e-IMRT User

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e-IMRT Users GUIDE
Version 0.2 2009/02/23
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Contents
e-IMRT users GUIDE

• Welcome window login
• Commissioning
• Tomograph management
• Creating a new treatment
• Launching a verification process
• Launching a optimization process

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Welcome window
e-IMRT users GUIDE
Entrance window login

• Entrance window to e-IMRT can be found in the web
  direction https//eimrt.cesga.es8443/eIMRT2/clie
  nt/.
• To go to the login window, click ENTER.

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Login
e-IMRT users GUIDE
Entrance window login

• In this window you must enter your user name and
  password to access the platform.
• You can send an e-mail to the administrator to
  request a new account.

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e-IMRT main page
e-IMRT users GUIDE
Entrance window login

• This is a view of the e-IMRT platform main page.
• We can see a series of buttons that will give us
  access to the different functions of the
  application.
• Now, we will begin explaining each one of the
  steps to use all these functions.

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Contents
e-IMRT users GUIDE

• Welcome window login
• Commissioning
• Tomograph management
• Creating a new treatment
• Launching a verification process
• Launching a optimization process

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Commissioning of accelerators
e-IMRT users GUIDE
Commissioning

• The commissioning of an accelerator is the first
  step to perform before using the platform.
• It consists in building a virtual accelerator
  that will reproduce its real behaviour (this is
  the physical properties and characteristics of
  the radiation beam which outputs the
  accelerator).
• The aim is to reproduce in calculations certain
  measurements carried out in an accelerator.
• This will assure that the result (in terms of
  dose) of any treatment calculated employing this
  virtual accelerator will be the same as the
  result of this treatment delivered to the patient
  with the real accelerator.

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Accelerator management
e-IMRT users GUIDE
Commissioning

• To start the commissioning process, we must click
  in the button labelled as Accelerator
  management.
• NOTE The first time you launch an e-IMRT applet,
  a warning window will be shown. You have to
  accept to allow the applet storing temporary
  information on your hard disk.

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Adding accelerators
e-IMRT users GUIDE
Commissioning

• We will proceed to a new window where we can
  select the accelerator which the hospital has and
  that we want to commission.
• We will need to commission two virtual
  accelerators one for optimization and another
  for verification. For each one of them we select
  the type of accelerator from among the available
  (in this case Siemens Primus with collimator 3D
  MLC).
• Subsequently we have to give him an internal name
  (for example "Demo Siemens Verif" for
  verification and "Demo Siemens Optim" for
  optimization) and click in "Add accelerator to
  hospital".

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Selecting algorithms
e-IMRT users GUIDE
Commissioning

• In this applet we can see the information of our
  accelerator.
• Below, we can select the dose and commissioning
  algorithms.
• For the verification accelerator, we will select
  the dose algorithm "BEAMnrc Monte Carlo" and the
  commissioning algorithm "BEAMnrc Monte Carlo
  Photon Beam Characterization".
• For the optimization accelerator, we must select
  the dose algorithm "Monte Carlo C/S Optimization"
  and the commissioning algorithm with the same
  name.

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Uploading data file
e-IMRT users GUIDE
Commissioning

• Now we should upload the data measured previously
  in the real accelerator.
• For this purpose, first we must select the format
  of the file that contains the data (Mephisto,
  eIMRT or RFA300). In our case, we select
  Mephisto.
• After that, we can select the measurements file
  ("Dummy Accelerator.exp") pressing Browse...".
• Clicking "Open", data is read and converted to
  internal format (eIMRT).

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Data preview
e-IMRT users GUIDE
Commissioning

• When data is translated to internal format, we
  can visualize this data selecting a field size
  and clicking "View".
• In a graphic we will see the PDD (Percentage
  Depth Dose) of that field.
• In another graphic, we see the lateral profiles
  at different depths.
• To execute the commissioning algorithm, we must
  click "Run".

