Planning Reference Guide

for Brachytherapy Planning

BrachyVision
Eclipse

P/N B401654R01G 3/MARCH/2004

v6.5
Abstract The Reference Guide for Brachytherapy Planning (P/N B401654R01G) provides
reference information and procedures for using the BrachyVision application and the
Brachytherapy Planning task of the Eclipse application, version 6.5.

Updates For updates to this guide, please refer to the Release Notes.

Manufacturer Manufacturer: European Representative:

and European
Representative Varian Medical Systems, Inc., Varian Medical Systems UK Ltd.
Worldwide Headquarters Gatwick Road, Crawley
3100 Hanson Way, West Sussex RH10 9RG
Palo Alto, CA 94304, USA United Kingdom

Notice Information in this user guide is subject to change without notice and does not represent
a commitment on the part of Varian. Varian is not liable for errors contained in this user
guide or for incidental or consequential damages in connection with furnishing or use of
this material.
This document contains proprietary information protected by copyright. No part of this
document may be reproduced, translated, or transmitted without the express written
permission of Varian Medical Systems, Inc.

FDA 21 CFR 820 Varian Medical Systems, Oncology Systems products are designed and manufactured in
Quality System accordance with the requirements specified within these federal regulations.
Regulations (CGMPs)

ISO 9000 and Varian Medical Systems, Oncology Systems products are designed and manufactured in
ISO 13485 accordance with the requirements specified within ISO 9001 and ISO 13485 quality
standards.

CE Marking Varian Medical Systems, Oncology Systems products meet the requirements of Council
Directive MDD 93/42/EEC.

Trademarks Argus Software®, Cadplan®, Clinac®, Diamond®, Emerald®, GammaMed®, Integral®,

Linatron®, PaxScan®, Perfix®, QCWatch®, Sapphire®, See & Treat Cancer Care®,
SomaVision®, Varian®, Varis®, VMS® and Worldtube® are registered trademarks,
Abacus™, Acuity™, AdvantageFusion™, Argus™, BrachyVision™, CadPlan PLUS™,
CamScale™, Click-Fit™, Dose Shaper™, DynaLog™, Dynamic Targeting™,
Eclipse™, Enhanced Dynamic Wedge™, Exact™, GammaMedPlus™, Generation 6™,
Helios™, Implant View™, Indexed Immobilization™, MammoSource™, Millenium™,
MLC Shaper™, NeoVision™, On-Board Imager™, Polaris™, PortalVision™, RPM™,
ScanVision™, See & Treat™, SeedFinder™, ShadowCurser™, Silhouette™,
SmartBeam™, SmartConnect™, SmartProtect™, Twister™, VariSeed™,
VariSource™, Varis Vision™ and XimaVision™ are trademarks of Varian Medical
Systems, Inc.

All other trademarks or registered trademark are the property of their respective owners.

WHO ICD-O codes and terms used by permission of WHO, from:

International Classification of Diseases for Oncology, (ICD-O) 3rd edition, Geneva,
World Health Organization, 2000.

ICD-10 codes and terms used by permission of WHO, from:

International Statistical Classification of Diseases and Related Health Problems,
Tenth Revision (ICD-10). Vols 1-3, Geneva, World Health Organization, 1992.

© 2004, Varian Medical Systems, Inc., Varian Oncology Systems.

All rights reserved.
Edited in Finland.

ii
Contents
CHAPTER 1 INTRODUCTION ......................................................................1-1
About This Manual ......................................................................................1-1
Related Publications ...................................................................................1-4
Product Support ..........................................................................................1-4

CHAPTER 2 BRACHYTHERAPY PLANNING WORKFLOW.......................2-1

CHAPTER 3 GETTING FAMILIAR WITH

BRACHYTHERAPY PLANNING TASK...................................3-1
About Brachytherapy Planning Task...........................................................3-2
Managing Objects in Vision.......................................................................3-10
Info Window ..............................................................................................3-15

CHAPTER 4 COURSES, PLANS AND PLAN TEMPLATES........................4-1

Plan-Related Concepts ...............................................................................4-3
Creating New Plans ....................................................................................4-6
Using the Plan Organizer ..........................................................................4-14
Managing Courses ....................................................................................4-19
Managing Diagnoses ................................................................................4-21

CHAPTER 5 DEFINING RADIOGRAPH IMAGING GEOMETRY.................5-1

About Imaging Geometries in Brachytherapy Planning Task......................5-2
Defining Radiograph Imaging Geometries in
the Brachytherapy Planning Task ...............................................................5-8
Creating DRR Images of Volume Images .................................................5-10
Defining the Registration Point
in the Brachytherapy Planning Task .........................................................5-11
Using Reconstruction Jigs.........................................................................5-13

CHAPTER 6 CREATING BRACHYTHERAPY PLANS ................................6-1

About Creating Brachytherapy Plans ..........................................................6-3
Adding Applicators to Radiographs/Localization Films ...............................6-6

iii
 Digitizing Applicators...................................................................................6-9
Adding Applicators to Volume Images ......................................................6-12
Detecting Applicators in Volume Images ..................................................6-14
Defining Source Positions .........................................................................6-18
Adding Seed Implants ...............................................................................6-20
Using Implant Templates to Add Applicators and Seeds ..........................6-21
Modifying Implant Template Settings ........................................................6-23
Modifying Applicators ................................................................................6-26
Copying Applicators ..................................................................................6-27
Defining Varying Dwell Activities for Applicators.......................................6-28
Changing the Radioactive Source for Applicators.....................................6-29
Modifying Applicator Parameters ..............................................................6-31
Modifying Seeds........................................................................................6-33
Applicators and Seed Visualization...........................................................6-35
Managing Dwell Times..............................................................................6-37

CHAPTER 7 REFERENCE POINTS AND REFERENCE LINES..................7-1

About Reference Points and Reference Lines ............................................7-2
Adding Reference Points ............................................................................7-4
Adding Reference Lines..............................................................................7-6
Defining the Use of Reference Points .........................................................7-8
Modifying Reference Points or Reference Lines.......................................7-10

CHAPTER 8 DOSE DEFINITION ..................................................................8-1

About Dose Calculation in the Brachytherapy Planning Task.....................8-3
2D Dose Calculation Area
in the Brachytherapy Planning Task ...........................................................8-4
Dose Matrix .................................................................................................8-5
Managing the Dose Visualization................................................................8-7
Plan Normalization ....................................................................................8-21

CHAPTER 9 DOSE OPTIMIZATION .............................................................9-1

About Dose Optimization in the Brachytherapy Planning Task...................9-2
Using Geometrical Optimization

iv Reference Guide for Brachytherapy Planning

 in the Brachytherapy Planning Task ...........................................................9-2
Using Volume Optimization
in the Brachytherapy Planning Task ...........................................................9-3
Using the Brachytherapy Dose Optimization
Parameter Library .......................................................................................9-7

CHAPTER 10 EVALUATING PLANS ...........................................................10-1

About Plan Evaluation...............................................................................10-2
Point Dose Value and Dose Profile...........................................................10-3
Dose-Volume Histogram ...........................................................................10-6
Comparing Plans Visually .......................................................................10-26
Summing Plans .......................................................................................10-27

CHAPTER 11 PRINTING PLAN INFORMATION..........................................11-1

Printing Screens and Windows ................................................................11-1
About Treatment Reports for Brachytherapy Plans ..................................11-6

CHAPTER 12 EXPORT AND IMPORT .........................................................12-1

Exporting Brachytherapy Plan to Treatment Unit......................................12-2
Exporting Plan and Image Data ................................................................12-4
Exporting Data with DICOM ......................................................................12-8
Importing Plan and Image Data ..............................................................12-11
Exporting Plan Data to VARiS 1.4 and Generation 6 Applications .........12-13
CadPlan Export and Import.....................................................................12-14
Managing CadPlan Export and Import Hosts..........................................12-20

APPENDIX A IMPORT AND EXPORT FILTERS .......................................... A-1

Configuring Import and Export Filters ........................................................ A-1

APPENDIX B KEYBOARD SHORTCUTS ..................................................... B-1

INDEX........................................................................................................INDEX-1

v
vi Reference Guide for Brachytherapy Planning
Chapter 1 Introduction

This chapter covers the notation used throughout this manual and lists other
publications related to this manual.

About This Manual

This section provides background information necessary for using the
application, who this manual is meant for, and the notation used throughout
this manual.

Before You Begin

This manual assumes that you are familiar with Microsoft® Windows NT® 4.0
or newer operating system. Before you begin using the application,
■ Read your Microsoft Windows NT documentation to become familiar with
the Windows NT environment.

Who Should Read This Manual

This guide is written mainly for medical personnel who may have specific
tasks in the treatment planning process, for instance, radiation oncologists,
dosimetrists, radiation therapy technologists, and medical physicists,
responsible for defining applicators and evaluating plans.

Note: Vision applications should be used by qualified personnel only.

Visual Cues
This section presents the types of notes and precautionary notices used in the
manual, along with their icons. The BrachyVision documentation uses the
following notational conventions:

1-1
 Note: A note provides non-critical information, such as user
requirements, computer messages, suggestions and shortcuts,
which can help the user to obtain optimum performance from
the equipment or software.

CAUTION: Describes actions or conditions that could result in minor or

moderate injury or damage to equipment or loss of data.

WARNING: Describes actions or conditions that could result in serious

injury or death.

Bold text
This guide uses bold text for
■ Menus and menu commands. Example: From the Edit menu, select Delete.
■ Command buttons. Example: To confirm, click Yes.
■ Option buttons. Example: In the dialog box, select the 3D option button.
■ Check boxes. Example: In the dialog box, select the Import Structures
check box.
■ Text boxes. Example: In the ID and Name text boxes, type the appropriate
information.

Lucida Console font

Programming code, text in export files, names of environment variables, files

and other items related to programming are written with the Lucida Console
font.

1-2 Reference Guide for Brachytherapy Planning

 Quotation marks

This guide uses quotation marks for

■ Internal cross-references. Example: See “Topic of Interest” on page X-X.
■ Text that you type in the user interface. Example: In the cell, type “Data.”

Italics

This guide uses italics for

■ References to other publications. Example: Refer to Reference Guide for
External Beam Planning.
■ Emphasis. Example: Always verify plans visually.

Procedures
A procedure is a group of numbered, sequential instructions that must be
followed in the order given. The basic format for procedures is the following:
1. Do this
This will happen.
Note: Any note regarding the step being taken.

2. Do this
This will happen.

Some procedures contain alternative actions of which one or several can be

followed. Alternative actions are printed in the following format:
3. Do one of the following:
■ Do the action this way.

■ Do the action this way.

This will happen.

Some commands are available from both menus and toolbars. The procedures
indicate the toolbar buttons related to the menu commands with the picture of
the toolbar button as follows:

1-3
 1. From the XYZ menu, select the ABC command.
This will happen.

Related Publications
For additional information, refer to the following sources:
■ Instructions for Use for Brachytherapy Planning—Provides basic
information and procedures for using the Eclipse treatment planning
system for brachytherapy planning in the daily workflow.
■ Reference Guide for Preparing Images for Treatment Planning—Provides
background information and detailed instructions for how to prepare
patient image data for use in the Eclipse treatment planning system.
■ On-line help—Provides background information and detailed instructions
for how to use Vision and Eclipse tasks, and describes all functions
available in the Vision and Eclipse applications.

Product Support
For BrachyVision support, please call the appropriate number below. Support
is available from 9:00 GMT to 16:00 Pacific time.

Access Access Access

Country Country Country
number number number
Australia 1 800 144 130 Hungary 06 80013 318 Norway 800 16 327
Belgium 0800 74 248 Indonesia 001 803 0441 Portugal 800 880 183
1109
Canada 1 888 226 8633 Ireland 1 800 551 716 Singapore 800 44 11 100
Denmark 80 88 07 45 Israel 1 800 944 11 80 South Africa 0800 992 872
Finland 0800 11 68 92 Italy 800 790 535 Sweden 0200 21 45 08
France 0800 905 397 Japan 00531 78 22 21 Switzerland 0800 83 75 77
Germany 0800 182 6937 Luxembourg 0800 25 67 Taiwan 0080 04 40 99
Holland 0800 022 5072 Malaysia 1 800 808 605 UK 0800 068 06 88
Hong Kong 0800 96 21 42 New Zealand 0800 445 938 USA 1 800 360 7909

1-4 Reference Guide for Brachytherapy Planning

 Note: In addition, toll-free access using the AT&T International direct
dialing network is available in over 150 countries. To access
this number, dial first the AT&T access number in your area
(for the access code in your area, see internet address:
http://www.att.com/business_traveler/guides_and_access/
international_dialing.html). Then after hearing the AT&T
signature tone, and, “Please enter the number you are calling”,
dial: 800-360-7909.
For countries not listed above or not in the AT&T International
dialing network, Telephone Support may be obtained via the
following numbers:
■ UK: +44 1293-601-327
■ USA: +1-434-979-1540

Our Applications Specialists can immediately return any calls

received on these numbers.

Fax Support
Please fax your questions to BrachyTherapy Technical Support on:
■ UK: +44 1293-542-626
■ USA: +1-866-385-1322
e-Mail
To submit a support request or general inquiry, please compose an e-mail with
a blank subject line, to: [email protected]. Please indicate the name of
your institution, your name and phone number, the product you are
commenting on, and your system number (if known).

www
Customer Technical Bulletins for Varian Medical Systems may be found on
the internet at: http://www.varian.com/onc/index.html, under Support. The
bulletins are organized by year of issue and title.

1-5
1-6 Reference Guide for Brachytherapy Planning
Chapter 2 Brachytherapy Planning
Workflow

This chapter introduces a typical workflow used when creating treatment plans
for brachytherapy.

Before you begin

■ Open the patient. Check that the patient is correctly contoured. For
instructions, refer to the online help and Reference Guide for Preparing
Images for Treatment Planning.

See
Step Workspace
page
Create a plan for the patient Entry, Planning

If necessary, create a course for the plan. 4-19

Create a plan for the patient. 4-6

Prescribe the dose for the plan. 4-9

Optional: Insert applicators into the plan Entry, Planning

Define applicator geometry for the plan

■ With localization films 6-6

■ In volume image 6-12

■ By automatic detection 6-14

Optional: Insert seeds into the plan Entry, Planning

Select the seed collection to insert and define a location for 6-20
each seed in the 2D views.

Create reference points to the plan Entry, Planning

Create the necessary reference points and define the reference 7-4
point locations.

Link the points to plan and define one of them as primary 7-8
reference point.

2-1
 See
Step Workspace
page
Create reference lines to the plan Entry, Planning

Insert reference lines into the images. 7-6

Set the dwell times Entry, Planning

Set the dwell times for the applicators or the seed collection. 6-37

Scale and shape the isodoses Entry, Planning

Scale and shape the isodoses

■ Manually 8-19

■ By volume optimization 9-3

■ By geometrical optimization 9-2

Planning,
Evaluate the plan
Plan Evaluation

Calculate and evaluate the DVH for the PTV and each critical 10-6
organ.

Evaluate the dose distribution with the measurement tools. 10-3

Compare the plan with alternative plans Plan Evaluation

If there are multiple plans,

■ Compare the plans visually 10-26

■ Compare by summing up 10-27

■ Compare by subtracting 10-27

10-30 Planning,
Approve the plan for treatment
Plan Evaluation

12-2 Planning,
Export the plan to the treatment unit
Plan Evaluation

2-2 Reference Guide for Brachytherapy Planning

Chapter 3 Getting Familiar with
Brachytherapy Planning Task

This chapter provides a brief introduction to the workspaces related to creating

and evaluating plans in the Vision Brachytherapy Planning task, briefly
describing the actions possible in each workspace. The chapter describes the
layout of each workspace of the application and provides information on
moving around in the workspaces.

For more information on working in the Windows NT environment, refer to the

online help or your Windows NT manuals.

In This Chapter

Topic Page

About Brachytherapy Planning Task .................................................... 3-2

Features of the Brachytherapy Planning Task ..................................... 3-3
Treatment Planning in the Brachytherapy Planning Task ................... 3-3
Workspaces in the Brachytherapy Planning Task ............................... 3-4
Entry Workspace ................................................................................. 3-4
Planning Workspace ............................................................................ 3-4
Constructing Plans.......................................................................... 3-5
Evaluating Plans ............................................................................. 3-5
Plan Evaluation Workspace................................................................. 3-5
Navigating in the Workspaces ............................................................. 3-6
To Access the Workspaces............................................................. 3-6
Navigating in the Entry Workspace..................................................... 3-7
Navigating in the Planning Workspace ............................................... 3-8
Navigating in the Plan Evaluation Workspace .................................... 3-9
Managing Objects in Vision.................................................................. 3-10
Context Window in the Entry Workspace
and Planning Workspace ................................................................... 3-10
Context Window in the Plan Evaluation Workspace ........................ 3-11
Object Explorer.................................................................................. 3-12
Saving Information ............................................................................ 3-13

3-1
 To Save Your Work to the Database............................................ 3-13
Closing Items ..................................................................................... 3-13
To Close Items.............................................................................. 3-14
Deleting Information ......................................................................... 3-14
To Delete Information from the Database.................................... 3-14
Properties Dialog Boxes .................................................................... 3-14
Info Window........................................................................................... 3-15
Info Window in the Plan Evaluation Workspace .............................. 3-15
Dose Prescription Tab of the Info Window....................................... 3-15
Plan Sum Tab of the Info Window .................................................... 3-16
Calculation Options Tab of the Info Window ................................... 3-16

About Brachytherapy Planning Task

The aim of radiation therapy is to damage malignant cells and at the same time
spare normal cells. In clinical practice, a prescribed absorbed dose according a
specified time-dose pattern is delivered to target volume(s). Meanwhile the
surrounding healthy tissue should get as low dose as possible.

The brachytherapy planning process serves to model the treatment in a patient

anatomy and to compute the dose distribution as accurately and as completely
as is reasonably achievable. The aim is to find an optimum way of irradiating
individual patients. Moreover, as the patient is usually waiting, the planning
process must be designed to be expeditious and easy to perform. This goal is
achieved by using the Brachytherapy Planning task.
The Brachytherapy Planning task is a three-dimensional workstation for
viewing and editing medical images and defining the patient’s anatomy and the
applicator or implant positions. It is a system designed for use with
high-dose-rate (HDR) afterloaders, manual loaded low-dose-rate (LDR)
brachytherapy and pulsed-dose-rate (PDR) brachytherapy. BrachyVision is
optimized for use with the VariSource HDR, and the GammaMed HDR and
PDR afterloaders.. However, it has extensions that facilitate other afterloaders,
manually loaded LDR brachytherapy and PDR brachytherapy.

The Brachytherapy Planning task is divided into different workspaces, each

used for specific purposes at different phases of treatment planning. The
Selection, Registration and Contouring workspaces are intended for preparing

3-2 Reference Guide for Brachytherapy Planning

 patient images for actual treatment planning, whereas the Entry, Planning and
Plan Evaluation workspaces provide tools for brachytherapy planning and
evaluation of the completed treatment plans.

Features of the Brachytherapy Planning Task

The Brachytherapy Planning task provides the following functionalities:
■ Creating plan data
– Setting up and visually optimizing applicators and seeds
– Detecting applicator shapes in volume images
– Using implant templates
– Viewing dose distribution data
– Visualizing applicators in 2D and 3D patient anatomy
– Calculating the dose distribution in 2D and 3D
– Re-scaling and re-shaping the isodoses
■ Evaluating plans
– Viewing the dose distribution in 2D and 3D
– Viewing DVHs for multiple plans and structures
– Viewing the dose at reference points, normalizing the dose
– Verifying the absolute dose
– Combining multiple plans (both brachytherapy and external plans)
– Approving plans

Treatment Planning in the Brachytherapy Planning Task

In the Brachytherapy Planning task, applicator position data is entered either
by using radiographs or on the basis of volumetric images. Pre-plans may be
generated by inserting an implant template to define the applicators and dwell
positions.

3-3
 After the applicator positions have been defined, source positions and their
dwell times in the applicators are defined. The dwell times or positions or both
can be adjusted to give the most suitable dose distribution in each clinical
situation. When using the VariSource treatment unit, the dwell times and
positions for each channel are transferred to the afterloader using a 3.5” floppy.
Treatment information is transferred to GammaMed units using either a floppy
disc, or by network transfer.

Workspaces in the Brachytherapy Planning Task

The Brachytherapy Planning task is split in number of workspaces, each
intended for performing specific actions. The workspaces each have:
■ A special window layout to provide an optimal environment for
performing the selected procedure

■ Menus and toolbars containing a set of common and a range of

task-specific features and functions

For information on image processing related workspaces, refer to Reference

Guide for Preparing Images for Treatment Planning.

Entry Workspace
The Entry workspace is used to enter plan data from digitized localization
radiographs imported into the system. In the Entry workspace, you display the
radiographs as images in the image views and then create the treatment plan by
adding the necessary plan data—applicators, reference points and reference
lines—on the images. The image quality on the screen can also be improved,
or particular details viewed in the images by enhancing the images with special
image processing tools. You can also create DRR images from volume images
in the Entry workspace.

Planning Workspace
The Planning workspace is used for constructing a treatment plan to irradiate
the target volumes to achieve the prescribed dose and for evaluating
brachytherapy plans.

3-4 Reference Guide for Brachytherapy Planning

 Constructing Plans

You add implants or applicators to plans and modify applicator parameters.

The Planning workspace provides you with facilities for

■ Inserting applicators and reference points to plans

■ Creating plans on the basis of predefined templates
■ Adjusting applicator positions
■ Adjusting dwell times
■ Using seeds

Evaluating Plans

The Planning workspace is also the basis for the plan evaluation. It provides
functions for
■ Viewing and modifying dose distribution
■ Viewing and modifying dwell positions
■ Controlling dose calculation
■ Controlling plan optimization
■ Using digitally reconstructed radiographs (DRRs)

Plans can be created and viewed, and applicators and reference points
positioned graphically. The size and shape of the applicators are modified
either in the 2D views or in the Applicator Properties dialog box and the
applicator setup can be viewed in the Model view.

Plan Evaluation Workspace

The Plan Evaluation workspace is used for analyzing and comparing
alternative plans to determine the most appropriate plan or combination of
plans to approve for treatment.

After calculating the dose for a treatment plan, you can view the dose
distribution data two-dimensionally by using isodose lines and dose color
wash, or three-dimensionally by using isodose surfaces and dose cloud mode.
In addition to visual evaluation, you can evaluate the plan by displaying DVHs

3-5
 for multiple plans or structures. The workspace also provides tools for viewing
the dose at reference points and normalizing the dose. These functions are also
available in the Planning workspace.

The special functionalities in the Plan Evaluation workspace enable visual

comparison of different plans side-by-side, and comparison of plans by
subtracting or adding (both brachytherapy and external plans). You can also
sum several plans together.

To finish the treatment planning, you may accept plans by approving them and
optionally moving them to treatment.

Navigating in the Workspaces

In each workspace, the menu bar contains commands related to the workspace.
The most commonly used menu commands are also available as toolbar
buttons. The Context window displays the relevant objects belonging to the
selected patient in the workspaces. For more details on the Context window,
see “Object Explorer” on page 3-12.

To Access the Workspaces

Do one of the following:

■ From the Workspace menu, select the workspace you wish to go to.

or

1. From the Window menu, select Workspace bar.

The workspace bar is shown at the bottom of the Focus window and image
views.
2. In the Workspace bar, click the tab of the workspace you wish to go to.
Note: The application will remember your last Workspace bar setting
on the particular workstation where you made changes.

3-6 Reference Guide for Brachytherapy Planning

Navigating in the Entry Workspace
The Entry workspace consists of a menu bar, a toolbar, the Context window,
two 2D image views and the Image Gallery. The workspace provides the
following image view layouts:
■ 2 views: for instance, anterior—posterior and lateral images
■ 3 views: for instance, anterior—posterior, frontal, and lateral images

The content of the view layouts depends on the defined geometry. Figure 3-1
illustrates the Entry workspace with two views.

A. Menu bar B. Toolbar C. Scope window D. Context window E. Focus window F. Image views G.
Patient orientation indicator H. Image Gallery

Figure 3-1 Elements of Entry Workspace

The menu bar contains commands for entering planning data and image
processing. In all image views, the patient orientation indicator in the lower left
corner shows the viewing angle to the selected patient. The Image Gallery
displays the images selected in the Object Explorer to be used in the creation
of the plan.

3-7
Navigating in the Planning Workspace
The Planning workspace consists of a menu bar, a toolbar, the Context window
and image views. The image view layout is:
■ Ortho layout—three equal-sized 2D views (transversal, frontal, sagittal)
and a 3D view

Figure 3-2 presents the layout of the Planning Workspace.

A. Menu bar B. Toolbar C. Scope window D. Context window E. Focus window F. Model view G.
Orthogonal image views

Figure 3-2 Planning Workspace

Three of the image views, the orthogonal image views, display 2D images of
the patient from three directions: transversal, sagittal and frontal. The order of
the views depends on the patient’s position when the original CT images were
produced. The fourth image view is the Model view that displays a volume
image of the patient.

3-8 Reference Guide for Brachytherapy Planning

Navigating in the Plan Evaluation Workspace
The Plan Evaluation workspace consists of a menu bar, a toolbar, the Context
window and image views. You can choose from the following image view
layouts:
■ Two orthogonal views—Two view sets consisting of three 2D views
(transversal, frontal and sagittal).
■ Two model/BEV views—Two view sets consisting of a 3D view.
■ Multiple plane views—One view set consisting of nine transversal views
displaying adjacent image planes.
■ Orthoviews and BEV—One view set consisting of three 2D views
(transversal, frontal and sagittal) and a 3D view.

A. Menu bar B. Scope window C. Context window D. Focus window E. Toolbar F. Image set G.
Info window

Figure 3-3 Plan Evaluation Workspace

3-9
Managing Objects in Vision
The Context window allows navigating and interacting with windows. The
information in the Context window is displayed as folders that are
hierarchically organized in a tree structure. It is divided into two parts, the
Scope window and the Focus window.

Context Window in the Entry Workspace

and Planning Workspace
Below is an example of the Context window in the Entry and Planning
workspaces of the Brachytherapy Planning task.

A. Scope window displays the objects opened in the Object Explorer. B. Focus window displays
the contents of the object selected in the Scope window. C. Selected object.

Figure 3-4 Context Window

In the example, the objects displayed in the Scope window are the patient, the
image, the course and the plans, with the patient at the top of the hierarchy. The
patient has an image series, volume image and one course. The course contains

3-10 Reference Guide for Brachytherapy Planning

 two plans. The contents of the Focus window depend on the object selected in
the Scope window. In this example, a plan is selected, and its contents are
shown in the Focus window. The plan is linked to a volume image and contains
applicators and the dose distribution. The volume image contains structures
and a reference point which are displayed in their own folders.

Note: Remember that you have to select an object before you can
modify it. For example, to add an applicator you have to select
a plan into which the applicator is then inserted.

Context Window in the Plan Evaluation Workspace

Below is an example of the Context window in the Plan Evaluation workspace
in the Brachytherapy Planning task.

A. Scope window displays the objects opened in the Object Explorer. B. Focus window displays
the contents of the object selected in the Scope window. C. Selected object is highlighted.

Figure 3-5 Context Window

In the example, the objects displayed in the Scope window are the patient, the
image, the course and the plans, with the patient at the top of the hierarchy. The
patient has an image series, volume image and one course, and the course
contains three plans.

3-11
 The contents of the Focus window depend on the object selected in the Scope
window. In this example, a plan is selected, and its contents are shown in the
Focus window. The plan is linked to a volume image and contains applicators
and the dose distribution. The volume image contains structures and a
reference point which are displayed in their own folders.

Note: Remember that you have to select an object before you can
modify it. For example, to add applicators you have to select a
plan where to add the applicators.

Object Explorer
The Object Explorer is a dialog box used to open different objects from the
database. These objects are typically images, courses and plans. The Object
Explorer shows all the data and plans contained in each selected object.
Figure 3-6 shows the Object Explorer.

A. Selected object B. This box displays details for the object selected in the left box.

Figure 3-6 Object Explorer

The right box of the Object Explorer displays more details for the object
selected in the left box. For more information on using the Object Explorer,
refer to the online help system.

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Saving Information
All data you work with is stored in the Vision database, and you load the
appropriate data to the memory of your computer to view and modify it. The
modifications you do to the data are not automatically saved to the database
from your computer.

Note: To avoid losing important information,

■ Save your work regularly to avoid losing important
information.
■ Make regular backups of your system. Especially beam data
and the patient database, including image directories,
should be backed up at regular intervals.

Note: The VARiS Vision database allows multiple users to work on a

central database. In some cases, another user may have
modified and saved the data that you are currently working
with. If this occurs, you lose your changes when trying to save
your data. To minimize the risk of this situation, use the Reload
All command before starting to make changes to the data.

To Save Your Work to the Database

■ From the File menu, select Save All.

The information is saved to the database

Closing Items
Sometimes multiple objects opened in the Scope or Focus window may be
distracting. To clean up the view, and to avoid situations where you make
changes to an wrong item, you can close extraneous items that you do not need
to work with any longer. Closed items are just removed from the application
windows, they are not removed from the database.

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 To Close Items

1. In the Focus or Scope window, select the item to be closed.

2. From the File menu, select Close.
If you have made changes to the item, you are prompted to save or discard
the changes. If there are no changes, the item is closed without prompts.

Deleting Information
All data you work with is stored in the Vision database. Since the modifications
you do to the data are not automatically saved to the database from your
computer, you need to communicate deletions to the database by saving the
deletion. To avoid information losses, be careful when deleting information.
For example, if you accidentally delete a course or a plan, you can reload the
objects from the database to return to the previously saved state.

To Delete Information from the Database

1. From the Edit menu, select Delete.

The information is deleted from the memory of your computer.
2. From the File menu, select Save All.
The information is deleted from the database.

Note: Patients cannot be deleted from the database while in the

Brachytherapy Planning task.

Properties Dialog Boxes

Data and settings for all objects used in Vision applications can be displayed
and modified in dialog boxes designed for this purpose. To display the
Properties dialog box of a structure, for instance, select the structure in the
Focus window, go to the Edit menu and select Properties .This manual

3-14 Reference Guide for Brachytherapy Planning

 describes only the parts of the property dialog boxes that are relevant to
treatment planning. For more information on the Properties dialog boxes and
the tabs contained in them, refer to the online help system.

Info Window
The Info window displays parameter values set for the plans and fields. It also
provides an easy way to set or edit some of these values. In the Brachytherapy
Planning task, the Info window is only available in the Plan Evaluation
workspace.

