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Eclipse 16.1 Cone Planning

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0% found this document useful (0 votes)

230 views286 pages

Eclipse 16.1 Cone Planning

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Criistiian Dariioo

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Eclipse 16.

1 Cone
Planning

EC222
EC16.1-CEM-12-A

Varian Confidential
Eclipse 16.1 Cone Planning

Abstract
This Eclipse 16.1 Cone Planning is an educational aid for Varian Eclipse Cone Planning software.

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

HIPAA
Varian’s products and services are specifically designed to include features that help our customers comply with the Health Insurance
Portability and Accountability Act of 1996 (HIPAA). The ARIA and VARiS Vision systems use a secure login process, requiring a
username and password that supports role-based access. Users are assigned to groups, each with certain access rights, which may
include the ability to edit and add data or may limit access to data. When a user adds or modifies data within the database, a record is
maintained of the data that was changed, the users ID and the date and time the changes were made. This establishes an audit trail that
can be examined by authorized system administrators.

Trademarks
ACUROS®, ARIA®, Clinac®, DoseLab® , Edge® , Halcyon®, HyperArc®, Mobius®, RapidArc®, TrueBeam®, Trilogy®, and VarianThink® are
registered trademarks of Varian. Eclipse™, HD120™, IDENTIFY™ and Varian Medical System™ are trademarks of Varian.

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

© 2022 Varian, a Siemens-Healthineer company.

All rights reserved.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

DC-DOC-11-D EC16.1-CEM-12-A
For education purposes only pg 2 EC16.1-CEM-12-A
Varian Confidential
Eclipse 16.1 Cone Planning

General Linac Fair Balance Safety Statement

Intended Use Summary
Varian Medical Systems linear accelerators are intended to provide stereotactic radiosurgery and precision radiotherapy for lesions,
tumors, and conditions anywhere in the body where radiation treatment is indicated.

Important Safety Information

Radiation treatments may cause side effects that can vary depending on the part of the body being treated. The most frequent ones are
typically temporary and may include, but are not limited to, irritation to the respiratory, digestive, urinary or reproductive systems, fatigue,
nausea, skin irritation, and hair loss. In some patients, they can be severe. Treatment sessions may vary in complexity and time.
Radiation treatment is not appropriate for all cancers.

Medical Advice Disclaimer

Varian as a medical device manufacturer cannot and does not recommend specific treatment approaches. Individual treatment results
may vary.

Eclipse Fair Balance Safety Statement

Intended Use Summary

The Eclipse Treatment Planning System (Eclipse TPS) is used to plan radiotherapy treatments for patients with malignant or benign
diseases. Eclipse TPS is used to plan external beam irradiation with photon, electron and proton beams, as well as for brachytherapy
treatments. In addition, the Eclipse Proton Eye algorithm is specifically indicated for planning proton treatment of neoplasms of the eye.
Eclipse should only be used by qualified medical professionals.

Important Safety Information

Radiation treatments may cause side effects, which, in some cases, may be serious. Severity can vary depending on the part of the body
being treated. Side effects are related to the type of treatments delivered and should be discussed between the clinician and the patient.

Medical Advice Disclaimer

Varian as a medical device manufacturer cannot and does not recommend specific treatment approaches. Individual treatment results
may vary.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

DC-DOC-11-D EC16.1-CEM-12-A
For education purposes only pg 3 EC16.1-CEM-12-A
Varian Confidential
Eclipse 16.1 Cone Planning

Contacting Support
Support services are available without charge during the initial warranty period.
Contact Varian Medical Systems for any of these reasons:
 You need information not included in this publication.
 You need to order additional documents.
 You need to obtain support by e-mail.
Find the most up-to-date contact information at MyVarian.com.

Online Resources
If you have access to the Internet, you can find various help resources here:
Varian.com | Oncology Systems: https://www.varian.com/oncology/service-education

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

DC-DOC-11-D EC16.1-CEM-12-A
For education purposes only pg 4 EC16.1-CEM-12-A
Varian Confidential
Table of Contents
Introduction TAB 1

Varian Resources

Stereotactic Radiosurgery TAB 2

Introduction to Stereotactic Radiosurgery

Varian SRS System Components

Administration for Cone Planning TAB 3

Administration

Cone Dose Calculation (CDC) Algorithm TAB 4

Cone Dose Calculation Algorithm Overview

Beam Configuration TAB 5

CDC Beam Data Requirements

CDC Model Configuration

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

DC-DOC-11-D EC16.1-CEM-12-A
For education purposes only pg 5 EC16.1-CEM-12-A
Cone Planning TAB 6

Image Registration

Contouring

Single Target Cone Planning

Verifying MU

Multiple Targets Cone Planning

Cone Planning Exercise

Appendix TAB 7

Cone Planning GUI Overview

Single Target Multiple Isocenter Planning

Additional Cone Planning Exercices

Export Machine Config from 4DITC Administration

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

DC-DOC-11-D EC16.1-CEM-12-A
For education purposes only pg 6 EC16.1-CEM-12-A
Introduction

Introduction TAB 1

Varian Resources 1

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

DC-DOC-11-D EC16.1-CEM-12-A
For education purposes only pg 7 EC16.1-CEM-12-A
1 1

VARIAN RESOURCES

EC16.1‐CEM‐12‐A

1 © 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
EC16.1‐CEM‐12‐A
DC-DOC-20-F

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 8 EC16.1-CEM-12-A
OBJECTIVES

• Documentation Library
• Support Cases 1
• Service Reports
• Product Ideas
• Knowledge Base & Known Issues
• Peer Answers
• Research Tools
• Training & Certificate Manager
• Events and Webinars
• Resources

• Provides a high-level overview of the information and features currently

available via MyVarian.com.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 9 EC16.1-CEM-12-A
MYVARIAN.COM

1 1

• To register for a MyVarian account, customers should go to

www.MyVarian.com, click on the ‘Create One>’ link and submit the
registration form.
• The MyVarian account will be available within 24 hours.

• To expedite the account registration process, customers can enter their

Customer Site ID.
• The Customer Site ID is a unique identifier for the institution
where Varian equipment is installed.
• If an expedited registration is necessary, customers can contact their
local Varian support representative or Clinical Operations Manager to
request their Customer Site ID.

• From the MyVarian home page visitors can access several areas that do not
require login, e.g., Webinars, Meetings, and Featured Stories.
• In addition, visitors can access additional resources and contact
us for assistance.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 10 EC16.1-CEM-12-A
MYVARIAN.COM

• Once logged in, MyVarian members can see recently posted documents,
setup ‘My Favorites’ workspaces and access several areas and information
available on MyVarian.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 11 EC16.1-CEM-12-A
MY ACCOUNT

1 1

• MyVarian members can visit My Account to update their MyVarian account

profile.

• In addition, customers can:

• Subscribe to My Notifications, a weekly email digest, listing content
added to MyVarian for their reference.
• Update security (e.g., password, security question) information.
• Request API keys for use with 3rd party systems.
• Register for a Learning Management System (LMS) account.
• Add supported institutions to their profile.
• Provide Varian consent to use remote service tools to gather installed
base configuration data in order to provide better customer service.
• Setup ‘My Favorites’ to gain quick access to regularly visited areas.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 12 EC16.1-CEM-12-A
DOCUMENTATION LIBRARY

• One of the most visited workspaces on MyVarian is the Documentation

Library which lists documents pertaining to Varian installed products.
• Browse the library to view and download documents of interest.
• Note, in many cases documents are translated to support local
language.
• In addition, MyVarian members can select their favorite documents
for easy access on subsequent visits.

• Myvarian.com > select Documentation Library > under Product Group>

select the Product from the dropdown > select the Document Type from the
dropdown > select the Version from the dropdown > add any Keyword
words > Apply.

• Reference Guides and Instructions for Use are located under the
Manuals Document Type.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 13 EC16.1-CEM-12-A
SUPPORT CASES

1 1

• MyVarian members are able create support cases and monitor their
progress to resolution.

• Emergency related support cases (i.e. accelerator is down) should not be

created via MyVarian.
• Emergency related supported cases should be created with a live
customer support agent.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 14 EC16.1-CEM-12-A
SERVICE REPORTS

• From the Support Cases workspace, MyVarian members can view,

download and print completed Field Service Reports (FSR) which detail
the work performed for their Varian equipment.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 15 EC16.1-CEM-12-A
PRODUCT IDEAS

1 1

• MyVarian members can provide suggestions for improvements to Varian

products via the Product Ideas workspace.

• In addition, they can comment and vote for ideas submitted by their peers.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 16 EC16.1-CEM-12-A
KNOWLEDGE

• Knowledge allows Varian customers to find answers to questions that help

them resolve common issues.
• The knowledge article library is part of the same knowledge base
used by Varian Support allowing customers to get answers at their
convenience.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 17 EC16.1-CEM-12-A
KNOWN ISSUES

1 1

• The Known Issues workspace displays known issues previously

published via the customer release notes (CRN) process and those
discovered between CRN publications.
• Note: Available to customers with ARIA Radiation Oncology or ARIA
Medical Oncology only.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 18 EC16.1-CEM-12-A
PEER ANSWERS

• On the Peer Answers workspace, allows customers to connect with peers

and learn from industry experts around the world.

• MyVarian members are contributors to the product-specific discussion

groups related to the Varian suite of products installed at their institution.
• Members can browse the various groups to connect with peers, ask
questions, share experiences, and discuss best practices.

• Accessing Peer Answers:

• After logging in to MyVarian, click on the ‘Support’ menu item and
then on the ‘Peer Answers’ menu item.
• When entering the Peer Answers workspace for the first time,
customers will be asked to agree to the terms of use.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 19 EC16.1-CEM-12-A
PEER ANSWERS – POSTING RAPIDPLAN MODEL

1 1

• To Post a RapidPlan Model, post a question on the Peer Answers

workspace, by clicking on the POST QUESTION button.

• Enter a question:
• Enter the relevant Peer Group.
* If submitting a RapidPlan model, please select the RapidPlan
Model Sharing Peer Group.
• Enter the Title.
• Enter a Description of the question.
* If submitting a RapidPlan model, please include details
relevant to the model being shared.
• Attach the relevant file.
• Click the Submit button.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 20 EC16.1-CEM-12-A
TRAINING

• MyVarian members can browse the training course library and register for
and attend courses via Varian’s Learning Management System (LMS)
and VarianThink.

• MyVarian members can also stay informed of the educational opportunities

available to their organization via the Training & Consulting workspace.

• Note the Training & Consulting workspace is not available in all markets.

• To learn more about how to take advantage of these offerings, contact the
Education team at [email protected].

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 21 EC16.1-CEM-12-A
CERTIFICAT MANAGER

1 1

• Customers who attend Varian hosted meetings or training that provide

educational credits can access the Certificate Manager to print out
certificates of attendance.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 22 EC16.1-CEM-12-A
EVENTS AND WEBINARS

• An oncology event calendar and Varian-hosted webinar schedule and

library are available for registration and attendance reference.

• Browse each to learn about events in your area and to attend or view
webinars of interest.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 23 EC16.1-CEM-12-A
RESEARCH TOOLS

1 1

• Monte Carlo Support:

• The Monte Carlo simulation package provides geometric data,
material specifications, and physical properties of the treatment head
components and accessories for accurate Monte Carlo modeling.

• Developer Mode:
• Developer Mode provides access to treatment examples and
manuals to assist clinicians and physicists to create and experiment
with novel treatment and imaging techniques in a research
environment.

• VarianDeveloper.com:
• Open-source community project to support Varian collaborators and
customers in their work with Varian Medical Systems public ESAPI.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 24 EC16.1-CEM-12-A
RESOURCES – VARIAN MEDICAL AFFAIRS

• Varian Medical Affairs provides visitors access to Varian’s Medical Affairs

website.

• This website allows clinicians around the world to exchange meaningful

clinical information, scientific research, and expert opinion around the
management of cancers and other conditions with an emphasis on
applications utilizing radiation.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 25 EC16.1-CEM-12-A
RESSOURCES – MARKETING YOUR CENTER

1 1

• MyVarian members can access marketing material designed to help

customers promote the benefits of their Varian technology to referring
physicians, patients, the media and their community.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 26 EC16.1-CEM-12-A
RESSOURCES – SERVICE & EDUCATION

• Service & Education links visitors to the Service & Education page on
Varian.com which details Varian’s full range of customer support options.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 27 EC16.1-CEM-12-A
1 1

Thank you

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 28 EC16.1-CEM-12-A
1

EC16.1‐CEM‐12‐A
DC-DOC-20-F

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 29 EC16.1-CEM-12-A
1 1

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 30 EC16.1-CEM-12-A
Stereotactic Radiosurgery

Stereotactic Radiosurgery TAB 2

Introduction to Stereotactic Radiosurgery

Varian SRS System Components

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

DC-DOC-11-D EC16.1-CEM-12-A
For education purposes only pg 31 EC16.1-CEM-12-A
2 2
STEREOTACTIC
RADIOSURGERY

EC16.1‐CEM‐12‐A

1 © 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
EC16.1‐CEM‐12‐A
DC-DOC-20-F

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 32 EC16.1-CEM-12-A
OBJECTIVES

• General concepts and definitions

• Eclipse Cone Planning 2
• Workflow with Varian Cones

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 33 EC16.1-CEM-12-A
2 2
GENERAL CONCEPTS
AND DEFINITIONS

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 34 EC16.1-CEM-12-A
GENERAL CONCEPTS AND DEFINITIONS
Requirements for SRS Planning

• Tight immobilization and motion management

• Conservative planning margins

− 0 to 2 mm margin typically added to the target 2
• Highly conformal treatment planning with steep dose gradients
− Eclipse Cone Planning Metrics:
− Conformality Index (CI) < 1.5 where,
𝑷𝑰𝑽 𝑷𝑰𝑽 = Planning Isodose line Volume and,
• 𝑪𝑰
𝑷𝑻𝑽 𝑷𝑻𝑽 = Planning Target structure Volume
− Gradient Index (GI) in mm where,

• 𝑮𝑰 𝑹𝟓𝟎% 𝟏𝟎𝟎%
𝒆𝒒𝑺 - 𝑹𝒆𝒒𝑺
𝑹𝟓𝟎%
𝒆𝒒𝑺 = equivalent Sphere Radius of half-prescription (50%) and,
𝑹𝟏𝟎𝟎%
𝒆𝒒𝑺 = equivalent Sphere Radius of full-prescription (100%)

• SRS is a surgery-like procedure where only the target needs to be

eliminated or ‘resected’.
• The planning and treatment requirements are a lot more stringent
than other 3D conformal types of treatments.
• With SRS (cranial) treatments internal patient motion is limited (if
not eliminated), and tight immobilization is employed, so PTV
margins are kept to a minimum.