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Running
e-IMRT users GUIDE
Commissioning

• In the case of the commissioning of an
  accelerator for the verification tool, the
  process will last less than one minute.
• Now, we should repeat the previous steps for the
  commissioning of the accelerator for the
  optimization tool.

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Finished
e-IMRT users GUIDE
Commissioning

• Here, we can see that the commissioning process
  of the verification tool has finished and the
  process for the optimization tool commissioning
  is running.
• When a process finishes, we can see the results
  clicking "Details".

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Percent Depth Dose (PDD)
e-IMRT users GUIDE
Commissioning

• Here, we can see a new applet that will show us
  the measured and calculated PDD (one for each
  field size) normalized to a depth of 10 cm.
• In the right side, we can see the percentage
  difference between measured and calculated
  points.

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Lateral profiles
e-IMRT GUIDE
Commissioning

• Selecting the buttons "X Profiles" or "Y
  Profiles", we can see the corresponding
  calculated and measured lateral profiles (for
  each field size) and its associated
  one-dimensional Gamma function.
• If the value of this function in a point is lt1,
  this indicates that the measured data is within
  tolerance with the calculated data in that point.
• We can change the tolerances. By defect, they
  are 2 in measured dose value and 2 mm in spatial
  separation.

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Validating accelerator (1)
e-IMRT users GUIDE
Commissioning

• If we agree with the obtained result, the
  following step is to validate the virtual
  accelerator.
• For that we should click in "Validate".

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Validating accelerator (2)
e-IMRT users GUIDE
Commissioning

• We can view again the obtained results. By
  clicking "Accept" we validate the accelerator.
• If we do not agree with the results we must press
  in "Reject".

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Ready!
e-IMRT users GUIDE
Commissioning

• Here, we can see the two validated accelerators.
  
• Now, we can use them.

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Contents
e-IMRT users GUIDE

• Welcome window login
• Commissioning
• Tomograph management
• Creating a new treatment
• Launching a verification process
• Launching a optimization process

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Main window
e-IMRT users GUIDE
Tomograph management

• The tomograph is the device used to imaging a
  patient by sections
• The platform needs the values of the tomographs
  ramps to convert from Hounsfield Unities to
  densities before the calculations
• To add a tomograph we must click in "Tomograph
  management" in the e-IMRT main window.

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Adding tomograph
e-IMRT users GUIDE
Tomograph management

• Tomograph will translate CT (Computed
  Tomography) images of a patient in maps of
  electronic densities.
• Clicking "Add tomograph" a new tomograph is
  created for which we will can define its
  parameters.

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Tomograph ramps
e-IMRT users GUIDE
Tomograph management

• Now we should define the tomograph.
• First, we have to give him a name.
• Second, we have to indicate the equivalences HU
  (Hounsfield Units) vs density for each material.
• These equivalences define the tomograph ramps.
• This example shows a good definition, so we can
  click in Add.

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Ready!
e-IMRT users GUIDE
Tomograph management

• The tomograph is ready.

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Contents
e-IMRT users GUIDE

• Welcome window login
• Commissioning
• Tomograph management
• Creating a new treatment
• Launching a verification process
• Launching a optimization process

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Main window
e-IMRT users GUIDE
Creating a new treatment

• We may click in Create a new treatment" in the
  e-IMRT main window.

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Name keywords
e-IMRT users GUIDE
Creating a new treatment

• The first step to create a treatment is to give
  him a name.
• Also we should assign him a series of keywords.
• Additional information could be also added like
  patient Clinic history, detailed treatment
  explanation, etc

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Ready!
e-IMRT users GUIDE
Creating a new treatment

• Finally, we may click in "Create" and the new
  treatment will be ready.

