Advantage Sim 4.

Operator Manual
2235887–100
Revision 1

Copyrighte 1999
by General Electric Co.
Operator Manual
 Regulatory
Requirements
Note: This equipment generates, uses, and can radiate radio
frequency energy. The equipment may cause radio frequency
interference to other medical and non-medical devices and
radio communications. To provide reasonable protection
against such interference, this product complies with emission
limits for Group 1 Class A Medical Devices as stated in
EN 60601–1–2.
However, there is no guarantee that interference will not occur
in a particular installation. If this equipment is found to cause
interference (which may be determined by switching the
equipment on and off), the user (or qualified service personnel)
should attempt to correct the problem using one or more of the
following measures:
- Reorientate or relocate the affected device(s).
- Increase the separating space between the equipment and
the affected device.
- Power the equipment from a source different from that of
the affected device.
- Consult the point of purchase or the service representative
for further suggestions.
The manufacturer is not responsible for any interference
caused either by the use of interconnect cables other than
those recommended or by unauthorized changes or
modifications to this equipment. Unauthorized changes or
modifications could void the user’s authority to operate the
equipment.
To comply with the regulations applicable to an electromagnetic
interface for a Group 1 Class A Medical Device, all
interconnect cables to peripheral devices must be shielded and
properly grounded. Use of cables not properly shielded and
grounded may result in the equipment causing radio frequency
interference in violation of the European Union Medical Device
directive and FCC regulations.

om 2235887–100 Rev. 1 Regulatory Requirements i

 This product complies with the regulatory requirements of the
following:

- Council Directive 93/42/EEC concerning medical devices

when it bears the following CE marking of conformity.

For a system, the location of the CE marking label is on the

CD ROM.

European registered place of business:

GE Medical Systems Europe

Quality Assurance Manager
BP 34
F 78533 BUC CEDEX
France

Tel: +33 (0)1 30 70 40 40

- Medical Device Good Manufacturing Practice Manual

issued by the FDA (Food and Drug Administration,
Department of Health, USA).

General Electric Medical Systems is ISO 9001 certified.

ii Regulatory Requirements om 2235887–100 Rev. 1

Advantage Sim
Indications for use
Virtual Simulation with Advantage Sim is used to prepare
geometric and anatomical data relating to a proposed external
beam radiotherapy treatment, prior to dosimetry planning.
Anatomical volumes can be defined in three dimensions using
a set of CT images acquired with the patient in the proposed
treatment position. The geometric parameters of a proposed
treatment field are selected to allow non–dosimetric, interactive
optimisation of field coverage.
Defined anatomical structures and geometric treatment fields
are displayed on transverse CT images, on reformatted
sagittal, coronal or oblique images; on 3D views created from
the CT images, or on a beam’s eye view display of defined
structures with or without the display of a Digitally
Reconstructed Radiograph.

om 2235887–100 Rev. 1 Regulatory Requirements iii

Blank page.

iv Regulatory Requirements om 2235887–100 Rev. 1

 Service Offices

For service issues, contact the Service office in your country or in

France (locations on following pages).

om 2235887–100 Rev. 1 Service Offices v

 AMERICAS

UNITED STATES OF AMERICA

GE Medical Systems Headquarters Tel: 414–544–3011
3000 North Grandview Blvd.
Waukeska, WI 53188
Mail:P.O. Box 414
Milwaukee, WI 53201

LATIN AMERICA
GE Medical SYstems Tel: 305–497–1200
Latin America Headquarters
5101 NW 21st Avenue, Suite 350
FORT LAUDERDALE, FL 33309

ASIA

NIPPON (Japan)
GEMSA Headquarters Tel: (81) 426 560007
GE Medical Systems Asia
4–7–127 Asahigaoka, Hino–shi
TOKYO, JAPAN 191

REST OF ASIA
GE Pacific Pte. Ltd (GEMS Asia) Tel: (65) 291–8528 [8*548–8528]
South East Asia Pacific Operations (SEAPO) Fax : (65) 291–7006 [8*548–7006]
298 Tiong Bahru Road
#15–01/06 Tiong Bahru Plaza
SINGAPORE 0316

vi Service Offices om 2235887–100 Rev. 1

 EUROPE
BELGIE/BELGIQUE (Belgium)
GE Medical Systems Benelux NV/SA (NL) Tel:+32 2 644 09 38
Manhattan Center (F) Tel:+32 2 644 08 42
Bolwerklaan 21 b 9 Avenue du Boulevard (LUX) Tel:0800 2973
B–1210 BRUSSEL/BRUXELLES Fax: +32 2 207 73 33

DANMARK (Denmark)
GE Medical Systems Danmark Tel: +45 45 51 00 55
Skovlytoften 4 Fax: +45 42 42 59 89
DK–2840 HOLTE

DEUTSCHLAND (Germany)
GE Medical Systems Deutschland GmbH & Tel: 0130 4367 (gebührenfrei)
Co. KG Fax: +49 69 7682 237
Praunheimer Landstrasse 50 Tlx: 412002 GEGF D
D–60488 FRANKFURT AM MAIN

ESPAÑA (Spain)
GE Medical Systems España Tel: +34 1 663 25 00
Avda. de Europa 22 Fax: +34 1 663 25 01
Parque Empresarial la Moraleja
E–28100 ALCOBENDAS

FRANCE (France)
GE Medical Systems Tel: +33 (0)1 30 70 40 40
283 rue de la Minière
BP34
F–78533 BUC CEDEX

HELLAS (Greece)
GE Medical Systems Hellas Tel: +30 1 93 24 582
41 Nikolaou Plastira Street Fax: +30 1 93 58 414
GR–171 21 NEA SMYRNI

ITALIA (Italy)
GE Medical Systems Italia Tel: +39 39 20 881
Via Monte Albenza 9 Fax: +39 39 73 37 86
I–20052 MONZA Tlx: 3333 28

NEDERLAND (Netherlands)
GE Medical Systems Nederland B.V. Tel: +31 73 6 457 457
Hambakenwetering 1 Fax: +31 73 6 441 233
NL–5231 DD S HERTOGENBOSCH

om 2235887–100 Rev. 1 Service Offices vii

ÖSTERREICH (Austria)
GE GesmbH Medical Systems Austria Tel: 0660 8651 (gebührenfrei)
Prinz Eugen Strasse 8/8 Fax: +43 1 505 38 74
A–1140 WIEN Tlx: 136314
POLSKA (Poland)
GE Medical Systems Polska
Krzywickiego 34 Tel: +48 2 625 59 62
P–02–078 WARSZAWA Fax: +48 2 615 59 66
PORTUGAL (Portugal)
GE Medical Systems Portuguesa S.A.
Rua Sa da Bandeira, 585 Tel: +351 2 2007696/97
Apartado 4094 Fax: +351 2 2084494
P–4002 PORTO CODEX Tlx: 22804
ROSSIYA (Russia)
GE Medical Systems Tel: +7 095 935 72 41
Kosmodamianskaya nab. 52, Bldg 1, 6th Floor Fax: +7 095 935 73 46 and 48
113054 MOSCOW Tel (satellite): +7 502 220 30 39
Fax (satellite): +7 502 220 32 59
Tlx: 613020 GEMED SU
SVERIGE (Sweden)
GE Medical Systems Tel: +46 8 457 95 20
Box 6768 Fax: +46 8 457 95 47
St. Eriksgatan 117 Tlx: 12228 CGRSWES
S–113 85 STOCKHOLM
SCHWEITZ/SUISSE (Switzerland)
GE Medical Systems (Schweiz) AG Tel: 155 6958 (gebührenfrei)
Sternmattweg 1 Fax: +41 41 421859
CH–6010 KRIENS
TÜRKIYE (Turkey)
GE Medical Systems Turkiye A.S. Tel: +90 212 75 5552
Mevluk Pehliran Sodak Fax: +90 212 211 2571
Yilmaz Han, No 24 Kat 1
Gayretteppe
ISTANBUL
UNITED KINGDOM
IGE Medical Systems
Coolidge House Tel: +44 753 874000
352 Buckingham Avenue Fax: +44 753 696067
SLOUGH
Berkshire SL1 4ER

viii Service Offices om 2235887–100 Rev. 1

 Revision History

REV DATE REASON FOR CHANGE

0 March, 1999 Initial release

1 May, 1999 Minor update

LIST OF EFFECTIVE PAGES

PAGE REVISION PAGE REVISION

Title page 1 8–1 thru 8–2 1

i thru xx 1 9–1 thru 9–18 1
1–1 thru 1–8 1 10–1 thru 10–28 1
2–1 thru 2–2 1 11–1 thru 11–16 1
3–1 thru 3–4 1 12–1 thru 12–20 1
4–1 thru 4–16 1 13–1 thru 13–6 1
5–1 thru 5–2 1 14–1 thru 14–4 1
6–1 thru 6–6 1 15–1 thru 15–4 1
7–1 thru 7–22 1 16–1 thru 16–4 1

NUMBER FORMAT REVISION

2235887–100TPH A5 1

om 2235887–100 Rev. 1 Revision History ix

Blank page.

x Revision History om 2235887–100 Rev. 1

 Chapter Tabs
Safety 1

Conventions 2

Introduction 3

Starting Advantage Sim 4

Layout for Advantage Sim 5

The Main Command Panel 6

The Image Viewer 7

The Display Command Panel 8

Defining Anatomical Structures 9

Defining Beams 10

Output to Printer 11

Managing Treatment Machine Data 12

om 2235887–100 Rev. 1 Chapter Tabs xi

Blank page.

xii Chapter Tabs om 2235887–100 Rev. 1

 Chapter Tabs
Setting User Preferences 13

Saving and Restoring Patient Data 14

Periodic Quality Assurance 15

Glossary 16

om 2235887–100 Rev. 1 Chapter Tabs xiii

Blank page.

xiv Chapter Tabs om 2235887–100 Rev. 1

 Table of Contents
Regulatory Requirements . . . . . . . . . . . . i

Indications for use . . . . . . . . . . . . . . . . . . iii

Service Offices . . . . . . . . . . . . . . . . . . . . . . v

Revision History . . . . . . . . . . . . . . . . . . . . ix

Chapter Tabs . . . . . . . . . . . . . . . . . . . . . . . . xi

Table of Contents . . . . . . . . . . . . . . . . . . . xv

Chapter 1 Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1–1

S Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1–1
S Required Knowledge . . . . . . . . . . . . . . . . . . . . . . . 1–1
S Choice of Treatment Plans . . . . . . . . . . . . . . . . . . 1–1
S Treatment Machine Parameters . . . . . . . . . . . . . 1–2
S Patient Position and Coordinates . . . . . . . . . . . . 1–2
S Display Precision . . . . . . . . . . . . . . . . . . . . . . . . . . 1–3
S Feasibility of Treatment . . . . . . . . . . . . . . . . . . . . 1–4
S Export of Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1–4
S Automatic Deletion of Patient Data . . . . . . . . . . . 1–4
S Patient Confidentiality . . . . . . . . . . . . . . . . . . . . . . 1–5
S Repairs and Modifications . . . . . . . . . . . . . . . . . . 1–5
S Machine and IEC Coordinate Conventions . . . . 1–5
S Source to Surface Distances (SSDs) . . . . . . . . . 1–5
S Treatment Plan Import . . . . . . . . . . . . . . . . . . . . . 1–6
S Export to Laser Marking Systems . . . . . . . . . . . . 1–7

Chapter 2 Conventions . . . . . . . . . . . . . . . . . . . . . . . . 2–1

om 2235887–100 Rev. 1 Table of Contents xv

Chapter 3 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 3–1
S Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3–1
S Hardware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3–1
S Image Formats and Network Protocols . . . . . . . 3–1
S Treatment Plan Formats . . . . . . . . . . . . . . . . . . . . 3–2

Chapter 4 Starting Advantage Sim . . . . . . . . . . . . . . 4–1

S Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4–1
S Access to Advantage Sim . . . . . . . . . . . . . . . . . . 4–1
S Creating a Treatment Plan from an Image
Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4–1
Series/Images Selection . . . . . . . . . . . . . . . . 4–1
The Browser Main Window . . . . . . . . . . . . . 4–3
Starting Advantage Sim for Treatment
Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4–4
Patient Position . . . . . . . . . . . . . . . . . . . . . . . 4–5
S Selecting a Previously Saved Treatment Plan . 4–7
S Treatment Plan Selection . . . . . . . . . . . . . . . . . . . 4–8
Reloading a Treatment Plan . . . . . . . . . . . . 4–10
Selecting Plans Created by Previous
Versions of Advantage Sim . . . . . . . . . . . . . 4–11
Selecting Structure Sets . . . . . . . . . . . . . . . . 4–11
Reloading a Treatment Plan Created by an
External System . . . . . . . . . . . . . . . . . . . . . . . 4–11
Hints for Enhancing Compatibility with
External Systems . . . . . . . . . . . . . . . . . . . . . . 4–14

Chapter 5 Layout for Advantage Sim . . . . . . . . . . . 5–1

Chapter 6 The Main Command Panel . . . . . . . . . . . 6–1

S The FILE Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . 6–2
S The UTILITIES Menu . . . . . . . . . . . . . . . . . . . . . . 6–4
S The CUSTOMIZE Menu . . . . . . . . . . . . . . . . . . . . 6–5
S The MODE Menu . . . . . . . . . . . . . . . . . . . . . . . . . . 6–6

xvi Table of Contents om 2235887–100 Rev. 1

Chapter 7 The Image Viewer . . . . . . . . . . . . . . . . . . . 7–1
S Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7–1
S The 3D Cursor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7–2
S Moving the 3D Cursor . . . . . . . . . . . . . . . . . . . . . . 7–2
S View Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7–2
S Axial View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7–3
The On–View Menu . . . . . . . . . . . . . . . . . . . . 7–4
User–Selectable Items . . . . . . . . . . . . . . . . . 7–5
Non–Selectable Annotations . . . . . . . . . . . . 7–5
Representation of Beams . . . . . . . . . . . . . . . 7–6
Patient Markers . . . . . . . . . . . . . . . . . . . . . . . 7–6
S 3D View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7–7
Additional Items in the 3D View . . . . . . . . . . 7–8
S Beam’s Eye View . . . . . . . . . . . . . . . . . . . . . . . . . . 7–10
The On–View Menu for the Beam’s Eye
View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7–12
Beam’s Eye View Annotations for Hardcopy
Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7–12
User–Selectable Items . . . . . . . . . . . . . . . . . 7–13
S Machine Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . 7–21
Color Coding . . . . . . . . . . . . . . . . . . . . . . . . . . 7–22

Chapter 8 The Display Command Panel . . . . . . . . . 8–1

Chapter 9 Defining Anatomical Structures –

The Patient Structures Panels . . . . . . . . 9–1
S The Structures Command Panel . . . . . . . . . . . . . 9–1
S Adding a new Structure . . . . . . . . . . . . . . . . . . . . 9–6
S Renaming a Structure . . . . . . . . . . . . . . . . . . . . . . 9–6
S Editing a Structure . . . . . . . . . . . . . . . . . . . . . . . . . 9–7
S Deleting a Structure . . . . . . . . . . . . . . . . . . . . . . . . 9–9
S Adding Margins . . . . . . . . . . . . . . . . . . . . . . . . . . . 9–10
S Defining a Structure in Automatic mode . . . . . . 9–12
S Defining a Structure in Fill mode . . . . . . . . . . . . . 9–15
S Manipulating Markers . . . . . . . . . . . . . . . . . . . . . . 9–17

om 2235887–100 Rev. 1 Table of Contents xvii

Chapter 10 Defining Beams . . . . . . . . . . . . . . . . . . . . . 10–1
S Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10–1
S External Beams Window . . . . . . . . . . . . . . . . . . . 10–2
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10–2
Adding Groups . . . . . . . . . . . . . . . . . . . . . . . . 10–5
Renaming Groups . . . . . . . . . . . . . . . . . . . . . 10–6
Deleting Groups . . . . . . . . . . . . . . . . . . . . . . . 10–6
Adding Beams . . . . . . . . . . . . . . . . . . . . . . . . 10–7
Renaming Beams . . . . . . . . . . . . . . . . . . . . . 10–7
S Controlling Beams – The Beam panel . . . . . . . . 10–8
The Top Section . . . . . . . . . . . . . . . . . . . . . . . 10–9
The Second Section . . . . . . . . . . . . . . . . . . . 10–11
The Third Section . . . . . . . . . . . . . . . . . . . . . 10–11
The Fourth Section . . . . . . . . . . . . . . . . . . . . 10–12
The Bottom Section . . . . . . . . . . . . . . . . . . . . 10–14
Manipulating Blocks and Cutouts . . . . . . . . 10–18
Summary of Beam characteristics –
the Beam Review Panel . . . . . . . . . . . . . . . . 10–24
The Leaf Position panel . . . . . . . . . . . . . . . . 10–25
The Laser Marking Review Panel . . . . . . . . 10–26

Chapter 11 Output to Printer . . . . . . . . . . . . . . . . . . . . 11–1

S Hardcopy Output (Printer or optional
Laser Camera) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11–1
S Output to Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . 11–2
Selecting Multiple Views . . . . . . . . . . . . . . . . 11–7
Print Confirmation . . . . . . . . . . . . . . . . . . . . . 11–8
Clipping Confirmation . . . . . . . . . . . . . . . . . . 11–8
S Output to Film . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11–8
Laser Camera Calibration . . . . . . . . . . . . . . 11–9
S Output of Plan Data Sheet . . . . . . . . . . . . . . . . . . 11–14

xviii Table of Contents om 2235887–100 Rev. 1

Chapter 12 Managing Treatment Machine Data –
The RT Machine Data panel . . . . . . . . . . 12–1
S Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–1
S Entering the Physicists’ Password . . . . . . . . . . . 12–1
S Managing Treatment Machine parameters . . . . 12–2
Adding or Modifying Treatment Machine
parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–5
Entering Collimator parameters . . . . . . . . . . 12–9
Entering Leaf widths . . . . . . . . . . . . . . . . . . . 12–13
Defining Photon energies . . . . . . . . . . . . . . . 12–15
Defining Electron energies . . . . . . . . . . . . . . 12–16
Adding Energy Levels . . . . . . . . . . . . . . . . . . 12–17
Saving Treatment Machine . . . . . . . . . . . . . 12–17
Printing RT Machine Data . . . . . . . . . . . . . . 12–18
S Saving Treatment Machine Parameters to
Diskette . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–18
Restoring Treatment Machine Parameters
from Diskette . . . . . . . . . . . . . . . . . . . . . . . . . 12–19
File Conflict . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–20
Add File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–20

Chapter 13 Setting User Preferences . . . . . . . . . . . . 13–1

S Main menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13–1
S Structure and Windowing Preferences . . . . . . . . 13–2
S Adding an anatomical Structure to the
Preferences Settings . . . . . . . . . . . . . . . . . . . . . . . 13–4
S DRR Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13–5

Chapter 14 Saving and Restoring Patient Data . . . . 14–1

S Insert Tape for Archive/Restore Patient Data . . 14–1
S Archive/Restore Patient Data . . . . . . . . . . . . . . . 14–1
S Copy tape contents to browser . . . . . . . . . . . . . . 14–2
S Overwrite tape contents with browser
selections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14–4

om 2235887–100 Rev. 1 Table of Contents xix

Chapter 15 Periodic Quality Assurance . . . . . . . . . . 15–1
S Verification of CT images on Advantage
Workstation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15–1
S Verification of RT Machine Data . . . . . . . . . . . . . 15–1
S Verification of Hard copy (paper and film)
output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15–2
S Verification of data export and import with
another system . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15–2
S Verification of printer calibration . . . . . . . . . . . . . 15–4
S Logging out and restarting the workstation . . . . 15–4

Chapter 16 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16–1

xx Table of Contents om 2235887–100 Rev. 1

CHAPTER 1

Safety
Overview 1
To assure an efficient and safe use of Advantage Sim, it is
essential to read this chapter before attempting to use the
package.
This chapter is extremely important. It contains safety
information that you must thoroughly understand before you
begin to use the package.
The package is intended for use by qualified and trained
personnel only. If you need additional training, seek assistance
from your GE applications specialist by contacting the
appropriate number in the front of the manual.
Make certain that the correct version of your operator manuals
are readily available at all times. Make a point to review the
procedures and safety precautions periodically.
Additional safety concerns are addressed in the Advantage
Workstation documentation.

Required Knowledge
Advantage Sim runs in the Advantage Workstation
environment. Therefore, the user MUST have a good
knowledge and understanding of the Advantage Workstation
software and operator manual.

Choice of Treatment Plans

Advantage Sim can generate several treatment plans for a
patient. The user is responsible for choosing and validating the
treatment plan before the actual treatment. Proper validation
protocols for the users of Advantage Sim are strongly
recommended.

om 2235887–100 Rev. 1 Safety 1–1

 Treatment Machine Parameters
Treatment machine parameters are data used by Advantage
1 Sim and are critical for its proper use. Only the person
responsible for machine data is authorized to create, delete or
modify treatment machine parameters. Access is therefore
protected by a password. The user is fully responsible for
password management:
- The password should only be given to a clearly defined list
of users.
- The password should be changed regularly and
systematically.
The user must exercise great care to enter the correct
treatment machine parameters and their associated coordinate
systems, and ensure that these parameters are regularly
checked and backed–up.