• High dose conformality and high dose gradients (particularly in the

direction of critical structures) are expected.
• The ideal is to go from the prescription dose isodose line to half
the prescription dose isodose line in a few millimeters.

• Note that the Gradient Index (GI) used in Cone Planning is different from
the RTOG GI definition.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 35 EC16.1-CEM-12-A
GENERAL CONCEPTS AND DEFINITIONS
Basis of SRS Cone Planning

• Multiple non-coplanar arcs from

different directions focused on target

2 − Dose is accumulated at the arc intersection

2
− Remaining volume receives a low dose cloud

• Dose gradient is maximized by use

of tightly focused circular apertures
(cones)
• For small single targets, single
isocenter is adequate
• For multiple targets, multiple
isocenters might be required
© 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
EC16.1‐CEM‐12‐A
DC-DOC-20-F

• The basis of SRS cone-based planning is that the dose results from the
sum of several arcs of radiation beams to the target.
• The dose concentrates to the arc intersection (like the spokes of a
bicycle), while very low dose is delivered from different areas.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 36 EC16.1-CEM-12-A
GENERAL CONCEPTS AND DEFINITIONS
Prescription Isodose Line

• Prescription isodose line for

SRS is different than
conventional planning 2
• Rx to Rx/2 gradient is 100% - 50%
reduced significantly when
prescribing to 80% isodose
80% - 40%

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 37 EC16.1-CEM-12-A
2 2
ECLIPSE CONE
PLANNING

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 38 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Basic Arc Beam Template

• Nine-arc set standard beam

template
2
• Nominal spherical dose
distribution
• Diameter = ~ collimator diameter
• Sagittal arcs equally spaced
• Arc spans 1000
• Table rotation of 200 Rx Isodose: 80% of maximum dose.
Shown on figure: 80%, 50%, 20%

• The dose distribution from the standard nine-arc set is displayed.

• It is nominally spherical and has a diameter that corresponds closely
to the collimator diameter.

• Each arc spans 1000 of gantry angle and a 200 table rotation separates
each of the nine arcs.

• The dose distribution at the 80% is usually chosen for dose prescription
because of the steep dose gradient outside the treatment volume.
• Picture shows the 80% (Rx), 50% and 20% isodose lines.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 39 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
SRS Targets

• Not all perfectly spherical

• Most are ellipsoidal in shape
2 (elongated spheres)
2
• Some have very complex
shapes
− Cone-based with multiple
isocenters
− MLC-based with single isocenter

• For very complex shapes, multiple isocenters are required.

• This will be discussed later during the course.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 40 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Treatment Planning for Ellipsoidal Targets

• Nominal spherical dose distributions are inadequate for ellipsoidal targets:

• Inadequate coverage
• Loss of conformality and gradient indices 2
• Different ellipsoidal shaped dose distributions can still be achieved from the
basic nine arc template:
• Allows maintaining a single isocenter
• To conform the dose distribution to ellipsoidal targets can manipulate:
• Cone size, arc start angle, arc stop angle, arc relative weight

• Finally, elimination of an arc reduces spread of radiation in the principal

direction of the eliminated arc

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 41 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
SRS arc Beam Templates

Arc Template Set Usage

To achieve lateral ellipsoid dose

2 4-arcs-lateral-CW 2
distribution
5-arcs-CW To achieve circular dose distribution
To achieve lateral ellipsoid dose
6-arcs-LR-CW
distribution
9-arcs-CW To achieve circular dose distribution
To achieve superior-inferior ellipsoid
5-arcs-SI-CW
dose distribution
Single arc pulls dose in that direction
Single-arc-90-270-CW
minimally
© 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
EC16.1‐CEM‐12‐A
DC-DOC-20-F

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 42 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Treatment Planning and Target Shapes

Circular Use circular 5 arc set

Axis in
coronal
Use arc elimination 2
Axis in Use start-stop angles
Ellipsoidal
sagittal or arc elimination

Axis in
Use multiple isocenters
axial

Non-Ellipsoidal Use multiple isocenters

or MLC planning

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 43 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Pituitary Gland Tumor Example

• Adjacent critical structure (optic

chiasm) superior to target
2 • Minimize superior dose by 2
increasing dose contribution
from lateral direction
− Can eliminate 3 central arcs from 9
arc template)
− Spreads dose distribution in lateral
direction

• 6 lateral arc fields plan

template can be used as starting
point
© 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
EC16.1‐CEM‐12‐A
DC-DOC-20-F

• For this example, the critical structure is located above the tumor, the optic
chiasm.

• The goal is to minimize the dose above it.

• This is achieved by using the 9-beam template and eliminating the
arc-rays that contribute dose in the vertical direction.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 44 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Acoustic Schwannoma Example

• Minimize radiation medially to

brain stem
• Elongate radiation dose
2
superiorly-inferiorly
• Ellipsoidal 5-arc template

• In this example, the target is elongated in the superior-inferior direction.

• In addition, the brain stem is located medially.
• The goal would be to minimize dose to this structure.

• By using the standard 9-arc template and eliminating the most lateral
beams, the radiation dose can be elongated in the desired direction.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 45 EC16.1-CEM-12-A
2 2
WORKFLOW WITH
VARIAN CONES

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 46 EC16.1-CEM-12-A
VARIAN SRS WORKFLOW
MRI Image/
Contouring/Pre-Plan • Pre-plan with MRI:
− Contour Body and Target structures on MR
− Create MR based pre-plan in Cone Planning
CT simulation
Patient Preparation • Immobilization Solutions: 2
− Frameless = Mask immobilization
− Frame = Varian Head Frame
Stereotactic
Imaging (CT) • Final CT Plan:
− Image Registration
− Contouring/Copy structures
CT/MRI Registration,
Contouring, and − Transfer pre-plan to CT dataset
Treatment Planning − Calculate 3D Dose in Cone Planning
− Evaluate Plan
© 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
EC16.1‐CEM‐12‐A
DC-DOC-20-F

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 47 EC16.1-CEM-12-A
VARIAN SRS WORKFLOW
Machine QA, • Machine & Patient Specific QA:
Plan specific QA
− Winston Lutz QA
− CBCT Verification

2 − Dosimetry QA 2
Patient Immobilization
• Patient Immobilization & Localization:
and Localization
− Secure SRS Head Frame or Mask to Support
Platform
− CBCT Matching
− Reposition Patient
− Verification CBCT
Radiation Delivery
and Patient Monitoring • Delivery Monitoring:
− IdentifyTM system tracks patient during delivery

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 48 EC16.1-CEM-12-A
2

Thank you

References:

• P1044595-001-A – Eclipse Photon and Electron Algorithms Reference

Guide
• P1044593-001-A – Eclipse Photon and Electron Instruction for Use
• P1004308-008-H – Varian Head Frame Instruction for Use
• P1008757-004-D – Varian Head Frame Customer Release Note v2.0 MR1

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 49 EC16.1-CEM-12-A
2 2

EC16.1‐CEM‐12‐A
DC-DOC-20-F

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 50 EC16.1-CEM-12-A
2
VARIAN SRS
SYSTEM COMPONENTS

EC16.1‐CEM‐12‐A

1 © 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
EC16.1‐CEM‐12‐A
DC-DOC-20-F

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 51 EC16.1-CEM-12-A
OBJECTIVES

• Overview Varian Intracranial SRS

Solutions
2 • Present IdentifyTM SGRS Surface
2
Guidance
• Overview Varian SRS QA tools

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 52 EC16.1-CEM-12-A
VARIAN INTRACRANIAL SRS SOLUTION
MLC Based

• HD120® MLC leaf width of 0.25 cm gives tight

penumbra
• RapidArc ® SRS or IMRS with standard AAA / 2
Acuros® models
• High Intensity Mode of up to 2400 MU/min
• Single isocenter can treat multiple lesions
• Large lesions (> 2 cm) or complex shapes
easily handled
• HyperArcTM High-Definition Radiotherapy
Solution

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 53 EC16.1-CEM-12-A
VARIAN INTRACRANIAL SRS
SOLUTION
HyperArc®
• Non-coplanar VMAT based technique
used for intracranial SRS treatments
2 based on a fixed geometry setup 2
• Collision prevention, avoidance and
detection
• Automated treatment delivery
• Can irradiate multiple targets at the same
time

• https://www.varian.com/products/radiotherapy/treatment-planning/hyperarc

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 54 EC16.1-CEM-12-A
VARIAN INTRACRANIAL SRS
SOLUTION
Cone Based

• Varian Conical Collimators

− Set of 7 cones with following diameters
2
− 4.0, 5.0, 7.5, 10.0, 12.5, 15.0, and 17.5 mm

• Varian SRS Head Frame

• Frameless systems are also available
from other vendors

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 55 EC16.1-CEM-12-A
VARIAN INTRACRANIAL SRS
SOLUTION
ICVI System
• Integrated Conical Collimator
Verification and Interlock System(ICVI)
2 consists of: 2
− Mount
− Conical Collimators
− Locking Ring
− Storage Disk
• Verifies that proper conical collimator
has been installed as defined in
treatment plan
• Available for use on Varian machines
that include a serial accessory
(custom coding) system
© 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
EC16.1‐CEM‐12‐A
DC-DOC-20-F

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 56 EC16.1-CEM-12-A
IDENTIFYTM SGRS
Surface Guidance Real Time Motion
Management Solution

• Compatible with a range of open face

masks
2
• Continuous patient tracking during
treatment

• Simple and fast SRS accuracy verification

& calibration procedure

• Verifies that MV, kV

and Surface
Guidance System
isocenters are
aligned correctly

 SGRS = Surface Guided RadioSurgery

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For education purposes only pg 57 EC16.1-CEM-12-A
IDENTIFYTM SGRT (SURFACE GUIDED RADIOTHERAPY)
System Components

2 2

• IdentifyTM is a video-based three-dimensional (3D) surface imaging system,

used to image the skin surface of a patient in 3D before and during
radiotherapy treatment.

• Consists of software, a computer workstation, three high precision cameras

with sub-millimetric accuracy and with a refresh rate of 5-10 frames/second,
cables, and camera calibration devices.

• It is non-invasive, does not require the use of body markers and produces
no irradiation during the imaging process.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 58 EC16.1-CEM-12-A
VARIAN SRS QA TOOLS
Varian ICVI QA Tool Kit

• Use to confirm alignement accuracy:

− Machine mechanical & radiation
isocenter 2
− Conical collimator centering

• Consists of 3D micrometer stage and

extender rod with tungsten ball
− Attaches to the couch top

• Confirming the isocenter and conical collimator alignment accuracy can be

accomplished by analyzing an MV image of a radiopaque ball, such as
tungsten or steel, suspended at the treatment isocenter.

• Varian ICVI QA Tool kit is mounted to the front of the couch.

• The micrometer stage is used to control the location of the
radiopaque ball.

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For education purposes only pg 59 EC16.1-CEM-12-A
VARIAN SRS QA TOOLS
Varian ICVI QA Tool Kit

• Position the radioopaque ball at the

isocenter
− Precisely center the ball at the treatment
2 isocenter with light field shining through conical 2
collimator

− Use the light field not the cross-hairs

• Obtain at least four MV images of the ball

(one from each of the cardinal gantry
angles)

• Using image analysis tools, analyze the

congruence of the centroids of the images
of ball and the conical collimator

• The sequence for performing Winston Lutz quality assurance technique is

as follows:
1. Use the Linac light field with a 7.5 mm conical collimator to
accurately position a radiopaque ball at the treatment isocenter.
• The radiopaque ball must be smaller than the cone used.
• The Varian Tungsten ball diameter is 6.5 mm; thus, using the 7.5
cone allows enough light around the ball’s shadow to assist in
precisely centering the ball.
2. Mount a larger conical collimator (e.g., 10 mm, 12.5 mm etc.), and
obtain at least four MV images of the ball (one from each of the
cardinal gantry angles).
 In addition, similar images can be obtained with the couch rotated
into extreme positions, with the gantry head up, to verify couch
rotation accuracy.
 Finally, collimator rotation and cone centering for each cones
can be checked separately.
3. Using image analysis tools, analyze the congruence of the
centroids of the images of the ball and the circular conical
collimator.

 The objective is to determine how close the match is between the machine
mechanical and radiation isocenter, and to verify the cone centering
with the collimator.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 60 EC16.1-CEM-12-A
VARIAN SRS QA TOOLS
Solutions
• MPC ICVI Tests on TrueBeam® machine
• Varian SRS End-to-End Phantom
• An anthropomorphic phantom that enables
dosimetric & workflow validation of clinical 2
procedures for SRS treatments
• DoseLab® Analysis software & Phantoms
• Perform automatic Winston-Lutz images
analysis
• Image Quality test for CBCT
• Mobius3D® Patient QA software
• Perform independent dose calculation
verification
• Treatment delivery verification with Machine
Logs
© 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
EC16.1‐CEM‐12‐A
DC-DOC-20-F

• Options available to help with the SRS QA process are summarized in this
slide.