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Contents
e-IMRT users GUIDE

• Welcome window login
• Commissioning
• Tomograph management
• Creating a new treatment
• Launching a verification process
• Launching a optimization process

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MC Treatment Verification
e-IMRT users GUIDE
Launching a verification process

• Hospitals rely on commercial platforms,
  thoroughly tested and called Treatment Planning
  Systems (TPS), to create treatments for their
  patients. As the amount of patients to treat is
  huge, dose calculation algorithms employed by TPS
  use limited accuracy to win calculation time.
• In clinical routine, treatments created by
  commercial TPS must be verified experimentally
  (in a human-tissue-equivalent phantom) prior to
  its deliverance to the patient.
• An alternative dose calculation method with
  higher accuracy would be extremely useful. Monte
  Carlo (MC) simulation fulfils the requirements in
  terms of precision but not in terms of speed.
  This fact may be bypassed by the use of vast
  computational resources (GRID)
• Our verification tool may help radiophysicists at
  hospitals to replace or to complement
  experimental verifications, reducing accelerator
  use

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Creating treatment
e-IMRT users GUIDE
Launching a verification process

• The first step is to create a new treatment.
• We can see a list of treatments in the main
  window.
• To launch a verification process we must select a
  treatment and click in "Treatment information".

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Treatment information
e-IMRT users GUIDE
Launching a verification process

• This is the treatment information window.
• Here we can launch new verification and/or
  optimization processes.
• To launch a verification process, we must click
  in "Verify".

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Uploading Dicom files
e-IMRT users GUIDE
Launching a verification process

• In this applet we can choose the accelerator, the
  tomograph and the algorithm we want to use.
• We must also upload the following Dicom files
• CT the CT images of the patient.
• STRUCT contains the information of the different
  anatomical structures.
• PLAN contains the information of the treatment
  to be verified.
• DOSE (optional) contains a dose map for the
  treatment, previously calculated. If we upload
  it, we will be able to compare the new dose map
  with this one, by calculating its Gamma Map.

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Sending Dicom files
e-IMRT users GUIDE
Launching a verification process

• We select the corresponding Dicom files and we
  click in "Send".
• The files suffer a process during which the
  private data of the patient are erased.
• After this process, the files are saved in the
  server.

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Preview
e-IMRT users GUIDE
Launching a verification process

• When all the necessary files are uploaded, we may
  click in Preview.
• This button will launch a new window

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Preview menu
e-IMRT users GUIDE
Launching a verification process

• This is the preview menu.
• In the CT images, the treatment couch will be
  present. For that reason, the first time that
  these images are processed, we must select the
  "Mark couch box for erasing the couch in the CT
  images.
• We can also indicate a reference dose in Grays
  (Gy) (to calculate the isodose lines) in the
  field "Prescribed dose".
• We must click in Generate Visualization.
• When this process ends, we must click in Open
  Viewer.

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Erasing couch (1)
e-IMRT users GUIDE
Launching a verification process

• This is the treatment viewer.
• As we have selected the Mark couch box, we can
  see a red region over the CT image. We can move
  up or down the horizontal green bar until the red
  region is placed over the couch.

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Erasing couch (2)
e-IMRT users GUIDE
Launching a verification process

• We have to be careful and do not cover any region
  within the body of the patient. It can be
  helpful to activate the box "Body in the
  CONTOURS list.
• The selection shown in this example is valid. We
  will cut the images overlapped by the red film
  clicking "Mark couch".

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Viewer
e-IMRT users GUIDE
Launching a verification process

• In the viewer we can find
• "COLORWASH" shows the dose map (in this case the
  content in the Dicom Dose uploaded).
• "GAMMA MAP" (It is not available in this case)
  shows the Gamma Map that compares the dose map
  calculated and the contained in the Dicom Dose
  uploaded.
• "CONTOURS list of the anatomic contours we can
  visualize.
• "ISODOSES" list of the isodose lines that we
  can visualize.
• "DOSE/VOLUME HISTOGRAMS" opens the corresponding
  histogram. We can see the data for each
  anatomical structure.

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Launch process
e-IMRT users GUIDE
Launching a verification process

• Now, we can execute the verification returning to
  this applet window and clicking "Verify".

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Process running
e-IMRT users GUIDE
Launching a verification process

• A new process will appear in the treatment menu.
• We must wait for the process to finish to see the
  results.

