XiO User Guide
You have purchased this feature.
A DICOM network has been established and tested between

XiO and the system (i.e., R&V, MU check program, etc.) that
will be receiving the exported DICOM information.
For more information, see the DICOM Export Setup and Configuration
document in the reference library in the online help. The XiO DICOM
Conformance Statement can also be found on the Elekta web site.
RTP Link
If you intend to export plan data to a receiving system, you will need to
map XiO identifiers with a receiving systems identifiers. Setup is only
required if you meet the following criteria:
Your receiving system does not support DICOM export or

your receiving system does support DICOM, but you have not
purchased DICOM Export.
RTP Link has been configured to transfer information via

floppy or network.
For more information, see the XiO RTP Link Conformance Statement in
the XiO Online Help and the XiO RTP Link and MLC Export document
in the reference library.
Customizing the Desktop

You can customize the following options for your operating system:
Add the XiO icon to the desktop.
Set the window focus.
Set the screensaver.
Set the taskbar to autohide.
Set print screen and screen capture shortcuts.
For more information, see the XiO Upgrade Instructions.
XiO
29
XiO Basics
XiO User Guide
Settings
Use the Settings menu to customize your treatment planning system
with predefined information and defaults. The following items are of
particular importance:
Create CT to ED file for heterogeneity correction
Define scanner/LMS for CT simulation (XiO will report shifts)
Anatomical site (setting up predefined contour names makes

contouring faster and easier)
Backup Utility (set up this utility to perform regular data

backups)
Scale DRRs so they print to the proper magnification
For more information:
Access the XiO Online Help.
See the Settings section in the XiO Training Guide.
See the Digitally Reconstruction Radiograph section in the

XiO Training Guide.
See the Scanner/LMS Definitions section in the XiO Training

Guide.
PFM and Teletherapy Preferences

You can customize your planning clinic with PFM and Teletherapy
preferences. The preferences dialogs are grouped in the Edit menus
they let you specify the default values for many of the tasks you perform
in XiO. Preferences will apply to the subsequent patient s or the
subsequent plans you make.
For more information, see the Preferences section in the XiO Training
Guide. You can also read the online help topics for PFM and Teletherapy
preferences.
Brachytherapy Source Types, Source Templates, and Catheter Types

If you would like step-by-step instructions for setting up these
parameters, follow the instructions in:
30
The Gynecological Brachytherapy Implant section in the XiO

Training Guide
XiO Basics
XiO User Guide
Dose Calculation: Brachytherapy under Algorithm

Discussions in the XiO Reference Library
RTOG Protocol Submission Software

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

If you intend to scan CT images into XiO using a VIDAR Film Scanner,
you will need to configure the film scanner in order to scan films into
XiO. The VIDAR Film Scanning Software is included in your software
packet. Loading the software is only required if you have purchased a
VIDAR Film Scanner.
For more information, see the XiO Upgrade Instructions and the Film
Digitizer System Users Guide in the reference library.
Navigation
Using the Mouse
The mouse used in XiO is a three-button mouse or a two-button mouse
with a scroll wheel that can be used as a third button when clicked.
XiO
Use the left mouse button to select or drag items on the screen.
Use the right mouse button to display drop-down lists in

active fields or windows.
Use the middle mouse button or click the scroll wheel to view
pop-up help information boxes in active fields. You can also
movie through images. Right mouse click in any single plane
view window and select Movie with a left mouse click. Use the
left and middle mouse buttons to move superior and inferior
or use the scroll wheel to movie through the images.
31
XiO Basics
XiO User Guide
Use the mouse to move over the fields to highlight the

required fields.
Figure 10: A red box indicates a required field
Using the Keyboard

Computer keyboards are used to enter and edit text and numerical data
in XiO. Keyboards might vary slightly in layout, but all the keyboards
used to enter and edit information in XiO use the same groups of keys.
These include:
Typewriter keys
Function keys
Cursor-movement keys
Keypad keys
Several XiO functions can be activated using alternate keyboard

combinations instead of the mouse. For more information, see the XiO
Online Help.
Dialog Box
The following screen buttons control the movement from page to page.
32
Select OK when you have completed all of the fields in a dialog

box.
CANCEL is sometimes used to discard the work done on the

current page.
PREV PAGE is available when a list of fields is too long to be

displayed on one page. Select PREV PAGE to move back one
text page at a time.
XiO Basics
XiO User Guide
Figure 11: OK and CANCEL
Limits and Color Definitions

The following is a list of the system limitations and definitions within
XiO. Many of these items are covered in more detail throughout the help.
General Limitations
XiO
I te m
L im it
Number of stored permanent plans
The number of plans that can be stored on

your system depends on the space available
on your hard drive.
Number of stored temporary plans

generated in Teletherapy
The number of plans that can be stored on

your system depends on the space available
on your hard drive.
Number of stored temporary plans

generated in Irregular Field Point Dose
Calculation
999
Number of cross sections allowed per

studyset
240
Number of structures allowed per

studyset
487
Number of contours allowed on a

single cross section
100
Number of points allowed on a single

contour
2048
Number of structures per anatomical

site
80
Number of bifurcated structures per

cross section
80
Number of interest points allowed per

studyset
999
Number of markers allowed per

studyset
999
Number of beams allowed per plan
99
Number of boluses per plan
Number of clinics per workstation
99
Number of anatomical sites per clinic
Unlimited
Number of contours defined per

anatomical structure per cross section
33
XiO Basics
XiO User Guide
34
I te m
L im it
Number of DICOM export locations

