i3d235

User's Guide

iSis 3D

WARNING

The iSis 3D software has been carefully developed, and checked as far as

possible. In spite of this efforts, some errors remains because it is not

possible to test every path neither every situations. We expect from you to

help us to enhance this product by let us know the coming up errors with

the help of fault sheet. Also thank to let us know which enhancement

you'd like with help of upgrade required sheet.

The clinical utilization is under the user's responsibility, whose has to

validate the obtained results. The most critical aspects, in term of

quality results or security, are indicated in bold characters.

TABLE OF CONTENTS

ISIS 3D - V 2.35 - March 2003 i

I. First contact and starting the application .......................................................... I-1 I.1 Introduction ...................................................................................................... I-1 I.2 User interface - generalities............................................................................ I-1 I.3 Starting the application ................................................................................... I-3 I.4 Customization of the application ................................................................... I-4

II. ISIS 3D - GENERAL PRINCIPLES ....................................................................... II-1 II.1 The functions hierarchy ................................................................................. II-1 II.2 Coordinate system and geometrical conventions...................................... II-1

II.2.1 Reference system and conventions for imaging equipment ........................ II-2 II.2.2 Machine parameters...................................................................................... II-3

II.3 Dose calculation.............................................................................................. II-5 II.3.1 Computing options......................................................................................... II-5 II.3.2 Taking heterogeneity's into Account ............................................................. II-7 II.3.3 Taking penumbra into account...................................................................... II-9 II.3.4 Theoretical and effective contribution ......................................................... II-10 II.3.5 Equivalent radiobiological doses................................................................. II-13

II.4 Elements of dialog ........................................................................................ II-15 II.4.1 Generalities.................................................................................................. II-15 II.4.2 Box for selecting the calculation plane ....................................................... II-16 II.4.3 Box for selecting the beam.......................................................................... II-18 II.4.4 Graphical representation of beams :........................................................... II-20 II.4.5 Management of the images and the box for adjusting the image contrast II-27 II.4.6 Box for the management of the list of isodoses ......................................... II-28 II.4.7 Options box for the calculation of the voxel’s volume ................................ II-29

II.5 Print................................................................................................................. II-32 II.6 Concept of “zone”......................................................................................... II-33 II.7 Statistics of activity ...................................................................................... II-34 II.8 Digitizer .......................................................................................................... II-34 II.9 Matching images (option) ............................................................................ II-36

II.9.1 Principle ....................................................................................................... II-36 II.9.2 Format of the series .................................................................................... II-36 II.9.3 Utilization ..................................................................................................... II-37

II.10 DICOM RT exchanges................................................................................... II-37

III. File menu .............................................................................................................. III-1 III.1 New .................................................................................................................. III-1

III.1.1 Creation of a new study starting from zero.................................................. III-1 III.1.2 Importation of external elements.................................................................. III-3

III.2 Open ................................................................................................................ III-6 III.3 Close................................................................................................................ III-8 III.4 Save ................................................................................................................. III-9 III.5 Kill .................................................................................................................. III-10 III.6 List of slices.................................................................................................. III-12 III.7 List of beams ................................................................................................ III-12 III.8 Treatment time.............................................................................................. III-13 III.9 Dose/volume contributions ........................................................................ III-16 III.10 Print current plane ....................................................................................... III-17 III.11 Print study..................................................................................................... III-19 III.12 Eject sheet .................................................................................................... III-20 III.13 Import ............................................................................................................ III-20

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ii ISIS 3D - V 2.35 - March 2003

III.13.1 Import contours ...........................................................................................III-20 III.13.2 Import Beams ..............................................................................................III-22

III.14 Export .............................................................................................................III-24 III.14.1 Export beams ..............................................................................................III-24 III.14.2 Exporting DICOM RT Contours/Beams......................................................III-27

III.15 Quit .................................................................................................................III-29

IV. Slices Menu.......................................................................................................... IV-1 IV.1 Header and list of slices ............................................................................... IV-1 IV.2 Create from..................................................................................................... IV-6

IV.2.1 Create from image ....................................................................................... IV-6 IV.2.2 Create from digitizer..................................................................................... IV-8

IV.3 Modify............................................................................................................ IV-10 IV.4 Duplicate/Adjust........................................................................................... IV-10 IV.5 Kill .................................................................................................................. IV-11 IV.6 Origin............................................................................................................. IV-11 IV.7 Opposed Z .................................................................................................... IV-12 IV.8 Structures/Bolus .......................................................................................... IV-12 IV.9 Expansion ..................................................................................................... IV-14 IV.10 Volumes ........................................................................................................ IV-17 IV.11 Points Of Interest ......................................................................................... IV-18

IV.11.1 Points Of Interest’ management box ........................................................ IV-18 IV.11.2 Input box for the characteristics of the points of interest........................... IV-20

V. procedure creation/ modification of contours ................................................. V-1 V.1 Selection of the slices to contour................................................................. V-3

V.1.1 The box for selection of images.................................................................... V-3 V.1.2 Passing from a slice to another .................................................................. V-10 V.1.3 The Slice Menu ........................................................................................... V-10

V.2 Contouring (slice by slice)........................................................................... V-11 V.2.1 Manual contouring....................................................................................... V-14 V.2.2 Automatic contouring .................................................................................. V-15 V.2.3 Contouring - modify..................................................................................... V-17 V.2.4 The trace mode ........................................................................................... V-20 V.2.5 Automatic Densities Calculation ................................................................. V-21 V.2.6 Structures/Bolus .......................................................................................... V-22

V.3 Display............................................................................................................ V-22

VI. Beams Menu ........................................................................................................ VI-1 VI.1 New and Change ............................................................................................ VI-2

VI.1.1 The window for creation/ modification of beams......................................... VI-2 VI.1.2 Creation and modification of the current beam ........................................... VI-4 VI.1.3 Beam parameters......................................................................................... VI-6 VI.1.4 Display options: .......................................................................................... VI-22

VI.2 Duplicate ....................................................................................................... VI-23 VI.3 Opposed........................................................................................................ VI-23 VI.4 Mirror ............................................................................................................. VI-24 VI.5 Kill .................................................................................................................. VI-24 VI.6 Dose per fraction ......................................................................................... VI-25 VI.7 Virtual simulation and field shape............................................................. VI-25

VI.7.1 The View Concept...................................................................................... VI-27 VI.7.2 Creation/Modification of a beam or of a view ........................................... VI-28

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ISIS 3D - V 2.35 - March 2003 iii

VI.7.3 Introducing and adjusting the field shape ..................................................VI-29 VI.7.4 Exporting the field shape............................................................................VI-34 VI.7.5 Multi-leaf collimator.....................................................................................VI-37 VI.7.6 Display options and calculation of DRR.....................................................VI-40

VII. ISODOSES MENU ...............................................................................................VII-1 VII.1 Calculation .....................................................................................................VII-1

VII.1.1 All beams .....................................................................................................VII-1 VII.1.2 Current beam...............................................................................................VII-2 VII.1.3 Calculation options ......................................................................................VII-2 VII.1.4 Saving the dose calculations.......................................................................VII-5

VII.2 List ..................................................................................................................VII-6 VII.3 Normalization.................................................................................................VII-8 VII.4 Dose at one point ..........................................................................................VII-9 VII.5 Profiles and exportation.............................................................................VII-10 VII.6 Dose/ Volume Histogram ...........................................................................VII-14 VII.7 New plane.....................................................................................................VII-20 VII.8 Kill plane.......................................................................................................VII-23 VII.9 New zone......................................................................................................VII-23 VII.10 Zone display ................................................................................................VII-23 VII.11 Importation of doses ( stereotactic ) ........................................................VII-24

VII.11.1 Generalities................................................................................................VII-24 VII.11.2 Launching the import.................................................................................VII-24 VII.11.3 Mechanism of associating the existent and imported planes...................VII-25 VII.11.4 Display and printing the results.................................................................VII-26

VIII. Display menu .....................................................................................................VIII-1 VIII.1 Image .............................................................................................................VIII-1 VIII.2 Contours........................................................................................................VIII-2 VIII.3 Beams............................................................................................................VIII-2 VIII.4 Isodoses ........................................................................................................VIII-2 VIII.5 Registered image .........................................................................................VIII-2 VIII.6 Isodoses 3D ..................................................................................................VIII-2 VIII.7 Level/Window ...............................................................................................VIII-3 VIII.8 Zoom..............................................................................................................VIII-5 VIII.9 Restore ..........................................................................................................VIII-7 VIII.10 Grid ................................................................................................................VIII-7 VIII.11 Distance measurement................................................................................VIII-7 VIII.12 Angle measurement.....................................................................................VIII-8 VIII.13 Visualization 3D (option) .............................................................................VIII-8

IX. Windows Menu .................................................................................................... IX-1 IX.1 Open on selection .......................................................................................... IX-1 IX.2 Store current plan .......................................................................................... IX-1 IX.3 List of photographed studies ....................................................................... IX-2

X. 3D Visualization ....................................................................................................X-1 X.1 surface reconstruction ...................................................................................X-1 X.2 Change zoom and the point of view .............................................................X-2 X.3 Display or hide objects...................................................................................X-3 X.4 Change object representation mode, color and transparency .................X-3 X.5 Change the value of the isodose surface ....................................................X-3 X.6 Print window ....................................................................................................X-4

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iv ISIS 3D - V 2.35 - March 2003

X.7 Display other scenes...................................................................................... X-4 X.8 Return to calculation mode ........................................................................... X-4

APPENDIX A. Text editor B. Description of set-up file

B1. Default set-up of application B2. File access zones configuration file B3. List of protocols B4. Defaults set-up Level/Windows B5. Color table B6. Automatic FTP parameters

C. Conversion, of Hounsfied number to densities, curve format D. Descriptiion of study files

D1. Slices file D2. Beams file D3. Administrative file

E. Export doses file format F. Waterphantom Program G. Photon Compensators

G1. Users’ guide G2. Description of Compensator file "DEPTH" (.PRF) G3. Description of Compensator file "REAL" (.CPR) G4. Description of Compensator file "THEORETICAL" (.CPT] G5. Description of Compensator file "HEK" G6. Description of Compensator file "Machine file"

H. Menu summary I. List of figures and tables

CHAPTER I - FIRST CONTACT

iSis 3D - V 2.35 - March 2003 I-1

I. FIRST CONTACT AND STARTING THE APPLICATION

I.1 Introduction

ISIS3D is part of the “ISIS” package of programs for radiotherapy. It concerns the

treatment planning part and the calculation of dose distributions for external

radiotherapy. Before starting the application some preliminary stages concerning data

preparation should be accomplished:

• create of the treatment unit library

• adapt the application to the needs and requirements of the user

• acquire the anatomical information of the patient under treatment

Not all these aspects are referred in the present brochure. The interested reader

should refer to the documents dedicated specifically to the subjects enumerated

before for more details.

I.2 User interface - generalities

The user interface is of the “MOTIF” type. All along the application will be encountered

a homogenous presentation, making use of pop-up menus, multiple windowing, dialog

boxes and buttons.

It is thus important to get familiar with this environment, very similar to those

encountered under Windows or Mac OS. In particular, the same important role is find

for the mouse, having the possibility to move, open or close graphical windows, to

access pop-up menus, select a string of characters, position the cursor in the text,

etc…

There are however some specific features :

The mouse has three buttons. In most of the cases the left button is used. The other

buttons are used only for some specific functions. The double click is sometimes used,

mainly to enter into the change mode (of slice or beam) or to select the field containing

the value selected to be replaced with another value, introduced from the keyboard.


I-2 iSis 3D - V 2.35 - March 2003

Every window, (including some boxes or menus) have in the upper part a title bar that

can be “dragged” with the mouse in order to move the window. On either sides of the

title bar is found a small box. The one at the left of the title bar accesses a control

menu of the graphical windows and the one at the right permits to transform the

window into an icon. This last process can be used at any moment. It transforms the

window into a small square (“icon”) identified by a drawing and a title recalling the

content of the window. The icon appears in a corner of the screen and can be

displaced to any other position. Double clicking on the icon makes the window retrieve

its original dimensions. On the contrary to what happens in the standard accessible

applications, in ISIS3D the dimensions of the window cannot be modified by clicking

and dragging their margins. The way a window is closed is again controlled by specific

buttons, the traditional “closing boxes” have no effect in this case. The user can

customize the screen as he wishes, transform the graphic windows into icons when he

wants them to be at hand but prevent the screen from being agglomerated without

reason.

Inside the windows are frequently found two types of buttons:

• The rectangular buttons on which is found a text or a symbol are used to start a

process.

• The on/off buttons have a characteristic appearance reflecting their status

(pressed or not). They allow the selection of some options. Sometimes they are

replaced by small boxes to be marked by the user.


iSis 3D - V 2.35 - March 2003 I-3

I.3 Starting the application

After keyboarding the user name and the password a window having on the upper part

a menu bar will appear on the screen, allowing the user to select the application

(Figure I-1).

Figure I-1 : Launch menu

This menu bar contains the “External R.T.” pop-up menu, which gives access to

starting the application ISIS 3D.

By choosing the option ISIS 3D from the pop-up menu you actually start the

application. A window is displayed at the upper left of the screen, showing that the

initialization is taking place. When the initialization is finished there are two important

possibilities:

• A study was interrupted following an accident and the computer asks if you want to

work again on this study,

• No previous study was interrupted and the computer displays the main menu bar of

the application ISIS 3D (Figure I-2)

Figure I-2 : iSis3D main menu

The main menu bar proposes the following choices:

• FILE :

o Create, open, save, print or close a file.

o Display summary of slices, beams, treatment time, dose/volume contribution

o Contours and Beams data import / export


I-4 iSis 3D - V 2.35 - March 2003

• SLICES :

o Acquisition and/or modification of the anatomical data

• BEAMS :

o Define, position and modify the beams.

• ISODOSES :

o Calculation and display of the dose distributions.

o Define non-transverse plan

o Dose / Volume Histogram

• DISPLAY :

o Chose the options for displaying the treatment plan.

o Display grid, measurement tools

• WINDOW :

o Options and "snapshot" of windows.

Each of the previously enumerated choices gives access, if simply clicking with the

mouse on it, to a specific submenu listed on the vertical. An arrow situated at the right

of the specific option indicates the presence of a supplementary choice level.

The detail of functions associated to each menus is explain later (see page III-1),

immediately after the section related to general principles of iSis 3D.

I.4 Customization of the application

Numerous elements of the application could be parameterized according to the user’s

preferences.

These preferences are specified through the files whose full description is given in

Annex 2: “Description of the parameter files and of calibration”.

The options and principal customizations of parameters are:


iSis 3D - V 2.35 - March 2003 I-5

o the working zones (cf : Appendix B2, Description of the parameter files and

of calibration, Format of the calibration file for accessing the files),

o the protocols (cf : Appendix B3, Description of the parameter files and of

calibration, Format of the protocol file),

o the optimal visualization of a tissue type (cf : Appendix B4, Description of the

parameter files and of calibration, Format of the file containing the list of the

pre-settings),

o the options for the automatic calculation of the complex fields (cf : Appendix

B1, Description of the parameter files and of calibration, Format of the file

containing the parameters of the terminal),

o the default options for the dose calculations (cf : Appendix B1, Description of

the parameter files and of calibration, Format of the file containing the

parameters of the terminal),

o the display options (cf : Appendix B1, Description of the parameter files and

of calibration, Format of the file containing the parameters of the terminal),

In a general frame, the mentions “customizable” and “customizable file” of this manual

make reference to the “parameter file of the terminal” described in Appendix B1


I-6 iSis 3D - V 2.35 - March 2003

CHAPTER II - GENERAL PRINCIPLES

iSis 3D - V 2.35 - March 2003 II-1

II. ISIS 3D - GENERAL PRINCIPLES

II.1 The functions hierarchy

After transferring to the system the images to be used, if this is necessary, the general

principle of functioning of iSis 3D is the following:

1. Creation of the file for a new patient

2. Creation of a set of contours from a series of slices (introduced via

digitizer or from images)

3. Assigning characteristics to the internal contours

4. Creation of the beam configuration

5. Calculation and study of the dose distribution in different slices

6. Saving and eventually printing the study

7. Eventually modify the study and return to 5

8. End session

More than this, as soon as a series of contours has been defined, it is possible to

obtain a surface 3D representation of the structures, completed if it is the case, with

the beams representation and the surface isodoses (option “3D surfaced”).

Apart from this standard scheme, many other similar schemes are possible, having, in

particular, the option to go back at any time to a previous function and to perform at

that stage a correction. The interdictions are controlled by the program and the

“dangerous” maneuvers or anomalies are signaled with dialog boxes.

99 slices, 40 structures and 56 beams can be defined at maximum.

II.2 Coordinate system and geometrical conventions

The introduction of the noncoplanar mode and other more and more automatic

treatment techniques, requires a high precision from the coordinates system and the

geometrical conventions. For the description of the machine’s parameters we have


II-2 iSis 3D - V 2.35 - March 2003

tried to comply as close as possible to the norms of the International Commission for

Electrotechnology (ICE 1217).

II.2.1 Reference system and conventions for imaging equipment

The reference coordinate system is link to the couch. The patient is supposed lie on

his back, the head towards the gantry (related to the patient), it is an orthogonal

system whose Z axis coincides with the longitudinal axis of the patient oriented from

the toes to the head. The X,Y plane is a transverse plane through the patient (X has

the sense from the right to the left of the patient and Y is parallel to the anterior-

posterior direction, as shown in the figure II-1). This system is associated with the

isocentric rotation of the table.

In this system, the anatomical structures are represented by an assembly of

transverse contours (perpendicular on the Z axis). The contours can be introduced

from the digitizer or directly from scanned images (or IRM).

.

Y

X

Z

o

Figure II-1 : Reference coordinate system

In this last case, the images corresponding to the slices acquisition are

necessarily axial (perpendicular to the Z axis). They must be acquired in treatment

position with the gantry and the table at zero degrees orientation. They are always

supposed to be looking towards the gantry. On the other hand, the patient position


iSis 3D - V 2.35 - March 2003 II-3

relative to the gantry is arbitrary: he may lie on his back, on the belly or on his side, the

head towards the gantry or in the opposite direction.

The patient position during the image acquisition in the scanner tunnel is specified

generally and transmitted together with the images. In the program iSis this

information is illustrated with indicators of the orientation (anterior, posterior, right, left)

which are displayed on the screen and on the printed document. In case of the images

are acquired "foots first", there are doubt on the way to interpret the orientation and an

warning message is displayed. If the position is not defined, the orientations X, Y, Z

are those previously specified.

The origin is defined when the contours are created. Afterwards it can be displaced

using the function “SLICES/Origin”. The measurement unit is the cm. A specific

function permits to invert the orientation of the Z axis, if necessary (“SLICES/Z

opposed”).

In most of the graphical windows, the position of the cursor is indicated by the pair (x,

y). For the transverse slices, it deals with the coordinates in the radiotherapy

coordinates system. On the other hand for other representation planes (oblique, virtual

simulation), the (x, y) pair represents the coordinates relative to the origin of the

displayed window. To avoid any possible confusion, the corresponding labels are

noted u (instead of x) and v (instead of y).

II.2.2 Machine parameters

For the machine parameters we followed rigorously the last recommendations of IEC

(1217). Relative to the anterior versions of iSis, some supplementary specifications

should be made:

- The field dimensions and the collimator rotation keep the same conventions.

However the terms “length” and “width” are avoided. They have been replaced by FX

and FY defined as follows (for a zero degrees collimator rotation):

• FX (instead of “width” La) perpendicular to the gantry rotation axis

• FY (instead of “length” Lb) parallel with the gantry rotation axis


II-4 iSis 3D - V 2.35 - March 2003

Note that convention from CEI for FX and FY dimensions has changed FX and FY, as

a result, for a certain number of treatment units, FX corresponds to the “Y” dimension

and FY to the “X” dimension!!

Note as well, that the “collimator opening” is henceforth defined at the isocenter. In

SSD, it does not deal anymore with the field dimensions defined at the skin surface. A

message reminds the user if a SSD treatment is done with a SSD value different than

SDA.

- For asymmetrical collimators, the values employed are the coordinates in the

coordinate system defined by the axes FX, FY, in such way that for a zero degrees

rotation of the table and the collimator, the gantry positioned at zero degrees, the

orientation of the axes FX and FY should coincide with the x and z axes orientation

respectively. In this way are obtained:

• X1 negative for a symmetrical field

• X2 positive for a symmetrical field

• Y1 negative for a symmetrical field

• Y2 positive for a symmetrical field

As in the case of FX and FY we refer now to the “collimator opening” (the field at the

isocenter) and not any more to the field at the skin surface.

- The only rotation allowed for the table is an isocentric rotation of the “patient

support”, in such way that the angle is increasing when the table rotates in the

counterclockwise sense, beams eye view, with the gantry at 00. Attention, the

convention from CEI for couch rotation has changed. It is thus in contradiction with

what is used for most of the tables installed, and with the program STEREO version

V038 !!

ATTENTION !

Generally speaking it is up to the user to check the conformity between the

conventions used in iSis and those of the treatment unit. In the case that they do

not agree the user should make sure that the appropriate conventions are properly

applied, in the case of putting into practice a treatment planned on iSis, or to


iSis 3D - V 2.35 - March 2003 II-5

calculate the dosimetry of a patient already in treatment position on a given

treatment unit.

II.3 Dose calculation

It is important that the user be aware of the possibilities and limitations of the dose

calculation algorithms therefore to know the basic principle of the method. These

principles are described in specific documents to which the interested reader is invited

to refer for more details (cf : Creation of the treatment unit library for the utilization of

iSis2, iSis3D, Calcum, Plex programs).

However, in the following paragraphs are given some indications with the aim to clarify

the selection of calculation options, the way to account for the heterogeneities, for the

penumbra and the weighting factors.

II.3.1 Computing options

The rich variety of new calculation options possibilities (since version 2.0) may confuse

the users. It is important to understand the fact that these possibilities are the result of

the following developments:

a) accounting for the real depths; the calculations are not any longer done like in

the versions anterior to 2.0, parallel o the beam axis but they are done

accounting for the beams divergence

b) the amelioration of the computational model so that it accounts for the

modifications of the lateral scatter, important especially in the case that a part of

the beam is in air (“double cutting out” method)

c) introduction of the noncoplanar mode, where the depths must be calculated on

the basis of three dimensional representation of the entrance surfaces and not

only on the basis of a cylindrical extension of the calculation section

d) introduction of the heterogeneity correction for electron (and proton) beams

e) the necessity to have as much as possible compatibility between the calculation

times and an interactive use of the system.


II-6 iSis 3D - V 2.35 - March 2003

f) Introduction of the equivalent radiobiological dose (cf.: § II.3.5, iSis3D – General

principles , Equivalent radiobiological dose).

To these developments is adding up the possibility to have a higher precision in the

isodoses representation by introducing a finer calculation grid and with variable step.

In the following paragraphs are presented schematically the principles:

• The “double cutting out” permits to account for the scatter variation as a

function of the depth of the element who gave this contribution. It is thus

important when the entrance surface present irregularities and even more when

a part of the beam is in air. It is not (for the moment) applied to account for the

scatter variation due to the presence of the wedge filter: it is the total dose which

is modified by the effective wedge transmission in the considered point. To

ensure its validity, the entrance surface of the patient should be defined for the

entire field surface. Hence it cannot be applied if a sufficient number of slices of

adequate thickness were not defined. Note that in the case the slices are not

joined (signaled by a message), the continuity between slices is realized through

interpolation and the detailed data are available from list of slices” (Z and

rescaled thickness). A warning message signals if the distance between the

slices seems not suitable with the field dimensions.

• The “simple cutting out” method was used in the previous versions. It

accounts for the scatter on the basis of a planar surface, perpendicular to the

axis and passing through the entrance point of the beam joining the source with

the calculation point. It is well adapted to regular entrance surfaces, entirely

covered by the field.

• The choice “fast” option is referring to the manner how the depths are

calculated for the primary beam attenuation:

o The “fast” mode considers only the first point of intersection of the

source-calculation point ray with the entrance surface; hence the rapid

method should be avoided if there are significant concavities and the

beam risks to get out in air, before meeting the calculation point.

o In “standard” method (answer “no” to the option “fast”), if the beams are

coplanar or not, the depth calculation is based on the “real” surface,


iSis 3D - V 2.35 - March 2003 II-7

corresponding to the slices packing, and it accounts for partial passages

through air (the case of arm, or ear).

II.3.2 Taking heterogeneity's into Account

The heterogeneity corrections can be applied either based on the introduced contours

(from the digitizer or from scanned images), or, in the case of images, using directly

the density information from the corresponding pixels matrix (option “voxel/voxel”).

Note that the conversion from Hounsfield numbers (“CT numbers”) to density is done

using the file « sc.den », which must contain the calibration curve of the scanner ( cf: :

Appendix C, : Conversion of Hounsfied number to densities, curve format ).

a) Correction based on Contours

Each closed contour is assigned a uniform density different from 1 (valid for all the

slice thickness) in one of the four following cases:

1 - the contour is created and associated to a structure previously defined with a

density different than 1

2 - the option “automatic calculation of densities” is not selected but a density

different from 1 is explicitly assigned to the contour (function "change")

3 - the option “automatic calculation of densities” is selected, the assigned

density is the average of the values obtained for the pixels in the interior of the

contour.

4 - the density of a structure is modified (function “structures”) - the densities of

all the contours associated to this structure are modified as a consequence.

The contours declared as “free makers”, i.e. those which are not associated to any

structure, even if they have a density different from 1, are taken into account for

coplanar photon beams but are not (for the moment) taken into account as

heterogeneities neither for electron beams, nor for proton beams, nor for noncoplanar

photon beams (rotation of the couch different from 0). Warning messages announce

the user about these particular cases.


II-8 iSis 3D - V 2.35 - March 2003

In the case it is effective, the following method is applied:

• For photons, the Batho method with beam subtraction (Kappas) accounts for

the scatter modifications including those due to small heterogeneity's located in a

big field or in points located laterally relative to the heterogeneity's. This method is

considered “standard”. So as it is implemented, it gives sometimes aberrant results

for heterogeneity's of complicated shapes (mainly “ring” shapes). More, it is not

applicable for noncoplanar beams.

For noncoplanar beams the Simple Batho method is used as “standard

method (based on the field dimensions at he level of the calculation point).

Differences may appear relative to the corrections applied for coplanar

beams in the case a small heterogeneity is placed in a big field and for points

located at the margins of the heterogeneity (in the interior or exterior of it). To

pass from the method “beam subtraction” to the “simple Batho” method it is

sufficient to modify slightly the table rotation (for example taking 0.10 instead

of 00).

• For electrons the method of equivalent “radiological depth” is applied (isodoses

translation). As it is implemented it is not compatible with the double cutout

method. If is required a double cutout together with heterogeneity correction, then

the simple cutout method will be used in fact for electron beams.

• For the protons, whatever is the chosen calculation method, only the primary is

accounted for. The heterogeneity correction through the “equivalent depth” does

not rise any problems.

The heterogeneity correction factor at the normalization is displayed in the beam

list for the beams which were used for isodoses calculation. It is equal to the ratio of

dose with on dose without heterogeneities.

b) Correction voxel by voxel

The Correction voxel by voxel does not require the explicit introduction of the contours

delimiting the structures. The voxels densities reconstructed directly from scanned

images are used. In order to be a valid reconstruction, a complete scanning of the

joined slices should be previously performed to acquire the necessary data. From

these scanned images the program will start reconstructing a voxel matrix. The


iSis 3D - V 2.35 - March 2003 II-9

characteristic of the voxels volume calculation are defined into dialog box. (cf.: § II.4.7,

iSis3D – General principles, Option box for calculation of voxel’s volume) These data

are display into each calculation plan as well as into dose/volume histogram windows.

“Het. Cor. : vox/vox P=0.85 R=2 NbZ=55”

where : P is the sampling step, R is the reduction factor to convert CT resolution to

Voxel resolution and NbZ is the number of voxel along the Z axis of the voxel volume.

For each calculation point, the program searches, within a surface limited by the

external contour, the voxels located between the source and the calculation point, on

the basis of a sampling process, the sample being of half the calculation grid step, as

defined on “calculation options”. The sum of the transverse thickness, weighted by

the elementary densities of each voxel, allows the calculation of an “equivalent

depth” for the point of calculation.

• For the photons, the dose is then correcte3d by the tissue-phantom ratio (TPR)

for this equivalent depth and for the true geometrical depth, taking as the field

dimensions the dimensions of the square field equivalent to the collimator opening

at the measurement point level. This TPR (or TAR) method is not as good as the

Batho method with beam subtraction for the interior of the heterogeneity or its

proximity. Apart from this case it gives equivalent results.

• For electrons and protons, the equivalent depth is used directly as in the case

of contours based correction.

II.3.3 Taking penumbra into account

The representation of the penumbra region makes use of the collimation constants

previously adjusted and stored in the treatment unit library, and accounts for the

influence of scatter and the lack of electronic equilibrium nearby the beam’s edges.

ISIS 3D makes automatically the difference between the field edges delimited by the principal collimator and those delimited by the additional blocks (secondary collimation). When a polygon segment which defines the field shape is superimpose to the edge defined by the principal collimator (with a margin of ± 2 mm), the principal collimator is taken into account for that segment. If this is not the case, the secondary collimator is taken into account (at the distance source-tray and for a transmission corresponding to the no. of trays used). According to the different segments


II-10 iSis 3D - V 2.35 - March 2003

considered, the penumbra width will be thus different, especially on the case of Cobalt 60 and electron beams.

For the trimmers, the distance source - trimmers and the transmission corresponding

to the no. of trimmers used are preserved for the entire field contour.

II.3.4 Theoretical and effective contribution

It is recommended to give particular attention to the importance of each beam’s

contribution (also called weighting) and to the relation with the calculation of the

treatment time (or number of monitor units). This contribution may be expressed as

absolute dose (Gy) or percentage, conform to the user choice. The point where this

contribution is calculated is called normalization point (see c, principles and example

of use) .

a) notion of “theoretical contribution” and “effective contribution”

The notions of “theoretical” contribution (or weighting) and “effective” contribution have

been introduced in order to take maximum advantage of the performances of the dose

calculation algorithms and in order to keep a link with the most accessible quantities

including in some complex situations (such as blocks placed on the beam axis) :

- the theoretical contribution (on the theoretical weighting point) refers to the

following conditions:

• Semi-infinite, water-equivalent, homogeneous medium with a flat surface

perpendicular to the beam axis at the entry point (intersection with the skin)

• Field defined by the primary collimator, having the actually used dimensions but

being always symmetrical in respect to its axis.

• Without any additional shielding blocks or multileaf collimator but with possible

presence of a block tray

• With possible presence of a trimmer

• With possible presence of a wedge and/or a bolus and/or a compensator

- the effective contribution (on the effective weighting point) takes into account all

the “real” characteristics of both the patient (irregular entry surface, heterogeneities


iSis 3D - V 2.35 - March 2003 II-11

etc.) and the radiation beam (asymmetrical collimator, additional blocks, multileaf

collimator etc).

In the case of electron beams only the “effective weighting” mode is authorized due to

the modification of the depth of maximum dose when an electron block is added.

b) Position of the weighting point

The weighting point is a point inside the patient, in principle associated to the radiation

beam, where the beam contribution is provided. This point may be placed either on the

collimator axis (most frequent case) or outside this axis (e.g. whenever there is a block

on the axis). The weighting point defined by the user is always the so called “effective”

weighting point. It is superimposed to the “theoretical” weighting point (where the

“theoretical” contribution is being provided) only when it is placed on the beam axis

and it is a matter of a photon beam. On the other hand, if the “effective” weighting

point is not placed on the beam axis, then the “theoretical” weighting point is placed on

the beam axis at the same depth with the “effective” point. Furthermore, for electron

beams, the “theoretical” weighting point is always placed at the depth of maximum in

absence of electron blocks, independently of the depth of the “effective” weighting

point.

The various possibilities are shown bellow:

• On-Axis Weighting :

o SSD Technique :

- For photon beams, the weighting point on the beam axis is either

at a depth specified by the user (a depth greater than the depth of

maximum dose), or at the depth of maximum dose, calculated

automatically for a field defined by the primary collimator (when the

depth entered by the user under theoretical conditions is zero).

- For electron beams, the depth of the weighting point is always the

depth of dose maximum, calculated under “real” conditions, taking

into account the additional electron blocks.

- For proton beams, the weighting point must be placed on the

modulation plateau. The point can be placed automatically in the


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middle of the modulation plateau by entering a weighting depth

equal to zero.

o SAD or ARC Technique :

The weighting point is always the isocenter, that may be found beyond the

depth of maximum dose.

• Off-Axis Weighting :

In that case, it is a matter of a point defined as a “Point Of Interest” of the type

“Weighting Point” (cf.: § IV.11, iSis 3D - Slices Menu, Points Of Interest).

o For photon beams, the depth of the ‘Point Of Interest’ must be greater

than the depth of dose maximum.

o For electron beams, there isn’t any verification over the depth of the

‘Point Of Interest’.

o For proton beams, the depth of the ‘Point Of Interest’ must correspond to

the depth of a point placed on the modulation plateau.

Weighting at the depth of max.

dose

Weighting on the axis Weighting at any point

photons Yes depth > depth of max isocenter if SAD or ARC

depth > depth of max

electrons Yes Prohibited in SSD mode Isocenter if SAD or ARC

no verification

protons Prohibited on the modulation plateau isocenter if SAD or ARC

depth of the modul. plateau

Table II-1 : Possibilities and system verification – Summary

c) Principles and examples of use

When the dose (or the percentage) contribution from a beam at the effective weighting

point is being expressed as “effective contribution”, it is taken into account in the

calculation of the dose distribution and the treatment time as an “effective” one and we

can be sure that the desired dose (or percentage) will be attributed to that point. On

the other hand, if that dose is expressed as “theoretical contribution”, then it will be

modified such that the actual characteristics of the irradiation are taken into account in

the calculation of the dose distribution. For example, in the case of a field defined by


iSis 3D - V 2.35 - March 2003 II-13

blocks that reduce by 10% the dose at a point situated on the beam axis at a certain

depth (due to the reduction of the total scattering volume), a “theoretical contribution”

of 10 Gy (5 fractions of 2 Gy) at that point corresponds to an “effective contribution” of

9 Gy and a treatment time of 1min per fraction. If we imagine that the contribution of

10 (Gy) is expressed either as a “theoretical contribution” or as an “effective

contribution”, then we have the following results:

contribution of 10 expressed

as:

calculated theoretical

contribution

Calculated effective

contribution

dose at the weighting point

Calculated treatment time

per fraction theoretical 10 (9) 9 1 min

effective (11,1) 10 10 1,11 min

Table II-2 : Example of calculation with theoretical and effective contribution

The interest of this approach is the possibility to use independent and simplistic

software for the calculation of the treatment times (or the Monitor Units) under

theoretical conditions. For example, in the case described above, this software would

give directly a treatment time of 1 min for the delivery of 10 Gy at the weighting point,

under theoretical conditions (or 1.11 min for 11,1 Gy etc.). It is also a way to keep a

weighting point on the beam axis, even if it is situated under a block, provided that we

work in “theoretical contribution” mode.

The deviations between “effective” and “theoretical” contribution appear explicitly in the

“List of Beams” in the form of two corrective factors :

• A corrective factor for the modifications in respect to a water-equivalent

homogeneous medium : Ef/Th(hom).

• A corrective factor for the tissue heterogeneities: Het. Cor..

Note : A part of the deviations appears due to the difference between the penumbra of

the primary collimator and the penumbra of the additional collimator. This difference

may, in some extreme cases, result to corrective factors (Ef/Th(hom)) slightly greater

than 1 (for example when a block creates a penumbra that is narrower than the

penumbra of the primary collimator).

II.3.5 Equivalent radiobiological doses

The representation in radiobiological equivalent dose distributions is intended to

translate the biological effects caused by the fractionation, taking into account the fact


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that at each session the patient receives in every point a dose different from that

prescribed. This effect is amplified, since the beams are not delivered all the same

day. The representation is expressed under the form of “classical fractionation

equivalent dose”, and can be adjusted at request, generally corresponding to a 2 Gy

per session. The used method is based on a linear quadratic model.

II.3.5.1 The Linear Quadratic model

The linear quadratic model is a mathematical model, which allows taking into account

the fractionation of an irradiation, in order to calculate its biological effect. The

mathematical model (given below) maintains its validity while the doses per fraction

are comprised within 1 and 5 Gy. It is up to the user to take into account this validity

range for the interpretation of the results.

Mathematical formula:

Let D be the total physical dose applied at a point P, for a fraction of d Gy.

Let a be the biological coefficient alpha/beta (expressed in Gy) corresponding to point P

The equivalent radiobiological dose per fraction of 2 Gy (LQED2Gy) to point P is:

LQED2Gy = D*(a+d)/(a+2)

This corresponds to a total dose delivered at the point P in 2 Gy fractions, which would

have the same biological effect as the total dose D delivered in d Gy fractions.

II.3.5.2 Seizure of the parameters

The visualization under ISIS 3D of the equivalent doses necessitates the knowledge of

the following parameters:

o alpha/beta coefficient

o doses per session and per beam, at the weighting point

o distribution of the dose expressed in total dose (Gy)

o grouping of the beams


iSis 3D - V 2.35 - March 2003 II-15

a) Choice of the alpha/beta coefficient

This parameter allows taking into account the biological nature of the irradiated

structures. It is generally fixed at 3 Gy for the healthy tissues with late response and

10 Gy for the healthy tissues with early response and the tumors.

The choice is performed within the dialog box which allows the management of the

structures (cf : § IV.8, iSis3D – Slice menu, structures/Bolus). This coefficient actually

is unique and is applied to all the points within the patient. The default value of the

coefficient (for example 3 Gy) is fixed within the customizaton file.

b) Choice of the doses per session and the grouping of beams

The values of the doses per session are those given for the calculation of the

treatment time (cf : § VI.6, iSis3D - Beams menu, Dose per fraction). At the

corresponding input box one can equally specify the group number to which each

beam belongs. All the beams of the same group are assigned to the same treatment

session.

For the calculation to be valid, the weights of each of the beams should imperatively

be expressed in total doses (in Gy) at the weighting point.

c) Visualization of the equivalent doses

The type selection of the displayed doses is performed within the dialog box of the

calculation options. The choice is proposed between the physical doses and the

radiobiological equivalent doses (cf : § VII.1.3, iSis3D - Isodoses Menu, Options of

calculation). The change is immediately taken into account; this is reflected on the

display of the isodoses for every calculation plane and on the representation of the

dose volume histograms (DVHs), the calculation type (EQUIVALENT RADIOBIOLOGICAL

DOSES) and the used parameters being recalled for this calculation.

II.4 Elements of dialog

II.4.1 Generalities

The main elements with which one can work while preparing a treatment plan are the

following:


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o a principal menu bar

o a box for selecting the calculation plane

o a box for selecting the beam

o graphical window

The basic graphical windows represent the calculation planes, wherein are displayed

images, contours, beams and isodoses. One of these windows, selected by a mouse

click is brought in front of the others, it is the current window, on which are effective

the functions from the principal menu. For more efficiency, the other windows, apart

from the current one, are not updated systematically. The windows not updated are

signaled with the message “DISPLAY TO REFRESH” displayed in the upper left corner of

those windows. When a window becomes the current window it is automatically

updated.

Other windows or boxes may remain permanently open to give access to certain

functions. It is, for example, the case of the window which permits to adjust the image

contrast (level/window) and of that window which permits to modify the list of

isodoses. Other windows are temporary and created only to realize certain stages of

the dialog. They must be closed in order to continue working and to access other

functions (see in mode virtual simulation, summary of slices, beams, Treatment

time,… zoom, selection, contouring, etc...).

The stage contouring, (creation and then modifications of contours) behaves like a

separate application which uses a specific window and a specific menu (cf.: § IV,

iSIs3D - Slices Menu).

Note: The menus and the windows logically inaccessible are automatically

transformed into icons, and they retrieve automatically their original size when they

become again accessible.

II.4.2 Box for selecting the calculation plane

The box for selecting the calculation plane (Figure II-2) permits to decide on the plane

to work with and to adjust the dimensions of the associated graphical window. It

contains the list of planes previously defined, identified by a code and their position:


iSis 3D - V 2.35 - March 2003 II-17

- The transverse slices wherein at least an external contour was defined are

identified by Ci, where i is the n° of order of the slice, as well as by its associated Z

value (in the radiotherapy coordinate system). These slices are ordered in ascending Z

order.

- The calculation planes which do not correspond to slices are identified by two

letters followed by a number: FR for frontal, SA for sagittal, FO and SO for oblique

frontal and sagittal oblique. Their position is identified by the distance d to the origin of

the coordinates, and for the oblique planes, by their angle.

The current plane, i.e. the plane on which are applied the selected functions is

identified by a frame. To make a plane the current plane click (once) on the plane

name in the box. The same result can be obtained if the window is already open by

clicking on it, this will make it pass in the front plane.

The selected planes are identified by a cross at the left of their name. When a

nonselected plane is made the current plane, it is automatically selected. To deselect

the current plane click (once) on the button labeled “no”. It switches then to “yes”. A

new click on this button makes it switch again and reselects the plane. The selected

planes are those for which the dose distribution is wanted. Only the selected planes

are taken into account for the automatic calculation of the isodoses in “all” the planes

(cf.: § VII.1.3, iSis3D - Isodoses Menu, Calculation Options) and during the global

print of the study (cf.: § III-8, File Menu, Treatment time).

The selected planes can be or not displayed. According to the chosen option

(cf.: § IX.1, iSis3D - Window Menu, "Open on selection"), they can be or not

automatically displayed in the moment they are selected. One click on the button

window, while it is labeled “open” displays the window of the current plane, using the

default dimension. Pressing one of the buttons in the upper part of the selection box:

“<” for small, “-“ for medium, or “>” for big, it is possible to open the window directly at

the desired size or to change its actual size.

This symbol is always present at the right of each plane name, when its corresponding

window is opened. The window can be closed clicking on the window’s button when it

is labeled “close” or made an icon if clicking on the corresponding small box of title

bar.


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Figure II-2 : Calculation planes selection box

Double clicking on the line corresponding to a slice in the selection box has the

meaning of a demand to modify the selected slice Si (cf.: § IV, iSis3D - Slice Menu).

The box for the selection of the calculation plane is permanently displayed while not in

the mode creation/modification. It can be displaced or made an icon, but it cannot be

nether resized nor deleted.

II.4.3 Box for selecting the beam

The box for selecting the beam (Figure II-3, Figure II-4) is made up of two area:

o the first lists horizontally the names of all the beams of the current study and

allow to define the display options.

o the second makes the correspondence between each beam and its activity

status. It specifies as well if the weighting factors of the following line are

expressed as “theoretic” or “effective” (cf.: § VI, iSis3D - Beam Menu), and allow

to define weighting factor.

The name of the current slice is recalled in the upper left part of the box for

selecting the beam. The name of the current beam is highlighted, it is the beam

which will be taken into account by the functions accessible from the BEAM menu.

The current beam is traced with red and has a more complete representation in the

graphical window than the other beams of the study.


iSis 3D - V 2.35 - March 2003 II-19

Figure II-3 : Beams selection box (1)

The name of the current slice is recalled in the upper left part of the box for selecting

the beam. The name of the current beam is highlighted, it is the beam which will be

taken into account by the functions accessible from the BEAM menu. The current beam

is traced with red and has a more complete representation in the graphical window

than the other beams of the study.

The display mode for non-coplanar beams or for non-transverse planes can be

selected in a pop-up list that offers three options : “all”, “none” and “ax/pt” for the “axis

and the intersection point between the axis and the plane”. The only available options

for the display of coplanar beams on transverse planes are “all” and “none”.

The beam display modes are explained in detail in the paragraph II.4.4, Graphical

representation of beams

The selection of the current beam is done by a simple mouse click. A double click has

the meaning of a demand to modify the selected beam. A simple mouse click on the

current beam cancels this property, as a consequence no beam is at that moment the

current beam, and only the option “New”, from the BEAM menu is accessible.

For the current slice, the status of the beam is shown in the second line of the box

(Figure II-4); the beams for which a dose calculation was done are emphasized by

shaded rectangles. In this case, the buttons, pressed or not, indicate the activation

status of each beam.

The “calculated” beams are traced with thick green lines in the graphical window of the

corresponding slice.

The calculated beams can be activated all with the button “All”, while the current

beam can be activated and in the meantime all the other beams deactivated with the

button “Curr. B”.


II-20 iSis 3D - V 2.35 - March 2003

Finally every beam can be activated or deactivated individually (Figure II-4), clicking

on the button which shoes the activation status of the beam. The individual

activation/deactivation become effective only after clicking with the mouse on the

validation button located in the lower left part of the box (“Display isodoses for

beams:”).

Figure II-4 : Beams selection box (2)

It is possible to search the best combination of the weighting factors, which gives the

desired dose distribution, editing directly the weighting factors values in the

corresponding fields. The introduced values are validated by touching the Tab button

(or clicking in a different field) and immediately accounted for.

When the maximum capacity of the box (11 beams) is exceeded, an arrow appear

allowing to analyze all the defined beams.