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Finished process
e-IMRT users GUIDE
Launching a verification process

• When the process has finished, we may click in
  "Show Results".

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Visualization options
e-IMRT users GUIDE
Launching a verification process

• A new window will be opened.
• In this window, we can set a series of parameters
  (prescribed dose (optional), tolerances to
  calculate Gamma Map and a dose cut value under
  which we do not want to see the value of the
  Gamma Map (optional)).
• Clicking Generate Visualization

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Generating visualization
e-IMRT users GUIDE
Launching a verification process

• The visualization data will be generated (this
  process can take over 1 minute).
• Now we may click in Open viewer

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Colorwash
e-IMRT users GUIDE
Launching a verification process

• In the viewer window, we will be able to activate
  all the options previously shown.
• Here we can view the dose colorwash.

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Gamma Map
e-IMRT users GUIDE
Launching a verification process

• This is the Gamma Map.
• It gives us an idea of the difference between the
  dose map calculated by the e-IMRT verification
  algorithm and the dose map uploaded in the Dicom
  Dose file.

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Isodoses
e-IMRT users GUIDE
Launching a verification process

• Here we can see some isodose lines related to
  given prescribed dose.

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Dose-Volume Histogram
e-IMRT users GUIDE
Launching a verification process

• Here we can see a Dose-Volume Histogram.

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Process viewed
e-IMRT users GUIDE
Launching a verification process

• If we close the viewer and return to the
  treatment information window, the process will be
  marked as viewed.
• We can see again the results in the future
  clicking "Show Results"

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Process viewed
e-IMRT users GUIDE
Launching a verification process

• If we close the viewer and return to the
  treatment information window, the process will be
  marked as viewed.
• We can see again the results in the future
  clicking "Show Results"

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Download DICOM RT Dose (1)
e-IMRT users GUIDE
Launching a verification process

• To download the resultant DICOM RT Dose press
  Process DICOMs to show the DICOMs associated
  with the Verification.

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Download DICOM RT Dose (2)
e-IMRT users GUIDE
Launching a verification process

• The applet will show all the files of the
  process. You can download any of them pressing
  Download button.
• To download the resultant DICOM RT Dose you must
  select it on Dicom RT Dose list and press
  Download. The name of the calculated DICOM starts
  with OUT.
• This file will be also available to use with a
  new Verification.

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Contents
e-IMRT users GUIDE

• Welcome window login
• Commissioning
• Tomograph management
• Creating a new treatment
• Launching a verification process
• Launching a optimization process

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Contents
e-IMRT users GUIDE

• Welcome window login
• Commissioning
• Tomograph management
• Creating a new treatment
• Launching a verification process
• Launching a optimization process

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Treatment optimization
e-IMRT users GUIDE
Launching a optimization process

• An Optimization is performed when the user wants
  to determine a set of optimal radiation
  configurations which fulfil the constraints
  defined by the doctor, i.e. what organs must be
  protected, what organs must be radiated, and what
  amount of radiation is allowed in each case.
• This tool can be of great aid in the radiotherapy
  planning service of a hospital, since minimizes
  the radiophysicists intervention in the
  generation of solutions that fulfil the
  prescriptions given by oncologists.
• This search of solution is done in most
  commercial TPS with a trial and error strategy.
  Radiophysicists choose certain beam incidences
  and adjust field shapes manually. After that they
  check the dose delivered to the organs and decide
  if this solution is good or not. This is called
  forward planning and it may take a lot of time
  depending on prescriptions.
• Our Optimization tool lets radiophysicists to
  perform an inverse planning of each treatment.
  This means that the radiophysicist uploads the
  desired dose and the platform looks for beam
  incidences and field shapes and intensities which
  deliver this desired dose automatically. The
  platform presents a set of solutions from which
  the user may choose what he considers the best.

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Creating treatment
e-IMRT users GUIDE
Launching a optimization process

• The first step is to create a new treatment or
  select one of the list and click in "Treatment
  information".