(storage class providers)
30
XiO Basics
XiO User Guide
IDs, Names, and Descriptions

I te m
L im it
Anatomical site
14 characters (a-z, A-Z, 0-9)
Anatomical structure name
14 characters (a-z, A-Z, 0-9, punctuation,

and spaces)
Clinic name

and spaces)
Patient name

and spaces). DICOM patient names are
limited to 64 characters.
Tolerance table name
16 free text characters
IDs
IDs have a limit of 14 characters unless

otherwise noted. DICOM patient IDs are
limited to 64 characters. Field IDs may be 5
characters. IDs are case-sensitive; this
means that capital letters and lowercase
letters are different.
Descriptions
Descriptions have a limit of 24 characters

unless otherwise noted. This includes a-z, AZ, 0-9, punctuation, and spaces.
Brachytherapy
I te m
L im it
Number of catheter templates allowed
20
Number of source templates allowed
20
Number of sources per plan
999
Number of catheters per plan
999
Number of interest points allowed per plan
999
Number of markers allowed per plan
999
Irregular Field Point Dose Calculation
XiO
I te m
L im it
Number of beams
1 or 2 (SSD or SAD)
Number of surface points per plan
50
Number of depths per surface point
50
Number of points/depths per plan
50
35
XiO Basics
XiO User Guide
System Color Definitions

Objects
Beam (active)
Unique user-defined in preferences
Beam (inactive)
User-defined in preferences
Bolus
Calculation volume
Compensating filter
Customized port
Multileaf collimator (MLC)
Scale icon
Wedge
Points
Arbitrary weight point (active)
Red
Arbitrary weight point (inactive)
Green
Interest point
Global maximum point
Red
Group point
Local maximum point
Pink
Marker
Measure points
CT origin
Light magenta
Prescription point
Reference point
Setup reference icon
Yellow
Irregular Field
Surface point incomplete
White
Surface point with no depths
Purple
Surface point with depths
Yellow
Getting Help
Access to the XiO Online Help is from the main menu bar of any
window. The type of help that displays is determined by where you are in
the system when help is requested. Example, if you are not working in a
dialog box, XiO displays the Help default window.
36
XiO Basics
XiO User Guide
The topics shown on the left-most panel of this window are presented in
the order in which XiO is used in a clinic environment.
Figure 12: Welcome to XiO help topic
The XiO Online Help is highly dynamic. It contains topics about all the
dialog boxes, step-by-step procedures, and background information. The
online help includes a Contents tab that identifies the help topics by their
titles and lets you open any of them. On the Contents tab, select the
Search XiO Help topic to perform a full-text search for topics that
contain specific words. The Index tab is an alphabetical list of all the
subjects covered in the online help. The Glossary tab allows you to look
up definitions for specific words.
Auto-Help/Answer-Help
XiO also offers Auto-Help and Answer-Help windows when completing
dialog boxes. Click the middle mouse button in the field. Depending on
the type of field, either an Auto-Help window displays with an
explanation (such as the number range to enter or date format to use) or
an Answer-Help window displays a list from which you can select an
item to complete the field.
XiO
37
XiO Basics
XiO User Guide
Figure 13: An Auto-Help pop-up window
Figure 14: An Answer-Help pop-up window
38
XiO Basics
XiO User Guide
Exiting XiO
When finished, exit each module according to the table below to ensure
files are properly closed.
M o du le
Teletherapy
Se le ct
and then
Irregular Field
Brachytherapy
Source File Maintenance
Data Export
RTOG Submission
Never exit XiO using a system break command. A system

break command causes the program to immediately
terminate XiO and return to the operating system. This is an
improper shutdown of the XiO system. Turning off the XiO
system improperly will result in the loss or corruption of
files.
Elekta recommends that you do not turn off the power to the
XiO workstation at the end of each working day. Doing so
may corrupt important system files.
There may be times when it is necessary to turn off the

system. Contact Elekta Customer Support for information
about how to turn off the system.
XiO
39
Chapter 3: Patient File Maintenance

The Patient File Maintenance module is where you develop the
information pertaining to the patient (differentiated from beam, plan, or
source information). The PFM toolbars include the main toolbar and
secondary toolbar. The main toolbar includes Contour, Beam, Port,
Dose, Tools, and IMRT buttons. All buttons on this toolbar, except the
Beam button, are inactive in PFM and grayed out.
The secondary toolbar modes are Draw, Paint Brush, Tablet, Keyboard,
Edit, AutoSegmentation, Auto-by-Threshold, and Point. Each mode has
a button. When you click a mode button, the system displays the modes
associated submode buttons.
Position the mouse over a toolbar button to view a tool tip. The tool tip
describes the button and its keyboard shortcut.
NOTE:
When a button icon is grayed-out, it is not available.