By default, the Info window is shown below the image views and the Focus
window. You can also move the window and have it float over the image views
or the Focus window.
■ To show the Info window, from the Window menu, select Info Window.

Note: Do not use screen print-outs containing the Info window for
conveying any planning information to the treatment. Some of
the information contained in it can only be viewed on screen by
changing the column widths in or by scrolling the Info window.

Info Window in the Plan Evaluation Workspace

In the Brachytherapy Planning task, the Info window contains two tabs in the
Plan Evaluation workspace: Dose Prescription and Plan Sum.

Dose Prescription Tab of the Info Window

In the Brachytherapy Planning task, the Dose Prescription tab can be used for
viewing the prescription information of both brachytherapy plans and external
plans. However, it is not recommended to change the prescription settings of
brachytherapy plans. For information on the Dose Prescription tab, refer to the
online help.

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Plan Sum Tab of the Info Window
The Plan Sum tab is used for viewing and editing the properties of the plan
sum. The sum is updated accordingly in the image views. This tab also shows
the type of summing (adding/subtracting). The Plan Sum tab lists the
parameters related to the summation procedure and the dose prescribed for the
plans:

Table 3-1

Column Description
Plan ID ID of each plan included in the sum

Course ID ID of the course to which each plan in the sum belong

Operation Indicates whether the plan is summed with (“+”) or subtracted from
(“-”) the other plans in the sum

Weight Weight of the plan in the sum

Total Prescribed
Dose

Calculation Options Tab of the Info Window

The Calculation Options tab shows the selected calculation algorithms, their
parameters and the parameter values for external plans. None of the parameters
can be changed in the Brachytherapy Planning task. For more information,
refer to the online help.

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Chapter 4 Courses, Plans and Plan
Templates
Entry Workspace, Planning Workspace

This chapter provides information on managing plans and courses in the Entry
and Planning workspaces and defines the concepts related to plans.
Instructions are provided for creating new plans, opening existing plans from
and saving plans to the database, and copying plans. The chapter also describes
the use of the Plan Organizer to manage plans, dose prescription and reference
points, and it contains step-by-step instructions for creating, opening, and
modifying courses. Moreover, the use of plan templates to store standard plan
characteristics in the database to quickly create new plans on the basis of the
stored plans is covered in this chapter.

In This Chapter

Topic Page

Plan-Related Concepts ............................................................................ 4-3

Plan ...................................................................................................... 4-3
Fraction ................................................................................................ 4-3
Dose Prescription................................................................................. 4-4
Dose ..................................................................................................... 4-4
Effect of Changing Dose Values in Brachytherapy Plans ................... 4-4
Plan-Related Concepts and the Context Window in
the Brachytherapy Planning Task........................................................ 4-5
Creating New Plans ................................................................................. 4-6
Using Plan Templates .......................................................................... 4-7
To Create a New Plan .......................................................................... 4-8
To Prescribe the Dose for a Plan in the
Brachytherapy Planning Task.............................................................. 4-9
To Create a Plan Using a Template in
the Brachytherapy Planning Task........................................................ 4-9
To Open Existing Plans ..................................................................... 4-11
Saving Plans....................................................................................... 4-11
To Save a Plan .............................................................................. 4-11

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 To Copy Plans.................................................................................... 4-11
To Modify Plan Templates ................................................................ 4-12
To Save a Plan as a Template in
the Brachytherapy Planning Task...................................................... 4-12
To Manage Plan Templates ............................................................... 4-14
Using the Plan Organizer...................................................................... 4-14
About the Plan Organizer .................................................................. 4-15
All Plans Tab ................................................................................ 4-16
Ref. Points Tab ............................................................................. 4-16
Tabs for Individual Fractionations in the Plans............................ 4-17
Modifying information in the Plan Organizer ................................... 4-17
To Prescribe the Dose in the Plan Organizer
in the Brachytherapy Planning Task ............................................ 4-17
About Defining the Primary Reference Point in the Plan Organizer. 4-18
To Define the Primary Reference Point in the Plan Organizer .... 4-18
To Evaluate the Planned Dose for the Reference Points.............. 4-18
Managing Courses ................................................................................. 4-19
To Create a New Course.................................................................... 4-19
To Open a Course .............................................................................. 4-20
To Modify Courses ............................................................................ 4-20
Managing Diagnoses.............................................................................. 4-21

4-2 Reference Guide for Brachytherapy Planning

Plan-Related Concepts

Plan
In the Brachytherapy Planning task, a plan includes the geometrical setup and
the dose prescription defined for the plan. Depending on the phase in the
treatment planning process, the status of a plan can be one of the following:

■ Planning plan: Plan used for planning the treatment of a patient and visible
in the Brachytherapy Planning task
– Unapproved planning plan (icon in the Brachytherapy Planning
task) —Plan being worked on, not used for the treatment of a patient.
All planning fields or applicators in these plans can be modified.
– Approved planning plan (icon in the Brachytherapy Planning task)
—Plan approved by a qualified specialist. Applicators in these plans
cannot be modified, and the plans can be moved to treatment.
Note: Although planning plans with planning approval are in read-only
state, you can still edit the dose per fraction at the primary reference
point, edit the number of fractions.
■ Treatment plan: Plan used for scheduling the treatment of a patient and
visible in other Vision applications
– Unapproved treatment plan —Plan that has been marked a
treatment plan and is intended to be used for the treatment of a patient.
These plans are visible in other Vision applications.
– Approved treatment plan —Plan that has been marked a treatment
plan and approved by a qualified specialist to be used for the treatment
of a patient. Treatment plans are approved by approving the course of
the plan. No applicators contained in an approved treatment plan can
be modified.

Fraction
The total treatment that will be administered to the patient is normally divided
into a number of sub-doses (fractions). One fraction is the dose given to a
patient during one treatment session. For a total dose of 40 Gy, for example,
the patient may receive 20 fractions, each consisting of 2 Gy.

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Dose Prescription
The dose prescription refers to the procedure of determining the total dose to
be administered to the patient. The dose is determined differently in the
planning of a treatment and in functions related to the actual treatment or
treatment scheduling. In Eclipse, the dose is prescribed to a specific isodose
percentage. In other Vision/VARiS applications, the determination of the dose
is based on reference points.

Dose
The dose distribution calculated for a plan is represented by a branch in the tree
structure in the Context window. The dose distribution is indicated either as an
absolute (Gy) or relative (%) dose, and conveyed by means of isodoses or color
wash visualization. The check box next to the Dose icon in the Focus window
can be cleared to hide the dose distribution in the 2D and 3D views.

Effect of Changing Dose Values in Brachytherapy Plans

The prescribed percentage and prescribed dose per fractions are used to set the
isodose levels. If the prescribed percentage is 80% and the prescribed dose per
fraction is 600cGy, the 100% isodose will display 750cGy.

If you change either of these values, the dose will re-scale accordingly.

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 The number of fractions can be set in two places. The effects of changing the
fractionation in these places is as follows:
■ Plan Properties: This will keep the dose per fraction the same. The
display will show the overall dose for the two fractions however the dwell
times will be for the individual fractions.
■ Plan Organizer: This will divide the dose per fraction and the dwell times
by the new number of fractions. Again, the system will display the
isodoses for the entire plan but the dwell times will display the times for
each fraction.
■ The display will always show the doses for the entire treatment.
■ The doses to reference points on the plan report will be for the entire
treatment.
■ The dwell times in the dwell control and plan report will display the times
for each fraction.

WARNING: Ensure that you fully understand this functionality before

applying it. Incorrect use could possibly cause a procedural
misadministration. When in doubt, please contact Varian
support for help.

Plan-Related Concepts and the Context Window in

the Brachytherapy Planning Task
The division of plan-related concepts is reflected in the Context window as in
the following figure:

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 A. Plans B. Plan selected in Scope window C. Dose D. Applicators contained in the plan

Figure 4-1 Plan-Related Concepts in Context Window

Creating New Plans

Plan or plans of a patient are always created to a course, sometimes multiple
courses, depending on the clinical practices. Before starting to create the plan,
check whether there are any courses created for a selected patient, and if there
are, whether they can be used for the new plan. (For instance, if the same
patient has been given a different diagnosis than before, you need to create a
new course.) For each plan, select the desired plan target and record the dose
and fractionations that best correspond to the treatment prescribed for the
patient.

Plans can be created using the Insert New Plan wizard or the Plan Template
wizard. Both wizards prompt you to either select the relevant course or create
one if the patient has no courses.

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 Note: Before creating a new plan:
■ See that the volume image you are using is constructed of a
sufficient number of planes when using CT images or
ultrasound images. This ensures that the volume image
covers all the structures necessary for treatment planning.
■ For more information on contouring, refer to Reference
Guide for Preparing Images for Treatment Planning.
■ Sometimes the image and structure import through DICOM
may result in multiple structures marked with Body
Volume Type. Check the properties of these structures and
either delete the extraneous ones or change their Volume
Type.
■ The imaging orientation must be defined in the images. For
more information on changing the patient imaging position
in relation to the couch, refer to Reference Guide for
Preparing Images for Treatment Planning.
■ If you are opening a plan that has been moved to treatment,
check whether any changes have been made to it.
Modifications made to plans in other Vision applications
are not automatically reflected in planning.

Note: By default, the treatment date of a brachytherapy plan is the date

when the first applicator is added to the plan. Before exporting
the plan to the treatment unit, the correct treatment date must be
defined for the plan. This can be done in the Plan Properties
dialog box after the first applicator has been inserted into the
plan, or, alternatively, after the plan is complete with all
applicators defined. The defined treatment date is used for all
applicators inserted into the plan.

Using Plan Templates

A plan template stores standard plan characteristics in the database. In the
Brachytherapy Planning task, the characteristics include information about
prescribed dose percentage, applicators and, if selected, dwell times and

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 reference points and lines. Optimization parameters are also saved in the
template. When using the template to create a plan for a patient, a similar plan
is created using the information in the template.

When creating a plan from a plan template, first find the desired plan template.
How the templates are named and stored depends on the clinical practices. To
find any relevant information about each template, read the template
comments. Then let the program create the plan from the selected template and
set up the applicator geometry and dose prescription to the plan.

To Create a New Plan

1. If the patient file is not already open, use the Patient Explorer and the
Object Explorer to open the desired patient and volume image. For
information on the Explorers, see the Section “Object Explorer” on
page 3-12 and refer to the online help.
2. When prompted to do so, select a course for the plan or create a new
course.
■ In the Available Courses list of the Select Course page, click the
course and then click Next.
■ To create a new course, click New Course and follow the instructions
in “To Create a New Course” on page 4-19, and then click Next.
3. In the ID and Name text boxes of the Plan Properties dialog box, type the
appropriate plan information.
4. For brachytherapy plans, define the treatment technique and the
application setup type. These settings are used in the DICOM export and
import.
5. Click OK.
The image set selected for the plan is opened in the image views and
appears in the Context window. A course and the plan appear in the Scope
window.

Next: In the Brachytherapy Planning task, continue by inserting

applicators in the plan. For more information, see Chapter 6. Before
exporting the plan to the treatment unit, define the correct treatment date
for the plan.

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To Prescribe the Dose for a Plan in the
Brachytherapy Planning Task
1. In the Context window, select the plan to prescribe the dose for.
2. On the Edit menu, click Properties.
The Plan Properties dialog box opens.
3. In the Plan Properties dialog box, select the General tab.
4. Type the appropriate information in the Prescribed Percentage,
Prescribed Dose/Fraction and Number of Fractions text boxes.
5. Click OK.

You can also prescribe the dose for a plan in the Plan Organizer. For more
information and instructions, see “About the Plan Organizer” on page 4-15.

To Create a Plan Using a Template in

the Brachytherapy Planning Task
1. From the Insert menu, select New Plan from Template.
The Patient Explorer opens.
2. Click Update List button to view the list of all patient records in the
database.
3. In the Patient Explorer, select the patient to which to connect the new plan
and click OK.
The Object Explorer opens.
4. Do one of the following:
■ Create a plan using an image: In the Object Explorer, select an image
for the new plan and click OK.
■ Create a plan without an image: In the Object Explorer, click Cancel.

The Select a Course for the New Plan dialog box opens.

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 5. Do one of the following:
■ To connect the new plan to an existing course: Select a course and
click OK.
■ To connect the new plan to a new course: Click New Course, enter the
information needed in the Course Properties dialog box that opens and
click OK.
The Create a Plan from Template wizard opens.

A. Select a template directory here. B. Displays the contents of the directory selected. C. The
Comment text box displays information about the selected template. D. Displays the location and
name of the template.

6. In the Templates list box, select the template to use. You can check the
template details in the Comment box.
7. Click Next.
8. Verify the library applicators and treatment units. To change the library or
treatment unit, click the cell and select a new one in the list box.
9. Click Finish.

Next: Continue by inserting applicators, reference points and reference

lines. If a reference point is linked to an applicator, it follows the
applicator when moved.

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To Open Existing Plans
1. If the patient file is not already open, use the Patient Explorer to open the
desired patient.
2. In the Object Explorer, select the desired plan and click OK.
The selected plan opens in the current workspace. In the Brachytherapy
Planning task, the Context window shows the selected patient, plan, image
used for the plan and the applicators added to the plan.
3. If there are several plans, drag the desired plan from the Scope window to
an image view.
The plan is displayed in the image views.
Next: In the Brachytherapy Planning task, continue by modifying the
applicators in the plan. For more information, see Chapter 6, the Section
“To Modify Applicator Settings” on page 6-32.

Saving Plans
In the Brachytherapy Planning task, saved plans include the images,
applicators, reference points and lines, and the 3D dose matrix.

You are prompted to save your changes when you close a patient or open a new
plan when you have a plan opened on screen.

To Save a Plan
■ From the File menu, select Save All.

To Copy Plans
In the Brachytherapy Planning task, you can copy a plan including the
applicators and dose data to the selected course.

1. In the Scope window, select the plan.

2. In the Edit menu, select Copy Plan.
3. Select the course to which to copy the plan.

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 4. From the Edit menu, select Paste Plan.
The Plan Properties dialog box opens.
5. Define the plan properties and click OK.
The plan is copied under the selected course.
6. To make the copied plan active, drag the plan from the Scope window to
an image view.

To Modify Plan Templates

1. Create a new plan from the template you want to modify.
2. Make the necessary changes to the plan.
3. Save the plan as a new template and rename it.

To Save a Plan as a Template in

the Brachytherapy Planning Task

Note: If you have used implant templates to create the plan to be saved
as a plan template, do not change the applicator IDs. Otherwise,
these applicators cannot be created when creating a new plan
based on this plan template.

1. When you have completed a plan that you would like to save as a template,
first save the plan.
2. From the Planning menu, select Save Plan as Template.
The Create Plan Template Wizard opens.
3. In the text boxes, edit the ID and name of the new template, if necessary.
The Comment text box displays information about the template, for
example, the number of applicators. If desired, you can edit the comment.
4. Click Next.

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5. In the Plan Template Tree box, select the folder to which you wish to save
the new template. The path is shown in the Plan Template Location text
box.
■ To create a new folder, click Create.

■ To change the name of an item, double-click it.

Note: The Next button is dimmed if the plan template name is not
unique. Go back and change the name.

6. Click Next.
7. Do one of the following:
■ To include dose shape in the template, select the appropriate check
box.
■ To include reference lines or points in the template, select the
appropriate check box.
Note: Make sure that you have specified a patient volume for each
reference point included in the template. For information about
reference point properties, see Chapter 7, the Section “Adding
Reference Points” on page 7-4.

8. If reference lines or points are included, select whether they are linked to
applicators. To change the linked applicator, click the applicator cell in the
table and select a new one in the list box.
Note: The reference table is shown only if the linking is selected. If a
reference point is linked to an applicator, it follows the applicator when
moved.

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 9. Click Next.
10. Verify the applicators to be used and click Finish.
Note: If there are non-library applicators in the plan, they are now
converted to library applicators. If the Create missing library
applicators silently check box is selected, the conversion is done
automatically. Otherwise, the Applicator properties dialog box is
opened for each applicator to be converted. For more information, see
Chapter 6, the Section “Modifying Applicator Parameters” on
page 6-31.

11. To save the changes to the database, from the File menu, select Save All.

To Manage Plan Templates

Plan templates are mainly managed in the Administration task. However, there
are some actions you can take in the Create Plan from Template and Create
Plan Template wizards when selecting the location for a template:
■ To create a new subfolder, select a folder and click Create.
■ To remove a template or a folder, select it and click Delete.
■ To rename a template or a folder, select it, click the name and then type a
new name.
■ To move a template or a folder, select it and then drag it to the new
location.

If you need to make changes to a template afterwards, you can create a new plan
using the template, make the changes and save the template with a new name.

Using the Plan Organizer

The Plan Organizer is a tool for monitoring and managing the planning
information regarding the active course. The Plan Organizer shows the
following information:
■ Plans contained in the course
■ Dose contribution of the plan for each reference point
■ In the Brachytherapy Beam Planning task, dose data for each plan,
including the dose at each reference point

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 Note: Use treatment applications to monitor the actual treatment
process.

About the Plan Organizer

The Plan Organizer is a dialog box that shows planning information for the
plans in the active course. The dialog box contains one tab showing
information for all plans, one showing information for the reference points in
the plans, and one tab for each fractionation in the active course. The
information in the tabs is shown in a table format. Cells containing
unacceptable values are marked with a red frame.

Figure 4-2 Plan Organizer

Note: Verify the information in the Plan Organizer before transferring

it to treatment as some of the information may be viewed only
by changing the column widths or by scrolling it on screen.

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 All Plans Tab
The All Plans tab summarizes the plans that exist currently in the active course.
Information about approved plans cannot be modified, and rows for approved
plans and plans that have been transferred to treatment are grayed out. You can
monitor and define the following for the plans in the Plan Organizer:
■ Change the name of the plan.
■ Check and change the primary reference point that describes the prescribed
dose for each plan in other Vision/VARiS applications.
■ View the target volume of the plan.
■ Change the prescribed dose defined for each plan.
■ Change the fractions/day and fractions/week values.

Ref. Points Tab

The Reference Point tab summarizes the information for the reference points
contained in the plans in the active course. You can do the following for
reference points in the Plan Organizer:
■ View the plan data: the plan and fractionation ID and the number of
fractions for each plan.
■ Monitor the dose per fraction at the reference points.
■ Sum up the total dose of the selected plans at the reference points.
■ Change the total dose and the daily dose limits for the reference points.

Note: The patient may also have other reference points that are not
listed in this tab, for example, reference points created in the
other Vision applications. To have these reference points appear
in the Plan Organizer, include the points in the plan by clicking
the Edit Reference Points button. For more information about
including reference points in the plan, see “To Include
Reference Points in Plans” on page 7-8.

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 Tabs for Individual Fractionations in the Plans

In the Brachytherapy Planning task, the tab of each individual plan summarizes
the dose data for the plan in the active course, including the dose for the
reference points defined for the plan. Information in this tab cannot be
modified.
In the Brachytherapy Planning task, you can monitor the following for
individual plans:
■ Reference points included in the plan.
The cell of the primary reference point is marked with a yellow frame.
■ Dose data for the reference points: the dose per point, dose per fraction and
total dose.
If the total dose contributed by the plans included in the total dose exceeds the
total dose of a reference point, the Planned Total Dose in the column of the
reference point is marked with a red frame.

Modifying information in the Plan Organizer

In general, you can modify the information in green table cells. To modify the
information, click the cell to activate it and then either type the new
information or select it from a list box that appears.

A. Click a cell and type a value in the cell. B. Click a cell, click the down arrow that appears and
then select a value from the list box. C. Volume ID of the reference point.

To Prescribe the Dose in the Plan Organizer

in the Brachytherapy Planning Task

Note: The dwell times depend on the prescribed dose, so changing the
dose prescription will also change the dwell times.

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 1. From the Planning menu, select Plan Organizer.
The Plan Organizer opens.
2. To change the dose settings, click the appropriate cell in the table and type
the new value in the cell.
Note: Multiple fractionations are not supported for brachytherapy
plans.

3. To include a plan in the total sum, select the corresponding check box.
4. Click OK to close the dialog box.
Note: You can determine the dose also on the General tab of the Plan
Properties dialog box where you can give prescribed dose percentage,
prescribed dose/fraction and number of fractions for the plan.

About Defining the Primary Reference Point in the Plan Organizer

In the Brachytherapy Planning task, the primary reference point is used in plan
normalization.
For more information about reference points, see Chapter 7, ”Reference Points
and Reference Lines”.

To Define the Primary Reference Point in the Plan Organizer

1. From the Planning menu, select Plan Organizer.

The Plan Organizer opens.
2. Click the Point cell at the row of the desired plan and select the primary
reference point from the list box that opens.
Note: You can also click Edit Reference Points and define the primary
reference point in the Reference Points dialog box.

To Evaluate the Planned Dose for the Reference Points

You can evaluate the planned dose per fraction at each reference point for
selected plans in the Plan Organizer.

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 1. From the Planning menu, select Plan Organizer.
The Plan Organizer opens.
2. Select the Ref. Points tab.
3. In the In Total column, select the check box for each plan to include in the
planned total dose.
The dose at the reference points in the included plans is displayed in the
Total Dose row.
4. Click Close to close the dialog box.

Managing Courses
A course represents the course of treatment that a patient will be given. Every
patient must have a course, and all plans always belong to a course. The course
describes the intent and status of the treatment. One course may contain several
plans, both approved and unapproved, including their fractionation schemes.
This way courses can be used to gather up plans that represent different phases
of treatment for a patient.

Note: When starting to create a plan for a patient, check whether the
selected patient has any courses. If the patient has a course,
check whether they can be used. For instance, if the same
patient has been given a different diagnosis than before, you
need to create a new course. Moreover, check which of the
courses have already been transferred to treatment, if any.

To Create a New Course

1. From the Insert menu, select New Course.
The Course Properties dialog box opens.

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 2. Define the course properties.
■ In the ID text box, a default identification code is displayed. If
necessary, type a new code for the course.
■ In the Intent drop-down list, click the purpose of the course.

■ In the Status drop-down list, click the status of the course.

■ In the Start text box, type the date for starting the treatment.

3. Click OK to add the course to the Context window.

Next: Continue by adding a plan to the course. For instructions, see
“Creating New Plans” on page 4-6.

To Open a Course
1. From the File menu, select Open.
The Object Explorer opens.
2. In the left list box, select the course.
3. Do one of the following:
■ To open the course and all plans under it, click OK.

The Context window displays the course and all plans.

■ To open the course and a particular plan, select the plan in the
right-hand list box and click OK.
The Context window displays the course and the selected plan.
Next: Continue by adding a plan to the course. For instructions, see
“Creating New Plans” on page 4-6.

To Modify Courses
1. In the Scope window, select the course.
2. From the Edit menu, select Properties.
The Course Properties dialog box opens.
3. Modify the properties as necessary. For instructions, see “To Create a New
Course” on page 4-19.

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 4. Click OK to modify the course properties.

Managing Diagnoses
You can add new diagnoses by going to the Insert menu and clicking New
Diagnosis. You then define the diagnosis parameters in the Diagnosis
Properties dialog box. Diagnoses are also edited in this dialog box. You can
also attach diagnoses to courses.

4-21
4-22 Reference Guide for Brachytherapy Planning
Chapter 5 Defining Radiograph Imaging
Geometry
(Entry Workspace)

This chapter provides information on defining the imaging geometry for

localization films (radiographs) used in adding applicators to a brachytherapy
plan, and if localization jigs were used in the production of the films, defining
the jig in them.

In This Chapter

Topic Page

About Imaging Geometries in Brachytherapy Planning Task............ 5-2

Geometries Available in the Brachytherapy Planning Task................ 5-2
Orthogonal Geometry..................................................................... 5-2
Stereoshift Geometry...................................................................... 5-4
Reconstruction Jig Geometry ......................................................... 5-6
Single Film Geometry .................................................................... 5-7
Defining Radiograph Imaging Geometries in
the Brachytherapy Planning Task ......................................................... 5-8
To Select the Geometry Type .............................................................. 5-8
To Define the Orthogonal Geometry................................................... 5-8
To Define the Stereoshift Geometry.................................................... 5-9
To Define the Jig Geometry ................................................................ 5-9
To Define the Single Film Geometry ................................................ 5-10
Creating DRR Images of Volume Images ........................................... 5-10
To Create DRR Images of a Volume Image...................................... 5-10
Defining the Registration Point
in the Brachytherapy Planning Task ................................................... 5-11
To Set the Registration Point............................................................. 5-12
To Set the Registration Point Using Three Radiographs................... 5-12
Using Reconstruction Jigs..................................................................... 5-13
To Define the Reconstruction Jig ...................................................... 5-14

5-1
About Imaging Geometries in Brachytherapy
Planning Task
To use radiographs in adding applicators, you first need to define the geometry
of the radiographs in relation to each other, and if localization jigs were used
in the production of the films, define the jig in them. After this, you are ready
to add applicators on the radiographs.

Geometries Available in the Brachytherapy Planning Task

When working with radiographs for the first time, you need to create a new
radiograph set and define the geometry of the radiographs in relation to each
other. BrachyVision supports four different radiograph geometries:
„ Orthogonal
„ Stereoshift
„ Reconstruction jig
„ Single film

Figure 5-1 shows the radiograph geometries available in BrachyVision:

A B C D

A. Orthogonal B. Stereoshift C. Reconstruction jig D. Single film

Figure 5-1 Radiograph Geometries Available

Orthogonal Geometry

When using the orthogonal imaging geometry, you define particular properties
for both beams, imaging plane properties and the magnification factor. The
definable beam properties include the angle, focus-to-film distance and
isocenter-to-film distance. The imaging plane (transversal, sagittal, frontal or

5-2 Reference Guide for Brachytherapy Planning

user-defined plane) defines the direction of the plane on which the two x-rays
used for the imaging intersect. If the distances for the imaging are not fixed,
use a magnification factor to determine the necessary distances. Figure 5-2 and
Table 5-1 summarize the meaning of the definable orthogonal imaging
geometry properties.

1. Focus

Figure 5-2 Orthogonal Geometry

5-3
 Table 5-1 Symbols in Figure 5-2

Symbol Meaning
A Isocenter-to-film distance, AP direction.
Focus-to-film distance is A + B.

B Focus-to-isocenter distance, AP direction.

Focus-to-film distance is A + B.

C Focus-to-isocenter distance, lateral direction.

Focus-to-film distance is C + D.

D Focus-to-isocenter distance, lateral direction.

Focus-to-film distance is C + D.

φ1 Beam angle, AP direction.

Measured clockwise in relation to the Y-axis so that the angle of
the normal AP is 0.

φ2 Beam angle, lateral direction.

Measured clockwise in relation to the Y-axis so that the angle of
the normal LAT images 90.

The magnification factor M is calculated as follows:

„ AP direction: M1 = ( A + B ) ⁄ B

„ Lateral direction: M2 = ( C + D ) ⁄ D

Stereoshift Geometry

When using the stereoshift imaging geometry, you define particular properties
for both beams and the imaging plane properties. The definable beam
properties include the angle and the focus-to-film distance. By defining the
imaging plane properties, you select the direction of the plane. Figure 5-3 and
Table 5-2 summarize the meaning of these definable properties.

5-4 Reference Guide for Brachytherapy Planning

 Figure 5-3 Stereoshift Geometry

Table 5-2 Symbols in Figure 5-3

Symbol Meaning
A Focus-to-film distance.

B Focus-to-film distance.

E Isocenter-to-film distance, common to both images.

φ1 Beam angle.
Measured counterclockwise in relation to the Y-axis.

φ2 Beam angle.
Measured counterclockwise in relation to the Y-axis.

Note: When you use stereoshifted imaging geometry, view the

projections of the reconstructed applicators on the radiographs
in the Model view in the Planning workspace.

5-5
 Reconstruction Jig Geometry

When using a reconstruction jig, you define certain beam properties and
imaging plane properties. The definable beam properties include the angle,
focus-to-film distance, jig size, jig-to-film distance, cross size, cross angle and
cross shift. By defining the imaging plane properties, you select the direction
of the plane. Figure 5-4 and Table 5-3 summarize the meaning of these
definable properties.

1. Cross in reconstruction box 1A. Plane crossing the center of the box. 1B. Cross shift, that is the
distance of the alignment cross from the center of the jig. 1C. Half of the cross size. Cross size is
twice the distance OA. 2. View of the reconstruction box 2A. Reconstruction box edges. 2B. Beam
in lateral direction. 2C. Beam in AP direction.

Figure 5-4 Jig Reconstruction Box

5-6 Reference Guide for Brachytherapy Planning

 Table 5-3 Symbols in Figure 5-4

Symbol Meaning
C Center of the reconstruction box

a Clockwise angle of the alignment cross in relation to the O-C plane

crossing the center of the box

O Center of the alignment cross

A Tip of the alignment cross

d1 Jig size in lateral direction.

The jig size is the distance between the proximal and distal alignment
crosses.

d2 Jig size in AP direction.

The jig size is the distance between the proximal and distal alignment
crosses.

d3 Jig-to-film distance
The jig to film distance is the distance of the surface of the film from the
distal alignment cross (the alignment cross closer to the film).

Single Film Geometry

When using a single film, you define certain beam properties, imaging plane
properties and the magnification factor. The definable beam properties include
the angle, focus-to-film distance and isocenter-to-film distance. By defining
the imaging plane properties, you select the direction of the plane. If the
distances for the imaging are not fixed, use the magnification factor to
determine the necessary distances.

5-7
Defining Radiograph Imaging Geometries in
the Brachytherapy Planning Task
To define a radiograph imaging geometry, you first create a new radiograph
set, select the geometry type for the set and then select one of the imaging
geometries available. The selected geometry settings are shown on the
Remarks tab of the Image Properties dialog box of the radiograph set and in
treatment reports.
Before being able to select the image geometry type, create a patient, a course
and a plan.

To Select the Geometry Type

1. From the Insert menu, select New Radiograph Set.
The Select the Object from the List dialog box opens.
2. Select an imaging geometry and click OK.
A dialog box opens displaying the selected geometry type.
3. To define the geometry settings in detail, select the corresponding tab.
4. Continue as instructed in the subsections below.

To Define the Orthogonal Geometry

1. In the Localization Jig Properties dialog box, select the Orthogonal tab.
2. In the Name and Angle text boxes, type the name and angle for each field.
3. In the Focus-to-film distance text box for each beam, type the distance
from the focus of the imaging device to the film.
4. In the Isocenter-to-film distance text box for each beam, type the distance
from the isocenter of the beam to the film.
5. In the Imaging Plane group box, click the appropriate option button to
select the direction of the plane.
6. Click OK.