II.4.4 Graphical representation of beams :

The graphical representation of the beams depends on the nature of the beam :

coplanar or non-coplanar, the nature of the calculation plane : transverse or non-

transverse, and the status of the beam : current or not, calculated or not.

The current beam is always drawn with red. The rest of the beams are drawn with

green (for calculated beams) or white (for not calculated beams). Furthermore, the

calculated beams are drawn with lines of double thickness.


iSis 3D - V 2.35 - March 2003 II-21

In general, the following elements are drawn (cf.: § VI.1.3, iSis3D - Beams Menu –

Beam Parameters) :

• the beam axis,

• the reference point,

• the weighting point,

• a legend reminding, among other things, the beam index,

• the limits of the primary collimator,

• the field limits,

• the presence of a wedge if there is any.

a) Graphical representation of coplanar beams in transverse planes:

When a beam is coplanar and the plane is transverse (Figure II-5), the drawing

corresponds to a truncated cone with a divergence that depends on the field size and

the source-isocenter distance. For the current beam, the field limits are extended

beyond the reference point (by 25cm in SAD mode and by 40cm in SSD mode) and

the field shape follows the external contour. Otherwise, the field limits are drawn up to

the patient surface and the field shape is not drawn at all. The field limits are drawn

using dashed lines, the field shape is drawn using solid lines and the beam axis is

drawn using a solid line on the reference slice and a dashed line on any other slice.

In the case of irregular shaped fields, the drawing of the field limits is enhanced using

“T”-shaped bars perpendicular to the beam axis illustrating the distance between the

limits of the primary collimator and the border of the irregular field. The field shape is

shown using two drawings: the first one shows the limits of the primary collimator

using dashed lines, the second one shows the shape of the irregular field using solid

lines (Figure II-6).

The reference point is represented by a crosshair having the form of a « ». The

weighting point is represented by a crosshair having the form of a « » (Figure II-6).


II-22 iSis 3D - V 2.35 - March 2003

Figure II-5 : Coplanar beams into a transverse plane (1)

In the case of irregular shaped fields, the drawing of the field limits is enhanced using

“T”-shaped bars perpendicular to the beam axis illustrating the distance between the

limits of the primary collimator and the border of the irregular field. The field shape is

shown using two drawings: the first one shows the limits of the primary collimator

using dashed lines, the second one shows the shape of the irregular field using solid


The reference point is represented by a crosshair having the form of a « ». The

weighting point is represented by a crosshair having the form of a « » (Figure II-6).

The legend denotes the name of the treatment machine and the Source – Reference

Point Distance (SAD or SSD). In case of collimator rotation there is an « R » added on

the legend (Figure II-6).

Coplanar Beam (not the current one) : color is white, field shape is not drawn, field limits are drawn up to the patient surface, beam axis is not on the slice.

Coplanar beam (current beam) : color is red, field shape is drawn, field limits are extended, beam axis is on the slice

Coplanar Beam (not the current one) : color is white, field shape is not drawn, field limits are drawn up to the patient surface, beam axis is on the slice.


iSis 3D - V 2.35 - March 2003 II-23

Figure II-6 : Coplanar beams into a transverse plane (2)

When a wedge is being used, there is a triangle drawn on the beam axis, just outside

the external contour, oriented according to the wedge orientation (cf.: § VI.1.3, iSis3D -

Beams Menu, Beam Parameters, Wedges). The following figure presents the 4

available wedge orientations (provided that the collimator rotation is equal to 0°):

“right”, “left”, and “gantry”, “target” (Figure II-7).

When a compensator is being used or when the beam intensity is being modulated

(e.g. using a dynamic multileaf collimator), a line segment is drawn perpendicular to

the beam axis indicating that this is an Intensity Modulated Beam (Figure II-8).

Bars indicating the difference between the primary collimator limits and the irregular field limits.

Reference Point

Weighting Poin

« R » indicating a collimator rotation


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Figure II-7 : Wedge representation

Figure II-8 : Intensity Modulation with Compensator or MLC

Right orientation Wedge

Left orientation Wedge

Target orientation wedge

Gantry orientation Wedge

Intensity Modulated Beam by physical compensator or dynamic collimator


iSis 3D - V 2.35 - March 2003 II-25

b) Graphical representation of non-coplanar beams in any type of planes (transverse or

non-transverse) and representation of any type of beams (coplanar or non-coplanar) in

non-transverse planes:

When the beam is non-coplanar or the plane is non-transverse, the beam is

represented by its intersection with the plane, limited by the external contour. The

irregular fields are drawn using solid lines and the primary collimator using dashed


Figure II-9 : Plane perpendicular to the beam axis of an anterior beam

The beam axis projection is drawn with a solid line when the axis is situated on the

observer’s side, with a dashed line when the axis is situated to the other side. A circle

marks the intersection point between the beam axis and the plane. The drawing is

extended up to the reference point if the later is located beyond the point of

intersection with the plan.

Structures (dashed)

Primary Jaws (dashed)

Irregular Field Shape (solid)

Circle indicating the intersection of the beam axis with the plane


II-26 iSis 3D - V 2.35 - March 2003

The legend associated to the beam, is located close to the external contour when the

drawing of the beam axis extends beyond the contour, otherwise close to the

intersection point between the beam axis and the plane.

Whenever there is a collimator rotation an « R » is added on the legend. A « B » is

added when a bolus is being used, a « P » is added when a trimmer is being used, a

« C » is added when a compensator is being used and a « M » is added in the case of

Intensity Modulated Beams.

Wedges are represented by a 3D dihedral having its base perpendicular on the beam

axis. Those points that are found in front of the representation (i.e. foreground) are

surrounded by a circle and the line segments that link them are drawn with solid lines

while the segments located behind the representation (i.e. background) are drawn with

dashed lines.

Figure II-10 : Non coplanar beam into transverse plane

NOTE : During the graphical representation of coplanar beams, it may happen at the

field edge, that the truncated cone appears to be closed but a field shape is being

drawn. This is the case when the beam limits do not intersect the external contour due

to the beam divergence: the truncated cone appears then to be closed, but there is still

an intersection between the beam and the representation plane.

Wedge

Extension of the beam axis projection from the intersection point to the reference point


iSis 3D - V 2.35 - March 2003 II-27

II.4.5 Management of the images and the box for adjusting the image contrast

The images to appear on the screen and serve as basis for the contours definition

must have been previously converted to the format ISIS 3D. These images should

exist as “with threshold” (or “calibrated”). According to the options valid at the moment

of the translation they were converted, but as well as “raw” images (Figure II-11).

Figure II-11 : Gray level selection

In the images with threshold are preserved only 64 gray levels, regularly distributed

between the low level and the high level chosen during the conversion. These levels

are by default (in the Hounsfield scale) between -1000 and +3000.

To benefit of a better image quality, the raw image can be saved during the image

conversion. In this case is occupied more space on the disk and the times of access

are longer but all the information present in the original image will be preserved. The

idea is then, before the display, to cutout a part of the raw image density scale and

rescales it in 64 levels. The choice of this density region belongs to the user, as well

as its moment and is free of constraints, and is done entering the mode high

resolution. This mode is particularly useful for the brain images, where the contrast is

generally low.


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The adjustment of the image contrast on the screen is done with the function

level/window (cf.: § VIII, iSis3D - Display Menu) which opens a box for adjustment

(Figure II-7). This box for adjustment, described in the chapter DISPLAY menu, makes

the correspondence between the selected density intervals (or Hounsfield numbers)

and a gray scale, going from white to black. The adjustment box for the image contrast

remains permanently open, so that the user has all the time “at hand” the tools

allowing him to adjust the quality of the display according to his wish.

Figure II-12 : Level / Windows adjustment box

II.4.6 Box for the management of the list of isodoses

This box (Figure II-13) contains the current list of isodoses. The values displayed by

default are either “standard” values, calculated automatically from the dose values of

the current plane, or ”initial” values, predefined by the user in a given protocol.

The user can modify (button Change) or delete (button Kill) individually, the value of

each isodose. Other buttons allow going back to the “standard” list or the “initial” list


iSis 3D - V 2.35 - March 2003 II-29

and redrawing all the isodoses. A button allows adding isodoses, while a list permits to

define their colors to be displayed on the screen. Finally, a button permits to close this

window.

Figure II-13 : Isodose management box

II.4.7 Options box for the calculation of the voxel’s volume

ISIS 3D offers the possibility to choose the calculation options for the voxel’s volume,

the DRR’s and the dose calculations in voxel/voxel heterogeneity, in order to allow the

user to optimize the quality/speed ratio. The dialog “Options DRR and voxel/voxel” is

systematically proposed since the first calculation of the DRR or since the first

calculation of voxel/voxel doses performed after the opening of the folder or after the

modification done on the slices data affecting the external contours.


II-30 iSis 3D - V 2.35 - March 2003

It is equally accessible within virtual simulation, by the push-down menu

“DRR/options…” and within the “Calculation options” dialog by the “Options…” button,

which is activated if the heterogeneity correction voxel/voxel option is chosen.

At the first opening, the option box contains the default parameters adapted to the

study and to the used workstation. When the study is retaken, the parameters used

from the preceding session of the same case are preserved.

Once the options are modified, all the dose calculations should be performed again

excepting for the already reconstructed DRR’s, which are saved.

CHARACTERISTICS OF THE VOXEL’S VOLUME

The characteristics of the voxel’s volume, influences the calculation of the DRR’s and

the voxel/voxel calculations.

- Dimensions of the images XY (pixels) (not adjustable)

The numbers of image pixels on X and on Y (slices) are used for the construction of

the voxel’s volume.

- XY reduction factor

Ratio (integer) between the X and Y dimensions of voxel volume « images » and

original images.

Ex: Dimensions of the images XY (pixels) : 512 x 512

If Factor = 1 (high resolution), the dimension of the voxels volume: 512 x 512 x Z

If Factor = 2 (medium resolution), the dimension of the voxels volume: 256 x 256 x Z

If Factor = 4 (coarse resolution), the dimension of the voxels volume: 128 x 128 x Z

By default: 1 for the stations having 128 MB RAM

2 for the stations having less than 128 MB RAM

- Adjacent images having the same thickness (not adjustable)

Information field (yes or no) indicating if the slices are homogeneous. If affirmative, the

volume reconstruction time is diminished.


iSis 3D - V 2.35 - March 2003 II-31

Figure II-14 : DRR and Voxel options box

- Number of voxels in Z

Number of equidistant “images” recalculated for constructing the voxel’s volume.

By default: - nbcoup (number of slices) if the slices are homogeneous

- nbcoup*2-1 if the slices are non-homogeneous

Validity: from 1 to 198

- Volume Dimension (voxels) (not adjustable)

Recapitulative of the dimensions of the reconstructed volume (in number of voxels)

following the precedent definition of parameters.

- Dimension of one voxel (mm) (not adjustable)

Recapitulative of voxel dimensions in millimeters, following the precedent definition of

parameters.


II-32 iSis 3D - V 2.35 - March 2003

CALCULATION OPTIONS FOR THE DRR’S

- Calculation step (mm)

Not used for sampling the points on the source -> target segment (point of the DRR)

By default: half of the smaller dimension of a voxel

Validity: minimum 0.01 mm

- Sharpness factor (dim vox/dim pix)

Ratio, between the dimension of a voxel and a dimension of a DRR pixel, allows

modifying the grain sharpness of the DRR. The image resolution is getting better as

this ratio is higher, but the DRR generation time is longer.

By default: 1.00

Validity: real number (preferably between 0.5 and 2)

- Dense tissues threshold (Hounsfield)

Starting value from which one point is considered dense for the DRRs reconstruction

of the dense tissues and DRR soft tissues.

By default: 350 (parameters file)

Validity: 0 to 2900

CALCULATION OPTIONS VOXEL/VOXEL

- Calculation step (mm)

Not used for sampling the points on the source -> target segment for the calculations

in voxel/voxel heterogeneity.

II.5 Print

The printing of most types of windows is possible at any time, either by pressing the

button "print", or selecting the item “print current plane” from the file menu. The

presentation of the document on paper is very close to what you see displayed on the

screen, according to the principle "WYSIWYG" ("what you see is what you get"),

keeping a strict control of the scales. At each print command, a confirmation box is

opening, allowing to select the output peripheral, and to specify a certain number of

options. The printing is always done as “background printing”, so that the user to

continue his work without having to wait for the end of the job printing. All paper


iSis 3D - V 2.35 - March 2003 II-33

formats are compatible, especially A4, A3, and A2. In some cases, more windows can

be printed on the same page, under the control of the operator.

The texts (tables, lists) can be directed, according to the choice, to “text” printers

(alphanumeric) or graphic printers but the graphics can only be directed to graphical

printers (HPGL or Postscript for example). The images are as well printed when the

printer allows it (Postscript).

It is as well possible to start printing globally an entire study, choosing the elements we

want to be effectively printed. In this case should be selected the item “Print study”.

The detailed description of the printing process control can be found in the paragraph

dedicated to the issue "Print study" from the “File” menu.

II.6 Concept of “zone”

The operations of creating or deleting a study, contours or beams import, beams or

doses export, creation from images, etc. make use of the concept “zone”.

A zone is a location identified by a name chosen by the user, where he can regroup

according to his wish the files or other elements for a better organization of his work.

From the advantages of this organization we count just the following:

o possibility to regroup the studies by zones in view of retrospective studies (for

example “breast” zone, “stereotactic” zone, “conformal” zone, zone “Dr. Dupont”,

…),

o possibility to use directly files or images located on other media (the case of

many drives) or on another network node,

o possibility to “import” elements (images, contours, beams) originating from other

applications and located on other media or on another network node: it is for

example the case when a file is destined to a virtual simulation station (e.g.:

"Advantage Sim" of GEMS, or "Acqsim" of PITKER)

o possibility to create libraries of contour types (phantoms) or beam configurations

in zones specially dedicated to this, and to “import” them in order to facilitate the

creation of new studies.


II-34 iSis 3D - V 2.35 - March 2003

The definition of new zones (regions), their path, and the associated authorizations are

to be done in a parameters file, created at the installation which may be later adjusted

(cf.: Appendix B2, Access Zones file).

II.7 Statistics of activity

A file of “statistics” can be created and updated systematically at each file closure,

in order to have available at posteriori information on the use of iSis 3D.

This file contains, for each study, information such as the patient and the calculation

identifications, the number of contours or beams.

This file can be then accessed by a text editor or exported to a program for database

management to extract from it useful information on the activity of preparing treatment

plans.

II.8 Digitizer

The digitizer is a device use to acquire manually contours (anatomical contours,

complex field) from film or other supports.

The digitizer is divided between 4 areas :

• One working area using the most surface of the digitizer, in which one the

objects are acquired (contours, ...),

• Three dialog areas, these area could be located in one of the corner of the

working area, this depend of the model and configuration of the digitizer. On

ACCUGRID digitizer the dialog area are replaced by button on the cursor. In this

case the area named CALL doesn't exist anymore.

This areas are :

o CALL (Not used with ACCUGRID)

o CORRECTION (button N° 2 on ACCUGRID)

o END OF WORK (button N°4 on ACCUGRID)

An acquisition sequence can consist of the acquisition of several objects (external

contours, internal structures, free markers, ...), all this objects should be located inside

the working area.


iSis 3D - V 2.35 - March 2003 II-35

- Call :

An acquisition sequence is controlled by messages displayed in the dialogue zone in

left bottom corner of the visualization window.

E.G. : Plot middle of table - absolute origin - C1

Plot contour C1, at the end do "END OF WORK"

Plot marker 1 of contour C1,

etc....

The points are acquired by positioning the pointer (the pen or cross of the cursor) on

the point to acquire and by pressing the pen or the button of the cursor).

A point will be valid only if a short sonorous signal (bip) is emit. A long bip indicate the

needed to get this point one more time. A message is displayed in the execution

program window.

- Correction :

It is possible to correct the point that you have just acquire if you think that it is a wrong

point.

To do this, you have to click in the correction area then get this point one more time

If you click twice in the correction area, you delete the current contours, then you have

to acquire all the point for this contours.

- End of work :

One click inside this area tell to the computer that the object is completely acquired

and that we want to go to next step of acquisition.

When several object can be successively acquired, a simple click inside END OF WORK

area achieved the acquisition of this object, when the last object has been acquired a

double click inside END OF WORK area achieve the sequence.


II-36 iSis 3D - V 2.35 - March 2003

II.9 Matching images (option)

II.9.1 Principle

The use under ISIS 3D of two images series belonging to the same folder (study case)

makes possible the elaboration of a treatment plan with the support of different nature

images (Scanner/MRI, Scanner/fusion,…). The user can switch from one series to the

other one, according to the specific needs of each elaboration phase (contouring,

beam creation, dose visualization).

WARNING !

In order to be able to use two image series it is suitable to previously have

rescaled the images with appropriate external software (for example an image

analysis workstation). One distinguish the main image series (generally scanner

slices), which serve as basis for the matching, and the matched image series

(usually MRI slices), whose geometrical characteristics (orientation, position,

thickness of the slices) were recalculated in order to be identical to those of the

principal image series.

It is up to the user to ensure that it effectively works with compatible image

series.

II.9.2 Format of the series

In order to jointly be used under ISIS 3D, the two image series should respect the

following constraints:

o the names of the image folders should be in “name_series” and

“name_series_r” forms, where the full character strings should have a length

less or equal than 16 (or a maximum of 14 characters for series_name before

adding the “_r” suffix).

o The image folders should be found in the same image “zone”.

o Within these 2 folders, the image files should bear the same names if they

belong to the same slice, so as to find the correspondence of the image

couples. (cf : Technical documentation – Descriptive of files – 10.5 module of

homogenization the file names of two image series).


iSis 3D - V 2.35 - March 2003 II-37

II.9.3 Utilization

The existence of the two image series is detected after one study is created and

specifically at the moment when the choice regarding the images is taken into account.

This happens again when the study is retaken. It is possible in most of the cases when

an image is displayed (slice or restored plan), to switch immediately between the

principal image and the corresponding rescaled image. This switch is obtained by

selecting the “Matched Images” item from the “Display” menu. It is equally obtained by

pressing simultaneously the “Ctrl” and “r” keys (with lowercase “r”).

Despite the existence of the two series, certain functions are applicable only to the

principal images: calculation of the densities, calculations voxel by voxel, calculation

and representation of the Digitally Reconstructed Radiographs (DRRs).

II.10 DICOM RT exchanges

ISIS 3D offers the possibility of importing and exporting data concerning contours and

beams according to the DICOM RT standard.

Objects of “DICOM RT Structure” and “DICOM RT Plan” are supported.

• With regard to the importation, a server is permanently available for the

reception of DICOM RT objects. When the server receives a DICOM RT object,

the later is being converted to ISIS format and saved in files having the name of

the patient followed by the study number and the extension “.CTR” for the

contours and the extension ".FSC" for the beams. These files are saved in a

predefined directory (see "ISIS 3D – technical documentation – DICOM

module"). It is then recommended to create a new folder inside ISIS 3D and

“import” the contours and beams corresponding to the DICOM RT objects either

into a new study (cf.: § III.1, iSis3D - File Menu, New) or into a currently used

study (cf.: § III.13, iSis3D - File Menu, Import).

• The exportation of DICOM RT objects can be done inside ISIS 3D using the

following commands: File Menu -> Export DICOM RT, Contours/beams. The

principle of the operation is described in the paragraph III.14.2, File Menu,

Export DiCOM RT Contours/beams.


II-38 iSis 3D - V 2.35 - March 2003

CHAPTER III - FILE MENU

iSis 3D - V 2.35 - March 2003 III-1

III. FILE MENU

The file menu proposes the following items:

- New...

- Open...

- Close...

- Save...

- Kill...

-----------------------------------

- List of slices...

- List of beams...

- Treatment times...

- Dose / Volume Contribution…

-----------------------------------

- Print current plane...

- Print study...

- Eject sheet

-----------------------------------

- Import >

- Export >

-----------------------------------

- Quit

III.1 New

The choice New is accessible only if no file is in use. It allows the creation of a new

study in a specified “zone” and gives the possibility to import some elements like the

contours or the beams from already existing files.

III.1.1 Creation of a new study starting from zero

- Create on allows to choose the zone where the study will be saved (Figure III-1).

The patient data file includes the following fields:

• Name: alphanumeric string

• First name : alphanumeric string

• File number : alphanumeric string

• HOSPITAL : scrolling list


III-2 iSis 3D - V 2.35 - March 2003

• PROTOCOL : scrolling list of "protocols"

Default file name chosen from Name or File Number

Figure III-1 : New study creation box

Once the NAME of the patient is introduced, the apostrophe “ ‘ “ and space “ “

characters are automatically replaced by the dollar $ and underline “ _ “ characters,

because the apostrophe truncates the name of the patient at the display, and the first

space character is considered as a separator between the surname and name of the

patient. The inverse correspondence is established after the export of the beam data.

The keyboarding of the File NUMBER could be optional according to the setup of the

customization file.

The Hospital is initialized with the value of the first hospital found in the library. It can

be modified in order to access the machines of other hospital in the library.

The other data given in the patient data file serve mainly to identify the study to be

created and to propose by default a file name.

Following the chosen option: (Name or File N°), the current study will have by default,

during the first saving procedure, a name based on either of these element. This



possibility is particularly useful when having homonymy problems with the names of

the patients, and is preferable to use the file numbers. The option selected by default

can be set as a parameter at the installation.

With Ok and Import is tested if it exists another study with the same name. If it exists

another study with the same name, the file description, is presented, including patient

name, file number and name, date and the time of the study, comments, ...) and the

user may confirm or refuse the replacement of the previous file.

Remark : Even if the replacement of the file is being asked, this will become effective

only in the moment the file will be saved. It cannot be performed neither if the study

name is modified during the procedure of saving nor if the file is closed without being

saved (cancellation of the file creation). In any case, each time a file with the same

name exists, a confirmation message (or modification message) is displayed in order

to warn the user. This message appears in both cases: when saving ("Save") the

study or closing it ("Close").

The choice of a Protocol makes available, for the next stages of the study, a list of

particular structures, and a list of isodoses, proposed by default. These lists are to be

defined by the person who performs he installation or by the user in a file containing

the studies’ parameters (see the document describing this file). In the case the

contours are imported, only the list of isodoses of the protocol is used, the list with the

structures associated to the imported contours being dominant over the one of the

protocol.

The button Cancel permits to cancel the current procedures.

After confirming by pressing the Ok button, the menu Slices becomes accessible and,

if there is place, the boxes for selecting the calculation plane and the beams are

displayed.

III.1.2 Importation of external elements

The button Import allows the import in a new created study of contours or beams from

the same zone or a different zone, no matter what is the name of the corresponding

files. This function may be useful in the following cases:



Figure III-2 : Object selection box

• systematic studies based on the same contour(s), stored forever in a particular

“zone”,

• recover the contours or the beams created by an external application (linked to

other “stations for virtual simulations” or with system for recording/verifying the

parameters),

• recover “standard configurations” (for example 4 beams in the “box” technique)

stored forever in a particular “zone”,

• recover in a new file the elements already used for other studies (creation of a

demo file, recover after an identification error).

From Import... a dialog box is opening (Figure III-2), including the following elements:

The type of the object to be imported is indicated by a scrolling list: Import. The

importable objects are the Contours and the Beams, in a format specified by the

scrolling list. Actually only the objects in format ISIS are directly importable.



After having eventually selected the region of interest (From), the whole group of

objects present in the region and conforming to specific criteria (type, format) and the

date of their last save are displayed, with an informative notice about the number of

found objects and the searching pattern (for example *.fsc for the beams). The

corresponding list may be displayed either in ascending alphabetical order, or in

descending date order, according to the selected option button).

The selection of a particular button can be done in two ways:

• scrolling the list and selecting the object with the mouse,

• typing the first letters of the object in the field Selection. The list will be

automatically positioned on the firs name which begins with these letters.

The rubric Import into recalls the name and the zone of the file where the objects will b

imported.

The objects can be visualized before the importation by clicking on View..., which

opens the files Header and list of slices and Beams description, for the objects type

contours and type beam respectively.

The import is effectively realized clicking on the button Import or double clicking on the

list. An informative message recalls then the type and the name of the imported object

as well as the file where to the import was done.

The import to the same contours and beams file requires two stages. The first

consists in selecting and importing the first object (either contours or beams, it makes

no difference). The second stage consists in changing the type of the object to be

imported - if it exists, the object with the same name will be selected - and start the

importation.

Once finished the procedures of visualization and import, pressing the button Close

permits to go back to the dialog for creating a new file.

Remarks :

• The object importation is irreversible, there isn’t any “cancel” function. However,

a new importation that will replace the previous one can always be performed.



• While attempting to replace a folder by specifying a folder name that already

exists, even after the initial confirmation by the user, for security purposes, there

appears a second dialog box offering the possibility to restore the existing

contours and/or beams. If the user refuses to restore them, then the new

contours and/or beams may be imported. They will overwrite the existing ones,

even if the folder creation is subsequently abandoned.

• Contours and/or beams can also be imported while a study is in progress. In that

case they are added to the existing contours and/or beams. (cf.: § III.12, iSis3D

– File menu, Importing contours and beams )

III.2 Open

Open is accessible only if no file is in use. It permits to select a patient file from a list of

files located in a certain “zone” (Figure III-3).

After having eventually selected the region of interest (scrolling list), the whole group

of studies, previously saved in the region, and the date of their last save are displayed.

The corresponding list may be displayed either in ascending alphabetical order, or in

descending date order, according to the selected option button.

A particular file can be selected in one of the following two ways presented below:

• read the list and select the file with the mouse (double click to open);

• type the first letters of the chosen file. The list is automatically leading to the first

name starting with these letters. Once having reached the file press OK.

After having selected the name of a file (= study name) and then clicked on the Ok

button, the file is going to be opened and displayed in the stage is has been saved.

According to the customization file, the date of backup of the file and the disk capacity,

the result of dose calculation could be or could not be , recover (cf. : § VII.1.4, iSis3D -

Isodoses menu, Saving the dose calculations). In all cases the automatic calculation

option is deactivated.

At the opening of file the user is inform of the possible presence of 2 series of

matching images (cf.: § II.9, iSis3D - General Principles, Matching images). A

message window give the name of the primary series and specify that the density



calculation, DDR and voxel/voxel heterogeneity will be calculate from the primary

series.

Figure III-3 : Study selection box

If the options corresponding to the open study are not found, we can either Continue

without images, or Find the images in the same region or in a different region.

The message "images not found" indicates that the folder with the image files

associated with the study has been found but at least one image (sometimes all of

them) cannot be associated. For example this is the case when certain files containing

these images have been renamed or deleted.

Remark 1 : A fast access to list of studies has been set up. This fast access could

lead to absence of studies in the list. In this case you should select again the zone to

refresh the list of studies.

Remark 2 : The number of folders that can be listed in the corresponding list is limited

to 1000. Whenever this number is almost reached it is recommended to archive some

folders or move them into a new zone.



Remark 3 : Opening a folder that has been saved using an older version of ISIS3D

(older than version 2.3) may cause a modification of the beam weighting method. This

may happen in the following cases:

In SAD mode, if the weighting point is not the isocenter, then a new Point Of Interest is

created in the place of that point. The weighting method becomes “weighting on a

Point Of Interest” using an “effective contribution”.

For electrons, in SSD mode, the weighting depth must be equal to the depth of

maximum dose. If the specified weighting method was “theoretical”, then it will become

“effective”.

If the case arises, an information message will clarify any modification that has taken

place, concerning the weighting mode/type, the weighting depth and/or the creation of

“Points Of Interest”.

III.3 Close

allows to close the current study in order to be able to create or open another study.

If important changes have been made to the study since its last save, a confirmation

box will open to allow to effectively close - without saving - (Ok), to go back to the

current study (cancel), or to save the file before closing. In this last case, the dialog of

the Save.

Otherwise, if the study is closed, the characteristic data set the of the eventually

incomplete study is printed and only the principal menu bar remains on the screen.

Remark : to access the dialog of the box Save… with the function Close… allow to

rearrange the slices (cf.: § III.4, iSis3D – File menu, Save).



III.4 Save

The dialog box for the saving of the files (Figure III-4) includes :

Figure III-4 : Save study box

• it recalls the zone where it was saved, the name and the number of the patient

file,

• it recalls the properties of the last saving (plan name, date and time of the last

modification performed and comments),

• the possibility to save as under a new name of the Study name and to modify

the comments.

The field study indicates by default the name of the last saved study. If the old file

name is preserved, the old study plan will be replaced (so the corresponding data will

be lost) after confirming the option in the dialog box. On the contrary, a new name can

be proposed to save another version of the treatment plan. This name will be used to

open the study. It can be different from the name of the file which contains the images.


III-10 iSis 3D - V 2.35 - March 2003

the field comments allow to introduce a text relevant to the study and will appear on

the output documents (it has maximum 72 characters). This field takes by default the

commentaries of the last saved study.

two buttons are dedicated exclusively to save the study with slices filing by

increasing Z. (the slice with the smallest Z becomes C1) or without filing. This

choice is not accessible when the slices are arranged.

Remark : The rearrangement of the slice requires to close and open again the study,

hence this possibility is recommended only when the saving dialog box is open in

the moment of closing the file (File/close... then press the button Save... of the

confirmation box); by File/Save..., the rearrangement of the slices is not

accessible.

Controls are performed by asking the user to press the Ok button to confirm the

eventual replacement of an already archived file (including the case of an update of a

file under the same name). Each saved study corresponds to a different file. To save

more than one study, different names should be used. In case of coincident names the

study is effectively saved, the characteristic data set the of the eventually incomplete

treatment plan is printed and the save dialog is closed.

On Cancel, the study saving is given up.

In the case that problems appear during the process of saving a file, a dialog box

signaling the failure of the process appears.

The user has two options:

• Restart the procedure,

• Interrupt ISIS 3D, search the source of error (the disk is full…) and restart ISIS

3D answering Yes to the question Recover interrupted study ?.

III.5 Kill

permits to delete one or more files from a given zone.

Kill... is accessible only if no study is loaded.


iSis 3D - V 2.35 - March 2003 III-11

Figure III-5 : Deletion studies box

After having eventually selected the region to be deleted (scrolling list), the whole

group of studies, previously saved in the region, and the date of their last save are

displayed. The corresponding list may be displayed either in ascending alphabetical

order, or in descending date order, according to the selected option button.

A file is selected with a simple mouse click and its name is recalled in the field "File to

be deleted”.

The combination Caps/small fonts + the left button of the mouse permits to include in

the selection all the files between the first selected file and the current position of the

mouse.

The combination Ctrl + the left button of the mouse permits to add files to the current

selection.

The name of the file to be deleted can be introduced from the keyboard, the character

“*” allowing to select the files having in common a part of their name. For example,

*dupon* will select to be deleted all the files 1dupond, dupond, dupont…

Remark : The selection of many files from the list and marking a file name are

mutually exclusive.


III-12 iSis 3D - V 2.35 - March 2003

If clicking on Ok or Kill a dialogue box will be displayed, presenting the name(s) of the

file(s) to be deleted and proposes to perform or cancel the delete procedure.

III.6 List of slices

displays a window with the principal characteristics of the slices included in the study.

Printing of the list into the chosen peripheral text (cf.: § III.9, iSis3D – File menu, Print

current plane), is done thank to the Print button.

The Ok button permits to close the window

For more details see ,§ IV.1, iSis3D - Slices menu, header and list of slices and figure

IV-1.

III.7 List of beams

displays a window (Figure III-6) describing in a table format the detailed description of

the beams of the study (cf.: § VI.1.3, iSis3D - Beams menu, Beam parameters).

Figure III-6 : List of beams

If there are more than 8 beams, the display (and printing) is done on more than one

page, and to pass from one page to another is necessary to use the buttons next or

previous (materialized by an arrow < or >).


iSis 3D - V 2.35 - March 2003 III-13


current plane), is done thank to the Print... button.

Pressing the Ok button allows to close the window.

Remark 1 : In case of electron beam, asterisk is displayed beside weighting point

depth in both following cases :

• Technique is not SSD

• Weighting point depth is different as the maximum depth

Remark 2 : In SSD technique, asterisk is displayed beside collimator size if SSD is

different as SAD.

Remark 3 : If the weighting point is not located on the collimator axis, then an asterisk

is displayed in the place of the weighting depth.

Remark 4 : The contribution (“theoretical” or “effective”) that does not correspond to

the specified type is being displayed within brackets.

Remark 5 : The contribution type (“in depth on-axis”, “at the depth of dose max.”, “on a

Point Of Interest”, "at isocenter") is being reminded

III.8 Treatment time

In the case the doses per fraction were defined for at least one of the beams (see

Dose per fraction of the Beams menu) it is possible to display a table (Figure III-7)

giving for each of the beams the time or the number of monitor units to display

(Display). This table recalls as well a certain number of beams characteristics, which

influence the calculation of the treatment time. Finally, the depth of maximum on the

axis (Depth mx) is displayed, in cm, and the dose per session at this point (Th dose

mx) in Gy.

From ISIS 3D-Version 2.3 it is possible to define a weighting point either on the beam

axis, or off-axis on a Point Of Interest. The calculated dose per fraction (Dose T)

corresponds to this weighting point, defined during the creation/modification of beams.


III-14 iSis 3D - V 2.35 - March 2003

Figure III-7 : Treament time

• For photon beams and for “on-axis weighting ”, it is expressed in terms of

either a “theoretical” dose (without taking into account the influence of blocks

and/or tissue heterogeneities) or an “effective” dose (accounting for blocks

and/or tissue heterogeneities), according to the selected option for each beam.

• For electron beams or else for “off-axis weighting”, it is necessarily expressed

in terms of an “effective” dose. The various correction factors, accounting for

the filed size (Colli), the block tray (Bl. tray), the wedges (Wedge), the blocks

for irregular filed shapes, the definition of an off-axis weighting point (

Ef/Th(hom) ), and the heterogeneities (Heter .), are also reminded. The first 3

come directly from library data. The last 2 are calculated by the system

depending on the field shape, the location of the weighting point and the

existence of tissue heterogeneities. If the dose is expressed in terms of

“theoretical” dose, then they are not taken into account and therefore they are

displayed in brackets.

For further details concerning the “theoretical” or “effective” weighting mode and their

repercussions on the calculation of treatment times, refer to § II.3.4, iSis3D - General

Principles, theoretical and effective contribution.


iSis 3D - V 2.35 - March 2003 III-15

When a bolus is associated to a beam, the bolus name is recalled (Bolus name), as

well as its thickness along the axis beam (Thickness), and its density (Density).

When bolus is use, the SSD and depth are calculated from the skin. One line

informs about this particularity.

The selected options for dose calculation are recalled.

It is remind that in case of asymmetric or multi-leaf collimator, the calculation doesn't

take in account a eventual influence from this elements on the primary dose : the

Collimator Opening Factor (C.O.F.) used is the one corresponding to the maximum

opening. Only the modification of the scatter is take in account.

The doses and the treatment time are displayed only for the beams for which have

been defined doses per fraction different from zero.

Remark 1 : The treatment for electron beams is not calculated if technique used is

not SSD. Asterisk is displayed beside weighting point depth.

Remark 2 : The weighting mode is displayed and an asterisk next to the weighting

depth is used as a reminder of the distinctive characteristics of that mode

If there are more than 8 beams, the display (and printing) is done on more than one

page, and to pass from one page to another is necessary to use the buttons next or

previous (materialized by an arrow < or >).


current plane), is done thank to the Print... button.

ATTENTION !

The validity of the treatment time calculations are the direct responsibility of the user.

This calculation is strongly dependent on the way the basic data of the treatment unit

library are introduced and interpreted. The data related to the “reference dose flow”,

the collimator opening factor, the accessories’ transmission are particularly important.


III-16 iSis 3D - V 2.35 - March 2003

III.9 Dose/volume contributions

A window appears (Figure III-8) showing a table including the dose delivered to each

“dose”-type point of interest by each beam (cf.: § IV.11 , iSis3D - Slices Menu, Points

Of Interest). These “dose points” are, in general, chosen so that they are

representative of the “volumes” of interest such as the target volumes or the organs at

risk.

These tables are used in order to separate the contribution of each beam and be able

to cumulate (either by hand or using a Control & Verify system) the dose delivered to

each volume during the treatment.

A first table shows the “absolute” dose delivered by each beam. It concerns not-

normalized values, calculated as the sum from the contribution of each beam (also

shown in the table). This table becomes particularly interesting when each

contribution is expressed in terms of total dose per beam (Gy). In that case, the sum of

each column gives the total dose delivered to each volume (Gy). All values are

rounded within 0.1 Gy.

A second table shows the “relative” dose (%) delivered by each beam to the dose

points. It’s purpose is to facilitate the task of recalculating the beam contributions when

it is necessary to express them in a different way, e.g. in terms of dose per fraction.

The treatment machine library identification, its creation/modification date as well as

the calculation options are also reminded.

The page format allows the display of only 16 beams and 9 dose points per page. If

there are more than 9 dose points, then only the first 9 will be displayed. If there are

more than 16 beams, then the absolute and relative dose tables will be displayed in

two pages.

The dose tables can be printed to the selected “text” printer using the “print” button

(cf.: § III.9, iSis3D – File menu, Printing the current plan).

The “close” button is used in order to close the window.


iSis 3D - V 2.35 - March 2003 III-17

Figure III-8 : Dose Volume contribution table

III.10 Print current plane

permits the immediate printing of the current plane.

The dialog box which appears (Figure III-9) is common to all printing request, if it

concerns a current plane, a study or a text window or graphical window. It permits to

confirm the printing option after having eventually specified certain options. It is made-

up of 4 area.

• the upper area recalls the detail of what we want to print. It is recommended to

verify carefully the agreement of this demand before the confirmation, the

according particular attention to the specification with images or “without

images”, whose consequences are important in terms of the time it takes to

print.

• the second area (Printers) permits to choose the output peripheral. Depending

on their characteristics, the peripherals have different possibilities: graphic with

or without image, text, many paper formats. So, or the graphic printer, the

scrolling list of the paper formats depends on the formats accepted by the printer

or the tracer chosen as destination. The text printer includes a scrolling list for


III-18 iSis 3D - V 2.35 - March 2003

the choice of the destination for the recapitulative files (“list of slices”, “list of

beams”, “file of the treatment time”, …). If no printer is specified, the output is on

the graphic printer. The choice of a text printer is not taken into consideration for

printing a study, or, for a homogenous presentation, all the pages come out

systematically on the selected graphic peripheral.

A name for the output file can be proposed as well (this file is temporary when

the chosen destination is a printer).

Figure III-9 : Printing box

• the third area (Options) permits to specify the objects that will appear on the

printed document (image, contours, beams,…)and if it is the case, the elements

of the study that we want to print and the desired number of copies.

If there are no images to print or the printer does not allow them to be printed,

the corresponding option is not accessible (appears gray). On the contrary, we

may want or not to print them. The other representation options refer to the

contours, the beams, and the isodoses. If the dose distribution was analyzed

deactivating some beams it is recommended to reactivate all the beams.


iSis 3D - V 2.35 - March 2003 III-19

• the inferior area contains buttons allowing to effectively start printing (Ok), to

cancel printing (Cancel), or to start saving before printing (Save...).

Remark : The drawing of the calculation planes and the virtual simulation views are in

real format (Ai) selected during the creation or modification by the Zoom function (cf.: §

VIII.7, iSis 3D, Display menu, Zoom). When the paper format of the graphic printer

allows it, many drawings may be done on the same page (for example: for a printer

with paper format A4 and the calculation plans in windows A5 => 2 drawings per

page). The recapitulative forms, the dose-volume histograms, the pages describing the

multi-leaf collimator and even the “Isodoses 3D” are always printed on A4 format. The

command draw is not given until the page is completely filled. To force the output of an

incomplete page, select the article Eject sheet (cf.: § III.11, iSis3D - File Menu, Eject

sheet).

ATTENTION !

If the command print is given before having saved a study, there is a risk to have

printed documents not conforming with the final saved file. It is recalled the date and

the time of the last modification, printed on all the documents and saved with the

study, allow to ensure the coherence of the file.

III.11 Print study

permits to start printing a series of pages corresponding to the whole current study, on

a given printer.

It is opened the previously described box to confirm the printing option. The area

Option/Contain of this box allows to specify the elements of the study to be printed. At

minimum, a study is composed of the assembly of the selected calculation planes

(identified by a cross). If the isodoses calculation was not performed for some of the

selected planes, a warning message appears.

It is also possible to avoid printing some elements of the study (such as the list of

slices, the list of volumes and points of interest, the list of beams, the dose

contribution tables, the treatment times (if calculated) and the shapes of irregular

fields) by deselecting the corresponding buttons. Other elements become available

for printing as soon as they are calculated: dose-volume histograms, dose profiles,


III-20 iSis 3D - V 2.35 - March 2003

“3D Isodose”, block shapes exported to a polystyrene cutting machine, MLC details

etc…

Remark 1 : while attempting to print the list of slices, if there isn’t any point of interest

defined, then the list of volumes and points of interest is not printed . In the same

way, the dose contribution tables are not printed if there aren’t any dose points of

interest defined

Remark 2 : To invite the user save the study before printing, a dialog recalls (if there

have been made modifications) that the study has not been saved and allows to

cancel printing.

III.12 Eject sheet

permits to terminate printing an incomplete page (for example a single A4 drawing on

an A3 page, or less than 4 drawings A6 on an A4 page). This item is gray (hence

inaccessible) if there is no incomplete drawing in queue.

III.13 Import

Displays the following sub-menus:

- Import contours...

- Import beams...

It is possible, while a study is in progress, to import contours and beams in order to

add them to the existing objects. The dialog box for importing contours and beams

during a study is similar to the previously described one (cf.: § III.1.2, iSis3D – File

menu, Importation of external elements), but the importation mechanism is totally

different since it concerns a simple addition of objects and not a global importation.

III.13.1 Import contours

Importing contours during a study offers the possibility to add structures, Points Of

Interest and slices to the existing slices. In order to avoid any confusion between the

imported objects and the existing objects, only the structures and Points Of Interest

that are not yet defined are being imported. However, there is an exception to this rule,

concerning the Points Of Interest declared as “isocenter” that are always imported


iSis 3D - V 2.35 - March 2003 III-21

(modifying, if necessary, their identification). Only those slices that do not match to the

existing ones are being created.

Once the file containing the contours to be imported is selected, a confirmation window

shows the objects that are about to be imported (Figure III-10) : list of structure names,

number of Points Of Interest, number of existing slices to be modified and number of

slices to be created (including their corresponding Z).

Figure III-10 : Demand of confirmation of structures importation (1)

In the case where there isn’t any slice to be created, there are 2 buttons, Import and

Cancel, offering the possibility to confirm or abandon the importation :

Figure III-11 : Demand of confirmation of structures importation (2)

If the structures for importation are defined on slices that do not match with the

existing ones, then there are 3 buttons, Import structures and Slices, Import

structures only and Cancel, offering the possibility to confirm the importation

accepting the creation of new slices, or to confirm the importation without creation of

new slices (in which case only the structures corresponding to already defined slices

are imported), or to abandon the importation.


III-22 iSis 3D - V 2.35 - March 2003

If all the structures to be imported already exist in the structure list of the current study,

then a message (Figure III-11) informs the user that there is nothing to import.

Remarks :

- During the creation of slices, the imported slices receive an arbitrary index.

- In order to perform a meaningful importation, it is recommended that the

coordinate systems of the existing study and the imported contours be in

coherence. Possible changes of origin are taken into account. It is still possible to

import the contours after having changed the coordinates, but with the condition

that the initial coordinate systems (generally the “image” systems) are the same.

Figure III-12 : Information about structures importation

III.13.2 Import Beams

Importing beams during a study, offers the possibility, at any moment, to add beams to

the existing beams (e.g. import a typical beam configuration or the beams of a

previous study concerning the same patient …). In order to avoid any confusion

between the existing and imported beams, the index numbers of the later are

arbitrarily modified in case of conflict.

Once the file containing the beams to be imported has been selected, a confirmation

window shows a list of the beams that are about to be imported (Figure III-13)

indicating their old and their new index. The user can confirm or abandon the

importation using the “Import” or “Cancel” buttons respectively.

Remark : In older versions of ISIS 3D (older than version 2.3), beam importation was

possible only if there weren’t any beams defined in the current study. In that case,

beam importation was resulting to a global importation of all “external” beams.


iSis 3D - V 2.35 - March 2003 III-23

Figure III-13 : Demand of confirmation of beams importation

With the Import Beams function, beams are “shifted” on the origin of the coordinate

system as this is defined at the moment of the importation. In the case of beams

defined according to the SSD technique, the entry points become the points of

intersection between the beam axis and the contours. Importing a “Beams” file that

has been created with a version of ISIS3D older than version 2.3 could cause the

modification of some beams (cf.: § III.2, iSIs3D - File Menu, Open).

In the case of beams attached to a common isocenter or associated to a Point Of

Interest defined as a “weighting point” (cf.: § IV.11, iSis3D - Slices Menu, Points Of

Interest), future treatments may be affected as follows: If the imported beam is

attached to a common isocenter, then the program searches for this point among the

existing Points Of Interest, using its identification code. If this Point Of Interest exists

and it is defined as “isocenter”, then the reference point of the beam is shifted on this

point. Otherwise, the corresponding Point Of Interest is being created. If the new

isocenter cannot be created, then the new beam is imported as a “free” beam. If the

case arises, a message informs the user that a new isocenter has been created, or

that the beam has been attached to an existing isocenter, or that the beam has been

detached from a common isocenter.