Different planning tasks have requirements you must meet
before these buttons are available, some of which are
licensing requirements.
XiO PFM Interface

The Patient File Maintenance (PFM) user interface includes the title bar,
menus, toolbars, graphics area, control list boxes, window/level slide
controls, and the status bar used in the Patient File Maintenance
functions.
XiO
41

XiO User Guide
Figure 15: Patient File Maintenance window
Title Bar The title bar displays the release number, patient name, patient ID, and
studyset ID.
Main Menu The main menu has the File, Edit, View, Insert, Tools, Reports, and
Help menus. Each of these menus has drop-down options.
Status Bar The status bar displays the date, time, mouse status, and other
information depending on the active function.
Main Toolbar The main toolbar includes
Contour, Beam, Port, Dose, Tools, and IMRT
buttons. All buttons on this toolbar, except
the Beam button, are inactive in PFM and
grayed out.
Supporting Toolbar Modes The secondary
toolbar modes are Draw, Paint Brush, Tablet,
Keyboard, Edit, AutoSegmentation, Auto-byThreshold, and Point. Each mode has a
button. When you click a mode button, the
42

XiO User Guide
system displays the mode's associated

submode buttons.
Supporting Toolbar Submodes The
submode buttons include Save, Zoom In,
and Zoom Out. Additional buttons display
depending on the toolbar mode.
Group and Contour Control List Boxes
Select the anatomical site from the Group
drop-down list; select the structure name
from the Contour drop-down list.
Window Level Presets Select and save a
predefined window and level value and
grayscale/color scale in any transverse single
plane view. You can also change the color of
the color scale for the Auto-by-Threshold
tool.
Window Controls Toggle the icons to:
o
Go between Transverse Mode and Scout

Mode.
Apply grayscale or color scale values.
Change the color for the Auto Threshold

color scale.
Window/Level Slide Controls Use the

window and level slider bars or enter values
in the W and L fields to adjust the contrast of
the image display.
XiO
43

XiO User Guide
Graphics Area The graphics area contains

the studyset and graphic objects used to set
up the treatment plan.
Cross Section Thumbnails Thumbnails

display a small image of each cross section. A
red outline shows the image currently
selected and displayed in the graphics area.
You can:
o
Click the middle mouse button to select

multiple cross sections.
Press Shift and click the middle mouse

button to select a range of cross
sections. A yellow outline shows all the
cross sections currently selected.
Click the right mouse button to select

all or unselect all the cross sections.
Reference Distance and Scale Factor The

reference distance shows the distance from
the origin of the studyset of the cross section
you are viewing in the graphics area single
plane view. The scale factor shows the
current magnification of the single plane
view.
Dialog Box Contains the prompts and
answer fields you will complete as you set up
the treatment plan.
44

XiO User Guide
Multiple Plane View (MPV) Displays all

the contours in a studyset without image
data.
For more information, see the online help for the planning task in
question.
The Mode Buttons

I con
M o de
Shor t cu t
D es cr ipt ion
Draw
F5
Draw contours with the mouse.
Paint Brush
F6
Paint the contours with the mouse.
Tablet
F7
Trace contours on the digitizing

tablet.
Keyboard
F8
Create contours from predefined

shapes with the keyboard.
Edit
F9
Edit or delete existing contours.
AutoSegmentation
F10
Create contours automatically with

AutoSegmentation.
Auto-by-Threshold
F11
Create contours automatically with

Auto-by-Threshold.
Point
F12
Enter, edit, or delete interest points

and markers with the mouse.
The Submode Buttons

There are no keyboard shortcuts for the submode buttons.
I con
XiO
S u bmo de
D es cr ipt ion
Primary Dataset
View a primary dataset that is fused to the

secondary dataset. A primary studyset is made of CTbased images, which serve as a baseline around
which you manipulate a secondary studyset in order
to create a registration.
Secondary Dataset
View secondary dataset that is fused to the primary

dataset. A secondary dataset is made of either CTbased, MR-based images, or PET images, which you
manipulate in order to create a registration.
Replace Segment
Replace a section of the selected contour.
Single Point Edit
Move a single contour defining point.
45

XiO User Guide
I con
46
S u bmo de
D es cr ipt ion
Triple Point Edit
Move three contour defining points.
Quintuple Point Edit
Move five contour defining points.
Symmetric Resize
Resize or stretch a contour symmetrically. The

opposite edge stays in place.
Asymmetric Resize
Resize or stretch a contour asymmetrically. The

opposite edge stays in place.
Interpolate
Automatically create contours on cross sections that

lie between two or more cross sections on which you
have already created contours.
3-D Auto Margin
Create a contour with 3-D Auto Margin.
2-D Auto Margin
Create a contour with 2-D Auto Margin.
2-D Auto Distance
Edit the distance between the initial contour and

the new contour.
Place Single AutoPoint
Place auto-points on a single cross section for Autoby-Threshold.
Place Multiple AutoPoints
Place auto-points on multiple cross sections for