• The Integrated Collimator Verification & Interlock (ICVI) system comes with
MPC ICVI Checks licenses for TrueBeam® & Edge® machines.
• The 2 MPC ICVI checks licenses are:
• MPC ICVI Check
• MPC ICVI Axis Alignment Check

• Mobius3D® has a Collapsed Cone Convolution algorithm which supports

calculation for the Varian cones.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 61 EC16.1-CEM-12-A
2 2

Thank you

References:

• P1033680-002-B – TrueBeam® Instructions for Use

• P1037065-002-B – ICVI Instruction for Use
• P1002972-002-B – ICVI Quality Assurance Reference Guide
• P1044659-001-A – Varian SRS E2E Phantom Instructions for use

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

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2

EC16.1‐CEM‐12‐A
DC-DOC-20-F

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 63 EC16.1-CEM-12-A
2 2

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Administration for Cone Planning

Administration for Cone Planning TAB 3

Administration

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Administration

Administration
Procedure

Objectives
Following along with your instructor, you will perform these tasks:
3 3
1) Create an external beam machine with the SRS cone set in RT Administration and review its parameters
related to Cone Planning.
2) Create an Isodose Level Template for Cone Planning in RT Administration.

Procedure Contents
1) Export machine from Treatment console System Administration.
2) Import into RT Administration.
3) Review Machine parameters in RT Administration.
4) Creating Isodose Level Template.

References
1) P1044592-001-A – ARIA Radiation Therapy Management RT Administration 16.1 Reference – Chapter 3,
4&7
2) P1033681-003-C – TrueBeam® Administrators Guide
3) P1037065-002-B – ICVI Instruction for Use

Important Note: This procedure demonstrates how to create a new external beam machine
in RT Administration for use with Cone Planning. SRS cones for an SRS enabled machine
are normally initially defined at the treatment console by the Varian Service personnel. The
SRS cones are included in the machine definition .xml file (exported from the treatment
console), and are automatically created in RT Administration, upon importing the machine
definition .xml file in RT Administration (e.g., to create a new machine or to update an
existing machine).

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Administration

A. Export Machine from Treatment Console

1) Select the System Administration mode. See Figure 1.

\\\\\\\\\\\\\\\\\

Figure 1: Mode Selection

Note: This procedure demonstrates exporting the machine definition .xml file for a
TrueBeam® type machine (from TrueBeam® System Administration). Please refer to the
Appendix for instructions on how to export the machine definition .xml file for a C-Series
machine (from 4DITC Admin).

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Administration

2) Login to the System Administration mode. See Figure 2.

Figure 2: Login Window

3) Select the Synchronization tab and then select the Export section. See Figure 3.
3 3

Figure 3: Synchronization Tab - Export Section

4) Select the version of Aria RadOnc in the Oncology Information System area, click the button to
browse for the export directory. In our example, the export directory (named PHYSICS) is located on the I
drive. After the directory has been selected, click Start Export to complete the machine .xml file export
process. See Figure 4.

Figure 4: Synchronization Tab - Export Machine xml File

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Administration

5) Make sure that the export was successful. This will be indicated by a message on the status window,
stating that the export operation was successful and complete. See Figure 5. Verify this statement by
navigating to the selected destination folder ((I:\PHYSICS in this example) and confirming that the
machineconfigvision.xml has been successfully created. See Figure 5. This .xml file contains all
machine information necessary to create (or synchronize) the machine in RT Administration.

Figure 5: Export Successful Verification

6) Close System Admin ( ).

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Administration

B. Import and create Machine in RT Administration

1) Login to UserHome ( ).
2) Go to RT Administration - select QuickLinks > Administration > RT Administration.
See Figure 6.

3 3

Figure 6: QuickLinks > Administration > RT Administration

3) Check workstations that are logged in. It is recommended that all workstations be logged off when making
changes in RT Administration. Click Continue to proceed. See Figure 7.

Figure 7: Entering RT Administration

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Administration

Warning: The system uses a central database that allows running the application on
different workstations simultaneously. If multiple simultaneous users work with the same
data, this may lead to situations where another user has modified and saved the data that
you are currently working with. Therefore, avoid situations with multiple users concurrently
editing the same patient data. If you try to save your changes, the system will issue a
warning message about another user already editing the same patient. Always carefully
verify the synchronized data, because it may contain changes made by both you and the
other user.

P1044592-001-A -- RT Administration Reference Guide ARIA Radiation Therapy

Management, Page 13.

4) Select Radiation and Imaging Devices workspace. Then click Import and select Import External Beam 3
Linac. See Figure 8.

Figure 8: RT Administration > Radiation and Imaging Devices

Important Note: If the machine already exists in RT Administration and was recently
upgraded with SRS Cones, select the machine from the machine list and use Update
External Beam Linac… option to import the machine definition .xml file exported from the
treatment console and synchronize machine definition in RT Administration with updated
machine settings defined at the treatment console. If updating a machine in RT
Administration investigate any differences and verify all parameters have been updated
correctly before applying any changes. Save and review the final update log file.

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Administration

5) Use the Windows Explorer to find and select the machine definition XML file previously exported from the
treatment console and click Open when done. In our example, this file name is Varian EDGE.xml and it is
located on Desktop. See Figure 9.

3 3

Figure 9: Find and Select Machine Definition .xml File

6) Click OK to acknowledge successful import. See Figure 10.

Figure 10: Creation Succeeded

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Administration

7) Check that the new machine is on the machine list. Click Save All to save changes in the system
database. See Figure 11.

Figure 11: Save All

8) Select Parameters have been reviewed and are correct and click Save Changes.
See Figure 12.

Figure 12: Confirm Changes

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Administration

C. Reviewing Machine Parameters

1) Double-click the machine in machine list to see its Properties. See Figure 13.

3 3

Figure 13: External Beam Properties

2) Review / modify available parameters in General, External Beam, and Description tabs. Click OK to
save the changes and close External Beam Properties dialog when done. See Figure 13.

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Administration

Important Note: Changing machine ID breaks links between machine and the calculation
algorithms already configured for the machine. All calculation algorithms would have to be
re-configured. System displays a warning message when user changes machine ID and
attempts to save, with the option to discard the ID change. See Figure 14.

3
Figure 14: Operating Limits

3) Select the Operating Limits tab. Utilize Show limit values using drop-down to choose a scale to be
used to display the limit values (IEC 61217 or selected machine’s scale). See Figure 15.

Figure 15: Operating Limits

4) Review the limits. Double-click a limit to display its property window if changes are to be made.
5) Set the default values for the operating limits.

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Administration

6) For Gantry Rotation, make sure the Motion Mode is set to Dynamic (to enable arc treatments) and
define the Max Speed. Click OK when done. See Figure 16.

3 3

Figure 16: Operating Limits > Gantry Rotation Properties

Note: If the Operating Limit for the Gantry Rotation Motion Max Speed parameter is left
empty, Eclipse uses the system hard-coded value of 4.8 deg/s, which is the maximum
gantry rotation speed a C-Series machine can deliver a plan clinically. A TrueBeam® type
machine is capable to rotate at a maximum rotational speed of 6 deg/s during clinical
treatments. For a TrueBeam® type machine, if desired to take advantage of this advanced
machine capability, enter a value of 6 deg/sec under the Gantry Rotation Max Speed
Operating Limit parameter.

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Administration

7) Select Technique tab. Make sure ARC and SRS ARC techniques are available. Select Show All
Techniques to see Operating Limit Overrides for all available techniques. See Figure 17.

Machine techniques

Machine Operating Limits Overrides

for the selected technique

Figure 17: Technique

Note: The operating limits and the primary fluence mode specific overrides are imported to
RT Administration with the machine definition .xml file.

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Administration

8) Operating Limit Overrides are defined per technique and each plan for the machine is validated against
the overrides upon plan approval. Operating Limit Overrides can be specified for:
a) Dose Dynamic MU - Defines the minimum and maximum number of MU for dose dynamic and
VMAT fields.
b) Monitor Units - Defines the minimum and maximum number of MU for fields that are not dose
dynamic.
c) MU / Degree - Defines the minimum and maximum number of MU per degree for arc fields.
d) Treatment Time - Defines the minimum and maximum treatment time in minutes for a field.
9) If an existing limit is to be changed, double-click the limit, make the necessary changes and click OK
when done. See Figure 18.
3 3

Figure 18: Changing an Operating Limit

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Administration

10) If a new Operating Limit Override is to be defined, make sure Show All Techniques is deselected, then
select the technique and click New Operating Limit. See Figure 19.

Make sure this is de-selected

Figure 19: Technique > New Operating Limit

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Administration

Note: For a TrueBeam® machine, refer to machine Administrator’s Guide document

(e.g., P1033681-003-C TrueBeam® Administrators Guide p.296) for appropriate values
and compare the Operating Limits Override values set in RT Administration against the
limits set in System Administration at the TrueBeam® console. See Figure 20.

3 3

Figure 20: TrueBeam® Operating Limits

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11) Define Primary Fluence Mode, Parameter Type, Label, and limit values. Click OK when done. See
example in Figure 21.

Figure 21: MU Limits for SRS ARC Technique for FFF Primary Fluence Mode

12) Repeat steps 9) – 11) as necessary to update/add new Operating Limits Overrides.

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Administration

13) Select Primary Fluence Mode tab. Verify that an appropriate primary fluence mode is available and
check its field size limits. Double-click the limits to display Properties if it is necessary to update the
limits. See Figure 22.

Figure 22: Primary Fluence Mode

3 3
Note: The Primary Fluence Mode (PFM) was introduced to represent different flattening
filter configurations. It allows the configuration of individual models for the high dose rate
energy beams (like 6x-SRS for C-Series machines, or 6x-FFF and 10x-FFF for TrueBeam®
type machines). Field size limitations are specific for each PFM. The maximum field size for
the 6X-SRS PFM (for C-Series machines) is limited to 15x15 cm2 symmetric, with a
minimum field size of 0.5x0.5 cm2. FFF modes do not have a minimum field size limit, and
the maximum field size is 40x40 cm2.

14) Select Energy Mode tab. Verify PFM is attached to Dose Rates that are associated with the SRS Mode on
the linac. See Figure 23.

Figure 23: Energy Mode

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15) Select Applicator tab. Verify that the SRS cones previously defined at the treatment console are available.
See Figure 24.

Figure 24: Applicator

Important Note: Physically, there are only 7 Varian cones available. See Figure 25. For a
TrueBeam® type machine all possible cone sizes come populated as part of the .xml
configuration file. The ICVI Instructions for Use document (e.g., P1037065-002-B ICVI
Instruction for Use p.12) provides a table listing the physical applicators with the
corresponding SRS Applicator Codes and Labels. See Figure 25.

Figure 25: SRS Applicator Sizes and Codes

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16) Double-click a cone to open Properties dialog. Select General tab and verify the settings – ID, Internal
Code; make sure External Verification is deselected. See Figure 26.

3 3

Figure 26: Applicator / Cone Properties -> General Tab

Important Note: The code range cannot be modified. Each cone size is associated with a
unique code at a hardware level; the code read by ICVI electronics must match code asked
for by the software (treatment console - based on plan data) for the cone to be successfully
verified.

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17) Select Applicator tab in the Properties dialog. Verify the cone size (Field Size) and Distance from the
source to the head of the applicator. Then click Configure Jaw Size… and verify / update / define field
size defined by jaws for the selected applicator and available energies. See Figure 27. Close Configure
Applicator Size dialog by clicking OK when done.

Figure 27: Applicator / Cone Properties -> Applicator Tab

Important Note: Jaw size must match field size used during beam data measurements.
Jaw size cannot be larger than 5.6x5.6 cm2.

Note: The value under the ‘Distance from the source to the head of applicator’ box,
under the Applicator Properties Window, is actually the distance from the source to the
end of the applicator (closest to the patient) and is used by Cone Planning to check for
potential collision with patient surface on the collimator central axis.

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18) Select Slots tab in Applicator Properties dialog and make sure Accessory Mount is assigned to the
cone. Double-click the Accessory Mount on the right side to make it a default slot for the selected cone.
See Figure 28.

3 3

Figure 28: Applicator / Cone Properties -> Slots Tab

19) Click OK to save changes and close the Applicator Properties dialog. See Figure 28.
20) Repeat steps 16) to 19) for all available cones.

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21) If necessary, a new cone can be added to a machine in RT Administration.

22) Click New Applicator. Define ID, Name and the Internal Code in the General tab. Leave External
Verification deselected. See Figure 29.

Figure 29: New Application / Cone -> General Tab

Important Note: If a new cone is created in RT Administration after importing a machine

definition file, the same cone must be created at the treatment console, as well, to
synchronize machine definitions between the TPS and the plan delivery side.

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23) Select Applicator tab in the Applicator Properties dialog. Deselect Rectangular and select Stereotactic.
Then define the cone size (Field Size) and enter the Distance from the source to the head of the
applicator value (see note above for definition). See Figure 30.

3 3

Figure 30: Applicator / Cone Properties  Applicator Tab

Note: It is not possible to configure jaw sizes for a new cone until it is enabled for the
appropriate combination of machine energy and technique under Configured EMT. Clicking
Configure Jaw Size… now would result in an error message. See Figure 31.

Figure 31: Applicator Energy not Configured Error Message

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24) Select Slots tab. Select Accessory Mount from All Slots available list and then click to assign it
to the cone. Then double-click the Accessory Mount in the Assigned Slots list to make it a default slot
for the cone. See Figure 32.

Figure 32: Applicator / Cone Properties -> Slots Tab

25) Click OK to close the Properties dialog when done. See Figure 32.
26) Select Configured EMT tab. See Figure 33.

Figure 33: Configured EMT

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27) Select the combination of machine energy and technique the new cone is to be available for. Then enable
the new cone in the Add-on list on the right side by selecting the checkbox next to it. See Figure 34.

3 3
Click the white space to select an
energy/technique combination.
Selected combination checkbox
background then turns blue

Figure 34: Configured EMT – Add-on Validation

28) Repeat step 27) for all other combinations of machine energy and technique that the new cone is to be
enabled for.
29) Return to Applicator tab. Select the new cone and click Configure Jaw Size. Then set the jaw sizes for all
enabled energies for the new cone and click OK. See Figure 35.

Figure 35: Applicator  Configure Jaw Size

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30) Click Save All ( ) to save changes.