Likewise, if the weighting point of an imported beam is a Point Of Interest, then the

later is being searched among the existing Points Of Interest using its identification

code. If the Point Of Interest exists, then the weighting point of the imported beam is

being shifted on this point, otherwise it is being created. If the depth of the weighting

point (existing or created point) is valid, then the weighting method is kept. Otherwise,

the weighting method is being changed to “On-Axis weighting”, isocentric or on the

beam entry, according to the current technique. This method is also applied if the

creation of a Point Of Interest has failed. If the case arises, a message informs the

user that the weighting point has been changed or that a new Point Of Interest has

been created.


III-24 iSis 3D - V 2.35 - March 2003

III.14 Export

Display following submenu

- Beams >

- Contours/Beams DICOM RT (Option)

III.14.1 Export beams

allows to export globally all the data for the beams with multi-leaf collimators.

Sub-menu will propose following options :

to Varian's MLC…

to Elekta's MLC…

to Lantis…

to Varis RTP file…

to ISIS RTP file…

Whatever is the chosen option the system will create RTP file into the exportation

zone. This file can be automatically transferred to external system using FTP protocol.

The setup of the ftp connection is done into the file I3D_EXPORTATION.CFG (see

appendix B6, i3d_exportation file setup).

Figure III-14 : Beams exportation box

The zone where to the files are exported is as well chosen from a scrolling list (To).

The file name (without extension) is specified in the rubric File. The extension of the

file is automatically added depending on the nature of the exported objects.

A rubric "format" is designed in order to be able to specify the exportation format,

variable for certain “objects”. For the multi-leaf collimators, this rubric has no meaning


iSis 3D - V 2.35 - March 2003 III-25

since the format selection is automatic according to the function and type of the

considered collimator (= accelerator type).

The Ok button permits to start the export and to close the dialog box.

The button Cancel permits to close the dialog box without starting the export.

An informative box indicating the created file(s) is subsequently presented. The file

name proposed by default is chosen automatically in such way that it is unique. In

case of modification of the name, the export is refused if it already exists a file with the

same name.

Remark : other “objects”, as the field forms or the dose distributions can be as well

exported. The procedure is slightly different in this case because these elements are

transported file by file in the moment they are manipulated on the screen while for all

the beams of the same study (of a treatment unit) only one file was globally exported.

For other exportations, the interested reader should refer to the specific functions.

III.14.1.1 Export Beams towards a VARIAN MLC

Offers the possibility to export MLC data only of Varian beams unit only.

This option create RTP file according to the following specifications :

MLC-G and MLC-F varian file format.

III.14.1.2 Export Beams towards an Elekta MLC

Offers the possibility to export MLC data of Elekta beams unit only towards

treatment units equipped with Elekta Multileaf Collimators, using a file format that is

compatible with the following Elekta specifications:

« Elekta Oncology Systems – Philips Medical Systems Radiotherapy » « User Manual for Interfacing External Computer Systems to the MLC » Doc. No : 4522 934 12111/764, 12-92


III-26 iSis 3D - V 2.35 - March 2003

ATTENTION !

Nevertheless, there are certain constraints and limitations, specific to the Elekta

multileaf collimators, that are not explicitly taken into account by ISIS 3D. At the

moment, they do not allow to formally guarantee the validity of the exported files.

If the case arises, the refusal will come from the Elekta workstation during the arrival of

the erroneous beam. The beam should then be corrected in ISIS and re-exported

towards the Elekta workstation.

Elekta MLC constraints and limitations that are not taken into account by ISIS 3D are

as follows:

• Heterogeneity of leaf position limits

• Maximum leaf positions (absolute values)

o Leaf pairs 1 and 40 : 16.4 cm




o Leaf pairs 5 to 36 : 20 cm

ISIS-3D does not offer the possibility to have different leaf position limits for

each leaf pair.

• Minimum leaf spacing between opposite leaves and adjacent opposite leaves

ISIS-3D offers the possibility to define a minimum leaf spacing between opposite

leaves of the same leaf pair, but cannot apply the same rule to the opposite

adjacent leaves.


iSis 3D - V 2.35 - March 2003 III-27

Jaw positions

Elekta imposes that all the leaves that are completely covered by a jaw, be completely

closed and that all the leaves that are not covered by a jaw, be completely open.

Additional accessories

If an additional accessory is used in conjunction with an Elekta MLC, then it must be

included in the « accessory mount » and « accessory fitment » fields inside the Elekta

beam file. These fields cannot be updated by ISIS 3D.

III.14.1.3 Export Beams towards Lantis

Offers the possibility to export, MLC and beam data of siemens beams unit only.


"Siemens LANTIS RTP Link Interface Guide - Revision A 10/96", the version 6 and

version 7.

III.14.1.4 Export Beams towards Varis RTP file

Offers the possibility to export MLC and beam data of all beams unit.


"Open RTP " ISS1701.doc Rev 1.1 of Impac Medical System, modified according to

the Varian RTP-Exchange application, driving the communication on VARIS system.

III.14.1.5 Export Beams towards ISIS RTP file

Offers the possibility to export MLC and beam data of all beams unit.


"Open RTP " ISS1701.doc Rev 1.1 of Impac Medical System, norme CEI

III.14.2 Exporting DICOM RT Contours/Beams

Offers the possibility to export contour and or beam data towards a server that

handles DICOM RT objects.


III-28 iSis 3D - V 2.35 - March 2003

The corresponding dialog box (Figure III-15) shows a sliding list offering the

possibility to choose the name of the exportation target among those defined in the

“zones” file (cf.: Appendix B2: format of the access configuration files). The option

“Other” offers the possibility to directly type in the identification of an exportation

target that is not in the list :

Figure III-15 : Dicom RT object exportation box

Application (AE title) : "application entity title", of the DICOM target, this field is

optional.

Address : IP address of the target. This field is compulsory.

Port : Communication port number between the two applications. This field is

compulsory.

Checking on the Contours and/or Beams checkboxes allows to choose the objects to

be exported.

Ok starts the exportation ; Cancel abandons the exportation.

The exported DICOM RT objects are RT Structure and RT Plan. More technical details

are found in the document entitled : "Appendix I-2, ISIS 3D – Technical Documentation

- Conformance statement DICOM RT".

Remark : Once ISIS 3D finishes the exportation the system control is handed to the

user. If the exportation target does not respond for a long time, then it is recommended

to interrupt the application.


iSis 3D - V 2.35 - March 2003 III-29

III.15 Quit

gives the same options as Close and more, it permits to quit the application ISIS 3D

after the confirmation demand.

Remark : in case an incident occurs during the application, to recover the current

work, restart immediately ISIS 3D and answer Yes to the question Recover

interrupted study?. You can then explicitly save with Save.


III-30 iSis 3D - V 2.35 - March 2003

CHAPTER IV - SLICES MENU

iSis 3D - V 2. 35 – March 2003 IV-1

IV. SLICES MENU

Allows the creation and modification of the contours belonging to the slices of the

patient (cf.: § II.2.1, iSis 3D - Reference system and convention for imaging

equipment) , and it gives access to the following functions:

- Header and list

- Create from >

- Change...

- Duplicate/Adjust...

- Kill

--------------

- Origin...

- Z Opposed

--------------

- Structures/Bolus...

- Expansion...

- Volumes...

- Point of Interest

The submenus Create from and Modify lead directly or indirectly to the phase of

Creation/Modification of the contours. Recall that it is the same as double clicking in

the box for the selection of the calculation plane.

Remark : After creation, modification or killing a slice, the calculations must be

restarted for all the slices.

IV.1 Header and list of slices

Displays a dialog box composed of 4 parts (Figure IV-1):

The first part allows the study identification.

The second part presents the header of the SLICES FILE, composed of the following

fields:

• Patient name : is the name introduced at the moment of the file creation.

• File N° : is the name introduced at the moment of the file creation, it can be

changed.


IV-2 iSis 3D - V 2.35 – March 2003

• Exam date : this field is eventually fund on the images, if they exist, it can be

changed.

• Exam N° : this field is eventually fund on the images, if they exist, it can be

changed.

• Series : this field is eventually fund on the images, if they exist, it can be

changed.

• Source : indicates if the file have been created starting from images (SC) or

from the digitizer (DI), it cannot be changed.

• Associated image index : if the images have been created starting from

images, this field indicates the folder where they are found (i.e. the name given

when creating them from images). It cannot be changed.

• Density conversion File : this is the name of the file containing the

Hounsfield/density conversion curve. The conversion file can be changed by

selecting a name from within a drop-down list. This list is formed from the

ensemble of the file names having the <<.den>> extension which are present

within the machines data directory.

A default file can be specified within the parameter customization file. This file will be

used by default following the association of an image series to a study case.

The modification of the scanner calibration curve during the execution of a study case

has as consequence all the heterogeneities to be assigned 1 density and the

cancellation of the already performed calculations.

The user is warned by a message asking for confirmation.

• Longitudinal anatomic origin : reference point used as reference for defining

the zero point of the longitudinal scale (Z) while acquiring the images. It can be

modified.

• SCREEN ORIENTATION/patient : Three scrolling lists (patient position, RIGHT,

HIGH) allow to define the patient position, and are mutually updating themselves.

The texts written with capital letters are referring to the SCREEN, those in

lowercases are referring to the patient. If the contours are obtained from


iSis 3D - V 2. 35 – March 2003 IV-3

scanned images, the correct values are normally recovered automatically in the

image descriptions and displayed by default. If this is not the case or the

orientation is not defined in the images, the position can be changed. In all

cases, the choices made determine the way the axes orientations are indicated

in the various graphic windows. In the absence of the patient position indicator,

the axes labels are expressed as (X,Y, Z) (cf.: § II.2.1, iSis 3D - Reference

system and convention for imaging equipment).

ATTENTION!

It is the responsibility of the user to make sure that the indicators of orientation are

correct. In particular, the system does not control the cases where the image encoding

is such that the images appear to be seen “from the head” and not “from the foot” of

the table of the acquisition system.

• Origin coordinates: recalls the values defined with the function Origin (cf.: §

IV.6, iSis 3D - Slices Menu, Origin). They cannot be changed.

• Comments : are commentaries on the slices. They can come from the images,

if they exist and if they contain commentaries. They can be changed.

The third part presents the STRUCTURES defined in the slices.

It opens the data produced by the function Volumes (cf.: § IV.10, iSis 3D - Slices

Menu, Volumes).

The fourth part displays the LIST IF SLICES (in the Z ascending order) and the following

characteristics:

• The name (Ci) - allowing to identify the slice. The index i corresponds to the

order in which the slices have been created. The names can be reaffected by

the ascending Z order by closing the dossier and saving with reorder. (cf.: § III-

3, File Menu, Close).

• The position Z (Z) as well as the thickness (EP) are obtained from image

related information, if images are used, or from the values given during the

process of introducing the data with the digitizer, after eventually using the

functions Duplicate/Adjust, Origin or Z opposed.


IV-4 iSis 3D - V 2.35 – March 2003

Figure IV-1 : Header and list of slices

• The position Z (Zregist) and the register thickness (EPregist) are normally

equal with their previous values, if there are joined slices. On the other hand, if

there are blanks or overlapping between the slices, the program performs a

“registering” of these values according to a list indicated so that the result will

be set of joined “equivalent” slices. The algorithm used for this rescaling

accounts for the slices thickness. If there is an empty space to be filled, each of

the two neighboring slices will fill half of the free space, accounting for the

corresponding thicknesses. Correspondingly, in case of overlapping, each of


iSis 3D - V 2. 35 – March 2003 IV-5

the slice thickness, each of the two slices will shrink back from half of the

overlap region.

The register values are used mainly for the following functions:

• Point of Interest display

• expansion of the structure in 3D,

• calculation of the structures volumes,

• depth calculations,

• reconstruction of structures’ contours in non-transverse planes (“other”),

• dose-volume histograms calculation.

• image and Zimage are respectively the name and the position of the image

associated to each slice (if it exists).

• heter. allows to know the names and the number of contours defined as

heterogeneities in each slice

Finally there is a control zone, allowing to print the file (Print), to validate (Ok) or to

cancel (Cancel) the changes performed, and there are buttons to change the page if

the slices to not all fit on the same page.

ATTENTION!

It is up to the user to make sure about the validity of the reconstruction of anatomical

structures, especially in the cases where the given slices are not joined or not

sufficiently thin to accurately represent the reality. The lack of information may cause

large errors in what concerns: the depth calculation, the volume calculation, the

automatic creation of structures by expansion, and the computation dose-volume

distributions.


IV-6 iSis 3D - V 2.35 – March 2003

IV.2 Create from

displays the following menu:

- images...

- digitizer...

images is used if an ‘image file” was previously created from the scanned images (or

IRM) transferred and converted to the format iSis 3D, and if the contours are to be

created from these images.

digitizer is used the contours, at a certain scale, are available on paper or film.

For coherence reasons, the first selected choice (image or digitalizer) is preserved for

creating the contours in the following slices. It is impossible to combine the two

modes of creating (or modifying) the slices.

IV.2.1 Create from image

While first calling Image, displays a box for the selection of the image files names,

giving the list of the available folders in each zone of the predefined images (Figure IV-

2).

Next is selected from a scrolling list the name of the image zone that is to be

analyzed. This zone can point to different local or distant media. Depending on the

selected zone, there will appear indications on the number of existing dossiers, and

about the available space, expressed as number of ”blocks” (512 Bytes) and as

number of images.

The names of the image dossiers and the corresponding dates of creation are

displayed as a list, and there is the possibility to rearrange the list either is ascending

alphabetical order, or in decreasing date order.

The name of the image dossier corresponding to the patient is selected with a simple

mouse click. The number of available images in this dossier is displayed in the lower-

left part of the box. The confirmation with Ok or by a double mouse click on the name

opens a graphic window for “selecting the images”, which gives a global view of the

images set in the dossier.


iSis 3D - V 2. 35 – March 2003 IV-7

Figure IV-2 : Set of image selection box

The button View has the same function as Ok, but it incites to use this function to

explore faster the content of different image dossiers without necessarily relating them

to the radiotherapy dossier which is open.

Figure IV-3 : Image selection box

In the window for selecting the images (Figure IV-3) all the images from the open

dossier appear in small format (icons). This window is used for the


IV-8 iSis 3D - V 2.35 – March 2003

creation/modification of the contours, which will be later described in detail. It may be

used as well to explore rapidly the content of the image files from many dossiers.

Actually, by clicking on Cancel, we return to the box for selecting the dossier name

and we can restart the operation for a new patient.

Remark : When the slices have been defined, unexpected results may appear if the

images referred to by the slices are altered (their content is modified). On the other

hand, new images can be added and is allowed to define supplementary slices.

Moreover, if the images corresponding to created slices are deleted, the current

dossier can be still used but a warning message warns announces that some images

have not been found.

IV.2.2 Create from digitizer

lead to creation of contours from digitizer function (cf.: § II-8, General principles,

Digitizer)

The slice creation from digitizer consist of two step. The first one consist of plot

contours, the second one consist of specify the characteristics of the slice (Z and

thickness) and the scale factor of the plot.

When plotting contours, a window come on (on the bottom left corner) which guide the

acquisition of the external contour and eventually internal contours by the way of

messages displayed.

- PLOT MIDDLE OF THE TABLE - ABSOLUTE ORIGIN - Ci

Plot the middle of the table which is normally located in the sagital median plane. The

axes Oy is merge with the sagital median plane.

- PLOT SAGITTAL MIDDLE PLANE, UP, -AXIS Y > 0

Plot a point on the Oy axes to positives y. This point should be located at least 10 cm

from the origin. Otherwise, a warning message appear and the user have to redo the

point.

- PLOT COMMON CENTER OF CONTOURS, (ORIGIN)

This is the O point of the Oy axes by which one the Ox axes perpendicular to Oy go

through

Then the plot of external contour start, with the display in real time of points plotted.


iSis 3D - V 2. 35 – March 2003 IV-9

- PLOT CONTOUR Ci, AT THE END DO "END OF WORK"

the number of points plotted for the external contour should be lowest or equal to 99.

The plot of internal contours follow the external contour acquisition.

- A THE END OF A PLOT DO "END OF WORK"

after the last, redo "end of work"

PLOT MARKER 1 OF CONTOUR Ci

The maximum number of internal contours is 40. The maximum number of point

plotted for all internal contours is 999. The internal contour plotted are named by

default, "contour 1", "contour 2", etc... in the acquisition order, they have a density

equal to 1, and their colour is yellow. The plot and their characteristic could be

modified (cf.: § V.2.3, iSis 3D - Procedure of creation/modification of contours,

contouring, change).

If the slices do not have any internal contours, you just have to do "END OF WORK", to

end the acquisition.

Remark : all contours are plotted in only one phase: external contour then internal(s)

contour(s). to add a markers to a slice, you should (at this time) re-plot all the contours

for this slice.

Once the contours plotting for one slice is achieved, a dialog box appears, proposing

the following options:

• Z Position : to introduce the Z of the slice, initialized to 0 by default

• Slice Thickness : to introduce the slice thickness, initialized to 0.5 cm by

default

• Scale X : introduce the X (horizontal) scale initialized to 1 by

default

• Scale Y : to introduce the Y (vertical) scale.


IV-10 iSis 3D - V 2.35 – March 2003

And the buttons:

- Next slice

- Ok and Cancel

Next slice saves the contours of the current slice and returns the control to the

digitizer for the introduction of a new slice.

Ok saves the contours of the current slice and then passes to the phase

Creation/Modification.

Cancel deletes the result of the digitization (after confirmation) and returns to the

principal menu.

Figure IV-4 ; Characteristic of plot box

IV.3 Modify

passes to the phase Creation/Modification of the current slice.

The same function is obtained by double clicking on the slice to be modified in the box

for selecting the calculation planes.

IV.4 Duplicate/Adjust

permits to copy and displace the current slice to a different longitudinal position (Z)

(Figure IV-5) saving all the other previously defined contours, together with their

characteristics.

The dialog box which opens permits as well (eventually keeping the same Z value) to

modify the thickness, the scale (relative to the current slice) by separating the

horizontal (X) and vertical (Y) directions and/or changing the origin. The new origin


iSis 3D - V 2. 35 – March 2003 IV-11

can be defined by its coordinates (relative to the old origin) or graphically, pressing the

button mouse capture (cf.: § IV.6, iSis 3D - Slices menu, Origin). Note that the

modifications are affecting only slice which is obtained (after duplication or

displacement). There is a risk of modifying the coherence of the slices set and thus,

these functions should be carefully used. For a global modification use the item origin.

Figure IV-5 : Duplicate / Adjust a slice

If the current slice was defined from a scanned image, the fact that it is duplicated or

displaced does not affect its association with the originally chosen slice.

IV.5 Kill

destroys the current slice after validation.

IV.6 Origin

permits to modify the position of the anatomical origin for the whole set of slices. The

slice whose Z corresponds to a given value in the options field of the dialog box (this of

the current slice by default) will take the Z value specified in a second options field (it

becomes by default the origin slice Z = 0) (Figure IV-6). If a displacement of the origin

was done before, the initial Z value of the current slice (called Z image) is recalled in

the dialog box.

The dialog box permits as well to get the position of the origin, X and Y, either by

reading the coordinates values in the options field specific for X and Y, or with the

mouse (displacing the principal axes in the graphical window with continuos display of

the current position, and exit by clicking on the Ok button of the graphical window).


IV-12 iSis 3D - V 2.35 – March 2003

Figure IV-6 : Origin for all slices

IV.7 Opposed Z

This function which starts the rearrangement of the slices, replacing each Z value by

its opposed value (-Z). It allows to retrieve a coherent order in the radiotherapy

coordinate system when a set of images was acquired inversely (e.g.: the Z is

increasing from the head to the toes). Note that, even if the images continue to be

correctly associated with the slices from which they originate, the correspondence is

lost in the box for selecting the image, because the Z images remain unchanged.

In the case a mistake occurs in the procedure, restarting the function Opposed Z

retrieves the initial order.

IV.8 Structures/Bolus

gives access to a dialog box dedicated to the management of structures and bolus

(Figure IV-7). This box includes the lists of: Names, Densities, Colours and Types of

the existing structures, as well as their option fields: Name, Density, Colour and Type

which allow to create new structures or to modify the existing ones.

This box is also provided with the buttons:

- Add, Change and Kill

- Ok and Cancel


iSis 3D - V 2. 35 – March 2003 IV-13

Figure IV-7 : Structures / Bolus management box

Add : creates a new structure of name, density, color and type specified in the option

field.

Change : assigns to the selected structure (click for example in the list Names) the

name, density, color and type specified in the option field. These characteristics are

influencing the whole set of contours affected by the structure, including the density

which replaces the previously given or calculated values for each individual contour.

Remarks : - 2 structures cannot have the same name

- a structure cannot have the same name with a previously defined

contour

Kill : deletes the selected structure. If the structure affected one or more contours, a

dialog box is opened, recalling the number of contours and the number of slices

affected and proposes either to save the contours after deletion (renaming them or

not), or to delete them as well.


IV-14 iSis 3D - V 2.35 – March 2003

Cancel : reestablishes the initial list of structures and contours affected by the

eventual deletions.

Ok : validates all changes and closes the dialog box.

The structures defined in this way (maximum 15) appear in a scrolling list, accessible

in the contours modification mode. When a contour is associated to a structure it takes

its color and properties. They are as well displayed at the right of the window:

creation/modification of contours.

The notion of structure becomes of major interest during three -dimensional

representations (virtual simulation or “beam’s eye view”, 3D visualization) and for

dose-volume histogram calculations.

The boluses are special structures, to whom is assigned the type “bolus” selecting it

from the corresponding scrolling list. The structures of type “bolus” are contoured, slice

by slice, in the same way like the ordinary structures but they may “come out” from the

patient external surface. The rules for introducing their data are given in the paragraph

V.2, Procedure Creation/ Modification of Contours, Contouring (slice by slice). They

can be afterwards associated to one or more beams and are making “fusion” with the

external contour, during the dose calculation for the associated beams. They can be

also generated with the function “expansion” (cf.: § IV.9, iSis 3D - Slices menu,

Expansion).

IV.9 Expansion

Permits to create a structure (for example a clinical target volume) starting from an

existing structure (for example the macroscopic tumor volume), allowing a uniform

margin in 3D and accounting for “obstacle” structures (Figure IV-8). The source

structure (“from”) must be defined in at least one slice. The destination source ("to")

must have been previously defined in the list of structures but a priori it does not

include any associated contour. Except for the case of bolus, the destination structure

must be different from the source structure.

In the case of expansion with positive margins, the algorithm used for expanding is

relatively complex (see the bibliography). Schematically, the introduction of a margin M

in a given slice (called “current” slice) is done by scanning all the slices located at a

distance less or equal to M, and projecting for each of them the contours of the source


iSis 3D - V 2. 35 – March 2003 IV-15

structure increased by a residual margin m. m is a fraction of M, increasing as the

projection slice is closer to the current slice. It results an expansion of the limits of the

source structure., not only on the lateral direction but also on the longitudinal direction,

It can be shown that to ensure an acceptable precision, the slices wherein is defined

the source structure, as well as the structures located laterally (on one side or the

other) (a distance smaller than M) must have a thickness at most equal to 0.5 M and if

possible of the order 0.1 M.

Figure IV-8 : 3D expansion of structure or bolus box

In the case of expansion with negative margin, the expansion is done in 2D in each

slice where the source structure is defined. This possibility in attractive in the case we

want to create the automatically inner side of an organ.

The "envelope" is a structure enveloping the source structure and limiting its

expansion in all the directions in space. It is for example the external surface of a

patient, or a whole internal structure (lung, meningial envelope limited by the cranial

skull,…). In the longitudinal case, there cannot be an expansion in the slices

immediately adjacent to the envelope (i.e. the first slices situated on one side or

another do not include any contour belonging to the “envelope” structure).

The structures defines as “obstacles” stop the expansion in the plans where they are

defined. Nevertheless, because of the three dimensional character of the calculation, it

may happen sometimes that obstacles are “surpassed” by the expansion process.

During the process of choosing the structures involved in the expansion, a control of

the coherence is done to avoid aberrant combinations.


IV-16 iSis 3D - V 2.35 – March 2003

It may happen that the process of expansion does not succeed. An informative

message is displayed and there are two possibilities:

1. Ignore and continue the expansion in other slices

2. Stop the expansion

The function expansion can be used as well for the automatic creation of a bolus of

given thickness. The user interface and the expansion mode are slightly modified in

this case:

a source structure of type "bolus" should have been previously defined in the

structures’ box (cf.: § IV.8, iSis 3D - Slices Menu, Structures/Bolus),

• Bolus should be define into Volume / Bolus management box

• this source structure is introduced slice by slice, following exactly the external

contour in the region where the bolus is applied,

• the chosen margin corresponds to the bolus thickness,

• the destination structure is, by default, identical to the source structure. It comes

to replace it but if the expansion does not succeed, the original structure is lost

and it must be introduced again.

• the expansion of boluses has the following characteristics:

1. It is a 2D expansion where the margin M is applied slice by slice, without

accounting for adjacent slices. In particular, the process is stopped in the

longitudinal; direction, at the level of the last slices where the source

structure has been introduced.

2. The target structure has straight sides, perpendicular to lateral ends.

3. The destination structure is “amputated” from its intersection with the

interior of the external contour. Only the “bolus” is effectively subsisting.

Remark : In case of later retouch of the bolus shape, it is recommended to make sure

that there is no space left between the bolus (the destination) and the skin. On the

contrary, there so inconvenience if the bolus “penetrates” in the interior of the contour,


iSis 3D - V 2. 35 – March 2003 IV-17

except that the external part only will be accounting for in the dose distribution

calculations (cf.: § V.2.b, iSis 3D - Creation/Modification of contours).

IV.10 Volumes

Shows a sheet (Figure IV-9) containing 2 parts.

The first part indicates the geometrical characteristics of the structures : the center,

the volume and the diameter of the smallest sphere containing exactly each one of

the existing structures. The volume and diameter are not shown in the case of

boluses.

Figure IV-9 : Geometric characteristics of structures

Structure volumes are calculated by multiplying the structure contour surface with the

slice thickness. Note that these calculations are not strictly valid if the structures are

not defined on consecutive adjacent slices. Indeed, if they are not, the system

restores the wanted continuity by “inventing” the missing information (cf. : § IV.1, iSis

3D - Slices Menu, Header and list of slices, Thickness Register). For security

purposes, if the case arises, the lack of continuity is mentioned by the system when

the “creation/modification of contours” phase ends.

The second part shows a summary of the defined Points Of Interest : their name,

their type, their coordinates and any comment associated to them.

Depending on the number of structures and the number of Points Of Interest, the

presentation may occupy one or two pages. The sheet can be printed from the

selected “text” peripheral using the Print button.

The window can be closed using the Close button.


IV-18 iSis 3D - V 2.35 – March 2003

IV.11 Points Of Interest

The Points Of Interest are points related to the patient anatomical structures, defined

either graphically, or by their numerical coordinates. They have various roles

according to their properties (“type” of point). According to their type, they can

eventually be “attached” to beams.

Slices / Points Of Interest… opens a dialog box showing the list of the defined

points, allows their management and gives access to the dialog box relative to the

properties of the Points Of Interest.

IV.11.1 Points Of Interest’ management box

Slices / Points Of Interest… gives access to the dialog box relative to the

management of the points of interest (Figure IV-10 ).

Each point of interest has an identification code with 2 alphanumerical characters, a

name, a color, one ore more types, coordinates and a comment.

The defined Points Of Interest are:

• Isocenter point, for grouping beams in respect to a common isocenter (cf.: §

VI.1.3, iSIs 3D - beams menu, beam parameters, point of reference)

• weighting point, for the definition of an off-axis weighting point, (cf.: §VI.1.3,

iSis 3D - menu beams menu, beam parameters, weighting)

• dose point, for the dose calculation at a point and for the dose/volume

contributions (cf.: § 3.8.1, iSis 3D - Beams file, dose/volume contributions)

At present, the types “mark” and “reference” are not exploited (except of a simple

graphical representation in the results sheet).

The dialog box contains :

• a list containing the identifying elements : ID:Name and Type of the selected

Points Of Interest depending on the display filter.

• a group of checkboxes offering the possibility to filter the displayed types of

Points of Interest. All of the types can be selected using the “All” button. A help


iSis 3D - V 2. 35 – March 2003 IV-19

button marked with the ? symbol opens an information box relative to the

available types and the use of the filter for the creation of the list.

• the buttons : New, Modify, Delete and Close, Print.

Figure IV-10 : Point of Interest management box

At present, the types “mark” and “reference” are not exploited (except of a simple

graphical representation in the results sheet).

The dialog box contains :

• a list containing the identifying elements : ID:Name and Type of the selected

Points Of Interest depending on the display filter.

• a group of checkboxes offering the possibility to filter the displayed types of

Points of Interest. All of the types can be selected using the “All” button. A help

button marked with the ? symbol opens an information box relative to the

available types and the use of the filter for the creation of the list.

• the buttons : New, Modify, Delete and Close, Print.


IV-20 iSis 3D - V 2.35 – March 2003

- New : opens an input box for typing-in the characteristics of the Points of Interest

(Figure IV-11). An identification code is suggested by default. It is the first available by

alphabetical order.

- Modify : opens an input box containing the characteristics of the selected point. If the

type of the Point of Interest is « isocenter » or « weighting point », then a modification

of the point results to the modification of any beam associated to the point. Following

user confirmation, the beams that have become invalid, are being detached from the

« common isocenter » or their weighting mode changes to on-axis weighting.

- Delete : deletes the selected point (if it is not used as “common isocenter” or

“weighting point”) and updates the list of Points Of Interest. In order to delete a point

associated to a beam, it is necessary to detach it first, using the beam modification

dialog (cf.: § VI.1.3, iSis 3D - beams menu, beam parameters)

- Print… opens the print-sheet described in the paragraph entitled Volumes (cf.: §

IV.10, iSis 3D - Volumes)

- Close : closes the dialog box.

IV.11.2 Input box for the characteristics of the points of interest

The input box for the characteristics of the interest points (Figure IV-11) opens

from the dialog box relative to the management of the Points of Interest, or during the

creation of a “common isocenter” or a “weighting point” (cf.: § VI.1.3, iSis 3D - Beam

parameters). It contains the input fields Code, Name, Color and Type.

The position of the Point of Interest can be defined either by entering its coordinates,

or using the automatic centering function on a structure (spherical or parallelepipedic),

or graphically in the current window. A comment can be associated to each point.

In order to enter (or modify), the position of a point graphically in the current window,

click on the mouse button of the dialog box. A cursor appears, that can be placed at

the desired position on the current window. While moving around the mouse keeping

the mouse button pressed, we can see in real time, at the lower left corner of the

window, the point coordinates (and the corresponding dose if this is a dose point).

Once the mouse button has been released the point is placed but not yet created

unless there is a validation in the characteristics input box.


iSis 3D - V 2. 35 – March 2003 IV-21

Figure IV-11 : Creation / Modification point of interest box

Ok : validates the creation or modification of the Point of Interest and closes the dialog

box.

Delete : deletes the Point of Interest (if it is not used as a “common isocenter” or as a

“weighting point” – see above)

Cancel : cancels the creation or modification of the Point of Interest and closes the

dialog box.

Remark : it is possible to change the current window for the graphical definition of the

point using the mouse, without closing the dialog box, by simply clicking on the desired

graphical window


IV-22 iSis 3D - V 2.35 – March 2003

CHAPTER V - CREATION / MODIFICATION OF CONTOURS

iSis 3D - V 2. 35 – March 2003 V-1

V. PROCEDURE CREATION/ MODIFICATION OF CONTOURS

This procedure is accessed either directly after selecting the item Create from from

the SLICES menu, or from the item Change of the same menu, or double clicking on

one of the slices from the box for selecting the calculation plans.

During this procedure, the main menu bar, the selection boxes for the calculation

plane, the beams, and the selected slices are kept in small format (icons).

A specific menu bar appears for this procedure. It is attached to an active window

and it allows the display of the slice to be modified (image and/or contours). The active

window has a title recalling the name of the image file, the chosen image and the slice

position. Note that this title can be only partially defined.

By select Create from/images, a box for selecting the images (or the slices)

appears. It is particularly useful for giving a global view over the whole set of images or

contours available and for giving the possibility to follow the progress of the operation

creation/modification of contours. The box for selecting the images is available and

can be called at any moment.

The creation/modification of contours behaves like an independent application,

called by iSis3D. The return to the main application is done through the item Quit from

the SLICE menu. In the case the series of slices taken into account does not constitute

a continuous volume (non joined slices), a warning message appears, indicating the

associated risks of error.

In the following paragraphs is described the procedure of creation/modification of

contours.

The menu bar of the procedure (Figure V-1) contains the following options:

• Slices : choice of the current slice whereto trace the contour,

• Contouring : function helping for the creation and/or modification of the

contours in the current slice,

• Display : choice of the display options.


V-2 iSis 3D - V 2. 35 – March 2003

Figure V-1 : Creation / Modification of slice

At the right of these 3 menus, appear 3 buttons which give direct access to the

following functions:

• Zoom... : allows to adjust at any moment the scale and the centering of the

image and the contours present in the window,

• Restore : allows to go back to the previous zoom (without opening the box),

• Level/Window... : allows to adjust the image contrast. Contrary to many other

boxes, this one does not need to be closed to continue the procedure, it may

remain open and it may be accessed at any moment.

To see the detailed description of these last three functions refer to the description of

the DISPLAY menu.

Three buttons located at the inferior part of the window, permit to start with a simple

click the operation of contouring in mode: manual, automatic or change.

Three buttons located at the lower right part of the window contain arrows which allow

to perform the selection of the slices on which to work.. The two extreme buttons


iSis 3D - V 2. 35 – March 2003 V-3

(right arrow and left arrow) allow to pass to the previous slice or to the next one on

the list of slices previously created. The central button (oblique arrow) allows to recall

or refresh the box for selection of images (or slices).

V.1 Selection of the slices to contour

V.1.1 The box for selection of images

a) Presentation

The box for selection of images (Figure V-2) permits to choose the slices serving as

basis for the anatomical representation of the patient. This representation requires the

acquisition of contours (internal and external) associated to each image. Only the

slices including at least an external contour will be retained for the patient

representation. They will appear then in the list of slices in the box for the selection of

the calculation planes.

In case of utilization of matching images, the selection box is generated from the

active series (cf.: § II.9, iSIs 3D - General Principles, Matching images)

b) Using digitizer

When the contours acquisition is done by digitizer (no image), the box for the

selection of images allows to display the set of slices previously digitized. It is then

completed with three buttons:

Digitizer which permits to acquire the contour from a new slice, by digitizer.

Cancel which permits to close the box and to cancel the current operations.

Ok which permits to close the box, after having loaded in the active window, the

current slice (i.e. that which is framed in the box for image selection).

c) Visualization and selection of images

If the contours are generated from scanned images, all the images available in the

folder previously defined (cf.: § IV.2, iSis 3D - Slices Menu, Create from images) are

displayed in the box. Maximum 99 images can be selected to perform the contouring

of the external surface and the internal contours.


V-4 iSis 3D - V 2. 35 – March 2003

Figure V-2 : Image selection box

First is tested the coherence of:

• the examination date,

• the patient name,

• the patient position,

• the series number,

• the examination number.

A warning message is indicating if incoherence have been found. Note that the

incoherence are not blocking the process and it is still possible, even in this case, to

select the images.


iSis 3D - V 2. 35 – March 2003 V-5

The selection of an image is done by a simple mouse click on the corresponding icon

in the selection box. Another simple mouse click on a selected images makes it

deselected.

A button select all located at the lower right part of the box permits to select all the

images of the box. It is always possible to deselect those images that we do not want

to contour.

A continuous selection of adjacent icons can be done as well sliding the cursor over

them while pressing the left mouse button. The same operation applied to neighboring

slices that were previously selected allows to deselect them. Finally, to deselect all it

is enough to update the window (for example pressing the corresponding button

(oblique arrow) situated in between the arrows that allow the passage from one slice to

another.

The selected icons are identified by a pink tablet located at the lower left corner. This

tablet changes appearance according to the status of the corresponding slice, the

largest frame is associated to selecting and the filled tablet signifies the presence of an

associated slice (containing at least a contour):

. no tablet →→→→ no contour defined, image not selected

. not filled tablet (frame) →→→→ no contour defined, image selected for

internal or external contouring

. completely filled tablet →→→→ contour(s) already defined, image not

selected

. half - filled tablet →→→→ contour(s) already defined, image selected

for internal or external contouring

. tablet replaced by a pink

cross

→→→→ the image cannot be used for one of the

following reasons:

- a slice of same Z value exists already ;

- the gantry angle overcomes +/- 2% ;

- the table angle overcomes +/- 10%.

A simple mouse click on an icon switches from a status to the other (selected/ not

selected), while the status of the other icons remains unchanged.


V-6 iSis 3D - V 2. 35 – March 2003

The last selected image, called the “current” image is framed.

For this current image, various information are recalled and updated in real time, in

the lower part of the window. These information are referring to:

slice identification (Ci), longitudinal position of the slice Z (in cm), slice thickness

(Thick=, in mm), associated image name, position (Zi) of the initial image (Zi = , in the

coordinate system of the imaging system).

Figure V-3 : Image information

It is possible to obtain supplementary information on the current image by double

clicking on the information icon. A window called "Informations image" will be

displayed then, showing the principal characteristics of the associated image and/or

slice (Figure V-3).

The displayed data are those fund in the header of the image file and re the result of

the image conversion.


iSis 3D - V 2. 35 – March 2003 V-7

In particular, the patient position information is given according to the DICOM

standards:

HF = Head First - Examples:

FF = Feet First

S = Supine HFS <=> decubitus dorsal DD

P = Prone

DR = Decubitus Right HFP <=> decubitus ventral DV

DL = Decubitus Left

Remark : the table angle of the imaging system is expressed as the absolute value of

the value read in the image file, modulo 180°, brought to 0° :

ex: for 355°, it will display 5°.

for 179°, it will display 1°.

for 182°, it will display 2°.

The displayed gantry angle is the absolute value of the value read in the image file.

It is not necessary to have the external contour defined before attempting to outline an

internal contour.

d) Contouring series

The scrolling menu Contour from >, allows to chose the contouring method :

threshold or interpolation

e) Contouring (external and internal) in series of images by treshold

The scrolling menu Contour from >, located at the lower right part of the window

create, in the selected images, either an external contour, or an internal contour

associated to one of the previously defined structures.

For the external contours are available two modes of work:


V-8 iSis 3D - V 2. 35 – March 2003

- the automatic mode starts immediately the creation of external contours,

- in semi automatic mode, it is possible to specified first a starting point for the

contours and in the meanwhile it is possible to adjust the contrast. These adjustments

can be done (in the box for adjusting the contrast) before starting the contouring. A

dialog box is displayed, recalling the threshold level for the contouring and asks the

user to choose a starting point on the current image which is displayed at this moment

in “normal” size within the window creation/ modification of contours. Pressing the Ok

button validates the choice. The contouring starts by exploring the image, beginning

from the left of the starting point (cf.: § V-2-3, Procedure Creation/Modification of

contours, Automatic Contouring). Choosing this point in an adequate manner, one can

avoid the contouring of container accessories or of the scanner table.

The internal contouring is always done in semi-automatic mode.

It is enough to select from the submenus, at the rubric " internal ctrs ", the structure

for which is desired a serial contouring. The choice of the adjustments and of the

starting point are determinant for the success of the contouring process. Actually the

contrast level (the lower limit of the window) must be such that the interior (or exterior)

of the structure of interest takes the color of the background, and the position of the

starting point remain valid for the whole set of selected images.

In both modes, the contour calculations continues automatically for each of the

previously selected images. The contours obtained are displayed one by one, as they

are calculated, in the same time the frame corresponding to the current image is

moved. A dialog box is displayed in the upper left corner of the screen. This permits to

follow the progress of the operation and to stop or restart at any moment the

contouring (it is recommended to wait for a while after pressing this button since the

effect is not immediate).

The images for which a valid contour was found are identified by a pink tablet,

according to the conventions described in the previous paragraphs. In case of error,

the user can either delete the wrong contours, or modify them (cf.: § V-3,,

Procedure Creation/Modification of Contours, Display), or delete the current slice

(SLICE menu), i.e. delete all the contours associated with it (the image remains intact

and can be contoured again).


iSis 3D - V 2. 35 – March 2003 V-9

Remark 1 : it is not necessary to have defined the external contour to perform the

internal contouring.

Remark 2 : to avoid aberrant results given by the semi-automatic contouring for the

see of slices, it is recommended to find before the best adjustments making trials on

some representative slices.

Remark 3 : In case of utilization of matching images series , the contouring by

threshold methods is done from the active series (cf : § II-9, General Principles,

Matching images)

f) Contouring (external and internal) by interpolation of the image series

The contouring by interpolation is performed on the internal structures and the external

contours. It is launched selecting by mouse a continuous image series, which accepts

“empty” slices with respect to the selected structure of interest; following select the

item of the “interpolation” menu.

The interpolation algorithm is based on the cloud of points method with recentering on

the isocentre and controlled erosion/dilatation of the existent contours. The relative

distance between the slice C where the contour of the interest structure S should be

calculated, and the neighboring slices where S exists, is taken into account according

to the following rules:

• if there are two slices C1 and C2 framing C where structure S is defined, the

generated contour is calculated by interpolation of the S contours defined in C1

and C2

• if there are contours only within the inferior slices (or the superior ones), the

interpolated contour is generated by copying the closest contour.

• If there is no contour defined for the structure S neither within the inferior slices

nor within the superior ones, the method cannot be applied.

g) Contouring (external) and loading a single image

The box for selecting images permits as well to start the automatic external contouring

in an arbitrary slice with a double click. If no contour is yet associated a dialog box

is displayed asking the user if he wants to preserve the external contour found. If the


V-10 iSis 3D - V 2. 35 – March 2003

answer is affirmative, the contour is saved and the corresponding slice (image and

external contour included) is loaded in the active window. Otherwise, only the image is

loaded and it is possible to perform the contouring automatically or manually. (to be

detailed in later paragraphs).

To close the box for selecting images there are available two buttons:

Cancel : simply closes the box. All the contours just calculated in automatic or

semiautomatic mode (the icons are identified by a pink filled tablet) are saved.

Ok : closes the box. If a current icon is selected, the corresponding slice or image is

displayed in the active window, with a proposed contour, if it is the case.

V.1.2 Passing from a slice to another

The right arrow and left arrow located at the lower part of the active window allow to

pass to the next or previous window from the list of the defined slices (i.e. having

defined at least one external contour). These contours remain accessible even during

the procedure creation/ modification of contours (to be detailed later). At the end of the

list, the arrow corresponding to the scrolling sense disappears, thus becoming

inaccessible.

If the selection box is open (for example by clicking on the central button identified by

an arrow pointing upwards), the frame corresponding to the current image is displaced

together with the displayed slice, this allowing to know where we are. The box for

selecting the images permits as well to load any slice. It is enough to double click on

the desired image.

Remark : if the contours associated with the images do not appear within the box for

selecting the images, it is necessary to click on the box to update it. This need to

update the display is eventually signaled by a message: "display to refresh", located in

the upper left corner of the window.

V.1.3 The Slice Menu

It gives access to the following sub-menu:

- Images selection...

- Digitize


iSis 3D - V 2. 35 – March 2003 V-11

- Kill

-----------------

- Quit

The item Kill has exactly the same function as in the principal SLICE menu

Images selection...: is accessible only if an image dossier has been previously

selected. It recalls the box for selecting images.

Digitize gives the control to the digitizer for creating a new slice. This sub-menu is not

accessible if an image dossier has been selected.

Quit validates the modifications and allows to go back to the main menu.

V.2 Contouring (slice by slice)

The contour acquisition can be performed from within the window creation/

modification of contours, in one o the following two ways. In manual mode the

contours are introduced with the mouse. In automatic mode it is enough to define a

starting point and the contour will be calculated according to the adjustments of the

contrast and the chosen starting point.

a) Contours property

Each contour has assigned a name. A colour and a density are equally assigned to

each contour. The name given by default is contour i, where i is automatically

incremented for each slice. The default color is yellow. The default density is equal to

1, except for the case of automatic densities calculation. The name, the color and the

density can be later modified (cf.: § V.4, iSis 3D - Procedure Creation/Modification

of Contours, Display).

Each contour may be considered as free marker or as belonging to a structure. In

the last case, the name , the color and the density assigned by default are those of the

structure. The names of the contours considered free landmarks appear in lower

cases, while those of the contours belonging to structures in capital letters. The fact

that a contour belongs to a structure can be specified from its creation.

Actually, the list of structures previously defined will be displayed at the right of the

active window, in both cases: automatic and manual contouring. It is enough to choose


V-12 iSis 3D - V 2. 35 – March 2003

the structure, at the beginning or during the contouring, and the current contour will be

assigned to it. An item free marker is added to this list, as well as an item new... to

define a new structure. Moreover, it is possible to change the assignment of a contour

at posteriori in the dialog box for contours modification (Figure V-8).