Auto-by-Threshold.
Chapter 4: Teletherapy
XiO Teletherapy Interface
The Teletherapy user interface includes the title bar, menus, toolbars, graphics
area, control list boxes, window/level slide controls, and the status bar.
Figure 16: Teletherapy user interface
Title Bar The title bar displays the release number, patient name, patient
ID, and plan type.
Main Menu The main menu has the File, Edit, View, Contour, Beam, Port,
Dose, Tools, Optimize, Reports, and Help menus. Each of these menus has
drop-down options.
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Status Bar The status bar displays the date, time, mouse status, and other
information depending on the active function.
Main Toolbar The main toolbar
includes Contour, Beam, Port, Dose,
Tools, and IMRT buttons. The active
button displays with a blue
background.
Supporting Toolbar Submodes The
submode buttons include Save, Zoom
In, and Zoom Out. The active main
toolbar button determines the types
of additional supporting buttons that
display.
Active Beam The Active Beam box
allows you to select an active beam.
Once a beam is selected, it becomes
the active beam.
Window Level Presets Select and
save window and level settings and
grayscale/color scale in any transverse
single plane view.
Window Controls Toggle the icons
to:
48
Apply the window/level

adjustment to an active window
or all displayed windows.
Display images in grayscale or as

outlined contours.
Set the mouse movie of an

oblique stack of images to show
images in grayscale or as outlined
contours.
Teletherapy
XiO User Guide
Window/Level Slide Controls Use

the window and level sliders or enter
values in the W and L fields to adjust
the contrast of the image display.
Graphics Area The graphics area is

the area of the screen with a graphical
display of information about the
patient, source, or treatment plan.
Each window in the graphics area has
a view format associated with it. The
view format determines how the
physical space in the subwindow is
used to display the treatment plan
information.
Teletherapy Functionality
The Teletherapy toolbars include the main toolbar and a supporting toolbar for
each main toolbar button. When you click a main toolbar button, the system
changes the button background to blue and displays its associated supporting
toolbar. Each supporting toolbar includes the Zoom In, Zoom Out, and Save
buttons. Position the mouse over a toolbar button to view a tool tip. The tool tip
describes the button and its keyboard shortcut.
NOTE:
When a button icon is grayed-out, it is not available. Different

planning tasks have requirements you must meet before these
buttons are available, some of which are licensing requirements.
The Main Toolbar

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Contour
Shift+F1
Use the Contour toolbar to draw, trace, or

edit contours with the XiO drawing and
editing tools.
Beam
Shift+F2
Use the Beam toolbar to manipulate beams

and add treatment aids. Use the Auto Port
button to quickly shape the beam. Use the
Beam Spreadsheet button to quickly
49
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manipulate beams.
Port
Shift+F3
Use the Port toolbar to draw, trace, or edit

ports with the aperture/block/MLC tools.
Dose
Shift+F4
Use the Dose toolbar to choose

normalization and weight, and view isodose
lines and histograms.
Tools
Shift+F5
Use the Tools toolbar to access general

planning tools during the planning or virtual
simulation process.
IMRT
Shift+F6
Use the IMRT toolbar to access the setup,

prescription, and dose review tools
necessary for IMRT planning.
Contour Supporting Toolbar

NOTE:
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50
Clicking the Contour button removes many of the teletherapy

options. To resume planning with these options, click the Beam
button on the main toolbar.
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Draw
F5
Draw contours with the mouse.
Paint Brush
F6
Paint the contours with the mouse.
Tablet
F7
Trace contours on the digitizing

tablet.
Keyboard
F8
Create contours from predefined

shapes using the keyboard.
Edit
F9
Edit or delete existing contours.
AutoSegmentation
F10
Create contours automatically.
Auto-by-Threshold
F11
Create contours automatically.
Point
F12
Create, edit, or delete interest points

and markers with the mouse.
Interpolate
None
Automatically create contours on

cross sections that lie between two or
more cross sections on which you
have already created contours.
Replace
None
Replace a section of the selected

contour.
Stretch1
None
Move a single contour defining point.
Stretch3
None
Move three contour defining points.
Stretch5
None
Move five contour defining points.
Symmetric
None
Resize or stretch a contour

symmetrically. The center of the
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contour stays in place.
Asymmetric
None
Resize or stretch a contour

asymmetrically. The opposite edge
stays in place.
3D Auto Margin
None
Create a contour using 3D Auto

Margin.
2D Auto Margin
None
Create a contour using 2D Auto

Margin.
2-D Auto Distance
None
Edit the distance between the initial

contour and the new contour.
Single Auto-byThreshold Mode
None
Place auto-points on a single crosssection using Auto-by-Threshold.
Multiple Auto-byThreshold Mode
None
Place auto-points on all cross

sections using Auto-by-Threshold.
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New
F5
Create a new beam.
Edit
F6
Edit the active beam.
Copy
F7
Copy the active beam.
Mirror
F8
Create a mirror copy of the active

beam.
Delete
F9
Delete the active beam.
Beam Spreadsheet
F10
Open the Beam Spreadsheet,

enabling a single interface for beam
and segment editing.
Auto Port
F11
Automatically add a port to the active

beam.
Wedge
F12
Add or edit a wedge for the active

beam.
Comp Filter
None
Add or edit a compensating filter for

the active beam.
Respiratory
Synchronization
None
Enable or edit respiratory

synchronization.
Couch
None
Add or edit couch for proton beam.
Fixation Device
None
Add or edit fixation device for proton

beam.
Range Compensator
None
Add or edit range compensator for

proton beam.
Scan Volume
Parameters
None
Set parameters for spot-scanning

proton beam.
Beam Supporting Toolbar

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DRR/BEV
None
Display a BEV or DRR for the active

beam.
None
Display a relative fluence map or a

BEV.
None
Display an ideal intensity map or a

BEV.
None
Display a segmented MLC intensity

map or a BEV.
None
Display a compensating filter

intensity map or a BEV.
Display Intensity
Maps/BEV
Port Supporting Toolbar

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Auto
F5
Automatically add a port/MLC to the active