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Treatment information
e-IMRT users GUIDE
Launching a optimization process

• This is the treatment information window.
• To launch a optimization process, we must click
  in Optimize".

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Uploading dicom files
e-IMRT users GUIDE
Launching a optimization process

• In this applet we must choose the accelerator,
  the tomograph and the algorithms we want to use.
• In this case, only the CT and STRUCT Dicom
  files are needed.
• An optimization process will generate as output
  the information contained in the PLAN and DOSE
  Dicom files (we will be able to generate and
  download a PLAN Dicom file for each solution).
• We can open the viewer (clicking "Preview") where
  we will be able to mark the couch (go to slides
  35 and 36).
• To continue with the process, we must click in
  "Prescript constraints".

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Prescriptions
e-IMRT users GUIDE
Launching a optimization process

• In this applet, we can introduce the medical
  prescriptions.
• Also, we can choose some parameters of the
  solutions that are going to be generated.
• We can save our prescriptions in a xml file.
• Also we can load the prescriptions from a xml
  file previously saved ...

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Prescriptions loaded
e-IMRT users GUIDE
Launching a optimization process

• Now, we may click in Next to continue with the
  process.

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Summary
e-IMRT users GUIDE
Launching a optimization process

• Here, we can see a summary of the prescriptions.
• We can review them to find possible errors and,
  if it is necessary, return to the previous window
  to fix them.
• To execute the optimization, we must click in
  "Optimize".

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Process running
e-IMRT users GUIDE
Launching a optimization process

• A new process will appear in the treatment menu.
• We must wait for the process to finish to see the
  results.

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Finished process
e-IMRT users GUIDE
Launching a optimization process

• When the process finishes, we may click in "Show
  Results".

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Dose-Volume Histogram
e-IMRT users GUIDE
Launching a optimization process

• A new window with a list of solutions will be
  opened (with information about its
  characteristics).
• Selecting one of them we can view the DVH.
• We can select the organs we want to see.

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Comparing solutions
e-IMRT users GUIDE
Launching a optimization process

• We can choose a solution as reference.
• If we select another solution we can compare its
  DVH with the reference DVH.

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Additional information
e-IMRT users GUIDE
Launching a optimization process

• We can open a new window with detailed
  information of each solution clicking Additional
  information.

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Display Colorwash (1)
e-IMRT users GUIDE
Launching a optimization process

• Again, as with the verification results, we can
  open the viewer to display de dose map of each
  solution.
• We must click in Display Colorwash.
• The visualization options window will be opened.
• We can set the Prescribed Dose in Gy and click
  in Generate Visualization.
• When the generation process finishes, we may
  click in Open Viewer

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Display Colorwash
e-IMRT users GUIDE
Launching a optimization process

• In the viewer, we can evaluate the solution.

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Download DICOM RT Plan (1)
e-IMRT users GUIDE
Launching a optimization process

• If we find a good solution, we can generate and
  download the RTPlan in Dicom format clicking
  Generate DICOM RTPlan.

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Optimization DICOM files (1)
e-IMRT users GUIDE
Launching a optimization process

• If we close the solutions window and return to
  the treatment information window, we can see that
  the optimization process is marked as viewed.
• After generating the DICOM RT Plans, they keep
  stored on the platform. You can access easily to
  them by pressing Process DICOMs button.

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Optimization DICOM files (2)
e-IMRT users GUIDE
Launching a optimization process

• The applet will show all the files of the
  process. You can download any of them pressing
  Download button.
• To download the resultant DICOM RT Plans you must
  select one on Dicom RT Plan list and press
  Download. The name of the generated DICOM starts
  with OUT.
• This files will be also available to use with a
  new Verification.

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Finish visualization
e-IMRT users GUIDE
Launching a optimization process

• If we close the solutions window and return to
  the treatment information window, we can see that
  the optimization process is marked as viewed.

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End
e-IMRT users GUIDE