31) Verify the changes to be saved. If the changes are to be saved, select Parameters have been reviewed
and are correct and click Save Changes. See Figure 36.

Figure 36: Confirm Changes

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D. Creating Isodose Level Template for Cone Planning

1) Select Templates workspace, then choose Isodose Level Template tab. See Figure 37.

3 3

Figure 37: Templates  Isodose Level Template

2) Click New Isodose Level Template… to create a new Isodose Level Template. Then define ID and the
Name of the new template. See Figure 38.

Figure 38: New Isodose Level Template

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Administration

3) Click Add level to add a new isodose level in the template. Then define the 2D, 3D options,
Dose [%], Color and Style and Line width for the new isodose level. See Figure 39.

Figure 39: Add Level

4) Repeat step 3) to insert all required isodose levels into the new template.

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Administration

5) When all desired isodose levels have been added to the template, click OK. See Figure 40.

3 3

Figure 40: Close Isodose Level Template Properties

6) Select the new template to verify its isodose levels. Click Save All to save the template.
See Figure 41.

Double-click a template, to
open its Properties dialog, if it
is required to modify the
template further …

Figure 41: Save All

7) Repeat steps 2) - 6) to create additional templates (e.g. 70/35) if desired.

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Cone Dose Calculation Algorithm

Cone Dose Calculation (CDC) Algorithm TAB 4

Cone Dose Calculation Algorithm Overview

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CONE DOSE
CALCULATION (CDC)
ALGORITHM
4 4
EC16.1‐CEM‐12‐A

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OBJECTIVES

• Introduction to dose calculation

• Calculation options and resolution
• Field Weighting
• MU calculation
• Normalization method
• Multiple isocenters function
• Limitations of CDC algorithm
• Automatic isocenter spacing
• MRI Body Search Algorithm 4

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CDC ALGORITHM –
DOSE CALCULATION

4 4

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CDC DOSE CALCULATION
Introduction

• Eclipse CDC algorithm calculates the dose distribution in Eclipse Cone Planning for
stereotactic conical collimators
• Dose calculation is based on:
− Tissue Maximum Ratio
− Off-axis ratio
− Cone output factor

• Arc beams are approximated by evenly distributed static fields

• The CDC calculations can only be performed in Eclipse Cone Planning.

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CDC DOSE CALCULATION
Dose to a Point
• Dose at any arbitrary point P is given by:
2
 SAD 
Dr, d , SSD, S   MU  DRref  OFTMRmax S  TMRd , S     OARr, S 
 SSD  d 
• r = Off-axis distance to point of interest
• d = Depth to location of interest along central axis
• SSD = Source to Skin Distance
• S = Nominal diameter of conical collimator
• D(d,r,S) = Dose at location of interest
• DRref = Reference dose rate - the absolute dose in water for
the reference field size at the reference point at the
calibration depth, expressed in Gray divided by MU
• OF(S) = Output factor
4 • TMR(d,S) = Tissue Maximum Ratio
4
• SAD = Source Axis Distance
• OAR(r,S) = Off axis ratio
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CDC DOSE CALCULATION
Dose Grid and Arc Approximation
• Arc Angle Resolution (1 – 100):
− Spacing of static fields used for dose
calculation
− Displayed in the arc plane view
• Dose Matrix Resolution (0.5 – 5.0 mm):
− X and Y resolution of the 2D dose matrix
• Dose Slice Interval (0.5 – 5.0 mm):
− Z-resolution of the 3D dose matrix
• Edit Options:
− Additional 3D dose calculation
normalization & matrix size options:
− Sparse grid  Point separation of 5 mm
− Fine grid  User-defined point separation
4
(default: 1 mm)

• Dose slice interval:

• By default, the value is the same as the slice distance of the
planning image.
• When this value is manually entered, only one decimal place is
supported, i.e., 1.2.

• Edit Options > Calculation grid resolution for the volume away from the
isocenter:
• Sparse grid: Point separation is 5 mm.
• Fine grid: Point separation is defined in Dose Matrix Resolution (1
mm by default).

• The fine grid is always used within the area twice the diameter of the
cone size + 5 mm.
• The fine grid size can always be adjusted by the user in the Cone
Planning Workspace.

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CDC DOSE CALCULATION
Dose Calculation Matrix

• Fine dose matrix is always used in the

volume surrounding the isocenter
• Size of fine dose matrix depends on size
of the cone
− Equals 2 * diameter of the cone + 5 mm
(from isocenter to edge of fine dose matrix)

• Area outside fine dose matrix calculated

using either a fine or sparse grid
− Depends on the calculation options
selection
4 4

• If you have two isocenters, you will have two fine grid dose matrix
regions.

• Differences in selecting fine or sparse gird, can be seen in areas of low

doses.

• Selecting fine grid can slow down calculation time.

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CDC DOSE CALCULATION
Arc Field Calculation

• Arc fields are approximated as multiple static beams separated by user-defined

separation angles (1 - 10 degrees)
• At each static beam location, a TMR value is determined based on depth from skin
surface to isocenter, and cone size
• The body contour structure created in Eclipse is used to determine calculation depth
• Eclipse CDC performs calculation only within the body outline
• Objects not part of body structure (i.e., support structures, cranial screws, posts, etc.)
will not be seen by the algorithm
• TMR values from all the static beams of an arc are averaged for dosimetric calculation 4

• The automatic body search may include the pins, posts, mask, etc., and
the depth calculation would use the distance out to these objects.

• Beams going through the posts or cranial screws will be modeled as if going
through water-equivalent material.

• If needed, the body outline can be cleaned up in Contouring task to edit

the contour to follow the skin surface.

• The depth calculation will be from the outer body surface to the
isocenter if there is a hole in the body, or for a beam that exists and re-
enters the body.
• This might be seen around the ear, or if a post is included in the body
outline which is disconnected from the primary body outline.

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CDC DOSE CALCULATION
Weighting

• Isocenter weight is the weight of each field

to its isocenter. This value is displayed, for
each field, in the fields section of the cone
planning workspace

• Total weight is the summation of all field

weights for fields having the same isocenter

• During the planning process dose can be

calculated and displayed in 2D slides prior to
3D dose calculation

• Since user can select to normalize dose to

100% at Dmax, the algorithm needs to know
4 the Dmax location even before the 3D dose
calculation
4

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CDC DOSE CALCULATION
Dose Maximum
• A different method is used to calculate the global maximum in doing 2D vs 3D calculation:
− For 2D calculations:
− The Global Dmax location is determined using a fairly high-precision, 3D gradient search, algorithm
− Arcs are given only relative weightings during the planning process, and their true relative dose weightings are
assigned at the final 3D dose calculation

− For 3D calculations:
− The Global Dmax is recalculated using the defined dose matrix
− Weightings are assigned at the final 3D dose calculation

• The resolution of 3D gradient search algorithm is finer than the 3D dose matrix
• The location and value of the global max might vary between the 2D and final 3D calculations
− Typical variances are on the order of 0.7 - 1.4 mm 4
− This could lead to differences in the displayed dose distribution after each 2D or 3D
calculation
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DC-DOC-20-F

• Global Dmax is represented as an orange circle in the 2D views.

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CDC DOSE CALCULATION
MU Calculation

• MUs for a given field are calculated using following formula:

𝑅𝑒𝑝𝑒𝑎𝑡𝐹𝑎𝑐𝑡𝑜𝑟 𝑊𝑒𝑖𝑔ℎ𝑡𝐹𝑎𝑐𝑡𝑜𝑟@𝐼𝑠𝑜
𝑀𝑈
𝐴𝑣𝑒𝑟𝑎𝑔𝑒𝑇𝑀𝑅 𝐶𝑎𝑙𝑖𝑏𝑟𝑎𝑡𝑖𝑜𝑛𝐹𝑎𝑐𝑡𝑜𝑟

where:

𝑅𝑒𝑝𝑒𝑎𝑡𝐹𝑎𝑐𝑡𝑜𝑟

4 4

• WeightFactor@Iso is the relative weight of the arc field at its isocenter.

• RepeatFactor is the absolute dose (per fraction) delivered per unit total
weight to the selected algorithm normalization point.

• AverageTMR is the average of the multiple static field TMRs.

• CalibrationFactor is the Dose/MU for a cone scaled to Dmax depth and

SAD geometry.
• CalibrationFactor = ConeOutputFactor ∗ AbsoluteDoseCalibration

• TotalWeight is the total weight of the relative dose before normalization at

the selected algorithm normalization point.
• If the Normalization method is Global Dose Max, then the maximum dose
point in the body determines the MU:
𝑫
• TotalWeight = ∑ 𝑾𝒆𝒊𝒈𝒉𝒕𝑭𝒂𝒄𝒕𝒐𝒓𝒔@𝑰𝒔𝒐 ∗ 𝒎𝒂𝒙
𝑫𝒊𝒔𝒐
• If the Normalization method is Isocenter, then the dose will be scaled so
that the isocenter dose matches the prescription:
• TotalWeight = ∑ 𝑾𝒆𝒊𝒈𝒉𝒕𝑭𝒂𝒄𝒕𝒐𝒓𝒔@𝑰𝒔𝒐

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CDC DOSE CALCULATION
Normalization

• Dose is normalized to 100% at the dose maximum point (hotspot) of the plan, or to
the user selected the plan isocenter
• Initial plan treatment percentage is set to 100% by default
− May be changed to achieve the better target coverage
− Typically prescribe to 80% for single isocenter and to 70% for multiple isocenters

• A cone plan will display “no normalization” in Eclipse External Beam Planning
• A plan can be re-normalized in Eclipse External Beam Planning
− A warning will be displayed upon subsequent re-opening of the plan in Cone Planning
− Any subsequent change to plan in Cone planning which invalidates dose distribution will 4
reset normalization back to the cone planning workspace user selected default normalization
option.
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DC-DOC-20-F

• Changes to normalization in External Beam Planning will be reflected with a

change in dose and MU which will be seen in External Beam Planning as
well as Cone Planning.

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CDC DOSE CALCULATION
Dose Calculation for Multiple
Isocenters

• For multi-isocenter plans, dose

contribution from all fields is summed
over the dose matrix
• Isocenter weights are automatically
rebalanced to include dose contribution
from fields belonging to other isocenters
• To change the weighting of pre-existing
fields or isocenters:
− Open the Rebalance Weights dialog box
− Type the desired weight
4 4
− Click “Rebalance”

• Desired weights, as entered in the rebalance tool window, are the relative
contributions for each isocenter.
• The maximum value that can be entered for a Field Weight or
Desired weight is 100.
• Total is the current total relative dose for the isocenter (Direct +
Indirect).
• Direct is the relative dose attributed to the isocenter only from the
arcs associated with the isocenter.
• Indirect is the relative dose attributed to the isocenter from arcs
associated with other isocenters.
• Weight at Dmax is the relative dose to the plan hot spot.

• When isocenters have differing prescriptions, set the plan prescription

equal to the larger dose and weight the isocenters such that the ratio of
the relative isocenter dose equals the ratio of the dose prescriptions.

• If “Rebalance” is not selected after an edit, the change will not take effect.

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CDC DOSE CALCULATION
Limitations

• The CDC algorithm approximates arc dosimetry calculations as multiple static beams
• Tissue heterogeneity not taken into account
• Beam axis assumed to be normal to patient surface
− No obliquity correction

• Absence of backscatter not taken into consideration

• Off-axis ratios independent of depth
• SSD can only range from 70.1 - 100 cm
4
• SSD + depth of any calculation point must be less than 130 cm

• To determine the average TMR for an arc, the system draws static beams
at specified arc increments, based on the user selected Arc Resolution
Calculation option.
• The system then averages the TMRs from all the static beams
representing an arc to determine an average TMR for dosimetry
calculations.

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CDC ALGORITHM –
ISOCENTER SPACING

4 4

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ISOCENTER SPACING
Warning

• For multi-isocenter plans:

− Eclipse automatically determines optimal
spacing of the isocenters

• Optimal spacing between any two

isocenters is a function of cone size
• Spacing between two isocenters is
compared against a pre-defined table
− A warning is given when isocenter spacing
is below a threshold 4

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ISOCENTER SPACING
Automatic Isocenter Spacing Tool

• Automatic Isocenter Spacing Tool

− Sets the isocenter spacing at a pre-
determined distance along the vector
connecting two isocenters

− Pre-determined optimal spacing distances

are hard-coded in a table in Eclipse

4 4

• Auto-spacing sets the distance between two isocenters to be the value in

the table + 1.2 mm.

• If one isocenter has multiple cone sizes, the largest cone size is used.

• If cone sizes used do not match those in the table, the closest cone size
on the chart will be used.

• If the cone size is exactly between two cone sizes listed in the table, the
larger cone size in the chart will be used.

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ISOCENTER SPACING
Manually Ajusted

• Spacing between two isocenters in a

plan can also be adjusted manually
• Select the isocenter to move relative to
the isocenter that will remain fixed
• Hot spot threshold value is the
minimum distance from the table
− Selecting Auto will automatically move the
isocenter

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For education purposes only pg 113 EC16.1-CEM-12-A
MRI BODY SEARCH
ALGORITHM

4 4

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MRI BODY SEARCH ALGORITHM
Description

• The algorithm uses an adapted watershed transformation algorithm

− The MR image is considered a topographic surface where pixel intensity constitutes
elevation
− A rising water level is simulated by flooding the surface of the image
− The algorithm evaluates its progress and determines the appropriate level which denotes
the final body segment

• The search threshold is disabled using the Body Search tool

• The VOI can be adjusted to avoid artifacts
• Window/Level settings significantly affects the outcome can be adjusted to improve
results 4

• To reduce possible noise, the algorithm operates on a Gaussian

smoothed copy of the MR image.