beam.
Mouse
F6
Draw a port/MLC with the mouse.
Tablet
F7
Trace a port/MLC on the digitizing tablet.
Edit
F8
Edit the shape of the active port (MLC

positions, aperture, or block). For
segmented beams, editing is for MLC
segments.
Aperture
F10
Define the active shape as an aperture.
Block
F11
Define the active shape as a block.
MLC
F12
Define the active shape as an MLC.
Port Properties
None
Enter or change parameters defining the

port shapes.
Delete Port
None
Delete aperture, blocks, or MLC.
Replace
None
Replace a section of the selected

port/MLC shape.
Stretch1
None
Move a single port/MLC shape-defining

point.
Stretch3
None
Move three port/MLC shape-defining

points.
Stretch5
None
Move five port/MLC shape-defining

points.
Symmetric
None
Resize or stretch a port/MLC shape

symmetrically. The center stays in place.
Asymmetric
None
Resize or stretch a port/MLC shape

symmetrically. The opposite edge stays in
place.
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XiO User Guide
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Conform Collimator
Jaws to Aperture
None
Adjust the collimator jaws to the defined

shape plus the collimator step size.
Conform MLC leaf

positions to the port
contour
None
Snap the MLC leaf positions to the port

shape after editing.
DRR/BEV
None
Display a BEV or DRR for the active

beam.
Display Intensity
Maps/BEV
None
Display a relative fluence map or a BEV.
None
Display an ideal intensity map or a BEV.
None
Display a segmented MLC intensity map

or a BEV.
None
Display a compensating filter intensity

map or a BEV.
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Dose Supporting Toolbar

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Absolute or Standard
Normalization
F5
Set the normalization mode to

absolute dose, if the beam-weighting
mode is absolute dose/MU.
Set the normalization mode to
standard, if the beam-weighting
mode is relative.
Global Normalization
F6
Set the normalization mode to global

maximum.
Set Normalization
Mode
F7
Set or change normalization mode.
Isodose Lines
F9
Display isodose lines or surfaces.
Dose in MPV
F10
Display, or remove from display, the

dose values in the MPV.
Beam Weight
F11
Edit a beams weight value, edit a

beam's MU value, turn doses on or
off, and define the weight point.
Time/MU
F12
Change the treatment date, if the

beam-weighting mode is absolute
dose/MU.
Calculate the amount of time or
number of monitor units required, if
the beam-weighting mode is relative.
XiO
Source Data
None
Display the Teletherapy Sources

Index that contains information for
each beam.
Histogram
None
Make a DVH, which is a plot of

volume versus dose.
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Redisplay Histogram
Data
None
Re-make the histograms with the

recalculated dose values.
TCP/NTCP
None
Calculate TCP or NTCP.
Dose Profile
None
Display a dose profile.
None
Display a relative fluence map or

BEV.
None
Display an ideal intensity map or

BEV.
None

map or a BEV.
None

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CT Sampling
F5
Sample points.
Display Intensity
Maps/BEV
Tools Supporting Toolbar

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For a CT-based patient, the system

reports CT values and relative electron
density at the sampled points.
For a non-CT based patient, the
system reports electron density at the
sampled points.
Setup Reference
Definition
F6
Position the setup reference

definition for a laser marking system.
Mark Anatomical
Reference
F7
Mark anatomical positions for a laser

marking system.
Review Compensator
F8
View a Par Scientific, Huestis, or

.decimal compensating filter in 3D.
Order a .decimal compensator; send
milling or QA information.
Display Intensity
Maps/BEV
54
F9

BEV.
F9

BEV.
F9

map or a BEV.
F9

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XiO User Guide
IMRT Supporting Toolbar

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IMRT Parameters
F5
Select beams to optimize.
IMRT Prescription
F6
Select targets and contoured

structures and enter dose goals.
Start Optimization
F7
Use an optimization algorithm to

optimize a plan.
Generate Treatment
Aids
F8
Generate segmented MLC or .decimal

compensator to deliver modulated
dose.
Segment Weight
Optimization
F9
Adjusts the weight of each segment

to ensure the final plan dose is
consistent with the prescribed dose.
Isodose Lines
F10
Display isodose lines or surfaces.
Dose in MPV
F11
Display, or remove from display, the

dose values in the MPV.
Histogram
F12
Make a DVH, which is a plot of

volume versus dose.
Redisplay Histogram
Data
None
Re-make the histograms with the

recalculated dose values.
IMRT Optimization
Index
None
Display the optimization summary

for the IMRT plan.
IMRT Delivery Index
None
Display the delivery summary for the

IMRT plan.
IMRT Prescription
Index
None
Display the prescription summary for

the IMRT plan.
Source Data
None
Display the Teletherapy Sources

Index that contains statistical and
descriptive information for each
beam.
None

BEV.
None

BEV.
None

map or a BEV.
None

Display Intensity
Maps/BEV
Teletherapy Features
This section contains highlights of some of the features within the Teletherapy
module. Refer to the XiO Training Guide or online help for more information on
how to perform these functions.
XiO
55
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XiO User Guide
Window Format
The graphics area is divided into smaller areas called subwindows. You can select
the number of subwindows, the view type, and their contents. The window
format choices depend on the current format and the subwindows contents.
The available view types are:
SPV Single Plane View
MPV Multiple Plane View
BEV Beams Eye View
ABV Active Beams Eye View
Window Display Formats