5-8 Reference Guide for Brachytherapy Planning

To Define the Stereoshift Geometry
1. In the Localization Jig Properties dialog box, select the Stereoshift tab.
2. In the Name and Angle text boxes, type the name and angle for each field.
3. In the Focus-to-film distance text box for each beam, type the distance
from the focus of the imaging device to the film.
4. In the Isocenter-to-film distance text box, type the distance from the
isocenter of the beams to the film.
5. In the Imaging Plane group box, click the appropriate option button to
select the direction of the plane.
6. Click OK.

To Define the Jig Geometry

1. In the Localization Jig Properties dialog box, select the Jig tab.
2. To select the beam whose properties you are defining, click the Beam 1 or
the Beam 2 option button.
3. In the Name and Angle text boxes, type the name and angle for the field.
4. Do one of the following:
„ In the Focus-to-film distance text box, type the distance from the
focus of the imaging device to the film.
„ If desired, select the Focus-to-film dist. fixed check box.
Note: The focus-to-film distance is the same as in the orthogonal
geometry. Selecting a fixed focus-to-film distance adjusts the jig-to-film
distance instead of the focus-to-film distance. This is useful if the
focus-to-film distance is known and the jig-to-film distance is variable.

5. In the Jig size and Jig-to-film distance text boxes, type the size and the
distance.
6. In the Cross size, Cross angle and the Cross shift text boxes, type the
appropriate information:
„ Cross size—Size of the alignment cross on the jig
„ Cross angle—Angle of the alignment cross
„ Cross shift—Distance of the alignment cross from the center of the jig

5-9
 7. In the Imaging Plane group box, click the appropriate option button to
select the direction of the plane.
8. Click OK.

To Define the Single Film Geometry

1. In the Localization Jig Properties dialog box, select the Single Film tab.
2. In the Name and Angle text boxes, type the name and angle for the field.
3. In the Focus-to-film distance text box, type the distance from the focus of
the imaging device to the film.
4. In the Isocenter-to-film distance text box, type the distance from the
isocenter of the beam to the film.
5. In the Imaging Plane group box, click the appropriate option button to
select the direction of the plane.
6. Click OK.

Creating DRR Images of Volume Images

You can also use digitally reconstructed radiographs (DRRs) for performing
brachytherapy treatment planning in the Entry workspace. The DRRs are
created from the volume image of the patient using the selected imaging
geometry.

To Create DRR Images of a Volume Image

1. In the Entry workspace, open the patient with the desired volume image.
2. Create a new plan for the patient.
3. From the Scope window, drag the volume image to the Image Gallery.
4. To activate the volume image, click it in the Image Gallery.
5. From the Insert menu, select New DRR Image.
The Localization Jig Properties dialog box opens.
6. Verify the geometry properties and click OK.

5-10 Reference Guide for Brachytherapy Planning

 7. Two digitally reconstructed radiographs are created from the geometry
settings to the Image Gallery.
Next: To continue planning using the DRRs, drag them from the Image
Gallery to the image views and add the necessary applicators. For
instructions, see Chapter 6, ”Creating Brachytherapy Plans”.

Defining the Registration Point

in the Brachytherapy Planning Task
If you are using orthogonal, stereoshift or single film imaging geometry, you
need to align the images to be able to use the radiographs for planning. The
images are aligned with a registration point to indicate the position of the films
and the patient when producing the radiographs, and to keep the applicator
geometry correct when completing the plan. The point ideally represents the
centerline of the imaging beam on the radiographs, or if this is not feasible, any
point shared by both radiographs that is close to the centerline. Figure 5-5
shows how the registration point is selected if the imaging focus point is
known.

A. Radiographs B. Imaging focuses C. Registration point

Figure 5-5 Definition of Registration Point

5-11
To Set the Registration Point
1. From the Localization menu, select Set Registration Point .

2. In one of the image views, click the point to use as the registration point.
3. In the other image view, click a point corresponding to the first registration
point to align the images to the registration point.

To Set the Registration Point Using Three Radiographs

1. From the Image Gallery, drag the first and the second of the three
radiographs to the two image views.
2. From the Insert menu, select New Radiograph Set.
The Select the object from the list dialog box opens.
3. Select an imaging geometry and click OK.
A dialog box opens displaying the selected geometry type.
4. Select the Orthogonal tab.
5. In the Beam 1 group box, type the desired angle in degrees for the first
image (for example -45°) in the Angle text box.
6. In the Beam 2 group box, type the desired angle in degrees for the second
image (for example 0°) in the Angle text box.
7. Click OK.
8. From the Image Gallery, drag the second and the third radiograph to the
two image views.
9. Repeat steps 2–4 as above.

5-12 Reference Guide for Brachytherapy Planning

 10. In the Beam 1 group box, type the desired angle in degrees for the second
image (for example 0°) in the Angle text box.
11. In the Beam 2 group box, type the desired angle in degrees for the third
image (for example 45°) in the Angle text box.
12. Click OK.
13. From the Window menu, select Entry layout (3 views).
14. Form the Image Gallery, drag the three radiographs to the image views.
15. From the Localization menu, select Set Registration Point .
16. In one of the image views, click the point to use as the registration point.
17. In the other image views, click a point corresponding to the first
registration point to align the images to the registration point.
Next: Continue by adding applicators.

Using Reconstruction Jigs

Reconstruction jigs are localization devices which allow the use of
semi-orthogonal images in planning. The 3D relationship of the images is
calculated by BrachyVision, based on the position of the jig crosses.

To be able to use the radiographs produced using a reconstruction jig, the focus
positions of the radiographs must be defined in BrachyVision. BrachyVision
calculates the focus position in relation to the reconstruction jig, and adjusts the
position of the registration point. An error estimate based on the new focus
position and the coordinates of the jig crosses is displayed. If the error is larger
than 1 cm, you need to verify the jig parameters and re-enter the crosses.

To define a reconstruction jig, first go to the Entry workspace and create a

radiograph set.

5-13
To Define the Reconstruction Jig
1. From the Localization menu, select Reconstruction Jig .
2. Click in a 2D image view.
Two crosses are displayed where you clicked, with a square moving handle
in the center of the cross, and similar handles at the ends of the two crosses.
The proximal cross is brighter, and the distal cross dimmer.

3. Align the cross centers by moving the handles with the crosses on the film.
4. Align the ends of the crosses with those on the films.
5. When the crosses are aligned, click OK in the Jig Calibration dialog box.
The image reconstruction is corrected for non-coplanarity and
non-orthogonality. The alignment crosses disappear from the image view.
6. Repeat steps 1–5 for both images.

5-14 Reference Guide for Brachytherapy Planning

Chapter 6 Creating Brachytherapy Plans
Entry Workspace, Planning Workspace

This chapter provides information on creating and modifying brachytherapy

plans in the Entry and Planning workspaces. The chapter goes through the
process of creating brachytherapy plans by using applicators or seed implants
with localization films or a volume image of the patient. Instructions are also
provided for creating plans using implant templates and viewing and editing
the dwell times for the applicators.

In This Chapter

Topic Page

About Creating Brachytherapy Plans ................................................... 6-3

Applicators........................................................................................... 6-3
Seeds and Seed Collections ................................................................. 6-4
Implant Templates ............................................................................... 6-4
Applicator Entry Methods ................................................................... 6-5
Adding Applicators to Radiographs/Localization Films ..................... 6-6
To Add Applicators with Localization Films ...................................... 6-8
Digitizing Applicators.............................................................................. 6-9
To Set the Applicator Options for Digitizing .................................... 6-10
To Digitize Applicators from Film Images ....................................... 6-10
To Digitize Applicators Using Film Images and Digital Images ...... 6-12
Adding Applicators to Volume Images................................................ 6-12
To Add Applicators Using Volume Images ...................................... 6-13
To Add New Applicators from the Library ....................................... 6-13
To Convert an Applicator to a Library Applicator ............................ 6-14
Detecting Applicators in Volume Images ............................................ 6-14
To Find the Applicator Shape in a Volume Image ............................ 6-15
Defining Source Positions ..................................................................... 6-18
To Define the Range for Positioning Sources ................................... 6-18
To Remove Source Positions from an Applicator ............................. 6-18
To Fit the Source Positions Inside a Structure................................... 6-19

6-1
 Adding Seed Implants ........................................................................... 6-20
To Add Seed Implants ....................................................................... 6-20
Using Implant Templates to Add Applicators and Seeds .................. 6-21
To Add Applicators with the Implant Template................................ 6-21
To Add Seeds with the Implant Template ......................................... 6-22
To Change the Treatment Unit for Applicators
Added with the Template................................................................... 6-23
Modifying Implant Template Settings................................................. 6-23
To Select and Include Holes in an Implant Template........................ 6-24
To Exclude Holes from an Implant Template ................................... 6-24
To Modify Hole Settings in an Implant Template............................. 6-25
To Show or Hide Hole Labels in an Implant Template..................... 6-26
To Show or Hide Hole Lengths in an Implant Template................... 6-26
Modifying Applicators .......................................................................... 6-26
To Manage Applicator Points with the Point Set Editor ................... 6-26
To Manage Applicator Points Graphically ........................................ 6-27
Copying Applicators.............................................................................. 6-27
To Copy and Paste an Applicator ...................................................... 6-27
Defining Varying Dwell Activities for Applicators............................. 6-28
To Define Varying Dwell Activities for an Applicator ..................... 6-28
Changing the Radioactive Source for Applicators ............................. 6-29
To Change the Radioactive Source for an Applicator ....................... 6-29
To Update the Radioactive Source .................................................... 6-30
Modifying Applicator Parameters ....................................................... 6-31
Modifiable Applicator Parameters..................................................... 6-31
To Modify Applicator Settings.......................................................... 6-32
Modifying Seeds..................................................................................... 6-33
Modifiable Seed Parameters .............................................................. 6-33
To Modify the Seed Collection Settings............................................ 6-34
To Move Applicators......................................................................... 6-34
To Rotate Applicators........................................................................ 6-35
Applicators and Seed Visualization ..................................................... 6-35
To Show the Applicators, Seeds or Reference Lines on a Plane....... 6-36
To Move the Focus to the Selected Radiograph................................ 6-36

6-2 Reference Guide for Brachytherapy Planning

 To Show or Hide the Applicator Labels ............................................ 6-36
To Show the Applicators Thicker...................................................... 6-36
Managing Dwell Times.......................................................................... 6-37
Dwell Control Window...................................................................... 6-38
To Show the Dwell Control Window ................................................ 6-38
To Change the Dwell Times .............................................................. 6-39
To Change the Dwell Positions ......................................................... 6-39
To Change the Dwell Activity or Source Strength............................ 6-39
To Set or Scale All Dwell Times....................................................... 6-40

About Creating Brachytherapy Plans

In the Brachytherapy Planning task, treatment plans are created by adding
applicators or seed collections to the selected patient’s images and then
modifying the applicator positions and other parameters to find the optimum
settings. Plans can also be created with the help of implant templates or plan
templates. Applicators and seed collections can be added either using two
localization films (radiographs) or a volume image created from CT or MR
images of the selected patient.

Applicators
Applicators are devices defining the source geometry. There are different types
of applicators that vary in their use and shape, for example, intracavitary
applicators and circular applicators. In BrachyVision, applicator properties
include the following:
„ Three-dimensional applicator shape
„ Two-dimensional applicator shape on radiographs
„ Length measured from the treatment unit
„ Source positions inside the applicator

6-3
Seeds and Seed Collections
Seeds can be used in BrachyVision in two ways; by placing a permanent
implant or a temporary implant in the patient.

The following actions are available for seed implants:

„ Adding with or without a template
„ Editing
„ Deleting
„ Changing source strength and activity
Seed implants can be either point seeds or line seeds. The configuration of the
source model selected for the plan determines the type of seeds. Point seed and
line seeds are moved in the 2D image views in slightly different ways. Point
seeds are visualized as small circles, or points, with a handle for moving the
point. Line seeds, however, are visualized as narrow rectangles with handles
for rotating and moving the seeds.

Implant Templates
Implant templates provide a quick way of creating a pre-plan, which is
particularly useful for prostate implants. An implant template is a rectangular
or circular grid of needle holes. The needles are pushed through some of the
holes to form a loading pattern based on the patient anatomy and treatment
system. Implant templates can also be used with seeds.
Implant templates can be used for

„ Defining new implant templates or editing existing ones

„ Creating a group of applicators with a template and editing them as a group

BrachyVision supports the use of, for instance, rectangular grid implant
templates and the Syed-Nebblett implant template. Figure 6-1 shows an
example of the layout of a Syed-Nebblett template.

6-4 Reference Guide for Brachytherapy Planning

 Figure 6-1 Syed-Nebblett Implant Template

The layout of each template can be graphically viewed and modified.

Implant templates are available in the Planning workspace.

Applicator Entry Methods

Applicators can be defined in plans in several ways: they can be entered
graphically with a digitizer, using two films, using the volume image (3D
patient model) and from an applicator library. In addition, an applicator can
also be added to a plan by defining its parameters in the Applicator Properties
and the Point Set Editor dialog boxes, or applicator shapes can be found in
images with a detection tool.

In all graphical methods, the applicator geometry is entered point by point. The
resulting collection of points form a linear curve in space that determines the
shape and position of the applicator. The points are located on the X-, Y-, and
Z-axes. For an example, see Figure 6-2.

6-5
 Figure 6-2 Points in an Applicator

Applicator points can be entered by

„ Typing the point coordinates

„ Clicking the points with the mouse, using orthogonal radiographs or a
volume image
„ Clicking the points with an electromagnetic digitizer, using radiographs
„ Automatically using the detection tool

Adding Applicators to Radiographs/Localization

Films
To use radiographs in adding applicators, you first need to define the geometry
of the radiographs in relation to each other, and if localization jigs were used
in the production of the films, define the jig in them. After this, you are ready
to add applicators on the radiographs.

6-6 Reference Guide for Brachytherapy Planning

When using radiographs, applicators are defined point by point with the mouse
to the films displayed in the image views. The start point of an applicator is
nearer to its tip, the stop point closer to the treatment machine.

Note: When adding applicators to brachytherapy plans, notice the

following:
„ The visualization of applicators is different in the Entry and
Planning workspaces. The Entry workspace shows the
radiographs and applicators drawn on them as projections,
taking perspective into account. The Planning workspace,
however, does not show perspective in the visualization of
plans. As a result, the same applicators may look slightly
different in the Entry and Planning workspaces.
„ By default, the treatment date of a brachytherapy plan is the
date when the first applicator is added to the plan. Before
exporting the plan to the treatment unit, the correct
treatment date must be defined for the plan. This can be
done in the Plan Properties dialog box after the first
applicator has been inserted into the plan, or, alternatively,
after the plan is complete with all applicators defined. The
defined treatment date is used for all applicators inserted
into the plan.
„ Because of the distance of the imaging device focus from
the film, all the markings and distances on the produced
radiograph are magnified. Based on the imaging geometry
parameters, the magnification is taken into account, and the
applicators are displayed in the correct size.
„ Use the 3D view in the Planning workspace to view
applicators inserted in radiographs in the Entry workspace.
Enter the Planning workspace to view the applicators in the
3D view. The 3D model can be rotated and zoomed in and
out as normal. In addition, you can select the radiograph to
focus on. For instructions, refer to Reference Guide for
Preparing Images for Treatment Planning.

6-7
To Add Applicators with Localization Films
To insert an applicator using two radiographs, first go to the Entry workspace.

1. From the Insert menu, select New Applicator.

The Applicator Properties sheet opens.
2. Enter the applicator properties as necessary and click OK.
For instructions, see “Modifying Applicator Parameters” on page 6-31.
3. In an image view, click the internal tip of the applicator.
The point you click is displayed as a rectangle. A line appears in the other
image view, showing the position of the point in it. The status bar displays
the reconstruction information.

A. Applicator point clicked in the image. B. Line showing the position of the point in the other
image.

4. Do one of the following:

„ Click the second point in the same image.
„ Click the first point in the other image.
The points are displayed in the images. If the reconstruction error
displayed in the status bar is zero, the point is in the correct position. If the
error is other than zero, the point is not in the correct position.

6-8 Reference Guide for Brachytherapy Planning

 5. Do one of the following:
„ If the point is in the correct position, repeat steps 1–4 until you have
clicked the necessary number of points for the applicator.
„ If the point is not in the correct position, change the imaging geometry
setup of the images or re-define the registration point.
Note: Remember to click an equal number of points for both images.
Whenever an equal number of points have not been defined in each of
the image views, the view that requires more points shows a notification.

6. To delete a point, right-click it. You can delete the points starting from the
one added last.
Next: Continue by setting dwell times for the added applicators.

Digitizing Applicators
BrachyVision also supports defining applicators by using an electromagnetic
digitizer or entering some points on the computer and then additional points
with a digitizer. You can also scan and import your film images into the system
and use them as reference images while digitizing applicator positions from the
original film images.

You use the digitizer in the Entry workspace similarly to using the mouse of
your computer. BrachyVision supports two types of digitizers; Numonics
Accugrid and Kontron Digikon.

Note: Sometimes the communications port for the digitizer cannot be

found, in which case a warning message is issued. To correct the
problem, turn your computer off and restart it.

To enter an applicator with a digitizer, first go to the Entry workspace.

6-9
To Set the Applicator Options for Digitizing
1. From the View menu, select Options.
The View Options dialog box opens.
2. Select the Entry Workspace tab.
3. In the Digitizer group box,
„ To always manually activate the view to which define points with the
digitizer, click the None option button.
„ To have the application activate the other image view after each click,
click the Always option button.
„ To have the application intelligently activate the image views, click
the Smart option button.
4. Click OK.
5. To define the port to which the digitizer is connected to, from the Tools
menu, select Task Configuration.
The Task Configuration dialog box opens.
6. Type the name of the port in the COM Port text box.
7. Click OK.

To Digitize Applicators from Film Images

1. Switch on the digitizer.
2. Position the films on the digitizer side by side by aligning them
horizontally with the digitizer.
Note: Secure the films on the digitizer with adhesive tape.

3. From the Insert menu, select New Radiograph Set.

You are prompted to define whether you wish to work without digital
images.
4. To continue, click Yes.
5. Define the imaging geometry of the films as in “Defining Radiograph
Imaging Geometries in the Brachytherapy Planning Task” on page 5-8.

6-10 Reference Guide for Brachytherapy Planning

6. With the digitizer mouse, enter the registration point for each film placed
on the digitizer.
The films are aligned. The registration points appear in the image views
but not necessary in “right” locations.
7. Make sure that the digitizing options are as desired. See “To Set the
Applicator Options for Digitizing” on page 6-10.
8. From the Insert menu, select New Applicator and define the applicator
parameters as in “Modifying Applicator Parameters” on page 6-31.
9. To define which plane the points are added to, activate the corresponding
image view.
10. With the digitizer mouse, click the internal tip of the applicator on either
of the films placed on the digitizer.
The point you click is displayed as a rectangle in the active 2D image view.
A line appears in the other image view, showing the position of the point
in it.
11. Depending on the set digitizing options,
„ Activate the view displaying the image to which to define the second
point, and with the digitizer mouse, click the second point on the
corresponding film.
„ With the digitizer mouse, click the second point on the film
corresponding to the active image view.
The second point appears in the image view. If the reconstruction error
displayed in the status bar is zero, the point is in the correct position. If the
error is other than zero, the point is not in the correct position.
12. Do one of the following:
„ If the point is in the correct position, repeat steps 10–12 until you have
clicked the necessary number of points.
„ If the point is not in the correct position, change the imaging geometry
setup of the films or re-define the registration point and then repeat
steps 10–12 until you have clicked the necessary number of points.
Note: Remember to click an equal number of points for both films.

13. To remove a point, right-click it in an image view.

Next: Continue by setting the dwell times for the added applicators.

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To Digitize Applicators Using Film Images and Digital Images
1. Switch on the digitizer.
2. Position the films on the digitizer side by side by aligning them
horizontally with the digitizer.
Note: Secure the films on the digitizer with adhesive tape.

3. From the Insert menu, select New Radiograph Set.

You are prompted to define whether you wish to work without digital
images.
4. To continue, click Yes.
5. In the Entry workspace, display the images in the 2D image view.
6. Define the imaging geometry of the films as in “Defining Radiograph
Imaging Geometries in the Brachytherapy Planning Task” on page 5-8.
7. In the image views, enter the registration point for the images as in
“Defining the Registration Point in the Brachytherapy Planning Task” on
page 5-11.
8. Make sure that the digitizing options are as desired. See “To Set the
Applicator Options for Digitizing” on page 6-10.
9. From the Insert menu, select New Applicator and define the applicator
parameters as in “Modifying Applicator Parameters” on page 6-31.
10. Continue by clicking the applicator points with the digitizer mouse as in
“To Digitize Applicators from Film Images” on page 6-10.
Next: Continue by setting the dwell times for the added applicators.

Adding Applicators to Volume Images

Note: When adding applicators to brachytherapy plans, notice the

following:
„ The visualization of applicators is different in the Entry and
Planning workspaces. The Entry workspace shows the
radiographs and applicators drawn on them as projections,

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 taking perspective into account. The Planning workspace,
however, does not show perspective in the visualization of
plans. As a result, the same applicators may look slightly
different in the Entry and Planning workspaces.
„ By default, the treatment date of a brachytherapy plan is the
date when the first applicator is added to the plan. Before
exporting the plan to the treatment unit, the correct
treatment date must be defined for the plan. This can be
done in the Plan Properties dialog box after the first
applicator has been inserted into the plan, or, alternatively,
after the plan is complete with all applicators defined. The
defined treatment date is used for all applicators inserted
into the plan.

To Add Applicators Using Volume Images

To enter an applicator using a 3D patient model, first enter the Planning
workspace.

1. From the Insert menu, select New Applicator.

The Applicator Properties dialog box opens.
2. Define the necessary applicator settings. For instructions, see “Modifying
Applicator Parameters” on page 6-31.
3. Click OK to add the new applicator in the Focus window and activate the
Contour Editor tool.
4. In an image view, click the first point of the applicator.
5. Click the necessary amount of points in the three 2D image views.
Next: Continue by defining the source positions and setting the dwell
times for the added applicators.

To Add New Applicators from the Library

1. From the Insert menu, select New Applicator from Library.
The Select the Applicator to Insert dialog box opens.

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 2. In the list box, select the applicator.
3. Click OK.
4. Move and edit the applicator as necessary.

To Convert an Applicator to a Library Applicator

1. In the Focus window, select the applicator.
2. From the Planning menu, select Applicators and then Convert To
Library Applicator.
The Brachy Applicator Properties dialog box opens.
3. Define an ID for the library applicator. If necessary, define also a name and
manufacturer.
4. In the Source Position Properties group box, define the total length of the
applicator. Enter also the first and the last source position and the distance
between the sources.
5. The default applicator type Rigid is automatically selected. This option
copies the shape of the applicator to library applicator. To define corner
points, click Shape and use the Point Set Editor as in “To Manage
Applicator Points with the Point Set Editor” on page 6-26.
Note: Selecting Flexible will not copy the shape of the applicator.
Selecting Template will create a new applicator implant template.
6. To save the applicator as a library applicator, click OK.

Detecting Applicators in Volume Images

To speed up treatment planning, the Brachytherapy Planning task features an
applicator detection function to automatically find the shape of applicators in
a volume image (for example, a CT image). You indicate the location of an
applicator on one slice, and the program then finds the applicator on the other
slices and constructs the applicator shape from the found locations. It is also
possible to detect a set of applicators using an implant template.

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 WARNING: Always verify the detected applicator shape and direction
visually.

Note: When detecting applicators, note that:

„ The applicator is not found in the image set if the initial
position is not correctly given.
„ The shape is reconstructed only partially if the image data
is insufficient.
„ The shape is not correct if the image data is ambivalent or
the applicator intersects with the same plane more than
once.
„ By default, the treatment date of a brachytherapy plan is the
date when the first applicator is added to the plan. Before
exporting the plan to the treatment unit, the correct
treatment date must be defined for the plan. This can be
done in the Plan Properties dialog box after the first
applicator has been inserted into the plan, or, alternatively,
after the plan is complete with all applicators defined. The
defined treatment date is used for all applicators inserted
into the plan.

To Find the Applicator Shape in a Volume Image

1. In the image views, show an image plane where the applicators are clearly
visible. Zoom in to the image if necessary. The applicators should be large
enough to easily click them. Note that the Detection Threshold windows
viewing angle depends on the orthogonal view you clicked on to select an
applicator.

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 2. From the Planning menu, select Applicators and then select Detect
Applicator from Image .
The Detect Applicator dialog box opens. The Detection tool is activated
and shown in the image views and the preview pane of the dialog box.

A. Move the slider to find the correct contrast level to display the applicators clearly. B. Click the
applicators with the mouse in the image view.

3. Do one of the following:

„ In the Type group box, select the applicator material.
„ In the Orientation group box, select whether the applicator tip points
up or down in the image. In the standard coordinate system, “up” is the
direction in which the Z-coordinate values increase.
4. With the slider, define a contrast level at which all the applicators are
visible and separate in the preview area. The applicator shape and size
should resemble the one in the active image view.

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5. Click on one of the applicators in the image view showing the applicators
clearly.
The detection tool appears where you clicked and in the Detect Applicator
dialog box. The applicators shape should be displayed in light green in the
Detection Threshold window.
If the applicator remains black try to place the target cross in a better
position in the orthogonal views.
6. Click Detect New (or press CTRL and click) to complete the detection and
add the new applicator to the plan.
7. If necessary, correct the detection result. Do one of the following:
„ Define a new applicator type and orientation.
„ If the detection fails to cover the whole applicator, define a lower
threshold.
„ If the detection does not stay inside the applicator, define a higher
threshold.
„ Re-click the applicator in an image view.
„ If the detection function tends to create curved applicator shapes
although you are using straight applicators, try selecting the Straight
Applicator check box.
„ If the detection function creates excess points in a curved applicator,
remove points manually with the Contour Editor.
8. To apply the changes, select the applicator to be corrected in the
drop-down list box and click Detect Selected (or press SHIFT and click).
9. Repeat the necessary steps for all applicators you wish to detect in the
volume image.
Next: Continue by defining the source positions and setting the dwell
times for the added applicators.

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Defining Source Positions

To Define the Range for Positioning Sources

Note: The source position range is always applied to the applicator

closest to the point where you start painting.

1. Do one of the following:

„ Entry workspace: On the Entry toolbar, click Set Source Position
Range .
„ Planning workspace: On the Planning toolbar, click Set Source
Position Range.
2. In a 2D image view, paint the range with the mouse.
The range appears on top of the applicator.

A. Paint the source range with the mouse.

3. When you are finished, deactivate the tool to add the sources on the
applicator.

To Remove Source Positions from an Applicator

1. Do one of the following:
„ Entry workspace: On the Entry toolbar, click Set Source Position
Range .
„ Planning workspace: On the Planning toolbar, click Set Source
Position Range.

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 2. In a 2D image view, press SHIFT and erase source positions with the
mouse.
3. When you are finished, deactivate the tool.

To Fit the Source Positions Inside a Structure

1. In the Focus window, select the applicator.
2. From the Planning menu, select Applicators and then select Fit Source
Positions Inside Structure .
The Fit Source Positions Inside Structure dialog box opens.
3. Select whether to fit all applicators or just the selected one.
4. In the Structure drop-down list, click the structure inside which to fit the
source positions.
5. Click OK.
6. The source positions are changed so that all the dwell positions are located
inside the selected structure.
Note: When an applicator is fitted to a curved structure, source
positions may also appear outside the structure if surrounded by the
structure. You can set the dwell times to zero for points outside the
structure as illustrated in Figure 6-3 below.

7. Check the dwell range, and if required, extend or reduce it by editing the
start and stop positions in the Applicator properties dialog box.

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 PTV

A. Dwell times set to zero B. Applicator

Figure 6-3 Applicator Fitted to a Curved Structure

Adding Seed Implants

To Add Seed Implants

1. From the Insert menu, select New Seed Collection.
The Select the Object from the List dialog box opens.
2. Select the source model to use.
The Seed Collection Properties dialog box opens.
3. If necessary, modify the seed collection properties as instructed in the “To
Modify the Seed Collection Settings” on page 6-34 and click OK.
The Contour Editor tool is activated.

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 4. Click in an image view on the location where you wish to place a seed.
Note: You can insert seeds in all 2D image views.

Line seeds: The seed is displayed as a line with two square handles.
Point seeds: The seed is displayed as a square.
The number of seeds in the seed collection appears in the upper right
corner of the 2D image views.
5. Do one of the following:
„ Line seeds: To move or rotate the seed, drag it from the square handles.
„ Point seed: To move the seed, drag it with the mouse.
6. To hide seeds that are not located on or do not intersect the plane currently
displayed in the 2D views, use the Cut mode setting. See “To Show the
Applicators, Seeds or Reference Lines on a Plane” on page 6-36.
7. Continue by clicking at each seed location and moving the seeds if
necessary, until you have added all seeds in the collection.
8. Click the Contour Editor tool to deactivate it.

Using Implant Templates to Add Applicators and

Seeds

To Add Applicators with the Implant Template

1. Click the title bar of the 2D image view in which to place the template’s
cross-section.
The implant template is inserted to the plan in the middle of the active 2D
image view with the needles perpendicular to the view (extending to the
“depth” direction of the image).
2. From the Insert menu, select New Implant Template.
The Select the Template to Insert dialog box opens.
3. Select the template in the list and click OK.
The Implant Template and Selected Hole(s) Properties dialog boxes open.

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 4. Select the holes in which to insert the catheters as in “Modifying Implant
Template Settings” on page 6-23.
Holes that are highlighted contain an applicator.
5. To add the applicators to the plan in the image views, click OK.
The template remains active after you have inserted it.
6. Continue by modifying the template and applicator settings as necessary.

To Add Seeds with the Implant Template

To be able to add a seed collection by using an implant template, your system
must have an LDR afterloader of the manual loading type configured.

1. From the Insert menu, select New Implant Template.

The Select the Template to Insert dialog box opens.
2. Select the template to use and click OK.
The Implant Template dialog box opens.
3. Continue by modifying the template and applicator settings as necessary.
For instructions, see “Modifying Implant Template Settings” on page 6-23
and “Modifying Applicators” on page 6-26.
4. Verify that the treatment unit in use is a manual loading unit. If it is not,
change the treatment unit. Follow the instructions in “To Change the
Treatment Unit for Applicators Added with the Template” on page 6-23.

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To Change the Treatment Unit for Applicators
Added with the Template

Note: When changing the treatment unit for applicators, notice the
following:
„ Changing the treatment unit also changes the source.
„ You can change the treatment unit for an individual
applicator in the Applicator Properties dialog box. For
instructions, see “Modifying Applicator Parameters” on
page 6-31.