Whatever the type of the considered element (free landmark, structure or bolus), it is

always possible to give the same name to many contours introduced from the same

slice.

It is possible at any moment to change the characteristics or the shape of a previously

defined contour, by going in the change mode.

b) Bolus

For a bolus structure, the introduction of the corresponding contour must necessarily

follow certain rules in order to be correctly accounted for: it is imperative that the

introduced contours be not “detached” from the external contour.

The bolus may be explicitly introduced, in which case they can “byte” largely from the

interior of the external contour. Only the external part will be considered.

It is also possible to call the function 3D expansion to define a bolus of a specified

thickness (cf.: § IV.9, iSis 3D - Slices menu, Expansion). In this case it is convenient

to define the bolus position as a line matching the shape of the external contour,

shortened at the extremities so as to account for the expansion.

Finally, in the case the images have been acquired, in the presence of bolus or the

boluses are automatically included in the “external contours” the procedure is to

"distort" the external contour so as to bring the bolus points to the skin (cf.: § V.2.4,

iSis 3D - Procedure Creation/Modification of Contours, Change) then to recreate a

bolus structure in manual and/or automatic mode. It is recommended the frequent use

of the distort function to bring the point of the bolus in the interior of the external

contour. To control if a bolus was correctly accounted for, verify in the "treatment times

sheet" the thickness (cf.: § III-8, File menu, Treatment times).


iSis 3D - V 2. 35 – March 2003 V-13

c) Memorization of the visualization setup

In both cases, creation or modification of contours, it is possible at any moment to

change the display of the image using the functions zoom and/or level/windows.

Figure V-4 : Memorization of visualization set-up

When a satisfactory adjustment has been found for contouring a structure or an organ,

it can be useful to memorize this adjustment, so as to recall it easily for any other slice.

This function was introduced and it is possible at any moment to memorize (or to

load) a “visualization setup”. This “setup” consists in the combination: structure

name + zoom parameters + contrast parameters + characteristics of associated copy.

Up to 6 different setups can be memorized (Figure V-4).

To memorize a setup, do the adequate adjustments, and choose from the scrolling

list associated to the button Store... the number of the backup memory. The memories

already used are identified by the color of the associated structure (if there is one) as

well as by a cross placed beside the number.

To load a setup from the memory, click on the button corresponding to the number of

the setup. Only the buttons for the memorized setup are accessible. The color of these

buttons is the same with that of the associated structure(if there is one).

d) Sequence of functions

It is not necessary to quit the current mode to pass to another mode (manual,

automatic or change); it is possible to pass directly from one to another by pressing


V-14 iSis 3D - V 2. 35 – March 2003

the corresponding button. It is possible to pass from a slice to another remaining in the

current mode, pressing on the corresponding arrows - the operations on the current

slice are then validated as by Ok.

V.2.1 Manual contouring

The function digitizing contours can be accessed with the mouse, clicking on the

button manual. To introduce manually the contour points, it is enough to place he

cursor at the desired place and to click either on the left mouse button, to produce a

contour from the continuous mouse movements, or on the central button to proceed

point by point, with a flexible position. These two modes can be alternated. The right

mouse button offers the possibility to cancel the points of the contour currently

introduced, 1 by 1, or continuously as long as the right mouse button is not released.

The list with available structures appears at the right and a series of buttons at the

lower part of the active window (Figure V-5) which recalls partially the functions found

on a digitizer table : Erase, Correct, Close, Next, Ok.

Erase deletes the contour that is being introduced at the current moment.

Correct cancels 1 by 1 the points of the contour that is being introduced at the current

moment. Keeping the finger pressed on the left mouse button leads to a continuos

cancellation of the previously introduced points.

Close links the current point to the first point of the contour, validates the contour that

is being introduced and passes to the next contour to be introduced.

Next validates the contour that is being introduced and passes to the next contour to

be introduced.

Ok validates the contour that is being introduced and ends the function. This validation

is obtained as well using the arrows for changing the slices or changing the mode

(passage to automatic or modify mode).

During the contour validation, an automatic control takes place in order to detect and

delete any overlapping segment. This verification is repeated for all structures and free

marks except of the external contour.


iSis 3D - V 2. 35 – March 2003 V-15

Figure V-5 : Manual contouring

V.2.2 Automatic contouring

The function automatic extraction of contours is accessed by clicking on the button

automatic. The list of available structures appears at the right and a series of buttons

at the lower part of the active window (Figure V-6): Contour, Validate, Do not

validate, Ok.

After having eventually specified in the list the structure assigned to the current

contour, click on the button Contour and follow the instructions given in the dialog box

at the lower left part of the active window:

- one way to proceed further is, if necessary (as at any time), to adjust the contrast

level (level/windows) in the corresponding adjustments’ box so as to emphasize the

edges of the organ to be contoured.

- - the automatic contour calculation can be started by clicking on a point located in

the interior or at the right of the of the edge of the region to be contoured (Figure V-

7), the calculated contour appears on the screen.


V-16 iSis 3D - V 2. 35 – March 2003

Figure V-6 : Automatic contouring

In case or troubles, the message "impossible to contour” appears in the dialog zone. It

is enough to restart the contouring by trying a new choice of the contrast value and/or

of the starting point. In case it is successful, it remains to confirm if it is desired or not

to save the contour obtained in this way.

Valid validates the contour that is being introduced and passes to the automatic

contouring of the next contour.

Do not valid cancels the calculation that has just been made and waits for the next

contouring.

Ok validates the last contour and ends the function automatic contouring. This

validation is obtained as well using the arrows for changing the slices or changing the

mode (passage to automatic or modify mode).


iSis 3D - V 2. 35 – March 2003 V-17

Figure V-7 : Choosing the region to be contoured

Remark : the message “point outside image => restart” corresponds to the fact that

depending on the zoom factor and the image dimensions (generally square if he

display window is rectangular) a margin is added so as to “fill” the display window. Any

point specified in that margin is exterior to the image and invalid for the automatic

contouring. It is expected to introduce a new point instead.

V.2.3 Contouring - modify

Figure V-8 : Characteristic of contour

A dialog box appears if clicking on the button Change..., It allows to modify the

parameters associated to each contour, but also to reshape the contour, add or delete

points (Figure V-8).


V-18 iSis 3D - V 2. 35 – March 2003

The contour to be modified is chosen by clicking on its name (left column) in the

dialog box. This causes the corresponding contour in the active window to be

highlighted, changing its color (pink).

Possibilities to modify an external contour: the name and the density associated to the

external contour are fixed. The external contour can be distort and kill. However an

external contour must exist in order to have the slab taken into account at the exit from

the mode creation/ modification of contours.

Possibilities to modify the internal contours or landmarks: the name of the internal

contours can be introduced from the keyboard or chosen from the scrolling list with

structures, which proposes 3 categories of choices:

- <new... > : gives access to the box for defining the structures (cf.: § IV.8, iSis 3D -

Slices Menu, Structures/Bolus),

- <free mark.> : redefine the contour as a free marker, and assigning a default name

(for example contour 1, contour 2),

- list of defined structures: It allows to link the external contour to a defined structure

from which it adopts the name, the density (except if “automatic calculation densities”

is active) and the color.

Compute : allows to start the calculation of the average density for a specified contour

(cf.: § V-2-6, Procedure Creation/Modification, Contouring, Automatic Densities

Calculation).

Distort : : offers the possibility to modify the shape of the selected contour (see

bellow).

Change : attributes to the selected contour the name, density and color specified in

the corresponding fields. The names of the free marks appear in small letters. The

names of the structure contours appear in Caps.

It is also possible to perform the same changes from the pop-up list that can be

activated on the “name” field.

Kill : deletes the selected contour.


iSis 3D - V 2. 35 – March 2003 V-19

Cancel : cancels all the modifications, if a contour reshaping was performed it is

proposed (confirmation box) to save the deformations independently of other

modifications.

Ok : validates all the modifications and closes the dialog box corresponding to the

contour reshaping…

The appurtenance of a contour to a structure is guaranteed by its name. The

characteristics of a contour can be modified without altering this link: the density and

form remain unchanged but the name and the color may change.

The internal contours can be distorted and deleted.

Distort : allows to modify the shape of the selected contour. A series of buttons

appears in the active window when pressing on “distort” (Figure V-9) : Add - Kill -

Change - Cancel - Ok.

- Add : initiates the mode add points to the contour (in between the two closest

points).

- Kill : initiates the mode delete contour points (delete the closest point to the point

indicated with the mouse).

Figure V-9 : Modification of contour menu

- Change : initiates the mode displacement of contour points (with an effect of flexible

link with the adjacent points).

For these three functions, the cursor has to be placed, with the aid of the mouse, in the

vicinity of the region we want to modify. Click with the right mouse button to activate

the desired modification (Add, Kill or Change).

. While adding points the cursor is an arrow.


V-20 iSis 3D - V 2. 35 – March 2003

. While deleting points the cursor is a pair of scissors, and when the scissors are in the

vicinity of a contour point, a small a small pink square shows the point.

. While modifying a contour, the cursor is an arrow, and when the arrow is in the

vicinity of a contour point, a small a small pink square shows the point.

- Cancel : retrieves the initial shape of the contour and ends the function.

- Ok : validates the new contour shape and ends the function “distort contour”.

V.2.4 The trace mode

The trace mode allows, during the contouring operation, to be guided by what was

done in adjacent slices. This function is particularly useful when introducing contours

for a structure difficult to be seen in the images. It is possible either to see the contours

from adjacent slices through transparency, or recopy one of these contours in order to

adjust it later by reshaping.

Two items from the CONTOURING menu are chosen in order to work in copy mode:

Trace and Options of tracing...

Trace starts the function copy. Actually, the name and the function of this item evolves

depending on the chosen options.

Options of tracing opens a specific dialog box (Figure V-10)

In he upper part of the box is a scrolling list containing a list of the structures and

items <-> and <all>, which allows to choose the structure to be trace (or the whole set

of internal contours if <all> is selected, <-> desnactive tracing mode).

Next should be specified if the contours to be displayed are to be taken on the upper

slice, the lower slice or on both. A slice is called “upper” if its Z is superior to the Z

of the current slice. In the opposite case it is called “lower” slice.

The option systematic trace allows to see through transparency the contour(s) of the

slice(s) specified systematically without needing to restart the function trace.

The option with re-copy of contours permits to retrieve in the current slice the

contour(s) originating form the superior or the inferior slice. This option is deactivated if

copying is asked in the same time from the two slices.


iSis 3D - V 2. 35 – March 2003 V-21

Figure V-10 : Option of trace

The option with recalculate density is accessible only in case of recopying. It allows

to restart the calculation of the average density as a function of the Hounsfield

numbers found (cf.: § V.2.6, iSis 3D - Procedure Creation/Modification of Contours,

Automatic Densities Calculation).

The function trace is not accessible if:

• the slice where to copy do not exist (beginning or end of list),

• the chosen structure is not available in the slices where to copy,

• no structure has been selected (<->)

• in the mode systematic copy.

If the option recopy is selected, the item trace of menu is replaced by Copy.

Meanwhile it will appear in the menu the name of the structure to be trace/multiplied

(or all) and in between parentheses the slice which contains the copy (up, low or

both).

V.2.5 Automatic Densities Calculation

The density assigned to the contours is used in the procedure for heterogeneities

correction. Instead of arbitrarily defining a density value either explicitly in the box for

contours modification, or intermediately in the structure density, the program can be

asked to calculate from the information contained in the image.


V-22 iSis 3D - V 2. 35 – March 2003

In practice, this solution is applicable only to images from an X scanner, for which the

values assigned to the pixels are expressed in the scale of Hounsfield numbers (from -

1000 to +3000). The conversion Hounsfield numbers →→→→ density is realized through

an intermediate - a curve in standard format “FIFI”, stored in the file “sc.den”. For the

moment, for a given user it is not possible to select the curve corresponding to a given

imaging device without modifying the content of this file. If the file exists, the densities

can be displayed in the box for adjusting the contrast (cf.: § VIII, iSis 3D - Display

menu), or calculated in the interior of a given contour.

The item automatic calculation of densities of the menu contouring can be switched

on or off. A tablet displayed at the left of the item indicates that this mode is active. In

this case, each time a contour is created or modified, the program starts automatically

the calculation of the average value for the pixels located in the interior of the contour.

This average value is afterwards converted to density and assigned to the contour.

The corresponding value will be displayed in the box for contour modification and in

the calculation plans where the used values will be recalled if there is a heterogeneity

correction to be performed. This mode remains active as long as the item of the menu

is not reselected.

Whatever mode is chosen, it is always possible to “force” the calculation of the

average density with the help of the compute button in the box for contour

modification.

V.2.6 Structures/Bolus

Permit to update the list of structures by opening the corresponding dialog box (cf.: §

IV.8, iSis 3D - Menu slices, Structures/Bolus).

V.3 Display

The display can be modified if this adds for contouring. The most frequent

modifications (Zoom, Restore and Level/Windows) are permanently accessible

through the corresponding buttons located in the upper part of the active window.

Other functions are accessible from under the rubric Display, of the menu bar, which

gives access to the following submenu:

- Image

- Contours


iSis 3D - V 2. 35 – March 2003 V-23

- Current Beam

------------------------

- Grid >

- Distance Measurement

- Angle Measurement

Image et Contours allow to display or hide the image(s) and/or the contours of the

current slice (cf.: § VIII, Display Menu).

Current Beam offers the possibility to display the current beam during the contouring.

This item is not accessible if there isn’t any current beam. Furthermore, this option is

only available in the Display option if the “Current beam visualization in

creation/modification of contours” option is activated in the corresponding configuration

file

Zoom allow to enlarge or reduce the field of vision of the slice.

Restore allows to return to the previous "zoom" values.

Level/Windows allows to adjust the image contrast. It is not accessible if there is no

image.

Grid allows to display (or delete) at any moment a grid of chosen step centered on the

origin and superimposed on the active window.

Distance measurement allows to measure the real distance between any two points

specified on the screen with the mouse.

Angle measurement allows to measure the angle between any two vectors specified

on the screen with the mouse.

All these functions are similar to those used during the manipulation of the calculation

planes (cf.: § VIII, iSis 3D - Display Menu).


V-24 iSis 3D - V 2. 35 – March 2003

CHAPTER VI - BEAMS MENU

iSis 3D - V 2. 35 – March 2003 VI-1

VI. BEAMS MENU

Proposes the following sub-menu:

- Inverse planning

---------------

- New...

- Change...

- Duplicate...

- Opposed...

- Mirror...

- Kill

- --------------

- Doses per fraction

- --------------

- Virtual simulation

This menu allows to create beams in different manners (New, Duplicate, Opposed,

Mirror) and then to modify them with Change, and to delete them with Kill.

It also gives access to " Virtual simulation ", in which the anatomical data are

projected onto a plane (“film”) according to a “point of view” which can be associated

or not to a beam. From the mode virtual simulation can be accessed interactively the

set of functions for the creation/modification of the beam.

The option "Inverse Planning" allows to launch the beam dynamic intensity modulation

optimisation. according to constrainst of dose. This optional module is described into

" ISIS3D – Inverse planning tools for IMRT "

The beams which are created are automatically named by the system B1, B2, B3,

…Bn respecting the order in which they have been created. The maximum

number of beams that can be created is 56. Beams can be imported from other

studies (cf.: § III.13.2, iSis 3D – File menu, Import beams).

Since the first beam has been created the box for selecting the beam represented in

figure VI-1 is available. It is displayed in the first plane while the window for

creation/modification of beams is closed.


VI-2 iSis 3D - V 2. 35 – March 2003

Figure VI-1 : Beam selection box

The description of Beam selection box is done at § II.4.3, Generale principles, beam

selection box.

VI.1 New and Change

New : This choice permits to open the window creation/modification of beams and to

display a new beam proposed by default as well as the complete list of parameters.

Change : This choice permits to modify the current beam, thus it is accessible only if

there is a current beam is designated. Another way to access this mode is to double

click on the name of the beam to be modified in the “box for selecting the beam”.

The beam to be created or modified will appear pink and overwritten on the weighting

slice (cf.: § VI.1.3 – iSis 3D, Beam menu, beam paramaters, reference point). which is

displayed in the graphic zone of the window creation/modification of beams.

VI.1.1 The window for creation/ modification of beams

All the operations concerning the beams are performed within a unique window,

having the screen size (Figure VI-2), from within which are accessible all the beam

parameters and the display options. This window is used for:

• creating new beams

• modifying the existing beams

• displaying the position and/or the shape of the field and of the structures

• creating, displaying or modifying the “views” starting from the memorized “point

of views”

The main elements of the window for creation/ modification of beams are the following:


iSis 3D - V 2. 35 – March 2003 VI-3

• The graphic area occupies the upper left part of the screen. In this zone is

displayed either the transverse weighting slice, or a beam eye view, for the

current beam.

• The list of views and beams, and associated command buttons, located in the

lower central region of the screen, allows to select the current beam and to

confirm the modifications. A complementary button allows to bring to the front

plane the window for visualizing the list of beams (Figure III-6), to consult it or

to print it.

• The list with the parameters of the current beam is displayed in the right part

of the screen.

• The display options are grouped in the lower left part of the screen, under the

visualization zone.

• Two changing mode buttons, located at the lower part of the window enable

the user to toggle the current view between “slice mode” (“reference slice” or

“weighting slice1”) and “virtual simulation mode” (=”beam’s eye view). The

“reference slice” mode and “weighting slice” mode are alternatively accessible

by using the “slice mode” button and changing the label on it. These options are

available when the reference point and the weighing point are located on

distinct slices. The initially suggested option is the “reference slice” mode. It is

also possible to enter the virtual simulation mode from the corresponding item in

the “Beams” menu.

• A close button located in the lower right part of the screen permits to quit the

mode creation/ modification of beams.

1 The reference slice, is the transverse slice containing the reference point (isocenter for SAD or ARC

technique, entry point point for SSD technique). The wieghting slice is the transverse slice containing

the weighting point.


VI-4 iSis 3D - V 2. 35 – March 2003

Figure VI-2 : Reference slice

Remark : Most of the operations of creation/ modification of beams can be done in

either modes (“weighting slice” or “virtual simulation”). However each of these

modes has its own particularities. In the following descriptive paragraph the operations

which are common to the two modes and those which are not. All the operations

specific to the mode “virtual simulation”, including the beam shape adjustment and the

creation of DRR ("Digital Reconstructed Radiographs"), are described in the

paragraph dedicated to virtual simulation (cf.: § VI.7, iSis 3D - Menu Beams, Virtual

Simulation).

VI.1.2 Creation and modification of the current beam

The usual method for creating a new beam consists in choosing the item New from the

BEAMS menu.


iSis 3D - V 2. 35 – March 2003 VI-5

A beam is then generated with the technique SAD centered, in the first common

isocenter point if defined (cf.: § IV.11, iSis 3D – Slice menu, Point od Interest), if not in

the origin, for a 10 cm x 10 cm field. The chosen treatment unit is the first treatment

unit found in the library if no beam has been defined, or the last selected in the

opposite case. This beam is displayed in the reference slice which is either slice with

the common isocenter or the current slice. The weighting point is located at the

isocenter of the beam. The reference slice and weighting slice are the same. Beam

characteristics can be modified then in the list with the beam parameters or directly in

the graphical window, with the mouse.

It is important to understand that the beam generated in this manner is temporary.

Hence it does not appear in the list with beams displayed in the central part of he

window. It can be modified according to the user desire.

The already existing beams appear in the list: Beam B1, Beam B2, .… The beam to

be visualized and modified can be selected by clicking on its name which appears as

inverted video and becomes the “current” beam. Its characteristics are displayed then

in numerical form in the right part of the screen and in graphical form in the

visualization window. Since its characteristics had been modified, its “original” status

becomes “modified”. At this moment it is in a temporary status. Allowing different trials.

A box situated in the immediate proximity of the list with beam identifiers allows to

recall the current beam number and its status. A field of options allows to assign to it a

specific label (anterior, lateral).

Two buttons located in the " LIST OF VIEW AND BEAMS" part of the list containing the

beam parameters allows to generate rapidly a beam “Opposed” or “Mirror” relative to

the current temporary beam status. The exact significance of these two statuses is

specified in the descriptions of the items of the corresponding menu (cf.: § VI.3 and

VI.4, iSis 3D - Beam Menu, Opposed, Mirror).

After modifying the beam parameters, the following operations are possible by

pressing the corresponding buttons:

• Create a new beam from the current beam parameters (Create Bn+1) [n is the

first available number on the list],

• .Change the modifications of the current beam (Change Bn),


VI-6 iSis 3D - V 2. 35 – March 2003

• Kill the current beam (Delete Bn).

Since a beam is “created” or “Changed” it goes back to its original status which will be

saved for the rest of the processes.

Remark 1 : to duplicate the current beam, it is enough to click on (Create Fn+1)

before modifying it. Then the program asks to specify its label (cf : § VI.2, iSIs 3D –

Beam menu, dupplicate),.

Remark 2 : The beam numbering order can be eventually modified, recopying the

beams placed in wrong positions (with “"create"), freeing the corresponding positions

(with "kill"), recreating in the correct order the beams from those which have been

previously recopied an finally deleting the beams which have been temporarily placed

at the list end…

Remark 3 : After the modifications, in case of changing the current beam (selected

from the list) or closing the window (Close), a warning message recalls that, if none

of the operations Create or Change was previously performed, the last modifications

made on the current beam will be lost. If the answer is Continue, this confirms the

option to continue without taking into account the modifications. If the answer is

Change or Create, this allows to validate the temporary parameters of the beam Bn

and the answer Cancel permits to return to the mode creation/ modification of the

current beam.

Remark 4 : In the case an irregular field was defined in order to protect certain

structures, most of the ballistic modifications (isocenter, gantry, table or collimator

rotation angles) risk to rise the problem of the validity of the field shape. A warning

message will appear thus on Change.

VI.1.3 Beam parameters

All the beam parameters are accessible as well in mode "slice", as in mode “virtual

simulation”. They can be modified in one of the following three ways:

• Type the numerical value of the parameter and then confirm it passing to the

next option fields pressing the Tab key or with a mouse click.

• Modify the current value acting on the buttons + and -, located on the sides.

Depending on the mouse button used: the left, the central or the right, the


iSis 3D - V 2. 35 – March 2003 VI-7

values are incremented (or decremented) with a step of 1. cm, 0.1 cm and 0.01

cm for the coordinates, of 10. cm, 1. cm and 0.1 cm for the distances to the

source, and of 10.0, 1.0 and 0.10 for the rotations, respectively.

• Move the mouse graphically in the visualization window. The simple fact to

bring the cursor in this window makes the cursor change shape, becoming a

“hand” which indicates the elements that might be displaced by “click and drag”.

Meanwhile the value of the parameter is displayed in real time in the left part of

the visualization window and can be thus controlled. The modification type is

recalled by a message in the active window (in the lower left part).

In the mode “slice”, the elements which can be modified in these ways are:

• the reference point (isocenter or entrance point) = the cursor is an arrow,

“pointing” to the reference point (reference slice only).

• the gantry rotation angle = the cursor is an angle; in the ARC technique the

start and final angles, identified by the letters S and E (from start and end)

respectively, are alternatively modified.

• the collimator opening = the cursor is a vertical rod, “pointing” to the jaws

• the depth of the weighting point on the axis can be modified also graphically,

but first should be clicked on the corresponding "mouse" button, in the list with

the beam parameters.

Remark 1 : If the displayed slice is not the reference slice only the gantry rotation can

be graphically modified.

Remark 2 : It is also possible to modify graphically the position of “Points Of Interest”

defined as “isocenter” or “weighting point”, but any modification is performed using the

corresponding functions in the list of beam parameters described above.

The list of the current beam parameters is located in the right part of the screen. It is

compartimented in many zones, eaach of them including a group of parameters

(Figure VI-4).

These zones are:


VI-8 iSis 3D - V 2. 35 – March 2003

BEAM IDENTIFIER (N°, LABEL, STATUS):

It appears in the beginning of the list with parameters. The

label can be modified in the case of introducing data in

the List of views and beams, located in the lower central part of the window creation/

modification of beams.

MACHINE AND TECHNIQUE:

Machine : The treatment machine, the

beam nature (photons, electrons, protons mode) and its energy can be selected from a

pop-up list containing the corresponding menus in cascade.

Each combination of machine/mode/energy is univocally referenced in the library with

a name chosen arbitrarily by the user, reminding the beam characteristics (ref.

documentation relative to the constitution and verification of the treatment machines

library). For example, SATX20 could represent a 20 MV photon beam (X) from a

SATurne treatment machine. In any case, the details of each combination can be

found in a correspondence table defined in the BIBAP2.TBL file (cf.: Appendix 1 of

Creation of the treatment unit library …, "MACHINE - UNIT" RELATIONSHIP TABLE

(BIBAP2.TBL)).

If a treatment machine has more than one particle modes (e.g. photons, electrons) and

more than one energies, then the appropriate combination can be selected from a

pop-up list with cascade menus. Depending on the selected machine, the machine

name, the beam nature ("X" (photons), "E" (electrons) or "P" (protons)) and its energy

are shown in the last item of the list.

These cascade lists have been defined based on the table of the BIBAP2.TBL file

mentioned above. The definition order of that table is kept in the creation of the lists.

Any machine defined in the BIBAP2.BIB library but not listed in the correspondence

table of the BIBAP2.TBL file, is grouped under the “Other” item. The option “None”,

corresponds to the definition of a “view” that is not attached to a particular machine

(cf.: § VI.7.1, iSIs 3D - Beams Menu, Virtual Simulation, Notion of view).


iSis 3D - V 2. 35 – March 2003 VI-9

Remark 1: Any machine defined in the correspondence table but not defined in the

library BIBAP2.BIB, is eliminated from the list. In that case, a message appears in the

execution window.

Remark 2: The generic name of the machine, as it is listed in the first level of the

cascade list, is also used in order to handle data exportation towards an exterior

Control & Verify System. (cf.: § III.14.1, iSis 3D - File menu, Export beams.). In the

special case where more than one generic names have been associated to the same

machine code, it would be useful to be able to know which of these names has been

used. For this reason, the current name of the actually used machine, is being

highlighted in the list (note that the list can be consulted at any time).

In the special case of proton beams, one machine from the library corresponds to the

entire range of energies. It is then necessary to further clarify the proton “range”

(=depth of 90% in cm) and the modulation (= distance in cm between the 90% distal

and the 90% proximal).

Technique: exclusive buttons for selecting the SSD technique (fixed source- skin

distance), DST = source tumor distance (isocentric) or ARC (arc therapy).

SSD (cm) or DSA (cm) : introduction of the reference distance.

This field is called SSD (cm) when the adopted technique is SSD and DSA (cm)

when the adopted technique is STD = isocentric (SAD) or ARC. DSA is

automatically displayed and corresponds to the SAD previously chosen for the

treatment unit and it cannot be modified. Only the SSD value can be modified.

It is possible to pass from the SSD technique to the isocentric technique and vice

versa. The rules to apply are the following:

- SSD DST : the weighting point in mandatory on axis. The normalization depth is

preserved. The isocenter is thus placed on the beam axis at the normaization point.

The field size remains unchanged.

If weighting is not on axis, it is not possible to change technique SSD -> DST.

Weighting point has to be set on axis before to change technique.


VI-10 iSis 3D - V 2. 35 – March 2003

- DST SSD : the normalization depth is preserved and the reference point is

brought to the skin.

It is not possible to pass directly SSD ↔ ARC. However it is possible to pass directly

SSD ↔ DST et DST ↔ ARC

REFERENCE POINT :

- Isocenter or Entry point: is displayed,

depending on the technique chosen.

Actually, the reference point of the beam is

the entrance point (intersection of the

beam axis with the external contour of the normalization slice) in the SSD technique. A

point in the interior of the contour will be the isocenter in the isocentric technique, DST

or ARC.

- X, Y, Z : correspond to the coordinates X, Y, Z of the reference point in the

radiotherapy coordinate system.

By default Z is the longitudinal position of the current slice named « reference slice »,

i.e. the (rescaled) slice which contains the normalization point. In case Z is changed,

the corresponding normalization slice is displayed again.

In the coplanar technique (without table rotation), the reference point can be moved

with the mouse in the slice windows mode or virtual simulation mode, whatever

technique used. (cf.: § VI.7.2.a, iSis 3D - Beams menu, Virtual simulation

creation/modification of beam). The X,Y and Z fields are accessible .

In the noncoplanar technique (with table rotation), the reference point can be moved

with the mouse only in “virtual simulation mode”, whatever technique used. It can be

also defined with X,Y and Z fields.

- Centering on: is a button which allows the automatic calculation of the reference

point in the center of the structure selected from the associated scrolling list “Center

on”. This “center” can be defined as the center of the smallest sphere encompassing

the structure ("Spherical centering ") or as the center of the smallest parallelepiped X,


iSis 3D - V 2. 35 – March 2003 VI-11

Y, Z encompassing the structure ("Parallelepipedique centering"). The second option

is better adapted for treatments in coplanar mode (without table rotation).

In the case of spherical automatic centering only, the diameter of the sphere including

the structure is being reminded.

- Related point :

Only in the case of SAD or ARC techniques, the “related point” offers the possibility to

attach a beam to a common isocenter (a Point of Interest defined as “isocenter”, (cf.: §

IV.11, iSIs 3D - Slices Menu, Points of Interest) that can be either predefined or

defined during the creation/modification of beams. The modification of the position of

that point can be done in two ways:

- By acting on those points (Input box for the “Point of Interest” characteristics),

- By moving (graphically) the current reference point and then shifting the

associated Point of Interest on this new position.

The second way is probably the most convenient one.

A pop-up list allows to define the attachment option for the beam:

- « None » is being displayed if the beam is not attached to any common isocenter. In

the opposite case, selecting this option cancels the association of the beam to the

common isocenter.

-« New » offers the possibility to define a new common isocenter. The selection of this

option opens the input box for the characteristics of the Point of Interest. (cf.: § IV.11.2,

iSIs 3D - Slices menu, Points of interest,… ). An identification code and a name are

being suggested by default, such as « Ix» and « Isocentre_x, x being the first available

index. The initial coordinates (by default) of the Point of Interest are the coordinates of

the beam isocenter. Compulsory, the type of the Point of Interest is « Isocenter ».

The point type can be completed, for example defining it as a dose point as well. The

position of the Point of Interest can be modified by entering new coordinates, by

automatically centering it in a structure or by defining it graphically, either on the

“virtual simulation” view, or in the “reference view”, according to the active display

mode at the moment of the dialog box opening. While in the “reference slice” display

mode, a modification of the Z results to the display of the corresponding slice that


VI-12 iSis 3D - V 2. 35 – March 2003

becomes the new “reference slice”. The creation of the new isocenter becomes

effective when the characteristics of the reference point are being validated using the

« OK » button. Closing the dialog using the « Cancel » button, cancels the creation of

the point associated to the beam isocenter.

By validating the Point of Interest , the coordinates of the beam reference point are

being updated according to the coordinates of the new isocenter. The menu of the

associated point shows the identification code of the new isocenter and the “Details”

button (cf .: § hereunder) becomes accessible.

- The list of beam attachment options is being completed with the list of all existing

common isocenters. Selecting an isocenter in this list offers the possibility to modify

the coordinates of the common isocenter and gives access to the « Details » button .

An information message is being displayed if, the position of the reference point or the

weighting depth have been modified.

Details opens the dialog box for the modification of the point characteristics. It is

initialized with the characteristics of the point associated to the beam isocenter.

Remark 1 : any modification of the Point of Interest, or “common isocenter”, results

to the change of the current isocenter and to the modification of all the beams

associated to this “current isocenter” ( cf : Remark 1). Match becomes accessible

when the reference point of the current beam is being moved and it is no more

superimposed to the associated point. The matching results to the modification of the

associated point or “common isocenter”, that is then placed on the reference point. If

other beams are also attached to the same “common isocenter”, then their reference

point is also modified ( ref : Remark 2)

Remark 2 : the weighting depth of the beams associated to this “common isocenter”

is being recalculated in the case of modification of its position using the Details or

Match options. If the new depth has not been validated, then the beams are being

detached from this isocenter and their Point of Interest is not being changed.

Remark 3 : canceling the modification of the current beam, also cancels the

matching of the associated “common isocenter” and as a consequence any

modification of the beams attached to this “common isocenter”.


iSis 3D - V 2. 35 – March 2003 VI-13

GANTRY ROTATION - TABLE ROTATION :

- Gantry rotation, start (and end)” : In SSD or in isocentric technique, the gantry

rotation angle, in degrees, is specified, in agreement with the conventions of ICE. In

ARC technique are indicated the starting and the final arc angles “Clock Wise" ”

(attention to the range!). The corresponding arc is represented graphically. In all cases

the angle can be adjusted directly with the mouse in the graphic window.

- Table rotation : The angle of the table isocentric rotation is specified, in agreement

with the conventions of ICE. Thus a beam entering from the head top usually

corresponds to a combination gantry rotation angle/ table rotation angle 90°/270° or

270°/90°. Taking into account the difficulties in defining the reference point, the table

rotation is not allowed in the SSD technique when the SSD value differs from the SAD

value.

In case of table rotation (noncoplanar technique), the beam is or is not displayed in the

calculation plane or virtual simulation, according to option selected into beam box ‘

COLLIMATOR :

The information given in this zone,

concern the main collimator jaws.

- Rotation (0) : introduce the collimator rotation angle, according to the ICE norms

(positive in the counter clockwise sense looking from the source to the isocenter). A

“shortcut” allows a rapid display; one of the 4 principal positions can be found in the

proximity of the field defining the wedge filter. If there is a collimator rotation, an “R”

appears nearby the entrance point in the transverse slices.

- FX and FY (cm): Introduce or display the dimensions of the principal collimator.

These dimensions are defined (starting with ISIS3D v2.1) at the distance from the

isocenter. Hence the values of the “collimator opening” are to be displayed

directly on the treatment unit. In the case it might be an ambiguity (SSD different

from SAD), a warning message recalls the adopted convention. The user may choose

not to be shown any more this message, ("Vu, ne plus m’alerter"), for the respective


VI-14 iSis 3D - V 2. 35 – March 2003

dossier and the message will be presented only after passing to the next dossier. This

message can also be inhibited with an option from the configuration file.

FX and FY are named according to the ICE conventions; Fx corresponds to the “width”

and FY to the “length” in the case of zero collimator rotation.

For each pair of jaws X or Y, it is possible to specify if it is used in mode symmetric,

asymmetric or multi-leaf.

- If the asymmetric mode is selected for one of the pairs of jaws, the fields for

introducing FX or FY becomes inaccessible and it should be clicked on the button

"Details" in order to introduce the individual values for X1, X2, Y1 or Y2

corresponding to each jaws pair. However it is more convenient to adjust the position

of each jaw by mousse in the graphic window (see also “virtual simulation” mode).

Note that it is possible (for the moment) to define the asymmetric mode for any pair of

jaws, even if the treatment unit does not actually permit that.

- If the treatment unit has a level of principal collimation (X or Y) equipped with a

multi-leaf collimator, this option becomes accessible having the possibility to

calculate automatically the leaves position after defining a field shape and chosen a

target (cf.: hereunder).

ADDITIONAL COLLIMATION :

The fields of options, scrolling lists and

buttons of this pop-up menu are related to

the eventual additional collimation.

Type

It is related to the trimmers, the blocks fixed on the block-trays already recorded in the

machine library as well as the leaves of the additional multi-leaf collimator. It is not

possible different combination of these elements. The selection “none” allows to

cancel all the additional collimation previously defined.


iSis 3D - V 2. 35 – March 2003 VI-15

Number

The trimmer or tray number, if it is the case, is selected form the from a scrolling list

limited by the available record for the selected unit. The Source-Tray Distance or

Source-Trimmer Distance is also displayed, as a verification.

Remark : When a tray or multi-leaf collimator is used, automatically is proceeded

to the “virtual simulation mode” in order to define the field shape. For more details on

the possibilities offered refer to the virtual simulation mode (cf.: § VI.7, iSIs 3D - Beam

Menu, Virtual Simulation, Multi-leaf Collimator).

WEDGE FILTER :

Select the desired filter from within

the drop-down list containing the

available filters for the current machine or answer “NO” in order to cancel the filter

previously selected. The corresponding angle is recalled for verification.

The filters are always “attached” to the main collimator, meaning that they accompany

the collimator rotation. They are four types, according to the way they were defined

within the library:

• either they occupy an unique position with respect to the principal collimator

(defined in the library)

• either they have the possibility to be inserted according several orientations.

• either they are dynamic of VARIAN EDW Y1IN type

• either they are dynamic of VARIAN EDW Y2OUT type.

In the first case, the orientation is performed playing with the rotation of the collimator.

The buttons corresponding to the principal orientations allow to rapidly rotate by 90° or

180°.

In the second case, the orientation which can be right, left, gun or target has to be

specified. This label corresponds to the thicker edge of the wedge filter considering the

rotations of the collimator and of the gantry equal to 0°.


VI-16 iSis 3D - V 2. 35 – March 2003

In the third case, there is about a Varian dynamic wedge, obtained by the

displacement of the Y2 leaf, during the irradiation, towards the target. This filter is

equivalent to a physical filter for which the orientation of the thicker edge is target

In the fourth case, is about a dynamic Varian filter, obtained by the displacement of the

Y2 leaf during the irradiation towards the target. This filter is equivalent to a physical

filter for which the orientation of the thicker edge is gun.

For these last two cases, the calculation of the monitor units is based on the value of

the Y dimension (according to the side of the equivalent square field). In any case, the

calculation of the monitor units is authorized only if the equivalent square field (or the

involved side for the dynamic filters) is part of the interval defined for the variation of

the transmission, which is function of field dimensions.

The selected orientation of the wedge filter can be checked by looking on the graphical

display area.

Remark : Do not forget to converse the length and width when the collimator is rotated

with 900 or 2700 .

COMPENSATOR / MODULATOR :

Modulators are dynamic intensity

modulation files such as those

generated by an inverse planing procedure. They concern only photon beams with

multileaf collimators.

Compensators are beam modifiers attached on the collimator that have been

previously calculated in order to compensate the patient’s irregular surface and/or

tissue heterogeneity. The COMPENSATOR/MODULATOR menu is accessible only for

photon beams with multileaf collimators and for proton beams, provided that structures

have been defined.

Actions relative to the buttons of this option depend on the type of the beam. The

procedure for photon beams is that of inverse planning and it is described in the

document entitled “ISIS3D – Inverse planning tools for IMRT”. Here, we will only

describe the application functions relative to the proton beams.


iSis 3D - V 2. 35 – March 2003 VI-17

Utilization of compensator with photon beam is described into Appendix G.

BOLUS :

It is possible to associate a bolus to the current beam with the condition that the

property “bolus” was previously associated to one or more structures (cf.: § IV.8, iSIs

3D - Slices menu, structures/bolus).

The bolus is selected form the list with available bolus for the current case. The

eventually free-space (between bolus and skin surface) is checked and a message is

displayed if free-space was detected, then the bolus is not taken into account. If the

bolus was taken into account (no free-space available) it is required to modify its

contour by selecting the creation/modification of the contour (cf.: § V.2.4, iSIs 3D-

Procedure Creation/Modification of Contours) and then re-associate it to the beam.

BEAM WEIGHTING :

The “weight” of each beam is being

defined according to its contribution on a

specific point called “weighting point”. In

ISIS 3D, there are two different ways of beam weighting: the “theoretical weighting”

mode and the “effective weighting” mode. From ISIS3D-Version 2.3, the weighting

point can be defined either on the beam axis or off-axis on a specific point defined as

“weighting point” (cf : § II.3.4, iSis 3D - General Principles, Theoretical and effective

contribution).

A- Type of weighting

A pop-up list offers the possibility of choosing the position of the weighting point :

• on-axis is the default option of the weighting point position.

In a SAD or ARC technique, the weighting point is compulsory the isocenter. In

a SSD technique, the weighting point is being defined automatically for electron

beams as the depth of maximum dose and it cannot be modified, otherwise it is

defined as a function of the specified weighting depth. The reference slice is the

same with the weighting slice.


VI-18 iSis 3D - V 2. 35 – March 2003

• New point offers the possibility to define a weighting point off-axis, or on-axis

but at a depth which is different than the automatically calculated one.

Selecting this option, opens an input box for the definition of the characteristics

of the point of interest. (cf.: § IV.11.2, Slices menu, Points of Interest,… ). An

identification code and a name are suggested by default, such as « Wx» and

"Weight._x", x being the first available index. The coordinates of the Point of

Interest are being initialized with the coordinates of the initial weighting point.

The “type” of the Point of Interest is compulsory the « Weighting Point » type,

and it can be further completed e.g. as a “dose point”. The position of the Point

of Interest can be modified by entering new coordinates, by automatically

centering it in a structure, or by defining it graphically, either on the “virtual

simulation” view, or in the “weighting view”, according to the active display

mode at the moment of the dialog box opening. While in the “weighting slice”

display mode, a modification of the Z results to the display of the corresponding

slice that becomes the new “weighting slice”. The creation of the new weighting

point becomes effective when the characteristics of the point are being

validated using the « OK » button.

By validating the Point of Interest, the coordinates of the beam weighting point, the

weighting depth and the weighting slice are being updated. The “Details” button (cf

hereunder) becomes accessible.

• The list of options relative to the position of the weighting point is being

completed with the list of all existing weighting points. Selecting a weighting

point in this list offers the possibility to modify the coordinates of the weighting

point, to recalculate the weighting depth, to update the weighting slice and to

access the « Details » button.

Details opens the dialog box for the modification of the point characteristics. It is

initialized with the characteristics of the weighting point.

Remark 1: any modification of the Point of Interest, results to the change of the

weighting point for the current beam but also for all the beams associated to this point.

If the new weighting depths are not correct, then following user confirmation the

weighting mode of invalid beams can be modified by removing the association and

returning to on-axis weighting mode.


iSis 3D - V 2. 35 – March 2003 VI-19

Remark 2 : canceling the changes done on the current beam, results to the

cancellation of any possible modification of the Point of Interest and as a consequence

any modification of the beams attached to that point.

B- Depth of the weighting point

The Mouse button, is accessible for photons or protons in SSD mode with on-axis

weighting and offers the possibility to graphically define the weighting point in the

reference slice or in the weighting slice.

Depth (cm) : is used in order to input (or as a reminder of) the weighting depth,

according to the applied technique and the position of the weighting point.

- Contribution: This is the dose (relative or absolute) at the weighting point due to

the current beam. To facilitate the searching for the optimum weightings, the weighting

of each beam is also displayed in the box for selecting the beams, where it can be

modified.

- Depth (cm): allows to input or recalls the depth of the weighting point.

The weighting point is on axis :

• In SSD technique

o For photons beams, this depth is specified by the user, but never can

be smaller than the depth of maximum dose. The 0 value allows to work

change in the mode “weighting at the entrance”. The depth of maximum

dose is then automatically recomputed, (beam modifiers are not take into

account) even if field dimensions or energy has been modified. On the

other hand, if depth greater than the depth of maximum dose is explicitly

given, than this depth is a priori saved for all the cases where the depth

of maximum dose is smaller.

o For electron, the depth of the weighting point is always the depth of

dose maximum, calculated under “real” conditions, taking into account

the additional electron blocks.


VI-20 iSis 3D - V 2. 35 – March 2003

o For proton beams, the weighting point must be placed on the

modulation plateau. The point can be placed automatically in the middle

of the modulation plateau by entering a weighting depth equal to zero.

• In SAD technique the normalization depth is automatically computed and, by

default, taken equal to the one of the isocenter. This value is not modifiable.

• In ARC technique, it is not possible to modify the normalization depth. This

depth is automatically computed and considered as equal to the “effective”

depth of the isocenter, that means at a depth which gives a TMR (Tissue-

Maximum Ratio) equal to the average TMR computed over all the area scanned

by the arc

The weighting point is associated to a point of interest :

• In SSD or SAD technique, the weighting depth displayed is the depth of point of

interest.

• In ARC technique the weighting depth displayed is the “effective” depth of point

of interest.

C- Value of contribution at weighting point :

Contribution: This is the dose (relative or absolute) at the weighting point due to

the current beam.

To facilitate the searching for the optimum weightings, the weighting of each beam is

also displayed in the box for selecting the beams, where it can be modified.

The two buttons, theor. and effect. allow to select between the modes:

- In “theoretic weighting” mode, where the dose contribution at the weighting

point is given considering the case of the semi-infinite medium and no

blocks or inhomogeneities are present.

- In “effective weighting” mode, the entire contribution at the weighting point

is effectively taken into account.


iSis 3D - V 2. 35 – March 2003 VI-21

The “theoretic” and “effective” contributions are both computed in any case and

displayed in the summary-file on the beams list.

In case of weighting at a point of interest or forelectron beam, the mode of contribution

is mandatory “effective” and cannot be modifiable.

For more information about ”theroretical’ and ”effective” mode, cf.: § II-3-4, iSis3D –

General principles, Tearetical and effective contribution.

D- Remarks about weighting

Remark 1: the button " mouse capture” related to the weighting depth allows to

adjust in the graphic area and in real time the corresponding depth by using the

mouse. The depth validation is performed by clicking on Ok button.