Patient Position and Coordinates

The patient position in the model used in Advantage Sim
corresponds to the patient position when the CT images were
acquired. However, when using CT images which have been
acquired with the patient in a “Feet–First” position, Advantage
Sim allows the user to specify that the treatment position is
“Head–First”. Special care must be taken to ensure that
differences in patient position are properly documented and
understood.
The user must ensure that the correct patient position is
entered at the CT console at time of image acquisition
The user must ensure that the patient position on the CT
scanner will produce an accurate representation of the patient
during radiotherapy treatment. This includes, but is not limited
to, the use of flat table top inserts on the CT scanner and
patient immobilization devices to be used during treatment.
The coordinate system origin used by Advantage Sim is the
origin defined on the CT scanner at the time of image
acquisition. All coordinates displayed and used by Advantage
Sim are relative to this point. (See “Machine and IEC
Coordinate Conventions”.)

1–2 Safety om 2235887–100 Rev. 1

 It is recommended that an independent method of verifying
coordinates is routinely used. Radio–opaque markers placed in
reproducible positions on the patient’s surface prior to
acquisition of CT images is one such method.
Display Precision 1
The precision of anatomical objects displayed on reformatted
views (sagittal, coronal or oblique) or in digitally reconstructed
radiographs (DRR) depends on CT slice spacing and
thickness.
The three–dimensional model of the patient used by
Advantage Sim is limited to the volume defined by the selected
set of CT images. The user must ensure that the images are
acquired and selected over a sufficiently large volume to
include the volumes and beams required for plan preparation.
Advantage Sim allows accurate positioning of collimator jaws
and beam modifiers (blocks and cutouts) on the BEV/DRR.
Small differences in position on the BEV/DRR may appear as
significant differences when projected onto oblique planar
views, as illustrated in the following diagram. In particular,
when defining beam modifiers (blocks or cutouts) to coincide
exactly with the collimator opening, a small difference in
position may not be visible on the BEV/DRR, but may be
visible on planar views.
DRR plane

Planar view

Note: Advantage Sim uses a 3D matrix of pixels which is generated

from the transverse CT images. The Axial View annotations
include the position of the axial image closest to the currently
displayed plane. This image position will not generally be the
actual position of the displayed axial view. The
Inferior–Superior co–ordinates of isocenters and markers use
the position of the displayed plane and not the position of the
closest axial image.

om 2235887–100 Rev. 1 Safety 1–3

 Feasibility of Treatment
Advantage Sim does not check if it is possible to reproduce a
1 defined treatment fields on the treatment machine. It also does
not check for any risk of collision with the patient or table when
the field is set up on the treatment machine.

Export of Data
Image and treatment plan data can be exported from the
Advantage Sim workstation to compatible systems. The export
of data from Advantage Sim has been validated to conform to
the Advantage Sim 4.0 DICOM Conformance Statement.The
user must ensure that any system to be connected to
Advantage Sim is compatible and that such a system has been
properly validated for the receipt of images and plans from
Advantage Sim. Of special note, a system receiving the ‘GE
Plan’ must be capable of correctly handling the ‘Treatment
Position’ (0249,D0) attribute which has been added to this
object in Advantage Sim 3.0 and 4.0.
It is not possible to load GE plans created by a system other
than Advantage Sim 1.2 or Advantage Sim 3.0.
It is not possible to load a treatment plan created by Advantage
Sim 4.0 on previous version of Advantage Sim (1.2 or 3.0).

Automatic Deletion of Patient Data

The Advantage Workstation system provides an “Autodelete”
feature which, when enabled, automatically removes patient
data when the disk becomes nearly full. To prevent this
occurring, the Autodelete option must be turned off. Refer to
the Advantage Workstation Operator Manual for a description
of this feature.

1–4 Safety om 2235887–100 Rev. 1

Patient Confidentiality
The InSite (remote connection) facility provided with the
Advantage Workstation product allows remote access to the 1
Advantage Sim application. To prevent unauthorized access,
the user should ensure that the modem link remains
disconnected except when being used by GE service
personnel.

Repairs and Modifications

Following all repairs, adjustments, modifications or
maintenance carried out on the Advantage Workstation
system, all RT Machine Data should be verified by the user
(see Chapter 15: Periodic Quality Assurance). It is the user’s
responsibility to ensure that all data has been properly backed
up before service interventions.

Machine and IEC Coordinate Conventions

Advantage Sim is capable of displaying and printing beam
parameters using either machine–specific or IEC 1217
coordinate conventions. By default, the machine–specific
coordinate conventions are used. The user must always
ensure that the appropriate conventions are selected when
creating or using printouts.
Whichever conventions are selected, jaw names (X1, Y1, X2,
Y2) are always displayed using IEC 1217 naming conventions.

Source to Surface Distances (SSDs)

The SSDs (source to surface distances) displayed on the
Beam review panel, on the printout, and on the laser setup
sheet are calculated by Advantage Sim using the distance from
the beam source to the surface of the 3D patient model. These
values may not correspond exactly to the physical patient SSD,
and should be used with caution. If the beam intersects an
object such as the treatment couch, then the SDD displayed
will be the distance to the object surface.

om 2235887–100 Rev. 1 Safety 1–5

 Treatment Plan Import
Advantage Sim can read DICOM RT Structure Set objects
1 (containing image references, structure and marker
information) and DICOM RT Plan objects (containing beam
and treatment information) that have been created by systems
other than Advantage Sim.
Advantage Sim performs a large number of tests to verify the
coherence and validity of these imported objects. However, the
user must nevertheless verify that the parameters loaded into
Advantage Sim correspond to those generated on the external
system. Particular attention is required to ensure that the
treatment orientation is correct, that the contours are located
correctly relative to the patient anatomy, and that the beam
isocenters are in the correct positions.
The correspondence between treatment machines used for
beams is defined using the highest numbered version of the
Advantage Sim treatment machine with the same name as
defined in the imported RT Plan object. The user must ensure
that the treatment machine parameters (such as source–axis
distance and collimator limits) defined on the highest–numbered
version of the Advantage Sim machine correspond to those
defined on the external system.
Requirements and limitations for the import of DICOM RT
objects from external systems are described in the Advantage
Sim DICOM Conformance Statement.

1–6 Safety om 2235887–100 Rev. 1

Export to Laser Marking Systems
Planning data from Advantage Sim can be used in conjunction
with a laser marking system. This is done by creating a 1
marking file on the Advantage Sim file system, which is then
retrieved by a compliant laser marking system and used to
position the lasers for patient marking.
It is the responsibility of the user to put in place an adequate
quality assurance system to ensure that the markers placed on
the skin of the patient are within an acceptable precision. It is
also the responsibility of the user to check that the data from
Advantage Sim are correctly interpreted by the laser marking
system. Appropriate quality control procedures must also be
performed on a regular basis, to ensure the ongoing accuracy
of the entire laser marking system.

om 2235887–100 Rev. 1 Safety 1–7

 Blank page.

1–8 Safety om 2235887–100 Rev. 1

CHAPTER 2

Conventions
The following conventions are used in the text of this manual.

Mouse and Keyboard

Left: left mouse button.

2
Right: right mouse button.

Click left: click the left mouse button.

Double click left: click the left mouse button quickly, twice.

Key–name: name of keyboard key. For example, shift.

Screen Panels, Windows, Menus and Buttons

In general screen items appear in the text in bold. The screen
displays windows and panels. Windows contain images and
panels contain menus, buttons and other controls.

Menu name: this is the name of a menu.

[Menu item]: this is an item in an Advantage Sim menu, with

its description.

(Button name): this is a button in an Advantage Sim Panel

with its description.

{Slider and other name}: this is a slider control (a control with

a continuous range of values) or Panel item other than a menu
or button.

om 2235887–100 Rev. 1 Conventions 2–1

 Coordinate system
The origin of the patient is the point defined by the CT scanner
as the coordinate origin. Usually, the point lies at the
intersection of the CT tunnel axis and the scanning plane when
the table is in the zero offset position.

2 The coordinate system axes for the patient are the anatomical
axes Right (R), Anterior (A), Superior (S).
The orientation of the patient axes, with respect to
CAUTION the RT treatment machine, depend on the patient
position/orientation used when CT images are
acquired.

IEC Machine parameters

IEC 1217: Radiotherapy Equipment: Coordinates, Movements
and Scales, 1996.

2–2 Conventions om 2235887–100 Rev. 1

CHAPTER 3

Introduction
Overview
Advantage Sim is a software application designed to be used
with Advantage Workstation.
- It generates reconstructed three–dimensional volumes and
reformatted cut planes from CT images.
3
- It provides complete volume definition and geometric beam
placement capabilities for radiation therapy.
To use this package the user MUST have a good
CAUTION knowledge and understanding of the Advantage
Workstation software and operator manual.

Hardware
Advantage Sim runs on a standard Advantage Workstation
platform. The package accepts image data acquired on all CT
systems compatible with Advantage Workstation.
Advantage Sim includes an A3 color printer for paper and
transparency output and a tape drive for patient data archive
and back–up.

Image Formats and Network Protocols

The only format used by Advantage Sim for CT images is
DICOM 3. No other CT image formats are supported. See the
Advantage Workstation Operator Manual for further
information.
The image format is identified in the Advantage Workstation
Browser exam list under the “Fmt” (format) column as “Dic”
(DICOM).

om 2235887–100 Rev. 1 Introduction 3–1

 Digitally Reconstructed Radiographs (DRRs), calculated by
Advantage Sim, may be saved on the system disk. The saved
images are stored in one of two formats: DICOM 3 Secondary
Capture (SC) image or DICOM 3 RT Image. The two formats
are available to ensure compatibility with the largest number of
systems, since a given system may not support both formats.
Advantage Workstation supports several network transfer
protocols: DICOM, Advantage Net and SdCNET. The transfer
of images and plans to another Advantage Sim workstation
3 can be done with any of these protocols. Transfer of images
and plans to any other system MUST be done with the
DICOM protocol only.
Refer also to Chapter 1 Safety and Chapter 15 Periodic Quality
Assurance Checks for further information on the transfer of
plans to another system.
Refer also to the Advantage Workstation Operator Manual for
the method of selecting the network protocol.

Treatment Plan Formats

Treatment plans are stored as a pair of standard DICOM RT
objects:
The RT Structure Set (RTSS), containing information relating
to structures and markers.
The RT Plan (RTPL), containing information relating to
treatment beams.

3–2 Introduction om 2235887–100 Rev. 1

 3

Appearance of DICOM plans in the Browser

The plan type can be identified in the Advantage Workstation
Browser series window “Type” column:
DICOM RT Plans identified as “RTPL” type
DICOM RT Structure Sets identified as “RTSS” type.
Note: Previous versions of Advantage Sim also created a GE Plan
object, identified by the “GEPL” type in the series window. The
GE Plan object contains information equivalent to both the RT
Structure Set and RT Plan objects together. For compatibility
issues requiring continued export of the GE Plan objects,
contact the GE Field Service Engineer.
When loading a saved plan created by the current version of
Advantage Sim, or by another non–GE system, select the
DICOM RT Plan (standard object). This locates and loads the
corresponding DICOM RT Structure Set (containing structure
and marker information), and then the DICOM RT Plan itself
(containing beam information).
When loading a plan created by a previous version of Advan-
tage Sim, select the GE Plan (private object), which includes
all structures, markers and beams that have been defined in
the plan.

om 2235887–100 Rev. 1 Introduction 3–3

 It is also possible to select and load an DICOM RT Structure
Set (standard object), in which case only the structure and
marker information will be loaded. This option is useful when
importing data from an external system that exports RT Struc-
ture Set only (such as an image fusion application).
Refer also to Chapter 1 Safety and Chapter 15 Periodic Quality
Assurance Checks for further information on the transfer of
plans between Advantage Sim and other systems.
In previous versions of Advantage Sim, DICOM
3 CAUTION RT objects were used for export only and could be
deleted if not required. In the current version the
DICOM RT objects are also used for reloading the
treatment plan, and therefore must not be deleted.

Both the RT Plan and RT Structure Set objects

CAUTION must be kept if the treatment plan is to be reloaded.
Deleting an RT Structure Set means that the
associated RT Plan can no longer be loaded.

3–4 Introduction om 2235887–100 Rev. 1

CHAPTER 4

Starting Advantage Sim

Overview
This chapter explains how to start Advantage Sim from the
Advantage Workstation Browser, and the use of the Advantage
Sim main command panel.

Access to Advantage Sim

Advantage Sim is selected from the Advantage Workstation
Browser panel. 4
Creating a Treatment Plan from an Image
Series
Series/Images Selection
Before starting Advantage Sim for treatment planning from a
set of images, you must first select a series or set of images
from the Browser with the following criteria:

- The same field of view, matrix size and display center,

- The same orientation and gantry tilt = 0 degrees,

- Only ONE image for each location,

- Only AXIAL images.

Large Inter–slice distance between images may

CAUTION lead to insufficient precision of defined anatomical
structures. Precision depends on the inter–slice
spacing, and it is the user’s responsibility to
determine if the chosen inter–slice distance is
acceptable. A spacing of 5 mm or less is
recommended.

om 2235887–100 Rev. 1 Starting Advantage Sim 4–1

 Image details are never smaller than the inter–slice
CAUTION distance, and may not be visible if large inter–slice
distances are used. Precision depends on the
inter–slice spacing and slice thickness, and it is the
user’s responsibility to determine if the chosen
inter–slice distance and slice thickness are
acceptable.

The use of the wrong patient images may lead to

CAUTION incorrect treatment. Before use, verify that the
correct Patient Name and Exam Number were
entered on the CT scanner and selected on the
4 Advantage Workstation Browser (see description
of Browser in Advantage Workstation Operator
Manual).

Note: If only the first image is selected on the Browser, the entire
series is used for treatment planning.
Advantage Sim uses the FIRST selected image in the Browser
as a basis for using/discarding the other images for treatment
planning. This means that, for instance, any image with a
different matrix size or gantry tilt not equal to zero will be
discarded from the plan.
Details on series selection and general image management
can be found in the Advantage Workstation Operator Manual.
This manual describes the basics of image selection using the
Browser.

4–2 Starting Advantage Sim om 2235887–100 Rev. 1

The Browser Main Window
Patient Application
list list

Exams list
for patient

Series list 4
for exam

Image/object
list for series

The Browser Main window has the following sub–windows:

- Patient window (top left),
- Exam window (top right),
- Series window (center right),
- Image window (bottom).
Click left on the first image to select all the images in the
series.
Pull–down menus:
- Application Menu,
- Filter Menu,
- Utility Menu,
- Sort Menus.

om 2235887–100 Rev. 1 Starting Advantage Sim 4–3

 Buttons for specific features:

- Remote host selection,

- Lock screen,

- Remove selected Patient/Exam/Series/Image,

- Push selected Patient/Exam/Series/Image.

Note: See the Advantage Workstation Operator Manual for a detailed
description of the Browser screen and its features.

Starting Advantage Sim for Treatment Planning

4 Once the first image, or the images of your choice, have been
selected, click left on Advantage Sim in the Applications List
of the Browser window. If “Advantage Sim” is displayed below
the Applications List icon, then Advantage Sim can be started
by clicking left on the start button .

The Advantage Sim Main Command panel appears and will

remain (although it may be iconified) while the Advantage Sim
application is running.
Note: The Main Command Panel will always be present whatever the
status of the application, but some elements might be shaded
gray (i.e. the functions are unavailable). The header bar will
show the Advantage Sim version number.
Click left on the FILE Menu. Select [Build Patient Model]
option from the pop–up list. A pull–right menu appears with two
options:

- Standard The model is built using a 256 x 256 matrix.

- High Resolution The model is built using a 512 x 512

matrix.
Note: Although 512 x 512 matrix models give better imaging
resolution, the 256 x 256 matrix model is generally adequate
and will allow larger models to be built. It also allows more
rapid manipulation of images and rotation of 3D models.

4–4 Starting Advantage Sim om 2235887–100 Rev. 1

 Standard
(256x256)

High–Resolution
(512x512)

Patient Position
After Build Patient Model has been selected, the operator is
asked to confirm the position of the patient during acquisition of
the CT images.

om 2235887–100 Rev. 1 Starting Advantage Sim 4–5

 The patient coordinate system and beam positions
CAUTION may be incorrect if the patient position during the
CT image acquisition has not been correctly
identified. Verify that the position displayed on the
confirmation panel is correct.

Note: The patient position during CT image acquisition is an

operator–entered parameter at the CT scanner console. CT
scanner operators must be aware of the importance of this
parameter when images are to be used for virtual simulation
and treatment planning.
4 In the case of patients scanned in a Feet–First position (FFS or
FFP), Advantage Sim gives the opportunity to define the
treatment position as Head–First instead.

If the treatment plan will be transferred to a

CAUTION treatment planning system using the GE Private
Object format, then the patient position for
treatment MUST be the same as the patient
position during CT image acquisition, except if the
treatment planning system explicitly supports the
patient treatment position attribute.

4–6 Starting Advantage Sim om 2235887–100 Rev. 1

 The patient coordinate system and beam positions
CAUTION may be incorrect if the wrong treatment position is
selected. Be sure to verify the intended treatment
position and ensure that any difference between
acquisition position and treatment position is
properly documented.

In the case of patients scanned in the Feet–First position,

Advantage Sim will display the selected patient treatment
position and ask for confirmation.

Selecting a Previously Saved Treatment

Plan
Advantage Sim can also be started with a previously saved
treatment plan.

om 2235887–100 Rev. 1 Starting Advantage Sim 4–7

 Treatment Plan Selection
From the Browser window, click left on the desired series of
saved treatment plans in the Series window. Saved plan series
are marked RT in the Modality column. The Series “Type” must
be “RTPL”.

Appearance of Treatment Plans in the Browser Series and Image/object windows

4–8 Starting Advantage Sim om 2235887–100 Rev. 1

 Once a series of treatment plans is selected, individual
treatment plans appear in the Image window, with information
on:
- Date and time of last update.
- Operator name
- Plan label and plan name (comment)
To select a treatment plan, click left on plan.
The use of the wrong treatment plan may lead to
CAUTION incorrect treatment. Make sure that the correct
patient is selected and use the comment field to
uniquely identify the desired treatment plan.
4

Note: Advantage Sim saves and loads data only from its local
database, even if more than one Advantage Sim workstation is
installed on a network.

om 2235887–100 Rev. 1 Starting Advantage Sim 4–9

 Reloading a Treatment Plan
With a selected saved treatment plan, you can now start
Advantage Sim:
- Click left on Advantage Sim in the Application List of the
Browser window.
- Once the Initial or Main Command window is open, click
left on the FILE Menu and select [Load] from the pop–up
list.

Advantage Sim then displays the principal attributes of the

selected plan, and before loading asks for confirmation that it
corresponds to your choice.
Note: When a saved plan is reloaded, semi–transparent structure
surfaces do not appear on the 3D view.

4–10 Starting Advantage Sim om 2235887–100 Rev. 1

Selecting Plans Created by Previous Versions of
Advantage Sim
When selecting a treatment plan created by a previous version
of Advantage Sim, the GE Plan (private object) must be
selected instead of the DICOM RT Plan (standard object).
Saved GE Plan series are marked RT in the Modality column.
The Series “Type” must be “GEPL”.

Selecting Structure Sets

Some external applications (such as image fusion or structure
contouring applications) may create RT Structure Set objects 4
with no corresponding RT Plan. In these cases, the DICOM RT
Structure Set (standard object) must be selected. Saved RT
Structure Set series are marked RT in the Modality column.
The Series “Type” must be “RTSS”.

Reloading a Treatment Plan Created by an

External System
When Advantage Sim reloads DICOM RT Plan or DICOM RT
Structure Set objects that were created by a non–GE system,
a series of checks are performed to verify the coherence and
compatibility of the objects. During the loading and checking
process, the following types of errors and warnings can be
generated:
- User error messages, displayed in a panel at the end of the
loading process. If one or more user errors are detected,
the objects are not loaded. Depending upon the nature of
the error, the user may be able to take action on either
Advantage Sim or the external system to correct the
problem. Generally this type of error represents a violation
of the Advantage Sim requirements for object import,
specified in the Advantage Sim DICOM Conformance
Statement.

om 2235887–100 Rev. 1 Starting Advantage Sim 4–11

 - Log error messages, written to a log file that can be
examined by the field engineer. If one or more user errors
are detected, the objects are not loaded. This type of error
action (such as a DICOM protocol error) generally cannot
be resolved by the user, and requires intervention from GE
or the manufacturer of the external system.
- User warning messages, displayed in a panel during
loading of the object. User warnings do not prevent the
objects being loaded and used by Advantage Sim, but
indicate actions taken by Advantage Sim during the loading
process (for example, conversion of a structure color to the
closest Advantage Sim color, or beam modifiers such as
4 wedges that have been ignored). Such messages may also
indicate unusual but non–fatal conditions detected by
Advantage Sim (for example, structures without structure
names).
Note: If a large number of user errors or warnings are generated
during object loading, some of these messages may not be
displayed in the message panel. However, all log errors, user
errors and user warnings will be recorded in the log file. The
log file can be accessed using the AW on–screen (right button)
menu, selecting the option “AdvSim Service Tools”, then
“View”, then “DICOM Log”.
It is the user’s responsibility to verify that the
CAUTION parameters loaded into Advantage Sim correspond
to those generated on the external system.