One (1 subwindow)
H Two (2 subwindows horizontal)
V Two (2 subwindows vertical)
Four (4 subwindows)
Six (6 subwindows)
Sym Six (6 equal subwindows)
Nine (9 subwindows)
Twelve (12 subwindows)
Save a Window Format

The layout of the graphics area can be saved and recalled. In the Window Format
dialog box, you can select a predefined graphics area setup or start from scratch and
make adjustments to the layout. Once you have the graphics area set up to your
liking, save the layout. The setup can then be selected later when creating a new
Teletherapy or QA plan. When the setup is no longer needed, it can be deleted.
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Synchronize Subwindows
You can synchronize the plans so that the same planes and reference distances
are visible concurrently in the graphics area. Group the subwindows to
synchronize certain functions, such as scaling, panning, or zooming in and out.
Making a Beam Active

When you select a beam from the Active Beam box in the upper right corner of
the Teletherapy window, the beam becomes the active beam. From this point, any
treatment aids you add or any edits you make are for the active beam.
Figure 17: Active beam
Editing Beam Parameters

To edit parameters for all beam types, you can:
Use the respective Beam dialog (photon, electron, or proton) for

individual beams
Use the Beam Spreadsheet for multiple beams
Beam Dialog
The beam dialogs let you change settings for the active beam. There are three
dialogs, one for each beam type (photon, electron, and proton). XiO
automatically opens the correct dialog for the active beam.
XiO
57
Teletherapy
XiO User Guide
Figure 18: Edit Photon Beam dialog box. XiO

automatically opens the correct dialog for the active beam.
Beam Spreadsheet
You can change parameters for multiple beams with the beam spreadsheet. The fields
on the spreadsheet are the same as the fields on the beam dialog boxes. When you
change a parameter on the beam spreadsheet, the beams dialog box shows the change
and vice versa. You can edit white fields but not light blue fields.
The Beam Spreadsheet has multiple tabs:
58
General lets you change basic beam parameters like Algorithm,

Setup, SSD, and Display options.
Beam lets you change specific beam parameters like Collimator, and
Gantry Angle.
Beam Weight lets you rebalance the beam weight.
Segments lets you control the segment quantity, the shape, and the
beam weight for beams containing MLC segments.
Teletherapy
XiO User Guide
Figure 19: Beam Spreadsheet Beam Weight tab.
Bolus
Bolus is a material that conforms to the patient surface. Its most common use is
to raise the dose to the skin for treatment of surgical scars, skin lesions, or
carcinomas that have invaded the skin.
You can define the description, bolus thickness, relative electron density,
orientation, and cross section reference distance of the bolus.
Add/Edit a Contour
Contouring is available to you from the Teletherapy toolbar. This is a quick
access method to add or modify a contour in Teletherapy. Once you have made
your additions or edits, XiO allows you to continue planning by clicking the
Beam button on the toolbar. To gain access to all contouring functions you have
to exit Teletherapy and enter PFM.
Enhance Contours
You can change the way the system displays patient anatomy structures in the
graphics area with the Enhance Contour function. You can determine the color
and rendering of the structures. When editing contours, turn off any structures
that are not needed. Only structures that are displayed are available for editing.
The graphics area automatically updates to reflect any changes.
Dose
The Dose menu in XiO provides these capabilities:
XiO
Enter calculation settings.
Evaluate or change dose (normalization) for your plan.
Display the isodose lines and surfaces. You also can define a new
structure from a selected dose value (only for certain display modes).
59
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Edit beam weight values.
Calculate Tumor Control Probability (TCP) or Normal Tissue

Complication Probability (NTCP).
Determine treatment time and monitor units.
Display or print a histogram.
Determine the dose status.
Save dose profile or dose plane.
Calculation Settings
Use this function to define the dose calculation region in an open treatment plan.
You define the calculation region dimensions, center, and distance calculation
points to measure radiation dose calculation.
Choose Calculation Mode
Refer to the Calculation Region topic described earlier in this guide for more
information on choosing a calculation mode.
Calculate Dose
XiO automatically performs the dose calculation whenever any part of the beam
definition changes. If you want to control the dose calculation yourself, use the
General Preferences dialog box under the Edit drop-down menu.
Dose Status
When you select the Dose Status option, XiO provides the following status
messages:
Beam number in progress...
The system displays the beam numbers for the beams with dose calculating.
Beam number completed...
The system displays the beam numbers for beams with completed dose
calculation.
The system also displays the dose status on the Status Bar.
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Histogram
A dose volume histogram (DVH) is a histogram used to generate plots of volume
versus dose. DVHs summarize dose distribution information throughout normal
tissue and tumors.
DVHs can be used to:
Enhance the dose information provided by isocurves and isosurface
Evaluate the uniformity of dose in a structure
Identify hot spots outside the target volume, which could potentially
cause damage to normal tissue
Figure 20: A dose volume histogram
Multiple Plan Review