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

For education purposes only pg 115 EC16.1-CEM-12-A
Thank you

4 4

References:

• P1044595-001-A – Eclipse Photon and Electron Algorithms Reference

Guide – Chapter 2, 7, 14
• P1038042-002-B – Image Registration and Segmentation Algorithms
Reference Guide – Chapter 3

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

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4

EC16.1‐CEM‐12‐A
DC-DOC-20-F

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4 4

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Beam Configuration

Beam Configuration TAB 5

CDC Beam Data Requirements

CDC Model Configuration

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CDC BEAM DATA
REQUIREMENTS

EC16.1‐CEM‐12‐A

DC-DOC-20-F
EC16.1‐CEM‐12‐A 5

CDC = Cone Dose Calculation

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OBJECTIVES

• Beam data requirements for the CDC

algorithm
• Approaches to Configuring CDC
• Set Default Calculation Models

DC-DOC-20-F
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BEAM DATA
REQUIREMENTS

5 DC-DOC-20-F
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CDC BEAM DATA REQUIREMENT
Overview

• Cone Set
− Tissue Maximum Ratios
− Off-axis Ratios
− Cone Output Factor table
− Absolute Dose Calibration

DC-DOC-20-F
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EC16.1‐CEM‐12‐A 5

• The jaw size defined in the Linac configuration must be used for all
measurements and the same jaw size should always be used for treatment.
• Using a different jaw size will cause the machine output to differ from
the conditions defined in Cone Planning configuration and could lead
to higher or lower delivered dose.

• TMR and OARs need to be saved in W2CAD format for import into Eclipse.

• Cone Output factors are manually entered into Eclipse.

• Absolute Dose Calibration is entered manually.

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CDC BEAM DATA REQUIREMENT
Small Field Measurements
AAPM TG155 recommendations:

• At least two suitable small-field detectors should be used to compare measurements

• Recommended detectors are:

For field size ≤ 1x1 cm2
− Single crystal microdiamond
− Unshielded stereotactic and electron diodes
− Plastic scintillator
For field size > 1x1 cm2
− Micro ionization chambers without high-Z electrode

• IAEA-TRS483 small field dosimetry formalism should be followed, and appropriate small field
correction factors should be applied

5 DC-DOC-20-F
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EC16.1‐CEM‐12‐A 5

• Due to the small fields used in stereotactic radiosurgery, partial volume

effects are noticeable if large volume detectors are used. Verify that the
measuring device is capable of accurately measuring very small fields.

• Detector systems usage:

• Diamond detectors: Single crystal MicroDiamond detectors are
preferable due to their tissue equivalence and very small size.
MicroDiamond detectors have been shown to measure dose with only a
small perturbation for very small-field sizes.
• Diodes: Choose unshielded diodes with a small active volume (a
stereotactic diode) and with an energy response suitable for beam data
acquisition.
• Ionization Chambers: Air-filled Micro ionization chambers are
recommended to be used if the field size is smaller than four times the
greatest dimension of the chamber. Ionization chambers are
recommended for absolute dose measurements, and for calibrating film and
diode detectors in central axis beams that fulfill the field size criteria stated
above.
• Plastic scintillator detectors: Advantages are their small size, tissue
equivalence, angular independence, and density similar to water.

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CDC BEAM DATA REQUIREMENT
TMR

• Measure a range of collimator sizes to be used clinically:

− Algorithm requires a minimum of 3 TMRs
− The 10 mm cone should be measured
− TMRs not measured are linearly interpolated and extrapolated from measured collimator data
− It is not recommended to use the 4 mm, 5 mm or 7.5 mm cone data for interpolation with larger cones

• Use Source to Detector Distance (SDD) of 100 cm

• Measure down to at least 20 cm depth

• Use as accurate resolution as possible:

− At least 5 mm from surface to dmax
− At least 10 mm past dmax

DC-DOC-20-F
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• Correct measurement of TMR is crucial for dose calculation accuracy.

• Therefore, consider validating the TMR data using at least two
instruments that use different physical approaches.

• Due to the very small field sizes, TMR data must be measured directly and
NOT converted from PDDs.

• It is recommended that you measure the 3 TMRs for the 10 – 17.5 mm cone
sizes.
• Additional TMRs may be added for the 4 mm, 5 mm and 7.5 mm
cones, but these should not be counted as one of the minimum 3
TMRs.

• TMR data will be stored in Beam Configuration with a resolution of 5 mm.

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CDC BEAM DATA REQUIREMENT
TMR Detection and Adaptation

• The CDC algorithm performs the following detections and adaptations:

− TMRs having negative values (for example, a few of the measurement points are in air):
− These values are removed

− TMR curves that drop to zero before the measurement ends:

− These values are removed

− TMR curves normalized to a value other than 100% at dmax are renormalized to 100% at dmax

5 DC-DOC-20-F
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EC16.1‐CEM‐12‐A 5

• Before calculating the configured beam data, the CDC configuration

program verifies the measured beam data and adapts the measured
values, if necessary.

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CDC BEAM DATA REQUIREMENT
OAR

• Measure a range of collimator sizes to be used clinically:

− Algorithm requires a minimum of 3 OARs
− 10 mm cone data should be measured
− It is recommended that you measure 3 OARs for the 10 mm – 17.5 mm cone sizes.
− Additional OARs may be added for the 4 mm, 5 mm and 7.5 mm cones, but these should not be counted as one of
the minimum 3 OARs

− OARs for cone sizes not measured are linearly interpolated and extrapolated from the measured
collimator data

• One Source to Phantom Distance (SPD) required

− If data for more SPDs are provided, these are used for averaging the input data for the fitting routine

DC-DOC-20-F
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EC16.1‐CEM‐12‐A 5

• CDC can handle OAR profiles for more than 3 collimator sizes.

• OAR data will be stored in Beam Configuration with a resolution of 1 mm.

• Due to the very small field sizes, OAR data must be measured directly.

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CDC BEAM DATA REQUIREMENT
OAR

• Measure at one depth

− Minimum depth of ≥ dmax

• Use as accurate a resolution as possible

− Use 1 mm spacing or less between measurement points regardless of SPD and cone size
− Lower resolution accepted by the system

• OAR profile should be correctly centered

− Utilize CAX correction tools during scanning

5 DC-DOC-20-F
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EC16.1‐CEM‐12‐A 5

• OAR data should be measured at one depth.

• OAR data will be stored in Beam Configuration with a resolution of 1 mm.

• OAR data can be stored at lower resolution if data is provided at a lower

resolution.

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CDC BEAM DATA REQUIREMENT
OAR Detections and Adaptation

• The CDC algorithm will perform the following detections and adaptations:
− When symmetric profiles are provided, only values with positive coordinates are used
− Profiles that drop to zero before the measurement ends, these values are removed
− Profiles normalized to a value other than 100% at the central axis are renormalized to 100% at the
central axis
− If the projected X coordinate of the 50% value of the profile deviates more than 1 mm from the
assumed field edge position (at the distance of SAD = 100 cm), an ERROR message is shown

DC-DOC-20-F
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EC16.1‐CEM‐12‐A 5

• Before calculating the configured beam data, the CDC configuration

program verifies the measured beam data and adapts the measured
values, if necessary.

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CDC BEAM DATA REQUIREMENT
Cone Output Factor

• Relative output factors at reference geometry

− Normalized to 1 for the reference field size
− Typically measured SAD at depth ≥ dmax

• Required for every cone to be used in planning

• Use the same jaw size opening for measurement of output factors as for treatment

• Absolute Calibration of CDC model must match geometry used in measuring Output Factors

5 DC-DOC-20-F
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EC16.1‐CEM‐12‐A 5

• The Output Factor (OF) is the relative dose at reference geometry as a

function of collimator size, normalized to unity for field size used in the
absolute dose calibration (typically open 10x10 cm2 field).

• Consider measuring the absolute dose and output factors in a

geometrical setup that is as close to the treatment geometry as possible.
• For example, for a 6 MV beam: SSD = 95.0 cm and depth to point of
interest = 5.0 cm.

• When configuring the CDC algorithm, there are upper and lower limits on
output factors, but the user is not notified until they attempt to calculate
beam data with output factors that exceed the system limits.

• The jaw size defined in the Linac configuration must be used for all
measurements and the same jaw size should always be used for treatment.

• Using a different jaw size will cause the machine output to differ from the
conditions defined in Cone Planning configuration and could lead to higher
or lower delivered dose.

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For education purposes only pg 130 EC16.1-CEM-12-A
CDC BEAM DATA
REQUIREMENT
Absolute Dosimetry

• Reference dose (Gy) at calibration depth for:

− Reference field size (usually 10x10 cm2)

− Reference MU

• Absolute dose calibration reference

geometry entered for the model must be the
same as output factor geometry

DC-DOC-20-F
© 2022 VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only.
EC16.1‐CEM‐12‐A 5

• Absolute dose measurement provides the algorithm calibration:

• Geometry for absolute calibration of the CDC model needs to be
the same as the geometry used for the output factor
measurements.

• The user specifies the geometric parameters used to specify the absolute
dose measurement in the software:
• Calibration Source to Phantom Distance
• Calibration Depth
• Reference Field Size

• The machine output is then given by providing the following for the
specified conditions:
• Reference Dose at Calibration Depth
• Reference MU

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For education purposes only pg 131 EC16.1-CEM-12-A
APPROCHES TO
CONFIGURING CDC

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For education purposes only pg 132 EC16.1-CEM-12-A
APPROACHES TO CONFIGURING CDC
Configuration Workflow

Use your Own Measured Beam Data Use ICVI Representative Beam Data

• Have your beam data (TMR & OAR) in • Downloaded ICVI beam from
W2CAD format MyVarian.com
• Import W2CAD files into beam model • Import W2CAD files into beam model
• Manually enter Cone Factors and • Manually enter Cone Factors and
Absolute Dosimetry data Absolute Dosimetry data
• Calculate and Approve CDC Beam data • Calculate and Approve CDC Beam data
model model

DC-DOC-20-F
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For education purposes only pg 133 EC16.1-CEM-12-A
APPROACHES TO CONFIGURING CDC
ICVI Beam Data

• Contains minimum required data (scans and output factor tables) to configure
CDC
• Posted on MyVarian.com under Documentation Library Tab
• ICVI Beam Data includes:
− TrueBeam®
− Acquired using multiple TrueBeam® linear accelerators (representing average TrueBeam®)
− 6 MV, 6-FFF MV, 10 MV and 10-FFF MV

− C-Series
− Acquired using multiple C-series linear accelerators (representing average C-series Linac)
− 6-SRS MV
5 15

DC-DOC-20-F
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EC16.1‐CEM‐12‐A 5

• On MyVarian.com Product Group - Eclipse -> DocumentType - Downloads

> ICVI Conical Collimators Representative Beam Data for Eclipse.

• Note: IAEA-AAPM TRS-483 recommended correction factors have not

been applied to ICVI Representative Beam Data set.

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For education purposes only pg 134 EC16.1-CEM-12-A
CALCULATIONS
DEFAULTS

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CALCULATION DEFAULTS

• To set Calculation Defaults:

− Click Beam Data drop-down

− Select Calculation Defaults

• Defaults are not specific to a machine

or an energy

5 DC-DOC-20-F
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For education purposes only pg 136 EC16.1-CEM-12-A
CALCULATION DEFAULTS

• Photon (Particle Type)  Stereotactic

Dose (Calculation Type)
− Select CDC model from Default Model
drop-down list

− Click Edit under Default Options

DC-DOC-20-F
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CALCULATION DEFAULTS

• Select Normalization method

− Global Dose Max

− Isocenter

• Select Grid size to be used away from

the isocenter
− Sparse = 5 mm grid

− Fine = 1 mm grid

5 DC-DOC-20-F
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• Global Dose Max normalizes dose 100% to Global Dose Maximum.

• Isocenter normalizes dose 100% to isocenter defined in option

Normalization isocenter.

• Fine grid will always be used around the isocenter to a radial distance
equal to twice the diameter of the cone plus 5 mm.

• A Sparse grid can be used to speed up calculations by using sparse grid in

low dose regions far away from isocenter (2 * Cone Diameter + 5 mm).

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For education purposes only pg 138 EC16.1-CEM-12-A
Thank you

DC-DOC-20-F
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EC16.1‐CEM‐12‐A 5

References:

• P1044595-001-A – Eclipse Photon and Electron Algorithms Reference

Guide – Chapter 2, 7, 14, Appendix C
• ICVI Conical Collimators Representative Beam Data for Eclipse Rev 2.0
document
• IAEA-TRS483. Dosimetry of Small Static fields Used in External Beam
Radiotherapy: an IAEA-AAPM International Code of Practice for Reference
and Relative Dose Determination. Technical Report Series No. 483. Vienna,
Austria: International Atomic Energy Agency; 2017 (https://www-
pub.iaea.org/MTCD/Publications/PDF/D483_web.pdf)
• Das IJ, Francescon P, Moran JM, et al. Report of AAPM Task Group 155:
Megavoltage photon beam dosimetry in small fields and non-equilibrium
conditions. Med Phys. 2021;48(10):e886-e921.
(https://doi.org/10.1002/mp.15030)

©Varian, a Siemens Healthineers company Eclipse 16.1 Cone Planning

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CDC Model Configuration

CDC Model Configuration

Procedure

Objectives
Following along with your instructor, you will perform these tasks:

1) Configure Eclipse Cone Dose Calculation (CDC) model for one photon beam energy.

Procedure Contents
1) Create a new therapy unit name starting with empty data.
5
2) Add a new cone set add on to the model.
3) Import measured TMR and OAR data as W2CAD files.
4) Manually enter Cone Output Factors and Linac absolute calibration reference conditions information.
5) Calculate and approve the model and review configuration results.

References
1) P1026479-002-B – Beam Configuration Reference Guide – Eclipse Chapters 3, 4
2) P1044595-001-A – Eclipse Photon and Electron Algorithms Reference Guide – Chapter 7

Important Note: This procedure demonstrates how to configure CDC Model. In our
example, we configure a CDC model using measured data. Note that the data used in this
example are the Varian ICVI Representative Beam Data set, where the IAEA-AAPM TRS-
483 recommended correction factors have not been applied. For configuring clinical
models, always check and follow the most current national and international protocols and
recommendations.

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CDC Model Configuration

A. Open Beam Configuration

1) Login to UserHome( ).

Note: ‘Configure Beam’ user right is necessary to access Beam Configuration.