All treatment plan data not relevant to the

CAUTION operation of Advantage Sim will be ignored and
discarded, including all dosimetry information and
all beam modifiers other than blocks (for example,
wedges, compensators and boli). Any plan
subsequently saved in Advantage Sim and
exported to another system will no longer contain
these data.

4–12 Starting Advantage Sim om 2235887–100 Rev. 1

 For correct interoperability of the external system
CAUTION and Advantage Sim, it is essential that the
treatment machine data used by the two systems be
coherent. Before importing treatment plans from
an external system, the treatment machine
database on the external system must be recreated
in the Advantage Sim machine database.

DICOM RT objects created by external systems will not contain

the GE private attributes present in objects created by the
Advantage Sim application itself. For a description of these
attributes, refer to the Advantage Sim DICOM Conformance
Statement. As a result:
4
- All beams will be placed in a single, default beam group,
with isocenters unlinked.
- Patient markers will be associated with the entire plan, and
not with specific beams.
- Machine name (and not GE Private Machine Instance UID)
will be used to find the corresponding Advantage Sim
machine.
- The user will be asked to enter the Build Resolution that
will be used to create the patient model.
Selecting Standard Resolution (256 x 256 pixels)
CAUTION when loading DICOM RT objects created in high
resolution by external systems can lead to multiple
structure contours being assigned to a single slice of
the 3D model. In general, High Resolution (512 x
512 pixels) should be selected when loading if the
external system uses greater than 256 x 256 pixels.

om 2235887–100 Rev. 1 Starting Advantage Sim 4–13

 Hints for Enhancing Compatibility with External
Systems
For Advantage Sim to accept and efficiently use DICOM RT
objects created by external systems, a number of compatibility
requirements must be met. This section gives some examples
of these requirements, including the most common ones.
However, an extensive list of requirements is described in
detail in the Advantage Sim DICOM Conformance Statement,
and the user must refer to this document regarding
compatibility issues.
Although many of these requirements are directed at the
4 manufacturer of the external system, the user must also take a
number of steps to ensure that the maximum level of
compatibility is attained.
In particular, the treatment machine names specified for the
beams in the imported plan must correspond to a treatment
machine name in the Advantage Sim database. If there is more
than one machine with the same name, the machine with the
highest numbered suffix is used. The user must ensure that the
Advantage Sim machine and the corresponding machine used
by the external system when creating the plan have compatible
parameters. Parameters to check include:
- Source–axis distance
- Particle types and particle energies
- Collimator types (symmetric, asymmetric in X or Y
directions, biasymmetric, multileaf in X or Y directions)
- Limits of collimator movement, number of collimator leaves
and collimator leaf widths
- Block tray distances

4–14 Starting Advantage Sim om 2235887–100 Rev. 1

 Once compatible treatment machines are defined, the following
general requirements must also be satisfied:
- All DICOM RT Objects must contain a Patient Name and
Study ID.
- At least 5 CT images must be used to create the plan
(typically many more than this are used to achieve good
DRR image quality).
- A Beam Name must not be used twice within the same
plan.
- A Block Name must not be used twice within the same
beam. 4
- Only static (not dynamic) beams must be defined.

om 2235887–100 Rev. 1 Starting Advantage Sim 4–15

 Blank page.

4–16 Starting Advantage Sim om 2235887–100 Rev. 1

CHAPTER 5

Layout for Advantage

Sim
Control panel Image Viewer
Main command panel

512x512 view 512x512 view

Display command panel

5
512x512 view 512x512 view

Mode panel

General layout for the Advantage Sim user interface

The general layout of Advantage Sim consists of:

- The Advantage Sim Image Viewer: A window of 1024 x

1024 pixels, normally divided into 4 views of 512 x 512
display pixels each.
- The Control Panel, with:
– A Main Command section, which has a menu with
functions not associated with display or patient
structure definition,
– A Display Command section, which controls
display–related functions, such as window level/width
presets, view placement/management and 3D view
rotations.

- A Mode panel.

om 2235887–100 Rev. 1 Layout for Advantage Sim 5–1

 There are two types of Mode panel but only one mode is active
at a time:
- A [Structures] panel for contouring, including functions
such as contour selection and editing, color selection,
addition of margins and selection of the active structure.
- An [External Beams] panel for the beam definition
process.
When the application is running, the main panel (with the Main
Command and Display Command sections) is always present.
The display controls are shaded gray if no patient model has
been built. When a model is built, the controls become
selectable and the [Structures] and [External Beams] items
then appear in the Mode menu of the main panel. Selecting
one of these items will cause the corresponding panel to
appear as the Mode panel.
5

5–2 Layout for Advantage Sim om 2235887–100 Rev. 1

CHAPTER 6

The Main Command

Panel
This chapter describes all the menus and buttons available in
the Main Command panel of Advantage Sim.

Standard
Build Patient Model High Resolution
Remove Couch
Clear Patient Model
Load Panel
Save Plan... Panel Ruler... Panel
RT Image Measurements... Panel
Save Image
Secondary Capture Graphics... Panel
Clear Beams
or Clear Structures 6
Print... Panel Backup RT Data Panel
Print Plan Data Restore RT Data Panel

About AdvantageSim... Panel Archive/Restore Patients Panel

Quit Preferences... Panel

Add...
Standard Groups Add...
Delete...
DRR Presets Delete..
RT Machine Data... Panel
Printer Calibration... Panel
Laser Camera Calibration... Panel
Structures Panel
External Beams Panel

Menu section of main panel

Access the Main Command window by clicking left on

Advantage Sim in the Application List of the Browser window.

om 2235887–100 Rev. 1 The Main Command Panel 6–1

 The Main Command window has the following menus:
- The FILE Menu,
- The UTILITIES Menu,
- The CUSTOMIZE Menu,
- The MODE Menu.

The FILE Menu

This menu contains the standard File functions associated with
Advantage Sim.
[Build Patient Model] allows you to construct a 3D model
from the images selected on the Browser window. It pops up a
pull–right menu with the options:
- Standard, which builds a model using a 256 x 256 matrix.
- High Resolution, which builds a model using a 512 x 512
6 matrix.
Although the 512 x 512 matrix provides better imaging
resolution, the 256 x 256 matrix is generally adequate and
allows a greater number of images to be used. It also allows
more rapid manipulation of images and rotation of 3D models.
[Remove Couch] allows you to remove the patient support
from the 3D model, provided that it is separated from the
patient by a low density material.
[Clear Patient Model] allows you to clear the currently loaded
patient model and associated treatment plan. New patient and
plan selection can be made after clearing the previous patient
model.
[Load] allows you to load the object currently selected in the
Browser window (it first builds the patient model associated
with the object). The object selected will normally be a DICOM
RT Plan, but can also be a DICOM RT Structure Set. For plans
created by a previous version of Advantage Sim, a GE Plan
must be selected. See Chapter 4 Starting Advantage Sim for a
full explanation of these options.

6–2 The Main Command Panel om 2235887–100 Rev. 1

 When a saved treatment plan is re–loaded the
CAUTION [Remove Couch] function is not activated
automatically even if it had been selected when the
plan was saved. SSD values for beams passing
through the couch may not be identical to chose
previously calculated. The user should check the
SSD’s and re–select the [Remove Couch] function.

Note: The transfer of plans to another system must be done using

the DICOM protocol unless plans are to be transfered to
another Advantage Sim station, when the SdCNET or
Advantage Net protocols can be used. Refer to the Advantage
Workstation Operator Manual for information about the
selection of network transfer protocol.
[Save Plan...] allows you to save the current status of the plan
(structures and beams) in the Advantage Workstation
database. If the plan has not been previously saved or has
been modified since the last save then a panel appears,
prompting for a comment and the name of the operator. 6
Selection of the incorrect treatment plan may lead
CAUTION to incorrect treatment. The final treatment plan
MUST be validated by an authorized specialist
before transfer or use. Advantage Sim can generate
several treatment plans for the same patient, and
the user is responsible for deciding which plan to
use for the actual treatment.

[Save Image] allows you to save the image in the active

window as either a Secondary Capture (SC) image or as an RT
Image. Only DRR images can be saved using the format RT
Image. The saved image will then be listed in the Browser
window. Images may be saved only if the current plan has
been saved and there have been no subsequent modifications.
[Clear Structures] or [Clear Beams] removes either all
defined structures or all defined beams, depending on the
selected mode. You need to confirm in either case.

om 2235887–100 Rev. 1 The Main Command Panel 6–3

 [Print...] pops up a window allowing you to define the
characteristics of the print operations and to request a
print–out on paper or laser film (an interface with your type of
film laser camera is an option of the Advantage Workstation
platform). The panel also allows specification of Scale (%) and
Source–Image Distance for Beam’s Eye Views.
[Print Plan Data] prints a plan “setup” sheet to the A4 laser
printer configured for the Advantage Windows platform. This
option is available only if the treatment plan has not been modi-
fied since it was last saved. The plan data sheet contains plan
information in a simple (non–graphical) format, and is suitable
for use in patient marking or inserting in the patient’s record.
See Chapter 11 Output to Printer for a description of the plan
data sheet.
[About AdvantageSim...] displays the Copyright panel and
software revision number.
[Quit] exits the application. If the plan has not been saved
since the last update, you are asked if you wish to save the
6 plan before quitting.
If you quit without saving a plan, you cannot
CAUTION recover the plan. Make sure that the plan will not be
required before quitting without saving the plan.

The UTILITIES Menu

The UTILITIES Menu contains other functions needed by the
application which are not standard File options.
[Ruler...] allows you to select or remove rulers, grids and/or
slice identification markings on the views. Slice identification
markers are only available on sagittal or coronal reformatted
images. Refer to Advantage Workstation 3D option Operator
Manual for more information on this function.

6–4 The Main Command Panel om 2235887–100 Rev. 1

 [Measurements...] allows you to make measurements of
distances, angles and areas. Click left on Create, then position
the cursor on the first point to be measured, and click left.
Next, press the (shift) key and move the cursor to the second
point and click left to see the distance between the two points.
Create further points to see the angle between two lines, or the
area enclosed by the points. Refer to Advantage Workstation
3D option Operator Manual for more information on this
function.
[Graphics...] allows you to control the display of graphics on
Advantage Sim views. Refer to Advantage Workstation 3D
option Operator Manual for more information on this function.
[Backup RT Data] allows data such as treatment machine
data, beam groups, and DRR preferences to be saved on a
diskette (See Managing Treatment Machine Data).
[Restore RT Data] allows you to restore RT Data from a
diskette, after entering the valid password (See Managing
Treatment Machine Data). 6
[Archive/Restore Patients...] allows you to archive patient
exams, including RT plans, to tape and to restore exams from
an Advantage Sim archive tape to the database (See Saving
and Restoring Patient Data).

The CUSTOMIZE Menu

The CUSTOMIZE Menu manages user–defined configuration.
[Preferences...] allows you to specify how you want the
product to be configured for structure definition. It is possible to
save different preferences under separate names (for example,
one set of preferences for each user). [Preferences...] is
selectable only when there is no currently defined plan (i.e. if
no structures or beams have been defined). (See Setting User
Preferences).
[Standard Groups] allows you to add, or delete standard
beam groups. The “Add Standard Group” function saves the
current beam group as a standard group. (See Defining
Beams).

om 2235887–100 Rev. 1 The Main Command Panel 6–5

 [DRR Presets] allows saving of current DRR settings as
preset DRR parameters, and also provides for deletion of
preset DRR parameters. When the user considers that the
active DRR parameters could subsequently be used on similar
DRRs, the user can save the parameters under a name which
can then be recalled for other simulations using the Beam
panel.
[RT Machine Data...] allows you to enter parameters specific
to a particular radiotherapy treatment machine (such as
machine distances, machine angle limits and rotation
directions, and beam energy data). (See Managing Treatment
Machine Data).
Note: Only authorized users — i.e. a physicist and not a standard
user — can modify treatment machine parameters. A
password is therefore necessary.
[Printer Calibration...] displays a panel allowing entry of the
horizontal and vertical size of the reference image on the
Advantage Sim printer. This allows the application to correct for
6 any inaccuracies in the printer mechanism.
Note: Scaled printing is enabled only if the printer has previously
been calibrated.
[Laser Camera Calibration...] displays a panel allowing entry
of the size of the reference image on a laser film camera. This
allows the application to correct for any inaccuracies in the
laser camera mechanism.

The MODE Menu

The MODE Menu allows you to select one of the two operating
modes for Advantage Sim:

- [Structures] allows you to create and edit structures and

markers.
- [External Beams] allows you to place and manipulate
external beams.
You cannot select the modes unless a patient model has been
built or a previously saved plan loaded. You can select only
one mode at a time.

6–6 The Main Command Panel om 2235887–100 Rev. 1

CHAPTER 7

The Image Viewer

This chapter describes all the possible views and the
operations that can be performed on the views.

Overview
A number of views –– usually four –– are visible at the same
time. The entire display area may also be used to display one
image. The types of view available are:

- 3D view which can be either a Physician’s Eye View or a

Beam’s Eye View and Digitally Reconstructed Radiograph.
- Axial view.
- Reformatted sagittal cut plane.
- Reformatted coronal cut plane.
- Any reformatted oblique plane.
- Reformatted plane along any curve.
- Density profile.
7
A given view can belong to one of following categories:
– A primary view, which is surrounded by a red border.
You make a view primary by clicking left once on the
view. Some operations apply themselves only to the
primary view. Only one primary view is available at a
time.
– A secondary view, which is surrounded by a green
border. Some operations with ‘precedence’ apply to
both primary and secondary views. There may be
more than one secondary view.
– An unselected view. Generally, operations do not
apply to unselected views.
When a new view is selected as primary, the old primary view
becomes a secondary view.

om 2235887–100 Rev. 1 The Image Viewer 7–1

 Note: Certain modes, such as Isomove, will automatically select all
views to ensure that displays are refreshed during
modifications.

The 3D Cursor
The 3D cursor provides 3D point identification on multiple
views (a red crosshair). If its position is outside the patient
model, the cursor appears as a yellow crosshair.

Moving the 3D Cursor

- Move the mouse pointer to the desired location on the
view. Press and hold down the Shift key. As long as you
keep the Shift key down, the 3D cursor follows your mouse
movements.
- When the 3D cursor is exactly where you want
it, release the Shift key to complete the cursor movement.
An alternate method is to point precisely on the 3D cursor,
press and hold left, drag to the desired location and release.
Because the defined point is 3D, as you move the 3D cursor
around one view, the other selected views will change
7 according to the cursor position.

View Selection
To select a view, click left anywhere on it EXCEPT on the red
on–screen “trackball” control points, the 3D cursor or any of the
red annotations.
The number of clicks produce different results:
- Clicking left ONCE on a view makes it primary (red border)
and changes the old primary view to a secondary view
(green border).
- Clicking left TWICE on a view makes it primary (red
border) and unselects all other views (no color border).
- Clicking left THREE TIMES on a view selects it as primary
(red border) and all non–icon views as secondary (green
border).

7–2 The Image Viewer om 2235887–100 Rev. 1

Axial View

An axial view with the on–view menu visible when the right
mouse button is pressed.

om 2235887–100 Rev. 1 The Image Viewer 7–3

 The On–View Menu
On axial views (and on other views), the following options are
available on the On–View Menu by holding down the right
mouse button while the cursor is in an image window.
- [Enlarge] allows you to increase the size of the current
image to full–screen size. The menu then changes so that
this selection becomes [Reset Size]. When the size is
reset back, all other views which were present become
visible again.
- [Reset pointer] allows you to move the 3D pointer back
into the center of the view. This is useful if the image needs
to be moved a long way from the image center (when the
image is zoomed, for example).
- [Set front depth (>)] allows the user to position the DRR
depth control plane closest to the beam source, so that it
intersects the current 3D cursor position. The front depth
plane is displayed as a dotted line on the axial view, with
the “>” symbol alongside the line. The menu option and
dotted line will appear only if the “depth control” option has
been selected on the DRR. See the section Beam’s Eye
7 View for a full description of this feature.
- [Set back depth] allows the user to position the DRR
depth control plane farthest from the beam source, so that
it intersects the current 3D cursor position. The back depth
plane is displayed as a dotted line on the axial view. The
menu option and dotted line will appear only if the “depth
control” option has been selected on the DRR. See the
section Beam’s Eye View for a full description of this
feature.

7–4 The Image Viewer om 2235887–100 Rev. 1

User–Selectable Items
These appear in red on the display:
- {3D cursor} normally appears as either a red cross
(default) or a small red dot in the center of the view. This
pointer appears simultaneously on all views, indicating the
position in 3D of the selected point.
- {Orientation annotations} appear to the center of each
view edge (A, P, R, L, I and S ). They are accompanied by
a number giving the distance from the edge to the center of
the field of view. If these annotations are in red, then the
position of the view within the window can be changed by
clicking and dragging on the annotation.
- {Patient name annotation} (at the top right). Click on this
to hide the patient name from view, replacing it by ‘****’ as
in the figure.
- {Window width} and {Window level annotations} (at the
bottom left). Modify the window level by clicking and
dragging with the middle button, and moving vertically.
Drag horizontally to change the window width.
- {Field of view annotation} ({DFOV} at the top left). Click
7
on the left or right mouse buttons over this annotation to
increase or decrease the view size within the current frame
size. Modify the view size continuously by clicking and
dragging on the middle mouse button.
- {Image annotation} ({Im} at the top left) is available only
for the acquisition views (normally axial) and indicates the
index of the current slice. Modify it continuously by clicking
and dragging on the middle mouse button. Use the left or
right mouse buttons to increase or decrease it’s value.

Non–Selectable Annotations
These are available on a standard view. Examples are image
series parameters (top left corner), and other parameters
(hospital and doctor names). At the lower right corner of the
view is a small cube showing the orientation of the slice with
respect to the ‘acquisition cube’.

om 2235887–100 Rev. 1 The Image Viewer 7–5

 Representation of Beams

Axial view in Advantage Sim user interface

The intersection of the beams with the view are also displayed
(see figure). The two slightly diverging lines represent a beam
which is in the axial plane. The parallelogram represents a
beam crossing the plane from a large angle.
The current (active) beam will be displayed in red and the other
(non–active) beams in green.
Patient Markers
Patient markers are also displayed on the axial view.
A marker is represented as a small cross, oriented in the same
plane as the acquisition slices (although not necessarily
located on a slice). A marker is always drawn in yellow.

7–6 The Image Viewer om 2235887–100 Rev. 1

3D View
A typical 3D view is illustrated in the figure below:

3D view in the Advantage Sim Image Viewer

This type of view is available in several modes, including:
- The [Surface] mode, which is the most routinely used.
- The [MIP] mode (maximum intensity pixel projection),
which is useful for visualizing some internal structures,
such as large regions of bone.
Refer to Advantage Windows 3D Operator Manual for a full
description of the display modes.

om 2235887–100 Rev. 1 The Image Viewer 7–7

 Additional Items in the 3D View
The general layout of the 3D view is similar to that of other
views, but there are a few small differences.
On–View Menu
The On–view Menu has the following additional items:
- [Lock orientation] prevents the view from being rotated. If
you select this, [Unlock orientation] appears on the
menu.
- [center on FOV] centers the view on the image field of
view.
- [center on object] centers the view on the center of the
current object. This is essentially the same as [center on
FOV] except when the patient is not near the center of the
scan.
- [Reset pointer] positions the 3D cursor at the center of the
view.
‘User–Selectable’ Items
7 - The 3D cursor, when selected, changes into a red
rectangle known as the trackball. Use the trackball to
change the orientation of the 3D view.
- The {Orientation annotations} change to show the
quadrant containing the given view edge (e.g. AL = anterior
left). Oblique view orientations are also described in this
way.
The surface represented in the 3D view is based on a
CAUTION pre–defined threshold of CT pixel values. Image
features and CT scanner calibration may make the
3D view unrepresentative of the actual patient
surface.

7–8 The Image Viewer om 2235887–100 Rev. 1

 Beam Display
A beam is shown on a 3D view by a group of diverging lines
(four for a standard collimated beam, but more for an MLC
beam). The lines will appear to come from the beam origin and
disappear into the patient surface. The entrance portals of the
beams are drawn on the patient surface.
Note: The orientation indicator cube at the lower right of the view is
replaced by a simplified patient with right arm raised, and a
schematic illustration of the patient’s face. These indicators are
designed to help visualization of the patient’s orientation.
The system does not prevent beams being defined
CAUTION which enter the patient model through the end CT
slices of the data set and which may not be valid for
subsequent dosimetry planning. Ensure that all
beams enter through the patient surface and not
through the end CT slices of the data set.

om 2235887–100 Rev. 1 The Image Viewer 7–9

 Beam’s Eye View

Beam’s Eye View

The major difference between the Beam’s Eye View (BEV) and
the other views is that the projection is conic, i.e. the patient is
viewed from a point source and not from a point at an infinite
distance from the viewing plane.
In the Beam’s Eye View, the viewing point coincides with the
beam origin, which is defined by the Source–Axis Distance
(SAD) in the selected RT Machine data file, for both photon
and electron beams. The displayed field of view ({DFOV})
shown on the image is in the plane perpendicular to the
currently selected beam axis containing the machine isocenter.