XiO lets you open up to three plans (primary, secondary, and tertiary) for the
same patient and view the beam arrangements and dose distributions
simultaneously. These are important factors in evaluating the alternative plans
developed for the patient.
You can also instruct XiO to graphically compare the plans. Instead of opening a
third plan, you can create a subtraction or addition plan.
Saving Plans
You can save the following types of plans (if you have multiple plans selected for
review, only the primary plan is saved):
XiO
61
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XiO User Guide
A temporary patient treatment plan: the system changes it from a

temporary plan to a permanent plan.
A revised permanent treatment plan.
The current state of a treatment plan in Optimize (IMRT or

conventional inverse planning).
You can also save templates and addition plans.
Enter your operator ID as part of the plan description as you save the
plan.
Add a signature line and date line to the hard copies for plan approval.
Plan Approval
You can add comments to a plan and, if you have the authority, approve a plan.
Note that your system administrator sets the plan approval authority for each
user.
The name of the approver is displayed and is stored with the approval comments as
the electronic signature of the approver. The approvers most recent comments are
stamped with the date and time. The time stamp and the approvers name is printed
on plan reports. If you do not have the authority to approve plans, you can enter
planners comments. You can toggle between the planners comments and the
approvers comments.
Next Step
To learn more about XiO, read the XiO Training Guide, XiO Online Help, and
the XiO Reference Library.
62
Teletherapy
XiO User Guide
XiO
63
Index
.decimal compensating filter, 19
1D compensators, 19
ABV, 56
Active beam, 48, 57
eye view. See ABV
Anatomical structure, 5
Anatomical structures, 6
Anatomy data, 5
classifications, 9
mode, 12
Anatomy site
general, 10
predefined, 9
specific, 10
user-defined, 10
Answer-help, 37
Auto margin, 7
Auto-by-threshold, 7
Auto-help, 37
Autosegmentation, 7
Beam
active, 57
entry point, 17
parameters, 17
weighting, 17
Beam supporting toolbar, 51
Beams eye view. See BEV
BEV, 56
Bolus, 59
Brachytherapy, 24, 30, 35
source information, 19
Calculation
algorithms, 20
mode, 14, 60
pixel-by-pixel, 7
region, 14, 60
settings, 60
Catheter
templates, 20
types, 30
Clinic, 28
Collimator settings, 17
Color definitions, 36
irregular field, 36
objects, 36
points, 36
Color definitions, 33
Commissioning, 16
Compensating filter, 17, 18
Computed tomography, 12
Contour control, 42
Contour supporting toolbar, 50
Contours, 6
add, 59
auto margin, 7
auto-by-threshold, 7
autosegmentation, 7
edit, 59
enhance, 59
import, 7
interpolation, 7
Coronal, 11
Couch settings, 17
Cross section, 6, 43
Customization, 27, 30
Data
demographic, 4
entering, 5
patient, 4
source physics, 17
Data export, 24
Demographic data, 4
Descriptions, 35
DICOM 3.0, 7, 25
DICOM export, 28
DICOM RT plan import, 28
Digitizer, 7, 31
film, 25
Index
XiO User Guide
Dose, 59
calculate, 60
calculation algorithms, 20
parameters, 17
status, 60
Dose supporting toolbar, 53
DVH, 61
Electron density
converted from assigned contour
density, 12
converted from CT pixels, 12
relative, 16
Ellis compensators, 19
Enhanced dynamic wedge, 18
Exiting, 39
Film digitizer, 25
Focal, 25
Gantry settings, 17
General limitations, 33
Graphics area, 43, 49, 56, 57
Group list box, 42
Heterogeneity, 15
Histogram, 61
Huestis, 19
IDs, 35
Image-based studyset, 9, 16
IMRT, 13, 62
IMRT supporting toolbar, 55
Intensity Modulated Radiation
Therapy. See IMRT
Interest points, 13, 15
Interpolation, 7
Irregular field, 24, 36
Irregular field point dose calculation,
35
Isocenter, 17
Keyboard
using, 32
Limits, 33
brachytherapy, 35
general, 33
IDs, names, description, 35
irregular field point dose calculation,

35
Linux
desktop, 29
screen capture, 29
Login, 23, 25
Machine commissioning, 16
Main menu
patient file maintenance, 42
teletherapy, 47
Main toolbar, 49
teletherapy, 48
Markers, 13
Milling machines, 19
Mode buttons, 45
Modules, 23
Motorized wedge, 18
Mouse
using, 7, 31
MPV, 44, 53, 56
Multiple plane view. See MPV
Names, 35
Navigation, 31
dialog box, 32
keyboard, 32
mouse, 31
Non-image-based studyset, 9, 16
Normalization, 17, 60
NTCP, 54, 60
Objects, 36
Online help, 36
answer-help, 37
auto-help, 37
Orientation, 10
Par Scientific, 19
Passwords, 25
Patient anatomy
file identification, 10
location, 12
orientation, 10
Patient data, 4
Index
XiO User Guide
Patient file maintenance