Remark 2: In “theoretical weighting” is normal (in the presence of blocks,

inhomogeneities or lack of scatter volume) to obtain at the normalization point a dose

different from the prescribed contribution. Change the mode or calculate with the rule

of three simple over the contribution in order to obtain the desired result then check if it

is coherent with the method specified for treatment time calculation.

Remark 3: In all the cases, a warning message signals an incorrect technique if the

normalization depth is placed at a depth smaller than the depth of maximum dose

(case of photons and electrons) or beyond the modulation region (proton beams). For

electron beams no check is performed if the normalization depth is placed beyond the

depth of maximum dose.

Remark 4: In the case of bolus, the depth and the SSD values are always defined

relative to the real skin.

Remark 5: Although is better to avoid this situation, if the central beam passes

through air before reaching the normalization point, only the effective tissue crossed

by the beam is taken into account

ATTENTION !

The beam data restrict the calculations validity and their conformity according to

the designed and accomplished treatment plan. So, it is important that the

significance of different parameters, the adopted conventions (which can be


VI-22 iSis 3D - V 2. 35 – March 2003

different than the ones of the machines used) be well understood. As a result, a

rigorous check of all data inputted for each study should be performed

(especially looking at the file with the beams used).

VI.1.4 Display options:

The slice mode implies a transverse view of the corresponding slice in the graphic

area. The parameters displayed are: the contours, the image (if it exists), point of

interest and the beams (with the exception of the non-coplanar beams). The current

beam is pink-colored and can be moved and adjusted by mouse (cf.: § VI.1.3, iSis 3D -

Beam Menu, New/Modify, Beam parameters).

“All cont.” or “Image” option buttons allow to select or not the contours or the images in

the objects list as well as the convenient display mode (visible or not). For other

objects included on the list, the selection of the display mode remains inaccessible for

the “weighting contour”. It can be used only in the “virtual simulation” (cf.: § VI.7, iSis

3D - Beam Menu, Virtual Simulation).

Browser bar located right under the graphic windows allows to display other slices to

check the limits of the beam.

The flag R indicate that the displayed slice is the reference slice of the selected beam.

Figure VI-3 : Browser bar

The flag W indicate that the displayed slice is the weighting slice of the selected beam.

Central button :

- If the displayed slice is not the weighting slice, this will move to weighting slice.

- If the displayed slice is the weighting slice, this will move to the previous displayed

slice.

-1 / +1 : Move backward or forward one slice (range all slices)

-5 / +5 : Move backward or forward five slice (range all slices)

|< & >| : Move backward or forward one slice (range only selected slices)


iSis 3D - V 2. 35 – March 2003 VI-23

Remark : slices are sorted according to the Z value and not the slice number

The Print button is right-down of the graphic area and allows to have a printout after

print options validation (cf.: § III.9, iSis 3D - File Menu, Print Current Study).

The most used display options are accessible due to the buttons placed right under

the graphic area. The buttons available are: Zoom, Refresh and Level/Window. The

Tools button includes the grid display, the distance measurement and the angle

measurement functions. All these functions are presented in detailed in the paragraph

dedicated to the DISPLAY menu (cf.: § VIII, iSis 3D - Display Menu).

VI.2 Duplicate

creates a new beam identical to the current beam and leads to the display of the beam

creation/modification window. The label of the new beam is by default “dup Bi”.

Weighting, dose per fraction, beam group are kept for the new beam.

The option “Duplicate” is accessible only for the current beam.

VI.3 Opposed

permits to create a new beam opposite to the current beam, that means co-axial but

the gantry is rotated with 1800, the field shape is inverted (taking into account the

leaves position), the rotation of the collimator and the wedge filter orientation. The

table rotation is preserved.

In the SSD technique, the coordinates of the reference point are recalculated and the

weighting depth is preserved. In the SAD technique, the isocenter position is

preserved and the normalization depth is recalculated if it is positioned at the

isocenter. If the normalization point is not placed at the isocenter, the normalization

depth is preserved. In all cases, the contribution value is preserved.

In SSD technique, the coordinate of reference point are recomputed and the depth of

the weighting point is kept if the qweithing is on axis. If the weighting point is a point of

interest, this point is kept and the weighting depth is recomputed. In SAD technique,

yhe isocenter position is kept as weel as the weigthing point located either at isocenter

or at point of interest. The weighting depth is recompute. In all case th contribution,

dose per fraction, beam group are kept.


VI-24 iSis 3D - V 2. 35 – March 2003

The label of the created beam is, by default, “opp Bi”.

The option “Opposed” is accessible only for the current beam.

VI.4 Mirror

allows to create the mirror beam of the current beam, that means symmetrical

relative to a reference sagittal plane or parasagittal (taking into account the

inversion of the field shape, the leaves position, the rotation of the collimator and the

wedge filter orientation). This reference plane crosses throughout:

• the isocenter of the current beam, in a SAD or ARC technique;

• the contour origin, in a SSD technique.

In the case of the noncoplanar beam, the rotation of the table remains unchanged.

In the SSD technique, the coordinates of the reference point are recalculated and the

normalization depth is preserved. In the SAD technique, the isocenter position is

preserved and the normalization depth is recalculated if is positioned at the isocenter.

If the weighting point is not placed at the isocenter, the weighting depth is preserved.

In all cases, the contribution value is preserved.

In SSD technique, the coordinate of reference point are recomputed and the depth of

the weighting point is kept if the qweithing is on axis. If the weighting point is a point of

interest, this point is kept and the weighting depth is recomputed. In SAD technique,

yhe isocenter position is kept as weel as the weigthing point located either at isocenter

or at point of interest. The weighting depth is recompute. In all case th contribution,

dose per fraction, beam group are kept.

The label of the created beam is, by default, “mir Bi”.

The option “Mirror” is accessible only for the current beam.

VI.5 Kill

deletes the current beam after user confirmation.


iSis 3D - V 2. 35 – March 2003 VI-25

VI.6 Dose per fraction

opens a dialog box (Figure VI-5) which includes the list with beams previously defined,

(identified by their current number and their label) in order to see their values for dose

per fraction. These doses are used to calculate the treatment time (cf.: § III.8, iSis 3D -

File Menu, Treatment times). Theoretical or effective doses can be selected as it was

stated in the definition of the beam weighting. Only the beams for which a dose per

fraction was already defined are available to compute the treatment time.

In specific cases (electrons or protons beams) the treatment time cannot (for the

moment) be computed. An informative message is displayed and should be validated.

If more than 8 beams are defined, an arrow allows to scroll all defined beams.

Figure VI-4 : Dose per fraction definition box

ATTENTION!

The validation of the treatment time is the direct responsibility of the user. This

calculation is strongly dependent on the method of data input and analysis of

the basic data inputted in the machine library. Reference dose rate data,

collimator opening factor, the transmission of the accessories are especially

important.

VI.7 Virtual simulation and field shape

The Virtual simulation mode ( = Beam Eye View) allows to control and adjust the beam

position and the field shape according to the structures specified on the transversal

slices. This modality is obligatorily active when the field shape (additional blocks or

multi-leaf collimator). is defined.

The Beam Eye View option is accessed either by selecting the option from the

“Beam” menu, or by clicking the “Virtual simulation” button while in


VI-26 iSis 3D - V 2. 35 – March 2003

creation/modification of beam mode, displaying the weighting slice. The switch is

automatic as soon as the functions from creation/ modification of the field shape are

accessed.

The window which is displayed is similar with the window for creation/modification of

beam, as it appears in "contour de weighting" mode. In particular we recognize the

possibility to access the set of beam parameters and the display options. On the other

hand, the graphic area represents the field as seen from the “source view”,

composed of the following graphical elements:

• the main collimator (pink),

• the shape of the additional collimation (pink),

• the contours of the anatomical structures and the marks previously

introduced in the transverse slices

• the point of interest

• the Digital Reconstructed Radiograph image.

These elements correspond to a conical projection from the source on a plane

perpendicular on the beam axis and situated at a distance from the source specified in

the field “Virtual SFD ”, located at the lower right of the zone where are specified the

display options. The graphic zone representing a “virtual film” can be printed at the

desired magnification factor.

The following elements are indented to help for an easier orientation:

• The screen’s vertical corresponds by default to the longitudinal axis of the

machine, the gantry being identified by a small fixed square. (cf.: § VI.7.6, iSis

3D - Beams Menu, Virtual Simulation, Display Option).

• While the gantry or the table are rotated, everything is taking place like we were

lying on the machine gantry, with the head towards the gantry (the fixed square)

and looking towards the isocenter. Only the projection of structures (source

view) is modified.


iSis 3D - V 2. 35 – March 2003 VI-27

• While we rotate the collimator, we remain “lying on the gantry”. We see so, the

collimator rotating. A pink mobile square attached to the jaws Y2 (oriented

towards the gantry for zero rotation) allows to appreciate more easily the

rotation angle.

• If there is a wedge filter, its symbol is displayed in the part where is the thick

side

• A system indicating the patient orientation is displayed at the lower left of the

graphical area.

VI.7.1 The View Concept

The “ source views” for each of the beams can be completed by other views

(“Observer Views”) where the observer eye takes the source place. These views can

be named, saved and retrieved.

Three “standard” views (non changeable during the study ) are systematically

included in the list of views and beams: a profile view, a frontal view and a transverse

view, centered on the origin, at the standard source-film distance.

The non standard views are named by default "view V1", "view V2". We can rename

them informing the field of options of the label. Their new names appear in the list in

the place of "view Vi".

Figure VI-5 : List of view

The views are characterized by the fact that none of the machines are associated to

them. They are defined in an isocentric technique by the coordinates X, Y, Z of the


VI-28 iSis 3D - V 2. 35 – March 2003

isocenter I, of the source to the point I (DSI), of the gantry rotation and of the table

rotation.

The characteristic parameters of the views are modified by using the same procedures

like for creation/modification of beams.

VI.7.2 Creation/Modification of a beam or of a view

By default the window of the virtual simulation opens presenting the first standard view

if none of the current beams is selected, or the current beam view alternatively.

According to the nature of the selected element in the list (beam or view), the right side

of the screen has more or fewer rubrics. For the views, none of the machines is

associated and only the useful parameters are preserved.

The parameters modification is done like in slice normalization mode, giving

numerical values, by using the buttons + and -, or starting the functions for automatic

placement (cf.: § VI.1.3, iSis 3D - Menu Beams, New/Modify, Beam parameters).

We can also act graphically with the mouse on the next elements:

a) Position of the reference point:

While the cursor above the center of the cross wires, takes a hand shape. We can

than move the reference point by using the mouse. First is done a translation of the

axis and than while we release the button the image is calculated and centered again

and the coordinates X,Y and Z are updated.

b) Position of the jaws of the principal collimator

While the cursor is passing above the margins of the principal collimator takes the

shape of a line or of a corner and an arrow, a hand shows the concerned side or the

corner . In symmetrical mode, according if we “grab” a side or an edge we move

symmetrically one side or two pairs of jaws. In asymmetrical mode each jaw can be

moved independently. In all the cases, the jaws positions are displayed in real time in

the left side of the graphical area.


iSis 3D - V 2. 35 – March 2003 VI-29

c) The Collimator Rotation:

While the cursor is passing above one cross wires axes, outside of the jaws, it takes

the angle shape and a hand highlights the cross wire’s axis. We can than move the

collimator using the mouse. The rotation value is displayed in real time in the left side

of the graphical area.

If a complex field is defined, the selection of the “Fixed form in rot” (zone “DISPLAY

OPTIONS”) allows not to apply the rotation of the collimator to the field’s shape. The

choice of the default option (Fixed form in rot) can be defined within the

customization file. By combining the collimator rotations with and without the selection

of the option, one can establish according to the wish, the positions of the block with

respect to the principal collimator.

d) The Field Shape

The field shape defined while there are the additional blocks or a multi-leaf collimator

can be modified by clicking on the button “Distort” of the area ”additional collimation “

(cf.: § VI.7.3, iSIs 3D - Menu Beams, Virtual Simulation, Introducing and Adjusting the

Field Shape).

While the characteristics of the beams or of a view are updated, we can click on the

buttons Create, Change and Kill like indicated previously (cf.: § VI.1, iSIs 3D - Menu

Beams, New/Modify, Creation/ Modification of Beams).

The label of these buttons is slightly different if is about the beams or views ("Create

Bi" or "Create", ...).

VI.7.3 Introducing and adjusting the field shape

Apart of the case that the field is defined only by the main collimator (rectangular) or

by the trimmer, the field shape is always defined in “virtual simulation” mode. The

possible options are essentially regrouped in the area of the parameters named

ADDED COLLIMATION:


VI-30 iSis 3D - V 2. 35 – March 2003

Figure VI-6 : Added collimation

A pop-up list allows to choose the type of the additional collimation used:

- “none” is displayed by default. By selecting “none” while the additional collimator was

defined, this is deleted after confirmation.

- “trimmer” allows to define the trimmer (cf.: § VI.1.3, iSis 3D - Menu Beams,

New/Modifier, Beam parameters)

- “Block-tray” allows the selection of tray number in the list with available numbers for

the current machine. We can so access the introduced field shape.

- “multi-leaf” is accessible only if the current machine allows this. The functions

relative to the definition and position modification of the leaves are described in the

paragraph “Multi-leaf collimator” (cf.: § VI.7.5, iSis 3D - Menu Beams, Virtual

Simulation, Multi-leaf Collimator).

When a tray is used, the field shape can be introduced in different manners,

depending on the choice made in the scrolling list “field shape after”:

• “Main colli.” Starts the field creation, limited by the blocks but having a form

which might be superimposed on that of the principal collimator,

• “1 film” or “2 films” permits to introduce with the digitizer 1 or 2 parts

according to the selected option. The film should be positioned in such way so

as to be seen from the source for a gantry rotation angle and collimator rotation

angle equal to zero (gantry up). The source - film distance (SFD) must be

specified, in cm, in the corresponding field with options. The user is guided by

messages appearing in the dialog box of the active window. The action of

finishing the work (fin du travail) ensures the closing of the field shape.


iSis 3D - V 2. 35 – March 2003 VI-31

The orientation and the position of the image (or one of each parts of both) of the field

on the digitizer are provide to the system by the plot of one of this axis.

• Define, by 2 point the vertical axis

- Plot the "BOTTOM" point

You plot one point one the Y axis of the field

- Plot the "TOP" point

You plot a second point on the Y axis. This second point should be located at least

at 3 cm from the first on, in positive Y direction. Otherwise, a warning message alert

the user and ask to repeat the both points 'BOTTOM" and "TOP".

- plot the "CENTER" of the field

The point should not be off more than 3 mm from the vertical defined by the two

first point. Otherwise, a warning message alert the user and ask to repeat the three

points 'BOTTOM", "TOP" and "CENTER".

The plot of the field start with real tie display of the plotting point taking account of the

collimator rotation.

- Plot the field shape :

After the last point, do "END OF WORK"

You plot the first point of the field. The total number of plotting points should be less

or equal to 299. After the plot of each point, the coordinates (taking account the

collimator rotation) and he number of point remaining are displayed :

1 ( 7.55, -1.37) - rest 298

2 (-1.16,-7.75) - rest 297

......

When plotting from 1 film, the action on "END OF WORK" close the field shape.

When plotting from 2 films, the current part is remind when plotting the axis.

- Plot of the part 1

- Plot of the part 2 with 290 points


VI-32 iSis 3D - V 2. 35 – March 2003

The plot of the first part is end by action on "end of work" and start the plot of the

second one, the last point plotted on the first part being linked to the first point

on the second part.

At the end of plot of the second part, the action on "END OF WORK" close the field

shape.

- “Mouse capture” permits the direct introduction in the graphic zone, eventually

using a grid displayed on the screen due to the button “tools” (cf.: § VI-1-4, Menu

Beams, New/Modify, Display Options). In mode “mouse capture” some other buttons

appear in the active window:

ERASE to restarting the current data introduction

CORRECT to going back point by point

CANCEL to quit without saving the last introduced data

OK to close the field shape and to account for the changes.

"structure" offers the possibility to automatically calculate the field shape according to

the shape of the target structure (target volume) in the “Beam’s Eye View”. A cascade

menu allows to select the structure of interest among the defined structures. Once the

structure has been selected, it is convenient to define a margin in cm around the

structure (using the pop-up list or typing a numerical value) and then create the

irregular field either “complete” or “reduced” depending on the neighboring structures,

clicking on the “Whole” or “Part” button of the “Create” menu respectively.

The Create/Whole option starts the automatic calculation of the field shape directly,

while

The Create/Part option opens the next dialog box offering the possibility to select the

structures to be avoided and to specify for each one of them a margin around them to

be respected. The automatic calculation of the “reduced” irregular field shape

according to these constraints is started using the Ok button. The Cancel buttons

allows to abandon the irregular field shape creation.


iSis 3D - V 2. 35 – March 2003 VI-33

Figure VI-7 : Customized collimator

Once the field shape has been introduced (or computed), the main collimator is

automatically repositioned in symmetric mode within the limits of the field contour,

respecting an additional margin, given in the parameters file. Then can be adjusted the

jaws position, in symmetric or asymmetric mode. However they are constrained to

remain exterior to the field. If this is not respected the message “Beam and field

dimensions not adjusted” does not allow the beam validation.

Whatever was the mode of introducing the field shape, it is still possible to modify it a

posteriori:

- The button "Distort" leads to the display in the graphic zone of the buttons: “ADD”,

“DELETE”, “MODIFY”, “CANCEL” and “OK”. These buttons allow to modify the field shape

on the screen in the same way as for the contours.

- The button “Delete” deletes all the tray, trimmer, or irregular field associated with the

beam. The same result is obtained selecting “none” in the list with the types of

additional collimation.


VI-34 iSis 3D - V 2. 35 – March 2003

Remark 1 : There is no preferential sense for introducing the field shape. In turn, the

data introduction should be continuos. In case there is a central block, it is necessary

to “cross” the exposed zone and then to continue introducing data in the inverse

sense, before “re-crossing” on the same way. A control on the coherence is done and

a warning message signals if the introduced shape seems abnormal.

Remark 2 : ISIS3D can distinguish between the margins delimited by the principal

collimator and those delimited by the additional blocks. It recognizes this automatically

if the irregular field shape was introduced following the jaws of the principal collimator,

there where they effectively define the beam. A graphic control can be done because

the margins delimited by the principal collimator appear with a fine line, while the

margins delimited by the additional blocks appear with a thick line.

VI.7.4 Exporting the field shape

For constructing personalized blocks (“Cerrobend”) using a computer controlled

machine for cutting polystyrene it is possible to export directly the files from ISIS3D,

respecting the format required by the cutting machine.

The exportation is done as one file per beam, clicking on the button “Export” from the

zone “additional collimation”. The graphic zone displays then the “block image” and a

new window will be opened allowing to choose the exportation parameters”

Protected area

Irradiated area


iSis 3D - V 2. 35 – March 2003 VI-35

Figure VI-8 : Field shape exportation

- The exportation control window permits (Figure VI-8):

• to choose the appropriate exportation format (zone Exportation, "Au format"),

• to choose the exportation file location and its name. A default file name is

proposed and the file extension is imposed by the chosen format. If it was

chosen a file name already existing, a warning message informs the user that

he should specify a new name.

• to choose the visualization parameters: “Visualization plane": bottom or top

of the block, "Mirror view" or not. These two options allow to check the

fabrication quality by directly superimposing the fabricated block on the printed

“block image”

• to specify the block thickness (the default value is indicated in the parameters

file)


VI-36 iSis 3D - V 2. 35 – March 2003

• to indicate to the cutting machine the method to be used, i.e. the wire or blade

position, if the block is ”outside“ or not.

• to modify the source to tray distance when the block should be located at

another position than on the tray (the default value corresponds to the distance

source-tray).

• to display the landmarks indicating the patient orientation relative to the

screen. These landmarks are freely chosen characters which are displayed at

the upper right part of the screen. They can be explicitly introduced from the

keyboard or selected from the associated scrolling lists, containing the usual

anatomic indications (“left”, “right”, “anterior”, “posterior”, “head”, “feet”) .

• to adjust the representation scale "Zoom",

• to print what is represented,

• to perform the exportation "Ok" or to cancel it with "Cancel"

- The graphic area presents the “block image”, taking into account the block thickness

and the different visualization parameters :

• with continuous line: image of the block and the collimator jaws at the

level of the representation plane (bottom or top) and at the specified

source - block distance.

• with dashed line: image of the block and the collimator jaws at the level

of the reciprocal of the representation plane (bottom or top).

depending on the support used for positioning the block, a clue can be specified (in the

characteristics of the cutting machine) and be plotted on the line (squares centered on

the coordinates of the clue, eventually truncated by the page margin),

the principal information related to the blocks are displayed: patient name, study,

concerned beam, name and location of the exportation file, plane and representation

mode, distance of the representation, block thickness and representation scale.


iSis 3D - V 2. 35 – March 2003 VI-37

VI.7.5 Multi-leaf collimator

For the treatment units which permit this, the

field shape can be defined by positioning the

collimator leaves, this being integrated either in

the principal collimator, or in the additional

collimator.

In order to have the option “Multi-leaf” accessible, the treatment unit library should

have been previously updated and a file should have been defined, containing the

characteristics of the multi-leaf collimator: number and thickness of the leaves,

orientation, boundary values for the displacement. In the case there is an additional

multi-leaf collimator, the margins are as well specified for the automatic recalculation

of the principal jaws position relative to the leaves.

The leaves positions is automatically calculated starting from the shape of the field to

be irradiated, called “Basic field”. This can also be done manually, defining one by

one the leaves positions. It is not possible (for the moment) to simultaneously have a

multi-leaf collimator and additional blocks.

To compute the position of the leaves, select “multi-leaf” as the type of additional

collimation. This selection is made automatically if this mode was selected at the level

of a pair of principal jaws. The possible cases are possible following this one are:

• if a field shape was previously defined (together with the type of tray), it is

considered as basic field,

• if not, it is possible to introduce the basic field by selecting one of the

possibilities from the list “after” : film, mouse capture, structure (cf.: § VI.7.3,

iSIs 3D - Beam menu, Virtual simulation, Introducing and adjusting field

shape).

The leaves positioning is effective if clicking on the button “compute”. The positions

of the main jaws are automatically readjusted and the field shape is displayed with

thick line (except for the segments delimited by the principal collimator). The

transformation from basic field to leaves positions is done according to the selected

options , clicking on the button “Options”. The proposed options permit to choose the

mode of positioning the leaves relative to the basic field (“Conformation”) including


VI-38 iSis 3D - V 2. 35 – March 2003

the following: internal, middle, or external (in, half or out). It is also possible the

optimization of the collimator rotation. The optimum rotation is that which minimizes

the difference between the surface covered by the basic field and that of the multi-leaf

collimator. The chosen options are recalled beside the button that starts the

computation.

Figure VI-9 : MLC computing option

The details about the leaves positions can be obtained by clicking on the button

“Details”. A new window will open, showing in numerical format the position of each

leaf (Figure VI-11). Meanwhile, the graphic zone is refreshed and replaced by a

drawing of the collimator, showing explicitly the leaves positions. It is possible to

displace individually the leaves with the mouse by grabbing them by the “hands”

displayed when the cursor is positioned nearby the leaf top. In the same time, the

selected leaf appears as inverted video in the window “multi-leaf Collimator”. The

complete set of these data (drawing and values) can be printed by clicking on the

button “Print”. By clicking on “Ok” or on “Cancel”, the modifications are validated or

canceled, respectively and we return to virtual simulation mode.


iSis 3D - V 2. 35 – March 2003 VI-39

Figure VI-10 : MLC Positioning

It is also possible to create a file containing the positions of the leaves and adapted to

the format of the considered treatment unit. This file is then exported to the

treatment unit with the aim to realize the treatment. As this concerns a global

exportation of a single file for all the set of beams from the study, it is realized at the

level FILE menu (cf.: § III, File Menu).

Remark 1 : A certain number of controls are performed when displacing the leaves

one by one (numerically or graphically). It may happen that the leaves refuse to move.

This is the case when the leaves tops are tangential (one leaf must be opened in order

to be able to command another, inclusive in the opening), or when the limits of the

displacement (absolute or relative) are attained.

Remark 2 : Even when the leaves position has been modified, the basic field remains

displayed and unchanged, which may lead to confusion. The position of the leaves can

be recalculated automatically, reintroducing the data or making a modification of the

basic field and restarting then the calculation for the multi-leaf.


VI-40 iSis 3D - V 2. 35 – March 2003

Remark 3 : In the case there is an additional multi-leaf collimator, the positioning of

the principal jaws follows the rules:

• In the sense of the leaves displacement, the jaws are positioned at a fixed

distance (can be set as parameter) to the most exterior leaves. It is not allowed

to close the jaws beyond the top of the leaves, if this happens when trying to

validate the beam will appear the message: “Beam Dimensions and complex

field shape not adjusted”.

• In the opposite sense, the jaws are positioned at a fixed distance (can be set as

parameter) to the basic field. They can be eventually modified while closing or

opening. When they are opened on the side of the non joined leaves, they are

accounting for beam limiting device.

VI.7.6 Display options and calculation of DRR

In mode “virtual simulation”, every modification is reflected graphically directly on the

visualization window in real time if the button “Display real time” is selected (lower left

corner). If not, the window updating is done by pressing the button Apply.

The objects concerned by the display options appear in a scrolling list. After selecting

one of them, the display mode should be specified, this varying according to the type

of the object. The contours and the free markers can be masked (invisible) or can

appear as complete contours (continuous line in front, dotted line in the back), as

limits as small lines (having a T shape), as solid (full filling) or cross-hashed (hashed

filling) of the same width with that of the slice. The collimator, the complex field and the

reconstructed image (if it exists) can be made visible or invisible, Two supplementary

objects permit a “global” manipulation at the level of all the objects and all the

contours. In this case the combined display mode signifies that various choices have

been made at the level of individual objects. These choices are preserved but the set

of concerned objects can be made invisible.

Remark : the structures are being displayed as 2D projections. Therefore, there is not

a notion of foreground, background or hidden side. The structures are being displayed

according to their order in the “list of structures”.


iSis 3D - V 2. 35 – March 2003 VI-41

A supplementary button recalls the colour of the selected object. If it is a structure, the

button “color” can be pressed to open a box for creation/ modification of structures and

change its characteristics.

Figure VI-11 : Display option

Under the graphic window are found the buttons: Zoom, Restore, Gantry orientation,

Level/Window, Tools et Print described in “normalization contour” mode and “virtual

simulation” (see also the description of the Display Menu). Note that these functions

are applied to a “film” type document. As for the zoom, a scale of 1 signifies that the

printed document can be directly superimposed on a simulation film taken with the

simulator in the same geometrical conditions (centering and “virtual” source-film

distance).

A series of buttons entitled gantry orientation permits to switch with 900 the graphic

zone to choose the most “convenient” orientation according to the working habits. The

fixed square is a symbolic representation of the gantry, is located in the upper part of

the graphic zone. It is recalled on the button and can be orientated upwards, to the left,

downwards, or to the right. The button corresponding to the current orientation

appears with a high contrast.

With the condition that the date have been introduced from transverse slices, it is

possible at any moment to ask the numerical reconstruction of a radiograph (DRR)

To start the reconstruction, it is enough to select any type of DRR from the scrolling


VI-42 iSis 3D - V 2. 35 – March 2003

list. The time until receiving an answer is longer the first time this is asked, since a

volume reconstruction is started. The image reconstruction in the plane of the virtual

film is automatically started. The next options are available:

• Full DRR all the densities traversed by the beams are taken into account

• Soft tissues DRR only the densities inferior to a threshold (that can be put

as a parameter) are taken into account

• Dense tissues DRR only the densities superior to a threshold (that can be

put as a parameter) are taken into account

• Maximum density DRR only the highest density along each beam is

preserved.

Figure VI-12 : D.R.R caluclated

The changing from one option to another doesn’t imply the complete recalculation but

only a redisplaying.


iSis 3D - V 2. 35 – March 2003 VI-43

The displayed image can be adjusted in contrast and luminosity by acting on the box

for adjusting the level/window which is opened by pressing the corresponding button

located in the graphic zone. The corresponding values do not have a particular

meaning but it is recommended to be in low resolution mode “low resolution” otherwise

an important part of the image might be lost.

The display of the DRR can be controlled by making visible or invisible the object

"image". If it is visible, the DRR can be printed (on a graphic printer) with the same title

with other elements from the graphic zone.

Remark : Once D.R.R. is computed, it is store in the same folder as images. It is not

recomputed until the beams or contours characteristics are changed.


VI-44 iSis 3D - V 2. 35 – March 2003

CHAPTER VII - ISODOSES MENU

iSis 3D - V 2. 35 – March 2003 VII-1

VII. ISODOSES MENU

presents the following submenu:

- Calculation >

- List...

- Normalization >

- ------------------

- Dose at one point...

- Profiles and exportations...

- Dose/volume Histogram...

- ------------------

- New plane...

- Kill plane

- -------------------

- New ROI

- Display ROI

- -------------------

- Import dose >

VII.1 Calculation

presents the following submenu

- All beams

- Current Beam

- Computing Options

VII.1.1 All beams

permits to start the dose calculation for all the beams belonging to the opened study,

according to the options defined for the calculation options (cf.: § VII.1.3, iSis 3D -

Isodoses Menu, Calculation, Computing options). This choice is accessible only if the

current calculation plan or the defined zone ( cf.: § VII.9, Isodose menu, New zone)

has at least one beam which is not calculated. After the calculation of all the beams,

the eventual current beam is deselected.


VII-2 iSis 3D - V 2. 35 – March 2003

VII.1.2 Current beam

launches the dose calculation for the current beam. This choice is accessible only if

there is a current beam and this one is not calculated yet.

Figure VII-1 : Calculation progress

Remark : During calculation phases the "calculation Progress" box appears. It

indicates the treated calculation plan and the retained calculation options (matrix,

model and heterogeneity correction). It allows as well following up the calculation

evaluation by successively displaying the number of the beam currently calculated and

the slice where these calculations are performed. It is possible to interrupt the

calculations by clicking the "Stop calculation" button. This button becomes

subsequently “Start calculation” and makes accessible the "Ok" button. By clicking

the "Ok" button the already performed calculations are validated and continued until

the calculation phase reaches the end. By clicking the "Start calculation" button the

calculation are relaunched as if no interruption took place.

VII.1.3 Calculation options

For every new study, the selected default calculation options are depending on the

user selected parameters. Following, these options are modified as desired and are

applied "a priori" to all the beams, leading a new calculation if necessary. For every

beam, the effectively retained options are taking into account certain cases. In case of

impossibility (e.g. double cutout for electrons and heterogeneity correction) these

options are displayed down in the beam list and the treatment time form. The above

mentioned options are globally displayed at the end of every calculation plan and the

dose volume histogram form.


iSis 3D - V 2. 35 – March 2003 VII-3

The selection of "Calculation option" object launches a dialog box (Figure VII-2) which

contains the following fields.

- Calculation grid : 3 exclusive buttons fine (2.0 mm), medium (4.0 mm) or Coarse

(6.0 mm) which allows the selection of the calculation grid minimal step. If necessary,

the calculation grid step is automatically adjusted in order to cover the whole external

counter. In any case, the step effectively used is calculations is displayed at the

inferior side of any calculation plan. For every grid type, the associated step can be set

as a parameter, as well as the default grid type.

Remark : Grid step concerne only the whole plane, It is not taking into account into

ROI (cf.: § VII.9, iSIs 3D – Isodose menu, New Zone)

- Model : 3 exclusive buttons Primary only, simple cutting out or Double cutting

out. Two exclusively complementary buttons allow to choose between the standard

mode and the rapid mode. The calculations are performed according the selected

option (cf.: § II.3.1, iSIs 3D - General principles, Dose calculation, Calculation options).

The "Primary only" option is reserved only for trials. Before the calculations are

launched a confirmation is asked. The PRIMARY ONLY information is displayed in

capitals over all the results

- Heterogeneity correction : 3 exclusive buttons No, Standard or Voxel/Voxel. The

calculations are performed according the selected option (cf.: § II.3.2, iSIs 3D -

General principles, Dose calculation, taking account heterogeneities).

Remark : The current calculation options concerning the calculation model and the

heterogeneity correction are saved for every study. While reopening, if these options

are not modified, the calculations are relaunched having assigned the same options.


VII-4 iSis 3D - V 2. 35 – March 2003

Figure VII-2 : Computing option

At the inferior part of the option selection box, other supplementary buttons allow the

automatic or non automatic calculations:

- Automatic Calculation : 2 exclusive buttons Yes or No.

The selection of this option lead accessible the All planes option. The calculations are

automatically performed after the creation or modification of a beam, after the creation

or modification of a slice without relaunching the calculations for all the beams or the

current beam.

This option is deactivated when the file is closed and has to be explicitly reactivated

every time the file is opened.

- All planes : 2 exclusive buttons Yes or No.

The access to this option is possible only if the Calculation automatic option is

active. In this case the calculations can be systematically performed for all the

previously selected calculation plans or for the current calculation plan.


iSis 3D - V 2. 35 – March 2003 VII-5

Remark : If ROI is activated into plane when selected this option, only the ROI is

calculated (not the whole plane)

This option persists after the file is closed.

- Dose type

Allows to specify the type of dose to display in calculation plane and histogram. Two

type of dose could be display : the physical doses and the equivalent radiobiological

doses (cf.: § II.3.5, iSis 3D – Generals priciples, Dose calculation, Equivalent

radiobiological dose)

The Figure VII-3 presents the result obtained after the calculation of the dose

distribution.

Figure VII-3 : Computed doses

VII.1.4 Saving the dose calculations

The calculated doses can be stored while saving a study case. It is enough to activate

the dose calculation saving option within the customization file.


VII-6 iSis 3D - V 2. 35 – March 2003

While a study is retaken, if the dose calculation saving option is effective, every active

plane for which the calculated doses are valid is displayed, accompanied by the doses

corresponding to all the beams calculated for this plane.

The control of the validity of stored doses is based on the version number of the

“contours” file, the version number of the “beams” file, the calculation parameters, and

for the non-transversal planes, the coordinates of the points defining the plane, which

are saved in the doses file associated to the plan. If the doses calculated for some

beams are not valid any more, these beams are considered as not calculated.

The control of saved calculated dose are base on, version number of contours file,

version number of beams file, computing option and for non tranverse plane, on the

coordonates of 2 points determinig the diagonal of region, kept into dose file. If this

data are not valid beams will be consider as not computed.

The access to the “All beams” and “Current beam” options depends equally on the

validity of the stored doses.

Remark : in order to avoid occupying the disk space due to the accumulation of dose

files, a certain control procedure for the disk space can be activated after each storage

(following configuration, consult your installation).

VII.2 List

List leads to the display of the dialog box which controls the isodoses list represented

in the (Figure VII-4) : this box stays active as long as it is not explicitly closed. The box

comprises the list of Values and Colour of isodoses prolonged respectively with the

fields Value and Colour (scrolling list).

This box contains as well the following buttons:

• Add, Change et Kill

• Initial Isodoses

• Standards Isodoses

• Apply and Cancel

• Close

The list of isodoses displayed in this box is taken into account for the active window

only if it is explicitly asked (Apply button). In this case, the list is applied for all the

calculation plans.


iSis 3D - V 2. 35 – March 2003 VII-7

Value : allows the definition of a new isodose value to be displayed. After the key-in

by pressing RETURN insteadðof TAB a default color appears at the level of the color

choice pop-up list.

FigureVII-4 : List of isodoses

Colour : by clicking this button, one obtains a pop-up list of available colors. Without

releasing the button, one selects the desired color by sliding in the list the mouse

cursor. Then one stops over the desired color and releases the mouse button. At this

moment, the name associated to the chosen color appears within the associated field.

Add: creates in the isodoses list a new isodose whose value and color were specified

in the key-in field.


VII-8 iSis 3D - V 2. 35 – March 2003

Change: after having selected an isodose from the list of available isodoses and after

introducing a new value and color in the associated options field, clicking change

attributes to the selected isodose the value and color specified in the SAISIE field.

Kill : eliminates the selected isodose. The next isodose is immediately selected and

could be eliminated as well if one presses the kill button once again. For the

elimination of isodoses in series, one has to start from the top of the list.

Initial isodoses: calls the list of doses associated to the protocol (cf.: § III.1, iSis 3D -

File Menu, New). If this list of isodoses does not exist the button is inactive.

Standard isodoses: calculates automatically a new list of isodoses depending on the

maximum dose observed and the number of active beams for the current plan.

Apply : validates all the modifications performed and updates the isodose lines for the

current calculation plan.

Cancel: reestablishes the list of isodoses settled after the last validation.

Close: closes the dialog box. This button is active only if the list was not modified after

the last validation.

VII.3 Normalization

allows to normalize the result of dose calculation; a sub-menu allows to select the

normalization mode

• -Without

• -At maximum

• -At one point

Without : cancels all the anterior normalization. In this case, the doses are calculated

taking directly into account the values each beam contributes to the dose

At maximum : the doses of all calculation plans are expressed as percentages of the

maximum found for the current beam in current plane.

At one point : the doses of all calculation plans are expressed as percentages of the

normalization point whose coordinates are visible in an associated box (Figure VII-5)

or within the current calculation plan with the aid of the mouse. The normalization

becomes valid by clicking the Ok button of the normalization box.


iSis 3D - V 2. 35 – March 2003 VII-9

Figure VII-5 : Normalisation point

The normalization mode is displayed in the legend located at the upper right side of

each window depicting the calculation plan. The same display holds for the

dose/volume histogram window.

The normalization functions are affecting all the calculation results of the current study.

The current calculation plan graphical window is updated while the other graphical

windows are updated if the corresponding calculation plan becomes current

Remark : if one has decided to normalize the isodoses, while one modifies the beams

or the weighting factors of the beams non the corresponding beam selection box, the

results are not automatically renormalized. The normalization function has to be

explicitly relaunched by choosing the corresponding sub-menu

VII.4 Dose at one point

leads to the display dialog box (Figure VII-6) in which are displayed continuously and

in real time the coordinates and the dose value corresponding to the current position of

the mouse cursor in the current calculation plan graphical window.


VII-10 iSis 3D - V 2. 35 – March 2003

Figure VII-6 : Dose at one point

A click on the current calculation plan graphical window adds the point to the list of

points whose doses are continuously displayed. The points are visible on the screen

as crosses (within the graphical window of the current calculation plan) The

corresponding doses are displayed aside each point.

The Erase points button allows the calculation of the list of points defined for the

current calculation plan and the refresh of the display

The Ok button ends the function.

VII.5 Profiles and exportation

leads to the display a dialog box (Figure VII-7) which allows the display the dose

profiles and the exportation of doses calculated for the current plan.

The control window display-exportation allows:

. to choose the type of data to be exported: the whole grid or one or many particular

profiles

.

to locate the placement and the name of the export file. A default file name is

proposed, while extension is free (“D3D” by default) If a name of an existing file is

specified, a message informs the user that a new name has to be specified.


iSis 3D - V 2. 35 – March 2003 VII-11

FigureVII-7 : Doses profiles and exportations (1)

In “grid” mode only the “Export grid” button is accessible, realizing the exportation

towards the specified file

In “profile” mode the “Definition of profile" zone allows to specify the following

parameters :

• Sampling step: by default equal to the calculation step of the calculation grid.

Determines the precision of the profile curve,

• Normalization at origin if this option is active, the dose at origin becomes 100,

• Type of the initially displayed: ”Profile”, profile parallel to the horizontal axis,

“Depth” profile parallel to the vertical axis or “Other”, to be specified on the

input field.

The “Mouse capture” button opens a profile visualization window and determines the

appearance of a arrow in the window of the current slice (Figure VII-8) representing

the visualization profile (pink line). This profile can be displaced using the mouse, by a

click and slide movement. The translation of the profile is realized selecting with the

name a central point of the profile while the rotation could be realized by selecting

another point (cf.: § VI.1.3.c, iSis 3D - Beam menu, New/modify, beam parameters). In

the dialog zone of the current plan are update the following: the profile type, the


VII-12 iSis 3D - V 2. 35 – March 2003

distance d from the profile to the origin, the profile angle with the vertical, the

coordinates x, y and z of the profile origin. The graph representing the dose

(normalized or not) function of distance to the reference point showed within the

profile visualization window is updated in real time.

Once the desired profile is obtained, the Ok button of the current plan window allows

to validate the profile. Following, a dialog which recalls the profile parameters appears

and suggests to add the entered profile within the content of the export file. More than

one profile could be exported to the same file. The “Cancel” button allows the

visualization canceling without to export the profile.

If a profile was validated (with or without exportation) the “Print profile” button allows

to keep a copy of the profile.

The Ok and Cancel buttons are closing the dialog. In case of cancellation, all the

export files (of the grid and/or of profile’s) are destroyed

The export file is a test file containing a lot of comments. Its format is specified to the

ISIS 3D software.

The profile files can be visualized and compared with the experimental data by using

the “support of experimental files” utility.


iSis 3D - V 2. 35 – March 2003 VII-13

Figure VII-8 : Doses profiles and exportations (2)


VII-14 iSis 3D - V 2. 35 – March 2003

VII.6 Dose/ Volume Histogram

The dose-volume histograms (DVH) are allowing the representation of the 3D dose

distribution for different interest structures. These are giving a sort of "resume" of what

is going on with these structures (target volume or critical organs) for all calculation

plans set. Thus, one can obtain rapidly global information about the "quality" of a

treatment plan :the min dose, max., average and modal for different structures, the

proportion of an organ receiving more than a certain dose. The dose volume

histograms are presented either in differential form where on the y axis are

represented the volumes receiving a given dose (or more precisely a small interval) or

in cumulated form where on the y axis is represented the volume (cm3 or %)

receiving more than a certain dose represented on abscissa. For a finer dose

distribution analysis at the border volume it may be interesting to create a fictive

structure by using the expansion tool (cf.: § IV.9, iSis 3D - Slices Menu, Expansion)

and then to launch the DVH, excluding the initial volume in order to get only a

peripheral zone.

It is possible to calculate successively the DVH for different previously defined

structures with or without exclusion, and then to display them on the same graph,

either in differential or in cumulative form (maximum 10).

It is also possible to store the graph in order to be compare the DVH of different

studies.

ATTENTION !

The DVH are not saved. They have to be printed once are calculated. It is the user

responsibility to get assured about the coherence of saved studies and the printed

DVH (based on the name and date + time of the study). Hence it is recommended to

save systematically the studies either immediately before or immediately after the

printing of the DVH.

The calculation method chosen for ISIS is the "random points" method, inspired

basically on the work of NIMIERKO. It consists in "extracting" random points inside a

parallelepiped which contains the structure of interest, but counting only these points

located inside the structure. This method presents several advantages:


iSis 3D - V 2. 35 – March 2003 VII-15

• The DVH calculation can be asked at any time without being necessary the

calculation for the slices plans to be previously launched

• The number of points necessary in order to get valuable calculations is

relatively small. NIMIERKO has shown that generally, a number of 400 points

(proposed here as default) gives coherent results.

Once a first result is obtained, it is possible to continue the extraction of points, until

the results are stabilized. It is possible to get assured that the points density is

sufficient for the dose distribution and the analyzed structure.

- The volume calculation, which is performed as well using the random points

method could be compared the result based on contours calculations (cf.: § IV.10, iSis

3D - Slices Menu, Volumes). A good agreement between the volume calculation

obtained with the two methods gives a good indication on the validity of the DVH

calculation (except for the case a structure is excluded).

For the current implementation, the choice of the random points is based on a

generator which uses as starting value the internal clock. For these conditions, two

successive calculations are susceptible to give slightly different results. The scope of

this choice is to test the validity of the result by evaluating the difference after the

same calculation restarted several times.

The performed calculations are taken into account constantly the options selected in

the calculation options box (cf.: § VI.3, iSis 3D - Isodoses Menu, Normalization).

They are realized for the whole beam set and are taking into account eventual

normalizations. In order to isolate the contribution of certain beams, the individual

weightings should be adjusted.

The selection of dose/volume histograms item opens the box represented below

(Figure VII-9).


VII-16 iSis 3D - V 2. 35 – March 2003

FigureVII-9 : Dose/Volume histogram dialog box

This box is composed of three parts (Calculation, Results, Graphic).

The CALCULATION part is composed of the following fields :

• Calculate in : allows to choose the structure where the calculations should be

performed.

• Exclude : allows not to take into account one structure . A check is

performed in order to forbid the structure to be calculated within the excluded

structure.

• nb iterations : allows the user to choose the number of points to be calculated.

This number is initialized to 40, but it could be changed to the desired one.

• Begin : launches the dose/volume histograms calculation. The calculation is

performed by extracting the random points until the "nb iterations" points are

found inside the chosen structure.

• Retry : is substituting "Begin" while a first calculation was performed for a

given structure. The calculation restarts from zero.

• Continue : allows to continue an already started calculation. This new

calculation stops when "nb iterations" supplementary points are found inside the


iSis 3D - V 2. 35 – March 2003 VII-17

structure of interest. Of course these points are added to the previously

calculated points which are integrally kept.

The RESULTS part presents the data of the last calculation :

• Volume (cm3) of : remembers the name of the structure for which the

calculation was performed.

• Expected : recalls the volume of the structure calculated from the entered

contours (the same as that one found in the "volume" pad)

• Computed : is the volume calculated with the random points method. It

corresponds to the structure volume minus the volume of the part to be

excluded.