1. In the Focus window, select an applicator that was added with the
template, then go to the Planning menu, select Applicators and then
Change Treatment Unit.
The Change Treatment Unit dialog box opens.
2. In the list box, select the manual loading treatment unit to use.
3. Do one of the following:
„ To change the treatment unit for all applicators that use the same unit
as the selected applicator, click the first option button (the treatment
unit is shown in the text box after the option).
„ To change the treatment unit for all applicators, click the second
option button.
4. Click OK.

Modifying Implant Template Settings

The implant template settings can be modified as necessary in the Select Hole
Properties dialog box. Several holes or applicators can be viewed and modified
at the same time. You can include holes in and exclude them from a template
(select the holes that will not contain an applicator in the treatment), and show
or hide the label and length of each hole in the Implant Template dialog box.

Implant template settings can be modified while adding an implant template to

a plan, with the Implant Template dialog box open, or after adding the template
by selecting the Edit Template command.

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To Select and Include Holes in an Implant Template
1. Add an implant template to the plan.
In the Focus window, select an applicator using a template and then go to
the Planning menu, select Applicators and then Edit Template.
2. Do one of the following:
„ To select and include an individual hole, first select the hole and click
again to include it in the template.
„ To select multiple holes,
– Press CTRL and click the holes
– Draw a rectangle that covers the desired holes
The holes inside the rectangle are selected.

3. To include the selected holes, go to the Select hole(s) properties dialog

box, select the In use check box and click Apply.
4. To close the dialog box, click OK.
5. Continue by modifying the template and applicator settings as necessary.

To Exclude Holes from an Implant Template

1. In the Focus window, select an applicator using a template and then go to
the Planning menu, select Applicators and then Edit Template.
The Implant Template dialog box opens.

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 2. Do one of the following:
„ To select and exclude an individual hole, first select the hole and then
click again to exclude it from the template.
„ To select multiple holes,
– Press CTRL and click the holes
– Draw a rectangle that covers the desired holes
Individual hole: Excluded holes are dimmed, and a check mark disappears
from the In use check box in the Select Hole Properties dialog box.
Included holes are highlighted, and a check mark appears in the In use
check box.
Multiple holes: The holes within the rectangle are selected.
3. In the Select Hole Properties dialog box, clear the In use check box and
click Apply.
The In Use check box appears gray.
4. Clear the In Use check box again and click Apply to exclude the
applicators.
5. To close the dialog box, click OK.

To Modify Hole Settings in an Implant Template

1. From the Planning menu, select Applicators and then Edit Template.
2. Select an individual hole or multiple holes to edit.
Individual hole: The properties of the selected hole or holes are displayed
in the Select Hole Properties dialog box.
Multiple holes: The Select Hole Properties dialog box shows values
common to all the selected holes.
3. Change the name, channel number and length, needle length, first and last
source position and step size of the catheter by typing new values in the
respective text boxes.
4. Click Apply.
5. To finish, click OK in the Implant Template dialog box.
6. Continue by moving the applicators to the desired positions and modifying
the plan parameters as necessary.

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To Show or Hide Hole Labels in an Implant Template
In the Implant Template dialog box,
„ To show the hole labels, select the Labels check box.
„ To hide the hole labels, clear the Labels check box.

To Show or Hide Hole Lengths in an Implant Template

In the Implant Template dialog box,
„ To show the hole lengths, select the Lengths check box.
„ To hide the hole lengths, clear the Lengths check box.

Modifying Applicators
The applicator points are modified, added or deleted in the Point Set Editor
dialog box or graphically in the image views with the mouse. The dialog box
shows the X, Y and Z coordinates that make up the applicator, using the units
of measurement set in the system configuration.

Note: If you edit the points of an applicator that was reconstructed

from the projections on 2D images in the Entry workspace, the
connection between the applicator and the image is lost.

To Manage Applicator Points with the Point Set Editor

1. In the Focus window, select the applicator.
2. Right-click and then select Properties.
The Applicator property sheet opens.
3. Click Geometry.
The Point Set Editor dialog box opens.

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 4. Modify the points by doing the following:
„ To change a coordinate of a point, type a new value in the appropriate
cell.
„ To add a point, click Add Point.
„ To delete a point, click any of its cells and then click Delete point(s).
5. To save the changes and close the dialog box, click OK.

To Manage Applicator Points Graphically

1. In the Focus window, select the applicator.
2. On the Entry Tools or Planning Tools toolbar, click Contour Editor .
The selected tool is activated. The points in the selected applicator are
displayed in the image views.
3. Modify the points by doing the following:
„ To move a point, drag it with the mouse.
„ To delete a point, right-click it.
„ To add new points to the applicator, click in the image view.

Copying Applicators
Planning Workspace

You can copy an applicator to the Clipboard and paste it to any brachytherapy
plan under any course shown in the Scope window. The copied applicator
maintains all properties of the original applicator. The ID and the channel ID
of the pasted applicator are changed so that they are unique in the target plan.

To Copy and Paste an Applicator

1. In the Focus window, select the applicator to be copied.
2. From the Edit menu, select Copy Applicator to copy the applicator to the
Clipboard.

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 3. In the Scope window, select the plan to paste the applicator into. There is
no need to select the plan, if you are copying and pasting applicators within
the same plan.
4. From the Edit menu, select Paste Applicator to paste the applicator from
the Clipboard to the selected plan.
5. To move the applicator to the desired position, go to the toolbar and select
Move Applicators or Rotate Applicators as in “To Move Applicators”
on page 6-34 and “To Rotate Applicators” on page 6-35.

Defining Varying Dwell Activities for Applicators

Planning Workspace

Manual loading devices enable using varying dwell activities in treatments by

placing a separate radioactive source to each source position in an applicator.
In BrachyVision, to support this technique, you can create plans with a
separate radioactive source in each source position and define the strength of
each of the sources as necessary. This technique is also reflected in the Plan
Report window, which shows the current strength of the radiation for each
radioactive source in the specified source positions.

Note: The use of separate sources is not saved to a plan template. If

you make changes to a plan that cause the number of source
positions of an applicator to be set to 0 or 1, you need to
redefine the use of separate sources.

To Define Varying Dwell Activities for an Applicator

1. In the Focus window, select the applicator with multiple source positions.
The treatment unit used in the applicator must be of the manual loading
type.
2. From the Planning menu, select Applicator and then select Separate
Source for each Position.

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 3. Open the Dwell Control Window and modify the dwell activities of the
sources as necessary. For instructions, see “Managing Dwell Times” on
page 6-37.
Note: If you set the number of source positions of an applicator
to 0 or 1, and later increase the number, you need to repeat the steps to
take separate sources into use again.

Changing the Radioactive Source for Applicators

The radioactive source used can be changed for an individual applicator or all
applicators in the active plan.

From time to time the radioactive source for an afterloader needs to be

changed. As this is done, the radioactive source for applicators needs to be
updated.

Note: When changing the radioactive source for applicators, note that:

„ The Change Source option can be selected only for

applicators using a manual treatment unit.
„ The sources are configured in the Administration task.

To Change the Radioactive Source for an Applicator

1. In the Focus window, right-click the applicator to change the source for it
and then select Change Source.
The Radioactive Source Properties dialog box opens.
2. In the ID and Name text boxes, type an identification code and a name for
the source.

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 3. In the Source Model list box, select the source model to use.
Note: The source models are configured in the Administration Task.

„ The Strength text box displays the strength of the source in cGy
cm2/h.
„ The Calibration Date text box displays the date when the source was
calibrated.
„ The Serial Number text box displays the serial number of the source.
Note: Either the strength and calibration date or serial number of the
source must be given.

4. Click OK.
You are prompted to confirm for which applicators the source is changed.
5. Do one of the following:
„ Click Yes to change the source for all applicators in the plan.
„ Click No to change the source for the selected applicator only.

To Update the Radioactive Source

1. In the Focus window, select the applicator to update the source for.
2. From the Edit menu, select Properties.
The Applicator Properties dialog box opens.
3. In the Afterloader drop-down list, click the afterloader to use. If the
appropriate afterloader is already selected, select it again to update the
radioactive source.
4. Click OK.

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Modifying Applicator Parameters
Applicator settings are modified in the Applicator property sheet, which opens
when you select the Properties command from the Edit menu.

Modifiable Applicator Parameters

The modifiable applicator parameters include the following:

„ ID—Identification code for the applicator

„ Channel number—Indicates the treatment unit channel with which the
treatment is performed
„ Afterloader—Treatment unit used for the applicator
„ Applicator length—The length of the applicator from its internal tip to its
open end
„ Step size—Distance between successive source positions measured from
source center to source center
„ First source position—Distance from the tip of the applicator to the tip of
the wire at its first dwell position
„ Last source position—Distance from the tip of the applicator to the end of
the last source. Defines the last source to be included in the applicator. The
last source position value may not always fall between two sources. In this
case, the number of sources included in an applicator is defined as
last source position – first source position .
number of sources = ---------------------------------------------------------------------------------------------------------------------------------------------------------
-
step size
In other words, the applicator will contain as many full sources as can be
fitted between the first and last source positions (assuming that the source
size equals the step size). The last source is then the one that is located in
front of a line indicating the last source position as in Figure 6-4.

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 A. Sources 1–3. B. Line indicating the first source position. C. The last source included in the
applicator. D. Line indicating the last source position. E. Source excluded from the applicator.

Figure 6-4 Source Positions

„ Equal source spacing—Indicates equal spacing between the dwell
positions.You define the first and the last source position. The tip of the
first source is placed to the first source position, and the rest of the sources
with spacing equal to the step size until the last source position.
„ Geometry—Positions of the points included in the applicator

Note: When modifying applicators:

„ Always verify that the channel number is correct.
„ Always check that applicator length is correct. It is
important that this measurement is made before each use of
an applicator. For more instructions, refer to VariSource
System User Manual.

To Modify Applicator Settings

1. In the Focus window, select the applicator.
2. From the Edit menu, select Properties.
The Applicator property sheet opens.
3. In the ID text box, type an ID for the applicator. The maximum length of
the code is 16 characters.

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 4. In the Channel number text box, type the desired channel number.
5. In the Afterloader drop-down list, click the desired treatment unit.
6. In the Source position parameters [cm] group box, type the applicator
length, step size and first and last source position in the respective text
boxes.
7. To position the sources with equal spacing, select the Equal source
spacing check box.
Note: Manually positioned sources are not moved if the check box is not
selected.

8. To change the applicator geometry, click Geometry and edit the point
coordinates. For instructions, see “Modifying Applicators” on page 6-26.
9. Click OK.

Modifying Seeds
You modify the parameters of a seed collection in the Seed Collection property
sheet and the Point Set Editor dialog box. The Seed Collection property sheet
opens when you create a new seed collection or select the Properties command
while a seed collection is selected in the Focus window. The Point Set Editor
dialog box can be opened from the Seed Collection Property sheet. The
modifiable parameters include

Modifiable Seed Parameters

„ Seed ID—Generated automatically, but you can change it as necessary
„ Source—The irradiation source model used
„ Calibration date—The date when the source was last calibrated
„ Duration—Determines whether the seeds are permanent or temporary
„ Strength—Determines the strength of the seeds in cGy cm2/h or mCi
„ Seed positions—The X-,Y-, and Z-coordinate of each point in the seed
collection

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To Modify the Seed Collection Settings
1. In the Focus window, select the desired seed collection.
2. From the Edit menu, select Properties.
The Seed Collection property sheet opens.
3. In the ID text box, define a new ID for the seed collection if necessary.
4. In the Source drop-down list, click the source for the seed collection.
5. To define the seed type, click the Permanent or the Temporary option
button.
6. If you selected the Temporary seed type, in the text box next to the option
button, type the duration, and in the list box select the desired unit of time
in seconds, minutes, hours or days.
7. To define the seed strength, first define the strength unit in the list box next
to the Strength text box and then type the value in the text box.
8. To change the seed positions, click Seed Positions and edit the point
coordinates. For instructions, see “To Modify the Seed Collection
Settings” on page 6-34.
9. Click OK.

To Move Applicators
1. Do one of the following
„ To select a single applicator, click it in the Focus window.
„ To select all applicators, in the Planning toolbar, click Select and
then right-click in a 2D image view.
„ To select multiple applicators, click Select, press SHIFT and click each
applicator to select.
Note: You can also select an individual applicator with the Select tool.

2. On the Planning toolbar, click Move Applicators .

3. Place the mouse pointer to an image view and move the applicator to the
desired position.
4. To attach the applicator to the new position, release the mouse button.
5. Repeat until the applicator position is the desired.

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To Rotate Applicators
1. Do one of the following:
„ To select a single applicator, click it in the Focus window.
„ To select all applicators, in the Planning toolbar, click Select and
then right-click in a 2D image view.
„ To select multiple applicators, click Select, press SHIFT and click each
applicator to select.
Note: You can also select an individual applicator with the Select tool.

2. On the Planning toolbar, click Rotate Applicators .

A small red circle indicating the center of rotation is shown in active 2D
image.
3. Place the mouse pointer to the red circle, and drag the circle to the point
around which you wish to rotate the applicator.
Note: To constrain the movement to 45° angles, press CTRL when
dragging.

4. Then place the mouse pointer on the applicator and rotate it to the desired
position. Release the mouse button to attach the applicator to the new
position.

Applicators and Seed Visualization

The visualization of applicators and seeds in the image views can be modified
as necessary to better viewing. Applicators, seeds or reference lines that are not
located on or do not intersect with the plane currently displayed in the 2D
views can be hidden in the image views. This is particularly useful in working
with seed collections with high numbers of seeds. The focus can be moved to
a selected radiograph to view the total dose on the radiograph. The applicator
labels can be shown or hidden in the 2D image views in the Entry and Planning
workspaces.

6-35
To Show the Applicators, Seeds or Reference Lines on a Plane
1. From the View menu, select Options.
The View Options dialog box opens.
2. Select the Planning Workspace tab.
3. In the Applicators group box, select the Cut mode check box.
4. Click OK to show only applicators on or intersecting the currently visible
plane in the 2D image views.

To Move the Focus to the Selected Radiograph

1. In the Focus window, right-click the radiograph to which to move the
focus and then select Focus on Radiograph.
The Focus on Radiograph dialog box opens.
2. In the list, select the radiograph you wish to focus on.
3. Click OK to view the applicators from the focus of the selected
radiograph.

To Show or Hide the Applicator Labels

1. From the View menu, select Options.
The View Options dialog box opens.
2. Select the tab specific to the workspace currently in use.
3. Do one of the following:
„ To show the applicator labels, select the View Labels check box.
„ To hide the applicator labels, clear the check box.
4. Click OK to show or hide the applicator labels.

To Show the Applicators Thicker

1. From the View menu, select Options.
The View Options dialog box opens.

6-36 Reference Guide for Brachytherapy Planning

 2. Select the Planning Workspace tab.
3. In the Applicators group box, select the Draw thicker check box.
4. Click OK to show the applicators thicker.

Managing Dwell Times

You can view and modify the dwell times and positions in the Dwell Control
window containing the dwell settings for the applicators in the plan. You can
modify the dwell activity or source strength values for seed implants, or define
the same dwell time for all applicators in the plan or for all source positions in
one applicator.

The dwell time related parameters are the following:

„ Dwell Time—Time which a moving source stays still in one defined

position. The dwell time is varied to control the absorbed dose.
„ Dwell Position—Position at which the tip of the wire stays still for a
defined time.
„ Source Strength—Air-kerma rate of radiation from the source at the time
of calibration, or the nominal strength if using a fixed strength source for
planning.
„ Source Activity—Intensity of radiation from the source in mCi units.
„ Conversion—Conversion from air-kerma rate to activity in mCi.
„ Treatment Length—Distance from the first source position to the last one.

Note: The dwell times are always shown for a single fraction. The
dwell times depend on the prescribed dose, so changing the
dose prescription and normalizing the dose also results in
changes in the dwell times.

6-37
Dwell Control Window
The dwell times and dwell positions can be viewed and edited in the Dwell
Control window. The Dwell Control window shows the dwell values for all
applicators in the plan. Show or hide the Dwell Control window as necessary.
Figure 6-5 shows an example of a Dwell Control window.

Figure 6-5 Dwell Control Window

You edit the dwell activity or strength, position and time either graphically by
moving the sliders or by typing the desired values in the text boxes in the Dwell
Control window. You can edit the dwell activity only when you are using seeds
in creating the plan. Dwell positions can be changed within the first and last
source position values. The dwell time scale changes in accordance with the set
dwell times; for instance, if all dwell times are lower than 10 seconds, the
maximum values are indicated on the scale with 2-second intervals, but if some
of the dwell times exceed 15 seconds, the values are indicated with 5-second
intervals.

To Show the Dwell Control Window

1. From the Window menu, select Dwell Control Window to show the
Dwell Control dialog box on top of the Model view.

6-38 Reference Guide for Brachytherapy Planning

 2. Do one of the following:
„ To show the information for the selected applicator only, right-click in
the Dwell Control window and then select View Selected.
„ To show the information for all applicators, right-click in the Dwell
Control Window and then select View All.
3. To show the dwell control sliders of each applicator source position, click
the buttons with the – (minus) signs.

To Change the Dwell Times

1. In the Dwell Control window, right-click and then select Slider Applies to
Time.
2. Do one of the following:
„ Move the dwell time bar with the mouse
„ In the Time text box, type a new value.

To Change the Dwell Positions

1. In the Dwell Control window, right-click and then select Slider Applies to
Position.
2. Do one of the following:
„ Move the dwell control bar with the mouse
„ In the Position text box, type a new value

To Change the Dwell Activity or Source Strength

1. In the Dwell Control window, right-click and then do one of the following:
„ Select Slider Applies to Activity.
„ Select Slider Applies to Strength.
2. Do one of the following:
„ Move the dwell control bar with the mouse
„ In the Activity or Strength text box, type a new value.

6-39
To Set or Scale All Dwell Times
1. From the Planning menu, select Modify Dose and then Set All Dwell
Times.
The Set All Dwell Times dialog box opens.
2. Do one of the following:
„ To apply the setting to all applicators, click the For all applicators
option button.
„ To apply the setting only to the selected applicator, click the For the
selected applicator option button.
3. To set dwell times:
„ Do not select the Scale check box.
„ In the Time text box, type the dwell time to use, and in the list box
select the unit of time desired in seconds, minutes, hours or days.
4. To scale dwell times:
„ Select the Scale check box.
„ In the text box, type the scaling factor to use. The dwell times are
multiplied according to the scaling factor used.
5. Click OK to accept the settings.

6-40 Reference Guide for Brachytherapy Planning

Chapter 7 Reference Points and Reference
Lines
Planning Workspace

This chapter provides information on reference points and reference lines, and
contains steps necessary for using them. The chapter describes the general
features of reference points and lines and their use in treatment planning.
Instructions are provided for managing reference points and lines, the
geographical locations of the points, and defining the use of reference points in
a plan.

In This Chapter

Topic Page

About Reference Points and Reference Lines....................................... 7-2

Reference Point and Reference Line Visualization ............................. 7-3
Location of the Reference Points ................................................... 7-4
Adding Reference Points......................................................................... 7-4
To Insert a Reference Point with a Geometrical Location .................. 7-5
To Insert a Reference Point without a Geometrical Location ............. 7-6
To Insert a Location for an Existing Reference Point ......................... 7-6
Adding Reference Lines .......................................................................... 7-6
To Add a Reference Line to a Brachytherapy Plan ............................. 7-7
To Add a Reference Line at a Distance from an Applicator ............... 7-7
Defining the Use of Reference Points..................................................... 7-8
To Include Reference Points in Plans.................................................. 7-8
To Define the Primary Reference Point
in the Reference Point Organizer......................................................... 7-9
To Define a Reference Point as the ICRU Point
in the Reference Point Organizer......................................................... 7-9
Modifying Reference Points or Reference Lines ................................ 7-10
To Edit Reference Point or Reference Line Properties ..................... 7-10
To Move Reference Points ................................................................ 7-10
To Reshape Reference Lines ............................................................. 7-11

7-1
 To Move the Viewing Planes to a Reference Point........................... 7-11
To Move a Reference Point to the Isocenter or Entry Point.............. 7-11
To Delete Reference Points ............................................................... 7-11

About Reference Points and Reference Lines

Reference points and lines are used for displaying, defining and prescribing the
therapeutic absorbed dose at specific locations.
In the Brachytherapy Planning task, you can use reference points and lines to:

■ Monitor dose at exact locations

■ Scale the dose to a given reference point
■ Prescribe the dose in the reference points for dose rescaling
■ Optimize the dose to given optimization points by adjusting the total dwell
times manually
■ Normalize the dose to Basal points
■ Convert reference lines to match points to register 2D images to volume
images
One of the reference points can be marked the primary reference point, which
can be used to evaluate the dose at this point in the Plan Organizer.

Reference points are managed in the following workspaces: Plan Evaluation,

Entry, Planning. You can add, modify, and delete reference points and
reference lines in the 2D image views with the mouse or on the keyboard. Each
point can have a unique name.
Reference points with a geometrical location normally represent an anatomical
structure or some other geometrical structure of interest. One reference point
can also be linked to different images, in which case it can have a different
geometrical location in each image. You can view how the dose distribution of
a plan affects the reference points, and when using multiple plans, you can
accumulate dose from different plans to the primary reference point.

7-2 Reference Guide for Brachytherapy Planning

Reference Point and Reference Line Visualization
Reference points linked to the active plan are shown in the Focus window with
a special icon ( ) in the Reference points folder. If a plan has been dragged
to the image views, the Reference Points folder is shown under the Plan object,
or if an image has been dragged to the image views, the folder is shown under
the Image object. For a plan sum, reference points with a location are shown
under the image in the Focus window. You can show or hide reference points
by selecting or clearing their visibility check boxes in the Focus window.

The following figure shows reference points in a transversal image in a 2D

view.

Figure 7-1 Reference Points in 2D View (not Selected)

The following figure shows a reference line in a transversal image in a 2D

view.

Figure 7-2 Reference Line in 2D View

Reference points, along with their IDs, are also shown in the Model view if
they belong to the active plan.

7-3
 Figure 7-3 Reference Points in Model View

Reference points may be seemingly invisible in the Model view. This is

because they are positioned realistically in 3D space and, depending on the
viewing angle, may be obstructed by a structure.

You can show or hide reference points by selecting or clearing their visibility
boxes in the Focus window.

Location of the Reference Points

Different visualizations are used to indicate the plane where each reference
point is located in relation to the active viewing plane:

■ —Active reference point located on the active viewing plane

■ —Reference point located on the active viewing plane

■ —Active reference point located in front of the active viewing plane
■ —Active reference point located behind the active viewing plane or
inactive reference point located in front of the active viewing plane

Adding Reference Points

After importing the images, you can create reference points to the areas in the
images where you wish to track the calculated dose.

7-4 Reference Guide for Brachytherapy Planning

 The modifiable reference point parameters are the following:
■ Daily Dose Limit
■ Total Dose Limit
■ Session Dose Limit
■ Volume represented by the reference point

To Insert a Reference Point with a Geometrical Location

1. From the Insert menu, select New Reference Point and Location.
The cursor changes to the Edit Reference Point tool.
2. In an image view, navigate to the desired plane and click where you wish
to insert the reference point.
Note: In the Entry workspace, click in both images.

The Reference Point Properties dialog box opens.

3. In the ID text box, type an identification for the reference point.
4. In the Name text box, type a name for the reference point.
5. In the Patient Volume drop-down list, click a patient volume that the point
will represent. If there are no suitable volumes, select the volume type
“None”.
6. To define the dose limits, type the values in the respective text boxes.
7. If you wish to change the coordinates of the reference point location, select
the Location tab and define the location with the X, Y, and Z coordinates.
Note: You can also drag the point to the correct position after adding it.

8. Type the coordinates in the respective text boxes.

9. Click OK.
Next: The reference point is automatically included in the open plan. If
the patient has more than one plan, include the reference points to the
desired plans. For more information, see “To Include Reference Points in
Plans” on page 7-8. Define also which reference point is the primary
point. For more information, see “About Defining the Primary Reference
Point in the Plan Organizer” on page 4-18.

7-5
To Insert a Reference Point without a Geometrical Location
1. Add a reference point as usual.
2. Press DEL.
The Delete Reference Point dialog box opens.
3. To delete the geometrical reference point location from the currently active
image, select Current Image.
4. Click OK.

To Insert a Location for an Existing Reference Point

1. From the Insert menu, select New Location for Existing Reference
Point.
The Select Reference Point dialog box lists the reference points that do not
have a location in the currently active image.
2. In the Reference Points for the Patient list box, select the point for which
to add the location.
3. Click OK.
The Reference Point Properties dialog box opens.
4. Select the Location tab to define the location of the reference point with
the X-, Y- and Z-coordinates.
5. Type the coordinates in the respective text boxes.
Note: You can also drag the point to the desired position.

6. Click OK.

Adding Reference Lines

Reference lines can be added by drawing them in the image views, or at a
defined distance and direction from the selected applicator.

7-6 Reference Guide for Brachytherapy Planning

To Add a Reference Line to a Brachytherapy Plan
1. From the Insert menu, select New Reference Line.
The Layer Properties dialog box opens.
2. In the ID text box, type an identification for the reference line.
3. In the Name text box, type a name for the line.
4. In the Type drop-down list, click the “User Defined” layer type.
5. Click OK.
The reference line branch appears in the Focus window in the Structures
and Layers folder. The Contour Editor tool is activated.
6. Continue by drawing the reference line the same way as drawing
applicators.

To Add a Reference Line at a Distance from an Applicator

1. In the Focus window, select the applicator.
2. Select a 2D view.
3. On the Insert menu, click New Reference Line at Distance
The Automatic Margin from Applicator dialog box opens.
4. In the Distance text box, type the distance from the applicator at which to
add the reference line.
5. Select either the Right Side or the Left Side check box to define the
direction of the reference line. The direction is defined in relation to the
applicator tip, looking towards it from the end of the applicator.
6. Click OK.
The Layer Properties dialog box opens.
7. In the ID text box, type an identification for the reference line.
8. In the Name text box, type a name for the line.
9. In the Type drop-down list, click the User Defined layer type.

7-7
 10. Click OK.
The reference line appears in the image views, and in the Focus window in
the Structures and Layers folder.

Defining the Use of Reference Points

To be able to use reference points created for a patient, the points must be
linked to each relevant plan. If you define reference points for a patient with an
open plan, the points are automatically linked to the open plan. However, if you
create multiple plans for the patient, the reference points are not automatically
linked to the plans, and you need to separately take the reference points into
use in the plans. One of the reference points can be marked the primary
reference point. You can also mark a point as the ICRU point (point that fulfills
the ICRU 50 definition for a reference point).

For information on the Plan Organizer, see “Using the Plan Organizer” on
page 4-14.

To Include Reference Points in Plans

1. In the Scope window, select the plan.
2. Verify that the reference point has a location in the image used for the plan.

7-8 Reference Guide for Brachytherapy Planning

 3. From the Planning menu, select Reference Point Organizer.
■ You can also open the Reference Point Organizer by clicking Edit
Reference Points in the Plan Organizer.
The Reference points for plan dialog box opens. Reference points defined
for the selected patient are displayed on the left. Reference points selected
for the active plan are displayed on the right.

4. To include a point in the plan, select it in the left and click Add.
5. To exclude a point from the plan, select it in the right list box and click
Remove.

To Define the Primary Reference Point

in the Reference Point Organizer
1. From the Planning menu, select Reference Point Organizer.
The Reference points for plan dialog box opens.
2. Select the point in the Reference points in plan list box and click Primary.
The text [PRIMARY] appears next to the selected point to mark it as the
primary reference point.
Note: Each reference point is linked to a patient volume. This link is
kept and the defined patient volume is automatically selected.

7-9
To Define a Reference Point as the ICRU Point
in the Reference Point Organizer
1. From the Planning menu, select Reference Point Organizer.
The Reference points for plan dialog box opens.
2. Select the point in the list box and click ICRU.
The text [ICRU] appears next to the selected point.

Note: An ICRU point is automatically defined as the primary

reference point.

Modifying Reference Points or Reference Lines

Reference point properties can be edited in the Reference Point Properties
dialog box. Reference line properties can be edited in the Layer Properties
dialog box, and the shape of reference lines can be edited with the Contour
Editor tool. Reference points can be moved to specific 3D locations with the
mouse or to the isocenter of a field by using the Move to Isocenter command.
The exact location of a reference point on each plane can be viewed with the
Move to Reference Point command.

To Edit Reference Point or Reference Line Properties

1. In the Focus window, select the reference point or the reference line.
2. From the Edit menu, select Properties.
The Reference Point Properties or the Layer Properties dialog box opens.
3. Edit the settings as necessary and then click OK. For more information on
the settings, see “Adding Reference Points” on page 7-4 and “Adding
Reference Lines” on page 7-6.

7-10 Reference Guide for Brachytherapy Planning

To Move Reference Points
1. In the Focus window, select the reference point to move.
The dose at the selected point and its coordinates appear next to the point.
2. On the toolbar, click Edit Reference Points .
3. Move the mouse pointer to the reference point and drag it to a new
position.
The viewing planes move to the reference point.

To Reshape Reference Lines

1. In the Focus window, select the reference line.
2. On the Planning toolbar, click Contour Editor to activate the points
of the reference line.
3. Click more points, drag points to new locations or delete existing points as
necessary.

To Move the Viewing Planes to a Reference Point

1. In the Focus window, select a reference point.
2. From the View menu, first select Move Viewing Planes to, then
Reference Point and then select the reference point.

To Move a Reference Point to the Isocenter or Entry Point

■ In the Focus window, right-click the reference point to move and then click
Move Reference Point to Isocenter.

To Delete Reference Points

1. Select the point to delete.

7-11
 2. From the Edit menu, select Delete.
The Delete Reference Point dialog box opens.

A. If the reference point is not part of the currently active image, these options are not available.
B. If the reference point is not part of the currently active plan, these options are not available. C.
If there are other reference point locations defined than the one currently in use, this option is not
available.

3. Do one of the following:

■ To delete the geometrical reference point location from the currently
active image, select Current Image.
■ To delete the geometrical reference point location from the currently
active plan, select Current Plan.
■ To delete the geometrical reference point location from the currently
active image and plan, select Current Image and Plan.
■ To delete both the reference point and its geometrical location, select
Current Patient.
4. Click OK.

7-12 Reference Guide for Brachytherapy Planning

Chapter 8 Dose Definition
Planning Workspace

This chapter describes the tools and options that the Brachytherapy Planning
task contains for evaluating the applicator setup and the dose calculation. The
chapter briefly describes the calculation models used in the task. Instructions
are provided from defining the calculation area through to calculating the 3D
dose and managing dose visualization by changing the dose display mode and
selecting the isodose levels displayed in the image views. The chapter also
instructs in changing the scale and shape of the resulting isodoses and in dose
normalization.