7–10 The Image Viewer om 2235887–100 Rev. 1

 The Beam’s Eye View shows:
- The collimator opening of the active beam. For standard
symmetric, asymmetric and bi–asymmetric collimators, the
opening is a rectangle.
For multileaf collimators, the opening is a more complex
polygon composed of ‘steps’.
The shape of the collimator may be adjusted using
on–screen editing.
When the collimator angle is changed, it appears rotated
on the BEV (i.e. the structures will not rotate). In the
diagram, the large rectangle represents the beam.
- Beam modifiers defined for the active beam. The types of
modifier available are photon blocks and electron cut–outs.
These are represented by a polygon displayed using dotted
lines, to differentiate them from full fields.
- Patient structures projected onto the isocentric plane. All
structures previously defined in the structure mode are
represented on the BEV. They may be shown in one of two
different but complementary ways:
– An external contour (envelope), representing the outer
limit of the projected structure, depending on the view 7
angle.
– A conical projection of all the 2D contours in each
structure.
Structures are displayed in the color that was defined using
the structure mode.
Structures cannot be modified on the BEV.
- The RT machine isocenter for the current beam. This is
represented by a small cross and a graduated crosshair
which can be activated and disactivated using the
on–screen menu.
- The Beam Name for the current beam, displayed as an
annotation in the lower left corner of the image.
- The Isocenter Coordinates (in the RAS coordinate system)
for the current beam, displayed as an annotation in the
lower left corner of the image, below the Beam Name.

om 2235887–100 Rev. 1 The Image Viewer 7–11

 Note: The beam isocenter (i.e. the rotation point of the Beam’s Eye
View) generally does not coincide with the 3D cursor position,
except when “Isomove” mode is active.
The On–View Menu for the Beam’s Eye View
The On–View Menu provides the following functions:
[Enlarge / Reset pointer] allows the view to be enlarge to fill
the entire view area, and reduced to the standard
quarter–screen size.
[Show/Hide crosshair] shows/hides the graduated crosshair
centered on the isocenter of the current beam. The crosshair
displays an annotation “IEC X+” along one of the axes, which
indicates the collimator rotation on the BEV.
[Capture Image] allows a DRR image to be captured for later
merging with another DRR image using the BLENDING mode
(any modification to the treatment plan parameters cancels the
captured image). This option is present only when BLENDING
mode is not active.
[Show/Hide contours] shows/hides the contours displayed in
the interior of structures. The structure envelopes are always
displayed.
7
Beam’s Eye View Annotations for Hardcopy
Output
The Beam’s Eye View image can be stored as an RT Image or
SC Image in the Advantage Windows database using the
[Save Image] option in the FILE Menu. In addition, Beam’s
Eye View images can also be sent to a laser camera using the
[Print...] option in the FILE Menu (see Chapter 11 Output to
Printer). In these cases, the following additional annotations
will appear on the hardcopy image (but will not be visible on
the screen):
- IEC table offsets in lower left corner of image (laser
camera only).
- Plan comment in lower left corner of image.
- Source–axis distance (SAD) of machine used for displayed
beam, in top left corner of image (laser camera only).

7–12 The Image Viewer om 2235887–100 Rev. 1

 - Source–image distance (SID) in top left corner of image
(laser camera only).
- Gantry, collimator and table angles of displayed beam, in
top left corner of image. These angles are displayed in the
currently selected coordinate convention.
If displayed machine angles are to be used for
CAUTION treatment setup, it is essential to verify that the
displayed angles are in the desired coordinate
convention (Machine or IEC).

User–Selectable Items
- {DRR} A Digitally–Reconstructed Radiograph (DRR), will
be generated when (DRR) is selected, Advantage Sim will
calculate a image by ray–tracing from the beam origin to a
plane beyond all voxels in the patient. For each ray, an
integral of the voxel densities is used to generate the
image. (DRR) is automatically selected when the Beam’s
Eye View is selected.
You can create a conically–constructed MIP (maximum
intensity pixel) projection (DRR Max), which will provide a
visualization mode where dense structures can be readily
identified. 7
Note: If the patient support is included in the model and within
projection of the beam, then it will be included in the DRR
image.
- {Std Res} / {Hi Res} / {OVERDRRIVE}
Both DRR and DRR–Max images can be generated in
standard, high definition (Hi Res) or OVERDRRIVE modes.
The sampling step size of the Hi Res mode is smaller than
that used in the standard mode.
OVERDRRIVE mode allows faster re–calculation of DRR
with reduced sampling frequency.
Note: Due to the sampling step size used in the standard or
OVERDRRIVE DRR, small localized objects (small skin
markers, for example) may not appear in the resulting DRR
image. Use of the Hi Res mode may overcome this problem.
Note: Refer to cautions contained in Chapter 1, Series/Images
selection relating to slice thickness and slice spacing.

om 2235887–100 Rev. 1 The Image Viewer 7–13

 - {No IsoMove} / {ISOMOVE}
When ISOMOVE is active, the position of the currently
selected beam’s isocenter is linked to the 3D cursor in all
active views. The isocenter can therefore be adjusted by
positioning the 3D cursor in any view. All other beams in
the same group will also be moved if ”Link Isocenter” is
selected. The beam’s eye view and DRR are updated
interactively as the 3D cursor is moved.
The message ”Move Isocenter” is displayed on the DRR to
indicate that Isomove mode is active.
The isocenter position can inadvertently be moved
CAUTION if Isomove remains active. Once the isocenter
position has been determined, be sure to deactivate
Isomove. The Isomove mode also interacts with the
“Depth Control” mode, that is referenced with
respect to the isocenter.

Note: ISOMOVE is deactivated automatically when Structures mode

is selected and when another beam is selected which has a
different isocenter position from the previous beam’s isocenter
position.
7 Note: ISOMOVE is deactivated automatically when Blending mode is
active.
Note: During interactive movement of the isocenter, the DRR is
displayed at reduced resolution. The currently selected
resolution is calculated after movement stops.
Note: If the 3D cursor is moved on the Beam’s Eye View/ DRR, the
isocenter will remain on the plane which is perpendicular to the
beam axis and passes through the isocenter (i.e. the isocenter
depth remains unchanged).
Note: When ISOMOVE is activated, the position of the 3D cursor is
moved to the currently selected beam’s isocenter.

7–14 The Image Viewer om 2235887–100 Rev. 1

 - {No Mixing} / {MIXING 1 1 1 –200 150 A}

MIXING allows the DRR to be modified to highlight or

suppress certain structures as a function of their pixel
values.
MIXING is managed using six parameters controlling four
density ranges. The six corresponding annotations, in order
of appearance, are: 7
– Low density tissues (e.g. lungs), with pixel values
between 1300 and –200. This parameter represents
the relative weighting (between 0 and 100) of this
density range in the DRR image.
– Soft tissues, with pixel values between –200 and
+150. This parameter represents the relative weighting
(between 0 and 100) of this density range in the DRR
image.
– Bone tissue, with pixel values above +150. This
parameter represents the relative weighting (between
0 and 100) of this density range in the DRR image.

om 2235887–100 Rev. 1 The Image Viewer 7–15

 – The last three parameters control a density range
which can be modified by the user to cover any
sub–range of image pixel densities. These parameters
represent the lower density threshold, the upper
density threshold, and the relative weighting of this
custom range. By default, this range is set to the soft
tissue thresholds (–200 to +150) and the relative
weighting of this range on the DRR is A.
– 200 : default low threshold value for custom range.
150 : default high threshold value for custom range.
A : relative weighting of custom range in the DRR
(between 0 and 100).
To adjust one of the values, position the cursor on the
value and:
– Click left to increase by one,
– Click right to decrease by one,
– Click middle and slide left or right to decrease or
increase the value.
All MIXING parameters, in particular the custom range
threshold and weighting values, can be modified by typing
7 the value while positioned over the corresponding
annotation. The sign “–“ must be typed first to enter a
negative threshold value.
To see the result of the custom range limits before
generating the image, click right on the MIXING option then
click left on “Preview Custom Range”. This will display in
green shading (as in automatic contouring) in the axial,
coronal, and sagittal views, the pixels included in the
density range specified by the custom range.

7–16 The Image Viewer om 2235887–100 Rev. 1

 Here are some examples of relative weights and their effect:

Low density Soft Tissue Bone Custom Custom Weighting

Threshold 1 Threshold 2

1 0 0 –200 +150 0

Low density Soft Tissue Bone Custom Custom Weighting

Threshold 1 Threshold 2

0 0 1 –200 +150 0

Combinations used will depend on body region and

structures to be seen or suppressed.

om 2235887–100 Rev. 1 The Image Viewer 7–17

 When Mixing is active and the weighting factors
CAUTION are not equal then not all ranges of pixel values are
equally visible, and the resulting image may
suppress some anatomical structures. The custom
range has priority over the others if its limits are
close to those of the fixed ranges.

- {No Depth Control} / {DEPTH CONTROL 0 50}

With No Depth Control, the DRR is calculated from all

pixels which lie on each line of projection.
DEPTH CONTROL provides DRR calculation using a
user–definable “slab” of the 3D patient model, rather than
the entire model.

7–18 The Image Viewer om 2235887–100 Rev. 1

 DEPTH CONTROL allows the offset with respect to the
isocenter (first displayed value) and thickness (second
displayed value) to be adjusted such that the DRR is
calculated from a slab of pixel data which is perpendicular
to the beam axis. (See figure below).
By default, DEPTH CONTROL is centered on the
isocentric plane, with a thickness of 50 mm (i.e. DEPTH
CONTROL 0 50)

Isocenter

Offset

Thickness

The front and back limits of the slab can also be defined
using the 3D cursor. This is done by positioning the 3D
cursor at the desired limit, then clicking right on the axial 7
view and selecting the corresponding on–view menu option
(Set Front Depth or Set Back Depth). See the section
Axial view for a description of this feature.
Depth Control can be used to enhance the DRR projection
of selected structures, excluding tissues above and below
which affect the clarity of the final image.
It can also be used, when the thickness is set to ’1’, to view
slices perpendicular to the beam axis.
When the path length is reduced, not all anatomical
CAUTION structures in the CT data set are projected onto the
resulting DRR image. For a full projection which
can be compared with an X–ray image, deselect the
Depth Control feature.
Note: Depth Control does not affect the wire frame projection of
defined structures which are always projected in full.

om 2235887–100 Rev. 1 The Image Viewer 7–19

 Effect of DEPTH CONTROL on visibility of a structure

- {No BLENDING} / {BLENDING POS 50}

Blending is active only if an image has previously been
captured using the DRR on–screen menu option {Capture
Image}.
Blending permits the merging of two DRR images on the
same beam, where the two images were created using
7 different values for Mixing or Depth Control parameters.
Any modification of treatment machine parameters cancels
BLENDING and deletes the captured image.
Blending can be utilized in “positive” mode (by default), or
“negative” mode, where the captured image pixel values
are inverted before being combined with the second DRR
image. This is done by clicking right on the POS annotation
and selecting NEG instead.
The relative weights (from 0 to 100) of the two component
images can be modified using the annotation to the right of
POS/NEG. By default its value is 50, representing equal
weighting of the current and captured images. Values less
than 50 weight the current image more heavily, while
values greater than 50 weight the captured image more
heavily.

7–20 The Image Viewer om 2235887–100 Rev. 1

 Examples of different blended images:

Blending 10% Blending 50% Blending 90%

Note: The MIXING and DEPTH CONTROL parameters of the

captured image are displayed in green, underneath the
parameters of the current image (displayed in pink). Similarly,
the lines defining the depth control regions are green for the
captured image and pink for the current image.

Machine Diagram
A schematic diagram (100 x 100 pixels) of a treatment
machine is displayed in the lower right corner of the BEV. It
shows the: 7
– machine gantry angle
– machine collimator angle
– machine table (patient support) angle
– treatment position of the patient for the currently
selected beam.
The diagram displays the above entities using one of three
viewing angles:
– Looking from room (default)
– Looking from top
– Looking towards gantry
It can also be enlarged to 200 x 200 pixels.
Click right on the machine diagram to access the machine
diagram controls.

om 2235887–100 Rev. 1 The Image Viewer 7–21

 Color Coding
– The machine gantry is displayed in pink.
– The machine collimator is displayed in blue, with a red
line on one face representing the IEC collimator (Beam
Limiting Device) zero position.
– The treatment table is displayed in blue, with a red line
allowing determination of the IEC Table (Patient
Support) angle.
– The right arm and right leg of the patient are displayed
in green, with the right arm bent to differentiate it from
the left arm.
– The left arm and left leg of the patient are displayed in
red.
– The chest and nose of the patient are displayed in
white.

7–22 The Image Viewer om 2235887–100 Rev. 1

CHAPTER 8

The Display Command

Panel
This chapter describes the menus and buttons available in the
Display Command panel.

Windowing parameter presets

Tilt/Rotate and Oblique icon

No view
3D
Axial
Sagittal
Coronal
Oblique
Profile 8
Curved

3D view orientation buttons

Start/Stop movie loop
Slow Movie loop speed
Fast

Display Command Panel

om 2235887–100 Rev. 1 The Display Command Panel 8–1

 The Display Command panel controls the appearance of the
images via:
- The (Tilt/Rotate) and (Oblique) radio buttons, mutually
exclusive functions which control the operation mode of the
mouse. In (Tilt/Rotate) mode, you can use the mouse to
grab the 3D cursor and rotate the 3D view. In (Oblique)
mode, you can use the mouse to rotate and translate the
planes of reformatted (oblique) views, which appear as
lines in the other defining views.
- The windowing parameter presets, which control the
window level and window width of all selected (primary and
secondary) views. The names and values of these presets
are set using the Settings Menu in the Advantage
Workstation viewer, and not by the Advantage Sim
application directly. You can also use the center mouse
button to control the window parameters directly on the
views themselves.
- The (view type) buttons, control which types of view
appear at which locations in the viewer. Advantage Sim
supports the 3D, axial, sagittal, coronal, oblique, profile,
and curved view types of the 3D viewer. Beam’s Eye View
and DRR are only displayed in a 3D view type.
- The (3D view orientation) buttons, which control the
orientation of the 3D view (if it exists). The six standard
baseline views are selectable. For other angles, the user
must rotate the view using the on–view 3D cursor.
8
- The (Start/Stop movie loop) button, which controls the
operation of slice–based movie loops. Press (Start) to
place the 3D cursor at the center of the first axial slice,
which then moves successively to all the other slices. If the
user has defined an axial view, this feature can be used to
verify the status of the outlining process on each axial view.
- When the movie loop is running, the button annotation
changes to (Stop), and pressing the button again causes
the movie to stop execution (and the button changes back
to (Start)). This function is selectable whether or not there
is a currently defined axial view.
- The (Movie loop speed) button, which controls how fast the
acquisition slices are scrolled when the movie loop is running.
This button gives a choice of two speeds: (Slow) and (Fast).

8–2 The Display Command Panel om 2235887–100 Rev. 1

CHAPTER 9

Defining Anatomical
Structures – The Patient
Structures Panels
The Structures Command Panel
This provides functions specific to the structure definition
application functions. Access is via Structures at the bottom of
the main panel.

Structures
External Beams

Main Panel

om 2235887–100 Rev. 1 Defining Anatomical Structures – 9–1

The Patient Structures Panels
 Add List
Red Body
Blue Left Lung
Green Spinal Cord
Yellow
Pink
Violet
Visible
Invisible
unknown
external
Panel PTV
Panel CTV
Panel ...

Edit mode Panel

Fill mode Panel
Automatic mode Panel
Panel

‘Patient Structures’ panel

- The Structure menu selects the structure currently being

9 modified (i.e. the current structure), or allows new
structures to be added.
- (Add) adds a new structure to the plan. The structure
names are the same as those in the structure list of the
‘Preferences’ panel (see following sections). They normally
include: [GTV], [CTV] and [body], and others such as
[spinal cord], [left lung], [right lung] etc. Structure
names which are already used are shaded in gray in the
pull–right menu.
Note: The structure names list may be added to or modified using
“Preferences” on the “Customize” menu.

9–2 Defining Anatomical Structures – om 2235887–100 Rev. 1

The Patient Structures Panels
 Note: Advantage Sim supports a maximum of seven internal
semi–transparent surfaces on the 3D view. If eight or more
structures are defined, then the semi–transparent surfaces will
not be displayed.
If the structure name is not on the list, you can select [Other...]
on the pull–right menu. A window appears, asking for the name
of the new structure. It then adds the structure to the structure
list defined for that patient and makes it the active structure.
The contouring thresholds are then set to their extreme values,
color is assigned a default value by cycling through the colors
in the order of the last use, and visibility is turned on.
- The Color menu changes the color of the contours
associated with the current structure. There is a choice of
six colors: red, blue, green, yellow, pink and violet.
- The Contours menu controls how the current structure will
appear on the views. Select [Invisible] and the structure
contours become invisible on all the views. Select [Visible]
and the structure is represented as contours, and also as a
semi–transparent surface if applicable.
You can select an invisible structure using the structure
selection list, but the property of visibility is not saved with the
structure when it is written to the Advantage Workstation
database. All structures are visible as wire frames immediately
after you load a structure set from disk.
All structures have a “wire–frame” appearance only (and not a
semi–transparent surface) after a plan is loaded.
- The Type menu allows the current structure to be defined 9
as having a type of unknown, external, PTV, CTV, GTV,
avoidance, organ, contrast, or cavity. The structure type
may be used when a plan is transferred to a treatment
planning system to determine how the structure is handled.

om 2235887–100 Rev. 1 Defining Anatomical Structures – 9–3

The Patient Structures Panels
 The structure types used are different from those
CAUTION used in previous version of Advantage Sim. This
modification has been made by GEMS in order to
conform to the recommendations of the DICOM
RT and ICRU50 standards. The following table
shows the correspondence between the old and new
types, and the contents of the DICOM RT Structure
Set ‘RT ROI Interpreted Type’ attribute.

AdvSim 4.0 AdvSim 1.2 DICOM RT

and later and AdvSim Structure Set
3.0
External Body EXTERNAL
PTV Target PTV
CTV – CTV
GTV Tumor GTV
Avoidance – AVOIDANCE
Organ Organ ORGAN
Contrast – CONTRAST
_AGENT
Cavity – CAVITY
Unknown Unknown Zero–length

Selecting the following buttons pops up subwindows:

9
- (Rename) modifies the alphanumeric name of the
structure.
- (Delete) (after confirming the action) deletes the entire
current structure.
- (Margins...) adds a user–defined margin to the current
structure. A window appears, asking you for the margins in
each of the six directions (Anterior, Posterior, Left, Right,
Inferior, Superior), and the name of the new structure.
This facility is used primarily to define target volumes from
tumor volumes, but you can also use it for other structures.

9–4 Defining Anatomical Structures – om 2235887–100 Rev. 1

The Patient Structures Panels
 Note: When the (Margins) function is used to define a new structure,
the semi–transparent surface for that structure will not appear
on the 3D view.
- (Auto) allows you to define (or re–define) the current
structure using automatic outlining tools. These allow you
to set the structure thresholds, place the cursor within the
structure, then start automatic structure definition.
- (Fill) allows you to define (or re–define) the current
structure using tools with which you draw (using a small,
medium or large paintbrush) the structure shape on a
number of selected parallel slices, then interpolate between
the slices to yield a 3D structure which can be converted
into a set of 2D contours. There is a [magnetic] cursor
option, where the line drawn tends to follow discontinuities
in patient density.
- (Edit) allows the contours of the currently selected
structure to be modified by adding and removing contour
segments.
Note: Advantage Sim does not model structures containing enclosed
contours. Enclosed contours created using the (Auto), (Fill) or
(Edit) modes will be eliminated.
- (Markers) allows you to add, move or delete patient
markers. Markers defined in this panel will NOT appear in
the Laser Marking Review panel (described later in this
chapter).
The following sections specify the function of sub windows
attached to the Patient Structures window. 9

om 2235887–100 Rev. 1 Defining Anatomical Structures – 9–5

The Patient Structures Panels
 Adding a new Structure

The Add Other Structure window

This window appears when you select (Add) in the Patient
Structures panel, followed by [Other] when the menu
appears. All other input is impossible. It allows you to add a
structure which is not available in the structure list. Type the
name of the desired structure in the text entry field (up to 16
characters), then select (OK).

Renaming a Structure

The Rename Structure window

This window appears when you select (Rename) on the
Patient Structures panel. It allows you to rename the current
structure. All other input is impossible. The window opens with
the current name of the structure in the entry field. Enter the
new structure name (up to 16 characters), then select (OK).