Remark: Those both volumes, determined with two different way, should have similar

value. If it is not the case, the number of ramdon points chosen is probably not enough

and you have to continue calculation up to volumes value are similar. In the case of

exclusion, the expected volume is always greater than the computed volume, because

the expected volume does not take into account the exclusion.

- the four other fields are displaying respectively the values of minimum dose,

maximum, average and modal2 calculated for the considered structure.

The GRAPHIC part allows to visualize the results of several successive calculations. It is

presented as follows

- Two exclusive buttons differential and cumulated allow the chosen graph display

mode (a prior or a posteriori)

- Centered on : allows to center the curve at a particular point of the curve and to

execute a local zoom on this point

- Two exclusive buttons "volume in cm3 " and "%" allow to choose the principal

measuring unit of y axis ( a priori or a posteriori). If "%" is selected, then the reference

2 The modal dose is the most frequent found dose; it corresponds to the peak of the

differential DVH


VII-18 iSis 3D - V 2. 35 – March 2003

(100 %) is the calculated volume of the structure. If there is a single DVH displayed,

both scales (cm 3 and %) are simultaneously present on the sides of the graph.

• title : allows the user to specify the name to be displayed at the top of the

graphical document (it is advised less than 18 characters)

• name : is the name to be given to the current DVH curve. ( to be calculated). By

default the name is given by the concerned structure name followed, if it is the

caase. by "sans" when another structure is excluded. The name can be

changed as desired (only the first 18 charecters are going to be displayed on

the result)

• colour : is a pop-up list which allows to choose the color of the graph (by

default is the same as the concerned structure)

create : allows to create a new graph having the title indicated in the "title" field which

displays the current curve with the specified "name" and "colour".

Erase : deletes all the present graphs from the pad after the confirmation was asked.

The main title is kept by default.

Add : adds the current curve to the curves already presented, but in the limit of

maximum to simultaneous curves. After the tenth curve is added, the button becomes

inaccessible. The user has the possibility to print before a new graphical page can be

created with Create or Erase.

Print : launches the printing process of the graphical window to the peripheral chosen

in printing options. Only the A4 "portrait" mode is supported

Ok : triggers the disappearance of the graphical window (after the confirmation and the

exit from the dose volume histograms box. The non printed graphs are lost. The

display of the curves is as indicated in Figure VII-10 ( the case of a graph in

cumulative form)

Header (the header) of the display presents a number of general information which

allow to find the characteristics of the associated study and the calculation conditions.


iSis 3D - V 2. 35 – March 2003 VII-19

Cumulated Differential

Figure VII-10 : Dose / Volume histogram

The graph itself supports up to five curves. For the case of a single curve, two scales

are displayed for the y axis, corresponding to the volumes expressed in cm3 and in %.

The X axis (doses) makes directly use of the weighting factors defined for each beam.

(without taking into account eventual normalization options)

Under the traced zone, one could find, line by line, the characteristics of each curve :

name, colour and type of feature, total number of points found within the structure,

the volume corresponding to the found points, minimum dose, maximum, average,

and modal dose inside the structure, width at half height of the peak, centered on

the modal dose (calculated in differential mode).

Additionally, the minimum dose and minimum dose coordinates are indicated ( for the

moment) in the execution window of the program.


VII-20 iSis 3D - V 2. 35 – March 2003

ATTENTION!

The Dose-Volume histograms calculation validity for a given dose distribution depends

strongly on the quality of the entered contour (for the associated structure) and the

number of random points extracted. It is up to the user to assure himself for this

validity

VII.7 New plane

permits to calculate the isodoses for non transversal planes. Only the planes

perpendicular to the slices are available.

These planes could be:

o Sagittal (SA) if perpendicular to the X axis

o Frontal (FR) if perpendicular to the y axis

o Sagittal Oblique (SO) or Frontal Oblique for all the intermediate positions,

with a limit arbitrarily fixed to 45°.

This function is accessible only if a current slice is selected. In fact, for this slice the

plane position is chosen.

When the function is called, a pink line representing the position of the plane (by

default sagittal median) appears within the window of the current plane (Figure VII-10).

This plane can be moved using click and slide function of the mouse. The translation is

realized by selecting with the mouse the central point of the line while the rotation by

selecting another point (cf.: § VI.I.3.c, iSis 3D - Beam menu, New/modify, beam

parameters). In the dialog zone of the window the following parameters are

permanently updated: the plane type, the distance d from the plane to the origin, the

angle of the plane to the vertical, the x, y, z coordinates of the new plane origin. It is

suitable to define the plane with regard to a slice a little but off z axis. The x and y

coordinates should be towards the center of the slice, in order to have contours

symmetrically placed around the origin, it is possible as well to prefer another origin in

order to counter the plane over the interest region.


iSis 3D - V 2. 35 – March 2003 VII-21

The position of the chosen plan is validated by clicking the Ok button located towards

the right side of the working window. It is created this way a new plane which is on

one hand added to the list of calculation plans and on the other hand displayed as a

window. For the moment, the only things appearing for this plan are the contours

depicting the intersections with the external surface and with the internal structures.

The images and the beams are not represented.

The list of the free markers associated to the current plan includes on one hand the

structures cut by the plane and one the other hand, in yellow, the other structures of

the study which could play a role in the calculation, especially if it is about

heterogeneities.

The plane created this way could be manipulated the same way as the transversal

slices planes correspondent to the entered contours (selection, iconification, scaling).

As for the other plans, the functions set of the ISODOSES menu is available for

launching and controlling the dose distribution calculation.

The used dose calculation algorithm is exactly the same as for the transversal slices.

In fact, for each calculation point belonging to the "new plane", the modified

transversal slice that contains the point is searched and following, the calculation is

performed for this slice. The rendering of the structures contours and the calculations

validity are better if there is a higher number of initially introduced transversal slices.

The plane created this way could be manipulated the same way as the transversal

slices planes correspondent to the entered contours (selection, iconification, scaling).

As for the other plans, the functions set of the ISODOSES menu is available for

launching and controlling the dose distribution calculation.

The used dose calculation algorithm is exactly the same as for the transversal slices.

In fact, for each calculation point belonging to the "new plane", the modified

transversal slice that contains the point is searched and following, the calculation is

performed for this slice. The rendering of the structures contours and the calculations

validity are better if there is a higher number of initially introduced transversal slices.

In order to get the calculation and the display of the reconstructed image for the new

created plan, the image option should be selected from the DISPLAY menu. (cf.: §

VIII.1, iSIs 3D - Display Menu, Image)


VII-22 iSis 3D - V 2. 35 – March 2003

Figure VII-11 : Non transverse plane axis selection

Figure VII-12 : Non transverse plane


iSis 3D - V 2. 35 – March 2003 VII-23

VII.8 Kill plane

permits to destroy the calculation plans that are not going to be kept. This operation is

applied only for the plans previously created using the sub menu "New plane".

VII.9 New zone

Offers the possibility to define, inside a slice, a rectangular zone inside which the dose

calculation is performed with improved resolution that doesn’t depend on the size of

the contours. In the interior of that zone, the step of the calculation grid is the finest

one defined in the calculation options. If necessary, the calculation step will be

automatically adjusted such that the entire zone be covered.

Using this function, the rectangular zone is defined, inside the active slice or plane,

with a click-and-drag movement of the mouse along its diagonal. The creation of the

zone is validated using the OK button. Only one zone per slice or plane can be

created. The zone can be modified by defining a new zone that replaces the previous

one. The creation of a zone makes its display active.

VII.10 Zone display

Makes the zone active for, the calculation or the display of the dose distribution. Dose

calculation (automatic or using the Calculate option from the Isodoses menu) and

dose display is limited in the zone. The calculation step inside the zone is defined

using the calculation options in the bottom of each plan.

The “toggle” function is not accessible unless a zone is defined in the active slice or

plan.

Dose normalization (cf.: § VI.3, iSis 3D - Isodoses Menu, Normalization) can take

place inside the zone. The introduction of a dose point outside the displayed zone will

be without any effect and any dose point defined on the slice or plane outside the zone

will be displayed without a dose value.

The 3D Visualization option in the Display menu is not accessible while in “Zone

display” mode.

Once the “Zone display” option deactivated, the zone is erased and then the dose

distribution (if it is calculated) is displayed on the slice or plane.


VII-24 iSis 3D - V 2. 35 – March 2003

VII.11 Importation of doses ( stereotactic )

VII.11.1 Generalities

The dose importation within the current plan allows overlying the dose distributions

calculated with another application to the images and/or contours defined within ISIS

3D. In order for this importation to have any meaning, it is necessarily for the

calculation performed with the external application to have been made starting from

the same anatomical data, for a patient having the same treatment position. It is also

important to having careful selected a common origin for the contours definition and

the same axes orientation. The display of the obtained doses is basically static, and

the modification of the technique, for example, should be accompanied by a

modification of the data coming from the external application, followed by a new

launch of the import function. This switch between the two applications is greatly

facilitated if they are both open on screen, on condition to taking care that after

contours, beams and calculation planes have been updated, to save the

imported study. One notices that only the dose distributions are displayed (with

superposition over the images and/or the current structures); within ISIS3D there is

neither graphical representation of beams from the imported study, nor display of their

characteristics.

For the moment, the only dose distributions that can be imported are those calculated

with the STEREO module belonging to the ISIS application chain.

VII.11.2 Launching the import

The “import doses” menu presents (as a unique item, the following sub-menu)

stereotactic

This item is accessible only if the option allowing the import of the stereotactic doses is

chosen within the customization file.

Following the selection of this item, it is checked within the menu, indicating that one

passes in import mode. The displayed doses are those of stereotactic. One can again

pass in “normal” mode by selecting the same item of the menu.

The following functions still remain accessible in import mode:

o normalization


iSis 3D - V 2. 35 – March 2003 VII-25

o dose to a point

o isodoses list

and most of the display and printing functions (study or current plan).

On the contrary, the following functions are deactivated:

o calculation

o profiles and export

o dose volume histograms

The passage from normal mode to the import mode and vice-versa, suppresses any

dose normalization. The dose points, defined in one or the other modes are preserved.

The display of the stereotactic doses is triggered at the moment any plan is opened

with ISIS3D (calculation plans selection box, “open” button). If the plan is already

opened, it is suitable to close it and then to re-open it. ISIS 3D then searches if the

same plan exists within the list of those which were stored by STEREO and, if

affirmative, displays the corresponding isodoses. If not, a message appears, indicating

the absence of the associated plane and giving information (coordinates of the 3

points defining the plane) for the calculation of the same plane to be launched from the

STEREO application.

The mechanisms of associating the calculation planes is given in the following.

VII.11.3 Mechanism of associating the existent and imported planes

In order to ensure that the calculations make use of the same anatomical data, an

initial check is performed on the coherence of the “contours” files. Every contour

modification in ISIS 3D should be accompanied by the storage of the study, before the

dose calculations are performed with the STEREO software.

The ISIS 3D method of plan recognition defined under STEREO is different if one

deals with a transversal plane or any other plane.

in the case of a transversal plane, only the Z of the STEREO plane and the Z of the

ISIS 3D slice are compared. On the contrary, in X,Y, the origin of the radiotherapy ISIS

3D system can be different from the origin used by STEREO, which generally


VII-26 iSis 3D - V 2. 35 – March 2003

coincides with one of the isocentres and which defines the centering of the calculation

grid (limited to 8 cm x 8 cm).

In the case of a saggital, frontal or oblique plane, the calculation planes are

completely defined by three points, which should be exactly the same under STEREO

and ISIS 3D. The implicit definition under STEREO of the saggital and frontal planes

cannot be used since the axes orientation is different from that defined under ISIS 3D.

It is necessarily to define them by explicitly specifying the coordinates of the three

reference points, copied from the values displayed in the ISIS 3D message box (see

below, VII-9-2 Launch of the import).

VII.11.4 Display and printing the results

At the bottom of the calculation planes where the stereotactic doses are displayed, the

essential elements of the calculation are remembered:

o number of the treatment plan under STEREO

o calculation step (fixed at 2 mm)

o calculation model employed (STEREO)

o absence of the heterogeneity correction

These plans can be, according to the wish, either printed individually, or globally, by

launching the printing of the whole study.

CHAPTER VIII - DISPLAY MENU

iSis 3D - V2. 35 – March 2003 VIII-1

VIII. DISPLAY MENU

permits the general control over the visualization of the current graphical window and

proposes the following options:

- Images

- Contours

- Beams

- Isodoses

- Registered images

-------------------

- Isodoses 3D

-------------------

- Level/Windows...

-------------------

- Zoom...

- Restore

-------------------

- Grid >

- Distance measurement

- Angle measurement

-------------------

- Visualization 3D (option)

VIII.1 Image

permits to display or not the image (if it exists). A button next to the item informs if

the option is selected or not.

In the particular case of the non Transversal planes previously created using "New

plane" (cf.: § VII.7, iSis 3D - Isodoses Menu, New plane), the option is by default not

selected (no images). If one selects it, it is possible to launch for the current plan an

image reconstruction from the transversal slices. The quality of the reconstruction is

better if there is a large number of close adjacent slices.

If the option is selected an appearing dialog box usage of quality improving filter. The

image is reconstructed and displayed after the confirmation was given. The

reconstruction time depends upon the power of the computer.

The different display option (Zoom, Level/Windows) are applicable.


VIII-2 iSis 3D - V2. 35 – March 2003

Remark : The reconstructed image is stored in the same directory with the transversal

slice images. If the calculation plan is not modified or deleted, upon the reopening of

an previously saved dossier, the reconstructed image is not recalculated.

VIII.2 Contours

permits to display or not the contours and points of interest, if there are any. A button

next to the item informs if the option is selected or not (maybe check box)

VIII.3 Beams

permits to display or not the active beams. A button (check box) next to the item

informs if the option is selected or not

VIII.4 Isodoses

permits to display or not the isodose curves and the points where the dose is to be

calculated. A button (check box) next to the item informs if the option is selected or

not.

VIII.5 Registered image

Allows to switch between two series of images, when this ones are available (cf.: §

II.9, iSis 3D – Generals principles, Matched Images). This option is also accessible by

the short-cut "Ctrl-r" from calculation planes.

VIII.6 Isodoses 3D

displays a 3D view of the dose distribution for the current calculation plan (where

the height represents the dose). An Ok button appearing in the graphical window

allows to return to the 2D view. An print button launches the printing.



VIII.7 Level/Window

permits to adjust the contrast of the image by modifying the width and the center value

of the gray scale window.

The modification of the window width (Figure VIII-1) is achieved by a click and drag

action of the mouse left button towards the interior of the scale. The level

displacement is achieved by the click and slide action of the mouse central button. A

single click at the desired position (of the appropriate button) allows to modify the

width of the window or the gray level value.

Figure VIII-1 : Level / Windows adjustment box

The movements of the mouse cursor are dynamically followed by the display of the

gray level, the window width, the minimum and maximum visible levels and the

modification of the image display.

The gray level and window width numerical values could be directly modified in their

corresponding entry fields.

A predefined level/window couple linked to a particular organ and known under the

name "tissues choice" could be equally selected from the scrolling list. The list of



names and available values is parametrizable and could be adopted to the

preferences of each user.

The mouse capture button allows to select a rectangular region of the image (by click

and slide) to which there is a special interest. Following, the contrast is automatically

adjusted so that the whole gray scale (from white to black) covers exactly the density

values of the selected region. This function is useful mainly for the passage to the high

resolution display (e.g. the brain case).

If the original image is available, once the settings are performed for a special interest

region it is possible to pass in high resolution mode. The values comprised within the

selected area are recalculated and sampled on 64 gray levels (cf.: § II.4.4, iSis 3D -

General Principles, Elements of dialog, Management of Images). This operation could

be restarted few times for areas smaller and smaller. In any moment the initial image

could be obtained by selecting the low resolution mode. The resolution mode is by

default kept for all newly displayed images

The “Grey Levels” (grey scale) option offers the possibility to choose the way the

gray levels are being distributed between the minimum and maximum gray value of

the window :

• Linear : gray levels are distributed evenly (default mode),

• Logarithmic : gray levels are distributed according to a logarithmic curve

(better contrast for the lower values),

• Exponential : gray levels are distributed according to an exponential curve

(better contrast for the higher values),

• Histogram : the distribution of gray levels is based on the image histogram

in order to enhance the contrast in the regions that are “rich” in information

(those containing more pixels),

• Black & White : using only two gray levels: all pixels with a value greater

than the minimum value are displayed in white ; the rest of the pixels are

displayed using the background color. This option offers the possibility to

better apprehend the borders detected by the “automatic contour” function

which is based on gray scale thresholding.



The effect of the gray-level distribution functions (logarithmic, exponential and

histogram functions) could be more or less obvious according to the adjustment of the

increase coefficient using the horizontal scroll bar. The effect is grater for higher

values of the coefficient.

The densities button offers the possibility to immediately convert all the Hounsfield

values, displayed in the ‘window level/window width’ box, into density values, using the

predefined conversion curve (cf.: § III.6, iSis 3D - File Menu, List of slices and IV.1,

iSIs 3D – Header and list of slice, and IV.2.1, iSis 3D - Slices Menu, Header and list

of slices and Creating from images).

The adjustment panel does not have to be closed. However, if necessary, it can be

closed using the two buttons situated in the bottom:

The Cancel button restores the initial window level/window width settings and closes

the dialog box.

The Ok button validates the window level/window width settings and closes the dialog

box.

Tree different settings are handled and activated automatically by the system ; the title

of the window level/window width dialog box shows the current setting. The first,

concerns the visualization of the calculation planes with the series of primary images

(title : « settings »), the second affects the visualization of the calculation planes with

the series of merged images (title : « settings (register series)») and the third is

specific to the DRRs (title : « settings (DRR) »).

VIII.8 Zoom...

permits to control the scaling of the display and the graphical center of the current

graphical window. It is applicable to must of the displayed windows (slice in(

creation/modification, calculation plane, virtual simulation, ...).

The scale should be interpreted by considering as reference the printed document

paper and the reality. In order to facilitate the interpretation of the screen display, the

width and height of the displayed graphical windows have the same rations as A3 or

A4 paper sheets in landscape disposal. The display scale and the corresponding

paper format are permanently displayed in the legend. For example, 9.5/A4 means a



half scale if the window is printed on an A4 paper sheet. In this case, the display at the

screen is the same as for a 1./A3 scale (multiplying factor and paper format multiplied

by 2)

Figure VIII-2 : Zoom adjustement box

The dialog box (Figure VIII-2) present the following fields:

- Factor : entry field for the scale + scrolling list that proposes the default scales

(parametrizable),

- Format : scrolling list (parametrizable) for the choice of the paper format to which the

display window is assimilated.

- Graphic Center : two entry fields for the window center coordinates X and Y (or U

and V) and a toggle button which allows to choose these coordinates using the mouse

cursor in the graphical window.

- Two buttons allow to mention to which window(s) the zooming is to be applied :

- Zoom kept : that all the windows that are going to be displayed from this point on

will be with the same parameters. This function is especially useful for the

creation/modification contour mode. If one would like to cancel this function while a

study is running, the "zoom" function is to be relaunched. Following one have to click

on this button again.

- Global zoom: allows to assign the zooming parameters to all the windows belonging

to the study (specially calculation plans), even if there were opened with another

zooming value.



Remark : The "Zoom kept" and "Global zoom" functions can not be accessed in virtual

simulation mode.

The box contains as well the following buttons:

- OK and Cancel

Cancel : reestablishes the initial display conditions and closes the dialog box.

Ok : validates the display conditions, updates the graphical window and close the

dialog box.

VIII.9 Restore

permits to came back to the precedent zoom and consequently to cancel the zoom

which is supposed to be used. This function could be several times applied in order to

balance between the last two zooms used. For the calculation plans cases, this

function has an effect only on the plan to be affected by the zoom modification.

VIII.10 Grid

allows to display in the current window a calibrated grid. The choice made in the

cascade ....... allows to get the step grid or to delete a previously displayed grid

("no"). The displayed grid is every time centered on the coordinates origin.

(corresponding to the patient).

The superposition of a grid of a known step may help to have an approximation of the

distances on screen or in order to create new contours (reference to a paper

document MRI film) when in contours creation/modification phase).

VIII.11 Distance measurement

determines the appearance in the current window of a dialog zone which 2 guides the

distances measurements with the mouse. One clicks on the first point and one move

the mouse with the button pressed while the second point is positioned. The points

coordinates and the distances between them are permanently displayed. The angle

indication allow to make measurements rigorously horizontal or vertical.



It is possible to follow consecutively the distance measurements for several segments,

but the corresponding values are not saved. In order to quit this function one have to

click on the Ok button at the right hand side of the working window.

VIII.12 Angle measurement

permits to measure the angle between two segments

As for the distance measurements, one starts by tracing a first segment. A third point

should be selected, linked in a elastic fashion to the second point. The angle taken into

account is that one whose tip is the second point.

The angles measurements could be performed consecutively for several segments,

but the corresponding values are not saved. In order to quit this function, click on the

Ok button at the right hand side of the working window.

VIII.13 Visualization 3D (option)

This mean item launches the surface representation module (optional). This module

allows to display in 3D:

• external surface of the patient

• the anatomical structures

• the beams

• an isodose surface, continuously variable.

If the Visualization 3D item is not grayed, it is accessible and is used to launch the

process which follows two steps:

1 - generation of "3D objets" of the study (allowed on all working posts).

2 - 3D display of these objects (allowed only for the authorized working post (s) )

The complete description of the 3D visualization module could be found in the chapter

X, Visualization 3D.

CHAPTER IX - WINDOWS MENU

iSis 3D - V2. 35 – March 2003 IX-1

IX. WINDOWS MENU

IX.1 Open on selection

proposes the sub option Open on selection which allows to choose or not the

opening of a graphical window after a calculation plan is selected (cf.: § II.4.2, iSIs 3D

- General principles, Elements of dialog, Calculation plane selection box).

IX.2 Store current plan

This function allows to compare on screen several studies and to pass from one to

another

When selecting Store current planes a dialog box opens (Figure IX-1) and proposes

to take a snapshot of the current calculation plan associating free comments and to

prepare an optional cliché of the beams list.

When clicking on Store the asked clichés are added to the "List of photographed

studies" of the WINDOWS menu (cf.: § IX.3, iSis 3D - Windows menu, list of

photographed studies). The "Cancel" button allows to cancel the function.

Figure IX-1 : «Store current plane » dialog box

In order to remember afterwards which study was associated to snapshot, you should

save this study. At the moment the snapshot was taken, a message warns the user

about this and proposes either to "Save" the study (cf.: § III-4, File Menu, Save) before

snapshot, or Store without saving - in which case the study could not be

remembered - or to cancel the snapshot.


IX-2 iSis 3D - V2. 35 – March 2003

Figure IX-2 : Confimation demand of snapshot

IX.3 List of photographed studies

This function allows to compare on screen several studies and to pass from one to

another.

The list of the photographed STUDIES contains all the photographs taken once a study

was opened (or created) till it was closed. All the intermediate steps of the study are

included, as well as the phases when the study name was changed.

The plans and list of the photographed beams are called "Ei.J - study name : plane

..." and "Ei.J - LIST OF BEAMS 1/1", where i represents the i-th save study after the

opening (or creation) and j the j-th snapshot realized for this study (Figure IX-2).

Figure IX-3 : Plane snapshot list

Selecting one of the snapshot determines its display on screen, in a window form

which contains a comment line, a graphical area identical to that of the current plan

at the capture moment and two buttons, “Recall study” and “Close” (Figure IX-4).


iSis 3D - V2. 35 – March 2003 IX-3

Figure IX-4 : Snapeshot of plane

The “Recall study” button is accessible only if the study was properly saved at the

snapshot time (cf.: § IX.2, iSis 3D - Windows menu, Store current plane). In this case

the button allows, after the validation of a confirmation question, to close the current

study (with the associated saving proposal) and to re-open the study correspondent to

the snapshot.

After successive study savings and openings, the photographs set is kept until the

explicit closing of the dossier is realized by the “File”/”Close”.


IX-4 iSis 3D - V2. 35 – March 2003

CHAPTER X - 3D VISUALIZATION

iSis 3D - V2. 35 – March 2003 X-1

X. 3D VISUALIZATION

X.1 surface reconstruction

The surface reconstruction concerns all the slices (transversal) that are appearing in

the slices selection box (or the slices list) either or not are selected. Starting from this

set of slices all the anatomical “objects” are reconstructed (external surface and

structures). The reconstructed objects are keeping the names and colors previously

assigned (cf.: § IV.8, iSis 3D - Slices menu, Structures/bolus). The isolated points, the

lines and the free markers are not reconstructed.

Figure X-1 : Surface reconstruction

The beam type “objects” are displayed as a cone region whose tip is the source and

for the base, the shape of the field. The principal collimator id not displayed (except if it

has no block). The default colors assigned to the beams are arbitrarily. They have

though a transparency property. All the existent beams are by default reconstructed

and displayed.


X-2 iSis 3D - V2. 35 – March 2003

The “surface isodose” object is reconstructed from the transversal planes calculated

dose distributions. In order the surface display to be meaningful, the calculation should

be mandatory launched in all the transversal slices of the interest region. An alerting

message warns about the possibility of an erroneously reconstruction if the calculation

is not performed for all the selected slices.

The surface reconstruction of the objects set takes usually few minutes. Meanwhile

one can see on screen the progressive advance of the scene. One have to wait until

the end of this reconstruction for modifying the display of the scene.

X.2 Change zoom and the point of view

The way to present in space the displayed objects (from the observers looking point)

can be modified in real time by using the mouse. The available functions are the

following:

• rotation in space: move the mouse keeping pressed the central button

• translation in the screen plane: move the mouse keeping pressed the right

button

• zoom move the mouse keeping pressed the central button and the Maj/min key

• continuous rotation keep pressed the mouse central button and slide it

rapidly in the rotation sense before to release the button; the sliding velocity

determines the rotation speed.

One can act as well on Display using the following buttons:

• limits: if this option is active (white color button), the mouse driven

transformation acts on the rectangle which contains the set of the objects

appearing on the screen; otherwise, the mouse acts in real time on the objects

with a reaction time that depends on the hardware configuration.

• Face/Back, Profile right/Profile left, From Head/From Feet: performs a

rotation according to the choice done

• Customized is the default display mode that allows to memorize the performed

transformations. Thus, if one of the Anterior/Posterior views are selected, the

“Personalized” button allows to recall the previous state of the display change.


iSis 3D - V2. 35 – March 2003 X-3

X.3 Display or hide objects

The set of objects is grouped in a scrolling list which can be explored using the scroll

bar and the mouse central button for ascending or descending, or the left or the right

mouse buttons for ascending and descending respectively. The object is selected by

clicking on its name in the list. The object becomes current.

Whatever the current object it is, it is possible to be displayed or not by clicking on the

Visible button.

X.4 Change object representation mode, color and transparency

The anatomical “objects” representation mode, the isodoses and the beams, could be

modified by clicking one of the three buttons: surface, lines or points. The effect is

almost immediate.

The color could be as well modified but its setting is a little more delicate since it is

based on the three basic colors: red, green and blue.

Finally, the transparency of the current object could be continuously adjusted from a

zero value opacity (object completely transparent) till an unity value opacity (object

completely opaque)

X.5 Change the value of the isodose surface

If the doses were previously calculated for a sufficient number of adjacent slices, one

can display a selected isodose by moving the “ISODOSE” cursor to the desired value.

The corresponding isodose surface gets “inflated” or “deflated” according to the

selected value and the re-display is performed at the moment the mouse button is

released.

This function is particularly useful in order to see if a given isodose surface “wraps”

the target volume without containing any cold point. It is recommended to the user to

use the “surface” representation mode for the target volume and the “lines” mode for

the isodose. The “surface” mode for the isodose is equally preferably because it allows

to see the target volume exceeding, if this is the case, the wrapping isodose.


X-4 iSis 3D - V2. 35 – March 2003

X.6 Print window

The print of the scene the way it is visualized is possible in Postscript mode. It is

enough to choose the printer paper format (“A3” or “A4”), the quality of the print

(“draft”, “stand.” Or “fine”) and to introduce or confirm the name of the file (normally the

name of the study followed by the extension .PS) in the “File” entry field. The printing

is launched by pressing Return or after the mouse quits the field once the name was

modified.

The choice of the printing quality influences directly the printing time. This amount of

time can vary from a few minutes for an inferior quality to tenths of minutes for the high

quality (with an ink jet printer). The medium quality (stand.) is generally satisfactory.

X.7 Display other scenes

The set of reconstructed objects constitutes a scene which takes by default the name

of the original study. Each time a new scene is reconstructed it replaces the previous

one. The corresponding files are systematically saved and a voluntary action should

be made (at the systems level) in order to destroy them.

It is possible this way, without quitting the surface visualization module to display as

well other scenes previously build. For this one have to click on “Choose study”.

Following, a list where one could select the scene to be displayed (clicking its name,

composed with the name of the study followed by the extension “.V3D”) is displayed.

In order to display the 3D objects generated on another working place click on New dir

and introduce:

• either the full access path as “node::disk:[dir1.dir2]”

e.g.: ALPHA2::DKA0:[DOSI.USR.PHYSIQUE.VUES3D])

• or a logical name previously defined (e.g. ALPHA2$VUES3D)

X.8 Return to calculation mode

Even if the surface visualization module is operational, the initial application remains a

priori active. It is possible to pass from one to another by simply clicking inside the

corresponding window. If the display window covers all the screen, it can be useful to


iSis 3D - V2. 35 – March 2003 X-5

minimize (make it as icon) it. A double click on the icon (called “V3D - VISUALIZATION

3D”) allows to come back to the visualization module.

An often encountered case is when one decides to adjust the beam parameters after

the results of the surface representation display were seen. In order to do this, one

have to get into the dose calculation application and then, after the parameters

modification to select a new item Visualization 3D standard or Full screen from the

DISPLAY menu. Every object of the current scene is then called and replaced by the

new objects of the modified study.

By clicking the Quit button, the surface representation module is completely closed. All

the object are kept (as well the continuously variable isodose surface). Only the

representation options are lost.


X-6 iSis 3D - V2. 35 – March 2003

APPENDIX

iSis 3D - V 2.35 - March 2003 1

APPENDIX

A. Text editor

B. Description of set-up file

B1. Default set-up of application

B2. File access zones configuration file

B3. List of protocols

B4. Defaults set-up Level/Windows

B5. Color table

B6. Automatic FTP parameters

C. Conversion, of Hounsfied number to densities, curve format

D. Descriptiion of study files

D1. Slices file

D2. Beams file

D3. Administrative file

E. Export doses file format

F. Waterphantom Program

G. Photon Compensators

G1. Users’ guide

G2. Description of Compensator file "DEPTH" (.PRF)

G3. Description of Compensator file "REAL" (.CPR)

G4. Description of Compensator file "THEORETICAL" (.CPT]

G5. Description of Compensator file "HEK"

G6. Description of Compensator file "Machine file"

H. Menu summary

I. List of figures and tables

APPENDIX

2 iSis 3D - V 2.35 - March 2003

APPENDIX A – TEXT EDITOR

ISIS 3D - V 2. 35 – March 2003 A - 1

A. USING THE TEXT EDITOR

To open a text file (with a known name) in order to be modified, the following

command has to be used:

Open a Decterm and since the $ is displayed, type:

ED/EDT FILENAME.ext;n RETURN

Ex : edt/edt SATX15.DAT;1

The system replay by *, type C then RETURN.

The, the system display the beginning of the file.

The function-keys

The keys of the right-side of the keyboard became the function-key.

(ATTENTION IF YOU WANT TO INPUT NUMBERS; DO NOT USE THE RIGHT-

SIDE OF THE KEYBOARD)

The figure A3-1 presents these function-keys.

You can have displayed this figure on the screen by pressing the key PF2 and deleted

by pressing the blank space key.

Prompt placing inside the text file

* In order to pass from one character to other, use the keys:

* In order to pass from one line to other, use the keys:

Searching for a string in the file

Press on PF1 then PF3.

The system asks for: search for :

Type the string, then press on PF3.

The prompt will be placed at the beginning of the string. If the text file includes strings

of the same type, press PF3 and the system will pass at the next.

If the system does not find the string, it answers by NOT FOUND.

APPENDIX A – TEXT EDITOR

A - 2 ISIS 3D - V 2. 35 – March 2003

Character insertion

Place the cursor at the desired place, then type the character.

Character deleting

Place the cursor after the character to be deleted, then press Back Space key.

File closing

Press on the key PF1 then on the key 7 (right-side of the keyboard).

The system asks for : command

type EXIT Closing and saving the file.

Or QUIT Closing without saving the file. the modifications will not

be taken into account.

Then press on the key ENTER on the right-side of the keyboard in order to

execute the command.

TOUCHES DE FONCTION

PF1 PF2 PF3 PF4

7 8 9

1 32

0

ENTER

UP DOWN LEFT RIGHTGOLD HELP FNDNXT

FIND

PAGE COMMAND

SECTFILL

APPEND REPLACE

DEL LUND L

DEL WUND W

4 5 6 ,ADVANCEBOTTOM

BACKUP TOP

CUTPASTE

DEL CUND C

WORDCHNGCASE

EOLDEL EOL

CHARSPCINS

ENTER

SUBS

LINEOPEN LINE

SELECT RESET

APPENDIX B – SETUP FILES

iSis 3D - V 2.35 - March 2003 B - 1

B. DESCRIPTION OF SET-UP FILES

Some parameters can be defined into following files to be taken into account at the

launch of application ISIS3D.

Those files are located into DOSI$USR:[PHYSICAL.POSTES] directory.

B1. Default set-up of application ISIS2_OPTIONS.ETL

B2. File access zones configuration file ISIS2_ZONES_DEFAUT.ETL

B3. List of protocols ISIS2_STRUCTURE.ETL

B4. Defaults set-up Level/Windows ISIS2_PREREGLAGES.ETL

B5. Color table ISIS2-ANGLAIS.TBL*

B6. Automatic FTP parameters I3D_EXPORTATION.COM

* ISIS2-ANGLAIS.TBL is located into “ISIS2$EXE:” directory

APPENDIX B – SETUP FILES

B - 2 iSis 3D - V 2.35 - March 2003

APPENDIX B1 – SESSION PARAMETERS FILE

ISIS 3D - V 2. 35 - March 2003 B1 - 1

B1. SESSION PARAMETERS FILE FORMAT (ISIS2_OPTION.ETL)

This file allow to set up :

• Logical names defining studies' location

• Logical names defining images' location

• Logical name defining temporary files location

• Default state of graphic window when selecting plane

• Logical name defining color table

• List of scale factor and paper size

• Background print-out color

• Default size of graphic window when selecting plane

• Default set-up of automatic densities calculation options

• The visibility of cursor in elastic mode

• Plot type of internal contours

• Computing option

• Complex field automatic computing option

• Availability of the 3D visualization option

• DRR calculation options

• Display information message in SSD , "SSD different than SAD"

• Default block thickness


B1 - 2 ISIS 3D - V 2. 35 - March 2003

Session parameters file example : Only blue line parameters can be modify by user

ISIS2:identification_du_fichier_de_parametrage

ISIS2

ISIS2:version_de_fichier_de_parametrage

18

MOTIF:FONT_UNIT_LARGEUR

7

MOTIF:FONT_UNIT_HAUTEUR

7

MOTIF:DUREE_DOUBLE_CLIC

500

MOTIF:Drapeau_de_demande_de_regeneration_du_trace_sur_EXPOSE

0

FICHIERS:Name_of_study_based_on_by_default_ :_0=the name__1=the_file_number

0

FICHIERS:File_number_mandatory_ :0=no__1=yes

0

FICHIERS:repertoire_des_fichiers_administratifs

ISIS2$DOSSIERS

FICHIERS:repertoire_des_fichiers_coupes

ISIS2$DOSSIERS

FICHIERS:repertoire_des_fichiers_faisceaux

ISIS2$DIRFSCX

FICHIERS:repertoire_des_repertoires_d'images

ISIS2$IMAGES

FICHIERS:repertoire_du_repertoire_d'images_temporaires___ZERO_si_aucun

ZERO

FICHIERS:default_conversion_density_curve_name

CURIE

FICHIERS:repertoire_des_fichiers_contextes

ISIS2$DIRCTX

FICHIERS:fichier_temporaire

ISIS2$DIRCTX:liste_dossiers.tmp

FICHIERS:fichier_statistiques_0=global___1=zone_par_zone

0

BOITE_COUPES:code_du_caractere_croix_de_la_boite_de_coupe

215

BOITE_COUPES:code_du_caractere_espace

32

BOITE_COUPES:default_OPEN_ON_SELECTION_value_0=NO__1=YES

1

ISODOSES:nombre_maximum_de_couleurs

16


ISIS 3D - V 2. 35 - March 2003 B1 - 3

ISODOSES:nombre_de_couleurs_utilisees_par_defaut

16

ISODOSES:premier_indice_dans_la_table_des_couleurs

0

CALCULS:step_of_calculation_for_fine_grid

2.0

CALCULS: step_of_calculation_for_medium_grid

4.0

CALCULS: step_of_calculation_for_coarse_grid

6.0

CALCULS: default_calculation_step

4.0

CALCULS:radial_step_calculation

3.0

CALCULS:calculation_model :0=simple_cutting_out,1=double_cutting_out,2=primary_only

0

CALCULS:heterogeneity_correction :0=no;1=standar;2=vox/vox

0

CALCULS:field_grid_step

2.0

CALCULS:fast_calculation:0=no;1=yes

1

CALCULS:save_calculated_doses:0=no;1=yes

1

CALCULS_HDV:display_and_save_DVH:0=no;1=dispay;2=save;3=display+save

3

COMPENSATEUR:pas_de_la_grille_de_calcul_des_profondeurs_en_U:PAS_GRILLE_COMP_U

0.1075

COMPENSATEUR:pas_de_la_grille_de_calcul_des_profondeurs_en_V:PAS_GRILLE_COMP_V

0.0931

DURCISSEMENT_FAISCEAU:prise_en_compte:0=non,2=primaire

0

CONTOURS:nombre_maximum_de_couleurs

16

CONTOURS:premier_indice_dans_la_table_des_couleurs

0

COULEURS:fichier_table_des_couleurs

ISIS2$TABLECOULEURS

WAVE:taille_allouable_pour_le_code

30000

WAVE:taille_allouable_pour_les_donnees

30000

ZOOM:formats_papier:nombre_puis_nom-dimensions-utiles-x-yy__5_format_maximum

5

A6 14.85 10.5

A5 21. 14.85


B1 - 4 ISIS 3D - V 2. 35 - March 2003

A4 29.7 21.

A3 42. 29.7

A2 59.4 42.

ZOOM:facteurs_d'echelle:nombre_puis_valeurs___10_echelles_maximum

9

0.25 0.5 0.75 1. 1.5 2. 3. 4. 5.

IMPRESSION:couleur_du_fond:0=couleur_standard,blanc_sinon

1

AFFICHAGE:tailles_des_fenetres:nombre(0/n-1)_puis_dimensions-utiles-x-y__5_tailles_max

4

869 614

340 240

724 512

996 704

AFFICHAGE:taille_de_fenetre_par_defaut:1=petite,2=moyenne,3=grande

2

AFFICHAGE:largeur_des_icones_en_pixels

80

AFFICHAGE:hauteur_des_icones_en_pixels

80

AFFICHAGE:largeur_virtuelle_des_icones_en_centimetres

30.

AFFICHAGE:hauteur_virtuelle_des_icones_en_centimetres

30.

CONTOURS:automatic_density_calculation:0(zero)=no,1=yes

0

CONTOURS:mouse_visible_in_elastic_mode_while_modifying_contours :0=no,1=yes

1

CONTOURS:line_style:0=line,1=points,2=dashs,3=dash-points,4=dash-pt-pt-pt,5=long_dashs

2

IMAGES:zoom_avec_interpolation_des_images:0=non,oui_sinon__[defaut=1]

1

SIMULATION_VIRTUELLE:marge_ajustement_colli_apres_saisie_champ_complexe_en_cm

0.5

SIMULATION_VIRTUELLE:marge_expansion_et_champ_complexe:nombre,valeurs_en_cm__6_valeurs_max

6

0.5 1. 1.5 2. 2.5 3

MULTILAMES:conformation_auto_par_défaut:1=interne,2=externe,3=moyenne

3

MULTILAMES:optimisation_par_rotation_collimateur:1=OUI,0=NON

0

MULTILAMES:pas_d'optimisation_en_degres

5.0

DRR:valeur_seuil_entre_tissus_mous_et_denses_en_Hounsfield__[defaut=+350]

350

DRR:valeur_des_tissus_denses_dans_DRR_tissus_mous_en_Hounsfield__[defaut=0]


ISIS 3D - V 2. 35 - March 2003 B1 - 5

0

DRR:valeur_min_des_tissus_dans_DRR_tissus_denses_en_Hounsfield__[defaut=-950]

-950

VOXEL_PAR_VOXEL_et_DRR:pas_d'echantillonnage_en_cm__[defaut=0.2]

0.15

MODULES_OPTIONNELS:visualisation3D:0=NON,1=OUI,2=OUI_sur_autre_poste

1

INFORMATION:Alert_if_SSD_different_of_SDA:0=no,1=yes

1

CACHE: Default_block_thickness_cm

7.0

IMPORTATION_DOSES_STEREOTAXIQUES:0=NON,1=OUI

1

COEFFICIENT_RADIOBIOLOGIQUE_DES_STRUCTURES_PAR_DEFAUT

3.0

DOSE_PAR_FRACTION

2.0

Equivalent radiobiological dose value "2.0" Gray


B1 - 6 ISIS 3D - V 2. 35 - March 2003

APPENDIX B2 – ACCESS ZONES FILE

ISIS 3D - V 2. 35 - March 2003 B2 - 1

B2. ACCESS ZONES FILE (ISIS2_ZONES_DEFAUT.ETL)

Line Content Format Commentaries

1 Identification A4 ISIS2

2 File version number I1 2

3 Comment

4 Number of defined Zones I2 NBZ

5 Comment

6 Comment

7 Comment

For each defned zones

+1 Index of zone I2

+1 Name A20 Name display into scroll list

Key A20 DISQUE

Key A15 ISIS

Path A64

End of zones definition

8 + (NBZ*2) Comment

+1 Number of zone association I2 7

For each association

+1 Comment

+1 Key

+1 Comment

+1 Number of zones associated I2 NBZA

+1 to +NBZA Index for zone associated I2

End of association

DO NOT MODIFY UNDER THIS LINE


B2 - 2 ISIS 3D - V 2. 35 - March 2003

ONLY BLUE LINES CAN BE MODIFIED

ISIS2

2

ISIS2:Number_of_defined_zones

5 Number of zones defined

ISIS2:pour_chaque_zone

ISIS2:numero_de_la_zone

ISIS2:nom_sur_20_CAR;Vecteur_sur_20_CAR;Format_sur_15_CAR;Chemin_sur_64_car_max

1 index of zone

ISIS Dossiers disque ISIS ISIS2$DISKDOSS:[DOSI.USR.PHYSIQUE.DOSSIERS] definition of zones

2 index of zone

ISIS Dossiers DEMO disque ISIS ISIS2$DISKDOSS:[DOSI.USR.DEMO] definition of zones

3 index of zone

ISIS Images disque ISIS ISIS2$DISKIMG:[DOSI.USR.IMAGES] definition of zones

4 index of zone

Images DEMO disque ISIS ISIS2$DISKIMG:[DOSI.USR.IMAGES_DEMO] definition of zones

5 index of zone

Export disque ISIS ISIS2$DISKDOSS:[DOSI.USR.EXPORT] definition of zones

ISIS2:nombre_d_affectation_possible_des_zones_(fixe)

7

ISIS2:nom_source_of_studies

source_études

ISIS2:nombre_de_zones_pour_l_affectation_suivi_des_numeros_des_zones

2 Number of associated zones

1 index of zone

2 index of zone

ISIS2:nom_destination_of_studies

destin_études



1 index of zone

2 index of zone

ISIS2:nom__sources_of_importations

source_import



1 index of zone

2 index of zone

ISIS2:nom_destination_of_exportations

destin_import



1 index of zone

2 index of zone

ISIS2:nom_sources_of_images

source_images



3 index of zone

4 index of zone


ISIS 3D - V 2. 35 - March 2003 B2 - 3

ISIS2:nom_zones_where_it_is_allowed_to_kill_studies

zones_destr



1 index of zone

2 index of zone

ISIS2:nom_zones_for_exportation_of_block_mlc_data_beam_data

zones_export



5 index of zone

DO NOT MODIFY UNDER THIS LINE

ISIS2:nombre_d_objets_ISIS2

9

ISIS2:nom_de_l_objet::contour

CONTOURS

ISIS2:nombre_de_formats_associes_à_l_objet_suivi_des_noms_de_format_plus_format

1

ISIS *.ctr

ISIS2:numero_de_la_zone_associee_par_defaut_a_l'objet__0_pour_aucune

0

ISIS2:nom_de_l_objet::faisceau

FAISCEAUX


1

ISIS *.fsc


0

ISIS2:nom_de_l_objet::etude

ETUDE


1

ISIS *.isx


0

ISIS2:nom_de_l_objet::repimage

REP_IMAGES


1

ISIS *.dir


0

ISIS2:nom_de_l_objet::compens

COMPENSATEURS


2

ISIS *.cpr

ISIS *.dlc


0


B2 - 4 ISIS 3D - V 2. 35 - March 2003

ISIS2:nom_de_l_objet::mlc

Faisceaux/MLC

ISIS2:nombre_de_formats=4,Automatique/RTP_Lantis(inutilise)/RTP_Varis/RTP_Isis

4

Automatique .