In This Chapter

Topic Page

About Dose Calculation in the Brachytherapy Planning Task ........... 8-3

Calculation Models in the Brachytherapy Planning Task ................... 8-3
To Calculate the 3D Dose in the Brachytherapy Planning Task ......... 8-3
2D Dose Calculation Area
in the Brachytherapy Planning Task ..................................................... 8-4
To Define the 2D Dose Calculation Area
in the Brachytherapy Planning Task.................................................... 8-4
Dose Matrix .............................................................................................. 8-5
To View and Edit the Dose Matrix Properties
for Brachytherapy Plans ...................................................................... 8-5
To Edit the Calculation Volume for
Brachytherapy Plans Graphically ........................................................ 8-6
To Reset the Calculation Volume........................................................ 8-6
Managing the Dose Visualization........................................................... 8-7
Isodoses in the Brachytherapy Planning Task ..................................... 8-8
Color Wash in the Brachytherapy Planning Task................................ 8-9
Defining the Dose Levels Displayed in the Color Wash Mode......... 8-10
Showing the Absolute or Relative Dose............................................ 8-11
To Show Absolute or Relative Dose ................................................. 8-11
To Show the Dose as Isodoses or in the Color Wash Mode.............. 8-12

8-1
 To Show the Surface Dose in the Model View ................................. 8-12
To Show and Hide the Isodose Lines in
the Brachytherapy Planning Task...................................................... 8-12
To Select the Dose Color Wash Levels in the 2D Image Views ....... 8-12
To Select the Isodose Levels Displayed in the Model View ............. 8-14
To Select a Predefined Isodose Set.................................................... 8-14
To Modify the Isodose Levels in an Isodose Set............................... 8-14
To Add Isodose Levels to an Isodose Set.......................................... 8-15
To Delete Isodose Levels from an Isodose Set.................................. 8-15
Dose Statistics.................................................................................... 8-16
Dose Maximum (Dmax) Point ..................................................... 8-16
Statistical Dose Information ......................................................... 8-17
To Show or Hide the Dose Statistics............................................ 8-18
To Show or Hide the Dose Maximum Point ................................ 8-19
To Move Viewing Planes to the Dose.......................................... 8-19
Changing the Isodose Scale and Shape
in the Brachytherapy Planning Task.................................................. 8-19
To Rescale Isodoses ..................................................................... 8-19
To Reshape Isodoses .................................................................... 8-20
Selecting the Plane to View the Dose Distribution ........................... 8-21
To Define the Viewing Plane for the Dose Distribution .............. 8-21
Plan Normalization................................................................................ 8-21
Plan Normalization Options .............................................................. 8-22
Basal Points in the Normalization of Brachytherapy Plans............... 8-22
To Normalize the Dose to the Target Minimum
in the Brachytherapy Planning Task.................................................. 8-23
To Normalize the Dose to the Target Mean
in the Brachytherapy Planning Task.................................................. 8-23
To Normalize the Dose to a Selected Point
in the Brachytherapy Planning Task.................................................. 8-23
To Normalize the Dose to a Selected Value
in the Brachytherapy Planning Task.................................................. 8-24
To Normalize the Dose to a Reference Point
in the Brachytherapy Planning Task.................................................. 8-24
To Normalize the Dose to the Basal Points
in the Brachytherapy Planning Task.................................................. 8-24

8-2 Reference Guide for Brachytherapy Planning

About Dose Calculation in the Brachytherapy
Planning Task
The dose calculation is a mapping from the sources and their radiation models
to a three dimensional absorbed dose distribution in an arbitrary anisotropic
orthogonal matrix. This matrix is also called the calculation area. The source
model is capable of modeling both linear and point sources. No tissue
inhomogenities are compensated in dose calculation, but the dose is modeled
as it were in water.

For more information on dose calculation, refer to the online help.

Calculation Models in the Brachytherapy Planning Task

There are two alternative calculation models available for brachytherapy plans:
■ Point source
■ Linear source
The model is configured separately for each radiation source in the
Administration task.

Note: All calculated dose distributions are invalidated if the

calculation model is changed.

To Calculate the 3D Dose in the Brachytherapy Planning Task

■ From the Planning menu, select Calculate 3D Dose.

Note: 3D dose is calculated automatically whenever you calculate

Dose Volume Histogram or Plan Comparison DVH.

8-3
2D Dose Calculation Area
in the Brachytherapy Planning Task
The 2D dose calculation area is a square area within which the dose
distribution is calculated. The size of the calculation area is determined by
defining the length of one of the sides of the square. The resolution of the 2D
dose calculation area is determined by dividing the area into small squares of
a defined size. The size of these small squares, that is, the resolution, is
determined by defining the length of one of the sides of the small squares.

The dose distribution can also be shown in the Model view.

To Define the 2D Dose Calculation Area

in the Brachytherapy Planning Task
1. From the View menu, select Options.
The View Options dialog box opens.
2. Select the Planning Workspace tab.
3. In the 2D Dose Matrix Properties group box, in the Size text box, type
the length of one side of the calculation area in centimeters.
4. In the Resolution text box, type the length of one side of the grid in the
calculation area in centimeters.

A. Value entered in the Size text box B. Value entered in the Resolution text box C. Calculation
area

5. Click OK to resize the calculation area.

8-4 Reference Guide for Brachytherapy Planning

Dose Matrix
The dose matrix is a three-dimensional matrix within which the dose
distribution is calculated. The dose matrix size is determined by the size of the
rectangular calculation volume, which is defined by setting the lengths of the
volume sides. The resolution of the dose matrix is determined by dividing it
into smaller elements: The smaller the elements, the finer the resolution. The
size of these elements is determined by defining their side lengths.

A. Dose matrix dimensions B. Resolution

Figure 8-1 Dose matrix and resolution

The default calculation volume is equal to the volume of the Body structure. If
no Body structure is defined, the default calculation volume is equal to the
image volume.

Note: When making changes to the calculation volume, be careful to

check that it covers the volume of interest.

To View and Edit the Dose Matrix Properties

for Brachytherapy Plans
1. In the Focus window, select the dose.
2. From the Edit menu, select Properties.
The Dose Matrix Properties dialog box opens.

8-5
 3. In the Geometry group box,
■ Position text boxes show the coordinates of the center point of the
volume. You can edit the value in this box.
■ Size text boxes show how many small parallelepipeds the volume
contains in each direction. You can edit the value in this box.
■ Resolution text boxes show the lengths of the sides of the small
parallelepipeds. You can edit the value in this box.

To Edit the Calculation Volume for

Brachytherapy Plans Graphically
1. In the Focus window, right-click the dose and then select Edit calculation
volume to show the Calculation Volume tool in the image views.
2. Drag the corner points of the Calculation Volume to resize the calculation
volume.
The modified volume is shown in all image views.
3. To inactivate the Calculation Volume tool, go to the Focus window,
right-click the dose and then deselect Edit calculation volume.

Note: All calculated dose distributions for the plan are zeroed if the
calculation volume is edited.

To Reset the Calculation Volume

■ In the Focus window, right-click the dose and then select Reset
calculation volume .

The calculation volume is reset to the default size.

Note: All calculated dose distributions for the plan are zeroed if the
calculation volume is reset.

8-6 Reference Guide for Brachytherapy Planning

Managing the Dose Visualization
After creating a plan and defining the dwell times in the Brachytherapy
Planning task, BrachyVision calculates and displays the dose distribution in
the 2D image views. You can also have the application calculate the 3D dose
to display it in the Model view.

The dose distribution information is indicated either as an absolute (Gy) or a

relative (%) dose, and visualized respectively. The absolute dose distributions
are shown only when the dose prescription has been defined.

You can change the visualization mode as necessary and define how the dose
values are displayed as follows:
■ Show the dose in the isodose or color wash mode in 2D image views; or in
the dose cloud mode or surface dose mode in Model view.
■ Select the isodose levels shown, and display only the most significant dose
levels, depending on what is appropriate in each situation.
■ Modify the isodose color and style used in Model view (contour,
translucent, segment).
■ Show or hide the isodose labels and the dose maximum point.
■ Show or hide the dose statistics in the 2D image views and the Model view.
■ Show or hide isodoses.
Hiding the isodoses from the 2D image views allows easier managing of
multiple applicators or seeds, and speeds up the functioning of the
application by disabling time-consuming dose calculation.

Only one visualization mode can be used at a time. You cannot display the dose
as isodose lines in one 2D image view and in the color wash mode in another.

Note: The dose is calculated on transversal planes only. When

viewing the dose on sagittal or frontal reconstructions, the dose
displayed is an interpolation of the dose calculated on the
transversal planes. To increase the accuracy in viewing the
interpolated dose, use a plane distance smaller than 5 mm. The
plane distance is defined in the Create 3D Image dialog box
which opens when you create a new volume image with the
Insert > New 3D Image command.

8-7
Isodoses in the Brachytherapy Planning Task
By default, the image views display the resulting dose as isodoses. In the Plan
Evaluation workspace, the 3D dose must be calculated before isodoses are
displayed. The following figure shows an example of the dose displayed as
isodoses.

Figure 8-2 Isodoses in 2D View

In this visualization mode, the selected isodoses are displayed as colored

contours in 2D image views and the Model view. A legend in the upper left
corner of the image views shows the color used for each isodose, and dose
values either in relative (%) or absolute (Gy) mode, depending on the selection.
The absolute dose distributions are shown only when the dose prescription is
done.

Note: You can view only significant isodose levels in the 2D image
views in particular treatment cases by using predefined isodose
sets. The isodose levels included in each set are defined in the
Administration task.

8-8 Reference Guide for Brachytherapy Planning

Color Wash in the Brachytherapy Planning Task
In the color wash visualization mode, the dose is displayed with a continuous
color map in the 2D image views. In the Model views, the dose can be
visualized as a dose cloud or a surface dose on the surface of the selected,
visible structure. In the surface dose, only the dose for the selected structure is
shown.

The following figure shows an example of a dose distribution displayed in the

color wash mode in a 2D view.

Figure 8-3 Dose Color Wash

In both 2D views and the Model view, the left corner of the view contains the
dose color wash slider, which shows the range of dose levels displayed and is
used to select the dose levels displayed. The slider also shows the use of
relative (%) or absolute (Gy) dose values. The absolute dose distributions are
shown only when the dose prescription is done.

8-9
Defining the Dose Levels Displayed in the Color Wash Mode
By default, the continuous color map used in the color wash dose visualization
mode contains all dose values in the defined dose range. You can either show
the whole dose distribution from the minimum to the maximum dose or limit
the visualization to view only the significant part of the dose distribution by
■ Numerically defining upper and lower dose values to be shown
■ Defining the upper and lower dose values to be shown by moving the
handles on the dose color wash slider with the mouse
■ Defining the lower dose value to the target minimum and the upper dose
value to the target maximum
■ Using the lowest and highest isodose level in the selected isodose level set
as the lower and upper dose value

The whole spectrum of the continuous color map is stretched or compressed

between the defined upper and lower dose value.

If some dose values fall outside the range when using the color wash slider to
define the dose range, they are visualized in a particular way. In a single plan,
dose values exceeding the range are shown with a special color, but dose values
below the range are not visualized. In a summed plan (in the Plan Evaluation
workspace), both dose values exceeding and below the range are shown with
special colors.

The following picture shows how the dose exceeding and under the defined
dose range are displayed in the Brachytherapy Planning task.

8-10 Reference Guide for Brachytherapy Planning

 A. Dose values exceeding the defined range in a single brachytherapy plan.

Figure 8-4 Visualization of Dose outside Defined Range in

Brachytherapy Plans

Note: To view only significant isodose levels in the 2D image views

in particular treatment cases, you can also use predefined
isodose sets. The isodose levels included in each set are defined
in the Administration task.

Showing the Absolute or Relative Dose

To be able to show the absolute dose on screen, you must first define the dose
prescription. If the dose prescription is not defined, the relative dose is always
displayed, even if the absolute dose is selected.

To Show Absolute or Relative Dose

1. In the Focus window, right-click the dose.
2. Do one of the following:
■ To display the absolute dose, make sure that the Absolute Dose menu
command is selected (has a check mark).
■ To display the relative dose, make sure that the Absolute Dose menu
command is not selected (there is no check mark).

8-11
To Show the Dose as Isodoses or in the Color Wash Mode
1. In the Focus window, right-click the dose.
2. Do one of the following:
■ To display the dose in the color wash mode, select Dose Color Wash
and then select Show Dose in Color Wash (a check mark appears
next to the command).
■ To display the dose as isodose lines, clear the Show Dose in Color
Wash menu command (the check mark disappears).

To Show the Surface Dose in the Model View

■ In the Focus window, right-click the desired structure and then select
Show Surface Dose.
The surface dose is displayed and the slider appears in the upper left corner
of the view.

To Show and Hide the Isodose Lines in

the Brachytherapy Planning Task
■ To show the isodoses in the 2D views, go to the Planning toolbar and select
Keep 2D Dose up to Date .
■ To hide the isodoses from the 2D views, go to the Planning toolbar and
deselect Keep 2D Dose up to Date.
The isodoses are shown in or hidden from the 2D image views, depending
on your selection.

To Select the Dose Color Wash Levels in the 2D Image Views

■ To define the upper and lower dose level shown with the color wash slider,
drag the slider handles.
Note: In this option, the color wash map is not compressed between the
upper and lower dose level.

8-12 Reference Guide for Brachytherapy Planning

■ To show the dose distribution between the isodose levels defined by the
positions of the color wash slider handles, drag the slider handles to the
desired levels. Then go to the Focus window, right-click the dose, select
Dose Color Wash, and select Range between Slider Handles.
■ To define the upper and lower dose level numerically, in the text boxes
below and above the slider, type the level values and press ENTER.
■ To show the dose distribution between the target minimum dose and the
target maximum dose, go to the Focus window and right-click the dose.
Select Dose Color Wash, and select Range from Target Dose Minimum
to Maximum.
■ To use the lowest and highest isodose level in the selected isodose level
set, go to the Focus window and right-click the dose. Select Dose Color
Wash, and select Range between Isodose Set Levels.
■ To return the color wash to the default state, in the Focus window,
right-click the dose, select Dose Color Wash, and select Reset Color
Wash.

The following figures show the slider.

A. Point at a handle in the color wash slider. B. Move the slider.

8-13
To Select the Isodose Levels Displayed in the Model View
1. From the Planning menu, select Isodose Levels.
Depending on the selected dose display mode, either the Relative Dose
Isolevel Editor or the Absolute Dose Isolevel Editor opens. If the dose
displayed is absolute, the unit in the Dose column is Gy. If the dose
displayed is relative, the unit in the Dose column is percentage.
■ In the 3D column, select the check box of the isodose level you wish
to show, or clear the check box to hide the isodose level.
2. Click OK.

To Select a Predefined Isodose Set

Note: The isodose level set is saved with the plan.

1. From the Planning menu, select Isodose Levels.

The Absolute/Relative Dose Isolevel Editor dialog box opens.
2. In Copy Levels from drop-down list, click the isodose set.
3. Click OK.

To Modify the Isodose Levels in an Isodose Set

Note: The isodose level set is saved with the plan.

1. From the Planning menu, select Isodose Levels.

The Absolute/Relative Dose Isolevel Editor dialog box opens.

8-14 Reference Guide for Brachytherapy Planning

 2. Do one of the following:
■ To change an isodose level, click its cell in the Dose column and type
the new isodose value in the cell.
■ To change the isodose color and style, click the cell in the Color and
Style column, and select the desired setting in the list box.
■ To show the new isodose level in the 3D model, select the check box
in its 3D column.
3. Click OK.

To Add Isodose Levels to an Isodose Set

1. From the Planning menu, select Isodose Levels.
The Absolute/Relative Dose Isolevel Editor dialog box opens.
2. To add an isodose level, click Add level.
3. Edit the cells as in “To Modify the Isodose Levels in an Isodose Set”
above.
4. To show the new isodose level in the 3D model, select the check box in its
3D column.
5. Click OK.

To Delete Isodose Levels from an Isodose Set

1. From the Planning menu, select Isodose Levels.
The Dose Isolevel Editor dialog box opens.
2. Do one of the following:
■ To delete one isodose level, click one of the cells in the row.

■ To delete several isodose levels, press the mouse button while pointing
at the first one to delete, and keeping the mouse button down, move the
mouse pointer to the last one to delete.
3. Click Delete level.
You are prompted to confirm the deletion.

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 4. To confirm the deletion, click Yes.
The selected isodose level(s) are deleted.
5. Click OK.

Dose Statistics
Apart from the visual representation of the calculated dose distribution, the
following information is also shown in the image views:
■ Location of the dose maximum (Dmax) point
■ Dose statistics

Dose Maximum (Dmax) Point

You can show the location of the dose maximum (Dmax) in a plan. The 2D
image views show the location of the Dmax on the active viewing plane; the
Model view shows the location of the 3D dose maximum inside the
three-dimensional calculation matrix. The Dmax can be shown in the Planning
workspace (the Model view only) and the Plan Evaluation workspace.

The dose maximum point is shown as a red dot accompanied with the dose
value at the point as in Figure 8-5.

Figure 8-5 Dose Maximum Point in 2D Image View and Model View

The 3D dose maximum point may be seemingly invisible in the Model view.
This is because it is positioned realistically in 3D space and, depending on the
viewing angle, may be obstructed by a structure or an isodose visualization.

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 The Dmax point located at the intersection of the viewing planes is shown
highlighted in the 2D image views in the Plan Evaluation workspace
(Figure 8-6).

Figure 8-6 Highlighted Dose Maximum Point in 2D Image View

Statistical Dose Information

The 2D dose statistics can be shown in every 2D view as a differential 2D
dose-area histogram (DAH). The DAH is shown for the active structure. If no
structure is active, the DAH is displayed for the Target Volume defined in the
Plan Properties dialog box. The DAH shows the minimum, maximum and
mean dose values for the structure. You can show or hide the DAH as is
convenient. The DAH is available in the Plan Evaluation workspace.
Figure 8-7 shows the DAH of a brachytherapy plan in a 2D image view in the
Plan Evaluation workspace.

Figure 8-7 Dose Area Histogram in Plan Evaluation Workspace

8-17
 The 3D dose statistics can be shown in the Model view. The statistics show the
dose values inside the entire calculation volume. The information displayed
includes the 3D dose maximum value, and maximum, mean and minimun dose
in the plan Target Volume. You can show or hide the 3D dose statistics as is
convenient. 3D dose statistics are available in the Planning workspace and the
Plan Evaluation workspace.

Figure 8-8 shows the 3D dose statistics of a brachytherapy plan in the Model
view in the Planning workspace.

Figure 8-8 Brachytherapy Plan Dose Statistics in Model View

To Show or Hide the Dose Statistics

1. From the View menu, select Options.

The View Options dialog box opens.
2. Select the Plan Viewing tab.
3. In the Dose group box, do one of the following:
■ To show the statistical dose information in the Model view, select the
3D Statistics check box.
■ To show the statistical dose information in the top left 2D image view,
select the 2D Statistics (DAH) check box and the In primary view
option.
■ To show the statistical dose information in all 2D image views, select
the 2D Statistics (DAH) check box and the In all views option.
■ To hide the statistical dose information, clear the appropriate check
box.
4. Click OK.

8-18 Reference Guide for Brachytherapy Planning

 To Show or Hide the Dose Maximum Point

1. From the View menu, select Options.

The View Options dialog box opens.
2. Select the Plan Viewing tab.
3. To show the dose maximum point, select the Show DMax check box.
■ To hide the point, clear the check box.

4. To see the coordinates of the Dmax point move the viewing planes to the
Global Dose Maximum (see “To Move Viewing Planes to the Dose” on
page 9-26). and check the coordinates at the bottom of each image view.

To Move Viewing Planes to the Dose

1. Go to the Plan Evaluation workspace.

2. From the View menu, select Move Viewing Planes to, then Dose and
select
■ Global Dose Maximum, to move the intersection point of the viewing
planes to the point that receives the maximum dose in the plan
■ Target Dose Maximum, to move the intersection point of the viewing
planes to the point that receives the maximum dose in the target
structure
■ Target Dose Minimum, to move the intersection point of the viewing
planes to the point that receives the minimum dose in the target
structure.

Changing the Isodose Scale and Shape

in the Brachytherapy Planning Task

To Rescale Isodoses

1. From the Planning menu, select Modify Dose and then Dose Rescaler
.

8-19
 2. Place the mouse pointer in an image view containing isodoses, press CTRL
and mouse button down and drag.
The isodoses are rescaled.
3. When the extent of the isodoses is the desired, release CTRL and mouse
button.

To Reshape Isodoses

1. From the Planning menu, select Modify Dose and then Dose Shaper .
2. To define the extent of the action, right-click in the image view.
The Dose Shaper dialog box opens.
3. Do one of the following:
■ To reshape the isodose curves all around the target, move the slider
towards Global
■ To reshape the isodose curves only in a certain area, move the slider
towards Local
4. Click OK.
5. Place the mouse pointer in an image view, press CTRL and mouse button
down and drag.
The isodose shape changes as you move the mouse.

A. Original isodose curves B. Local reshaping C. Global reshaping

6. When the isodose shape is the desired, release CTRL and mouse button.

8-20 Reference Guide for Brachytherapy Planning

Selecting the Plane to View the Dose Distribution
You can define the orientation of any viewing plane by clicking three points in
the volume image. This is useful for viewing the dose distribution on a specific
plane, for instance, on a plane going through the tip of the tandem and both
ovoids in a Fletcher-Suit-Delclos applicator.

To Define the Viewing Plane for the Dose Distribution

1. Add the necessary applicators to the plan.

2. From the Planning menu, select Set Viewing Plane.
The Set Viewing Plane dialog box opens. The Viewing Plane tool is
activated.
3. In the 2D image views, click three points to form the new viewing plane.
You can click in all three 2D image views.
Note: The points should not be on a line or very close to each other.

If you click outside an applicator, the application finds the point nearest to
the one you clicked, located in an applicator.
4. If necessary, to redefine all points, click the fourth time in a 2D image view
and then click the two other points.
5. To accept the points and show the defined viewing plane in the image
views, click Apply in the Set Viewing Plane dialog box.

Plan Normalization
In plan normalization, total dose distributions are normalized to 100% at a
selected value or point, or to a selected patient structure.

Basically, before using any of the special plan normalization methods, you
perform dose calculation to acquire a non-normalized, relative dose
distribution for the plan. You then select the appropriate plan normalization
method, if necessary.

8-21
 Note: The plan does not necessarily contain any single point that would
exactly correspond to the defined normalization percentage.

Plan Normalization Options

Table 8-1 Plan Normalization Options in Brachytherapy Planning Task

Option Description
Target minimum The minimum dose value in the plan target volume is normalized
to 100%.

Target mean The mean dose value in the plan target volume is normalized to
100%.

Selected point The dose at the point clicked with the mouse is normalized to
100%.

Selected value A user-given dose value is normalized to 100%.

Reference point By default, the dose at the selected reference point is normalized
to the defined dose prescription value. The value can also be
changed.

Basal point The dose at the Basal points is normalized to 100% or 118%.
Brachytherapy Planning task only.

Note: The plan normalization is lost if the dose distribution is

changed. After any changes in the plan, re-normalize it.

Basal Points in the Normalization of Brachytherapy Plans

Basal points are calculated to a plan in accordance with the Paris system. The
basal points are automatically calculated from the intersections of the
applicators and the central plane. You can also create basal points using the
active viewing plane as the central plane, or use the points in a selected

8-22 Reference Guide for Brachytherapy Planning

 reference line as the basal points. The applicator shape is determined by the
positions of the active sources in the applicator. The rest of the applicator shape
is ignored.

Basal points are stored in a new reference line, which is named “Basal Points”
by default.
In normalization, BrachyVision calculates the mean value of the dose at each
basal point and then normalizes the plan to either 100% or 118% at the
calculated mean dose.

To Normalize the Dose to the Target Minimum

in the Brachytherapy Planning Task
■ From the Planning menu, select Normalize to and then select Target
Minimum to normalize the dose to 100% at the target minimum dose.

To Normalize the Dose to the Target Mean

in the Brachytherapy Planning Task
■ From the Planning menu, select Normalize to and then select Target
Mean to normalize the dose to 100% at the target mean dose.

To Normalize the Dose to a Selected Point

in the Brachytherapy Planning Task
1. From the Planning menu, select Normalize to and then select Selected
Point.
2. Click the desired point with the mouse in a 2D view to normalize the dose
to 100% at the point.

8-23
To Normalize the Dose to a Selected Value
in the Brachytherapy Planning Task
1. From the Planning menu, select Normalize to and then select Selected
Value.
The Normalize to Selected Value dialog box opens.
2. In the text box, type the desired value to normalize to 100% dose.
3. Click OK.

To Normalize the Dose to a Reference Point

in the Brachytherapy Planning Task
1. From the Planning menu, select Normalize to and then select Reference
Point.
The Reference Points in Plan dialog box opens.
2. In the Reference Points in Plan list, select the reference point to which you
wish to normalize the plan.
3. By default, the text box below the list displays the dose prescription
defined for the plan. If you wish to consider some other dose value as the
prescribed dose at the selected reference point, define the value in the text
box.
4. Click OK.

To Normalize the Dose to the Basal Points

in the Brachytherapy Planning Task
1. Do one of the following:
■ From the Planning menu, select Normalize to and then select Basal
Points.
■ To use a reference line to determine the basal points, in the Focus
window, select the reference line. The go to the Planning menu, select
Normalize to and then select Basal Points.
The Normalize Options dialog box opens.

8-24 Reference Guide for Brachytherapy Planning

2. Define the method of determining the basal points.
■ To calculate the points automatically from the applicators, select
Automatically Calculate Basal Points.
■ To calculate the points from the active viewing plane, select Calculate
Basal Points Using Current Viewing Plane as Central Plane.
■ To use the selected reference line, select Use points in selected
reference line as Basal Points.
3. To remove multiple basal points that emerge in the calculation of the
points, select Remove Multiple Basal Points and define the tolerance
value in the text box.
Note: Removing multiple basal points ensures that the dose values are
correctly weighted in the normalization.

4. Define the normalization value by selecting the appropriate option button.

5. Click OK.

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8-26 Reference Guide for Brachytherapy Planning
Chapter 9 Dose Optimization
Planning Workspace

This chapter provides information on optimizing the dose to meet dosimetric

requirements and contains the steps necessary for the optimization. The
chapter describes the two optimization methods available; the geometrical
optimization and the volume optimization, and provides step-by-step
instructions for using them. Instructions are also provided for using the
optimization parameter library to store commonly used optimization
parameters and to load them from the library.

In This Chapter

Topic Page

About Dose Optimization in the Brachytherapy Planning Task ........ 9-2

Using Geometrical Optimization
in the Brachytherapy Planning Task ..................................................... 9-2
To Use Geometrical Optimization for Brachytherapy Plans............... 9-3
Using Volume Optimization
in the Brachytherapy Planning Task ..................................................... 9-3
To Optimize Brachytherapy Plans with Volume Optimization........... 9-4
To Optimize Brachytherapy Plans to Objective Dose......................... 9-6
To Optimize Brachytherapy Plans within Constraints ........................ 9-7
Using the Brachytherapy Dose Optimization
Parameter Library .................................................................................. 9-7
To Load Brachytherapy Dose Optimization Parameters
from the Library................................................................................... 9-8
To Save Brachytherapy Dose Optimization Parameters
to the Library ....................................................................................... 9-9
To Delete Brachytherapy Dose Optimization Parameters
from the Library................................................................................... 9-9

9-1
About Dose Optimization in the Brachytherapy
Planning Task
The aim in dose optimization is to achieve a dose distribution that meets the
user-defined requirements. The optimization is done for all applicators
simultaneously.

Note: Verify the optimized dose by viewing the calculated dose by

isodoses or isosurfaces.

BrachyVision provides two different types of dose optimization methods

„ Geometrical optimization
„ Volume optimization

Using Geometrical Optimization

in the Brachytherapy Planning Task
The purpose of geometrical optimization is to produce a dose distribution in an
implant which is as homogeneous as possible. This type of optimization is
typically used for multi-catheter or multi-needle implants in interstitial
treatments when the catheter or needle placement has not been optimal.1 The
method applied in BrachyVision is based on inter-source distances. The
relative dwell time at each source position is determined by its distance to the
other positions.

A crude calculation is made of the relative dose at each source position

contributed by all other sources, excluding the dose from current source. The
dwell time is then set in inverse proportion to that relative dose. The
optimization results in a relative dose.

1. For more information about the theory of this method of optimization, refer to
Edmundson: Geometry based optimization of stepping source implants. In brachytherapy
HDR and LDR. Ed. A. A. Martinez, C. G. Orton and R. F. Mould.

9-2 Reference Guide for Brachytherapy Planning

 Note: The results from geometrical optimization can be arbitrarily
combined with the previous dose distribution.

To Use Geometrical Optimization for Brachytherapy Plans

1. From the Planning menu, select Modify Dose and then Geometrical
Optimization.
The Geometrical Optimization dialog box opens.
2. In the list box, select a reference point to which to normalize the dose.
3. With the Blending slider, define the ratio in which the previous isodose
curves are taken into consideration when optimizing the dose. By default,
the slider is in the right-most position, and the previous isodose curves do
not affect the result.
4. Click OK to optimize the dose geometrically.

Note: Approve the optimized dose by verifying the isodoses or

isosurfaces in the calculated dose.

Using Volume Optimization

in the Brachytherapy Planning Task
Volume optimization enables automatic calculation of dwell times to give the
desired dose to selected structures and reference lines. You first select the
structures and reference lines and then specify the desired dose for them by
giving the constraint values inside which the dose should fall after the
optimization. The optimization algorithm then tries to find the optimal dwell
times that meet these constraints.

Two methods can be used for volume optimization: optimization to an

objective dose, and optimization between constraints.

In the optimization to an objective dose, you specify the dose inside the
selected structure or reference line by setting an objective dose, towards which
the dose calculation iterates, plus the maximum deviation from the objective.

9-3
 In the optimization between constraints, you specify the dose inside the
selected structures and reference lines by setting constraints in the
dose-volume histogram. For example, the constraints can be of form
„ Upper limit: No more than X% of the structure gets Y Gy or more.
„ Lower limit: No less than X% of the structure gets Y Gy or more.

Multiple constraints can be defined for each structure or reference line. To

control the importance of the constraints, specify each one a weight factor.