9–6 Defining Anatomical Structures – om 2235887–100 Rev. 1

The Patient Structures Panels
Editing a Structure

The Edit Structure panel

This panel appears when you select the edit icon from the
Patient Structures panel. It allows you to select and edit the
contours of the current structure. The current structure is
displayed in red. When the panel is active, only contours
forming part of the current structure are selectable.
If a 3D view is the primary view then the Perimeter, Area and
Volume are all displayed as zero.
Note: The edit function is intended for small modifications to existing
9
contours: for larger modifications use the feature defined on
the previous pages to re–create the desired structure on the
planes where changes are required.
Note: When the edit function is used to modify a structure, the
semi–transparent surface for that structure will no longer
appear on the 3D view.
Use the mouse to select and edit a given contour, then use:
- (Delete) to remove the current contour.
- (Apply) to save the current contour modifications.

om 2235887–100 Rev. 1 Defining Anatomical Structures – 9–7

The Patient Structures Panels
 - (Undo) to cancel the last editing action.
- The Total length display field for the absolute perimeter (in
mm) of the current trace.
- The Area display field for the absolute area (in mm2) of the
current trace.
- The Volume display field for the volume (in cm3) of the
structure containing the current trace.
- (Close) to quit and return the application to its previous state.
To edit a structure, press and hold down, the ‘◊’ key on the
lower right of the keyboard. Editing points will then appear on
the contour. Position the cursor on the point closest to the
place where you wish to start the contour modification, and
click left on the point. This begins the first segment of the
modification. Position the cursor at the end position of the
segment, and click left to draw the segment and begin another.
Continue creating segments by clicking left on the view. The
last segment must be attached to one of the points of the
original contour. Advantage Sim then displays in violet the
original contour segments selected to be deleted by the editing
operation. Alternatively, if the violet part of the contour is to be
conserved, pressing the (space bar) will select the other part of
the original contour as the segments to be deleted. Finally,
select {Apply} in the ‘Edit Contours” panel to apply the
modifications.
When using the space bar to change the selected
CAUTION segment, the mouse cursor must not be positioned
9 on an Advantage Sim (blue) panel (this will cause
the last panel action to be repeated, instead of
changing the contour segment).

If a structure has more than one contour on a given plane then

the contour to be edited can be selected by clicking left on the
contour to be edited.

9–8 Defining Anatomical Structures – om 2235887–100 Rev. 1

The Patient Structures Panels
Deleting a Structure

The Delete Structure window

This panel appears when you select (Delete) in the Patient
Structures panel. It allows you to delete the current structure.
All other input is impossible. Confirm the deletion or otherwise.

om 2235887–100 Rev. 1 Defining Anatomical Structures – 9–9

The Patient Structures Panels
 Adding Margins
None
Pairs
All

Structure name

Margin sliders

Apply margin
Cancel

The Margin window

This panel appears when you select (Margins) in the Patient
Structures panel. It defines a new structure based on an
existing structure, but with an added margin. It has the
following controls:
- The Name entry field for the name of the new structure (up
to 16 characters).
- The Link Menu, with the following choices:
– ([None]) the sliders are independent,
– ([Pairs]) the IS (Inferior and Superior), AP (Anterior
9 and Posterior), LR (Left and Right) are linked,
– ([All]) all sliders are linked. The default is [All].
- The {Inferior} slider, controls the inferior margin.
- The {Superior} slider, controls the superior margin.
- The {Left slider}, controls the left margin.
- The {Right slider}, controls the right margin.
- The {Anterior slider}, controls the anterior margin.
- The {Posterior slider}, controls the posterior margin.

9–10 Defining Anatomical Structures – om 2235887–100 Rev. 1

The Patient Structures Panels
 - (Apply), generates the new structure based on the current
margins, adds it to the structure list and closes the window.
- (Cancel), cancels the margin definition, closes the window
and returns the application to its previous state.
An automatically applied margin may not define
CAUTION the desired volume. The user must check all
contours after the use of this function.

Margins are added to structure along the orthogonal axes as

follows:
Left, Right, Anterior, Posterior margins:
The selected L, R, A, P margins are applied orthogonally to all
points of the original structure on each CT image plane.
A

R L

M(D)M(G)
M(A)
M(P)
P 9
Superior, Inferior margins:
After application of the L, R, A, P margins, the system copies
the resulting structure from the extreme Inferior and Superior
CT planes onto the adjacent planes until the Inferior and
Superior margins are reached.

om 2235887–100 Rev. 1 Defining Anatomical Structures – 9–11

The Patient Structures Panels
 Defining a Structure in Automatic mode

Threshold sliders

Off
1 voxel
2 voxels
3 voxels
4 voxels
5 voxels
Close panel
Remove contours
Apply automatic

The Automatic window

This panel appears after selecting (Automatic) in the Patient
Structures window. It provides an automatic thresholding
mode. All other input is impossible. For automatic contouring of
the entire structure on the regions satisfying the threshold
limitations (shaded semi–transparently in green), place the 3D
cursor within a structure (preferably close to the structure
edge if the local contrast is low) and select (Automatic).
9 The panel has the following features:
- {Threshold sliders}, which control the minimum and
maximum CT numbers allowed in the region of interest.
For structures with high local contrast, the contouring
algorithm will be relatively insensitive to these settings.
When adjusting these values, pixels within the range are
shaded with a green color wash to indicate the likely result
of the contouring operation.
For standard structures (spinal cord, lung etc.), there are
default settings for these thresholds, which the user can modify
in the [Preferences] window.

9–12 Defining Anatomical Structures – om 2235887–100 Rev. 1

The Patient Structures Panels
 - The Remove Bridges Menu, which controls whether or
not the automatic thresholding algorithm removes small
connections between adjacent structures, and what size
bridges will be removed. The volume, determined from the
threshold values selected, is first reduced in size by
erosion of voxels from its surface. Any bridge smaller than
or equal to the number of layers selected will be removed
and disconnected volumes discarded. The resulting volume
is then dilated to the original size.
Note: The erosion–dilation process will also smooth the surface of
the structure and remove small irregularities.
- (Apply), is selected if the currently indicated volume is to
be contoured, and added to the current structure defined in
the Patient Structures panel. The panel remains open,
showing the thresholds used, until the user is satisfied with
the result and closes the panel using (Close). If Advantage
Sim detects that a large number of internal contours have
been taken into account by the automatic contouring, and
that the internal contour elimination could take several
minutes, then a panel warns the user and asks if they wish
to continue.

Contouring Confirmation window

- (Remove), which removes the contours currently defined

for the structure, but maintains the panel open with the
currently defined thresholds. This option will be selectable
only immediately after an (Apply) operation.
- (Close), which closes the Automatic panel

om 2235887–100 Rev. 1 Defining Anatomical Structures – 9–13

The Patient Structures Panels
 The shape of volumes defined automatically may
CAUTION not conform to the desired anatomic structures on
all images. All volumes defined automatically
should be carefully checked to ensure
conformation to the desired anatomical
structure(s).

At the Superior and Inferior limits, the

CAUTION erosion–dilation process may produce contours
which are smaller than desired.

All volumes defined automatically should be

CAUTION carefully checked to ensure conformity to the
desired anatomical structure(s).

9–14 Defining Anatomical Structures – om 2235887–100 Rev. 1

The Patient Structures Panels
Defining a Structure in Fill mode

Pencils/erasers Magnetism on/off

Slice index slider

The Fill window

This panel appears when you select (Fill) in the Patient

Structures panel. Structures can be interpolated from 9
contours defined on a few slices to create a 3D structure.
Note: Fill mode is not available for use with oblique reformatted
images.
Its controls are as follows:

- (Small Pencil/Eraser), which draws or erases on the

current plane using thin lines.

- (Large Pencil/Eraser), which draws or erases on one or

more adjacent planes using thick lines. (See note below)

om 2235887–100 Rev. 1 Defining Anatomical Structures – 9–15

The Patient Structures Panels
 - The user activates the pencil by pressing (shift) and
moving the cursor (using the mouse) to the contours which
are to be edited. The eraser is activated by pressing (alt
graph) and contouring the area to be removed.
- The user can move up one slice by pressing the (up arrow)
key, or move down one slice by pressing the (down arrow)
key.
- (Magnet), which aids drawing along the edges of
structures. It can be toggled off or on.
- (Image Index), which allows the user to change the current
axial slice.
- (Undo), which cancels the last drawing action (valid for
one action only).
- (Unpaint Current Plane), erases all the drawing on the
current plane.
- (Unpaint All Planes), erases all the drawing for the
current structure.
- (Apply), which interpolates the currently painted areas to
form a 3D structure, which is then contoured and added to
the current structure defined in the Patient Structures
panel. It then closes the window.
- (Cancel), abandons the drawing, then closes the panel.
Note: All the buttons at the top of the panel are mutually exclusive
9 except [Magnet]. You can select only one at a time.
Note: The Medium and Large pencils search the volume defined by
the 3D size of the pencil, for a structure edge. The structure
edge proposed by the system is based on an histogram
analysis of the pixel values contained within the cubic cursor
volume. It does not depend on a pre–defined pixel value range
as used in the Automatic Mode.

9–16 Defining Anatomical Structures – om 2235887–100 Rev. 1

The Patient Structures Panels
Manipulating Markers

The Markers panel

This panel appears when you select (Markers) in the Patient

Structures panel. It adds, moves, renames and deletes
patient markers. All other input is impossible. Its controls are
as follows:
9
- The Marker Name list of currently defined markers. The
field allows up to 16 characters. It shows the coordinates of
each marker in the RAS (Right/Anterior/Superior)
coordinate system (See “Conventions–Co–ordinate
System”).

- (Add), which pops–up a panel for the user to define a new

patient marker, which is placed at the current cursor
position. The marker name must be unique within the
marker list. Otherwise, the application beeps when you
select [OK], prompting you to change the marker name.

om 2235887–100 Rev. 1 Defining Anatomical Structures – 9–17

The Patient Structures Panels
 The Add Marker panel

- (Delete), which deletes the marker and removes it from the

marker list.
- (Move to Cursor), which moves the current marker to the
current 3D cursor position and updates the marker
coordinates display field.
- (Cursor to Marker), which places the 3D cursor at the
location of the currently selected marker.
- (Close), which closes the window.
Note: All markers added by opening the (Markers) panel from the
Patient Structures panel are not associated with a specific
treatment beam. This panel can also be accessed from the
External Beams panel (see Chapter 10 Defining Beams), in
which case markers added will be associated with the currently
selected beam. The difference between these two approaches
is important when the marker data are used by a laser marking
system.

9–18 Defining Anatomical Structures – om 2235887–100 Rev. 1

The Patient Structures Panels
CHAPTER 10

Defining Beams
Overview
The external beam panels contain functions specific to the
simulation of external beams in the plan. Access is via [Mode],
followed by (External Beams). Three main panels are
available:
- The External Beams panel at the lower left of the screen
in the position occupied by the Patient Structures panel. It
contains all the functions related to beam groups and beam
selection, addition, renaming and deletion.
- The Beam panel, normally placed over the lower left view
(it can be repositioned by the user). It provides controls
specific to the current beam. Access is via (Beam) on the
External Beams panel, and it can be closed.
- The Beam Review panel, normally at the top of the screen
(it can be repositioned by the user). It provides a display of
the settings for all beams defined in the plan. Access is via
(Review –> Beams) on the External Beams panel, and it
can be closed.
- The Laser Marking Review panel, positioned over the
images (it can be repositioned by the user). It provides a
display of the isocenters and markers that will be written to
the laser marking file. Access is via (Review –> Laser
Marking) on the External Beams panel, and it can be
closed.

10

om 2235887–100 Rev. 1 Defining Beams 10–1

 External Beams Window
Overview

Group list
Add beam group Panel
Rename beam group Panel
Delete current beam group Panel

No
Yes
No
Yes
Copy Aperture
Beam list

Add beam Panel

Rename beam Panel
Delete beam

IEC
Machine
Beam Panel
Beams Panel
10 Laser Marking Panel

The External Beams window

10–2 Defining Beams om 2235887–100 Rev. 1

 The External Beams panel contains functions relating to
beams, and is used to select, add, rename and delete both
beam groups and beams within the selected group. It has the
following features:
- The Group list, which shows all currently defined beam
groups, with the active beam group highlighted. If a
different beam group is selected, then the names in the
Beams list (see below) will change correspondingly.
- (Add beam group), which defines a new beam group. A
panel appears to specify the name of the new beam group.
- (Rename beam group), which renames the current beam
group. A panel appears to enter the new name.
- (Delete beam group), which deletes the current beam
group. A panel appears to confirm the deletion of the group
and all the beams within it.
- (Link Isocenters), which allows if the beams in the group
to be locked to a common isocenter. If (Yes) is selected,
moving one beam’s isocenter will cause the isocenter of all
other beams in the group to move together. Otherwise,
(Equal Angles) is not selectable (it is shaded gray).
Default value: (Yes).
- (Equal Angles), which allows the beams in the group to be
spaced at equal angles around the common isocenter. The
orientation of the beam plane is defined by the first two
beams in the group. Default value: (No).
Note: (Equal Angles) applies only to the gantry angle, and does not
consider table angles. Therefore beams may not lie in the
same plane if table angles are not the same for all beams in
the group.
10
- (Copy Aperture), copies the aperture setting of the
currently selected beam onto the opposing beam. Jaw/leaf
settings produce the same field shape at the isocentric
plane. The collimator settings are ‘reflections’ for opposed
pairs. Similarly, any blocks and cutouts are reproduced for
both beams (this is equivalent to a “copy and reflect block”
operation). This function is available only if the current
beam group contains two opposing fields.

om 2235887–100 Rev. 1 Defining Beams 10–3

 When (Link Isocenters) and/or (Equal Angles) are
CAUTION active, modifications to one beam will automatically
induce modifications to all other beams in the same
group. After selecting (Link Isocenters), (Equal
Angles) and (Copy Aperture), verify that beam
parameters for all beams are those desired.

Note: The Beam Group functions enable you to rapidly define beams
with similar properties. For example, to create an opposed pair:
define a single beam, make sure the beam is selected, use
(Add Beam) to create a second beam and use the {gantry
slider} to change the beam angle. Alternatively, if you select
(Equal Angles) for the beam group, then the angle is altered
automatically.
The currently selected Beam Group may be saved by selecting
[Standard Groups] (Main Command Window, Customize
Menu). This feature allows commonly used beam
arrangements to be quickly defined for a new patient/plan.
Standard Groups store the treatment machine, radiation type,
and energy value.
- The Beam list, which shows all currently defined beams for
the current group, with the active beam highlighted.
- (Add beam), which defines a new beam. A panel appears
to specify the name of the new beam. A new beam has the
same initial settings as the previously selected beam
(including the isocenter). If the beam is the first beam in the
plan or in a group, then the beam isocenter is placed at the
current position of the 3D cursor.
- (Rename beam), which renames the current beam. A
window appears to specify the new name of the beam.
10 - (Delete beam), which deletes the current beam. This is
done without user confirmation.
- (Convention), which decides if machine parameters are
displayed using IEC conventions or machine–specific
conventions. Beam angles are stored within Advantage
Sim software as IEC angles (see IEC 1217: 1996,
Radiotherapy Equipment: Coordinates, Movements and
Scales). By default, “Machine” conventions are used.

10–4 Defining Beams om 2235887–100 Rev. 1

 If you select (IEC), then these angles are displayed, and the
standard IEC jaw names (X1, X2, Y1, Y2) are used. If
(Machine) is selected, then all machine angles displayed in the
user interface (i.e. gantry angle, collimator angle and table
angle) are converted into the physical scales appearing on the
machine used to define the beam, and the user–defined jaw
names are used. A status line in the beam panel shows the
selection.
Incorrect specification of machine parameters may
CAUTION lead to incorrect treatment. The user must verify
that the convention selected or defined accurately
describes the convention implemented on the
simulated treatment machine.

The IEC conventions used in Advantage Sim differ

CAUTION from the previous IEC 601–2–1 standard (1981).
Ensure that the conventions used in Advantage Sim
are fully understood by all users.

Adding Groups

10
The Add Group window
This panel appears after selecting (Add) under Groups in the
External Beams panel. All other input is impossible. Enter the
group name (up to 16 characters) and select (OK). A new
beam group is automatically added. There is no default group
name. Select (Cancel) to abandon group definition.

om 2235887–100 Rev. 1 Defining Beams 10–5

 Renaming Groups

The Rename Group window

This panel appears when you select (Rename) under Groups

in the External Beams panel. All other input is impossible.
Enter the new name for the group (up to 16 characters) and
select (OK). The default group name is the existing group
name. Select (Cancel) to abandon group renaming.

Deleting Groups

10

The Delete Group window

This panel appears when after selecting (Delete) under

Groups in the External Beams window. All other input is
impossible. It asks for confirmation to delete the current beam
group.

10–6 Defining Beams om 2235887–100 Rev. 1

Adding Beams

The Add Beam window

This panel appears when you select (Add) under Beams in the
External Beams panel. All other input is impossible. Enter the
beam name (up to 16 characters) and select (OK). A new
beam is automatically added. There is no default beam name.
Select (Cancel) to abandon beam definition.

Renaming Beams

10
The Rename Beam window

This panel appears after selecting (Rename) under Beams in

the External Beams panel. All other input is impossible. Enter
the new name for the beam (up to 16 characters) and select
(OK). The default beam name is the existing name of the
beam. Select (Cancel) to abandon beam renaming.

om 2235887–100 Rev. 1 Defining Beams 10–7

 Controlling Beams – The Beam panel

10
The Beam panel
The Beam panel, which is divided into five sections, contains
functions relating to the currently selected beam.

10–8 Defining Beams om 2235887–100 Rev. 1

The Top Section
This section provides the following functions:
- (Show BEV), which replaces the first 3D view by the
Beams Eye View for the currently selected beam. A
machine must have been selected before this button
becomes active.
- (Edit on BEV), which, if the BEV is displayed, opens the
Edit on BEV panel, allowing the user to move each jaw or
leaf of the current beam interactively on the BEV. The
on–screen menu option “Link/Unlink 3D cursor” can be
used to enable and disable automatic positioning of the 3D
cursor at the edge of the leaf being edited. Enabling this
option allows the intersection of the leaf with the other
planar views to be clearly seen. By default the 3D cursor is
unlinked.
- (Leaves), which, for MLC collimators, opens a panel
displaying the leaf positions for the current beam.
- (Blocks/Cutouts), which opens a panel allowing blocks
(for photon beams) or cutouts (for electron beams) to be
added or modified for the currently selected beam. The
beam modality (particle type) must be selected for this
button to be active. This panel can be used to manually
edit a block or cutout, or conform it automatically (with or
without a margin) to one or several structures, in the same
way as beams.
- (Markers...), which opens the Markers panel, as described
in the “Patient Structures” section. When the Markers
panel is opened using this icon, the current beam name will
be displayed in the panel title. Markers defined from this 10
panel will appear in the Laser Marking Review panel and
laser marking file, described later in this chapter.
- (Iso to Cursor), which moves the isocenter of the currently
selected beam to the current position of the 3D cursor.
- (Iso to Struct), which moves the isocenter for the currently
selected beam to the center of the currently selected
structure. (See “Four Section” of the beam panel).

om 2235887–100 Rev. 1 Defining Beams 10–9

 The center of the selected structure is defined as the
CAUTION geometric center of a box which encloses the 3D
structure. This method may not be suitable for
particular volumes and/or treatment techniques. It
is the user’s responsibility to ensure correct
positioning of isocenters.

Both (Iso to Struct) and (Iso to Cursor) buttons will

CAUTION also move all other beams in the same beam groups
if the “Link Isocenters” selection is set to “Yes”.
Ensure that parameters for all beams are those
desired after moving the isocenter.

- (Center Iso on Aperture), which positions the isocenter at

the center of the currently defined aperture, without moving
the field edges relative to the patient anatomy. This
function is available for asymmetric and biasymmetric
collimators.
If the asymmetric field size has an odd value, the
CAUTION transformation to a symmetric field will modify the
field opening by 1 mm, in order to create a
symmetric field.

This function modifies the position of the isocenter.

CAUTION For beams which have their isocenters linked, the
other beams in the group will also be moved. The
user must therefore verify that they continue to
cover the PTV, by examining the DRRs.
10 - (Cursor to Iso), which moves the 3D cursor to the current
isocenter position for the selected beam.
- (Close), which closes the Beam Panel.

10–10 Defining Beams om 2235887–100 Rev. 1

The Second Section
- (Machine), for the machine of the current beam. Selecting
this displays a menu which contains all the currently
defined machines. The machine cannot be changed unless
energy is set to “No energy”. Default value: No machine.
- (Modality), for the modality of the current beam. Selecting
this displays a menu which contains all the modalities
currently defined for the selected machine (usually
[Photons] and [Electrons]). The modality can be changed
only if the “No Energy” option is selected. Default value: No
Modality.
- (Energy), for the energy of the current beam. Selecting
this displays a menu which contains all the energies
defined for the current machine and modality, and the
option [No Energy] to indicate that no energy is specified
for the given beam. Default value: No Energy.
- (Preset), which is selectable only when in BEV mode.
When selected, this button displays the list of DRR Presets
which have been defined using the {Customize} menu. The
user can choose the preset to apply when calculating the
DRR.