2) Navigate to Beam Configuration workspace:

QuickLinks > Treatment Planning > Beam Configuration. See Figure 1.

5 5

Figure 1: QuickLinks > Treatment Planning > Beam Configuration

3) Read the message and click Continue to proceed. See Figure 2.

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CDC Model Configuration

Figure 2: Entering Beam Configuration 5

Note: Modifying calculation and/or optimization models in the Beam Configuration module
affects calculation and/or optimizations on all workstations using affected models.

4) In the Scope Window find the treatment unit the ECDC model is to be configured for.
See Figure 3.

Figure 3: Scope Window – Machine List

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CDC Model Configuration

5) Expand the tree under treatment unit of interest by clicking until you see the ECDC model for the
energy to be configured. See Figure 4.

Figure 4: ECDC Model

5 5
Note: Actual name (‘ECDC’) of the calculation model may vary depending on the label
selected at the time of the installation. On creating models in beam configuration it is always
advisable to name the models based on the algorithm and full algorithm version (including
build number).

6) Right-mouse click the calculation model name, and select New Beam Data…. See Figure 5.

Figure 5: New Beam Data

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CDC Model Configuration

7) Select Start with empty data, define Therapy Unit Name and Energy and click OK.
See Figure 6.

Figure 6: Insert New Beam Data

Note: A Calculation Model can use existing data. Data from an existing calculation model
can be either copied or assigned to the new calculation model.

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CDC Model Configuration

8) Highlight General Parameters and verify the settings. See Figure 7

Figure 7: General Parameters

9) Right-mouse click the Therapy Unit Name and select New Add-On…. See Figure 8.

5 5

Figure 8: New Add-On

10) Enable Cone set checkbox and click OK. See Figure 9.

Figure 9: New Add-On Data

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CDC Model Configuration

11) Highlight the new Cone set - CN add-on, right-mouse click and select Import > Measured Tissue
Maximum Ratios. See Figure 10.

Figure 10: Import -> Measured Tissue-Maximum Ratios

12) Navigate to desired directory and select the desired file (change the file extension filter accordingly if
needed). Click OK to import the selected file’s content. See Figure 11. 5

Select curve data and preview.

All file content is imported, not
just selected curve

Figure 11: Import Basic Measurement Data

Note: File extension may be different depending on the water phantom software. The file
must be in correct W2CAD format.

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CDC Model Configuration

13) Highlight Measured Tissue-Maximum Ratios and define Source to detector distance for all TMR
measurements. See Figure 12.

5 5

Figure 12: Measured Tissue Maximum Ratios

14) Repeat step 11) to 12) to import Off-Axis Ratios.

15) After the import, highlight Measured Off-Axis Ratios and review the imported data. See Figure 13.

After selecting a curve the system

displays ‘Curves at Field Size’,
‘Curves at Depth’ and ‘Curves at
SSD’, each in a separate view

Figure 13: Off-Axis Data Review

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CDC Model Configuration

16) Highlight the Cone Set - CN add-on, right-mouse click, and select Insert > New Measured output
factors. See Figure 14.

Figure 14: Insert > New Measured Output Factors

Note: When configuring the CDC algorithm, there are upper and lower limits on output 5
factors, but the user is not notified until they attempt to calculate beam data with output
factors that exceed the system limits.

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CDC Model Configuration

17) Highlight Measured Output Factors. Then define parameters for output factor measurements, cone
Sizes[mm], and corresponding Output Factors. See Figure 15.

5 5

Figure 15: Cone Output Factors

18) Highlight the Cone Set – CN add-on, right-mouse click and select Insert > New Absolute dose
calibration parameters. See Figure 16.

Figure 16: Insert > New Absolute Dose Calibration Parameters

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CDC Model Configuration

19) Highlight Absolute dose calibration parameters and define model calibration parameters. See Figure
17.

Figure 17: Absolute Dose Calibration Parameters

Note: Absolute calibration geometry entered must be the same as output factor
measurement geometry.

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CDC Model Configuration

20) Right-mouse click the Cone Set – CN add-on and select Calculate Beam Data. Confirm the message to
save all data. See Figure 18.

Figure 18: Calculate Beam Data

21) Confirm that the data will be saved – click OK. See Figure 19.

5 5

Figure 19: Data Will Be Saved

22) Review calculated objects. See Figure 20.

Figure 20: Configured Cone Set

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CDC Model Configuration

23) Highlight the Cone Set – CN add-on, right mouse click and select Match and Assign Add-Ons…. See
Figure 21.

Figure 21: Match and Assign Add On.

24) Verify that all cones for which the output factor value is defined are matched to the Add-on ID. Click 5
Close when done. See Figure 22.

Figure 22: Match and Assign Add-Ons verification

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CDC Model Configuration

25) Highlight the Therapy Unit Name, right-mouse click and select Approve Data. See Figure 23.

Figure 23: Approve Data

26) Select Beam data has been reviewed and it is correct and click Approve to confirm model approval.
See Figure 24.

5 5

Figure 24: Approval Confirmation

Note: The data must be approved to be able to calculate dose distribution with the model.

Note: Beam Analysis cannot be used to calculate cone dose.

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Treatment Planning with Cones

Treatment Planning with Cones TAB 6

Image Registration

Contouring

Single Target Cone Planning

Verifying MU

Multiple Targets Cone Planning

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Image Registration

Image Registration
Procedure

Objectives
1) Lead by instructor, the students will register a CT image dataset to an MR image dataset to be used for a
single target cone plan.

Procedure Contents
1) Review Registration workspace GUI.
2) Register the CT to the MR dataset for the selected patient using the Auto Rigid Registration tool.
3) Identify the Review Options.

6 6
References
1) P1053285-001-A – Eclipse Photon and Electron Instruction for Use – Chapter 3, 4, 17
2) P1044595-001-A – Eclipse Photon and Electron Algorithms Reference Guide – Chapters 3, 4, 5

3) P1038042-002-B – Image Registration and Segmentation Algorithms Reference Guide – Chapter 2

4) P1036224-006-F – Image Registration and Segmentation Instructions for Use – Chapter 3, 4

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Image Registration

A. Registering Image Sets

Note: This procedure assumes that the patient data (CT and MR) have been imported in
Eclipse using DICOM Import Export workspace.

1) Login to UserHome( ).
2) Select QuickLinks > Imaging > Image Registration. See Figure 1.

Figure 1: QuickLinks > Imaging > Image Registration

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Image Registration

3) Click Open Patient and then use the Patient Explorer dialog to open the required patient (US-
SRS-01). See Figure 2.

6 6

Figure 2: Patient Explorer

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Image Registration

4) Current patient data will be loaded; available 3D image sets are previewed in the Image Icon Strip.
Context Preview shows the active 3D image set. See Figure 3.

Image Icon Strip

Context Preview

Figure 3: Registration GUI

5) Double click on the image icon to load the desired image if necessary.

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Image Registration

6) Create a new Rigid Registration.

a) For the exercise, Auto Match will be used to register the images.
b) Click Registration > Auto Matching. See Figure 4.

Figure 4: Registration > Auto Matching

Note: Creation of registration does not perform matching. Always verify the results of
matching.

6 6

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Image Registration

7) Define the registration Name and select Target (Primary) and Source (secondary) images. Click OK to
continue. See Figure 5.

Figure 5: New Rigid Registration

6
8) A new Rigid Registration is created by overlapping selected image sets in the view.
a) The Registration Name (AUTOREGISTRATION) is displayed above Context Preview.
b) The registration is represented by a line pointing from the Source Image to the Target Image.
c) Both images will be opened in the Context Preview. See Figure 6.

Figure 6: MRI to CT Registration

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Image Registration

9) The Auto Matching dialog box opens automatically.

a) Select the Parameter Set and adjust Volume of Interest to cover desired area of both images in all
planes.
b) Click Start to run the auto matching algorithm. See Figure 7.

6 6

Figure 7: Auto Matching

Note: For more information on matching algorithms and options, refer to Eclipse Image
Registration and Segmentation Algorithms Reference Guide and Eclipse Image
Registration and Segmentation Instructions for Use.

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Image Registration

10) When the automatic matching is completed, click Close.

Figure 8: Auto Matching > Close

11) Thoroughly evaluate results; make adjustments if necessary with Manual Match tool active.
a) Several tools are available for this purpose: Blending, Split Window, Moving Window and Color Blend
tools.

b) Use tool to toggle between transversal, sagittal and coronal views. With Manual Match active
images can be moved with mouse or arrow keys on the keyboard. See Figure 9.

Moving Window
example

Figure 9: Match Evaluation

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Image Registration

12) Undo (CTRL+Z) is also available from Edit menu if changes are to be reverted.

13) Click Save All when done. See Figure 10.

With Manual Match

active, the Source Image
can be moved with
mouse or arrow keys on
the keyboard

6 6

Figure 10: Save All

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Contouring

Contouring
Procedure

Objectives
1) Lead by instructor, the students will contour a few basic structures for a single target cone plan using a
patient with a Frameless CT Image dataset previously registered to an MR Image dataset.

Procedure Contents
1) Create and edit the body structure contours.
2) Demo the assignment of a CT scanner to a 3D CT image dataset, show the assignment of a Physical
Materials Table and discuss related caviats specific to Cone planning.
3) Create and contour the PTV structure as a high resolution structure.
4) Create and contour the Brain structure using the Segmentation Wizard tool.
6
5) Create the Brain-sub-PTV structure and contours using the Booling Operators tool and discuss Controlled
Structure Terminology.
6) Assign and discuss User Orgin.

References
1) P1044593-001-A – Eclipse Photon and Electron Instruction for Use – Chapter 5, 17

1) P1044595-001-A – Eclipse Photon and Electron Algorithms Reference Guide – Chapter 4, 6

2) P1038042-002-B – Image Registration and Segmentation Algorithms Reference Guide – Chapter 3

3) P1036224-006-F – Image Registration and Segmentation Instructions for Use – Chapter 3, 5

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Contouring

A. Contouring

Note: This procedure assumes that the patient has CT and MRI 3D image datasets that
have already been registered.

1) Login to UserHome( ).
2) Select QuickLinks > Treatment Planning > Contouring. See Figure 1.

6 6

Figure 1: QuickLinks > Treatment Planning > Contouring

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Contouring

3) Click Open Patient and then use the Patient Explorer dialog to open the required patient.
See Figure 2.

Figure 2: Patient Explorer Window

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Contouring

4) Available 3D image datasets are displayed in the Image Icon Strip. Double-click the CT icon on the
image strip to load and activate the 3D CT image, if necessary. Hover over the Context Preview to make
sure CT image is active. See Figure 3.

Image Icon Strip

Context Preview

Figure 3: Contouring Workspace – Available Image Sets and the Active Image Set

5) To create a new structure, right-mouse click the CT image in Context Preview and select New
Structure…. See Figure 4. Alternatively, a new structure can be inserted by selecting New Structure…
from the Structure menu.
6 6

Figure 4: New Structure Creation

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Contouring

Note: Since v15, body auto-segmentation is now automatically applied to all CT images.
User with System Administration rights can change default processing options for Body
Auto-segmentation by setting current options of the Body Search tool as institution default.
CBCT and MRI images require applying the Body Search tool manually. If the body
structure is not outlined, you can proceed in the following way.

6) Create the Body structure (if body contour has not been automatically created) – start typing Body in the
Structure code box; the system will dynamically search the structure dictionary as you are typing, select
Body from the list. See Figure 5.

6
Figure 5: Create New Structure – Body Label Search

7) Review / define the structure ID and structure Color. Then click Create. See Figure 6.

Figure 6: Create New Structure Window – Body Structure Creation

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Contouring

8) With the Body structure selected in the Context Preview, select the Search Body from the Drawing
Tools toolbar to segment the body outline. See Figure 7.

6 6

Figure 7: Drawing Tools - Search Body Tool Selection

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Contouring

9) Select the HU Threshold, review / modify Post Processing options and click to enable VOI for
segmentation. Finally, click Apply to segment the body outline. See Figure 8.

Adjust VOI if
enabled

Figure 8: Search Body Tool Options

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Contouring

10) Use mouse wheel or Page Up/Page Down keys to scroll through CT slices and review results. If
needed, repeat step 9) to recreate the body structure contours until segmentation results are
satisfactory.

Note: The structure Set is created automatically when the first new structure is created for
the 3D CT image. See Figure 9.

Structure Set

Figure 9: Structure Set Automatically Created with First New Structure Creation

Note: The CT scanner assigned to the 3D CT image can be verified in the Series tab of the
3D CT image Properties Window. See Figure 10. Note however, that the Cone Dose
Calculation algorithm does not have heterogeneity correction and therefore does not use
the CT scanner information. Cone Dose Calculation can be performed, and results are the
6 same, independent of whether a CT scanner has been assigned to the 3D CT image or not. 6

Figure 10: 3D CT Image Dataset Properties and CT Scanner Assignment

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Contouring

Note: Physical Material Table can be defined in CT Value and Material tab of Structure
Properties, if necessary. Only AcurosXB can use and requires this information. See Figure
11.

Figure 11: Defining Physical Material Table for Structure Set

11) Create a new PTV structure. Right-mouse click the CT image in the Context Preview and select New
Structure…. See Error! Reference source not found..

Figure 12: New Structure Creation

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12) In the Create New Structure dialog, start typing PTV in the Structure code box and then choose the
most appropriate option from the structure code dropdown list. See Figure 13.

Figure 13: Create New Structure – PTV Label Search

13) Review / define the structure ID, Type and structure Color. Then click Create. See Figure 14.

6 6

Figure 14: Create New Structure Window – PTV Structure Creation

14) In the Context Preview, right-mouse click the PTV structure and select Convert to High Resolution
Segment. See Figure 15.

Figure 15: Convert to High Resolution Structure

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15) Confirm the conversion by clicking OK. See Figure 16.

Figure 16: Confirm Conversion to High Resolution Structure

16) Double-click the registration chain to blend the registered CT and MR image sets. Adjust the blender to
sufficiently see the tumor on the MR image. See Figure 17.