To Optimize Brachytherapy Plans with Volume Optimization

Note: Always define a sufficient number of sample points for each

structure. Otherwise, the dose-volume histograms shown
during the optimization will be too coarse and will not illustrate
the dose distribution accurately.

9-4 Reference Guide for Brachytherapy Planning

1. From the Planning menu, select Modify Dose and then Volume
Optimization.
The Volume Optimization dialog box opens.

A. Limits for PTV B. Dose histogram for PTV C. Error function curve D. Dwell time/position curve

2. In the Structures and reference lines list box, define the number of
sample points to be evaluated during the optimization.
„ For structures, select the Surface check box to evaluate the dose only
on the surface. Otherwise, the dose is evaluated inside the whole
volume.
3. Select the row of a structure to activate it, and then click Objective (to
define a +/- target dose) or Add (to define a number of dose constraints).
Define the optimization settings as in “To Optimize Brachytherapy Plans
to Objective Dose” on page 9-6 or “To Optimize Brachytherapy Plans
within Constraints” on page 9-7.
You can also optimize the dose only to the surface of a structure, and
assign the weight to that constraint.
4. Type the maximum optimize time and the maximum dwell time in the text
boxes.

9-5
 5. Do one of the following:
„ To visualize the error function during the optimization, select the
Show error function check box.
„ To visualize the dwell times in each dwell position, select the Show
dwell times check box.
6. When the settings are appropriate, click Optimize to start the optimization.
7. The optimization stops when:
„ The limits are met
„ The maximum optimization time has elapsed
„ You click Stop
You can click Stop to end the optimization routine early if the error
function has flattened off, and the DVH is showing an acceptable
distribution.
8. To accept the optimization and to apply the solution, click OK to apply the
solution. At this point, if the constraint set is not saved in the library, you
can add it to the library.

To Optimize Brachytherapy Plans to Objective Dose

1. In the Volume Optimization dialog box, select a structure for which to
define a dose limit and click Objective.
The Desired Dose dialog box opens.
2. In the text boxes, define the objective dose for the selected structure or
reference line and the allowed maximum deviation from the objective
dose.
3. Click OK.
Two constraints based on the defined values appear in the Volume
Optimization dialog box.
4. To start the optimization, click Optimize.
5. Continue the optimization as in “To Optimize Brachytherapy Plans with
Volume Optimization” on page 9-4.

9-6 Reference Guide for Brachytherapy Planning

To Optimize Brachytherapy Plans within Constraints
1. In the Volume Optimization dialog box, select a structure for which to
define a dose limit and click Add.
2. Edit the constraints as desired:
„ To define the upper limit or lower limit, type U or L in the second
column, respectively.
„ In the % column, type the limiting dose portion.
„ In the Gy column, type the limiting absolute dose.
„ In the Weight column, type the weight factor for this constraint. The
difference in weight factors of different constraints must be sufficient,
for example 1:100 where 100 is the highest weighting.
The constraints are visualized in the Dose Histogram box with colored
triangles (pointing upwards for lower limits and downwards for upper
limits). Edit the constraints by moving the triangles in the histogram with
the mouse.
Note: You can edit the constraints even during the optimization.

3. To display all the constraints simultaneously in the histogram, select the

Show all limits check box.
Note: To show a wider dose range, rescale the histogram box by
dragging the blank area.

4. Continue the dose optimization as in “To Optimize Brachytherapy Plans

with Volume Optimization” on page 9-4.

Using the Brachytherapy Dose Optimization

Parameter Library
Instead of defining optimization constraints individually for each plan, the
constraints can be selected from a library of optimization constraints. The
library can be used to store frequently used optimization parameters that have
been found suitable for specific tumor cases. It can also be used to store
optimization parameters defining the constraints that must be met for the plan
to be acceptable.

9-7
To Load Brachytherapy Dose Optimization Parameters
from the Library
1. In the Volume Optimization dialog box, select the Constraint Library tab.

A. The color is the one used in the optimizer tab for the structure. If black, the structure has not
been defined for the current patient. B. To change the matching structure, click the cell and select
a new one in the list box.

2. In the Constraint Sets list box, select a constraint set and check that the
volumes are correctly matched.
3. Click Load.
The loaded parameters are displayed in the Preview box and in the
Optimizer tab.
Note: You can change the matching structure.

9-8 Reference Guide for Brachytherapy Planning

To Save Brachytherapy Dose Optimization Parameters
to the Library
1. In the Volume Optimization dialog box, select the Constraint Library tab.
The constraints currently defined in the Optimizer tab are listed in the
Preview box.
2. In the Constraint Sets list box, select <current set> and click Save.
You are prompted to type an ID for the set.
3. Click OK.

To Delete Brachytherapy Dose Optimization Parameters

from the Library
1. In the Volume Optimization dialog box, select the Constraint Library tab.
The constraints currently defined in the Optimizer tab are listed in the
Preview box.
2. In the Constraint Sets list box, select the set and click Delete.

9-9
9-10 Reference Guide for Brachytherapy Planning
Chapter 10 Evaluating Plans
Planning Workspace, Plan Evaluation Workspace

This chapter describes how to use the plan evaluation tools. The tools for
viewing the point doses and dose profiles are described. Step-by-step
instructions are provided for comparing plans visually, using dose-volume
histograms for evaluating a single plan and multiple plans, as well as for
summing up plans to compare and evaluate alternative plans created for a
patient. Instructions for approving plans for treatment are also included.

In This Chapter

Topic Page

About Plan Evaluation .......................................................................... 10-2

Point Dose Value and Dose Profile....................................................... 10-3
Displaying the Point Dose ................................................................. 10-3
To Display the Dose at the Selected Point ................................... 10-4
Creating a Dose Profile...................................................................... 10-4
To Display the Dose Along a Line ............................................... 10-5
To Export the Dose Profile........................................................... 10-5
To Print out the Dose Profile........................................................ 10-6
Dose-Volume Histogram ....................................................................... 10-6
Available DVH Types ....................................................................... 10-7
Cumulative DVH.......................................................................... 10-8
Differential DVH.......................................................................... 10-9
Natural DVH ................................................................................ 10-9
DVH for a Single Plan..................................................................... 10-11
To Calculate DVH for One Plan ................................................ 10-12
DVH for Multiple Plans................................................................... 10-13
To Calculate a DVH for Multiple Plans ..................................... 10-16
To Calculate a DVH for Summed Plans .................................... 10-18
Boolean Operations in DVH Calculation ........................................ 10-18
To Create Boolean Structures for DVH Calculation.................. 10-19
Exporting DVHs .............................................................................. 10-19
About the DVH Export File ....................................................... 10-20
To Export a DVH ....................................................................... 10-22

10-1
 DVH Print-Outs ............................................................................... 10-23
About DVH Print-Outs............................................................... 10-23
To Print a DVH .......................................................................... 10-25
Accuracy of the DVH ...................................................................... 10-25
Comparing Plans Visually .................................................................. 10-26
To Compare Plans Visually ............................................................. 10-26
Summing Plans .................................................................................... 10-27
Dose Matrices in Summed Plans ..................................................... 10-27
Plan Sum Visualization.................................................................... 10-28
To Sum and Subtract Plans.............................................................. 10-28
To Evaluate the Plan Sum................................................................ 10-29
To Print a Plan Sum......................................................................... 10-29
Approving Plans .............................................................................. 10-30
Planning and Treatment Approval ............................................. 10-30
To Approve Plans in Brachytherapy Planning Task .................. 10-30

About Plan Evaluation

Eclipse can evaluate plans as follows:
■ Visually by reviewing and comparing 3D dose distributions to decide
which of the alternative plans will be used for treatment
Note: In the Plan Evaluation workspace, you cannot change any
parameters that would invalidate the dose calculation.

■ Quantitatively by using the dose measurement tools—point dose value and

dose profile
■ Reductively by using dose-volume histograms
■ Summing plans to make sure that the delivered dose is acceptable if the
treatment consists of multiple plans

10-2 Reference Guide for Brachytherapy Planning

Point Dose Value and Dose Profile
Planning Workspace and Plan Evaluation Workspace

Use the measurement tools together with isodoses and color wash to verify the
dose distribution. The point dose and line dose tools enable studying the dose
at one location or dose gradients at particular critical locations, respectively.

Displaying the Point Dose

The point dose is the dose calculated for a point that you click on a plane
displayed in an image view. For instance, use point doses for defining the
normalization value used for normalizing the dose distribution to a selected
point or for checking the dose values at a critical point. You can display several
point doses at the same time and drag the points to the desired locations.

In the Brachytherapy Planning task, the point dose information contains the
following:
■ Total dose percentage or absolute dose
■ Point coordinates The (x, y, z) coordinates of the point expressed in
centimeters

Figure 10-1 Point Dose Dialog Box in Brachytherapy Planning Task,

Absolute and Relative Dose

10-3
 To Display the Dose at the Selected Point

1. From the View menu, select Measure and then Point Dose .
2. In an image view, click a point of interest to show the point dose
information.
The Point Dose dialog box opens, displaying the dose at the selected point.

Creating a Dose Profile

Create a dose profile to derive additional information from the isodose plot of
the dose distribution. The dose profile is useful to view the dose or dose
gradients at critical locations in the plan. The following information is
displayed for the selected line:
■ Graph of the dose along an arbitrary line through the plan
■ Start and end points of the dose profile line
■ Dose sampling steps and the step size
■ Maximum dose along the line in percentage of the prescribed total dose or
in absolute dose (Gy)

Figure 10-2 shows an example of a line profile.

Figure 10-2 Dose Line Profile Dialog Box

10-4 Reference Guide for Brachytherapy Planning

To Display the Dose Along a Line

1. From the View menu, select Measure and then Dose Profile .
2. In an orthogonal view, click the starting point of the dose profile.
The Dose Line Profile dialog box opens.
3. Move the mouse to where you wish to end the line.
The dose profile is shown and changes as you move the mouse.
4. Click the end point of the line.
The dose profile shows the dose intensity along the line.
Note: You can move the line in the image view by panning it or by
dragging the handles at either end of the line. To constrain the
movement to vertical and horizontal directions, press SHIFT when
dragging. You can maximize, minimize or resize the dose line profile
dialog box as necessary and print the dose profile.

5. To display the dose value and distance at any point along the line profile,
place the mouse pointer in the graph.
The value and distance at that point are displayed in labels.

To Export the Dose Profile

1. To save the dose profile as a text file, click Export in the Dose Line Profile
dialog box.
The Export Dose Profiles dialog box opens.
2. In the Export Dose Profiles dialog box, select the profiles to save and click
OK.
The Save As dialog box opens.
3. In the Save As dialog box, type a name for the profile and click Save.
The profile is saved in the application directory.

10-5
 To Print out the Dose Profile

1. To save the dose profile as a text file, click Export in the Dose Line Profile
dialog box.
The Print dialog box opens.
2. Select the desired printer and number of copies to be printed.
3. Click OK.

Dose-Volume Histogram
Planning Workspace and Plan Evaluation Workspace

A dose-volume histogram (DVH) reduces the complex 3D dose distribution

into a plot of the percentage volume of structures receiving a given dose. The
DVH reveals the dose uniformity throughout structures and is an excellent tool
for evaluating dose distributions from various plans.

The DVH algorithm is based on calculated dose distributions and a

shape-based interpolation model for volumes, which rounds structure edges to
better reproduce the shapes of biological structures. The rounding effect is
strongest in the Z-direction. The same shape-based model is also used in
volume calculation and 3D visualization. For more information on volume
modelling in DVH, refer to Reference Guide for Eclipse Algorithms.

10-6 Reference Guide for Brachytherapy Planning

 Note: When using a DVH, note the following:
■ Display the structure, plan, dose or target volume relevant
to points along a histogram curve by moving the mouse
pointer on the curve.
■ Before creating the DVH, prescribe the dose for the plan.
■ Dose statistics shown for structures in DVH dialog box may
differ from dose statistics shown elsewhere. This is due
different modeling of the structure. For more information
on volume modelling in DVH, refer to Reference Guide for
Eclipse Algorithms.
■ You can also calculate DVHs for structure combinations;
for more information, see “Boolean Operations in DVH
Calculation” on page 10-18.
■ In cases where a defined structure is very small, the spatial
resolution is different for the dose matrix and the defined
structure. This leads to a situation where the sampling
coverage of the DVH is not 100%, and the DVH curve and
statistics may not be fully accurate. For more information,
see “Accuracy of the DVH” on page 10-25.

The DVH can be printed and exported in ASCII format.

Note: In the Brachytherapy Planning task, the 3D dose is

automatically calculated when the DVH command is used.

Available DVH Types

DVHs for multiple structures from a single plan can be plotted on the same
graph (single-plan DVH). Likewise, DVH curves for multiple structures from
several different plans can be plotted on the same graph (multi-plan DVH).

The available DVH types are

■ Cumulative
■ Differential
■ Natural

10-7
 For more information, see “DVH for a Single Plan” on page 10-11 and “DVH
for Multiple Plans” on page 10-13.

Cumulative DVH

The cumulative DVH graph displays the percentage (relative) or volume

(absolute) of structures that receive a dose equal to or greater than a defined
dose. It is particularly useful for summarizing the dose delivered to a target
structure. Figure 10-3 illustrates a cumulative DVH graph:

A. For example, this point indicates that 100% of the structure receives at least 81% of the
prescribed dose (or 38 Gy). B. The closer these angles are to a right angle the more uniform is the
dose distribution.

Figure 10-3 Cumulative DVH Graph

In the cumulative DVH graph, the Y-axis represents the share of the total
volume of the structures receiving a particular dose. The share of the volume
is indicated in percentage or cm3. The lower X-axis represents the dose
indicated in percentages between the dose range values defined in the Dose
Volume Histogram dialog box. The upper X-axis represents the dose indicated
in Gy.

10-8 Reference Guide for Brachytherapy Planning

Differential DVH

The differential DVH displays the share of the total volume in structures
receiving a certain dose as a function of equivalent dose intervals. It is useful
for summarizing the dose distribution to normal tissue. Figure 10-4 illustrates
a differential DVH graph for a structure.

A. In this example, most of the volume of the structure receives 88% to 90% of the prescribed dose
(or 35.2 to 36 Gy). B. The area under the curve is equal to the total volume of the structure. The
wider the peak, the less uniform is the dose distribution.

Figure 10-4 Differential DVH Graph

In the differential DVH graph, the Y-axis represents the share of the total
volume of the structures receiving the dose. The volume is indicated in
cm3/Gy. The lower X-axis represents the dose intervals with the dose indicated
in percentage, and the upper X-axis represents the dose intervals in Gy.

Natural DVH

The natural DVH graph displays the share of the total volume of structures
receiving a certain dose against a set of non-equidistant dose intervals. In other
words, the natural DVH is the differential DVH plotted in a different
coordinate system. It is particularly useful in cases where a differential DVH
does not clearly focus on the desired details because of the obscuring effect of
the inverse square law. The natural DVH suppresses that effect and preserves
proportionality between the volume and the area under the curve, and provides
a more concrete view at the plan than other types of DVH.

10-9
 The following figures compare a differential and a natural DVH for the same
brachytherapy plan.

A. For brachytherapy plans, it is often not easy to interpret the high-dose peak in differential DVH
graphs.

Figure 10-5 Differential DVH of a Brachytherapy Plan

In a differential DVH, it may be difficult to distinguish any dose variations that

occur at higher dose rates because the volume receiving low doses is so much
larger.

10-10 Reference Guide for Brachytherapy Planning

 A. The visual effect of the large volume with low dose is suppressed by converting the scale. B.
The high-dose peak is now more distinguishable.

Figure 10-6 Natural DVH of a Brachytherapy Plan

A natural DVH clearly shows peaks that result when sources are added to the
plan.

DVH for a Single Plan

Use a single-plan DVH to compare the dose received by several structures in
one plan. To create a DVH for one plan, you first select the structures to
include in the DVH and let the program calculate the DVH. You then define
how to view and scale the DVH, select the DVH type and the dose range
included in the DVH.

A single-plan DVH contains the following information:

■ X- and Y-axis information as indicated in “Available DVH Types” on
page 10-7.
■ The curve for each structure in the DVH graph is drawn in different colors,
corresponding to the color of the viewing material selected for the
structure. The structure list indicates the color corresponding to each
structure.

10-11
 For an example of a cumulative single-plan DVH, see Figure 10-3. For an
example of a differential single-plan DVH, see Figure 10-4. For an example of
a natural single-plan DVH, see Figure 10-6. For a list of parameters defined for
a single-plan DVH, refer to the online help.

To Calculate DVH for One Plan

1. From the Planning menu, select Dose Volume Histogram.

The Dose Volume Histogram dialog box opens.

A. Define temporary dose B. Adds a structure combination C. Structures and structure

combinations in the active image D. Shows the contents of a structure combination

2. In the Structures and Expressions list box, select the check boxes of the
structures to be included in the DVH.
3. To use a different prescribed dose and treatment percentage for the DVH,
type the desired values in the corresponding text boxes.
Note: New values typed in the Treatment % and Prescribed dose text
boxes are intended only for previewing the DVH with new values. The
values are not saved in the plan.

10-12 Reference Guide for Brachytherapy Planning

 4. When you have defined the settings, click Calculate to compute the DVH
for the structures.
During the calculation, a progress indicator is displayed. The finished
DVH appears in the dialog box.
Note: If the calculation volume does not cover the volume of interest, a
notification is shown.

5. To view the dose information for each structure in percentage or in Gy,

select the Relative [%] or Absolute [Gy] option button.
6. To show a grid in the DVH graph, select the Grid check box.
7. To define the DVH type, click the Cumulative or Differential or Natural
option button.
8. To define the volume scale, click the Relative or Absolute option button.
9. To define the dose range, type the upper and lower limit in the text boxes
and click Apply Range to update the DVH graph.
10. To close the dialog box, click Close.

Note: When using DVH calculation, notice the following:

■ If the target structure exceeds the selected calculation
volume, the DVH is partially calculated and a message is
displayed. This may often be the case for the Body structure
because the dose calculation and the volume calculation
interpret the volume differently. If the Partial calculation
percentage stated is close to 100% for the Body structure,
the message is not critical.
■ Dose statistics shown for structures in DVH dialog box may
differ from dose statistics shown elsewhere. This is due to
different modeling of the structure.

DVH for Multiple Plans

A multi-plan DVH shows the DVH curves for multiple structures from several
different plans on the same graph. Use a multi-plan DVH to compare the dose
received by one or several structures included in a number of plans or summed
plans. The plans can belong to different courses.

10-13
 The curves in a multi-plan DVH are differentiated from each other using a
different color for each graph. The particular colors used for the graphs depend
on the number of plans and structures included in the DVH.

To create a multi-plan DVH, first open the plans you wish to compare. Start
the comparison by selecting the relevant plans and structures to be included in
the DVH in the Plans and Structure Selections dialog box. Then let the
application calculate the DVH for the selections. You can also create Boolean
structures for a multi-plan DVH (see “Boolean Operations in DVH
Calculation” on page 10-18).

For a description of the parameters defined for a multi-plan DVH, refer to the
online help.

Note: When using a DVH, note the following:

■ Display the structure, plan, dose or target volume relevant

to points along a histogram curve by moving the mouse
pointer on the curve.
■ Before creating the DVH, prescribe the dose for the plan.
■ Dose statistics shown for structures in the DVH dialog
boxes may differ from dose statistics shown elsewhere.
This is due to different modeling of the structure. For more
information on volume modeling in DVH, refer to
Reference Guide for Eclipse Algorithms.

Figure 10-7 shows an example of a cumulative multi-plan DVH:

10-14 Reference Guide for Brachytherapy Planning

A. Cumulative DVH curves for structure A in two plans B. Cumulative DVH curves for structure B
in two plans.

Figure 10-7 Cumulative Multi-Plan DVH

Figure 10-8 shows an example of a differential multi-plan DVH:

Figure 10-8 Differential Multi-Plan DVH

Figure 10-9 shows an example of a natural multi-plan DVH:

10-15
 Figure 10-9 Natural Multi-Plan DVH

To Calculate a DVH for Multiple Plans

1. From the Planning menu, select Plan Comparison DVH.

The Plan and Structure Selections dialog box opens.

A. Select the structures for which to calculate the DVH. B. Select plans to compare with the DVH.

10-16 Reference Guide for Brachytherapy Planning

2. In the Patient Volumes and Expressions list box, select the structures for
which to calculate the multi-plan DVH.
3. In the Plans list, select the plans for which to calculate the multi-plan
DVH.
Note: The list contains only active plans that have the dose distribution
calculated.

4. Click OK to compute the multi-plan DVH.

The Plan Comparison with Dose Volume Histogram dialog box opens,
showing the calculated DVH for the selected structures.

Note: If the calculation volume does not cover the volume of interest, a
notification is shown.

5. Define the parameters for calculating the DVH as in “DVH for a Single
Plan” on page 10-11.
6. To close the dialog box, click Close.

Note: Dose statistics shown for structures in DVH dialog box may
differ from dose statistics shown elsewhere. This is due
different modeling of the structure.

10-17
 To Calculate a DVH for Summed Plans

1. In the Plan Evaluation workspace, create a plan sum as in “Summing

Plans” on page 10-27.
2. From the Evaluation menu, select Plan Comparison DVH.
3. Select the structures to be included in the plan sum as in “DVH for
Multiple Plans” on page 10-13.
4. In the Plans list, select the plan sum for which to calculate the DVH.
5. To calculate the DVH, click OK.

Boolean Operations in DVH Calculation

Sometimes it is useful to calculate a combined DVH for a set of structures. For
example, you may want to calculate the DVH for the part of the lungs that does
not overlap with the PTV. To do this, use the Structure Expression
Editor/Patient Volume Expression Editor tool. The tool creates Boolean
combinations of the structures defined in the Contouring workspace. The tool
uses the following logical operators:

■ AND—A AND B : includes the areas that are shared by both A and B

■ OR—A OR B : includes the areas that belong to A and B

■ XOR—A XOR B : includes the areas that belong to either A only or B

only but not A and B

■ SUB—A SUB B : includes the area that belongs to A only

■ NOT—NOT B : includes all the areas that do not belong to B

In addition, you can use parentheses with Boolean operators.

Note: The combined structures are temporary, and they are not saved
into the database. You can only use them to evaluate plans with
DVHs.

10-18 Reference Guide for Brachytherapy Planning

 To Create Boolean Structures for DVH Calculation

1. Do one of the following:

■ Single-plan DVH: In the Dose Volume Histogram dialog box, click
Add.
■ Multi-plan DVH: In the Plan Comparison with Dose Volume
Histogram dialog box, click Selections.
■ Multi-plan DVH: In the Plan Patient Volumes and Expressions dialog
box, click Add.
The Structure Expression Editor or Patient Volume Expression Editor
dialog box opens.
2. In the Structures or Patient Volumes list box, click the first structure to
be used to define the new structure.
The selected structure is shown in the Value list box.
3. Click the appropriate operator button.
The operator is shown in the Value list box.
4. Repeat steps 2 and 3 as necessary.
5. In the Name text box, type a name for the combined structure.
6. Click OK.
The dialog box closes. The new structure is displayed in the Structures
and Expressions list box of the Dose Volume Histogram dialog box or in
the Patient Volumes and Expressions list box of the Plan Comparison
with Dose Volume Histogram dialog box.
7. Do one of the following:
■ To edit a combined structure, select it and click Edit.

■ To remove a combined structure, select it and click Delete.

Exporting DVHs
The DVHs can be exported, or saved as a text file which can be opened, for
example, in a spreadsheet program for further analysis.

10-19
 Note: Notice the following about DVH export:
■ Only the values within the dose range set in the DVH dialog
box are exported.
■ DVH can also be exported in the DICOM format with the
dose data using the Export/Import wizard. For more
information, see Chapter 12, ”Export and Import”

About the DVH Export File

The export function saves the DVH to an ASCII file. The export file of both a
single-plan and multi-plan DVH contains the following information:

■ Name and ID of the patient

■ Export date and time
■ DVH type (cumulative, differential or natural)
■ Name and ID of the plan(s)
■ Name and ID of the selected structure(s)
■ Plan information
■ Structure information in numerical format (percentage of volume
calculated, volume of the structure)
■ Dose information in numerical format (prescribed dose, treatment
percentage, dose minimum and maximum, dose mean, median and modal,
standard deviation)
■ DVH graph information in numerical format, depending on the type of the
DVH (cumulative or differential)

10-20 Reference Guide for Brachytherapy Planning

The DVH information for a single-plan DVH is saved in the export file in the
following format:

Patient Name : <name of the patient

Patient ID : <identification of the patient>
Comment : <user-defined comment>
Date : <dd.mm.yyyy> <hh:mm:ss>
<Cumulative/Differential/Natural> Dose Volume Histogram
PLAN: <name and ID of the plan>

Histogram : <name and ID of the structure>

Prescribed dose [Gy]: <dose in Gray>
% for dose (%): <treatment percentage>
Calculated vol (%): <percentage of the volume calculated>
Volume [cm³]: <volume>
Dose minimum [%]: <dose minimum>
Dose maximum [%]: <dose maximum>
Dose mean [%]: <dose mean>
Dose median [%]: <dose median>
Dose modal [%]: <dose modal>
Standard dev : <standard deviation>
Dose[%] nnnnnnnnnn Volume(%)
<percentage> <percentage>
2.437 nnnnnnnnnnn100.000
4.874 nnnnnnnnnnn100.000

The same information is written for each structure included in the DVH.
The DVH information for a multi-plan DVH is saved in the export file in the
following format:

Patient Name : <name of the patient>

ID nnnnnnnn: <identification of the patient>
Comment : <user-defined comment>
Date : <dd.mm.yyyy> <hh:mm:ss>
<Cumulative/Differential/Natural> Dose Volume Histogram
PATIENT VOLUME: <name and ID of the selected structure>

Histogram : Plan: <plan ID> - <plan name> / <structure name and ID

Prescribed dose [Gy]: <prescribed dose in Gray>
% for dose (%): <treatment percentage>
Calculated vol (%): <percentage of volume calculated>
Volume [cm³]: <volume of the selected structure>
Dose minimum [Gy]: <dose minimum in Gy>
Dose maximum [Gy]: <dose maximum in Gy>
Dose mean [Gy]: <dose mean in Gy>
Dose median [Gy]: <dose median in Gy>
Dose modal [Gy]: <dose modal in Gy>
Standard dev : <standard deviation>
Dose[Gy]nnnnnnnnnn Volume[cm³]
<dose in Gray>nn<volume of the structure>

The same information is written for each plan and structure included in the
DVH.

10-21
 To Export a DVH

1. Calculate the DVH to show it in the Dose Volume Histogram dialog box.
2. Click Export.
The DVH Export Options dialog box opens.
3. Define the start and end values of the Dose range in percentage.
4. Define the interval at which the dose values are printed to the export file to
the Step size box.
5. Click OK.
The Save As dialog box opens.
6. In the Save in list box, select the directory into which to save the export
file.
7. In the File name text box, define a name for the export file.
8. Click Save to save the DVH to the defined export file.

10-22 Reference Guide for Brachytherapy Planning

DVH Print-Outs

About DVH Print-Outs

Both single-plan and multi-plan DVHs can be printed. In both cases, the DVH
print contains the DVH graph, and under it, the following information,
depending on the type of the DVH:

■ Name and ID of the patient

■ Name(s) and ID(s) of the course(s)

■ DVH type (cumulative, differential or natural)

■ Name(s) and ID(s) of the selected plan(s)
■ Name(s) and ID(s) of the selected structure(s)
■ Course information
■ Structure information in numerical format (coverage, volume)
■ Dose information in numerical format (min., max., mean, modal, median,
standard deviation)
■ User defined comment, if any
■ Print date and time

The DVH graph in a DVH print-out is similar to that displayed in the Dose
Volume Histogram dialog box. The following figure shows an example of a
DVH print-out.

10-23
 Dose [Gy]

100.0

105.0

110.0

115.0

120.0
10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

55.0

60.0

65.0

70.0

75.0

80.0

85.0

90.0

95.0
5.0
0
3.2 3.2
3.1 3.1
3.0 3.0
2.9 2.9
2.8 2.8
2.7 2.7
2.6 2.6
2.5 2.5
2.4 2.4
2.3 2.3
2.2 2.2
dVolume / dDose [cm³/Gy]

2.1 2.1
2.0 2.0
1.9 1.9
1.8 1.8
1.7 1.7
1.6 1.6
1.5 1.5
1.4 1.4
1.3 1.3
1.2 1.2
1.1 1.1
1.0 1.0
0.9 0.9
0.8 0.8
0.7 0.7
0.6 0.6
0.5 0.5
0.4 0.4
0.3 0.3
0.2 0.2
0.1 0.1
0 0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
110.0
120.0
130.0
140.0
150.0
160.0
170.0
180.0
190.0
200.0
210.0
220.0
230.0
240.0
250.0
260.0
270.0
280.0
290.0
300.0
0

% of prescribed dose (40.00 Gy)

Structure Coverage [%] Volume [cm³] Min [%] Max [%] Mean [%] Modal [%] Median [%] STD
PTV 100.0 119.4 17.7 2579.5 121.4 38.6 92.8 23.43

DIFFERENTIAL DOSE VOLUME HISTOGRAM

Patient Nam
e : BrachyTest, BrachyTest ID: BrachyTest
Course Name : ID: C2
Plan Name : Plan1 ID: Plan1
Comment : DVH for pelvic patient
Date : Tuesday, November 21, 2000 09:30:16

BrachyVision Brachytherapy Planning

Figure 10-10 DVH Print-Out

10-24 Reference Guide for Brachytherapy Planning

 To Print a DVH

1. Calculate the DVH to show it in the Dose Volume Histogram dialog box.
2. Click Print.
The DVH Print Properties dialog box opens.
3. In the Comment line text box, type a comment for the DVH, if desired.
4. Click OK.
The Print dialog box opens.
5. In the Name drop-down list, click the printer.
6. Click OK to print the DVH graph.

Accuracy of the DVH

Some compromises are inevitable regarding the accuracy of a DVH, because
the DVH algorithm performs interpolation and sampling to combine the dose
and structure set data. Interpolation and sampling are needed because of the
differences in the spatial resolution and position of the dose matrix and the
volume image (the dose matrix usually has coarser resolution than the
structures in the volume image). The structure shapes are sampled and
interpolated from the images to the dose matrices, and volume modeling uses
the interpolated structure shapes. The cumulative DVH is generated as an
integral of the sampled dose over the interpolated structures.
This process interpolation and sampling leads to inaccuracy of the volume in
the dose space. The inaccuracies are most pronounced in very small structures,
where a minor error in the volume estimation can be a large fraction of the
structure volume. The effect is also amplified if the dose calculation planes are
far apart from the image planes.