The Third Section

- The Gantry slider, which controls the machine angle (in
degrees) for the current beam. To change the gantry
angle, click left over the {slider}, or enter the angle in the
entry field and press Return.
The minimum and maximum allowed values of the gantry
angle are 0 to 359 degrees for the IEC system (see 10
Conventions chapter). These are machine dependent if you
select the machine conventions system. The gantry angle
resolution is one degree and beam angles are displayed as
integers (e.g. 90). Default value: 0 degrees. The slider label
indicates the convention used.

om 2235887–100 Rev. 1 Defining Beams 10–11

 - The Collimator slider, which controls the machine collimator
angle (in degrees) for the current beam. To change the
collimator angle, click left over the {slider}, or enter the
angle in the entry field and press Return.
The minimum and maximum allowed values of the
collimator angle are 0 to 359 degrees for the IEC system
(see Conventions chapter). These are machine dependent
if you select the machine conventions system. In
Advantage Sim, the collimator angle resolution is one
degree and collimator angles are displayed as integers
(e.g. 90). Default value: 0 degrees. The slider label
indicates the convention used.
- The Table slider, which controls the machine table angle (in
degrees) for the current beam. To change the isocentric
table rotation angle, click left over the {slider}, or enter the
angle in the entry field and press Return.
The minimum and maximum allowed values of the table
angle are 0 to 359 degrees for the IEC system (see
Conventions chapter). These are machine dependent if you
select the machine conventions system. For Advantage
Sim, the table angle resolution is one degree and beam
angles are displayed as integers (e.g. 90). Default value: 0
degrees. The slider label indicates the convention used.
The Fourth Section
This section contains:
- The isocenter entry fields, which indicate the x, y, and z
coordinates of the beam isocenter in the RAS co–ordinate
system (See Conventions, Coordinate System). These
fields are automatically updated if the treatment machine
10 isocenter is moved using (Isocenter to Structure),
(Center Isocenter on Aperture) or (Isocenter to Cursor)
in the External Beams window, or IsoMove on the Beam’s
Eye View. The fields show settings in millimeters (e.g.
21.6 mm). Default value: the current 3D cursor position.

10–12 Defining Beams om 2235887–100 Rev. 1

 - It is also possible to enter the isocenter coordinate values
by typing them in the three entry fields corresponding to
the Right, Anterior, and Superior coordinates of the
isocenter in the RAS coordinate system. If the
displacement of a coordinate relative to the RAS system
origin exceeds 400 mm, it will not be accepted by
Advantage Sim.

- The SSD field, whose value reflects the SSD for the
current beam along the collimator axis of rotation. The
minimum permitted SSD is 500 mm and the maximum,
2000 mm. The default value is defined by the isocenter
position.

The SSD is calculated using the surface of the 3D

CAUTION patient model. If the 3D patient model does not
represent the surface of the patient (image artifacts,
patient table or accessories) then the calculated
SSD may not be correct. Be sure to check this value
before using for other purposes.

- Treatment Table Displacements, which indicate the

displacements in the IEC coordinate system of the
treatment table (patient support), in order to position the
patient at the treatment isocenter. These offsets are
expressed relative to the CT coordinate system origin.

- One approach for positioning the patient at the isocenter is

as follows:
– Position the patient on the table by aligning skin
markers (placed during scanning) indicating the CT 10
origin with the isocenter of the treatment machine
(using the alignment lasers).
– Move the treatment table (patient support) by the
treatment table displacements indicated by Advantage
Sim, in the IEC Patient Support directions Xt, Yt, and
Zt, in order to place the patient at the treatment
isocenter defined by the virtual simulation.

om 2235887–100 Rev. 1 Defining Beams10–13

 The user must verify that the displacements
CAUTION indicated are consistent with the limits of
displacement (Xt, Yt, Zt) of the treatment table.

- The Structure menu, which displays a list containing all

the currently defined structures. The structure selected
from this list will be used for the (Isocenter to Structure)
and (Conform) functions.

- When the “Conform to multiple structures” function is being

used, the user must select using this menu the new
structure to which the collimator is to be conformed, after
having selected the “Combine” conformation option (see
section on conformation).

The Bottom Section

This section features:

- The Mode menu, which controls the mode in which the

collimator is being operated. There are up to five choices:
[Symmetric], [Asymmetric X] or [Asymmetric Y],
[Biasymmetric] and [Multileaf], depending on the type of
collimator defined for the machine.

- For symmetric collimators: [Symmetric] is selectable.

- For asymmetric collimators: [Symmetric] and

[Asymmetric X] or [Asymmetric Y] are selectable.

- For biasymmetric collimators: [Symmetric], [Asymmetric

X] or [Asymmetric Y], and [Biasymmetric] are selectable.

- For multileaf collimators: [Symmetric], [Asymmetric X] or

10 [Asymmetric Y], [Biasymmetric] and [Multileaf] are
selectable.
For all collimator types, the default mode is [Symmetric] (i.e.
the mode with the lowest degree of freedom).

- (Margin), which allows the user to specify the size of

margin (in mm) to be added around the structure envelope
during automatic conformation.

10–14 Defining Beams om 2235887–100 Rev. 1

 - (Conform), which automatically adjusts the aperture to the
shape of the currently selected structure. This button is
selectable only in BEV mode. The user can conform the
beam to one or several structures. To conform to one
structure, select the desired structure using the Structure
menu, then use the “Alone” option on the (Conform) menu.
To combine to several structures, the conform function
must be used repeatedly, by first conforming the beam to
the selected structure, then selecting another structure
using the Structure menu, and using the “Combine” option
on the (Conform) menu. This process can repeated to
integrate the desired number of structures.

- (Algorithm), which selects the leaf fitting algorithm for the

multileaf collimator. If the current machine does not have a
multileaf collimator, this function is not selectable. Leaf
fitting algorithms defined for Advantage Sim are:
– Inside, where the leaves are placed such that the
leaves are just inside the projected target volume.

Leaves conforming to
selected structure using
“Inside” algorithm

CAUTION
When conforming to concave (re–entrant) 10
structures, where the concave part of the structure
is hidden from the MLC leaves, the conformation
algorithm will, in certain cases, place the leaves at
the interior edge of the structure. This may not
correspond to the conformation desired by the user,
and in all cases the user must verify the
conformation visually.

om 2235887–100 Rev. 1 Defining Beams10–15

 – Half, where the leaves are placed such that the
midpoint of each leaf edge lies on the projected target
volume edge.

Leaves conforming to
selected structure using
“Half” algorithm

– Outside, where the leaves are placed such that no part

of the projected target volume is covered by the leaves
(i.e. the leaves are just outside the projected target
volume).

Leaves conforming to
selected structure using
“Outside” algorithm

The leaf fitting algorithm used affects the

CAUTION resulting field size and shape. The default value is
10 Outside. The user must verify that the desired
algorithm is selected.

10–16 Defining Beams om 2235887–100 Rev. 1

 - The {collimator sliders}, which control the settings of the
individual collimator jaws. When IEC conventions are
selected, the jaw names (X1, X2, Y1, Y2) are the standard
IEC jaw names. Select the machine conventions option to
use the machine jaw names specified in the RT treatment
machine file. The current conventions (machine or IEC) are
indicated after the jaw names.
Each slider has an associated number representing the jaw
position. The two additional numbers between the jaws
indicate the jaw opening size. For each type of collimator
mode, the sliders have a default setting equal to the minimum
jaw positions defined for the appropriate machine, and will
appear as follows:
– In the symmetric, asymmetric, and biasymmetric
modes, all four sliders are active.
– In the multileaf mode, all four sliders are inactive.

10

om 2235887–100 Rev. 1 Defining Beams10–17

 Manipulating Blocks and Cutouts
In the description in this section, the panels relating to Blocks
are shown. Those relating to Cutouts are identical except for
the panel names, and are not shown here.

10
The Blocks/Cutouts window
This panel appears when you select (Blocks/Cutouts) in the
Beams panel. It defines and modifies photon treatment blocks
and electron cutouts. All other input is impossible.
- The Current Blocks/Cutouts list allows selection of one of
the beam blocks defined for the current beam.

10–18 Defining Beams om 2235887–100 Rev. 1

 - (Add) allows entry of the name of the new block/cutout to
be created. Enter the block/cutout name (up to 64
characters) and select (OK). Default name: none. Select
(Cancel) to abandon block/cutout definition.

The Add Block/Cutout window

- (Rename) allows you to rename an already defined

block/cutout. All other input is impossible. Enter the
block/cutout name (up to 64 characters) and select (OK).
Select (Cancel) to abandon block/cutout definition.

10
The Rename Block/Cutout panel

- (Delete) deletes the current block/cutout.

om 2235887–100 Rev. 1 Defining Beams10–19

 - (Conform) lists the currently defined patient structures.
Selecting a structure causes the block/cutout shape to
conform to that structure. If a margin is defined in the
Margin entry field, then it is applied to the block/cutout
before the collimator is conformed. If the structure is
entirely outside the beam, there is no change.
- (Alone/Combine) allows conformation of a block/cutout to
one or many structures, in an similar fashion to that
described for conformation of the collimator. In the case of
conforming to multiple structures, “Combine” must be
selected before selecting the structure.
- (Conform) collimator to block/cutout allows
conformation of the machine collimator to the block/cutout
selected in the Current Blocks/Cutouts list. If a margin is
defined in the Margin entry field, then it is applied to the
block/cutout before the collimator is conformed. The
block/cutout must have defined points and the (Type) must
be set to APERTURE for this option to be active. After the
conformation has been performed, a panel appears asking
if the block/cutout should be deleted.
- (Algorithm) conformation, which selects the leaf fitting
algorithm for the current shaper. Leaf fitting algorithms
defined are identical as for conform beam to structure:
– Outside,
– Half,
– Inside.
- The Margin entry field allows you to specify an additional
margin to be added to the projected shape of the target
when you activate (Conform) or (Conform) collimator to
10 block/cutout. Default value: 0 mm.
- (Type), which selects if the block/cutout is APERTURE,
where the blocking material is located outside the defined
shape; or SHIELDING, where the blocking material is
located inside the shape, thereby covering the structures
within the shape. APERTURE shapers are displayed on
the DRR in yellow, and SHIELDING shapers in blue. The
default block/cutout type is APERTURE.

10–20 Defining Beams om 2235887–100 Rev. 1

 Treatment plans generated by Advantage Sim 1.2
CAUTION and Advantage Sim 3.0 do not contain type
information for blocks and cutouts. When read by
Advantage Sim versions 4.0 and later, these blocks
and cutouts are always assigned an APERTURE
type. For SHIELDING blocks and cutouts, the user
must manually modify the type after loading.

APERTURE Block/Cutout SHIELDING Block/Cutout

- (Close) closes the window and returns the application to its

previous state. If one or more blocks/cutouts do not have
any associated points, a message appears indicating this
and the panel will remain open.
- (Edit) opens the following panel:

10

The Edit Block/Cutout panel

om 2235887–100 Rev. 1 Defining Beams10–21

 This panel appears when you select (Edit) in the Blocks or
Cutouts panel. It selects and edits the current contour on the
Beam’s Eye View. All other input is impossible.
- (Draw Shape) creates a contour by drawing directly on the
BEV, using a method similar to that described for “Fill”
structure contouring (see Chapter 9 Defining Anatomical
Structures – The Patient Structures Panels). Activate the
pencil to draw a shape or add to an existing shape by
pressing (shift) while moving the cursor. Activate the eraser
to remove a shape or part of a shape by pressing (alt
graph) while moving the cursor. In either case, when the
mouse button is released the drawn shape will be closed
by a straight line from the last point to the first point of the
drawn shape.
Note: If a drawn shape is completely disconnected from the existing
shaper, then the existing part will be removed and replaced by
the new part.
Note: If a drawn shape or erased shape cuts the existing block/cutout
into two or more separate regions, then Advantage Sim will
use only one of these regions (generally the largest) when
combining with the drawn or erased shape.
Note: If a drawn shape or erased shape covers all but a very small
part of the existing shape, then this small part will not be used
when calculating the new shape (this avoids the creation of
very small blocks/cutouts that may not be easily visible or may
be too small to edit).
- (Edit Shape) edits the block/cutout shape using the
methods described in “Editing a Structure” in Chapter 9
Defining Anatomical Structures – The Patient Structures
Panels. This option will not be selectable if no points have
been defined using the (Draw Shape) option.
10
- (Move/Rotate) moves or rotates the current block/cutout
on the Beam’s Eye View. A red box with control handles
appears on the Beam’s Eye View for modifying the
block/cutout orientation or position. This function is the
same as that of the trace rotation and translation box in 3D
Analysis Package User’s Manual: Graphics Command
Windows. This option will not be selectable if no points
have been defined using the (Draw Shape) option.

10–22 Defining Beams om 2235887–100 Rev. 1

 - (Stretch) allows the user to select and drag on one of 8
boundary points, in order to “stretch” the shape in one or
two dimensions. This option will not be selectable if no
points have been defined using the (Draw Shape) option.
- (Apply) saves the current block/cutout modifications.
- (Undo) cancels the last editing action.
- (Close) closes the window and returns the application to its
previous state.

10

om 2235887–100 Rev. 1 Defining Beams10–23

 Summary of Beam characteristics – the Beam
Review Panel

The Beam Review panel

This window provides a summary of all the beams. It gives you
an easy way of comparing the settings for all the beams in the
plan.
The Beam Review panel also displays the patient treatment
orientation.
If the machine has a multileaf collimator, then MLC appears in
the Jaws columns.
The isocenter position is given relative to the origin of the
patient coordinate system using the RAS convention (See
“Conventions–Coordinate System”).
All machine jaw names displayed in the Beam
CAUTION Review Panel are in the IEC convention. The user
must know, and apply, the appropriate conversions
to the actual machine jaw names. (See conventions;
IEC Machine parameters).

10

10–24 Defining Beams om 2235887–100 Rev. 1

The Leaf Position panel

10

The Leaf Position panel

om 2235887–100 Rev. 1 Defining Beams10–25

 This panel appears when the treatment machine collimator is a
multileaf collimator and the (Leaves...) button on the “Beam”
panel is selected. It displays the extensions (openings) of the
leaf pairs which are identified by a leaf–pair index (in increasing
order starting from the most negative position in the IEC
coordinate system). Leaf pair 1 is therefore nearest the IEC X1
or IEC Y1 jaw.

The Laser Marking Review Panel

An important part of the CT simulation process is the marking
of specific points on the patient’s skin to allow accurate
repositioning of the patient during treatment. This marking can
be done on the CT couch using a system of movable lasers
that projects the points to be marked.
Advantage Sim provides the possibility to create a file
containing these points on the Advantage Sim file system, that
can be retrieved by the control software of the laser marking
system. This file is created using the Laser Marking Review
panel, described below. The following types of points are
supported:
- isocenters, always provided for each beam in the plan.
- markers, defined by the user for each beam using the
(Markers) icon on the Beams panel.
Note: The Advantage Sim software option for communication with a
specific laser marking system must be installed and configured
by a GE Service Engineer before use.
The Laser Marking Review panel appears when the (Review
–> Laser Marking) button on the External Beams panel is
selected. It provides a summary of the isocenter and marker
10 data that can be written to a laser marking file, and allows the
user to write the file if the data is acceptable.

10–26 Defining Beams om 2235887–100 Rev. 1

 The Laser Marking Review panel
The panel shows patient identifying data and treatment
position, followed by a list of isocenter and marker points for
each beam in the treatment plan.
Note: The marker points contained in the laser marking file are not
listed in the same order as the points displayed on the Laser
Marking Review panel.
Note: Only markers that have been associated with a beam using the
(Markers) icon on the Beam panel will be listed and written to
the laser marking file. Markers defined using the (Markers)
button on the Structures panel will not appear. For each beam
defined in the plan, the isocenter will automatically appear in
the list.
On the Laser Marking Review panel, the following controls
are provided:
- (Close), which closes the panel and returns the application
to the External Beams panel.
- (Save Laser Marking File), which creates a file on the
Advantage Sim file system containing the data displayed in
the panel. This file can then be retrieved by a CT mounted
laser marking system, for use when positioning and
10
marking the patient. If the current treatment plan has been
modified since it was last saved, then this button will not be
selectable, since a laser marking file must correspond to a
saved plan.

om 2235887–100 Rev. 1 Defining Beams10–27

 Note: If the patient position has been “flipped” for treatment, for
example the patient has been scanned FFS (feet–first supine)
and will be treated HFS (head–first supine), then it will not be
possible to save the laser marking file. This restriction prevents
incorrect marking of the patient on the CT couch when the
patient is not in the treatment position.
Marker and isocenter data read from an Advantage
CAUTION Sim laser marking file and subsequently used on a
laser marking system must be handled correctly by
that system. It is the user’s responsibility to verify
that the data are correctly transferred and
interpreted by the external system.

10

10–28 Defining Beams om 2235887–100 Rev. 1

CHAPTER 11

Output to Printer
Hardcopy Output (Printer or optional
Laser Camera)
The panel appearing when the “Print” item in the “File” menu is
selected (see figure) is illustrated in the figure below. The
“Print” panel can only be displayed if the current plan has been
saved and no further modifications have been mode. This
panel is provided so that the user can modify parameters
related to how the printing function works, and then send the a
print job containing the currently selected primary view to the
printer or optional laser camera.
The first control in the panel is the Output Device choice list,
which allows the user to select if hardcopy output will be sent
to the Advantage Sim color printer, or to a laser film camera
configured for use with Advantage Sim. The panel controls are
now described for each of these devices in turn.
Printer
Camera
Fit
Scaled
100%
50%
25%
SAD
SBD
Custom

Custom source–to–
image distance
Portrait
Landscape 11

”Print” subpanel (in “FILE” menu)

om 2235887–100 Rev. 1 Output to Printer 11–1

 Output to Printer
When printing to paper using the Advantage Sim color printer,
the following additional controls are provided:
- The Sizing Mode choice list, where the user enters the
policy for sizing the printed output. Choices are “Fit”, which
scales the image in order to produce the largest complete
image possible on the selected format, and “Scaled”, which
calculates the scaled printed image size according to the
paper size and the setting of the “Scale” control. The option
“Scaled” will not be selectable if multiple views are selected
for printing.
- The Scale choice list, which the operator selects to define
the scale, relative to actual size, for printed views. Options
are 100%, 50%, and 25%.
When any image other than a BEV/DRR is printed
CAUTION in Scaled mode, the Source–Image Distance (see
below) is ignored when calculating the image size.

- The Source–Image Distance choice list, which the

operator selects to define the beam source to image plane
distance for conically–projected views. Options are “SAD”
(source–to–axis distance), “SBD” (source–to–block
distance), and “Custom”. If “Custom” is selected then the
“Custom SID” entry field (see below) will be selectable.
- The Custom SID entry field, where the user enters the
beam source to image plane distance (in mm) for
conically–projected views, when the “Custom” option has
been selected in the “Source–Image Distance” choice list.
When one of the other options is selected, this entry field
will be deactivated. The minimum distance is 150 mm, and
maximum distance is 3000 mm.
11

11–2 Output to Printer om 2235887–100 Rev. 1

 - The Page Orientation choice list, which the operator uses
to select the desired image orientation on the page. When
“Portrait” is selected, the image will be placed at the top of
the page in “Portrait” orientation, with the space below
reserved for plan information. When “Landscape” is
selected, the image will be placed at the top of the page in
“landscape” mode, with a space below reserved for plan
information. “Landscape” will allow for a very rectangular
field of view, whereas the “Portrait” mode is more suitable
for square images. If 2 images are selected for printing this
choice will be forced to “Landscape” and “Portrait” will be
grayed out, and if 3 or 4 views are selected it will be forced
to “Portrait” and “Landscape” will be grayed out.
- The Reset to Defaults button, which resets the panel
settings to those specified the last time the defaults were
saved (which may have been in a previous session).
- The Save as Defaults button, which saves the current
panel settings as the defaults, to be used when the
application is started or the “Reset to Defaults” button is
pressed.
- The Multiple Views button, which pops–up a sub–panel
(see figure below) allowing the user to select multiple
image views for printing; This button will be grayed out
unless the user has selected the “Fit” option for the sizing
mode.
- The Print button, which sends the selected primary image
to the printer in the format specified by the current panel
selections. If the image is a BEV/DRR then the image is
scaled using the selected scale if the “Scaled” sizing mode
is selected. If the image is a planar view or a conventional
3D image then the scale factor is ignored. Since the printer
may be remote, and the cost per page may be expensive,
the user will be asked to confirm the print operation. If the
image has to be clipped in order to fit onto the page, the 11
user will also be asked to confirm this.

om 2235887–100 Rev. 1 Output to Printer 11–3

 Note: The Advantage Sim printer supports two printing technologies:
thermal transfer and dye sublimation. Each printing technology
requires a specific type of paper, and a specific type of
transparency film. The user must change the paper or film type
when changing printing technology.
- The Close button, which closes the panel and returns the
application to its previous state.
Two possible page layouts are available. In the “portrait” mode,
an area will be reserved at the bottom of the page for plan
information, and the rest of the page (approximately square)
will be used for the image(s). In the “landscape” mode, the plan
information will also be at the bottom of the page, and the rest
of the page (rectangular) will be available for the image(s).
The contents of the “plan information” sections are illustrated in
figure below. There are five sections:
- The Patient Data section, containing the patient name, RT
patient ID, patient orientation during image acquisition and
patient orientation for treatment.
- The Plan ID Data section, containing the plan save
date/time, operator name, plan comment, and referenced
image series. It contains the message “Plan approved by:
______”.
- The Print Description section, containing the printout scale,
source–image distance, source–axis distance, and sizing
mode. It also contains the message “Print calibration
checked by: ______”.
- The Beam Data section, containing the settings for all
beams in the plan. If more than 15 beams are present, the
entire table illustrated in figure below will be printed out on
a second page. In this case the first page will show the
“Patient Data”, “Plan ID data”, “Print Description” and
11 “MLC” sections, along with the currently illustrated beam
(for a BEV or DRR) in the “Beam Data” section. The layout
of this section will be identical to that illustrated in the
“Beam Review” panel. The currently selected beam will
always be shown in red print, and the other beams will be
shown in black print.