RTP_Lantis .RTP

RTP_Varis .RTP

RTP_Isis .RTP


1

ISIS2:nom_de_l_objet::champ

FORME_DU_CHAMP


0


1

ISIS2:nom_de_l_objet::doses

DOSE


0


1

ISIS2:nom_de_l_objet::CopieFenetre

Copie_de_Fenetre


1

BMP .bmp


0

ANNEXE B3 – LISTE DES PROTOCOLES

iSis 3D - V 2.35 - March 2003 B3 - 1

B3. FORMAT DU FICHIER DES PROTOCOLES

Identification : ISIS2_STRUCTURES.ETL

Location : DOSI$USR :[PHYSICAL.POSTES]


1 Identification A4 ISIS2

2 File version number I1 4

3 Number of protocol I2 NBP

4 Comments A64

5 Number of type of POI I1 5

For each protocol

+1 Index I2 IP

+1 Name A20 Name display into scroll list

End of protocol name and index definition

For each protocol

6 + (NBP*2) Index of protocol I2 IP

+1 Number of structure I2

For each structure

+1 Index I2 Right justify

Name A12 Right justify

Density F(6.2) Right justify

Color I4 Right justify

Index for zone associated I2 Right justify

End of structure definition

+1 Number of point of interest I2

+1 Comment

For each Point of interest

+1 Code A2 Mandatory (no space)

Name A16

Color I2 Right justify

Flag type 5 x I2 00=false, 01=true (only one of five flags can set to true)

Coordinates X Y Z 3 x F(6.2) Right justify (99.99 99.99 99.99 means cordonates not defined)

End of point of interest definition

For each isodose

+1 Value I or F(x.1) Free lenght

Separator A1 ,

Color I2

End of isodose

+1 End of list -1, 0

End of Protocol


B3 - 2 iSis 3D - V 2.35 - March 2003

Color index for : Structures and point of interest

Isodoses

white 0 1 blue_1 1 2 red 2 3 green_2 3 4 orange_1 4 5 cyan 5 6 green_1 6 7 yellow 7 8 blue_2 8 9 orange_2 9 10 purple 10 11 pink 11 12 blue_3 12 13 brown 13 14 green_3 14 15

gray 15 16


iSis 3D - V 2.35 - March 2003 B3 - 3

Example of structures file : ISIS2 4 7 !!! nombre de types de point ISOC(Is) POND(Po) DOSE(Do) REPERE(Re) BILLE(Bi) 5 1 DEFAUT 2 SEIN 3 CRANE BENIN 4 CRANE MALIN 5 PROSTATE 6 GYNECO 7 UROLOGIE VESSIE 1 6 1VOLUME CIBLE 1.00 0 5 2VOL. TUMORAL 1.00 0 1 3MOELLE 1.00 0 4 4POUMON GAUCH 1.00 0 3 5POUMON DROIT 1.00 0 3 6OS 1.00 0 6 0 !!! Types IsPoDoReBi -1, 0 2 2 1POUMON 1.00 0 3 2VOL CIBLE 1.00 0 2 5 !!! Types IsPoDoReBi AACMI 3 LM 5 0 0 1 0 0 99.99 99.99 99.99 ABCMI 1,5 LM 6 0 0 1 0 0 99.99 99.99 99.99 ACsus clav 10 0 0 1 0 0 99.99 99.99 99.99 ADsous clav 11 0 0 1 0 0 99.99 99.99 99.99 AEaxillaire 2 0 0 1 0 0 99.99 99.99 99.99 5, 16 10, 5 20, 6 30, 7 40, 8 42, 12 45, 3 47, 11 50, 9 52, 4 60, 10 70, 11 80, 12 -1, 0 3 13 1/00/540 1.00 0 2 2VCA/00/ 1.00 0 5 3OEIL-G 1.00 010 4OEIL-D 1.00 0 6 5TRONC CEREB 1.00 0 9 6CERVELET 1.00 0 8 7LOB.TEMP-G 1.00 0 3 8LOB.TEMP-D 1.00 011 9REG.CHIASMA 1.00 0 7 10ENCEPHALE 1.00 0 4 11HYPOPHY/THAL 1.00 014


B3 - 4 iSis 3D - V 2.35 - March 2003

12DENTURE 1.00 013 13MOELLE 1.00 015 0 !!! Types IsPoDoReBi -1, 0 4 11 1VT GLIOME 1.00 0 2 2VP/00/60 1.00 0 5 3OEIL-G 1.00 010 4OEIL-D 1.00 0 6 5TRONC CEREB 1.00 0 9 6CERVELET 1.00 0 8 7REG.CHIASMA 1.00 0 7 8ENCEPHALE 1.00 0 4 9HYPOPHY/THAL 1.00 014 10DENTURE 1.00 013 11MOELLE 1.00 015 0 !!! Types IsPoDoReBi -1, 0 5 13 11.PROSTATE 1.00 0 2 22.PROSTAT+VS 1.00 012 3REF-GANG/ 1.00 011 4RECTUM-EXT 1.00 013 5VESSIE-EXT 1.00 0 7 6T.FEMUR-G 1.00 0 1 7T.FEMUR-D 1.00 0 6 8SACRUM/SYMPH 1.00 0 3 9S12/ILI/ISCH 1.00 010 101.VP/105/ 1.00 0 5 112.VP/105/ 1.00 0 9 121.ETUDE/5MM 1.00 014 132.ETUDE/5MM 1.00 014 0 !!! Types IsPoDoReBi -1, 0 6 13 11.VT/TUMEUR 1.00 0 2 2VESSIE 1.00 0 7 3URETRE-PROST 1.00 015 41.VP/150/XX 1.00 0 5 52.VP/I50/XX 1.00 0 9 6RECTUM-EXT 1.00 013 7GGILIA-G/XX 1.00 0 6 8GGILIA-D/XX 1.00 0 1 9SYMPH/ISCHIO 1.00 010 10FEMUR-G 1.00 0 1 11FEMUR-D 1.00 0 6 12E:VESSIE+10 1.00 0 0 13PAROI RECTUM 1.00 0 4 0 !!! Types IsPoDoReBi -1, 0

APPENDIX B4 - LEVEL/WINDOWS PRE-SETUP FILE

ISIS 3D - V 2. 35 - March 2003 B4 - 1

B4. LEVEL/WINDOWS PRE-SETUP LIST

Identification : ISIS2_PREREGLAGES.ETL

Location : DOSI$USR:[PHYSICAL.POSTES]


1 Number of pre-set-up I

+1 Label A15

Level I8 Left justify

Windows I8 Left justify

Pre-set-up file example : 5 soft_tissus 0 500 lungs_displ -700 500 lungs_ctrs 0 500 bones_displ 675 1200 bone_ctrs 300 120

APPENDIX B4 - LEVEL/WINDOWS PRE-SETUP FILE

B4 - 2 ISIS 3D - V 2. 35 - March 2003

APPENDIX B5 – COLOR TABLE

ISIS 3D - V 2. 35 – March 2003 B5 - 1

B5. COLORS TABLE FILE FORMAT

Identification : ISIS2-ANGLAIS.TBL

Location : ISIS2$EXE:


1 Number grey I2 64

+1 R V B 3 x I3 0 to 255

Name A8 Gray

66 Number of color I2 16

+1 R V B 3 x I3 0 to 255

Name A8 Display into scroll list

83 Not used

Remark : About gray

• the first "triplet" correspond graphic windows background ((67, 72, 74) default)

• Next "triplets" define a regular gradation from black (dark gray) to white

Remark : About color

• The first "triplet" (default: white) define the axis, legend, not current and not computed beam color

• The third "triplet" (default: red) define current beam color

• The fourth "triplet" (default: green_1) define computed beam color

• The eighth "triplet" (default: yellow) define default contours color

APPENDIX B5 – COLOR TABLE

B5 - 2 ISIS 3D – 2.35 – March 2003

64 Number of grey level

67 72 74 gray 165 165 165 gray

4 4 4 gray 170 170 170 gray

8 8 8 gray 174 174 174 gray

12 12 12 gray 178 178 178 gray

16 16 16 gray 182 182 182 gray

20 20 20 gray 186 186 186 gray

24 24 24 gray 190 190 190 gray

28 28 28 gray 194 194 194 gray

32 32 32 gray 198 198 198 gray

36 36 36 gray 202 202 202 gray

40 40 40 gray 206 206 206 gray

44 44 44 gray 210 210 210 gray

48 48 48 gray 214 214 214 gray

52 52 52 gray 218 218 218 gray

56 56 56 gray 222 222 222 gray

60 60 60 gray 226 226 226 gray

64 64 64 gray 230 230 230 gray

68 68 68 gray 234 234 234 gray

72 72 72 gray 238 238 238 gray

76 76 76 gray 242 242 242 gray

80 80 80 gray 246 246 246 gray

85 85 85 gray 250 250 250 gray

89 89 89 gray 254 254 254 gray

93 93 93 gray 16 Number of colors

97 97 97 gray 255 255 255 white

101 101 101 gray 0 146 255 blue_1

105 105 105 gray 255 0 0 red

109 109 109 gray 0 239 23 green_2

113 113 113 gray 255 185 109 orange_1

117 117 117 gray 0 255 255 cyan

121 121 121 gray 0 255 168 green_1

125 125 125 gray 254 249 0 yellow

129 129 129 gray 0 0 255 blue_2

133 133 133 gray 255 113 0 orange_2

137 137 137 gray 165 2 186 purple

141 141 141 gray 225 8 193 pink

145 145 145 gray 5 59 199 blue_3

149 149 149 gray 146 0 0 brown

153 153 153 gray 0 177 4 green_3

157 157 157 gray 222 190 190 gray

161 161 161 gray 5 Not used

APPENDIX B6 – I3D_EXPORTATION FILE SETUP

iSis 3D - V 2.35 - March 2003 B6 - 1

B6. I3D_EXPORTATION FILE SETUP

This file will allow to export automatically MLC, RPT and block-cutter files, throught

FTP connection. FTP server service on destination system must be activate and

configured.

Three kinds of object file can be configured for exportioon :

Type MLC, will manager exportation of MLC and RTP file

Type DECOUPEUSE, will manage exportation of block-cutter file

Name : i3d_exportation.com

Localization : DOSI$USR:[PHYSICAL.POSTES]

2

1

TYPE MLC

IPADR xxx.xxx.xxx.xxx (IP address of ftp server)

USERNAME login_name (username to login)

PASSWORD password (password to login)

REMOTE_DIR c:\\ path to access to remote directory*

MODE IMAGE

NB_EXTENSIONS 2

EXTENSION_1 MLC

EXTENSION_2 RTP

2

TYPE DECOUPEUSE

IPADR

USERNAME

PASSWORD

REMOTE_DIR

MODE ASCII

NB_EXTENSIONS 0

* According to the ftp-server OS, the path has to be define with double "\" or not, also drive could or

clould not be define into the path.

The easyest way is to define FTP account accessing directly into destination directory, in this case path

is "."

APPENDIX B6 – I3D_EXPORTATION FILE SETUP

B6 - 2 iSis 3D - V 2.35 - March 2003

If file doesn't exist create it, with following command :

$ SET DEF DOSI$USR:[PHYSICAl.POSTES]

$ copy i3d_exportation.cfg_modele i3d_exportation.cfg

to modify the file use following command :

$ edit i3d_exportation.cfg

(to exit from edit mode, press execute key, then key-in exit at command prompt)

Exemple :

2

1

TYPE MLC

IPADR 192.167.114.32 (IP address of ftp server)

USERNAME anonymous (login-name to login)

PASSWORD pass (password to login)

REMOTE_DIR c:\\rtpfile path to access to remote directory

MODE IMAGE

NB_EXTENSIONS 2

EXTENSION_1 MLC

EXTENSION_2 RTP

2

TYPE DECOUPEUSE

IPADR

USERNAME

PASSWORD

REMOTE_DIR

MODE ASCII

NB_EXTENSIONS 0

APPENDIX C – CONVERSION HOUNSFIELD / DENSITIES CURVE

iSis 3D - V 2.3 – Septembre 2001 C - 1

C. CONVERSION, OF HOUNSFIED NUMBER TO DENSITIES, CURVE FORMAT

The conversion curve of Hounsfile number to densities allow to calibrate scanner.

IDENTIFICATION : name.DEN

Remark : ^ means space charater

Line Data Format Comments

1 A3 ___ (par défaut)

Image device A7 Name of device

A5 CTDEN

I2 1

Comments A72

2 A5 ^DENS

F7.2 0.00

A8 ^^^^^^û

A5 ^^^CT

F7.2 ^^^0.00

A8 ^^^^^^û

A5 ^^^^ ̂

F7.2 ^^^0.00

A8 ^^^^^^^ ̂

Number of points I2 50 points maximum

3 Couple of data (F5.1, F6.3) 12 couples maximum by line

4 Couple of data (F5.1, F6.3) 12 next (if neccessary)



7 Couple of data (F5.1, F6.3) 2 last (if neccessary)

Remark: Curve containts densities as abscissa and “Hounsfiel number/1000” as

ordinate.

Example of file : sc.den

___SC^^^^^CTDEN^1Correspondance entre l'echelle des nombres Houndsfield et les densites

^DENS^^^0.00^^^^^^û^^^CT^^^0.00^CT/1000^^^^^^^^0.00^^^^^^^^^^^^^^^^0.00^^^^^^^^^^^^^^^^0.00^^^^^^^^4

^^0.0-1.000^^1.0^0.000^^1.2^0.200^^2.2^2.000

Remark: This curve is defined by 4 points : (0.0 ; -1000), (1.0 ; 0.0), (1.2 ; 200) et (2.2

; 2000)

APPENDIX C – CONVERSION HOUNSFIELD / DENSITIES CURVE

C - 2 iSis 3D - 2.35 - March 2003

APPENDIX D – STUDY FILES

iSis 3D - V 2.35 – March 2003 D - 1

D. DESCRIPTION OF STUDY FILES

D1. Slices file *.CTR

D2. Beams file *.FSC

D3. Administrative file *.ISX

APPENDIX D – STUDY FILES

D - 2 iSis 3D - V 2.35 – March 2003

APPENDIX D1 – SLICE FILE

iSis 3D - V 2.35 - March 2003 D1 - 1

D1. SLICES FILE FORMAT

IDENTIFICATION: name.CTR

The name length is up to 20 characters.

STRUCTURE: sequential ASCII file

FORMAT:

Line Content iSis3D Variable Format Commentaries

File header:

1 file format version number

'**VERSION13**'

NVERSION A20

keyword '~~CPEIMAGE~~' A12

2 version number of slices definition

version_contours I5 increased at each saving

date of last saving date_fich_contour I2-I2-I2 dd-mm-yy

time of last saving heure_fich_contour I2 :I2 hh :mm

3 patient's name ADM_NMAL A20

file number NUMDOS A10

examination date IDAT 3I2

examination number NUMEX A16

number of slices NBCOUP I3 99 max MAXCONT

number of structures KR I2 40 max NMAXR

number of points of interest PTI_NB I4 50 max NMAXPTI

4 provider code PROV A2

DI=digitizer SC=images

serial number SERIE A12

patient's position POSPAT_REEL

A6

HFS, HFP, HFDR, HFDL

FFS, FFP, FFDR, FFDL

HF=Head First

FF=Feet First

DL=Decubitus Left

DR=Decubitus Right

S = Supine

P =Prone

patient's side / right of image ORIEDR A6

LEFT,RIGHT,ANTER,POST

patient's side / top of image ORIEHA A6

LEFT,RIGHT,ANTER,POST

longitudinal anatomical origin ORIGAN A6 commentary


D1 - 2 iSis 3D - V 2. 35 - March 2003

note COMMEN A72

5 images' directory NOMIM_SAV A16

NOMIM_SAV_R A16

origin of Radiotherapy XORMAT F6.2 cm

coordinate system related to YORMAT F6.2 cm

Images coordinate system ZORMAT F6.2 cm

For each structure:

+1 structure's index NCODE_STR (1:KR) I2

structure ID STR_ID (1:KR) A1

structure's name STRUCT (1:KR) A12

structure's density DENSTR (1:KR) F6.2

structure's type STRTYPE (1:KR) I3 0=organ, 1=bolus,

2=vector (brachyt.)

alpha / beta coefficient COEFSTR(1 :KR) F6.2

color, red value STR_CLR_R (1:KR) I3

color, green value STR_CLR_V (1:KR) I3

color, blue value STR_CLR_B (1:KR) I3

range: from 0 to 255

-1=not defined

DICOM color of the structure

Implemented for future use

For each point of interest (POI):

+1 POI’s index NP I4

POI ID PTI_ID A2 Ix,default for isocenters

Px, default for weighting points

POI’s name PTI_NOM A16

POI’s coordinates PTI_X F7.2

PTI_Y F7.2

PTI_Z F7.2

cm, scale 1

99.99 if not defined

POI’s type PTI_TYPE I5 combination of types

0 not specified

2° isocenter

21 weighting point

22 prescription point

23 dose point

24 marker point

25 referential point

POI can be edited PTI_EDITABLE L1 T=yes, F=no

color, red value PTI_CLR_R I3

color, green value PTI_CLR_V I3

color, blue value PTI_CLR_B I3


-1=not defined


number of additional lines of values

nb_ligne_valeurs I2


iSis 3D - V 2.35 - March 2003 D1 - 3

note PTI_COMMENT A64

For each slice:

+1 slice's index nc I3 indices might be not contiguous

+2 longitudinal position Z POSCOU (nc) F7.2

min longitudinal position Z CPE_ZMIN (nc) F7.2

max longitudinal position Z CPE_ZMAX (nc) F7.2

cm

Provides the ability to import asymmetrical slices

The actual Z position is, at the moment, recalculated as the middle of min and max positions and the thickness as the difference between max and min

tilt INCLIN (nc) I3 degrees

vertical scale of plot ECHRELV (nc) F4.2 for memory

horizontal scale of plot ECHRELH (nc) F4.2 for memory

name of associated image file NIMAG_SAV(nc)

A16

reserved A16

origin of contour related to NPXORMAT (nc) I5 pixels

image NPYORMAT (nc) I5 pixels

slice label CPE_LIBELLE A16

key word '~~CPEIMAGE~~' A12

+3 DICOM: image SOP Instance UID

CTR_IMG_UID A64 DICOM tag (0008, 0018)

+4 DICOM: image SOP Class UID CTR_IMG_CLASS A64 DICOM tag (0008, 0016)

+4 DICOM: image Frame of Reference UID

CTR_IMG_FRAME A64 DICOM tag (0020, 0052)

+5 nb of points of external contour NPXY (nc) I3 100 max MAPTCE

external cont. color, red value CTREXT_CLR_R I3

external cont. color, green value CTREXT _CLR_V I3

external cont. color, blue value CTREXT _CLR_B I3


-1=not defined

DICOM color of the external contour


+6 external contour coordinates XREL(1:NPXY,nc) F6.2 cm, scale 1

..

YREL(1:NPXY,nc) F6.2 1 pair by ligne

+6+NPXY number of internal contours NREP(nc) I2 40 max MAREPC


D1 - 4 iSis 3D - V 2. 35 - March 2003

For each internal contour:

+1 internal contour’s name NOMREP

(1:NREP,nc)

A12

index of related structure KOREP (1:NREP,nc)

I2 0=no related structure

internal contour’s density REP_DENS (1:NREP,nc)

F4.2

internal cont. color, red value REP_CLR_R I3

internal cont. color, green value REP _CLR_V I3

internal cont. color, blue value REP _CLR_B I3


-1=not defined

DICOM color of the contour


For each internal contour +1:

+1 index of first point of the internal contour

NPREP(1:NREP+1,nc)

I4

.. in the table of all coordinates

998 max MAPTRP

for all internal contours

-> the last value is the total number of points in the table plus one

if no internal contour

1 line with “1”

+ coordinates of all internal contours

XREP(1:NPREP-1,nc)

F6.2 cm, scale 1

.. YREP(1:NPREP-1,nc)

F6.2 1 pair by ligne

APPENDIX D2 - BEAMS FILE

iSis 3D - V 2.35 - March 2003 D2 - 1

D2. BEAMS FILE FORMAT

IDENTIFICATION: name.FSC



FORMAT :

Information type Format Description

File Version

vers_fich_faisc I2 file format version number (13)

Header

ver_faisc I2 version number of beams definition

date_fich_fais A8 date of last saving (dd-mm-yy)

heure_fich_fais A5 time of last saving (hh:mm)

code_centre A3 center code

adm_nmal A20 patient's name

nb_max_faisc I2 number of beams

comment_faisc A40 free commentaries

For each beam

Unit definition nf I2 beam’s index (might be not contiguous)

descript_faisc A12 beam’s description

nomapp A7 unit name

machine A20 treatment machine name

modalite I2 modality: 1=photons, 2=electrons, 3=protons

energie F6.2 energy (MV if modality=1 or else MeV)

parcours F6.2 proton range, 0. if modality is not « proton », (cm)

modulation F6.2 proton modulation, 0. if modality is not « proton », (cm)

Technique definition technique A3 technique: « DSP »=SSD, « DST »=SAD,

« ARC »

dsp F6.2 SSD value if tech=« DSP », SAD value otherwise, (cm)

xe F6.2 point of reference coordinates: isocenter or


D2 - 2 iSis 3D - V 2.35 - March 2003

ye F6.2

ze F6.2

entry point (SSD technique), (cm)

dsproj F6.2 source - projection plane distance, (cm)

code_tech_3D L1 « T » if table angle not null, « F » otherwise

code_mod_fais L1 « T » if wedge filter, trimmer, block tray or MLC

Point of reference characteristics

pos_point_ref I2 point of reference type:

1=free, 4=linked to common isocenter

Id_pti_or blank characters A2 common isocenter ID

struct_ptref A12 name of the structure used to define the position of the point of reference

Rotations

angle (fi ou akb) F6.2 gantry rotation DSP/DST, start if ARC, (°)

ake F6.2 end ARC, (°)

followed by, only if code_tech_3D true « T » - i.e. table angle not null

nb_sect I2 always 0

ang_tab F6.2 table angle, (°)

Main collimator

code_asym L1 « T » if asym./mlc, « F » if symmetric

psi F6.2 collimator rotation, (°)

enw1 F6.2 width of collimator at SAD, (cm)

enw2 F6.2 height of collimator at SAD, (cm)

half-dimensions (if code_mod_fais true « T ») collipal_lax I1 « la » jaws : 0=Sym, 1=Asym, 2=MLC

collipal_lby I1 « lb » jaws : 0=Sym, 1=Asym, 2=MLC

demi_larg_D F6.2 right half-width, psi=0, (cm)

demi_larg_G F6.2 left half-width, psi=0, (cm)

demi_haut_H F6.2 top half-height, psi=0, (cm)

demi_haut_B F6.2 down half-height, psi=0, (cm)

Modificators (if code_mod_fais true « T ») nfilt A10 « 0 » or name of wedge filter

iwig A1 thick edge side

nom_comp A20 empty or name of compensator

nom_bolus A20 empty or name of bolus

type_pcp I1 1=Block-T, 2=Trimmer, 3=MLC, 0=void

kcache I2 0 or block-tray number

iprol I2 0 or trimmer number

dsf F6.2 source film distance of field shape

dsf_film F6.2 source film distance of plot


iSis 3D - V 2.35 - March 2003 D2 - 3

Shape of reference (if multileaf collimator, type_pcp=MLC) Number of points of shape of reference

base_npoin I3 number of points shape of reference

Coordinates of shape of reference at dsf_film, 5 pairs at most by line (if base_npoin > 0) base_xch(1..base_npoin) F6.2 X coordinate of the nth point, (cm)

base_ych(1..base_npoin) F6.2 Y coordinate of the nth point, (cm)

Characteristics of shape of reference (if base_npoin > 0)

orig_ch_base I2 defined after :

0=Main Collimator,

1=Digitization on 1 film,

2=Digitization on 2 films,

3=Mouse,

4=Contour,

5=Structure(s),

6=Importation

nom_str_ch_base A12 empty or structure name if defined from structure

marge_ch_base F6.2 margin around structure if defined from structure, (cm)

ch_base_modif I2 1 if field has been modified since its creation, 0 if not

Multileaf collimator data (if type_pcp=MLC)

Number of leaf pairs

mlc_nleav I3 number of leaf pairs

Leaves position, 5 pairs at most by line

MLC_X1(1..mlc_nleav) F6.2 position of leaf 1 of the nth pair, (cm)

MLC_X2(1..mlc_nleav) F6.2 position of leaf 2 of the nth pair, (cm)

MLC informations

LEAF_L I3 first opened pair of leaves

LEAF_H I3 last opened pair of leaves

LEAF_M I3 number of opened pairs of leaves

MLC_MAX_Y F6.2 position of the pair of free jaws

MLC_MIN_Y F6.2 in case of integrated MLC, (cm)

Irregular field

Number of points of irregular field npoin I3 number of points of irregular field

Coordinates of irregular field at dsf_film, 5 pairs at most by line (if npoin > 0) xch(1..npoin) F6.2 X coordinate of the nth point, (cm)

ych(1..npoin) F6.2 Y coordinate of the nth point, (cm)

code_bord_champ(1..npoin) l1 « T » if nth-(n+1)th side is limited by block


D2 - 4 iSis 3D - V 2.35 - March 2003

Irregular field informations, (if npoin > 0) origine du champ I2 defined after :

0=Main Collimator,

1=Digitization on 1 film,

2=Digitization on 2 films,

3=Mouse,

4=Contour,

5=Structure,

6=Importation

nom_str_champ A12 empty or structure name if defined from structure

marge_champ F6.2 margin around structure if defined from structure, (cm)

champ_modif I2 1 if field has been modified since its creation, 0 if not

Weighting tp F6.2 weithing depth, (cm)

t (if theoretical) or fh (if effective) F6.2 weigth

code_pond_theo L1 « T » if theoretical ponderation, « F » otherwise

weighting mode pos_point_pond

code_pond_entree

code_pond_isoc

I1 weighting mode :

1= at axis

2= SSD, at the depth of maximum

3= SAD or ARC, at isocenter

5= at a point of interest (POI)

pti_id(ind_pti_pond) or empty A2 POI ID if weighting at a POI

X_ptpond F6.2

Y_ptpond F6.2

Z_ptpond F6.2

weighting point coordinates, (cm)

Treatment time dose_seance F6.2 0. or dose by fraction, (Gy)

tt_unit I1 Treatment time units :

0=monitor units, 1=minutes

tt_duree F6.2 0. or monitor units if tt_unit=0

0. or minutes if tt_unit=1

tt_date A10 empty or calculation date if tt_unit=1, (dd-mm-yyyy)

fsc_numgrp I2 beam group number

APPENDIX D3 - ADMINISTRATIVE FILE

ISIS 3D - V 2. 35 - March 2003 D3 - 1

D3. ADMINISTRATIVE FILE

IDENTIFICATION : name.ISX

The maximum length of administrative file is 20 characters

STRUCTURE : sequential ASCII file

FORMAT :

Line Contain Variable iSis3D Format Commentaries

File header:

1 version number of administrative file format

adm_versfich I2 Version 27

date of file adm_datefich A8

patient's name adm_nmal A20

file number adm_ndos A10

center code adm_codectre A3

file version nvers I4

commentaries adm_comment A72

Study date

2 date ct_date A8

hour ct_heure A5

software version version A7

Software name Prog A10

Images directory

3 Image directory name ISIS2_DIRIMGS A64

4 current slice ct_cpecur I12

current beam ct_fsccur I12

5 number of planes ct_nbpdc I12

For each plane

+1 plane index I12

+1 plane type ct_codepdc A2

plane number ct_numpdc I3

Selected plane

+1 number of selected planes I12

for each selected plane

+1 selected plane index I12

Current protocol code

+1 current protocol code ct_code_protcur I12


D3 - 2 ISIS 3D - V 2. 35 - March 2003

Isodoses

+1 number of isodoses ct_ntabiso I12

+1 isodose value (ct_ntabiso) ct_tabiso F15

isodose color (ct_ntabiso) ct_tabisoclr I12

Normalization

+1 normalization type ct_typenorm I

normalization point abscissa ct_normx F

normalizationpoint ordinate ct_normy F

normalization slice ct_normcpe A12

normalization value ct_normval F

normalization factor ct_normval F

Display

+1 Current series of image Ct_nivfen_modecur I 0=main, 1=register

+1 Number of different setting NIVFEN_NBMODES I 3 : main series, register series, DRR

For each setting

+1 window level ct_niveau I Hounsfield number

window width ct_fenetre I Hounsfield number

+1 range type ct_type_plage I

density mode ct_modedensites I

+1 resolution type

(high/low)

ct_hteres I

low resolution limit ct_hteres_bornemin I

high resolution limit ct_hteres_bornemax I

+1 Curve of grey level conversion

Ct_tab_tabcol() I 0=linear

1=logarithmic

2=exponential

3=by histogram

4=blck & white

Conversion coefficient Ct_tab_tabcol_param() F

Calculation Parameters

+1 heterogeneities correction ca_houi I

Calculation model ca_modele I 0=primary,

1= simple cutting out,

2= double cutting out

automatic calculation ca_auto I

automatic calculation every slices

ca_autottes I

calculation step ca_pascalc F

fast calculation or not ca_calcul_rapide I

type of dose displayed ca_type_dose I 0 : physical dose

1 : radiobiological dose


ISIS 3D - V 2. 35 - March 2003 D3 - 3

Options for voxel volume, DRR, voxel/voxel calculation Options

reducing factor Fact_reduc I

number of voxel (Z) vox_nbvox_w I

no crossing for DRR vox_pas_traverse_drr F

no crossing for voxel/voxel calculation

vox_pas_traverse_vpv F

threshold soft tissue/hard tissue for DRR

Drr_seuil_mou_dur I

Sharpness factor of DRR Fact_finesse F

Structures Colors

+1 Max number of structures NMAXR I 40

+1 structures color nkclrs I

State of beam inside plane

+1 Max number of planes NB_PLANS_MAX() I 119

Max number of beams NFMAX I 56

for each plane

+1 lice number I

+1 flag active beam inside slice cs_fsc_actif I

+1 flag calculated beam inside slice

cs_mcalc I

+1 calculation step inside slice cs_etatcalc I

automatic density calculation

+1 flag automatic density calculation

ct_densauto I

zoom and virtual simulation options

+1 zoom virtual simulation ct_sim_zoom F

paper format ct_sim_fmtpapier A12

graphic center abscissa ct_sim_cgx F

graphic center ordinate ct_sim_cgy F

+1 display option ct_sim_optionsaff I

number of option for

structures

MARPC+1 I

+1 displ. option structures ct_sim_affstruct I*(MARPC+1)

number of non transverses planes

+1 number of non transverses planes

nb_plans I

view data


D3 - 4 ISIS 3D - V 2. 35 - March 2003

+1 number of view nb_vue I

number of fixed view nbvues_fixes I 3

for each view

+1 view index I

+1 view description vue_descrip A12

source isocentre distance vue_dsi F6.2

source distance film vue_dsf F6.2

X isocenter position vue_xe F6.2

Y isocenter position vue_Ye F6.2

Z isocenter position vue_Ze F6.2

gantry rotation vue_rotbras F6.2

table rotation vue_rottab F6.2

image name associated to view

vue_nimag A16

DRR

+1 number of beams nbfscx I

for each beam

+1 beam index I

+1 image name associated to view

fsc_nimag A16

Other

+1 option message dimensions colli

ct_option_colli_dsp I

+1 Name of scanner file setup Fich_houndens-cour A64

APPENDIX E – EXPORTATION DOSE FILE

iSis 3D - V 2.35 – March 2003 E - 1

E. EXPORT DOSES FILE FORMAT

IDENTIFICATION : free name, extension .D3D by default

Les fichiers d’exportation de doses sont des fichiers auto-documentés qui comportent

les informations suivantes :

• identification de l’étude dont ils sont issus,

• indice et nature du plan de calcul concerné,

• identification des faisceaux pris en compte,

• un ou plusieurs profils de dose et/ou la grille de calcul complète.

Les fichiers d’exportation de doses sont relus par le programme CUVE qui permet

ainsi de comparer des profils calculés et mesurés (cf.: Appendix F, Waterphantom

program).

example of file :

ISIS2

DEXPORT:Numero_de_version

1

DEXPORT:Nom_du_patient

EXEMPLE

DEXPORT:Numero_de_dossier

LD0001

DEXPORT:Nom_etude

EXEMPLE

DEXPORT:Date_etude

3-09- 1

Identification of study

DEXPORT:Plan_concerne

C1

DEXPORT:Type_de_plan_C=1_PS=4_PF=8_PSO=16_PF0=32

1

DEXPORT:Origine_du_plan

0.00 0.00 -5.74

DEXPORT:Caracteristiques_du_plan_distance_inclinaison

0.00 0.00

Index and type of plane:

C = Slice,

PS = Sagittal,

PF = Frontal,

PSO,PFO = PS or PF Oblique

DEXPORT:Nombre_de_faisceaux

2

DEXPORT:Indices_des_faisceaux

1

identification of beam

APPENDIX E – EXPORTATION DOSE FILE

E - 2 iSis 3D - V 2.35 – March 2003

2

DEXPORT:DEBUT_COURBE Start of curve

DEXPORT:volume=3_ou_grille=2_ou_profil=1

1

DEXPORT:Type_de_courbe

Traversee

DEXPORT:Commentaires

Type of data

DEXPORT:Taille_du_tableau

85 0 0 0

Number of point

then X,Y size (grid)

and Z size ( volume)

DEXPORT:Coordonees_premier_point_dose

-17.00 -1.70 -5.74 9.50

DEXPORT:Coordonees_dernier_point_dose

16.60 -1.70 -5.74 99.32

Start and End coordinates

X Y Z Dose

DEXPORT:Normalisation_a_l_origine_du_profil

1

DEXPORT:Coordonnees_point_normalisation_du_profil

13.40 -1.70 -5.74

DEXPORT:Dose_au_pt_de_normalisation

103.12

Coodinates of normalization point and dose at this point.

DEXPORT:Tableau_X_Y_Z_DOSE_DISTANCE_A_L'ORIGINE

-17.00 -1.70 -5.74 9.50 -30.40

-16.60 -1.70 -5.74 9.72 -30.00

-16.20 -1.70 -5.74 9.95 -29.60

-15.80 -1.70 -5.74 10.18 -29.20

-15.40 -1.70 -5.74 10.41 -28.80

-15.00 -1.70 -5.74 10.65 -28.40

-14.60 -1.70 -5.74 10.89 -28.00

-14.20 -1.70 -5.74 11.37 -27.60

-13.80 -1.70 -5.74 11.68 -27.20

-13.40 -1.70 -5.74 11.95 -26.80

-13.00 -1.70 -5.74 12.22 -26.40

-12.60 -1.70 -5.74 12.51 -26.00

-12.20 -1.70 -5.74 12.87 -25.60

-11.80 -1.70 -5.74 13.23 -25.20

………………………………………………………………………………………………………

15.00 -1.70 -5.74 107.48 1.60

15.40 -1.70 -5.74 109.15 2.00

15.80 -1.70 -5.74 110.52 2.40

16.20 -1.70 -5.74 110.93 2.80

16.60 -1.70 -5.74 99.32 3.20

data

DEXPORT:FIN_COURBE End of curve

APPENDIX F - WATERPHATOM

ISIS 3D - V 2. 35 - March 2003 F - 1

F. WATER PHANTOM PROGRAM

Introduction This program deals with data files directly acquired from the water phantom tank. The recognized systems are: POSEIDON PRECITRON MP3 PTW MP2 PTW RFA 300 SCANDITRONIX WP700 WELLHOFER WP600 WELLHOFER Data files imported from the floppy disk The importation of the files is performed by using PCDISK. On a DECterm, since the $ sign is displayed, type :

mcr PCDISK PCDISK> USE A: <name the floppy disk reading system> (this name is given while

installing your ISIS system) A:> EXPORT A:*.* [directory name where the data will be saved] A:> EXIT

In the utilization example, will be described :

The floppy disk reading system is DVA0; The directory name where the files will be saved is CUVE; The name of the acquisition system is PTW.

On a DECterm, since the $ is displayed, type :

mcr PCDISK PCDISK> USE A: DVA0: A:> EXPORT A:*.* [.CUVE]

A:> EXIT All the above commands copy all the files from the diskette in the directory CUVE. Note: If the directory does not exists, it can be created. Checking the existence of the directory : Type DIR CUVE.DIR If the system reply :

If the system reply :

Directory DOSI$USR:[PHYSIQUE] %DIRECT-W-NOFILES, no files found CUVE.DIR;1 Total of 1 file.

the directory exists the directory does not exists Directory creation: $ CREAT/DIR [.CUVE]


F - 2 ISIS 3D - V 2. 35 - March 2003

EXEMPLE OF UTILISATION 1 MAIN MENU

0- Selection of the acquisition system 1- Open an experimental file

5 - Creation of a new FIFI file

8 - Comparison of two curves 9 - Option

99 - End

Your selection : 0ˆ̂̂̂ 2 1ˆ̂̂̂ 10 5ˆ̂̂̂ 50 8ˆ̂̂̂ 80 9ˆ̂̂̂ 90 10ˆ̂̂̂ 100

2 Source of the experimental files : 1 - PTW 2 - WP700 3 - RFA300 4 - POSEIDON 5 - PROFILS ISIS3D 6 - COURBES FIFI N°ˆ̂̂̂ 10 10 Directory where the file is located ( [] for the current directory ) [.CUVE] ˆ̂̂̂ 11 11 File name (with extension) Give the filename with the extension the same as the one on the diskette. xxxxx.yyyˆ̂̂̂ 20 If the file can not be open, the following message is displayed: "Impossible to open the specified file !" 1 20 MAIN MENU

0- Selection of the acquisition system ( PTW ) 1- Open an experimental data file 2- Summary display 3- Display one curve from the summary 4- Print one curve from the summary 5 - Creation of a new FIFI file

8 - Comparison of two curves 9 - Option

99 - End


ISIS 3D - V 2. 35 - March 2003 F - 3

Your choice: 0ˆ̂̂̂ 2 1ˆ̂̂̂ 10 2ˆ̂̂̂ 25 3ˆ̂̂̂ 30 4ˆ̂̂̂ 40 5ˆ̂̂̂ 50 8ˆ̂̂̂ 80 9ˆ̂̂̂ 90

99ˆ̂̂̂ END 25 File PTW-Freiburg Mephysto Export V.5.0 Created on 2-JUN-1995 12:33

Curves list N° Machine Type X/e En. SSD LX LY depth

Correct? Mev (mm) (mm) (mm) (cm) Y/N

1 STANDARD ELECTRONS CAX e 20.0 1000 100 100 0.0 NO 2 STANDARD ELECTRONS CAX e 18.0 1000 100 100 0.0 NO 3 STANDARD ELECTRONS CAX e 15.0 1000 100 100 0.0 NO 4 STANDARD ELECTRONS CAX e 12.0 1000 100 100 0.0 NO 5 STANDARD ELECTRONS CAX e 10.0 1000 100 100 0.0 NO 6 STANDARD ELECTRONS CAX e 8.0 1000 100 100 0.0 NO 7 STANDARD ELECTRONS CAX e 6.0 1000 100 100 0.0 NO

The curve number to be displayed ( RETURN if none) ? ˆ̂̂̂ 20

N°ˆ̂̂̂ display the curve, then 20 30 The curve number to be displayed ( RETURN if none) ? ˆ̂̂̂ 20 N°ˆ̂̂̂ display the curve, then 20 40 The number of the recorded curve ( RETURN if none) ? ˆ̂̂̂ 20 N°ˆ̂̂̂ Display the curve, then 20 or 55 or 65 ˆ̂̂̂ 20 or 55 or 65 50 INPUT OF THE FIFI FILE CHARACTERISTICS Center name (max 3 char) : CURˆ̂̂̂ Machine name (max 7 char ) : SATE12ˆ̂̂̂ Photon or electron ( X / e) : eˆ̂̂̂ Energy ( in MV if X, in Mev if e ) : 12ˆ̂̂̂ Dose on-axis or profiles(o/p ) :

oˆ̂̂̂ pˆ̂̂̂ 1 - Normalized depth dose ( NDD ) Open field profile ( TRAV) 2 - Tissue-Maximum Ratios ( TMR ) 3 - Tissue-Phantom Ratios ( TPR ) NDDˆ̂̂̂ SSD ( cm ) SSD (cm) 100ˆ̂̂̂ 100ˆ̂̂̂

Do you want to modify any characteristics of FIFI file ( Y / N ) ? Yˆ̂̂̂ 50 Nˆ̂̂̂ 55


F - 4 ISIS 3D - V 2. 35 - March 2003

55 MAIN MENU 0- Selection of the acquisition system ( PTW ) 1- Open an experimental data file 2- Summary display 3- Display one curve from the summary 4- Print one curve from the summary 5- Creation of a new FIFI file 6- Add curve to FIFI file 7- Save FIFI file 8 - Comparison of two curves 9 - Option

99 - End

Your choice: 0ˆ̂̂̂ 2 1ˆ̂̂̂ 10 2ˆ̂̂̂ 25 3ˆ̂̂̂ 30 4ˆ̂̂̂ 40 5ˆ̂̂̂ 50 6ˆ̂̂̂ 60 8ˆ̂̂̂ 80 9ˆ̂̂̂ 90

99ˆ̂̂̂ END 60 File PTW-Freiburg Mephysto Export V.5.0 Created 2-JUN-1995 12:33

Curves list N° Machine Type X/e En. SSD LX LY depth.