The statistical parameters are extracted from the calculated DVH curve. The
structure volumes are calculated more accurately from the original structure
data in the image to allow verifying the parameters and the accuracy of the
volume modeling.

The volume inaccuracy is shown in the DVH dialog box, which displays the
percentage of each structure’s volume covered by the dose matrix and the
percentage of the structure’s volume used for the DVH calculation (see “DVH
for a Single Plan” on page 10-11).

10-25
 Note: If you encounter reduced DVH accuracy in the Brachythrapy
Planning task, modify the 3D dose matrix properties so that the
Z-resolution is the same as the slice spacing of the volume
image.

Comparing Plans Visually

Plan Evaluation Workspace

When you have calculated the dose distribution for at least two plans, compare
them visually. To display isodoses in the Brachytherapy Planning task,
calculate the 3D dose.

To Compare Plans Visually

1. Open the plans to compare.
The plans are shown in the Scope window.
2. Do one of the following:
■ Drag the first plan into the plan evaluation view set on the left.
■ Drag the second plan into the plan evaluation view set on the right.

3. From the Window menu, select a view layout:

■ Two orthogonal views—2D images of both plans.

■ Two Model/BEV views—Volume images of both plans.

4. To connect views based on the same CT image series, select the Link
View Geometries tool .
When the tool is selected, changes to the view geometry of the left view
set are also applied to right view set and vice versa. This way you can
automatically see the same location in both plans.

10-26 Reference Guide for Brachytherapy Planning

 5. Do one of the following:
■ View the dose distribution with the viewing tools (Zoom, Pan, Reset,
Next plane, Previous plane, Rotate; for more information, refer to
Reference Guide for Preparing Images for Treatment Planning).
■ Evaluate the dose with the dose measurement tools (Point dose, Dose
profile). For instructions, see “Point Dose Value and Dose Profile” on
page 10-3.

Summing Plans
Field Setup and Plan Evaluation Workspace

Each plan in the sum can have its own prescription point. Summing up plans is
possible if the plans are based on the same volume image. Plans that use
different volume images must first be registered. The plan sum images can be
printed out like any other plan images. For more information and instructions
on image registration, refer to Reference Guide for Preparing Images for
Treatment Planning. For information on print-outs, see Chapter 11, ”Printing
Plan Information”.

Note: When summing plans, note that:

■ Before summing plans, prescribe the absolute dose for the

individual plans.

Dose Matrices in Summed Plans

The calculation volume for the dose in a plan sum comprises an intersection of
all calculation volumes of the plans included in the plan sum.

If some of the plans included in the plan sum are based on matched images, the
dose matrices in the plans are handled differently. If the original dose matrices
have different resolutions, the resolution of the summed plan will be that of the
plan with the finest resolution. If the original dose matrices are of different
size, the size of the summed plan dose matrix will be changed to cover all the
volumes in the sum. As a result, the summed plan and the DVH calculated for
it in the case of plans using matched images are reliable only for those areas of
the original plan matrices that are shared by all the plans.

10-27
Plan Sum Visualization
Brachytherapy plan sums can be created and viewed in the Plan Evaluation
workspace. The Focus window shows the brachytherapy plans included in plan
sum.

A. Individual plans used to form the plan sum B. Plan sum C. Plans included in the plan sum

Figure 10-11 Plan Sum in Focus Window

To view a plan sum in the image views, drag it to an image view from the
Scope window. The volume image used for and the geometry of the plan sum
is shown in all image views. The dose distribution is also displayed in all image
views.

To Sum and Subtract Plans

1. Open the patient and all the courses that include plans to be summed.
Check that the plans have dose prescription.
The plans are shown in the Scope window.
2. From the Insert menu, select New Sum Plan.
The Insert New Plan Sum dialog box opens.
3. In the Plan Sum ID, type an identification for the new plan sum.

10-28 Reference Guide for Brachytherapy Planning

 4. In the Image drop-down list, select the image to be used in the plan sum.
Note: If you are summing plans that are based on matched images,
select the image on which you wish to display the sum.

5. Do one of the following:

■ To include a plan in the sum, select the check box in front of it.
■ To exclude a plan from the sum, clear the check box in front of it.

6. Do one of the following:

■ To add a plan, double-click in the Operation column and select “+”
■ To subtract a plan, double-click in the Operation column and select “-”

7. Click OK.
The image selected for the plan sum, the plan sum (including all
applicators and the summed dose contribution of the plan sum) are shown
in the image views. A plan sum icon appears in the Scope window.
8. To save the plan sum, from the File menu, select Save All.
Next: Continue by evaluating the sum with the dose evaluation tools. For
more information, see “Point Dose Value and Dose Profile” on page 10-3.

To Evaluate the Plan Sum

1. Evaluate the summed dose distribution with viewing tools and dose
measurement tools as usual. For more information, see “Point Dose Value
and Dose Profile” on page 10-3 and “Dose-Volume Histogram” on
page 10-6.
2. To compare two plan sums visually, drag the plan sum icons from the
Scope window into the plan evaluation view sets.

To Print a Plan Sum

To print a plan sum,
■ In the Scope window, select the sum and display it in the view set.
■ From the File menu, select Print and then Windows Print.
The 2D Print dialog box opens.

10-29
 For more instructions, refer to Reference Guide for Preparing Images for
Treatment Planning.

Approving Plans
Planning workspace, Plan Evaluation workspace

Note: When approving plans, note the following:

■ Make sure that plans are always approved by qualified
personnel.
■ Do not unapprove a plan in any other Vision application
than the one you used to create the plan.
■ To modify an approved plan, you must first change its
status to Unapproved.

Planning and Treatment Approval

Plan approvals fall into two categories: planning approval and treatment
approval. The planning approval is a tool to indicate that the planning phase is
completed. The plan can then be reviewed, and treatment approval can be done
to grant permission to move the plan to the treatment phase to start the actual
patient treatment process.
Plans have two states: Approved and Unapproved. Plans are marked Approved
in the Plan Properties dialog box. The status of the images linked to an
approved plan also change to Approved. Plans and images with the Approved
status can be distinguished from those with the Unapproved status in the
Context window—the approved plan and image icons are marked with
a colored frame.

To Approve Plans in Brachytherapy Planning Task

Before approving a plan, make sure that the geometry and dose are acceptable.

1. In the Scope window, select the plan to approve.

2. From the Edit menu, select Properties.
The Plan Properties dialog box opens.

10-30 Reference Guide for Brachytherapy Planning

3. In the Planning Approval list box, change the plan status to Approved.
4. Click OK.
You are prompted to type your password.
5. Enter your password and click OK.

10-31
10-32 Reference Guide for Brachytherapy Planning
Chapter 11 Printing Plan Information

This chapter provides information about printing out information in plans and
describes the different methods for printing. The layout and information entries
of the default report template are covered, and instructions are given for
modifying templates.

In This Chapter

Topic Page

Printing Screens and Windows ........................................................... 11-1

To Print Screens and Windows.......................................................... 11-1
To Print 2D Views or the Model View.............................................. 11-2
Information in Print-Outs of Active Views ....................................... 11-3
Textual Information in Print-Outs of Active Views..................... 11-3
Graphical Information in Print-Outs of Active Views ................. 11-5
About Treatment Reports for Brachytherapy Plans.......................... 11-6
To Print Treatment Reports for Brachytherapy Plans ....................... 11-7
Information on the Treatment Report for a Brachytherapy Plan....... 11-7
Layout of Information on the Default Report .............................. 11-7
Information Entries on the Default Report................................... 11-8
Editing Report Templates in the Brachytherapy Planning Task ....... 11-9

Printing Screens and Windows

To Print Screens and Windows

1. From the File menu, select Print and then select Print Screen.
The Print dialog box opens.
2. In the Name drop-down list, click the desired printer.
3. To print out multiple copies, go to the Copies group box and define the
desired number in the Number of copies spin box. By default, one copy is
printed.

11-1
 4. Click OK to print the screen on the selected printer.
Note: The resulting print-out is not to scale.

To Print 2D Views or the Model View

1. To activate the view to print out, click its title bar.
2. From the File menu, select Print and then View.
The 2D Print dialog box opens.
3. Define the printer to use.
■ In the Printer drop-down list, click the printer

■ To define the printer properties, click Properties.

4. Use the Number of copies spin box to define how many copies to print
out.
5. In the Comment text box, type your comment to show on the print-out.
6. To print the image in the active 2D view, select the Include CT/MR
image check box.
7. To print the textual information and the image on separate pages, select the
Start image from an empty page check box.
8. To print the image on a white background, select the Turn image
background white check box.
9. To print all lines black, select the Turn all lines black check box.
10. In the Pages group box, define the page layout for the print-out:
■ To define the number of pages used horizontally and vertically, click
the Use option button and type the numbers of pages in the text boxes.
■ To let the program decide the number of pages used, click the
Automatically arrange on multiple pages option button.
11. In the Zoom group box, define the zoom factor:
■ To define the zoom ratio, click the Scale option button and type the
zoom ratio in the text box.
■ To let the program zoom the image on the selected number of pages,
click the Fit to page(s) option button.

11-2 Reference Guide for Brachytherapy Planning

 12. Do one of the following:
■ To see a preview of the print-out, click Preview. Click Print in the
preview window that opens.
■ Click OK to print the active window to the default printer.

Note: If you select the Automatically arrange on multiple pages

option, the first preview page illustrates the order in which the
image parts will be printed. For information on printing out the
BEV, refer to Reference Guide for External Beam Planning

Information in Print-Outs of Active Views

The print-outs of active views contain textual and graphical information about
the items visible in the view at the moment of producing the print-out.

Textual Information in Print-Outs of Active Views

The textual information in the print-out of an active view depends on the
workspace from which it is produced.

Table 11-1 Textual Information in Header

Information printed Workspace

Patient’s name and identification codes 1 and All
2

Hospital All

Last modification date and time of the plan All

and the name of the modifier

Comment: All
Text typed in the 2D Print dialog box

Plan Comment: External Beam Planning: Field Setup, Plan

Text typed in the Comment tab of the Plan Evaluation
Properties dialog box Brachytherapy Planning: Entry, Planning,
Plan Evaluation

11-3
 Table 11-1 Textual Information in Header

Information printed Workspace

Course identification code External Beam Planning: Field Setup, Plan
Evaluation
Brachytherapy Planning: Entry, Planning,
Plan Evaluation

Plan identification code External Beam Planning: Field Setup, Plan

Evaluation
Brachytherapy Planning: Entry, Planning,
Plan Evaluation

Image series name Selection, Registration, Contouring

Image identification code All

Plan normalization value External Beam Planning: Field Setup, Plan

Evaluation
Brachytherapy Planning: Entry, Planning,
Plan Evaluation

Calculation grid External Beam Planning: Field Setup, Plan

Evaluation
Brachytherapy Planning: Entry, Planning,
Plan Evaluation

Maximum dose in the plan (if calculated) External Beam Planning: Field Setup, Plan
Evaluation
Brachytherapy Planning: Entry, Planning,
Plan Evaluation

Maximum and minimum dose in PTV External Beam Planning: Field Setup, Plan
(if calculated) Evaluation
Brachytherapy Planning: Entry, Planning,
Plan Evaluation

Mean dose in PTV (if calculated) External Beam Planning: Field Setup, Plan
Evaluation
Brachytherapy Planning: Entry, Planning,
Plan Evaluation

11-4 Reference Guide for Brachytherapy Planning

 Table 11-2 Textual Information in Footer

Information printed Workspace

Patient’s name and identification code 1 All

Course identification code External Beam Planning: Field Setup, Plan

Evaluation
Brachytherapy Planning: Entry, Planning,
Plan Evaluation

Plan name and identification code External Beam Planning: Field Setup, Plan
Evaluation
Brachytherapy Planning: Entry, Planning,
Plan Evaluation

Image series name Selection, Registration, Contouring

Image identification code Selection, Registration, Contouring

Printed image plane (not shown in Model All

view or BEV prints)

Scaling factor All

Patient treatment orientation All

User origin DICOM offset and comment All

Application name and version All

Date and time All

Page number All

Grid size (if grid is on) All

Graphical Information in Print-Outs of Active Views

Print-outs produced of an active view contain the same graphical information

as on screen. Items not visible on screen are not included in the print-outs.

11-5
 Table 11-3 Graphical Information in Image View Print-Outs

Graphical Information Workspace

Patient orientation indicator All

Coordinate axes indicator All

Image scale indicator All

Orientation labels All

Grid (if grid is on) All

Structure outlines All

Isodose curves or color wash External Beam Planning: Field Setup, Plan
Evaluation
Brachytherapy Planning: Entry, Planning,
Plan Evaluation

About Treatment Reports for Brachytherapy Plans

A treatment report is a description of a plan or plan sum in textual format,
containing all the relevant information of the patient, the plan or plans included
in the sum, and all fields in the plan or plan sum in textual form.

The application contains a ready-made treatment report form that determines

the layout of and the information included in a treatment report.You can also
define the layout of the treatment report according to your needs, and include
only the information relevant in your environment. For more information, see
“Editing Report Templates in the Brachytherapy Planning Task” on page 11-9.
Treatment reports can be printed from the Planning workspace only.

11-6 Reference Guide for Brachytherapy Planning

To Print Treatment Reports for Brachytherapy Plans
1. From the Window menu, select Plan Report.
The Plan Report window opens.
2. View the Plan Report window by scrolling it or pressing the PAGE UP and
PAGE DOWN keys.
3. To print the treatment report, use the Windows Print command from the
File menu. For instructions, see “Printing Screens and Windows” on
page 11-1.

Information on the Treatment Report for a Brachytherapy Plan

Layout of Information on the Default Report

The information on the default treatment report template is organized as

presented in Figure 11-1.

11-7
 A. Header B. Form C. Footer

Figure 11-1 Example of Plan Report

Information Entries on the Default Report

The header contains the name and version of the software and the name of the
hospital. The footer contains the name of the hospital and patient, the date and
time of printing, and identification code for the plan. The main text, form,
contains information concerning the patient, plan, prescribed treatment,
sources and applicators.

11-8 Reference Guide for Brachytherapy Planning

Editing Report Templates in the Brachytherapy Planning Task

Note: The customization of forms should normally be done by a

Varian service engineer.

This section provides basic information on customizing the print-out forms.

The forms are defined in three files in the configuration directory, which is
usually c:\Program Files\Varian\Oncology\Vision\Config\BT. The file
names are HEADER.DAT, FORM.DAT, and FOOTER.DAT. They contain a header,
main text and a footer of the print form, respectively.

The .dat files can be edited in a text editor (for instance, Notepad). Change
lines that contain text fields as necessary. Lines with text fields begin with
Text= .

Note: Always make a backup copy of these files before customizing

them.

CAUTION: The files also contain symbols for important variables that are
printed. Each of these variables start with the symbol $ in the
files. Do not change the print variables. If you accidentally
change a variable, the unrecognized symbol is displayed with ?
(question mark) characters on both sides.

Table 11-4 Print Variables

Variable Meaning
$CurrentDay Day of producing the print-out

$CurrentHour Hour of producing the print-out

$CurrentMinute Minute of producing the print-out

11-9
 Table 11-4 Print Variables

Variable Meaning
$CurrentMonth Month of producing the print-out

$CurrentSecond Second of producing the print-out

$CurrentYear Year of producing the print-out

$NumFractions Prescribed number of fractions

$PageNumber Page number

$PatientComment User-defined comment

$PatientDateOfBirth Patient’s date of birth

$PatientFirstName Patient’s first name

$PatientId Patient’s identification code

$PatientLastName Patient’s last name

$PatientMiddleName Patient’s middle name

$PatientSex Patient’s sex

$Physician Physician of the patient

$PlanCheckSum Last modifications to the plan.

Prints the date and time when modifications were
last saved, or the text Modified after save if
the plan has been modified but the modifications
have not been saved to the database.

$PlanCreationDate Date of creating the plan

$PlanName Name of the plan

$Planner Person who last modified the plan

$TotalAirKerma Total air Kerma in the plan

$TotalCurieSeconds Total Curie seconds in the plan

$Prescription Prescribed dose

$RadiographInformation Imaging geometry of the radiograph set used for

the plan

$SourceCalibrationDate Calibration date of the source

11-10 Reference Guide for Brachytherapy Planning

 Table 11-4 Print Variables

Variable Meaning
$SourceCalibrationStrength Calibration strength of the source

$SourceHalfLife Half-life of the source in days

$SourceIdentifier Serial number of the source

$SourcePlanStrength Strength of the source on the day of treatment

$TreatmentDate Date of treatment

$TreatmentSite Patient volume to be treated

$Version Application name, task name, version

The following additional symbols can be used to output multiple data

structures:

■ AllPoints—Displays all geometrical coordinates including dwell point

coordinates.
■ CatheterList—Displays all catheters with dwell position distances and
times.
■ ReferencePoints— Displays all reference points with dose readings.
■ SeedList—Displays all seed collections.

The additional symbols require a prefix of @ and a specific number of

parameters. The following example shows the use of each of the additional
symbol with the correct numbers of parameters:

11-11
 @SeedList=180;20;Seed Collection;Source Model;Treatment
Date;x;y;z;Strength;Time;No seeds
RelativeMove=0;10
HorizontalLine=50;1900
RelativeMove=0;10
@ReferencePoints=200;40;Reference point: ;x;y;z;Total dose;Desired dose;, %d
fraction(s);No reference points
RelativeMove=0;10
HorizontalLine=50;1900
RelativeMove=0;10
Text=Geometrical information
@AllPoints=200;40;Points: ;x;y;z;Total dose;Desired dose;No reference points
RelativeMove=0;10
HorizontalLine=50;1900

RelativeMove=0;10

The default forms are designed for A4 paper size. If you use letter-size paper,
you may need to change the parameters that depend on the size of the paper.
This applies especially to the Move command in the FOOTER.DAT file and
Form Size command in HEADER.DAT file.

11-12 Reference Guide for Brachytherapy Planning

Chapter 12 Export and Import
All Workspaces

This chapter provides information on exporting and importing plans. You can
transfer brachytherapy plans from the Brachytherapy Planning task to the
VariSource afterloader. The application also supports combining plans created
in it with external treatment plans created in other systems. Image and structure
data can be exported to CadPlan for external treatment planning, and the
resulting external plan can then be imported to BrachyVision for further
processing.

In This Chapter

Topic Page

Exporting Brachytherapy Plan to Treatment Unit ............................ 12-2

Data Exported to VariSource............................................................. 12-3
To Prepare Plans for Export in the Brachytherapy Planning Task.... 12-3
To Export Brachytherapy Plans to VariSource ................................. 12-3
To Export Brachytherapy Plans to GammaMed................................ 12-4
Exporting Plan and Image Data........................................................... 12-4
About Export Options........................................................................ 12-5
Dose Export .................................................................................. 12-5
Planar Dose Details ...................................................................... 12-5
DVH Export Details ..................................................................... 12-6
DVH Dose Bin Width Parameter ............................................ 12-6
To Use the Export/Import Wizard for Exporting .............................. 12-7
To Export the Dose Plane .................................................................. 12-7
Exporting Data with DICOM............................................................... 12-8
Transforming DICOM Files to ASCII Files...................................... 12-9
To Transform DICOM Format Files to the ASCII Format .......... 12-9
Exporting Plan Data for Clinical Trials ............................................. 12-9
To Export Planning Data for the ATC in DICOM Format ........ 12-11
Importing Plan and Image Data......................................................... 12-11
To Use the Export/Import Wizard for Importing ............................ 12-12
Exporting Plan Data to VARiS 1.4 and Generation 6 Applications 12-13

12-1
 Export to VARiS 1.4........................................................................ 12-13
Export to Varian Generation 6 Applications ................................... 12-14
CadPlan Export and Import............................................................... 12-14
Exporting Planning Data to CadPlan............................................... 12-14
VARiS Equivalents in the CadPlan Configuration .................... 12-15
Image Information in the Export Files.................................. 12-15
Structure Information in the Export Files ............................. 12-16
To Export Plans and Images to CadPlan .................................... 12-16
To Export Images and Structures to CadPlan ............................ 12-17
To Use the Exported Plans in CadPlan ...................................... 12-17
Importing Planning Data from CadPlan .......................................... 12-18
CadPlan Import File Information ............................................... 12-18
Field Information in the Import Files ................................... 12-18
Dose Information in the Import Files.................................... 12-19
To Import Plans from CadPlan................................................... 12-19
Managing CadPlan Export and Import Hosts.................................. 12-20
To Create a New CadPlan Host and Edit CadPlan Host Settings.... 12-20
To Delete CadPlan Export/Import Hosts......................................... 12-21

Exporting Brachytherapy Plan to Treatment Unit

In the plan export to the treatment unit, BrachyVision creates an export file of
the selected plan, which can then be transferred to the treatment unit. The plan
data can be exported directly to VariSource, or the treatment can be controlled
through the GammaMed application.

Note: Verify all plans before moving them to treatment.

12-2 Reference Guide for Brachytherapy Planning

Data Exported to VariSource
The export file for VariSource contains the following plan information:
„ Dwell positions, times and strengths (in mCi)
„ Applicators
„ Patient name and ID
„ Source
„ Calibration date and time
„ Plan time and date
„ File name

BrachyVision verifies that the exported plan is compatible with the treatment
machine, and issues a warning if it encounters inconsistencies.

To Prepare Plans for Export in the Brachytherapy Planning Task

„ From the Planning menu, select Prepare Plan for Export.
The dwell times are adjusted so that they meet the resolution of the selected
treatment unit. In other words, all dwell times are rounded to the nearest
time the treatment unit can handle. If the resulting total time differs more
than 2% from the original total time, a warning is displayed.

Note: The preparation is done automatically when you export the plan
to the treatment unit.

To Export Brachytherapy Plans to VariSource

1. From the File menu, select Export and then select Plan to Treatment
Unit.
The Export Plan dialog box opens.
2. In the Save in list box, select the directory to which to save the plan to
export.

12-3
 3. In the File name text box, define a name for the export file if you do not
wish to use the default name.
Note: The default filename extension is .dwl.

4. Click Save.
If the same file name is found on the floppy disk or directory you are
saving the export file to, you are prompted to either change the name or
overwrite the existing file.

To Export Brachytherapy Plans to GammaMed

1. From the File menu, select Export and then select Plan to Treatment
Unit.
GammaWin installed in the current workstation: The export file is saved
to the GammaWin folder, and GammaWin is started up.
GammaWin installed in another workstation: The Export Plan dialog box
opens.
2. GammaWin installed in another workstation: Select the directory to which
to save the plan to export, define a name for the export file if you do not
wish to use the default name, and click Save.
Note: The default filename extension is .g12.

Next: Continue the treatment with the GammaWin application.

Exporting Plan and Image Data

To be able to export data to another system, configure export filters for all data
formats you need to use, for instance, CART, DICOM, Gen 6 link, and Eclipse
Communicator. For instructions, see Appendix A.

Use the Export/Import wizard to transfer data, such as images, structure sets,
plans and dose data, to other systems from Eclipse.

12-4 Reference Guide for Brachytherapy Planning

 Note: Verify all data before exporting it.

About Export Options

This section only describes some of the export options. For a description of all
export options, refer to the online help.

Dose Export
You can export the total plan dose (volumetric dose) separately or with other
plan data. In both cases, the dose is exported either as absolute or relative dose,
and in accordance with the DICOM standard.

Planar Dose Details

The dose on the viewing plane currently shown in the active image view can
be exported either in the absolute or relative mode. The export is done in
accordance with the DICOM standard.

The resolution of the dose is determined by defining the lengths of the sides of
the dose matrix in X and Y directions and the number of pixels inside the dose
matrix.

You can also mark the corners of the image with high dose pixels for correct
alignment of the dose image.

12-5
 DVH Export Details

A DVH is exported in accordance with the DICOM standard, along with the
volumetric dose and the plan. The following are among the export options for
DVH export:
„ DVH Structures—Structures for which you wish to have the DVH
calculated and exported. You can also include or omit structures for which
the DVH has been partially calculated. By default, the DVH is calculated
for all structures, and all structures are included in the DVH export.
„ Dose bin width—Resolution of the DVH, expressed in Gy for absolute
dose and in percentage for relative dose. The range for this value is 0–10
exclusive. By default, the dose bin width is 0.1. For more information, see
“DVH Dose Bin Width Parameter” on page 19-5.
„ Volume unit—Unit of measurement in which the volume of the structures
included in the DVH are expressed.

Note: The DVH can be exported only with the volumetric dose.

DVH Dose Bin Width Parameter

The dose bin parameter defined in the export expresses the resolution of the
DVH calculated during the export. The parameter is defined in Grays or
percentage, depending on the dose mode.

Figure 12-1 Dose Bin Width Parameter for External Plans

For brachytherapy plans, the defined dose bin width applies to that part of the
DVH where the volume of the structures included in the DVH exceeds 1%.
Dose values from other parts of the DVH (with volume < 1%) are cumulated
to one single dose bin. The figure below shows how the dose bin width is
defined for brachytherapy plans.

12-6 Reference Guide for Brachytherapy Planning

 A

C E

{
B
D

A. Volume axis B. 1% volume C. Dose bin width D. Dose axis E. Last dose bin

Figure 12-2 Dose Bin Width Parameter for Brachytherapy Plans

To Use the Export/Import Wizard for Exporting

1. From the File menu, select Export and then select Wizard.
The Export wizard opens.
2. Define what you wish to export and click Next.
The wizard proceeds to the next step.
3. Define other export parameters in the wizard and click Next.
The wizard proceeds to the next step. The number of steps in depends on
the selected objects to be exported.
4. Select the appropriate export filter and click Next.
The wizard proceeds to the next step.
5. Check the items to be exported.
6. To remove data from the list, select them and click Remove Selected
Object(s).
7. To save the selected data to the defined export directory, click Finish.

To Export the Dose Plane

1. In an image view, display the desired viewing plane.

12-7
 2. In the Focus window, right-click the dose and then select Export Dose
Plane.
The Export wizard opens.
3. Define the dose export options and click Next.
4. Select the appropriate export filter and click Next.
5. Check the items to be exported.
6. To save the dose plane data to the defined export directory, click Finish.

Exporting Data with DICOM

Eclipse uses the methodology defined in the DICOM (Digital Imaging and
Communications in Medicine) standard to transfer image, structure, plan, dose
and DVH data to another system. The purpose of the standard is to standardize
the communication of therapeutic information, such as radiotherapy images
and therapy plans, between devices that produce different image formats.

How Eclipse conforms to the standard is defined in Eclipse DICOM

Conformance Statement.

The transferred data includes the following, depending on the plan:

„ Applicator data
– Applicators and seed collections
– Sources
– Treatment unit data

„ Dose data
– Relative or absolute plan dose
– DVH data for selected structures
„ Structure data
Note: Only structures marked patient volumes are exported.

„ Image data.

12-8 Reference Guide for Brachytherapy Planning

 Note: With DICOM, note that:
„ DICOM does not make a distinction between overlapping
and non-overlapping structures. The result of structure
import may not always be as expected. Always visually
verify the import result for structures.
„ To achieve a reliable result in the transfer, the treatment unit
configuration must be exactly the same in both the source
and destination system.

Transforming DICOM Files to ASCII Files

Files exported from Eclipse in the DICOM format can be converted into the
ASCII format using the Dcm2Ascii.exe application, which saves the converted
files to the defined folder, over the network or locally. The input file must be
in the Implicit VR Little Endian Uncompressed format, which is the format
used in Eclipse.

Note: Dcm2Ascii.exe cannot be used to read data that uses the

Explicit VR Little Endian Uncompressed format.

To Transform DICOM Format Files to the ASCII Format

1. To start the ASCII converter, navigate to the directory that contains the
Dcm2Ascii.exe file.

2. Double-click the file.

3. Select the input file, output options and output directory.
4. Click Apply.

Exporting Plan Data for Clinical Trials

The ATC (Advanced Technology Consortium) is a multi-institutional
cooperative organization for cancer research that collects treatment histories to
be used as the basis of analyses and reports from the members.

12-9
 You can export RT data (image and plan data) from Eclipse to participate in
the ATC studies. To be able to complete the export, you need the ITC
DICOMpiler application. The export from Eclipse is done in the DICOM
format, and the data is then modified for the ATC in DICOMpiler, which
creates the DICOM file set required. To transfer the DICOM file set, the data
must be copied to a transfer medium (CD or FTP server). You also need to
configure the DICOM Storage Service SCU filter (for instructions, see
Appendix A and refer to the on-line help).

For more information on the ITC DICOMpiler application, refer to Varian

Installation Instructions, ITC DICOMpiler Software Installation Guide and
ITC DICOMpiler Quick Start Guide. The ITC DICOMpiler documentation is
available at the ITC website (http://itc.wustl.edu). For an FTP account,
contact the ITC at [email protected] or go to the ATC website
(http://atc.com) or the ITC website.
The ATC sets the following restrictions for plans and images exported for ATC
studies:
„ Image orientation must be HFS (head-first-supine).
„ Contours must be closed contours. Point contours or open-ended line
contours are not supported.
„ Plans must contain a primary reference point with a location, the
volumetric dose must be calculated, at least one valid dose prescription and
valid plan treatment percentage must be found in the plans.

If these restrictions are not fulfilled in the plan and images to be exported, the
Export wizard shows warnings concerning the unacceptable parts.
„ Brachytherapy sources in plans must be point sources.
„ Brachytherapy seeds in plans must use sources with equal dosimetric
properties (radioactive source model, source strength and source
calibration date).

Note: Ultrasound images or Boolean structures cannot be exported for

the ATC.

12-10 Reference Guide for Brachytherapy Planning

 To Export Planning Data for the ATC in DICOM Format

1. Make sure that you have the DICOMpiler program installed and that it is
running.
If DICOMpiler is not running, start it by double-clicking
ITC_DICOMpiler.exe. In the ITC DICOMpiler window, start the
Receiver by clicking Run DICOM Receiver.
2. In Eclipse, from the File menu, select Export and then select ATC
DICOM Export.
The Export wizard opens.
3. To define whether to export the plan or the images, select the appropriate
option button and click Next.
4. Define the export options and click Next.
5. Check any remarks about the export and click Next.
6. In the Configured Export Filters list box, select the appropriate filter for
the export and click Next.
7. Check the items to be exported.
8. To remove data from the list, select them and click Remove Selected
Object(s).
9. To save the selected data to the defined export directory, click Finish.
10. Transfer your files to the ATC via an internet-based transfer, such as FTP.

Importing Plan and Image Data

To be able to import data from another system, configure import filters for all
data formats you need to use, for instance, CART, DICOM, Vidar scanners,
Gen 6 Link, and Eclipse Communicator. For instructions, see Appendix A.

Use the Export/Import wizard to import objects, such as plans and structure
sets, from other systems into Eclipse.