Double-click registration to blend

Figure 17: Image Registration Blended View

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Contouring

17) Select the PTV structure in Context Preview and then select the Draw Planar Contour tool from the
Drawing Tools toolbar. See Figure 18.

Figure 18: Draw Planar Contour Tool Selection

18) Select the Draw Planar Contour options to be used and then contour the PTV. You can move between
slices using mouse wheel or Page Up / Page Down keys. Use CTRL + mouse wheel to zoom in / out and
press the mouse wheel down to pan. See Figure 19.

6 6

Figure 19: Draw Planar Contour Tool Options

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Important Note: If Automatic Interpolation option is not used and the PTV is not drawn on

all the slices where the target is, use the Interpolate Structure tool to interpolate the
contour between slices where it was drawn.

19) Create a new structure for brain. Right-mouse click the CT image in Context Preview and select New
Structure…. See Figure 20.

6
Figure 20: New Structure Creation

20) Start typing Brain in the Structure code box and then select the most appropriate option from the
Structure code dropdown list. See Figure 21.

Figure 21: Create New Structure – Brain Label Search

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21) Review / define the Structure ID, Type and Structure Color. Then click Create. See Figure 22.

Figure 22: Create New Structure Window – Brain Structure Creation

22) With Brain structure active, select the Segmentation Wizard tool from the Drawing Tools toolbar. See
Figure 23.

6 6

Figure 23: Segmentation Wizard Tool Selection

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23) Select Brain as the organ to be segmented, check Target Structure, enable VOI if desired and define its
size and position on all views. Click Apply to segment the brain. See Figure 24.

Figure 24: Segmentation Wizard Tool Options

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24) Create a new structure for brain without PTV. Right-mouse click the CT image in Context Preview and
select New Structure…. See Figure 25.

Figure 25: New Structure Creation

25) Start typing Brain in the Structure code box and then select the most appropriate option from the
Structure code dropdown list. See Figure 26.

6 6

Figure 26: Create New Structure – Brain Sub PTV Label Selection

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Note: Not all codes in the structure dictionary are enabled by default. If you can’t find
appropriate Label for your structure, go to RT Administration > Clinical Data > Structure
Dictionary to see whether there is an appropriate Label that is inactive and activate it. See
Figure 27. Eclipse must be closed and re-started for the changes to take effect.

Figure 27: Structure Code Properties Window in RT Administration

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26) Review / define the structure ID, Type and structure Color. Then click Create. See Figure 28.

Figure 28: Create New Structure – Brain Sub PTVs Structure Creation

27) With Brain sub PTV structure active, select Boolean Operators tool from Drawing Tools toolbar.
See Figure 29.

6 6

Figure 29: Boolean Operators Tool Selection

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28) Select First Structure, Second Structure and the operation to be performed (Operator). Check the
Target Structure and click Apply. See Figure 30.

Boolean operators can be used

between structures of different
resolution (High or Normal)

Figure 30: Boolean Operators Tool Options

29) Double-click the CT image in the Image Icon Strip to un-blend the view and display CT image only.
30) Evaluate results on all slices.
31) Contour additional structures as needed using any appropriate tool available in Drawing Tools.

32) Click Save All .

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B. User Origin
1) The imaging device used for patient imaging saves the DICOM origin to the image data. When the images
are imported into Eclipse, the user origin is created and positioned at the DICOM origin location. All
coordinates in Eclipse are shown with respect to User Origin.

a) The User Origin is shown in the 3D image views as a ‘green +’ .

2) You can change the position of the user origin as follows:
a) Move the User Origin with the mouse.
b) Define the location of the new User Origin in relation to the DICOM coordinates.
c) Move User Origin to a predefined position such as Viewing Plane Intersection (or Field Isocenter,
Field Entry Point available in External Beam Planning workspace).
3) The User Origin can be used for automatically calculating the couch shifts required for the patient
treatment. For this purpose, the User Origin can mark a reference setup point in the patient, such as the
simulation isocenter. For instance, you can mark the reference point by moving the user origin to a fiducial
marker. When imaging the patient, the images produced by the CT include the fiducial markers, which will
show in the images imported into Eclipse.
4) Verify the position of User Origin. Right-mouse click User Origin and select Move Viewing Planes to
User Origin to see transverse, coronal and sagittal planes where the User Origin is located. See Figure
31.
6 6

Figure 31: User Origin Location

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5) If the position of the User Origin needs to be changed, define its new location by moving the viewing
planes. Double-click the registration to blend CT and MR, if MR assistance is required. Then right-mouse
click the User Origin and select Set User Origin…. See Figure 32.

Double-click registration to blend

Images are blended

6
Figure 32: Set User Origin

6) Set “Set to predefined target” to Viewing plane intersection and click OK. See Figure 33.

Figure 33: Set User Origin Window – Set User Origin to Viewing Plane Intersection

Note: The user origin must be placed to the reference setup point, such as the simulation
isocenter for the results of the couch shift calculation to be usable and correct for the patient
treatment.

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Single Target Cone Planning

Single Target Cone Planning

Procedure

Objectives
1) Lead by instructor, the students will create a Cone Plan for Stereotactic Radiosurgery for a patient with a
Frameless CT Image dataset which has previously been contoured.

Procedure Contents
1) Use the Create New Plan wizard to add a new plan in the cone planning workspace.
2) Use the Cone Planning tools to locate the PTV center and add the plan beams using one of the Varian
arc templates.
3) Discuss editing the cone plan geometry and demo the cone planning workspace general GUI tools and
6 navigation. 6
4) Discuss adding a prescription and evaluating the 2D dose.
5) Demo reviewing and modifying dose calculation options and calculate the final 3D dose.
6) Discuss cone planning workspace tools for plan review and evaluation (including review of DVH and
target structure metrics).
7) Demo the preparation of a cone plan for treatment and show the printing options within the cone planning
workspace.

References
1) P1044593-001-A – Eclipse Photon and Electron Instruction for Use – Cone Planning Chapter

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Single Target Cone Planning

A. Cone Planning

Note: The following procedure assumes the image set has been imported, registered and
contoured.

1) Login to UserHome( ).
2) Select QuickLinks > Treatment Planning > Cone Planning. See Figure 1.

Figure 1: QuickLinks > Treatment Planning > Cone Planning

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3) Select patient (SRS, Frameless) from list of Recent Patients or select More Patients to open Patient
Explorer. See Figure 2.

“More Patients”
opens the Patient
6 Explorer 6

Figure 2: Recent Patient List

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4) From the Object Explorer, select the CT image set. See Figure 3.

Figure 3: Object Explorer

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B. Create Single Isocenter Cone Plan

1) Under the Fields tab, select Create New Plan. See Figure 4.

Figure 4: Create New Plan

2) In the Plan Wizard, select Create new plan to the current image. Click Next. See Figure 5.

6 6

Figure 5: Plan Wizard - Select Operation

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3) In Plan Information, enter Plan ID and select or enter a Course ID. Select a Protocol/Phase if desired.
Click Next. See Figure 6.

Figure 6: Plan Wizard - Plan Information

4) In Treatment Unit, select desired Technique/Energy, Dose Rate and Tolerance. Click Finish. See Figure
7.

Figure 7: Plan Wizard - Treatment Unit

Note: Above plan parameters cannot be changed in Cone Planning. Open the plan in
Eclipse to change the name, energy or dose rate.

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5) Select the Structures tab and highlight the PTV. See Figure 8.

6) Click the Move Viewing Plane to Structure Center Point button ( ) to move the viewing plane
intersection to the center of the PTV. See Figure 8.

6 6
Figure 8: Move Viewing Plane to Structure Center Point

7) Select the Fields tab. Click Insert Arcs from Template tool. This tool can be found at two locations. See
Figure 9.

Figure 9: Insert Arcs from Template

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8) Select an Arc Set Template from the list, choose a cone diameter, and enter a Desired Weight. Click
Insert. See Figure 10.

Figure 10: Select Arc Set Template 6

Tip: For appropriate selection of Arc Set Template:

a) Approximate spherical dose distributions are attained from 5 and 9 arc templates.
b) Non-spherical lesions may require multiple isocenters packed inside the target area.
c) If multiple isocenters are needed, a suggested minimum spacing between isocenters is
calculated by Cone Planning. A warning will be displayed if isocenters are too close.
d) For single isocenter plans, the prescribed isodose display is defaulted to 80 and 40%.
For multiple isocenter plans, the default is 70 and 35%.
e) If Desired Weight is left blank, the fields will default to a relative weighting value of 1.0.
f) Maximum Desired Weight is 100 per isocenter.

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C. Edit Cone Plan Geometry

1) Reposition Isocenter, if necessary, using the Move Isocenter tool. See Figure 11.

6 6

Figure 11: Move Isocenter Tool

2) The isocenter can also be moved by typing in the Isocenter Position. See Figure 12.

Figure 12: Type in Isocenter Position

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3) Highlight each arc field to modify its parameters.

4) Edit gantry angle manually by typing Start and Stop angles or graphically by clicking and dragging start
and stop angle handles in the Arc Plane View. See Figure 13.

Figure 13: Edit Gantry Start and Stop Angles

6
5) Edit the couch angle manually by typing value for selected field or graphically by dragging any of the three
handles displayed in the Frontal View. See Figure 14.

Figure 14: Edit Couch Angle

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6) The Cone Size for all fields associated with an isocenter can be changed by highlighting the isocenter and
then selecting the desired cone size in the drop-down list. See Figure 15.

6 6

Figure 15: Edit Cone Size for All Fields Associated with Isocenter

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7) To edit the cone size for an individual arc, highlight the arc field and select the Cone Size from the
drop-down menu. See Figure 16.

Figure 16: Edit Cone Size for Individual Arc Field

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D. Calculate and Evaluate Cone Plan

1) Select the Prescription tab and enter the treatment prescription. See Figure 17.

6 6

Figure 17: Enter Treatment Prescription

2) Select the Calculation tab. Ensure that the correct Calculation Model is selected and click the
Calculate 3D Dose button. See Figure 18.

Figure 18: Calculate Plan

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Caution: Verify the dose calculation and dose display against independent verification
methods, for example, manual calculations or measurements. This is to ensure that the
following is correct:

 MU data is correctly interpolated and calibrated.

 MU calculation is correct.

 Configuration of the dosimetric data is correct.

P1053285-001-A Eclipse Photon and Electron Instructions for Use,

Page 354.

3) In the Fields tab, click the Move Viewing Plane to 3D Dose Maximum button to move images to plan
hotspot, indicated by an orange circle. See Figure 19.

Figure 19: Move Viewing Planes to 3D Dose Max

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4) Select Prescription tab to Add or Delete isodose line values. Click on the colored square to edit the line
color or width. See Figure 20.

6 6

Figure 20: Edit Isodoses

5) In the Images tab, the desired registered image set may be selected to display blending with planning CT.
See Figure 21.

Figure 21: Select Registered Image to Display

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6) The Blend tool can be adjusted to display either image set, or a blend of both image sets. See
Figure 22.

Figure 22: Blend Tool

7) The window and level of either image set can be adjusted with the Window/Level tool( ).

8) Select the desired image to window/level then adjust by moving the blue dot, shifting the slider bars,
manually typing desired values or selecting preset levels. See Figure 23. 6

Figure 23: Window/Level Tool

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9) Select the Measure Distance tool then click and drag to measure distances in any orthogonal view or the
Arc Plane View. See Figure 24.

Figure 24: Measure Distance Tool

10) RMC on the Measure Distance line or click on the down arrow to Delete line or Show Dose Line Profile.
See Figure 25.

6 6

Figure 25: Dose Line Profile

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11) Use the Point Dose tool to view doses outside of target. RMC on the point or click on the down arrow
to display menu options: Delete (the point), Show Dose Curve (displayed as blue dotted line), Show
Coordinates of the point and Move to… to manually define X, Y, Z coordinates of the point. See Figure
26.

Figure 26: Point Dose Tool

12) The isodose labels can be toggled on and off by selecting the Isodose Visibility tool. See Figure 27.
6

Figure 27: Isodose Visibility Tool

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13) Toggle the dose labels between Gy and % using the Absolute/Relative Dose tool. See Figure 28.

Figure 28: Absolute/Relative Dose Tool

14) Highlight desired arc field then select the Arc Plane View to check the path of the arc field and adjust if
necessary. Repeat for all fields. See Figure 29.

6 6

Figure 29: Arc Plane View

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E. Review the DVH for Contoured Structures

1) To view DVH select Cumulative DVH Chart from the drop-down in the upper right window.
2) Highlight structure(s) to be displayed in the DVH graph either in the Structure list under the Structures tab
or under Select structures to show at the top of the DVH window. See Figure 30.

Figure 30: Cumulative DVH Chart

1) Place mouse on DVH curve to display Equivalent Sphere Diameter for the volume as well as
dose, volume information. The isodose line for the selected dose is displayed with a dotted line in
the orthogonal views. See Figure 31.

Figure 31: Equivalent Sphere Diameter

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3) Under the Structures tab, highlight the desired structure and review Dose Statistics. See Figure 32.

6 6

Figure 32: Structure Dose Statistics

Note: Conformity Index and Gradient Measure will only display results for the structure
defined as PTV.

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F. Prepare Plan for Treatment

1) In the Fields tab, highlight arc field to change field ID if desired. See Figure 33.

Figure 33: Edit Field Name

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2) Reorder fields into desired treatment order prior to treatment approval and export.

3) Select the Edit treatment order tool ( ).

4) Highlight fields and click Move Up or Move Down to arrange fields in the desired treatment order. Click
Apply. Once they are in desired order, click Rename Fields to change Field ID to match new treatment
order. See Figure 34.

6 6

Figure 34: Edit Treatment Order Tool

Note: Renaming field will overwrite current name and replace with reordered Field #.
Comments will auto populate with beam number, isocenter number and collimator size.

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5) Review calculated monitor units for each field in the Fields tab. See Figure 35.

Figure 35: Review MU

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G. Save and Approve Plan

1) Click Save ( ).
2) Under the Prescription Tab, click Change Status. See Figure 36.