11–4 Output to Printer om 2235887–100 Rev. 1

 Note: For symmetric jaw pairs, the total collimator opening (IEC “FX”
or “FY”) is displayed in the left–hand jaw column, and the
right–hand jaw column remains blank.
- The MLC Data section, containing the multileaf collimator
leaf settings. If there is no BEV or DRR, or if the beam is
not an MLC beam, then this area will be blank. The
collimator leaves will not be numbered, but the jaw names
(i.e. “X1”, “X2”, “Y1”, and “Y2” IEC names) will be shown
so that the user can determine which pair of leaf settings
corresponds to each leaf pair illustrated on the image. The
jaw settings are shown in red print.
All machine jaw names are printed using the IEC
CAUTION convention. The user must know, and apply, the
appropriate conversions to the actual machine jaw
names. (See conventions; IEC Machine
parameters).

GE Advantage Sim 4.0.x Conventions: MACHINE

Patient Name: THORAX_VY Operator: xx Sizing Mode: Fit
Patient ID: 9419830 Comment: essai1 Requested Scale (%): 100
Scan Orientation: Head–First Supine Plan date: 1997–02–26 15:03
(HFS)
Treatment Orientation: Head–First Referenced Series: 2 Source–Image distance (mm): 1000
Supine (HFS)
Source–Axis distance (mm): 1000
Plan approved by:
Print calibration checked by: ______
MACHINE ANGLES (deg) JAWS (IEC names) (mm) ISOCENTER (mm) SSD ENERGY
BEAM GROUP GANTRYCOLL TABLE X1 X2 Y1 Y2 R A S (mm) MACHINE MODA MV,MeV
ap ap/pa 0 0 0 –41 +41 +66 +90.2 –35.3 +28.5 +572.6 sat41–syn – –
pa ap/pa +180 0 0 –41 +41 +66 +90.2 –35.3 +28.5 +572.6 sat41–mlc – –

11

om 2235887–100 Rev. 1 Output to Printer 11–5

 MULTILEAF COLLIMATOR
X1/Y1 X2/Y2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
–35 29
–35 37
–40 40
–43 43
–48 44
–42 39
–39 37
–38 35
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Layout of Advantage Sim printed plan information

11

11–6 Output to Printer om 2235887–100 Rev. 1

Selecting Multiple Views
The panel appearing when the “Multiple Views” button is
selected on the “Print” panel (see figure above) is illustrated in
figure below. This panel allows the user to add one or more
additional views to the list of views to be printed. When this
panel is first opened the “Views Selected” field will indicate the
name of the view currently selected, and adding or asks the
user for confirmation that they wish to print the page.

“Select Multiple Views” subpanel (in “Print” panel)

The use of unscaled hardcopy of image may lead to
CAUTION incorrect measurements. Use of Advantage
Workstation Film Composer with “screen–save”
images is not recommended for radiotherapy
planning applications where scale information is
important. The Advantage Sim Print function
should be used instead.
- The Add Selected View button, which adds the currently
selected primary view to the “Views Selected” view list.
- The Delete Selected View button, which removes the
currently selected primary view from the “Views Selected”
view list. 11
- The Views Selected, label field, which shows a list of the
currently selected views.
- The Close button, which closes the panel and returns to
the “Print” panel.

om 2235887–100 Rev. 1 Output to Printer 11–7

 Print Confirmation
The panel appearing when the “Print” button is selected on the
“Print” panel (see figure above). It will block all other user input.
This panel asks the user for confirmation that they wish to print
the page.

Clipping Confirmation
The panel appearing when the “Print” button is selected on the
“Print” panel (see figure above) and the image is too large to fit
on the page asks the user for confirmation that they wish to
print the clipped image.

Output to Film
Advantage Sim provides capability for sending DRR images
only to a laser film camera using an analog or digital protocol.
This function exists only if the appropriate filming option for
Advantage Workstation has been installed.

All films generated from Advantage Sim have a

CAUTION resolution of 512 x 512 pixels. Therefore, only
cameras which support this image size can be used
in conjunction with Advantage Sim.

After selecting the “Camera” output device option, it is

necessary to enter the Source–Image Distance (SID), so that
Advantage Sim can print at the desired scale.
When filming to a laser camera, the “Sizing Mode”, “Scale”,
Page Orientation”, and “Multiple views” options are not
available. The scale is forced to 100%, and portrait orientation
is used. Only the DRR can be printed to film.
11 Note: The treatment plan parameters are not printed on film.
Note: Advantage Sim uses the laser camera services provided by the
Advantage Workstation. The user can determine the current
state of the laser camera queue by using the appropriate
service of the “Film Composer” application.

11–8 Output to Printer om 2235887–100 Rev. 1

 In order to guarantee the precision of film scaling,
CAUTION the laser camera MUST be calibrated before use. It
is the responsibility of the physicist to verify the
validity of the calibration in the context of a daily or
weekly quality assurance process (see Periodic
Quality Assurance). GEMS can in no case be held
responsible for any problems related to the scaling
of filmed DRR images.

Laser Camera Calibration

Calibration of the laser film camera can only be carried out on
site, and only by the person responsible for quality assurance
of the site (typically a physicist).
A panel asking for the physicists’ password allows access to
the calibration sub–menu.
The calibration sub–menu is located in the “Customize” menu.
It provides for calibration of the laser camera, and is accessible
only if there is no plan currently loaded.

Physicists’ Password panel for laser camera calibration

Once the correct physicists’ password has been entered, the

calibration panel appears. It contains the following controls:

- The Laser Camera Name choice list, where the physicist

selects the name (type) of the desired laser camera. If no
choices are available, please check with the GE Service 11
Engineer that the laser camera interface has been installed
correctly.

- The Print Uncalibrated Image button, which sends the

calibration image to the laser camera.

om 2235887–100 Rev. 1 Output to Printer 11–9

 - The Film Format entry field, where the physicist enters the
physical size in (mm) of the film. This string is
subsequently used to signal the expected format to the
user each time a film is sent to the laser camera.

- The Measured Image Width and Measured Image

Height entry fields, where the physicist enters the
horizontal and vertical sizes of the uncalibrated reference
image when sent to the laser camera. The horizontal and
vertical sizes must be identical.

Laser Camera Calibration panel

To calibrate the laser camera, the physicist must perform the

following steps:

- Select the camera type (e.g. “3M 952”), corresponding to

the type of camera installed on the Advantage Workstation.

- Print the calibration image using the “Print Uncalibrated

Image” button.

- Enter a string clearly identifying the film format used by the

11 laser camera (typically indicating the film size).

- Measure the horizontal and vertical physical sizes of the

calibration image on the film (see figure), and enter these
values into the “Measured Image Width” and “Measured
Image Height” fields.

11–10 Output to Printer om 2235887–100 Rev. 1

 Width

Height

The distances to be measured are between the

CAUTION outsides of the white borders of the calibration
image, as illustrated below. The two values entered
must be always identical in order to guarantee the
conservation of the distances when filming in scale
mode. If the measures diverge by more than 1mm,
then the laser camera must be re–adjusted by the
laser Service Engineer so that the calibration image
is perfectly square.

11

om 2235887–100 Rev. 1 Output to Printer 11–11

 Width

Height

- Once the calibration values have been entered, press “OK”

to terminate the calibration procedure.
- To verify the calibration of the laser camera, it is necessary
to film a BEV/DRR image using the Advantage Sim
application, and verify the scale (in the following diagram,
the distances indicated by the two dotted lines must be
equal to 300 mm, as displayed on the crosshairs).

11

11–12 Output to Printer om 2235887–100 Rev. 1

 Vertical: 300 mm

Horizontal: 300 mm

GEMS strongly recommends adoption of a weekly

CAUTION quality assurance process verifying calibration of
the laser camera.

If, for whatever reason, the laser camera cannot be

CAUTION correctly calibrated with the Horizontal and
Vertical Scale lengths being equal, GEMS
recommends to not use the laser camera and to
immediately call the Laser Camera Field Engineer
in order to have the laser camera adjusted. 11

om 2235887–100 Rev. 1 Output to Printer 11–13

 Output of Plan Data Sheet
When the [Print Plan Data] option in the File Menu of the
Main panel is selected, a plan data sheet is printed to the A4
laser printer configured for the Advantage Windows platform.
Note: To configure the Advantage Windows A4 laser printer, contact
the GE Field Service Engineer.

11

The Plan Data Sheet

11–14 Output to Printer om 2235887–100 Rev. 1

 The plan data sheet contains plan information in a simple
(non–graphical) format, suitable for use in patient marking or
inserting in the patient’s record. It contains information grouped
into the following sections:
- Page header, containing the Advantage Sim version
number and the patient’s name.
- Patient and Study identification, containing patient
identification, CT study information, and patient position.
- Plan identification, containing plan comment, operator,
date/time, and additional fields that can be completed by
the user after printing.
- Defined volumes, containing a list of defined structures,
with their structure types.
- Beam setup, containing a list of defined beams, with the
beam parameters. The coordinate conventions used
(Machine or IEC) are also displayed
- Laser marking, containing isocenter and marker
coordinates in the IEC 1217 Table Top coordinate system.
If the treatment position is different from the scan position,
i.e. the patient has been “flipped” for treatment, then laser
marking information will not be printed.
- Page footer, containing plan identifying information and the
page number.
If displayed machine angles are to be used for
CAUTION treatment setup, it is essential to verify that the
displayed angles are in the desired coordinate
convention (Machine or IEC).

11

om 2235887–100 Rev. 1 Output to Printer 11–15

 Blank page.

11

11–16 Output to Printer om 2235887–100 Rev. 1

CHAPTER 12

Managing Treatment
Machine Data – The RT
Machine Data panel
Overview
This chapter describes the management of the data associated
to a treatment machine. Only authorized users can perform
those operations. A password is therefore necessary to access
those data.
Unauthorized modification to RT machine data
CAUTION may lead to incorrect treatment. Treatment
machine data is critical for the system. Its access is
protected by a password. The user is fully
responsible for the management of this password,
which should only be given to authorized users.

Entering the Physicists’ Password

To access, first select (Customize) from the Main command
window. Then select (RT Machine Data).

The Physicists’ Password window

This panel appears after selecting (RT Machine) in the
Customize panel. All other input is impossible. It warns that
modification of machine data should be made by a physicist
and asks for the physicist’s password. Select (Cancel) to
return to the Customize Menu.
Note: (RT Machine) is unavailable (i.e. shaded in gray) if you have
12
loaded a patient model.

om 2235887–100 Rev. 1 Managing Treatment Machine Data – 12–1

The RT Machine Data panel
 Managing Treatment Machine parameters

The RT Machine window

This window appears when you enter the correct password. It

contains functions related to the definition of therapy machine
characteristics. The window displays a list of treatment
machines available for planning and provides specific functions
to modify their parameters. All other input is impossible.

- The machine name list contains the names of the

12 machines available for virtual simulation, the machine
version number, the modification date and the machine
comment. Click within the list to select a machine.

12–2 Managing Treatment Machine Data – om 2235887–100 Rev. 1

The RT Machine Data panel
 When you edit a machine without changing its name, the
version number is modified and it is one greater than the
highest current version number for machines of that name. If
you change the name, then the number is reset to 1, unless
the name already exists (in which case the version name is
one greater than the highest current version).

- (Add) enters the data related to the new treatment

machine. (See Adding or Modifying Treatment Machine
parameters).

- (Edit) allows you to edit the data related to the treatment

machine selected in the list. (See Adding or Modifying
Treatment Machine parameters).

- (Delete) deletes the current treatment machine in the list. It

warns that deleting a treatment machine will invalidate the
beams of any currently stored plans which use the
machine. It then asks for confirmation for the action.

The Delete RT Machine window

YOU CANNOT RECOVER A DELETED RT

WARNING MACHINE FILE UNLESS IT WAS PREVIOUSLY
SAVED ON DISKETTE. ALL PLANS USING A
DELETED RT MACHINE FILE BECOME INVALID.

- (Print) prints all the RT treatment machine parameters for

12
the selected machine.

om 2235887–100 Rev. 1 Managing Treatment Machine Data – 12–3

The RT Machine Data panel
 - (Change Password) changes the password. All other input
is impossible. Enter a new password (up to 16 characters)
and select (OK). Select (Cancel) to abandon the change.

The Change Physicist’s Password window

- (Close) closes the window and returns the application to its

previous state.

12

12–4 Managing Treatment Machine Data – om 2235887–100 Rev. 1

The RT Machine Data panel
Adding or Modifying Treatment Machine
parameters

The RT Machine Data window

This panel appears when you select (Edit) or (Add) in the RT 12
Machine panel. It allows you to add or edit RT treatment
machines. All other input is impossible.

om 2235887–100 Rev. 1 Managing Treatment Machine Data – 12–5

The RT Machine Data panel
 (Edit) displays the values corresponding to the machine
selected in the RT Machine window. If you select (Add), it
displays a set of default values (described below).
- The Name entry field edits the name of the current
machine. The name (up to 12 characters) corresponds to
the one listed in the RT Machine window. Renaming the
machine will cause the version number to be reset to 1 (or
1 higher than the current highest version, if the name
already exists).
- The Comment entry field enters a comment (up to 64
characters) for the machine, which will appear in the list of
the RT Machine window. Default value: blank.
- The SAD Distance entry field enters the source–axis
distance (in mm) of the current machine. Minimum value:
500 mm. Maximum value: 2000 mm.
- The Block Tray Distance entry field enters the source to
lower block surface distance (in mm) for the current
machine. Minimum value: 100 mm. Maximum value: 1000
mm.
Incorrect specification of block tray distance may
CAUTION lead to incorrect scaling of beam’s eye view
print–out. In the print panel, the user may select
the block tray distance to define the scale of the
beam’s eye view print–out. In some instances this
may be different for machine gantry angles 0 and
180°. The user must ensure that the correct distance
is used when requesting BEV print out.

- The (Gantry Rotation Direction) defines the direction of

increasing gantry angular position for the current machine.
Choice: (CW) (clockwise) or (CCW) (counter–clockwise).
- The Gantry Zero Position entry field allows you to enter the
gantry angle indicated by the machine when the gantry is in
the IEC zero–angle position. Minimum value: minus 360
degrees. Maximum value: 360 degrees.
12 - The Gantry Min Angle entry field allows you to enter the
lower limit of the gantry angle in the machine scale.

12–6 Managing Treatment Machine Data – om 2235887–100 Rev. 1

The RT Machine Data panel
 Minimum value: minus 359 degrees. Maximum value: 359
degrees.
- The Gantry Max Angle entry field to enters the upper limit
of the gantry angle in the machine scale. Minimum value:
minus 359 degrees. Maximum value: 359 degrees, must be
larger than the Gantry Min Angle.
- (Collimator Rotation Direction) defines the direction of
increasing collimator angular position for the current
machine. Choice: (CW) (clockwise) or (CCW)
(counter–clockwise), when viewed from the radiation
source.
- The Collimator Zero Position entry field enters the
collimator angle on the machine scale when the collimator
is in the IEC zero–angle position. Minimum value: minus
360 degrees. Maximum value: 360 degrees.
- The Collimator Min Angle entry field enters the lower limit
of the collimator angle in the machine scale. Minimum
value: minus 359 degrees. Maximum value: 359 degrees.
- The Collimator Max Angle entry field enters the upper limit
of the collimator angle in the machine scale. Minimum
value: minus 359 degrees. Maximum value: 359 degrees,
must be larger than the Collimator Min Angle.
- The X1 Jaw Name entry field enters the name of the
machine jaw which corresponds to the IEC X1 jaw.
- The X2 Jaw Name entry field enters the name of the
machine jaw which corresponds to the IEC X2 jaw.
- The Y1 Jaw Name entry field enters the name of the
machine jaw which corresponds to the IEC Y1 jaw.
- The Y2 Jaw Name entry field enters the name of the
machine jaw which corresponds to the IEC Y2 jaw.
- (Properties) defines the type and features of the
machine’s collimator (see Entering Collimator Parameters).
- (Table Rotation Direction) defines the direction of
increasing table angular position for the current machine 12
when viewed from above the isocenter. The choice: (CW)
(clockwise) or (CCW) (counter–clockwise).

om 2235887–100 Rev. 1 Managing Treatment Machine Data – 12–7

The RT Machine Data panel
 - The Table IEC Zero Position entry field enters the
isocentric table angle on the machine scale when the table
is in the IEC zero–angle position. Minimum value: minus
360 degrees. Maximum value: 360 degrees.
- The Table Min Angle entry field enters the lower limit of the
isocentric table angle in the machine scale. Minimum
value: minus 359 degrees. Maximum value: 359 degrees.
- The Table Max Angle entry field enters the upper limit of
the isocentric table angle in the machine scale. Minimum
value: minus 359 degrees. Maximum value: 359 degrees
must be larger than Table Min Angle.
- (Photons) defines RT machine parameters associated
with photon beams.
- (Electrons) defines RT machine parameters associated
with electron beams.
- (OK) saves any modification of the current machine (i.e.
saves a new machine instance), after a user confirmation,
then returns the application to its previous state. It always
creates a new machine file, but the version number
changes.
- (Cancel) closes the panel and returns the application to its
previous state, without saving the modified machine.

12

12–8 Managing Treatment Machine Data – om 2235887–100 Rev. 1

The RT Machine Data panel
Entering Collimator parameters

The Collimator Properties panel

12

om 2235887–100 Rev. 1 Managing Treatment Machine Data – 12–9

The RT Machine Data panel
 This panel appears when you select (Properties) in the RT
Machine Data window. Select next the type of collimator fitted
to the machine and enter the associated configuration data.
This activates the collimator’s corresponding data entry fields,
while those fields related to the other three types of collimator
remain deactivated. All other input is impossible.
- The Name entry field enters the name (up to 16
characters) of the selected collimator.
- (Type) selects one of the six types of collimator:
(Symmetric), (Asymmetric X), (Asymmetric Y),
(Biasymmetric),(Multileaf X) and (Multileaf Y).
Note: For all field dimensions described below, the dimension is
defined at the plane perpendicular to the beam central axis
passing through the machine isocenter.
- The X Min Field entry field enters (in mm) the smallest field
which the symmetric collimator X jaws can realize.
Minimum value: 0 mm. Maximum value: 499 mm.
- The Y Min Field entry field enters (in mm) the smallest field
which the symmetric collimator Y jaws can realize.
Minimum value: 0 mm. Maximum value: 499 mm.
- The X Max Field entry field enters (in mm) the largest field
which the symmetric collimator X jaws can realize.
Minimum value: 1 mm. Maximum value: 500 mm, must be
greater than the X Min Field.
- The Y Max Field entry field enters (in mm) the largest field
which the symmetric collimator Y jaws can realize.
Minimum value: 1 mm. Maximum value: 500 mm, must be
greater than the Y Min Field.
- The Sym min field entry field enters (in mm) the smallest field
which the symmetric jaws of the asymmetric collimator can
realize. Minimum value: 0 mm. Maximum value: 499 mm.
- The Sym max field entry field allows you to enter (in mm)
the largest field which the symmetric jaws of the
12 asymmetric collimator can realize. Minimum value: 1 mm.
Maximum value: 500 mm, must be greater than the Sym
min field.

12–10 Managing Treatment Machine Data – om 2235887–100 Rev. 1

The RT Machine Data panel
 - The Asym min field entry field enters (in mm) the smallest
field which the asymmetric jaws can realize. Minimum
value: 0 mm. Maximum value: 500 mm.
- The Asym retraction entry field enters the position value (in
mm) of the asymmetric jaws when they are fully opened.
Minimum value: 0 mm. Maximum value: 250 mm, must be
greater than the Asym extension.
- The Asym extension entry field enters the position value (in
mm) of the asymmetric jaws when they are fully closed. A
negative value indicates that the jaw travels past the
collimator axis. Minimum value: –200 mm. Maximum value:
250 mm.
- The Biasym min field entry field enters (in mm) the smallest
field which the X and Y jaws can realize. Minimum value:
0 mm. Maximum value: 500 mm.
- The Retraction entry field enters the position value (in mm)
of the X and Y jaws when they are fully opened. Minimum
value: 0 mm. Maximum value: 250 mm, must be greater
than the Biasymmetric extension.
- The Extension entry field enters the position value (in mm)
of the X and Y jaws when they are fully closed. A negative
value indicates that the jaws travel past the collimator axis.
Minimum value: –200 mm. Maximum value: 250 mm.
- The Leaf pair number entry field enters the number of leaf
pairs which make up the multi–leaf collimator. Minimum
value: 2. Maximum value: 100.
- (Set Leaf widths) opens the Leaf Width panel (described
below), where the leaf width for each leaf pair can be
entered. This button is active only if a value has been
entered in the (Leaf Pair Number) entry field.
Note: This parameter is represented as a fixed–point number with
one decimal place.
- The Leaf retraction entry field enters the position value (in
mm) of the MLC leaves when they are fully opened. 12
Minimum value: 0 mm. Maximum value: 250 mm, must be
greater than the Leaf extension.

om 2235887–100 Rev. 1 Managing Treatment Machine Data – 12–11

The RT Machine Data panel
 - The Leaf extension entry field enters the position value (in
mm) of the MLC leaves when they are fully closed. A
negative value indicates that the leaves travel past the
collimator axis. Minimum value: –200 mm. Maximum value:
250 mm.
- The Multileaf Asym min field entry field enters (in mm) the
smallest field which the MLC asymmetric jaws can realize.
Minimum value: 0 mm. Maximum value: 500 mm.
- The Asym Retraction entry field enters the position value:
(in mm) of the asymmetric jaws when they are fully
opened. Minimum value: 0 mm. Maximum value: 250 mm,
must be greater than ‘Asym Extension’.
- The Asym Extension entry field enters the position value:
(in mm) of the asymmetric jaws when they are fully closed.
A negative value indicates that the jaw travels past the
collimator axis. Minimum value: –200 mm. Maximum value:
250 mm.
- (OK) closes the window and returns the application to its
previous state.
- (Cancel) undoes all the changes made in the Collimator
Properties panel, closes it and returns the application to its
previous state.