functionality, 44
mode buttons, 45
preferences, 30
submode buttons, 45
user interface, 41
Permanent plans, 4
PFM. See Patient file maintenance
Physical wedge, 18
Pixel images, 5
Pixel-by-pixel calculation, 7
Plan
approval, 27, 62
basics, 4
comments, 62
modes, 13
review, 61
save, 62
types, 4
Points, 36
Port supporting toolbar, 52
Preferences, 27
teletherapy, 30
Program license agreement, 3
Radiation source information, 16
Reference distance, 12, 17, 44
Relative electron densities, 16
RTOG
protocol submission software, 31
simulation, 25
RTP link, 29
Sagittal, 11
Save
plan, 62
window format, 57
Scale factor, 44
Single plane view. See SPV
Source
templates, 19, 30
types, 19, 30
Source file maintenance, 24
XiO
Source information
brachytherapy, 19
radiation, 16
Source physics data, 17
SPV, 56
Status bar
teletherapy, 48
Studysets, 9
Submode buttons, 45
Tablet, 7
TCP, 54, 60
Teletherapy
features, 56
functionality, 49
preferences, 30
source parameters, 17
toolbar, 49
user interface, 47
Templates, 62
catheter, 20
source, 19
Temporary plans, 4
Three-dimensional plan, 13
Thumbnails, 43
Tissue density, 5, 7
heterogeneities, 15
Title bar
teletherapy, 47
Tool tip, 44, 49
Toolbar
beam supporting, 51
contour supporting, 50
dose supporting, 53
IMRT supporting, 55
main, 49
modes, 42
port supporting, 52
submodes, 48
tools supporting, 54
Tools supporting toolbar, 54
Transverse, 11
67
Index
XiO User Guide
Treatment plan. See Plan

Two-dimensional plan, 13
User
add, 25
authorization, 26
definable setup, 27
utility, 25
Usernames, 25
VIDAR film scanner, 31
View types, 56
Virtual wedge, 18
Wedge, 17, 18
Window
level presets, 42, 48
slide controls, 43, 49
Window format, 56
display, 56
save, 57
synchronize, 57
Window size, 28
Wireframe contours, 12
Manufacturer
Elekta Business Area Software Systems
IMPAC Medical Systems, Inc.
13723 Riverport Drive
Suite 100
Maryland Heights, MO 63043
USA
European Union Authorized Representative

Elekta Limited
Linac House, Fleming Way
Crawley, West Sussex
RH10 9RR,
United Kingdom
Phone: +44 129 365 4242
Fax: +44 1293 471347
www.elekta.com
Corporate Head Office:
Elekta AB (publ)
Box 7593, SE-103 93
Stockholm, Sweden
Tel +46 8 587 254 00
Fax +46 8 587 255 00
info@elekta.com
Human Care Makes the Future Possible

Regional Sales, Marketing and
Service:
North America
Atlanta, USA
Tel +1 770 300 9725
Fax +1 770 448 6338
info.america@elekta.com
Europe, Latin America,

Africa, Middle East &
India
Tel +44 1293 544 422
Fax +44 1293 654 321
info.europe@elekta.com
Asia Pacific
Hong Kong, China
Tel: +852 2891 2208
Fax: +852 2575 7133
info.asia@elekta.com

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XiO User Guide

XiO version 4.70.00

IMPAC Medical Systems, Inc.

Contact Information, Revision History, Trademarks

Document Name: LUGXIO0470 (3.0)

Contact Information, Revision History, Trademarks

Updated for release 4.62

Contact Information, Revision History, Trademarks

Document Name: LUGXIO0470 (3.0)

Chapter 2: XiO Basics ............................................................ 23

Irregular Field Point Dose Calculation ................................................................... 35

Chapter 4: Teletherapy .......................................................... 47

Chapter 1: Introduction to XiO

Intended Users of the XiO RTP System

Intended Use of the XiO RTP System

Patient/User Safety and Residual Risk

Training on the XiO RTP System

Using the XiO RTP System

Program License Agreement

The Basics of a Treatment Plan

Information about the patient

Information about the radiation sources used (the teletherapy

Information that describes how the radiation is to be applied

Anatomical structure contours

Tissue density of anatomical structures

Entering Patient Anatomy Data

Figure 1: Pixel image

A tablet (digitizer), which is used to trace drawings from graph

entered from the digitizer will be assumed to have an axial

A mouse, which is used to either trace a structures contour

Auto-by-Threshold XiO draws a contour around the edge of

AutoSegmentation XiO draws a contour after analyzing

Auto Margin XiO draws a second contour around a

Interpolation XiO generates contours on cross sections that

Figure 3: Contour with an automatically generated margin

Figure 4: Pixel image with contours traced on it

Anatomy Data Classifications

Patient The patients external outline (the skin); this

Tumor (Tum) The tumor to be treated.

Target Volumes 1 through 5 (TV1, TV2, TV3, TV4, and TV5)

account for microscopic extensions of the tumor that you

Patient Anatomy File Identification

orthogonal (perpendicular to one of the three axes)

semi-orthogonal (at some angle other than 90 to the

Orthogonal planes are classified as being transverse, sagittal, or coronal.

Cross sections or image planes that are perpendicular to the

Cross sections or image planes that are perpendicular to the

Cross sections or image planes that are perpendicular to the

Figure 6: Patient orientation

Figure 7: Reference distance

Anatomy Data Mode

Wireframe contours (WC)

Computed tomography (CT)

Electron density converted from CT pixels (EP)

Electron density converted from assigned contour density

If you have more than 30 cross sections, you can display

Intensity Modulated Radiation Therapy

Interest Points and Markers

In the actual studyset, while entering cross sections. These

Interest points and markers in three-dimensional planning

Interest points and markers in two-dimensional planning

maximum terma extent, the system calculates only the scatter

Figure 8: 3D calculation region