12-11
 Note: When importing structures, those that are not compatible with
the internal data model are discarded, which can cause missing
structures (for instance, structures out of slice contours and
overlapping contours marked interpreted as non-overlapping).
Always visually verify any imported structures.

To Use the Export/Import Wizard for Importing

1. From the File menu, select Import and then Wizard.
The Import wizard opens.
2. Select the appropriate import filter and click Next.
The wizard proceeds to the next step.
3. Do one of the following:
„ Select the data to be imported from the default directory.
„ To use another directory, click Change Directory, select the
appropriate directory, click Open, and then select the data to be
imported from the list displayed in the wizard.
4. Click Next.
The wizard proceeds to the next step. The Source Patient Information box
displays the patient information found in the data.
5. Select the target patient to whom to import the data. The detailed
information about the selected patient will be displayed in the Selected
Target Patient group box.
„ Select a patient suggested by the wizard in the Closest Matches in
Database box.
„ To import the data to the patient currently open, click Task Patient.
„ To open the Patient Explorer and import the data to a patient existing
in the database, click Open.
„ To create a new patient to import the data to, click New.
„ You can connect the images to the object hierarchy under the selected
patient either automatically or by hand. To let the wizard automatically
import the data to the selected patient, select the Try automatic
import check box.

12-12 Reference Guide for Brachytherapy Planning

 6. Click Next.
Automatic import: The wizard closes after the automatic import is
completed.
Import by hand: The wizard proceeds to the next step.
7. Do one of the following:
„ If the data has gray indicators in the tree structures in the Import Data
and Vision Data panes, you need to connect the data to the object
hierarchy under the selected patient. To do this, drag the data from the
Import Data pane to an appropriate place under the patient in the
Vision Data pane. Click Finish to close the wizard.
„ If the data has green indicators in the tree structure, click Finish.

Exporting Plan Data to VARiS 1.4 and Generation 6

Applications
To be able to export data to older systems, such as VARiS version 1.4 or
Varian Generation 6 applications, you need to configure the export filters for
this purpose in the Tools menu. For instructions on configuring export and
import filters, see Appendix A and the online help.

Export to VARiS 1.4

Export to VARiS version 1.4 is done through the Eclipse Communicator, a
separate program that transfers the data from Eclipse to VARiS. To be able to
use it, the DICOM RT Storage filter must be configured in Eclipse. For
instructions on configuring export and import filters, see Appendix A and the
online help.

The export to VARiS 1.4 is DICOM-based. The data transferred in the export
is defined in the DICOM protocol.

12-13
Export to Varian Generation 6 Applications
Export to Varian Generation 6 applications, such as Vision 6.XX or VARiS 6,
is done through the Gen 6 Daemon, a separate program that transfers the data
from Eclipse to VARiS or Vision 6. To be able to use it, the Gen 6 Daemon
must be configured on the target system. For instructions on configuring export
and import filters, see Appendix A and the online help.

The export to Generation 6 applications is DICOM-based. The data transferred

in the export is defined in the DICOM protocol.

Note: Keep the configuration of the treatment units identical to the

VARiS/Vision 6 database to ensure that the plans are identical
in both systems.

CadPlan Export and Import

Exporting Planning Data to CadPlan

You can combine brachytherapy plans with external plans created in CadPlan
by exporting the image and structure information to the CadPlan treatment
planning system.

The export process produces export files from the selected information over
the network directly to the CadPlan workstation through the Samba SMB/CIFS
file server. For information on the configuration of this system, see “Managing
CadPlan Export and Import Hosts” on page 19-26 and refer to the online help.
Before exporting plans and images, verify the plans visually and verify that the
plan information is correct.

Note: The CadPlan version must be 6.0 or later.

12-14 Reference Guide for Brachytherapy Planning

VARiS Equivalents in the CadPlan Configuration

To be able to share information with CadPlan, make sure that the VARiS
equivalents (treatment unit codes) have been defined in the configuration of the
CadPlan system. For more information, refer to CadPlan External Beam
Modelling Configuration.

Image Information in the Export Files

Only CT images mapped to HUs can be exported to CadPlan. All transversal

images are exported. The maximum number of planes in a volume image is
100. If exceeded, the export is aborted. The exported image information
includes the following:
„ Pixel values (in HUs) and pixel size
„ Imaging orientation
„ Imaging device (CT scanner model)
„ Z-coordinate of the image plane
„ ID that uniquely identifies the exported image in the Vision database. The
ID enables identifying the image in plan import.
„ Structures

Make sure that the imaging orientation of the image to be exported has been
defined. Plans without the imaging orientation defined cannot be exported to
CadPlan. Moreover, the imaging orientation and the treatment orientation must
be the same.

12-15
 Structure Information in the Export Files

The following information is included in the export files:

„ 40 largest structures selected to be visible in the Focus window. They are
saved as passive volumes in CadPlan.
„ Body and PTV: Body and PTV outlines are exported to the CART image
file to locations 1 and 7, respectively. As CadPlan cannot handle multi-part
structures consisting of several volumes, the Body volume and the Target
volume are linked into one structure by connecting them with a line into
one volume.
„ Disjoint areas: If a structure other than the Body or PTV structure has
disjoint areas, it is divided into closed sub-volumes. Each sub-volume is
stored separately to the CadPlan volume file. Sub-volumes smaller than
2% of the total structure are ignored.
„ Contour points: Each contour can contain the maximum of 127 points. If
exceeded, the contour points of the exported structure are sampled (the
form of the contour is changed).

Note: The Body and Target structure are always exported. Other
structures are exported only if they are marked visible in the
Focus window. Boluses are not exported.

To Export Plans and Images to CadPlan

1. Open the plan.

2. Make sure that only the structures needed in CadPlan are marked visible.
All other structures must be invisible.
3. From the File menu, select Export and then select to CadPlan.
The CadPlan Export dialog box opens.
4. In the Export to list box, select the destination to which to export the plan.
The default destination is the one used in the previous plan export.
5. To exclude the image information from the export file, select the Plan only
check box.
Note: This is useful if you have exported the patient’s images to
CadPlan earlier on.

12-16 Reference Guide for Brachytherapy Planning

6. Click OK to save the plan export file to the selected destination.

Note: Although the location of the isocenter stays the same relative to
the patient anatomy, the isocenter coordinate values may
change in the export, because the coordinate systems in
CadPlan and Eclipse can be different.

To Export Images and Structures to CadPlan

1. Make sure that only the structures needed in CadPlan are marked visible.
All other structures must be invisible.
2. From the File menu, select Export and then select to CadPlan.
The CadPlan Export dialog box opens.
3. In the Export to list box, select the destination to export the plan to. The
default destination is the one used in the previous plan export.
4. Click OK to save the plan export file to the selected destination.

To Use the Exported Plans in CadPlan

The following steps only briefly describe the procedure needed in CadPlan
when using plans exported from Vision. For more detailed instructions, refer
to CadPlan External Beam Modelling User Guide.

1. Start up the CadPlan system.

The CadPlan main screen is displayed.
2. Go to the Patient Management workspace and load the patient.
3. Select the patient and go to the Contouring workspace to show the patient
with the Body and Target structures (the active volumes) visible.
4. Find and copy other necessary structures to show them in the CT images.
5. Go to the Planning workspace and import the plan to show the plan
geometry.
6. Continue working with the plan.

12-17
Importing Planning Data from CadPlan
External plans saved as export files in CadPlan can be imported over the
network through the Samba SMB/CIFS file server. For information on the
configuration of this system, see “Managing CadPlan Export and Import
Hosts” on page 19-26 and refer to the online help.

Note: To enable the MU value calculation in Vision, make sure that

the dose prescription is defined in CadPlan for plans to export.

CadPlan Import File Information

Field Information in the Import Files

When you import plan information from CadPlan, the following field
information is contained in the import files:
„ Maximum of 10 fields per plan, including the treatment unit, planning
technique, field geometry and parameters. If the number of fields is
exceeded, only the first 10 are imported.
„ Field accessories
– MLC: One MLC with 0° MLC bank rotation per field.
– Block: Maximum of 10 shielding blocks and one aperture block. The
blocks must have the same add-on material. If the number of shielding
blocks is exceeded, only the first 10 are imported.
Aperture block and MLC cannot be defined in the same field.
– Wedge: Standard, Dynamic, Enhanced Dynamic and motorized
wedges. The VARiS wedge equivalents must be configured in the
CadPlan system.
„ Field geometry

12-18 Reference Guide for Brachytherapy Planning

Dose Information in the Import Files

The following information is contained in the import file for each field:
„ Field calculation method
„ Number of fractions, prescribed dose (total dose in Gy) and treatment
percentage
„ MU coefficient (monitor units per Gray)
„ Inhomogeneity correction method
„ Non-normalized field reference dose and field dose matrix
„ Field normalization value and method
„ Plan normalization value

Note: CadPlan calculates the dose per slice, and this dose is
interpolated between slices. If the slice distance exceeds 1 cm,
you are notified about reduced dose accuracy. The 2D and 3D
views also display a notification.

To Import Plans from CadPlan

Note: The images used in the plan to import from CadPlan must
originate from Vision (they must be found in the Vision
database).

1. From the File menu, select Import Plan.

The Select the Plan dialog box opens.
2. In the Plans at list box, select the source from which to import the plan.
The default source is the one used in the previous plan import.

12-19
 3. Select the plan to import and click OK.
If the patient currently open is different from the patient used in the plan to
import, the patient currently open is closed.
Plan originates from Vision: You are prompted to select whether to
overwrite the original plan.
Plan originates from CadPlan: The Select the Course dialog box opens.
4. Do one of the following:
„ Plan originates from CadPlan: Select the course to connect the plan to
and click OK.
„ Plan originates from Vision: Click OK.
The plan is imported and connected to the selected course.

Managing CadPlan Export and Import Hosts

The settings necessary for creating or editing the settings of an import or export
host are defined and modified in the CadPlan Import/Export Host Settings
dialog box. These settings include the name, IP address and the shared
directories. The export and import directories are defined in CadPlan as
follows:

„ CadPlan import directory is contained in the environment variable

SOMAVISION_IMP

„ CadPlan export directory is contained in the environment variable

SOMAVISION_EXP

To Create a New CadPlan Host and Edit CadPlan Host Settings

1. In the CadPlan Export or Import dialog box, click Hosts.
The CadPlan Import/Export Hosts dialog box opens.
2. Do one of the following:
„ To edit the host settings, click Modify.
„ To create a new host, click New.
The CadPlan Export/Import Host Settings dialog box opens. If you clicked
New, the dialog box is empty.

12-20 Reference Guide for Brachytherapy Planning

 3. In the Name text box, type a descriptive name of the computer where the
plan is exported from or imported to.
4. Depending on the SAMBA installation, type its IP address or symbolic
name of the computer in the IP Address text box.
5. If you do not wish to use the default import and export directories, define
the directory to use in the Import Directory and Export Directory text
boxes.
6. Click OK to show the new settings in the CadPlan Export/Import dialog
box.

To Delete CadPlan Export/Import Hosts

1. In the CadPlan Export or Import dialog box, click Hosts.
The CadPlan Import/Export hosts dialog box opens.
2. Select the host to delete and click Delete to delete the selected host from
the list box.
3. Click OK.

12-21
12-22 Reference Guide for Brachytherapy Planning
Appendix A Import and Export Filters
All Workspaces

This Appendix briefly describes how to configure new import and export
filters for your system or removing filters.

Configuring Import and Export Filters

Import and export filters are needed for transferring information with different
file formats from various sources and to a number of destinations. Generally,
the filters are configured during system configuration. For detailed
instructions, refer to the online help.

Note: You need sufficient user rights to configure Import and Export
filters.

To Add New Import and Export Filters

The procedures for adding an import or export filter are identical. In the
following, an import filter is added to the system.

1. From the Tools menu, select Import/Export Configuration.

The Import/Export Configuration dialog box opens.
2. Click Add.
The Add New Filter dialog box opens.
3. To save the filter parameters in a server register, select the Global Access
Filter check box.
Note: Modifications made to a global access filter in one workstation
changes the filter parameters in all the workstations using the filter.

4. Select the appropriate filter and click Add.

The relevant filter configuration dialog box opens. The contents of the
dialog box depend on the selected filter.

A-1
 5. If necessary, type a new name in the ID text box.
6. Define the parameters of the filter.
7. Click OK to add the filter.

Note: Note that there can be various configurations for a particular

import filter. For example you can make two different
configurations for a DICOM Media File Filter with different
import directories by defining a different name and parameters
for the two filters. Name the filters with easily recognizable,
descriptive names.

To Modify the Import/Export Filter Configuration

In this example, the filter modified is the Dicom Media file filter.

1. From the Tools menu, select Import/Export Configuration.

The Import/Export Configuration dialog box opens.
2. Select an installed filter.
3. Click Configure.
The relevant Filter Parameters dialog box opens.
4. Define the necessary modifications for the selected filter.
5. Click OK.
6. Continue to configure more filters or quit by clicking Exit.

Note: Note that there can be various configurations for a particular

import filter. For example you can make two different
configurations for a DICOM Media File Filter with different
import directories by defining a different name and parameters
for the two filters. Name the filters with easily recognizable,
descriptive names.

A-2
To Delete Import/Export Filters
The procedures for removing an Import or Export filter are identical. In the
following step list an Import filter is removed from the registry.

1. From the Tools menu, select Import/Export Configuration.

The Import/Export Configuration dialog box opens.
2. Select the filter and click Remove.
You are prompted to confirm the deletion.
3. Click OK.

A-3
A-4
Appendix B Keyboard Shortcuts

This appendix lists the keyboard shortcuts available.

Table B-1 Keyboard Shortcuts

Shortcut Action

ALT+1 Switch between tasks

ALT+2
ALT+3
ALT+4
ALT+ENTER Opens the Properties dialog box of the active object

CTRL+C Copies the active object

CTRL+N Creates a new patient

CTRL+O Opens the Object Explorer

CTRL+P Prints the active window

CTRL+S Saves all data to the database

CTRL+V Pastes the copied object

CTRL+W Automatically adjusts the Window/Level settings

CTRL+1 Switch between different workspaces

CTRL+2
CTRL+3
CTRL+4
CTRL+5
DEL Deletes the active object

F10 Creates a new opposing field

F5 Calculates the dose distribution within the calculation volume

F6 Calculates the dose distribution on the active plane

F8 Creates a new plan

B-1
 Table B-1 Keyboard Shortcuts

Shortcut Action

F9 Creates a new field

PAGE DOWN Shows the previous image

PAGE UP Shows the next image

SHIFT+CTRL+1 Change image view layouts

SHIFT+CTRL+2
SHIFT+CTRL+3
SHIFT+CTRL+4

B-2
Index

Numerics labels, hiding, 6-36

2D dose calculation area (Brachytherapy) labels, showing, 6-36
defining, 8-4 modifying parameters, 6-31, 6-32
definition, 8-4 modifying points, 6-26
resolution, 8-4 moving, 6-34
2D view moving with template, 6-36
applicator, 6-7, 6-35 overview, 6-3
color wash, 8-9 rotating, 6-35
Dmax, 8-16 rotating with template, 6-36
dose, 8-9 showing on visible plane, 6-36
dose statistics, 8-16 showing thicker, 6-36
printing, 11-2 source activity, 6-37
3D dose source positions, 6-18
calculating, 8-3 source strength, 6-37
updating radioactive source, 6-30
A visualization in Entry and Planning
afterloader,supported, 3-2 workspace, 6-7, 6-12
applicator approving
adding plans, 10-30
from library, 6-13
points, 6-26 B
to radiographs, 6-6 basal point
to volume images, 6-13 definition, 8-22
with implant template, 6-21 normalization of plan to, 8-24
with localization films, 6-6 bold text in user guide, 1-2
changing radioactive source, 6-29 Boolean operators
connection to image, 6-26 DVH, 10-18
converting to library applicator, 4-14, 6-14 brachytherapy plan export file, 12-2
deleting points, 6-26 Brachytherapy Planning, 3-3
detecting, 6-14
digitizing C
options, 6-10 CadPlan
overview, 6-9 creating host computer for plan export,
with images, 6-12 12-20
without images, 6-10 define dose prescription, 12-18
dwell activity, 6-37 deleting host computer for plan export,
dwell position, 6-37 12-21
dwell time, 6-37 exporting plans to, 12-14, 12-16
editing graphically, 6-27 image export, 12-17
editing with Point Set Editor, 6-26 importing plans from, 12-18
entry methods, 6-5 multi-part structures, 12-16

Index-1
 structure export, 12-17 reference points, 4-14, 4-16
using data exported from Vision, 12-17 critical point, dose at, 10-3
VARiS equivalents, 12-15 cumulative DVH, 10-8
CadPlan import file, 12-18
calculation volume D
resetting, 8-6 diagnosis
calculation volume (Brachytherapy) adding, 4-21
editing, 8-6 editing, 4-21
color wash, 8-9 DICOM
2D views, 8-9 overlapping and non-overlapping
defining dose range, 8-10 structures, 12-9
dose cloud, 8-9 verify imported structures, 12-9
Model view, 8-9 differential DVH, 10-9
selecting displayed dose levels, 8-10 Dmax (dose maximum)
selecting displayed levels, 8-12 showing in 2D views, 8-16
configuration showing in image views, 8-16
adding filter showing in Model view, 8-16
export, A-1 dose
import, A-1 absolute, 8-11
digitizer port, 6-10 calculating, 8-3
modifying filter moving viewing planes to, 8-19
export, A-2 relative, 8-11
import, A-2 dose (Brachytherapy)
removing filter 2D view, 8-8
export, A-3 at critical point, 10-3
import, A-3 changing prescription, 4-16
constraint (brachytherapy) definition, 4-4
loading from library, 9-8 dose profile, 10-4
saving to library, 9-9 monitoring in plans, 4-14
constraint library (brachytherapy) Plan Organizer, 4-14
loading optimization parameters from, 9-8 point dose, 10-3
optimization parameters, 9-7 prescribing, 4-9, 4-17
saving optimization parameters, 9-9 primary reference point, 4-16, 7-8
Context window dose (External Beam)
Focus window, 3-10 at ciritical point, 10-3
overview, 3-11 changing prescription, 4-16
Scope window, 3-10 definition, 4-4
Contouring workspace, See Preparing Images dose profile, 10-4
for Treatment Planning exporting, 12-5
course monitoring in plans, 4-14
changing, 4-20 point dose, 10-3
creating, 4-19 primary reference point, 4-16, 7-8
definition, 4-19 dose cloud, 8-9
monitoring plans, 4-15 dose matrix
opening, 4-20 size, 8-5

Index-2
dose maximum. See Dmax single-plan, 10-11
dose normalization. See normalization, plan types, 10-7
dose per fractions, 4-4 DVH export file, 10-20
dose plane, exporting, 12-5 dwell activity
dose prescription, 4-4 changing, 6-39
dose profile, 10-4 varying activities in applicators, 6-39
displaying, 10-4 Dwell Control window
information in, 10-4 overview, 6-38
saving, 10-5 showing, 6-38
dose range, defining for color wash, 8-10 dwell position, changing, 6-39
dose statistics dwell time
showing in 2D views, 8-16 changing, 6-39
showing in Model view, 8-16 scaling all, 6-40
dose visualization setting all, 6-40
changing mode, 8-11
color wash, 8-9 E
dose cloud, 8-9 editing
dose range, 8-10 calculation volume (Brachytherapy), 8-6
interpolation of dose on reconstructed entry point
slices, 8-7 moving reference point to, 7-11
isodose lines, 8-8 Entry workspace
showing absolute, 8-11 navigating in, 3-7
showing as isodoses, 8-12 overview, 3-4
showing in color wash, 8-12 export
showing relative, 8-11 brachytherapy plan export file, 12-2
dose, point, 10-3 brachytherapy plans, 12-2
Dose-Volume Histogram. See DVH dose data, 12-5
double quotation marks in user guide, 1-3 dose plane, 12-5
DRR (Digitally Reconstructed Radiograph) dose profile, 10-5
creating in Brachytherapy, 5-10 DVH, 10-19, 12-6
DVH export options, 12-5
print-out, information in, 10-23 including reference images, 12-5
DVH (Dose-Volume Histogram), 10-6 plan to VariSource, 12-3
Boolean operators, 10-18 plans to CadPlan, 12-14
calculating preparing brachytherapy plans for, 12-3
for multiple plans, 10-16, 10-18 using data in CadPlan, 12-17
for one plan, 10-12 volumetric dose, 12-5
cumulative, 10-8 export filter
differential, 10-9 adding, A-1
dose bin width parameter (export), 12-6 different configurations, A-2
exporting, 10-19, 12-6 modifying, A-2
multi-plan, 10-13 naming, A-2
natural, 10-9 removing, A-3
printing, 10-23 export host
saving, 10-19 creating, 12-20

Index-3
 deleting, 12-21 creating, 12-20
editing settings, 12-20 deleting, 12-21
external cross-references in user guide, 1-3 editing settings, 12-20
Info Window
F in Plan Evaluation WS, 3-15
file server, Samba, 12-4 screen print-outs, 3-15
focus, moving to selected radiograph, 6-36 viewing information, 3-15
fraction, 4-3 internal cross-references in user guide, 1-3
isocenter
H moving reference point to, 7-11
host computer (CadPlan) isodose
creating for plan export, 12-20 rescaling, 8-19
deleting, 12-21 reshaping, 8-20
selecting displayed levels in Model view,
I 8-14
ICRU point, defining reference point as, 7-10 isodose (Brachytherapy), 8-8
image export, 12-17 2D views, 8-8
to CadPlan, 12-17 color wash, 8-9
implant template hiding, 8-12
adding applicators with, 6-21 Model view, 8-8
adding seeds with, 6-22 showing, 8-12
excluding holes, 6-24 See also color wash, 8-9
for applicators, 6-21 isodose level
for seeds, 6-22 adding to isodose set, 8-15
hole labels, hiding, 6-26 deleting from isodose set, 8-15
hole labels, showing, 6-26 modifying in isodose set, 8-14
hole lengths, hiding, 6-26 isodose set
hole lengths, showing, 6-26 adding isodose levels, 8-15
including holes, 6-24 deleting isodose levels, 8-15
modifying hole settings, 6-25 modifying isodose levels, 8-14
modifying settings, 6-23 selecting isodose levels in 2D views, 8-11
moving applicators, 6-36 italics in user guide, 1-3
overview, 6-4
rotating applicators, 6-36 J
selecting holes, 6-24 jig
import defining for radiographs, 5-13
plans, 12-18 defining geometry, 5-9
import filter geometry, 5-6
adding, A-1 overview, 5-13
different configurations, A-2
modifying, A-2 L
naming, A-2 library (Brachytherapy)
removing, A-3 adding applicators from, 6-13
import host (CadPlan) library applicator, 6-14
localization film, using for planning, 6-6

Index-4
Lucida Console font in user guide, 1-2 verifying optimized dose, 9-2
volume optimization, 9-3
M optimization parameter library. See constraint
margin library (brachytherapy)
applicator, 7-7 orthogonal geometry
misadministrations, 4-5 defining, 5-8
Model view jig, 5-8
applicator, 6-7, 6-35 radiographs, 5-2
Dmax, 8-16
dose, 8-8, 8-9 P
dose statistics, 8-16 parameter library. See constraint library
isodoses, 8-8, 8-9 (brachytherapy)
printing, 11-2 PC, sharing information with UNIX, 12-4
modifying calculation volume plan
(Brachytherapy), 8-6 approving, 10-30
MU (Monitor Unit) combining with external plans, 12-4
coefficient for Gy or cGy, 4-17 comparing visually, 10-26
Plan Organizer, 4-17 copying, 4-11
MU value creating, 4-8
define dose prescription in CadPlan, 12-18 creating for patient with no courses, 4-8
creating from template, 4-9
N creating new, 4-6
natural DVH, 10-9 definition, 4-3
navigating exporting, 12-16
in Entry workspace, 3-7 exporting to CadPlan, 12-14
in Plan Evaluation workspace, 3-9 exporting to VariSource, 12-2
in Planning workspace, 3-8 importing, 12-18
normalization, plan, 8-21 modifying approved, 10-30
after changes to dose, 8-22 normalizing, 8-21
and dose distribution, 8-22 opening, 4-11
defined normalization percentage in plan, planning plan, 4-3
8-22 preparing brachytherapy plan for export,
options, 8-22 12-3
to basal point, 8-24 prescribing dose, 4-9
to reference point, 8-24 saving, 4-11
to selected point, 8-23 saving as template, 4-12
to selected value, 8-24 subtracting, 10-27
to target mean, 8-23 summing, 10-27
to target minimum, 8-23 treatment plan, 4-3
using plans exported to CadPlan, 12-17
O verify from simulation or treatment, 4-7
optimization (brachytherapy) plan (External Beam)
geometrical, 9-2, 9-3 Plan Organizer, 4-14
methods, 9-2 plan evaluation
overview, 10-2

Index-5
 subtracting plans, 10-27 using, 4-9
summing plans, 10-27 plan verification
visual, 10-26 portal dose prediction, 10-30
Plan Evaluation workspace using phantom, 10-30
navigating in, 3-9 planning plan
overview, 3-5 approved, 4-3
plan export, 12-4 unapproved, 4-3
Body structure, 12-16 See also plan, 4-3
brachytherapy plan file, 12-2 Planning workspace
CadPlan, 12-14, 12-16 navigating in, 3-8
creating CadPlan hosts, 12-20 overview, 3-4
deleting CadPlan hosts, 12-21 Point, 10-3
isocenter coordinates, 12-17 point dose, 10-3
multi-part structures, 12-16 displaying, 10-3
overview (brachytherapy), 12-2 information in, 10-3
structures, 12-16 Point Set Editor, 6-26
Target structure, 12-16 portal dose prediction
treatment unit configuration, 12-9 calculation of, 10-30
verifying plans, 12-4 overview, 10-30
plan import Prescribed Percentage, Prescription Dose and
creating CadPlan hosts, 12-20 Fractionation
define dose prescription in CadPlan, 12-18 changing the values, 4-4
deleting CadPlan hosts, 12-20 prescription dose
dose interpolated between slices, 12-19 plan organizer, 4-5
from CadPlan, 12-18 plan properties, 4-5
import file contents, 12-18 primary reference point
original images in Vision database, 12-19 defining, 4-18
Plan Organizer defining point as, 7-9
content of plans, 4-15 printing, 10-4
modifying information in, 4-17 2D views, 11-2
prescribed dose, 4-14 dose profile, 10-4
prescribing dose, 4-17 DVH, 10-23
reference points, 4-16 information in print-outs, 11-3
verify plans before treatment, 4-15 Model view, 11-2
plan sum plan sum, 10-27
dose matrix, 10-27 screen, 11-1
evaluating, 10-27 treatment report (brachytherapy plan), 11-7
printing, 10-27 windows, 11-1
plan template procedures in user guide, 1-3
creating, 4-12 product support, 1-4
deleting, 4-14 profile, dose, 10-4
managing, 4-14 properties dialog boxes, 3-14
modifying, 4-12
overview, 4-7 R
renaming, 4-12 radioactive source

Index-6
 changing, 6-29 reloading object from database, 3-14
updating, 6-30 rescaling
radiograph isodoses, 8-19
creating DRRs in Brachytherapy, 5-10 reshaping
defining imaging geometry, 5-2 isodoses, 8-20
imaging geometries, 5-2
jig geometry, 5-6, 5-9 S
moving focus to, 6-36 Samba SMB/CIFS file server, 12-4
orthogonal geometry, 5-2 saving
selecting geometry, 5-8 all, 3-13
single film geometry, 5-7 DVH, 10-19
stereoshift geometry, 5-4 seed
using for planning, 6-6 adding, 6-4
reconstruction jig. See jig adding with template, 6-22
reference line modifying, 6-33
editing properties, 7-10 modifying settings, 6-34
inserting, 7-6 overview, 6-4
managing, 7-3 showing on visible plane, 6-36
modifying, 7-10 seed collection. See seed
overview, 7-2 selected point, normalization of plan to, 8-23
reshaping, 7-11 selected value, normalization of plan to, 8-24
showing on visible plane, 6-36 Selection workspace, See Preparing Images
reference point for Treatment Planning
defining as ICRU point, 7-10 setting dose levels, 4-4
defining as primary point, 7-9 sharing information between PC and UNIX,
deleting, 7-11 12-4
editing properties, 7-10 single film geometry
in Plan Organizer, 4-16 defining, 5-10
including points to use, 7-8 jig, 5-7
inserting, 7-4 source position
inserting location for, 7-6 defining in applicators, 6-18
managing, 7-3 source strength, changing, 6-39
modifying, 7-10 stereoshift geometry
moving defining, 5-9
to entry point, 7-11 jig, 5-4
to isocenter, 7-11 viewing in Planning workspace, 5-5
viewing planes to, 7-11 structure
normalization of plan to, 8-24 exporting, 12-17
overview, 7-2 structure export
primary, 7-8 Body structure, 12-16
reference point location, adding, 7-6 Target structure, 12-16
registration point, adding (Brachytherapy), to CadPlan, 12-17
5-11 summed plan. See plan sum
Registration workspace, See Preparing Images surface dose, showing, 8-12
for Treatment Planning

Index-7
T target dose minimum, 8-19
target mean, normalization of plan to, 8-23 visual cues in user guide, 1-1
target minimum, normalization of plan to, 8-23 volume image
template, Brachytherapy. See implant template verify construction before planning, 4-7
template, External Beam. See plan template volume optimization (brachytherapy), 9-3
treatment plan
approved, 4-3 W
unapproved, 4-3 warnings in user guide, 1-1
verify before editing, 4-7 window
treatment report (Brachytherapy) printing active, 11-1
editing templates, 11-9 workspace
information on, 11-7 Contouring, See Preparing Images for
print variables, 11-9 Treatment Planning
printing, 11-7 Entry, 3-4
template, backups of, 11-9 Plan Evaluation, 3-5, 10-2
treatment unit configuration Planning, 3-4
plan export, 12-9 Registration, See Preparing Images for
Treatment Planning
U Selection, See Preparing Images for
UNIX, sharing information with PC, 12-4 Treatment Planning
user guide
bold text in, 1-2
double quotation marks in, 1-3
external cross-references in, 1-3
internal cross-references in, 1-3
italics in, 1-3
Lucida Console font, 1-2
programming items in, 1-2
visual cues, 1-1
warnings in, 1-1

V
VARiS
equivalents in CadPlan configuration,
12-15
VariSource
exporting plans to, 12-3
verification plan
portal dose prediction, 10-30
using phantom, 10-30
viewing plane
moving to
global dose maximum, 8-19
target dose maximum, 8-19

Index-8