12

12–12 Managing Treatment Machine Data – om 2235887–100 Rev. 1

The RT Machine Data panel
Entering Leaf widths

12
The Leaf Width panel

om 2235887–100 Rev. 1 Managing Treatment Machine Data –12–13

The RT Machine Data panel
 This panel appears when you select (Set Leaf widths) in the
Collimator Properties panel. It allows you to define multileaf
collimator leaf widths for the selected treatment machine,
either by modifying individual leaf pairs or by applying a single
value to a range of leaf pairs. Collimators having multiple leaf
widths can thereby be modeled using this panel.
- The Leaf Width check boxes display the width of each leaf
pair alongside the leaf pair number. Selecting the individual
check boxes modifies the leaf width to be equal to the
value currently entered in the Width entry field (see below).
- The Start Leaf Number entry field specifies the start
(smallest) leaf pair number in the range that will be
modified when the (Apply) button is pressed.
- The End Leaf Number entry field specifies the end (largest)
leaf pair number in the range that will be modified when the
(Apply) button is pressed.
- The Width entry field specifies the leaf width (mm) that will
be applied to the specified range of leaves when the
(Apply) button is pressed, or when the individual leaf
check boxes are selected. The leaf width must be between
1 mm and 500 mm, and fractional values are permitted.
- (OK) closes the window and returns the application to the
Collimator Properties panel. It will not be possible to close
the panel unless all the leaf widths are defined.
Note: The leaves are numbered following IEC1217 standard.
- (Cancel) undoes all the changes made in the Leaf Width
panel, closes it and returns the application to the Collimator
Properties panel.

12

12–14 Managing Treatment Machine Data – om 2235887–100 Rev. 1

The RT Machine Data panel
Defining Photon energies

The Photons panel

This panel appears when you select (Photons) in the RT
Machine Data window. It defines a list of available photon
energies. All other input is impossible.
- The Energies list lists the photon energies which the
treatment machine is able to deliver. You can choose any
energy for editing or deletion.
- (Add) enters a value for the new energy (See Adding
Energy Levels below).
- (Delete) deletes the current energy.
- (Close) closes the window.

12

om 2235887–100 Rev. 1 Managing Treatment Machine Data –12–15

The RT Machine Data panel
 Defining Electron energies

The Electrons panel

This panel appears when you select (Electrons) in the RT
Machine Data window. It allows you define a list of available
electron energies. All other input is impossible.
- The Energies list tells you which electron energies the
treatment machine is able to deliver. Select any energy for
editing or deletion.
- (Add) enters the value of the new energy (See Adding
Energy Levels below).
- (Delete) deletes the current energy.
- (Close) closes the window.

12

12–16 Managing Treatment Machine Data – om 2235887–100 Rev. 1

The RT Machine Data panel
Adding Energy Levels

The Add Energy panel

This panel (or the equivalent one for electrons) appears when
you select (Add) in the Photons or Electrons window. It allows
you to enter the nominal energy of the beam to be defined.
- The Energy entry field allows you to enter the new energy.
Minimum value: 1. Maximum value: 50.
- (OK) saves the new energy in the RT Machine data base.
(See Saving Treatment Machine below)
- (Cancel) cancels the action of the Add energy button in the
Photons or Electrons window, closes the window and
returns the application to its previous state.
Saving Treatment Machine

The Update RT Machine panel

This panel appears when you select (OK) in the RT Machine
Data window. Select (Yes) to confirm the action or (No) to
abandon RT machine update.
Note: It is strongly recommended to produce a hard copy of all
verified RT Machine Data parameters and to save the 12
parameters to diskette to provide a record for subsequent
Quality Assurance checks.

om 2235887–100 Rev. 1 Managing Treatment Machine Data –12–17

The RT Machine Data panel
 Printing RT Machine Data
RT Machine Data hard copy is obtained by selecting (”Print”)
on the RT machine panel.

Saving Treatment Machine Parameters to

Diskette
This panel appears when you select [Backup RT Data] in the
Utilities Menu. It asks you to place a formatted diskette in the
workstation’s diskette drive. All other input is
impossible.

The Backup RT Data panel

Lost RT Machine Data files may lead to inability to

CAUTION use saved treatment plans. Back–up RT Machine
Data frequently to at least two diskettes. Keep the
diskettes in different physical locations.

12

12–18 Managing Treatment Machine Data – om 2235887–100 Rev. 1

The RT Machine Data panel
Restoring Treatment Machine Parameters from
Diskette
The panel appearing when the “Restore RT Data” item in the
“UTILITIES” menu is selected is illustrated in the figure below.
It will block all other user input. This panel asks the user to
place the disk to be restored from in the workstation’s floppy
drive, enter the physicist’s password (field size 16 characters),
and press enter. All machine files, user preferences, standard
beam groups, and DRR presets are then restored. For each
file, there are four possibilities:
- File exists on diskette, file exists on hard disk, files
identical: No action.
- File exists on diskette, file exists on hard disk, files not
identical: A panel appears asking the user if they wish to
replace the file on hard disk with the file on the diskette.
- File exists on diskette, but not on hard disk: A panel
appears asking the user if they wish to add the file to those
stored on the hard disk.
- File exists on hard disk, but not on diskette: No action.

- “Restore RT Data subpanel” (in “UTILITIES” menu).

12

om 2235887–100 Rev. 1 Managing Treatment Machine Data –12–19

The RT Machine Data panel
 File Conflict
A panel appears when a currently–existing file is discovered
during the “Restore RT Data” process (see figure above). It will
block all other input. This panel asks the user if they really do
wish to replace the existing file with the file found on the floppy
disk. Note that since machine names have unintelligible file
names, the actual machine name is extracted from these files
prior to message being displayed.

Add File
A panel appears when a “new” file (not on the hard disk) is
discovered during the “Restore RT Data” process. It will block
all other user input. This panel asks the user if they really do
wish to add the new file to the hard disk contents. Note that
since machine names have unintelligible file names, the actual
machine name is extracted from these files prior to the
message being displayed.

12

12–20 Managing Treatment Machine Data – om 2235887–100 Rev. 1

The RT Machine Data panel
CHAPTER 13

Setting User
Preferences 13
Main menu
The figure below shows the Advantage Sim main panel, with
the location of the two menu items related to user–definable
preferences.

Main Panel

om 2235887–100 Rev. 1 Setting User Preferences 13–1

 Structure and Windowing Preferences

13

The Preferences panel

13–2 Setting User Preferences om 2235887–100 Rev. 1

 This window appears when you select [Preferences] in the
Customize Menu. It allows you to save the way in which the
user interface is configured, for use as a default start–up
condition. It also contains settings related to how Advantage 13
Sim functions, notably during the outlining process. All other
input is impossible.
- (Preference) selects from a list of stored preference
settings.
- (Save) saves the current preference settings, by displaying
an sub–panel where the Preference name can be entered.
Use the current preferences name or save the preferences
under a new name. This facility for saving multiple settings
‘protocols’ allows several different users to retain their
preferred settings.
- (Delete) deletes the current user–preference settings from
the list of stored preferences.
- The Default views buttons – (3D), (Axial), (Coronal), and
(Sagittal) –– select the default view type for each of the
four view slots of the display.
- The Structure Menu selects from a list of default structure
types and updates the other controls in the window to
reflect the settings for the selected structure. You can
modify the preferences settings for all default structure
types. To add a new default structure type, select [Add].
(See below: Adding an Anatomical Structure to the
Preferences Settings)
- (Color) selects the default color for the current default
structure.
- (Type) selects the default type for the current default
structure.
- The Low threshold entry field allows you to enter the low
threshold CT number for contouring the current structure.
- The High threshold entry field allows you to enter the high
threshold CT number for contouring the current structure.
- The openings entry field allows you to enter a default value
for the erosion/dilatation method of removing bridges.

om 2235887–100 Rev. 1 Setting User Preferences 13–3

 - (Delete) deletes the current structure from the preferences.
You do not need to confirm your action.
- (Close) closes the panel and returns the application to its
13 previous state.

Adding an anatomical Structure to the

Preferences Settings

The Add Structure window

This panel appears when you select [Add] in the Structure
Menu. It allows you to add a new default structure type to the
Preferences settings. Enter the name of the new structure (up
to 16 characters), select (OK) or Return to return to the
Preferences window with the new structure activated. Select
(Cancel) to abandon structure addition. All other input is
impossible.

13–4 Setting User Preferences om 2235887–100 Rev. 1

DRR Presets
This option is available only when the application is in “beam”
mode, and a DRR is displayed. It permits the user to save 13
settings such as Mixing values and Depth Control values which
are related to the DRR currently displayed, if the user
considers that these settings can serve as a protocol for future
patients with the same type of localization.
These presets can then be used during the preparation of the
treatment plan using the BEV mode. They are available on the
Beam panel (see Beam Panel section).
In the “Customize” menu of the main panel, when the user
selects “DRR Presets” a sub–menu appears offering the
options of adding of deleting a DRR Preset. If a preset is being
added, a panel appears asking for the name of the new preset
(see figure below).

Similarly, the “Delete” sub–menu option can be used to delete

a DRR Preset. Selecting this option pops up a panel asking for
the name of the DRR Preset to be deleted.

om 2235887–100 Rev. 1 Setting User Preferences 13–5

 Blank page.

13

13–6 Setting User Preferences om 2235887–100 Rev. 1

CHAPTER 14

Saving and Restoring

Patient Data
Insert Tape for Archive/Restore Patient
14
Data
This panel appears when the “Archive/Restore Patients” item
in the “UTILITIES” menu is selected. It will block all other user
input. This panel simply asks the user to place a tape in the
tape drive. The “Cancel” button returns the application to the
main panel.

Archive/Restore Patient Data

This panel appears when the “Archive/Restore Patients” item
in the “UTILITIES” menu is selected, and a tape has been
placed in the tape drive. This panel has buttons allowing the
user to archive and restore at the patient level (i.e. image
series and plans associated with a given exam). The following
controls are provided:
- The Copy tape contents to browser button, which copies
the tape contents to the Advantage Workstation database.
A confirmation panel will pop–up asking the user to confirm
this action.
- The Overwrite tape contents with browser selections
button, which overwrites the current tape contents with the
exams currently selected on the Advantage Workstation
browser. A confirmation panel will pop up asking the user
to confirm this action. If no exam is selected in the
Advantage Workstation browser, a notice will pop–up to
indicate this.
- The Close button, which closes the panel and returns the
application to its previous state. This button will not be
selectable when archiving/restoring is in progress.

om 2235887–100 Rev. 1 Saving and Restoring Patient Data 14–1

14

“Archive/Restore Patients” panel

Copy tape contents to browser

The panel appears when the “Copy tape contents to browser”
button in the “Archive/Restore Patients” panel is selected. It will
block all other user input.

Restore Patients panel

Advantage Sim first reads the table of contents of the tape,
and displays the list of patients saved. The panel has three
buttons:
- All Patients, which restores all patients present on the
tape to the browser. When selected, a panel appears
indicating the number of patients and estimated restore
time, and asks for confirmation (see figure below);

14–2 Saving and Restoring Patient Data om 2235887–100 Rev. 1

 - Single Patient, which restores only the patient currently
selected in the list of patients. This operation can be
performed several times, selecting a different patient each
time.

14

- Cancel, which cancels the restore operation and closes the

panel.
HINT:
Advantage Sim reads the list of patients stored on the
tape, and displays the patient names in the order in which
they appear on the tape. To restore several patients
consecutively, it is recommended to select them in the
order in which they appear on the tape, in order to
optimize the loading time.
Note: When a tape is copied back to the Browser using “Restore All”,
the entire contents of the tape will be restored. To avoid
problems of available disk space it is recommended to:
– Limit the number of images stored on a tape (it is
recommended to store no more than 3 GB of data at a
time).
– Keep sufficient space free on the Browser to
accommodate this number of images. The amount of
space available is displayed on the Browser screen.
Multiple processes attempting to write data to a full
CAUTION database may result in corruption of data. Patient
Data should be restored from tape only when there
are no network transfers of data in progress.

om 2235887–100 Rev. 1 Saving and Restoring Patient Data 14–3

 Do not attempt to restore more than the available
CAUTION disk space.

Note: Tapes written under Advantage Sim 1.2 cannot be read directly
by this version. Many modifications have been made to
improve the safety of treatment plans and to the way in which
structures are referenced in the GE Plan object. Use the
14 service tool menu option in order to restore a tape in
Advantage Sim 1.2 format.

Overwrite tape contents with browser

selections

Archive Patients panel

The panel appears when the “Overwrite tape contents with
browser selections” button in the “Archive/Restore Patients”
panel is selected. It will block all other user input; This panel
asks the user if they are sure that they wish to overwrite the
current tape contents.
To avoid accidental loss of data, it is recommended
CAUTION that you periodically copy all patient data onto tape
and keep it safety to enable subsequent recovery of
data, in case of accidental erasure or hardware fault.

Due to Advantage Workstation constraints, it is not

CAUTION possible to archive data belonging to a single
patient. At least two patients must be selected when
archiving data.

14–4 Saving and Restoring Patient Data om 2235887–100 Rev. 1

CHAPTER 15

Periodic Quality
Assurance
It is strongly recommended that you follow a monthly
procedure of Quality Assurance (QA) checks to ensure
consistent operation of Advantage Sim.

A recommended minimum set of checks is described here. 15

Verification of CT images on Advantage
Workstation
Images of known dimensions and with known slice positions
and slice numbers (determined from the CT scanner) should
be transferred to the Advantage Workstation system from each
CT scanner used for RT plan preparation. Use the Analyzing
Images functions (see Advantage Workstation Operator
Manual) to verify the dimensions of objects in the images along
the axes X, Y and Z.

Note: See “Measurements, accuracy of” in the Advantage

Workstation Operator Manual to understand the level of
accuracy which can be obtained.

Verify that regions of known pixel value have the correct

displayed pixel values using Regions of Interest analysis.

Verification of RT Machine Data

Make sure that the latest revision number for each RT Machine
Data file corresponds to the revision number of the last
validated and saved version. (See RT Machine Panel).

Using the RT Machine Data menu from the Customize menu,

select each machine data file in turn and make sure that all
parameters are identical to those shown on the hard copy of
the latest, verified revision.

om 2235887–100 Rev. 1 Periodic Quality Assurance 15–1

 AFTER THIS CHECK, BE SURE TO SELECT NO IN
WARNING THE “UPDATE RT MACHINE” PANEL PROMPT IF
NO MODIFICATIONS TO THE STORED
PARAMETERS ARE INTENDED.

Verification of Hard copy (paper and film)

output
It is recommended that you produce a set of standard plans
15 and archive them in order to allow routine verification of hard
copy output, to both the Advantage Sim color printer and
(optionally) to a laser camera producing film.
The plans should be based on a phantom or patient of known
dimensions, using fields of known geometry. Hard copies
should be generated for each beam’s eye view, 3D and
reproducible reformatted images for future reference.
Verify that after retrieval of the reference plans that the hard
copies corresponding to those described above are identical in
size and orientation to the reference hard copies.
A weekly verification of the printer and laser camera calibration
is strongly recommended.

Verification of data export and import with

another system
Advantage Sim allows data to be exported to other systems
using DICOM 3.0. Treatment Plans (structures and beams)
can be exported either in the GE Private Object format or the
DICOM RT format. In both cases the communication protocol
is DICOM 3.0.
Note: It is the users responsibility to ensure that compatibility of the
systems has been determined.
It is essential that the integrity and interpretation of
CAUTION exported data is verified by the user before using
data on the receiving system for the first time, after
any software modification on either system, and
periodically.

15–2 Periodic Quality Assurance om 2235887–100 Rev. 1

 Advantage Sim also allows data to be imported from other
systems using DICOM 3.0. Treatment Plans (structures and
beams) can be imported only using the DICOM RT Objects RT
Structure Set and RT Plan.
It is essential that the integrity and interpretation of
CAUTION imported data is verified by the user before using
data on the Advantage Sim for the first time, after
any software modification on either system, and
periodically.
15
The criteria for verification must be determined by the user,
based on the function and limitations of the receiving system
and the data used by the receiving system. The following list of
items to verify is provided for guidance only and is not intended
to cover all possible circumstances:
- Direction of axes and scales (images).
- Patient orientation during CT image acquisition and
treatment.
- Direction of axes and scales (treatment machines).
- Coordinate systems.
- Scale and location of contours.
- Labeling/naming of patient, contours, beams, blocks.
- Validity of transmitted data on receiving system:
– Number of slices allowed.
– Patient orientation during image acquisition.
– Image display orientation (view from feet or head).
– Number of contour points.
– Structures with multiple contours on slices.
– Beam parameters (blocks, cutouts, MLC, etc.).
– Block types (APERTURE or SHIELDING)
– Treatment machine parameters (such as source axis
distance, block tray distance, and collimator limits)

om 2235887–100 Rev. 1 Periodic Quality Assurance 15–3

 See Advantage Sim DICOM Conformance Statement for
further explanation of validation requirements, and Chapter 4
Starting Advantage Sim for hints on ensuring compatibility
when importing data.

Correct interpretation of GE Private objects or

CAUTION DICOM objects by a receiving system is the
responsibility of the receiving system.

15 Verification of printer calibration

It is essential to periodically verify the printer calibration
(consult the service engineer). It is possible to periodically
verify calibration using the ‘Print calibration image’ option of the
RT Tools service menu.
If necessary, calibrating the printer can be done using the
‘Printer Calibration’ panel, accessible by entering the
physicists’ password. It will block all other user input. This
panel provides the user the possibility to correct for the
mechanical inaccuracies of their particular printer. It has the
following features:

- The horizontal scale length entry field, where the user

enters the physical size in mm of the horizontal direction
the calibration image.
- The vertical scale length entry field, where the user enters
the physical size in mm of the vertical direction of the
calibration image.
Refer to the Advantage Workstation User Manual regarding
laser film cameras (these are options of the AW platform).

Logging out and restarting the

workstation
It is recommended that the user logs out of the ‘sdc’ account at
the end of each day. It is also recommended that the user
restart the workstation approximately once a week, using the
browser ‘Shutdown’ menu option followed by the ‘boot’
command.

15–4 Periodic Quality Assurance om 2235887–100 Rev. 1

CHAPTER 16

Glossary
BEV
Beam’s Eye View
A display of defined patient anatomical structures as seen from
the radiation source position of a treatment field, at a distance
defined by the Source–Axis Distance (SAD) for the selected
RT machine, along the beam’s central axis. The BEV shows
the projection of the following objects: machine collimator jaws;
shielding blocks or cut–outs; volumes defined by the user.
Blending 16
DRR utility permitting merging of two DRR images, controlling
the contribution of each image to the total image. The captured
image can be displayed with normal or inverted pixel values.
CT
Computed Tomography.
Depth Control
DRR utility allowing DRR image reconstruction over a limited
region of the patient model, controlled by the user.
DFOV
Displayed field of view
The real size, in centimeters, of the width of an image display
window.

om 2235887–100 Rev. 1 Glossary 16–1

 DRR
Digitally Reconstructed Radiograph
An image reconstructed from a set of CT images using a conic
projection whose origin is coincident with the radiation source
of a treatment field. The DRR geometry is identical to the
Beam’s Eye View display, and the two displays are often
combined.
A DRR may be created using either of 2 methods: integration
of all pixel values encountered along a given projection line or;
display of the maximum pixel value encountered along a given
projection line.
16 Isocenter – beam
Isocenter – RT machine
The point about which the RT machine gantry, collimators and
isocentric table rotate, and through which the beam central
axis passes.
MIP
Maximum intensity pixel.
Mixing
DRR utility allowing the relative weighting of certain tissue
types to be modified in the DRR calculation, (low, medium, and
high density, plus a custom density range).
MLC
Multileaf collimator.
Origin of patient co–ordinate system
Position in patient model defined by the CT scanner as the
coordinate origin. Usually, the point lies at the intersection of

16–2 Glossary om 2235887–100 Rev. 1

 the CT tunnel axis and the scanning plane when the table is in
the zero offset position.
Pixel
2D graphical element.
Projected target volume
The projection of the outside limit of a target volume onto the
viewing plane of a beams’ eye view.
RAS
Patient oriented coordinate system with axes pointing towards
patient Right, Anterior and Superior directions.
SAD 16
Source to Axis (isocenter) Distance.
SBD
Source to Block Distance.
SID
Source to Image Distance.
SSD
Source to Skin Distance.
Voxel
3D graphical element.

om 2235887–100 Rev. 1 Glossary 16–3

 Blank page.

16

16–4 Glossary om 2235887–100 Rev. 1