Correct? Mev (mm) (mm) (mm) (cm) Y/N 1 STANDARD ELECTRONS CAX e 20.0 1000 100 100 0.0 NO 2 STANDARD ELECTRONS CAX e 18.0 1000 100 100 0.0 NO 3 STANDARD ELECTRONS CAX e 15.0 1000 100 100 0.0 NO 4 STANDARD ELECTRONS CAX e 12.0 1000 100 100 0.0 NO 5 STANDARD ELECTRONS CAX e 10.0 1000 100 100 0.0 NO 6 STANDARD ELECTRONS CAX e 8.0 1000 100 100 0.0 NO 7 STANDARD ELECTRONS CAX e 6.0 1000 100 100 0.0 NO

The curve number to be displayed ( RETURN if none) ? ˆ̂̂̂ 55

N°ˆ̂̂̂ display the curve, then 62 62 The curve is displayed on the screen as well as a dot curve. The initial curve (full line) includes too many points. Do you accept the corrected curve? (dot curve) Y / N ? :

Yˆ̂̂̂ recording the curve then, 65 ( or 63 )

Nˆ̂̂̂ 65, without recording the curve


ISIS 3D - V 2. 35 - March 2003 F - 5

63 The following messages can be displayed in the cases: The curve type in not the same as the one of the FIFI file The radiud is not the same as the one in the FIFI file The energy is not the same as the one in the FIFI file The SSD is not the same as the one in the FIFI file. Do you want to adjust the curve from FIFI file (Y / N ) ? :

Yˆ̂̂̂ recording the curve then, 65 Nˆ̂̂̂ 65, without recording the curve 65 MAIN MENU

0 - Selection of the acquisition system ( PTW ) 1 - Open an experimental data file 2 - Summary display 3 - Display one curve from the summary 4 - Print one curve from the summary 5 - Creation of a new FIFI file 6 - Add a curve to FIFI file 7 - Save FIFI file 8 - Comparison of two curves 9 - Option

10 - End Your choice: 0ˆ̂̂̂ 2

1ˆ̂̂̂ 10 2ˆ̂̂̂ 25 3ˆ̂̂̂ 30 4ˆ̂̂̂ 40 5ˆ̂̂̂ 50 6ˆ̂̂̂ 60 8ˆ̂̂̂ 80 9ˆ̂̂̂ 90

99ˆ̂̂̂ 100 70 Filename without extension (max 6 characters) : SATE12ˆ̂̂̂ 65

so, the file is recorded in the [PHYSIQUE] directory with the following name:

SATE12.RPF, SATE12.TRV, SATE12.RTM or SATE12.RTF next option choose in 50 80 THE FIRST EXPERIMENTAL FILE : Source of the experimental file: 1 - PTW 2 - WP700 3 - RFA300 4 - POSEIDON 5 - PROFILS ISIS3D 6 - COURBE FIFI N°ˆ̂̂̂ 81


F - 6 ISIS 3D - V 2. 35 - March 2003

81 Directory where the file is saved ( [] for the current directory) [.CUVE] ˆ̂̂̂ 82 82 Filename ( with extension ) Give the same filename as the one used to save it on the diskette.

xxxxx.yyyˆ̂̂̂ 83 If the specified file can not be openned, the following message is displayed: "Impossible to open the specified file!" 1

83 THE SECOND EXPERIMENTAL DATA FILE : Source of the experimental file: 1 - PTW 2 - WP700 3 - RFA300 4 - POSEIDON 5 - ISIS3D 6 - COURBE FIFI N°ˆ̂̂̂ 84 84 Directory whre the file is located ( [] for the current directory ) [.CUVE] ˆ̂̂̂ 85 85 Filename ( with extension ) Give the same filename as the one used to save it on the diskette..

xxxxx.yyyˆ̂̂̂ 86 If the specified file can not be opened, the following message is displayed: "Impossible to open the specified file!" 1

86 FILE : [.ptw]test (here is displayed the filename defined at 82) The curve number to be displayed (return if no) ? ˆ̂̂̂ 55 or 65

N°ˆ̂̂̂ display the curve, then 87 87 FICHIER : [.ptw]test (here is displayed the filename defined at 85) The curve number to be displayed (return if no) ? ˆ̂̂̂ 55 or 65

N°ˆ̂̂̂ display the curve, then 88 88 Normalize the comparison ? : [N] Oˆ̂̂̂ normalization of curves then 88b Nˆ̂̂̂ 88b 88b Change the scale of curve N° 2 ? : [N] Oˆ̂̂̂ Scale ? : enter a value (e.g. : .1 = 1/10) 89 Nˆ̂̂̂ 89 89 Print the comparison ? : [N] Nˆ̂̂̂ 86 Yˆ̂̂̂ printout the curves, then 86


ISIS 3D - V 2. 35 - March 2003 F - 7

90 In an exceptional, this dialog is reserved to the personnel from Technologie Diffusion

1 - Printer parameters 2 - Display parameters

10 - Quitter options Your choice: 1ˆ̂̂̂ 91 2ˆ̂̂̂ 95 10ˆ̂̂̂ 1 or 20 or 55 or 65 91 Queue of printing : [CUVE$PRINT] name of a queue for printing ˆ̂̂̂ 92 ˆ̂̂̂ 92 92 Printer type : [PS] 1 - PS 2 - HPGL 1ˆ̂̂̂ or 2ˆ̂̂̂ or ˆ̂̂̂ 93 93 Exit file : [CUVE_IMP.PS] filename ˆ̂̂̂ 90 ˆ̂̂̂ 90 95 Normalize curves ? : [N] Nˆ̂̂̂ 90 Yˆ̂̂̂ 90 100 Do you really want to quit ? [O/N] : Nˆ̂̂̂ 1 or 20 or 55 or 65 Yˆ̂̂̂ end of program


F - 8 ISIS 3D - V 2. 35 - March 2003

APPENDIX G – PHOTON COMPENSATORS

iSis3D - V 2.35 - january 2003 G - 1

G. PHOTON COMPENSATORS (available from version v2.35)

G1. Users' guide

G2. Description of Compensator file "DEPTH" (.PRF)

G3. Description of Compensator file "REAL" (.CPR)

G4. Description of Compensator file "THEORETICAL" (.CPT]

G5. Description of Compensator file "HEK"

G6. Description of Compensator file "Machine file"

APPENDIX G – PHOTON COMPENSATORS

G - 2 iSis3D - V 2.35 - january 2003

APPENDIX G1 – PHOTON COMPENSATORS

iSis3D - V 2.35 - january 2003 G1 - 1

G1. USERS' GUIDE

G1.1 General principle

The compensators are modifiers attached to the collimator, designed in order to

compensate for the surface irregularities and/or for the inhomogeneities. The ISIS

version 2.35 allows for compensators interposed in proton and photons beams. For

proton beams, compensators are used to modulate the depth of penetration as a

function of the position in the field, whereas for photon beam, it is the fluence (or

intensity) which is modulated. Photon fluence is handled differently if a MLC is present

or not :

• if an MLC is present, the compensation is assumed to be performed with

appropriate movement of the leaves, as for Intensity Modulated Radiation

Therapy (IMRT).

• if no MLC, the compensation is performed by interposition of appropriate

thickness of suitable material.

The compensator computation is a two steps process :

• the first step is the calculation of the theoretical compensator

• the second step is the calculation of the real compensator and the creation of

the associated drilling (or milling) files.

In case of photons beam, the theoretical compensator is calculated by using intensity

modulation matrix F(x,y) generated (exclusively for v.2.35) by Konrad inverse planning

module. One way to compensate an individual beam in order to obtain a uniform

distribution in one plane is to create a flat virtual structure (typically 0.5 cm thick)

perpendicular to the beam axis and to ask Konrad to compute the fluence resulting in

a uniform dose within this structure. The theoretical compensator is then a matrix of

transmission factors Tr(x,y)

The transmission factor Tri(xi,yi) at point (xi, yi) is calculated as the ratio of the fluence

Fi(xi,yi) to the maximum fluence Fmax(xmax,ymax).


G1 - 2 iSis3D - V 2.35 - january 2003

If no MLC, the manufactured compensator is defined by a material thickness matrix

Th(x,y) calculated from the transmission factor matrix Tr(x,y) according to the following

expression:

Log(Tri(xi,yi)) Thi(xi,yi) = - —————— µ

where Thi is the thickness in cm and µ is the attenuation coefficient in cm-1.

G1.2 User interface

G1.2.1 Access to compensator dialog in the virtual simulation mode

In the ‘Virtual Simulation’ mode (or beam modification) the < Compensator /

Modulator > box of the current beam displays the following pull-down menu :

• None

• New

• Open

None : Is the default option. If a compensator has been previously defined, it allows to

remove the compensator from the current beam.

New : launches the theoretical compensator calculation. As soon as this option is

selected, the Konrad – Inverse planning window appears.

Figure G1-1 : Associating an intensity ‘Modulator’ to a beam

Fill-in the name given to the Konrad’s plan created by KonRad in the field <

Konrad’s plan name >.

Click the < ok > button.


iSis3D - V 2.35 - january 2003 G1 - 3

The transmission matrix of the theoretical compensator, is calculated and displayed in the graphic zone.

Note : The name of the theoretical compensator is obtained by the concatenation of

the Konrad’s plan name with the beam number and cannot be modified.

Open : this option gives access to the selection of a theoretical compensator file in a

list located in a specific directory ("zone") predefined for this purpose.

A message is displayed if the beam parameters are inconsistent with the compensator

data .

The button <Manufacture> becomes accessible after computing or selecting a

theoretical compensator.

Note : If a multi-leaf collimator is selected for the current beam, a dynamic intensity

modulation will be applied and the button <Manufacture>will not be sensitive.

Manufacture :

By clicking the button Manufacture a dialog box appears to define the manufacturing

parameters (see G1.2.2).

Details :

The button Details becomes sensitive after a compensator has been computed or

when an existing one is selected. It gives access to a dialog box where the main

characteristics of the compensator are displayed (see G1.2.3).

G1.2.2 Launching the manufacture of a real compensator

After clicking on <manufacture>, box is displayed (Figure G1-2).

The upper part of the box permits to choose:

• the type of machine used for compensator realisation (“Manufacturing

options”).

• the location and the name (8 characters at most) of the file to be exported to

the computer driven milling machine.


G1 - 4 iSis3D - V 2.35 - january 2003

A default file name is proposed and the file extension is imposed according to the

chosen export format. If the chosen file name already exists, a warning message

prompt the user to give a new name.

Figure G1-2 : Compensator manufacture box

The second part of the box permits to specify the compensator properties.

The items and the layout could be slightly different according to the milling machine.

The following description refers to the HEK machine.

• S-base of comp. Dist. : distance from source to base of the compensator in

cm


iSis3D - V 2.35 - january 2003 G1 - 5

• Attenuation coefficient : attenuation coefficient of compensator material in

cm¹

• Tool size : the tool size, specified in cm, defines the step along FY of the

calculation grid. The resolution of the calculation grid along FX is defined in the

session parameters file (see 3, associated files).

• Maximum thickness : upper limitation of the compensator thickness in cm.

(not used for the HEK machine).

• Height of cut. loop : this parameter is defined in the default parameters file

of HEK machine and cannot be changed. It is used to calculate the number of

requisite cutting loops.

• Additional thickness : this thickness refers to the whole field area (in cm)

• Safety margin : specified in cm. In the safety margin region the compensator

is extended with a thickness equal to the maximum calculated thickness.

The lower part of the box contains two buttons :

• Ok : to start the computation of the real compensator.

• Cancel : to close the dialog box without calculating the compensator.

At the end of the calculation the dialog box is closed.

G1.2.3 Accessing to the details of the compensator characteristics

After clicking on <Details>the following window appears, which describes the

parameters of the compensator and the parameters of the associated beam.

Note : The required block thickness includes the additional thickness.

The required length and width of the compensator include the lateral safety

margin.


G1 - 6 iSis3D - V 2.35 - january 2003

In this window five buttons are accessible.

• Redefine : displays the Konrad – Inverse planning window to calculate a new

theoretical compensator.

• Profiles display : starts the plotting program CONTROL. A dialog window is

opened to define the profiles to plot and to print if necessary.

• Matrix display : displays the transmission matrix in the graphic zone.

• Print… : prints the parameters of the beam and compensator.

• Close : closes the window.

Figure G1-3 : Compensator characteristic box

G1.3 Associated files

Some of the parameters used for the computation of the compensators are stored into

specific files. In addition, the compensator process generates new files which are

described below.

When a milling machine is used, it is considered as part of the ISIS environment and

therefore defined through a specific file : “name of the milling machine”.ETA located in


iSis3D - V 2.35 - january 2003 G1 - 7

the directory ISIS2$DIRETAETL (i.e. HEK_SE_70.ETA for the Hek machine SE 70)

which contains its main characteristics (cf.: Appendix G6, Description of machine

parameters file HEK_SE_70.ETA).

Some other fixed parameters are fixed in the “session parameter file” :

ISIS2_OPTIONS.ETL, which is described in the appendix of the ISIS brochure :

“SET-UP and PARAMETERS FILE DESCRIPTION”.

In particular, the step of the grid for the theoretical compensator calculation is defined

in this file.

After the compensator module has been launched, three

files can be computed :

• the theoretical compensator file (.CPT)

• the real compensator file (.CPR)

• the milling compensator file (according to specifications of the milling

machine)

The theoretical and real compensator files are created for all types of compensation .

In case of planning inverse compensation, these files have the name of Konrad’s plan

specified by the user.

The theoretical compensator file has the extension “.CPT”.and contains the matrix

of transmission factors. It is described in the appendix : “Theoretical compensator file

format”

The real compensator file has the extension “.CPR” in case of static compensator

(for an MLC it is replaced by the sequencing file of the MLC). It contains the matrix of

material thickness. This matrix is calculated from a theoretical thickness matrix ( cf.: §

G1.1 general principle) according to the tool size and it is used for the dose

calculation. It is described in the appendix : “Real compensator file format” )

The milling file(s) is (are) created only for a static compensator.


G1 - 8 iSis3D - V 2.35 - january 2003

For the HEK milling machine, two milling files are created. Only the name of these

files is specified by the user, the extension of header information file « iii » and the

extension of data file « ddd » are imposed (cf.: Appendix G6, Description of machine

parameters file HEK_SE_70.ETA).

The detailed format of these two files is described in the appendix : “HEK compensator

file format”. It should be noted that part of the header file could be customized through

an ISIS file (the name of which is defined in HEK_SE_70.ETA as

ISI$REALCOMP_C_PARAMDEF) that is copied at the appropriate position (“copied

from *.mas file”) in the header information file.

APPENDIX G2 – DEPTH COMPENSATOR FILE

iSis 3D - V 2.35 - March 2003 G2 - 1

G2. DEPTH COMPENSATOR FILE

IDENTIFICATION: name.PRF



FORMAT:

Line Element description ISis Variable Format Notes

1 Revision ID NVERSION A20 "**version02**

2 Information line A60 "Nom fichier patient dossier Ident pl trait Date Heure"

3 File Name (.PRF) NOMFIC A20

Patient Name NOM_FICH A20

File ID NUM_DOSS A10 File ID of the patient within the hospital

Plan ID PLAN_TRAIT A10

Free A5

Plan Date IDAT_CREAT() 3 x I2 ddmmyy

Plan Time HEURE_CREAT A8 hh :mm:ss

4 Information line A60 "N faisc Descriptif faisc"

5 Beam ID NUM_FAISC I2

Free A5

Beam description DESCR_FAISC A12

6 Information line A60 "POSPAT X_ISO Y_ISO Z_ISO ANGBRA ANGTAB ANGCOL DSA Co/VCIBLE"

7 Patient Position POS_PATIENT A6 Position of the patient relative to to the imaging equipment space. Defined terms (see DICOM [0018,5100]) :

HFS,HFP,HFDR,HFDL,FFP,FFS,FFDR,FFDL

Beam isocentre X_ISO

Y_ISO

Z_ISO

3 x F6.2 Isocentre coordinates in the radiotherapy coordinate system

Free A5

Gantry rotation ANGBRA F6.2 gantry rotation angle, in degrees, ICE conventions

Free A5

Table rotation ANGTAB F6.2 Isocentric table rotation angle, in degrees, ICE conventions

Free A5

Collimator rotation ANGCOL F6.2 collimator rotation angle, in degrees, ICE conventions

Source-calculation plan Dist_S_COMP F6.2 cm

APPENDIX G2 – DEPTH COMPENSATOR FILE

G2 - 2 iSis 3D - V 2. 35 - March 2003

distance

Source axis distance D_S_AXE F6.2 cm

Target volume ID NCOD_VCIB I2 Index of target volume in iSis tables

Not used for intensity or fluence maps

Target volume name NOM_VCIB A12 Name of target volume


Heterogeneity correction

CO_HETERO I2 0=No 1=Yes

8 Information line A60 NP_TOTU,NP_TOTV"

9 Number of values in U direction

NP_TOTU I3

Free A5

Number of values in V direction

NP_TOTV I3

10 Information line A60 Coordonnées des trois points du plan du compensateur

11 Plan origin XPL(1)

YPL(1)

ZPL(1)

3 x F6.2 Origin coordinates in the radiotherapy coordinate system

12 Point in U direction XPL(2)

YPL(2)

ZPL(2)

3 x F6.2 coordinates in the radiotherapy coordinate system

13 Point in V direction XPL(3)

YPL(3)

ZPL(3)

3 x F6.2 coordinates in the radiotherapy coordinate system

14 Information line A60 « PAS_GR_INI_U , PAS_GR_INI_V »

15 Grid step in U direction PAS_GR_INI_U F8.6

Grid step in V direction PAS_COMP_V F8.6

16 Information line A60 S U_GRI V_GRI prof_min, prof_max dsp

17 Boolean true if the point is inside the structure

NUAGE_STR(I,J) L1 ‘T’ if the point is inside the target structure

Coordinates of the point U_GRILL(I)

V_GRILL(J)

2 x F10.6 I from 1 to NP_TOTU

For I constantI ,J =1, NP_TOTV

Free A5

Minimum Depth PROF_MIN_STR(I,J) F10.6 Cm

Free A5

Maximum Depth PROF_MAX_STR(I,J) F10.6 Cm

Free A5

Source_skin Distance at the point

DIST_SP (I,J) F10.6 Cm

APPENDIX G3 – "REAL" COMPENSATOR FILE

iSis 3D - V 2.35 - March 2003 G3 - 1

G3. "REAL" COMPENSATOR FILE

IDENTIFICATION: name.CPR



FORMAT:


1 Keyword to identify the content

CODEFIC A20 "COMP. REALISE" or

Revision ID NVERSION A20 "**version04**

2

3

Information line

Compensation type

NTYPE A60

I2

« TYPE : 1 : Forme de compensation »

INVERSE PLANNING = 16

4

5

Information line

Compensator format

MODE_REA A60

I2

« MODE : 1 :Mode de réalisation / format

HEK manufacturing = 1

6 Information line A60 "Nom patient N dossier Ident pl trait Date Heure"

7 Patient Name NOM_FICH A20



Free A5





Free A5


10 Information line A60 "POSPAT X_ISO Y_ISO Z_ISO ANGBRA ANGTAB ANGCOL DSA Co/VCI"

11 Patient Position POS_PATIENT A6 Position of thepatient relative to to the imaging equipment space. Defined terms (see DICOM [0018,5100]) :



Y_ISO

Z_ISO


Free A5



G3 - 2 iSis 3D - V 2. 35 - March 2003

Free A5

Table rotation ANGTAB F6.2 Isocentric table rotation angle, in degrees, ICE conventions

Free A5







Heterogeneity correction

CO_HETERO I2 0=No correction 1=Standard correction

2=Voxel/voxel correction



YPL(1)

ZPL(1)

3F6.2 Origin coordinates in the radiotherapy coordinate system


YPL(2)

ZPL(2)

3F6.2 coordinates in the radiotherapy coordinate system


YPL(3)

ZPL(3)


16 Information line A60 "DIST_S_COMP /U_MIN,U_MAX/V_MIN,V_MAX/NP_CMPU,NP_CMPV/ PAS_U_V"

17 Source – calculation plan distance

DIST_S_COMP F6.2 Source compensator distance, in cm or

Free A6

ROI limits U_MIN_UTIL

U_MAX_UTIL

V_MIN_UTIL

V_MAX_UTIL

4 x F6.2 Limits of the Region Of Interest:

Limits of the structure (compensator)

Free A5

Number of values in U direction for compensator

NP_COMP_TOTU I3

Free A5

Number of values in V direction for compensator

NP_COMP_TOTV I3

Grid step in U direction for compensator

PAS_COMP_U F6.4

Grid step in V direction for compensator

PAS_COMP_V F6.4

18 Information line A60 "PAS_GR_INI_U(V)/TYPE_GRILLE/NP_TOTU(V)"

19 Grid step in U direction PAS_INI_U F6.4

Grid step in V direction PAS_INI_V F6.4


iSis 3D - V 2.35 - March 2003 G3 - 3

Free A5

Type of grid ITYPE_GR I1 = 1 aligned grid, =2 alternated grid

Free A5

……

Number of values in U direction for grid

Free

NP_TOTU I3

A5

Number of values in V direction for grid

NP_TOTV I3

20 Information line A60 "Taille de l’outil en CM / Coef. d’atténuation » or

RAYON FRAISEUSE en CM /Densité plexi "

21 Tool size or

Drill Radius

RAYN_FRAISE F6.4 If MODE_REA = 1 (HEK)

Free A5

Attenuation coefficient or

Material density

COMP_COEFF_ATT

DENS_MAT_COMP F6.4 If MODE_REA = 1 (HEK)

22 Information line A60 "EP_COMP_MAX UMAX VMAX EP_COMP_MIN UMIN VMIN"

23 Maximum value EPAISS_COMP_MAX F6.2 Maximum thickness for compensator

Free A5

Coordinates of maximum value

U_COMP_MAX_ERR V_COMP_MAX_ERR

2 x F6.2

Minimum value EPAISS_COMP_MIN_ERR F6.2 Minimum thickness for compensator

Free A5

Coordinates of minimum value

U_COMP_MIN_ERR

V_COMP_MIN_ERR 2 x F6.2

24 Information line A60 « NUL,NUL,NUL,MARGE DE SECURITE » if MODE_REA=1 (HEK) or

MARG_PROX MARG_DIST M_ERR_DSC ,M_ERR_DSA"

25 Proximal margin

Distal margin

DSC error margin

Safety margin

VMARG_PROX

VMARG_DIST

VMARG_ERR

VMARG_LAT

F6.2 0.if MODE_REA=1

0. if MODE_REA=1

0. if MODE_REA=1

Safety margin

26 Information line A60 "EPAIS_SUP_COMP,EPAIS_MAXI_COMP,LONG_FY_COMP, LARG_FX_COMP if MODE_REA=1 or

EPAIS_MIN_PLEXI,EPAIS_MAX_PLEXI,DIAM_MIN_PLEXI"

27 Additional thickness

Maximum compensator thickness

Compensator length or

Compensator diameter

EPAISS_MIN_PLEXI

EPAISS_MAX_PLEXI

LONG_U_NECESS

DIAM_MIN_PLEXI

LARG_V_NECESS

4 F6.2


G3 - 4 iSis 3D - V 2. 35 - March 2003

Compensator width If MODE_REA=1

If MODE_REA=1

28 Information line A60 If MODE_REA=1 this record is not defined

PAR_SC,PMOD_SC,PARC_AC,PMOD_AC_ERR"

29 Practical range without compensator

Modulation without compensator

Practical range with compensator

Modulation with compensator

PARC_SC

PMOD_SC

PARC_AC

PMOD_AC

4 x F6.2

30 Information line A60 "FICHIER COMPENSATEUR THEORIQUE"

31

32

Number of files

File name of theoretical compensator

I2

A20

Number of files = 1

33 Information line A60 « FICHIER MACHINE

34

Number of files

Name of drilling files

(NB_FICH_MACH next lines)

NB_FICH_MACH I2

A75

Number of drilling files

30 Information line A60 T U_GRI V_GRI EP_COMP

31 Boolean true if the point is inside the compensation area

Coordinates of the point

Compensator thickness

Source_skin distance

NUAGE_MACH(I,J)

U_GRILL(I)

V_GRILL(J)

EPAISS_COMP_MACH(I,J)

DIST_SP(I,J)

L1

4 x F6.2

0. if inverse planning

APPENDIX G4 – "THEORETICAL" COMPENSATOR FILE

iSis 3D - V 2.35 - March 2003 G4 - 1

G4. "THEORETICAL" COMPENSATOR FILE

IDENTIFICATION: name.CPT



FORMAT:


1 Keyword to identify the content

CODEFIC A20 "COMP. REALISE" or

Revision ID NVERSION A20 "**version04**

2 Information line A60

3 Compensation type NTYPE I2 « TYPE : 1 : Forme de compensation »

INVERSE PLANNING = 16

4 Information line A60

5 Compensator format MODE_REA I2 « MODE : 1 :Mode de réalisation / format

HEK manufacturing = 1

6 Information line A60 "Nom patient N dossier Ident pl trait Date Heure"

7 Patient Name NOM_FICH A20



Free A5





Free A5


10 Information line A60 "POSPAT X_ISO Y_ISO Z_ISO ANGBRA ANGTAB ANGCOL DSA Co/VCI"

11 Patient Position POS_PATIENT A6 Position of thepatient relative to to the imaging equipment space. Defined terms (see DICOM [0018,5100]) :



Y_ISO

Z_ISO


Free A5


Free A5

Table rotation ANGTAB F6.2 Isocentric table rotation angle, in degrees, ICE ti


G4 - 2 iSis 3D - V 2. 35 - March 2003

ICE conventions

Free A5







Heterogeneity correction CO_HETERO I2 0=No correction 1=Standard correction

2=Voxel/voxel correction



YPL(1)

ZPL(1)

3F6.2 Origin coordinates in the radiotherapy coordinate system


YPL(2)

ZPL(2)



YPL(3)

ZPL(3)


16 Information line A60 "DIST_S_COMP /U_MIN,U_MAX/V_MIN,V_MAX/NP_CMPU,NP_CMPV/ PAS_U_V"

17 Source – calculation plan distance

DIST_S_COMP F6.2 Source compensator distance, in cm or

Free A6

ROI limits U_MIN_UTIL

U_MAX_UTIL

V_MIN_UTIL

V_MAX_UTIL

4 x F6.2 Limits of the Region Of Interest:

Limits of the structure (compensator)

Free A5

Number of values in U direction for compensator

NP_COMP_TOTU I3

Free A5

Number of values in V direction for compensator

NP_COMP_TOTV I3

Grid step in U direction for compensator

PAS_COMP_U F6.4

Grid step in V direction for compensator

PAS_COMP_V F6.4

18 Information line A60 "PAS_GR_INI_U(V)/TYPE_GRILLE/NP_TOTU(V)"

19 Grid step in U direction PAS_INI_U F6.4

Grid step in V direction PAS_INI_V F6.4

Free A5

Type of grid ITYPE_GR I1 = 1 aligned grid, =2 alternated grid

Free A5

Number of values in U di i f id

NP_TOTU I3


iSis 3D - V 2.35 - March 2003 G4 - 3

……

direction for grid

Free

A5

Number of values in V direction for grid

NP_TOTV I3

20 Information line A60 "Taille de l’outil en CM / Coef. d’atténuation » or

RAYON FRAISEUSE en CM /Densité plexi "

21 Tool size or Drill Radius RAYN_FRAISE F6.4 If MODE_REA = 1 (HEK)

Free A5

Attenuation coefficient or

Material density

COMP_COEFF_ATT

DENS_MAT_COMP

F6.4 If MODE_REA = 1 (HEK)

22 Information line A60 "EP_COMP_MAX UMAX VMAX EP_COMP_MIN UMIN VMIN"

23 Maximum value EPAISS_COMP_MAX F6.2 Maximum thickness for compensator

Free A5

Coordinates of maximum value

U_COMP_MAX_ERR

V_COMP_MAX_ERR

2 x F6.2

Minimum value EPAISS_COMP_MIN_ERR F6.2 Minimum thickness for compensator

Free A5

Coordinates of minimum value

U_COMP_MIN_ERR

V_COMP_MIN_ERR

2 x F6.2

24 Information line A60 « NUL,NUL,NUL,MARGE DE SECURITE » if MODE_REA=1 (HEK) or

MARG_PROX MARG_DIST M_ERR_DSC ,M_ERR_DSA"

25 Proximal margin

Distal margin

DSC error margin

Safety margin

VMARG_PROX

VMARG_DIST

VMARG_ERR

VMARG_LAT

F6.2 0.if MODE_REA=1

0. if MODE_REA=1

0. if MODE_REA=1

Safety margin

26 Information line A60 "EPAIS_SUP_COMP,EPAIS_MAXI_COMP,LONG_FY_COMP, LARG_FX_COMP if MODE_REA=1 or

EPAIS_MIN_PLEXI,EPAIS_MAX_PLEXI,DIAM_MIN_PLEXI"

27 Additional thickness

Maximum compensator thickness

EPAISS_MIN_PLEXI

EPAISS_MAX_PLEXI

4 x F6.2 If MODE_REA=1

Compensator length or

Compensator diameter

Compensator width

LONG_U_NECESS

DIAM_MIN_PLEXI

LARG_V_NECESS

If MODE_REA=1

28 Information line A60 If MODE_REA=1 this record is not defined

PAR_SC,PMOD_SC,PARC_AC,PMOD_AC_ERR"

29 Practical range without compensator

PARC_SC 4 x F6.2

Modulation without compensator

PMOD_SC

Practical range with compensator

PARC_AC

Modulation with compensator

PMOD_AC


G4 - 4 iSis 3D - V 2. 35 - March 2003

30 Information line A60 "FICHIER COMPENSATEUR THEORIQUE"

31 Number of files I2 Number of files = 1

32 File name of theoretical compensator

A20

33 Information line A60 « FICHIER MACHINE

34

Number of files

Name of drilling files

(NB_FICH_MACH next lines)

NB_FICH_MACH I2

A75

Number of drilling files

35 Information line A60 T U_GRI V_GRI EP_COMP

36 Boolean true if the point is inside the compensation area

NUAGE_MACH(I,J) L1

Coordinates of the point

Compensator thickness

Source_skin distance

U_GRILL(I) V_GRILL(J)

EPAISS_COMP_MACH(I,J)

DIST_SP(I,J)

4 x F6.2 0. if inverse planning

APPENDIX G5 – "HEK" COMPENSATOR FILE

iSis 3D - V 2.35 - March 2003 G5 - 1

G5. "HEK" COMPENSATOR FILE

IDENTIFICATION: name.mas


FORMAT:

HEK Medizintechnik

HEK Compensator File Format for DOS-based software

Unit :HEK SE 70

Version D 1.0X.X asp 01.2002

This document describes the file format for the compensator files used for the HEK cutting software.

Each compensator consist of two files :

Header - information [extension must III]

data file [extension must ddd]

A compensator can hold max: 99 profiles ( runs)

Each run max 150 coordinates

At the end of the Header file a copy of the default parameter set ( files with the extension *.mas) is add

to the file.

So it is possible to do some changes in the cutting parameters only for this compensator.

due to the dos-operating system you can only use 8 letters or numbers for the filenames

Description Format File Output sample

Header Information- File

number of adjustment holes integer 0

in case number of holes is <> 0 then loop for all holes

x and y – Coordinates of hole [cm*1000] 2 x integer 5000 -5000

....................

number of profiles ( runs) integer 34

number of necessary heights integer 2

not used integer

width of the tools [cm *1000] integer 400

maximum height of the compensator [cm *1000] integer 2800

distance focus compensator [cm *100] ( integer) integer 5400

distance center point to start of compensator [cm *1000] integer -844

additional height [cm *1000] ( integer) integer 0

savety border [cm *100] ( integer) integer 0


G5 - 2 iSis 3D - V 2. 35 - March 2003

loop for all profiles

maximum height of this profile [cm *1000] integer 1800

number of points of this profile integer 130

Name of CT-serie ( not used) 0

No of first CT-image ( not used) 0

No of CT images ( not used) 0

Patid of CT-images (not used) 0

Patname of CT-images (not used) 0

Date of CT-images (not used) 0

Pixel size (mm) (not used) 0

Min and max positions of images (not used) 0

Distance source to midplane (not used) 0

First image for calculation (not used) 0

Last image for calculation ( not used) 0

Center image ( not used) 0

Loop over all images with distance to next image (not used) 0

Row where calculation starts (not used) 0

Row where calculation ends (not used) 0

Col where calculation starts (not used) 0

Col. where calculation ends (not used) 0

Direction flag : up or down ( 0 or 1) ( not used) 0

Calculation flag ( not used) 0

Distance midplane skin in center ( not used) 0

Row of centerpoint (not used) 0

Col of centerpoint (not used) 0

First CT 0

Last CT 0

Flag for interpolation (not used) 0

Total width (cm) Real 21.

Min width (cm) Real -9.

Max width (cm) Real 12.

Total length (cm) Real 12.3

Min length (cm) Real -5.1

Max length (cm) Rea 7.2

Ct diameter (not used) 0

Half-value thickness used for calculation (not used) 0

Thickness in centerpoint (not used) 0


iSis 3D - V 2.35 - March 2003 G5 - 3

now a copy of the parameters is following, you have to copy this information from a *.mas file:

Masch-Id string maschid HEK _ Default

type of unit string Ger„tetyp HEK SE 70

date of changes string „nderung 12.3.1997 15:27

Source tray dist. [cm] real fbu 51.00

source –film dist [cm] real ffa 120.00

cutting speed for holes real gescw1 2.50

cutting speed for wire real geschw2 2.50

height of cutting loop [cm] real schlho 2.20

width of cutting loop [mm] real schlbr 4.00

attention coefficient for modi-area real HWS 1.75

flag for external frame integer ikreis 0

flag for cutting –Tool ( Wire or Pin) integer idraht 2

filename for external frame string form.FOR

flag for cutting way string . . 1

distance rectangle irreg field [cm] real . . 1.00

diameter of cutting tools [cm] real . . 0.44

speed cutting real . . 0.40

speed fast movement real . . 5.00

flag for display field integer .feldflag . 0

reference distance [cm] real .feldref . 100.00

field edges xmin [cm] real .xmin . -15.00

field edges xmax [cm] real .xmax . 15.00

field edges ymin [cm] real .ymin . -15.00

field edges ymax [cm] real .ymax . 15.00

flag for cutting irreg field integer . . 0

distance of rectangle around [cm] integer . . 1.00

irreg filed integer

absolute xmin coordinate [cm] real . . -14.00

absolute xmax coordinate [cm] real . . 14.00

absolute ymin coordinate [cm] real . . -14.00

absolute ymax coordinate [cm] real . . 14.00

flag for symmetry of rectangle around integer . . 1

speed real Geschwpin 0.10

diameter real srad1 1.40

height of loop[cm] real Schlho 2.20

width of loop [cm] real Schlbr 4.00

not used real leer 0.00


not used real lee 0.00


G5 - 4 iSis 3D - V 2. 35 - March 2003

Data - File

loop for all profiles ( number in Header )

loop for all points of profile ( number in Header )

"x Position [cm *1000] ;z Position ( depth) [cm *1000] " integer 5620 2735

the y- position is calculated from informations in the header file :

width of the tools and distance of central point to start of compensator

APPENDIX G6 – MACHINE PARAMETERS FILE

iSis 3D - V 2.35 - March 2003 G6 - 1

G6. MACHINE PARAMETERS FILE

IDENTIFICATION: Machine.ETA

Location : DOSI$DAT:[PERIPHS]

FORMAT:

HEK_SE_70.ETA

HEK cutting machine parameters file

ISI$DECOUP_C_MODELE HEK_SE_70

ISI$DECOUP_C_FILEFORMAT 2

ISI$DECOUP_C_FILEEXT HEK0????.HEK

ISI$DECOUP_C_DETROMP 0.92!0.10

ISI$DECOUP_C_PARAMDEF HEK_DECOUPEUSE Default parameters file for blocks

ISI$REALCOMP_C_MODELE HEK_SE_70

ISI$REALCOMP_C_FILEFORMAT 1

ISI$REALCOMP_C_FILEEXT_1 HEK0????.iii

ISI$REALCOMP_C_FILEEXT_2 HEK0????.ddd

ISI$REALCOMP_C_PARAMDEF lucknow Default parameters file for compensators (.mas)

APPENDIX G6 - MACHINE PARAMETERS FILE

G6 - 2 iSis 3D - V 2. 35 - March 2003

IDENTIFICATION: lucknow.MAS

Location : DOSI$DAT:[PERIPHS]

LUCKNOW.MAS

Masch-Id string maschid linac

type of unit string Ger„tetyp HEK SE 70

date of changes string „nderung 8-14-2001 9:20

Source tray dist. [cm] real fbu 56.00

source –film dist [cm] real ffa 80.00

cutting speed for holes real gescw1 2.50

cutting speed for wire real geschw2 2.50

height of cutting loop [cm] real schlho 2.20

width of cutting loop [mm] real schlbr 4.00

attention coefficient for modi-area real HWS 1.60

flag for external frame integer ikreis 1

flag for cutting –Tool ( Wire or Pin) integer idraht 1

filename for external frame string form.FOR

flag for cutting way string . . 2

distance rectangle irreg field [cm] real . . 1.00

diameter of cutting tools [cm] real . . 0.40

speed cutting real . . 4.00

speed fast movement real . . 5.00

flag for display field integer .feldflag . 0

reference distance [cm] real .feldref . 100.00

field edges xmin [cm] real .xmin . -15.00

field edges xmax [cm] real .xmax . 15.00

field edges ymin [cm] real .ymin . -15.00

field edges ymax [cm] real .ymax . 15.00

flag for cutting irreg field integer . . 0

distance of rectangle around [cm] integer . . 1.00

irreg filed integer

absolute xmin coordinate [cm] real . . -14.00

absolute xmax coordinate [cm] real . . 14.00

absolute ymin coordinate [cm] real . . -14.00

absolute ymax coordinate [cm] real . . 14.00

flag for symmetry of rectangle around integer . . 1

speed real Geschwpin 1.50

diameter real srad1 0.80

height of loop[cm] real Schlho 2.20

width of loop [cm] real Schlbr 4.00



not used real lee 0.00

APPENDIX H – MENU SUMMARY

ISIS 3D - V 2.35 – March 2003 H - 1

H- MENU SUMMARY

MAIN MENU

FILE

New.. Patient data input box

Open... Patient's study selection box

Close... Study save management box

Save... Study save management box

Kill... Destruction confirmation box

List of slices... Slices data display form

List of beams... Beams data display form

Treatment Time… Treatment times data display form

Dose/volume Contributions Contribution of each beam at defined point display form

Print current plane… Paper output control box

Print study… Paper output control box

Eject sheet

Import > Import box

Import contours… contours file

Importer faisceaux beams file

Export >

Beams> Export box

to Varian's MLC … MLC data to Varian's "MLC file"

to Elekta's MLC … MLC data to Elekta's "MLC fle"

to Lantis… Beams data to Lantis RTP Link file

to Varis RTP file Beams data to Varian's "RTP Exchange" file

to ISIS RTP file Beams data to ISIS's "RTP IEC" file

Contours/beams DICOM RT Exportation menu to DICOM RT server

Quit... Study save management box

SLICES

Header and list... Slices data display form

Create from >

Images... Image's study selection box and Creation of contours menu

Digitizer... Digitizer parameters input box

Change... Modification of contour Menu

Duplicate / Adjust...: Slice position adjustment box

Kill

Origin... Modification of the origin box

Z opposed

Structures / Bolus … Structures/Bolus management box

Expansion... Structures/Bolus expansion options box

Volumes... Volumes and Structures/Bolus data display form

Points of Interest… Point of Interest management box


H - 2 ISIS 3D - V 2.35 – March 2003

BEAMS

Inverse Planning launch dialog of inverse planning

New "Slice" management window

Change... "Slice" management window

Duplicate... "Slice" management window

Opposed... "Slice" management window

Mirror... "Slice" management window

Kill... Destruction confirmation box

Doses per fraction Beams dose definition box

Virtual simulation "Virtual simulation" management window

ISODOSES

Calculation >

All beams Calculation progression box

Current beam Calculation progression box

Computing option... Calculation parameters set-up box

List... Isodoses parameters set-up box

Normalization >

Without Annulation de la normalisation éventuelle

At maximum Dose normalization at maximun of dose into the plane

At one point Dose normalization at defined point

Dose at one point Doses value position box

Profiles et exportations…

Dose / Volume Histogram Dose/volume histogram calculation box

New plane...

Kill plane...

New ROI... Enhanced calcultion resolution region definition

Display ROI ON/OFF ROI calculation display

Import doses > Import stereotactic calculated dose

DISPLAY

Image ON/OFF images display

Contours ON/OFF contours display

Beams ON/OFF beams display

Isodoses ON/OFF isodose display

Registered Images Switched between CT and MRI images

Isodose 3D 3D dose distribution visualization

Level / Window... Level / Window adjustment box

Zoom...: Scale set-up and Graphic center control box

Restore

Grid > ON/OFF grid display

None

…..

Distance measurement Distance measurement tool

Angle measurement Angle measurement tool

3D Visualization > Launch 3D visualization

standard

full screen


ISIS 3D - V 2.35 – March 2003 H - 3

WINDOWS

Open on selection ON/OFF automatic opening plane when selected

Store current plane Snapshot option box

List of STUDIES' snapshot: Snapshot visualization window

CREATION / MODIFICATION OF CONTOURS MENU

SLICES

Images selection… Images selection box

Digitize New slice from digitizer

Kill Kill current slice

Quit

CONTOURING

Trace Tracing option

Option of tracing Option of trace set-up box

Automatic densities calculation Toggle switch

Structures / Bolus Structures / Bolus selection box

Points of Interest Point of interest management box

DISPLAY

Image ON/OFF images display

Contours ON/OFF contours display

Curent Beam ON/OFF current beam display

Registered images Switched between CT and MRI images

Grid ON/OFF grid display

Distance measurement Distance measurement tool

Angle measurement Angle measurement tool

ASSOCIATED BUTTONS

IMAGE SELECTION

Left arrow

Selection arrow

Right arrow

CONTOURING

Manual Control button

Automatic Automatic contouring control button

Change Modification of contours box

ZOOM

Restore Scale set-up and Graphic center control box

Level / Windows Level / Window adjustment box


H - 4 ISIS 3D - V 2.35 – March 2003

APPENDIX I – LIST OF FIGURES AND TABLES

ISIS 3D - V 2.35 - March 2003 I - 1

I. LIST OF FIGURES AND TABLES

List of Figures :

Figure I-1 : Launch menu ..................................................................................................................I-3 Figure I-2 : iSis3D main menu...........................................................................................................I-3 Figure II-1 : Reference coordinate system ......................................................................................II-2 Figure II-2 : Calculation planes selection box ...............................................................................II-18 Figure II-3 : Beams selection box (1) .............................................................................................II-19 Figure II-4 : Beams selection box (2) .............................................................................................II-20 Figure II-5 : Coplanar beams into a transverse plane (1) .............................................................II-22 Figure II-6 : Coplanar beams into a transverse plane (2) .............................................................II-23 Figure II-7 : Wedge representation.................................................................................................II-24 Figure II-8 : Intensity Modulation with Compensator or MLC ......................................................II-24 Figure II-9 : Plane perpendicular to the beam axis of an anterior beam.....................................II-25 Figure II-10 : Non coplanar beam into transverse plane ..............................................................II-26 Figure II-11 : Gray level selection...................................................................................................II-27 Figure II-12 : Level / Windows adjustment box .............................................................................II-28 Figure II-13 : Isodose management box ........................................................................................II-29 Figure II-14 : DRR and Voxel options box .....................................................................................II-31 Figure III-1 : New study creation box .............................................................................................III-2 Figure III-2 : Object selection box ..................................................................................................III-4 Figure III-3 : Study selection box ...................................................................................................III-7 Figure III-4 : Save study box ...........................................................................................................III-9 Figure III-5 : Deletion studies box ................................................................................................III-11 Figure III-6 : List of beams ............................................................................................................III-12 Figure III-7 : Treament time...........................................................................................................III-14 Figure III-8 : Dose Volume contribution table .............................................................................III-17 Figure III-9 : Printing box ..............................................................................................................III-18 Figure III-10 : Demand of confirmation of structures importation (1) .........................................III-21 Figure III-11 : Demand of confirmation of structures importation (2) .........................................III-21 Figure III-12 : Information about structures importation..............................................................III-22 Figure III-13 : Demand of confirmation of beams importation.....................................................III-23 Figure III-14 : Beams exportation box............................................................................................III-24 Figure III-15 : Dicom RT object exportation box ...........................................................................III-28 Figure IV-1 : Header and list of slices ........................................................................................... IV-4 Figure IV-2 : Set of image selection box ....................................................................................... IV-7 Figure IV-3 : Image selection box .................................................................................................. IV-7 Figure IV-4 ; Characteristic of plot box ....................................................................................... IV-10 Figure IV-5 : Duplicate / Adjust a slice ........................................................................................ IV-11 Figure IV-6 : Origin for all slices .................................................................................................. IV-12 Figure IV-7 : Structures / Bolus management box ..................................................................... IV-13 Figure IV-8 : 3D expansion of structure or bolus box................................................................ IV-15 Figure IV-9 : Geometric characteristics of structures ............................................................... IV-17 Figure IV-10 : Point of Interest management box......................................................................... IV-19 Figure IV-11 : Creation / Modification point of interest box ........................................................ IV-21 Figure V-1 : Creation / Modification of slice ................................................................................. V-2 Figure V-2 : Image selection box ................................................................................................... V-4 Figure V-3 : Image information ...................................................................................................... V-6 Figure V-4 : Memorization of visualization set-up...................................................................... V-13 Figure V-5 : Manual contouring ................................................................................................... V-15 Figure V-6 : Automatic contouring .............................................................................................. V-16 Figure V-7 : Choosing the region to be contoured .................................................................... V-17 Figure V-8 : Characteristic of contour......................................................................................... V-17 Figure V-9 : Modification of contour menu................................................................................. V-19 Figure V-10 : Option of trace.......................................................................................................... V-21 Figure VI-1 : Beam selection box................................................................................................... VI-2 Figure VI-2 : Reference slice .......................................................................................................... VI-4

APPENDIX I – LIST OF FIGURES AND TABLES

I - 2 ISIS 3D - V 2.35 - March 2003

Figure VI-3 : Browser bar.............................................................................................................. VI-22 Figure VI-4 : Dose per fraction definition box............................................................................. VI-25 Figure VI-5 : List of view............................................................................................................... VI-27 Figure VI-6 : Added collimation ................................................................................................... VI-30 Figure VI-7 : Customized collimator ............................................................................................ VI-33 Figure VI-8 : Field shape exportation .......................................................................................... VI-35 Figure VI-9 : MLC computing option ........................................................................................... VI-38 Figure VI-10 : MLC Positioning ...................................................................................................... VI-39 Figure VI-11 : Display option.......................................................................................................... VI-41 Figure VI-12 : D.R.R caluclated ...................................................................................................... VI-42 Figure VII-2 : Computing option..................................................................................................... VII-4 Figure VII-3 : Computed doses ...................................................................................................... VII-5 Figure VII-5 : Normalisation point.................................................................................................. VII-9 Figure VII-6 : Dose at one point ................................................................................................... VII-10 FigureVII-7 : Doses profiles and exportations (1)...................................................................... VII-11 FigureVII-9 : Dose/Volume histogram dialog box...................................................................... VII-16 Figure VII-10 : Dose / Volume histogram ...................................................................................... VII-19 Figure VII-11 : Non transverse plane axis selection..................................................................... VII-22 Figure VIII-1 : Level / Windows adjustment box ........................................................................... VIII-3 Figure VIII-2 : Zoom adjustement box ........................................................................................... VIII-6 Figure IX-1 : «Store current plane » dialog box............................................................................ IX-1 Figure IX-2 : Confimation demand of snapshot............................................................................ IX-2 Figure IX-3 : Plane snapshot list.................................................................................................... IX-2 Figure IX-4 : Snapeshot of plane ................................................................................................... IX-3 Figure X-1 : Surface reconstruction .............................................................................................. X-1

List of Tables

Table II-1 : Possibilities and system verification – Summary ..................................................II-12 Table II-2 : Example of calculation with theoretical and effective contribution......................II-13

i3d235

Documents

d warning

d software

d general principles

table of contents isis

help of upgrade

help of fault sheet

reference system

coordinate system