6 6

Figure 36: Change Status

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3) The Plan Approval Status window will appear. Check the Warnings and errors, Dose Summary, and 3D
Dose Statistics. In the Approval section, select Planning Approved under Set Status to section. If desired,
select Calculate treatment times checkbox and enter the desired value in Multiply with factor box. See
Figure 37.

Figure 37: Plan Approval Status

4) Click Finish and enter password. See Figure 37 above.

5) Select Print to print desired reports. See Figure 38.

Figure 38: Print Menu

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H. Information Printed
6) Plan Parameters Report
a) General Patient and Plan information
b) Transversal image of isocenter
c) Calculation Notes
d) Prescription Details
e) Field Parameters
7) Dosimetry Report
a) General Patient and Plan information
b) Calculation Notes
c) Prescription Details
d) Isocenter Weighting details
e) Setup Parameters
f) Dosimetric Parameters
8) Setup Form
a) General Patient and Plan information
6 b) Setup and Validation Procedure
6
c) Winston-Lutz Test
9) Instruction Form
a) General Patient and Plan information
b) Prescription Details
c) Treatment Instructions for isocenter position and field setup
10) Images Report
a) General Patient and Plan information
b) Prescription Details
c) Orthogonal views for each isocenter

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Verifying MU

Verifying MU
Procedure

Objectives
1) Following along with your instructor, you will perform hand calculations from first principles and also using
the information provided in the Dosimetry Report.

Procedure Contents
1) Print and discuss the information available from the dosimetry report as needed for monitor unit
calculations.
2) Review the monitor unit calculation equations, discuss the individual terms and demo how to obtain their
values from first principles, for a single field,does based on the plan information as available in the cone
planning workspace. 6
3) Compare the values of the individual terms in the monitor unit equations as reported in the dosimetry
report against the values calculated from first principles (in step 2 above) to validate the dosimetry print
report values.

References
4) P1044593-001-A – Eclipse Photon and Electron Instruction for Use – Chapter 17

5) P1044595-001-A – Eclipse Photon and Electron Algorithms Reference Guide – Chapter 7

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Verifying MU

A. Print Dosimetry Report for Calculated Plan

6) Login to UserHome( ).
7) Launch Cone Planning: select QuickLinks > Treatment Planning > Cone Planning.
See Figure 1.

6 6

Figure 1: QuickLinks > Treatment Planning > Cone Planning

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Verifying MU

8) Open the patient, US-SRS-01. If the patient is not listed under Recent Patients, click More Patients and
open the desired patient using the Patient Explorer dialog. See Figure 2.

Figure 2: Select a Patient

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Verifying MU

9) Select the plan for which MU are to be verified. See Figure 3.

Figure 3: Select a Plan

10) After the plan has loaded, select the Fields tab and verify that the plan has MU. See Figure 4.

6 6

Figure 4: Fields Tab

11) Click the Open print menu in the top toolbar and select Dosimetry Report. See Figure 5.

Figure 5: Open Print Menu > Dosimetry Report

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12) Review Dosimetry Report and click the Print to print the report. See Figure 6.

Figure 6: Dosimetry Report

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Verifying MU

B. Calculate Monitor Units for Cone Plan Manually

1) Calculate MU using the following formula:
RepeatFactor ∙ WeightFactor@Iso
MU
AvgTMR ∙ CalibrationFactor
where:
DosePerFraction
RepeatFactor
TreatmentPercentage ∙ TotalWeight

a) WeightFactor@Iso is the relative weight of the arc field at its isocenter.

b) RepeatFactor is the absolute dose (per fraction) delivered per unit total weight to the selected
algorithm normalization point. The units are cGy (or Gy).
c) AverageTMR is the average of the multiple static field TMRs. This is different than the TMR for the
average arc depth; however, this can be used as an approximation.
cGy Gy
d) CalibrationFactor is the Dose/MU in or for a cone, scaled at dmax depth and SAD geometry:
MU MU

CalibrationFactor = ConeOutputFactor * AbsoluteDoseCalibration

i) The equation for scaling the CalibrationFactor to the dmax and SAD geometry can be found in the
Eclipse Photon and Electron Algorithms Reference Guide as follows:
6 6
𝑃𝐷𝐷 𝑆, 𝑆𝑆𝐷, 𝑑 𝑆𝑆𝐷 𝑑
𝐎𝐅𝐓𝐌𝐑𝐌𝐚𝐱 𝐒 𝑂𝐹 𝑆 ∗ ∗
𝑃𝐷𝐷 𝑆, 𝑆𝑆𝐷, 𝑑 𝑆𝐴𝐷

e) TotalWeight is the total weight of the relative dose (total relative dose [%] / 100%) before
normalization at the selected algorithm normalization point.
2) Each of these factors can be calculated manually from information within the Cone Planning and Beam
Configuration Workspace.

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Verifying MU

3) DosePerFraction and TreatmentPercentage: The Dose per fraction can be found in the Prescription tab
of Cone Planning. See Figure 7.

Figure 7: Dose per fraction and Treatment Percentage

DC-DOC-16-D EC16.1-CEM-12-A
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Verifying MU

4) TotalWeight: The Total Weight will depend on the plan Normalization Method used in the final 3D dose
calculation.
a) Plan normalizated to Global Dose Max:
i) If the plan normalization method is Global Dose Max, then the maximum dose point in the body
determines the MU.
ii) The equation for TotalWeight becomes:
𝐃𝐦𝐚𝐱
TotalWeight = ∑ 𝐖𝐞𝐢𝐠𝐡𝐭𝐅𝐚𝐜𝐭𝐨𝐫𝐬@𝐈𝐬𝐨 ∗
𝐃𝐢𝐬𝐨

iii) For this procedure example, if the plan normalization is set to the Global Dose Maximum, the
TotalWeight can be calculated as:

TotalWeight = 5.7 * = 5.781

where 0.985 is the relative dose to the isocenter. See Figure 8:

6 Figure 8: Determining Dose to the Isocenter using the Point Dose Tool
6
b) Plan normalizated to Isocenter:
i) If the plan Normalization method is Isocenter, then the dose will be scaled so that the isocenter
dose matches the prescription.
ii) Since the isocenter dose is usually less than Dmax, this setting usually increases the MU which
will decrease the Total Weight.
iii) The equation for TotalWeight then simplifies to:
TotalWeight = ∑ 𝐖𝐞𝐢𝐠𝐡𝐭𝐅𝐚𝐜𝐭𝐨𝐫𝐬 @𝐈𝐬𝐨

iv) For this procedure example, if the plan Normalization method is set to Isocenter, the TotalWeight
will be 5.7.
5) Repeat Factor (RF): Using the formula in step 1), the Repeat Factor can be calculated as:

1800
𝐑𝐅 𝟑𝟖𝟗. 𝟐𝟏
0.8 ∗ 5.781

**If this field was normalized to Isocenter, 𝐑𝐅 𝟑𝟗𝟒. 𝟕𝟒, and the MU of this field would
. ∗ .
change by the percentage difference between these two numbers.**

DC-DOC-16-D EC16.1-CEM-12-A
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Verifying MU

6) WeightFactor: The weight factor is the weight of the arc for which the MU is being calculated. This can
be found in the fields tab of Cone Planning. See Figure 9.

Figure 9: Weight Factor is the weight of the arc within the arc set

DC-DOC-16-D EC16.1-CEM-12-A
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Verifying MU

7) Compare Average Depth and Average TMR values on the printout with those measured in Arc Plane
View. Select Arc Plane View in upper right window. See Figure 10.

Figure 10: Arc Plane View

6 6

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Verifying MU

8) Select a field in Fields tab, maximize the Arc Plane View and enable the Measure Distance

. The Average Depth and Average TMR can be calculated from multiple static fields. See
Figure 11.

6
Figure 11: Arc Plane View – Measure distance tool

DC-DOC-16-D EC16.1-CEM-12-A
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Verifying MU

a) In this procedure example, by sampling many measurements, the average depth calculated as
6.31cm.
b) At this point, navigate to the beam model used to calculate this field in Beam Configuration. With the
Processed TMR of the appropriate cone size selected, either:
i) View the TMR value at 6.31cm from the curve or,

ii) Use the curve editor ( ) tool to estimate the TMR value. See Figure 12.

6 6

Figure 12: Curve Editor to determine TMR value

c) In this procedure example then, the value of the TMR is found to be around 77.3.
d) Note that this measurement may be the largest source of error due to the difficulty in measuring the
distance from the patient external surface to the isocenter.

DC-DOC-16-D EC16.1-CEM-12-A
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Verifying MU

9) CalibrationFactor: The calibration factor is specific to the cone, not the plan. Thus, all values of the
calibration factor can be found in Beam Configuration as a property of the beam model. Below is the
calculation for the 17.5 mm cone.
a) The ConeOutputFactor for this beam model for the 17.5 mm cone (as used in this plan procedure
example) is 0.852.
b) The AbsoluteDoseCalibration Factor is 0.924.
c) To scale the output factor to Dmax use the Processed Tissue Maximum Ratio for a rough estimation
since it has been scaled to have a maximum value at Dmax. Here we can calculate:
TMRdmax / TMR5cm = 1.202

d) Combining these the CalibrationFactor, 𝐂𝐅 can be calculated as:

𝐂𝐅 0.852 ∗ 0.924 ∗ 1.202 𝟎. 𝟗𝟒𝟔

NB: Calibration factor only needs to be calculated once for each cone.
10) Combine all values to calculate the MU:

𝐑𝐅 ∗ 𝐖𝐅@𝐈𝐬𝐨 389.21 ∗ 1.5

𝐌𝐔 𝟕𝟗𝟖. 𝟒 𝐌𝐔
𝐓𝐌𝐑 𝐀𝐯𝐞 ∗ 𝐂𝐅 0.773 ∗ 0.946

**Note that for this particular example, the calculated MU value is 1.2% different than the nominal MU
as repoted in the dosimetry plan report.**
6

DC-DOC-16-D EC16.1-CEM-12-A
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Verifying MU

C. Calculate Monitor Units for Cone Plan with Dosimetry Report

1) These values can also be calculated from the Dosimetry Report. This may help determine where the 1.2%
difference comes from, in the manual calculation.
2) The TotalWeight@Iso and RepeatFactor can be determined from the listed values under the
prescription section of the dosimetry report. See Figure 13.

6 6
Figure 13: TotalWeight@Iso and RepeatFactor Values from Dosimetry Report

a) Remember to use the Weight at Dmax if the normalization is set to Global Dmax, and use the Total
Weight if the normalization is to the Isocenter.

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3) Compare your measured values to calculated Average Depth and AverageTMR reported for each field
under the Treatment Fields section of the Dosimetry Report. The CalibrationFactor is also listed in this
section and can also be verified against the values calculated from the previous section. See Figure 14.

Figure 14: Dosimetry Report – Treatment Fields

4) Calculate MU for an arc field - from the Dosimetry Report, using the MU equation:
RepeatFactor ∙ WeightFactor@Iso
MU =
AvgTMR ∙ CalibrationFactor
6

Note: For the above example then, the MU for Field 1 can be calculated as:
389.22 ∗ 1.5
MU = = 789.4 MU
0.781 ∗ 0.947

5) Repeat for each arc field in the plan.

Note: While the example uses values in the Dosimetry Report, it is recommended to use
custom table value for Average TMR and Calibration Factor.

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

Multiple Targets Cone Planning

Procedure

Objectives
1) Following along with your instructor, you will create a Cone Plan for multiple targets of different
prescriptions using multiple separate isocenters.

Procedure Contents
1) For a CT data set with multiple targets, use the cone planning workspace tools to create a single
isocenter plan for the first target.
2) To the same plan, add the beams for the second isocenter (second target) and discuss definining
prescription and using the dose rebalance tool so that the system can properly account for the dose
6 contribution from each of the isocenters. 6
3) Demo basic plan evaluation tools and discuss different caviats associated with multi-target, multi-
isocenter plans in cone planning workspace.

References
1) P1044593-001-A – Eclipse Photon and Electron Instruction for Use – Cone Planning Chapter

DC-DOC-16-D EC16.1-CEM-12-A
For education purposes only pg 228 EC16.1-CEM-12-A
Multiple Targets Cone Planning

A. Create Multiple Isocenter Cone Plan

1) Login to UserHome( ).
2) Select QuickLinks > Treatment Planning > Cone Planning. See Figure 1.

Figure 1: QuickLinks > Treatment Planning > Cone Planning

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

3) Select a recent patient or click More Patients… and then select your patient using the Patient Explorer
dialog. See Figure 2.

6 6

“More Patients”
opens Patient
Explorer

Figure 2: Selecting a Patient

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

4) Select the planning image. See Figure 3.

Figure 3: Selecting the Planning Image

6
5) Click Create New Plan…. See Figure 4.

Figure 4: Create New Plan

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

6) Select Create new plan to the current image and click Next. See Figure 5.

Figure 5: Plan Wizard – Create a New Plan to the Current Image

7) Enter Plan ID, select or enter Course ID and define Protocol/Phase, if desired. Click Next when done.
See Figure 6.

6 6

Figure 6: Plan Wizard – Plan Information

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

8) Select Treatment Unit, Technique/Energy, Dose Rate and Tolerance for plan. Click Finish when done.
See Figure 7.

Figure 7: Plan Wizard – Treatment Unit, Technique, Energy, Dose Rate and Tolerance

9) Select the Structures tab and highlight the PTV2. Then click Move Viewing Plane to Structure Center

Point to move the viewing plane intersection to the center of PTV2. See Figure 8.
6

Figure 8: Move Viewing Plane to Structure Center Point

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

10) Select the Fields tab. Click Insert Arcs from Template tool. See Figure 9.

Figure 9: Insert Arcs from Template Tool

11) Select an Arc Set Template from the list and choose a cone diameter. Click Insert.
See Figure 10.
6 6

Figure 10: Select Arc Set Template

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

12) Reposition isocenter, if necessary, using the Move Isocenter tool or manually entering Isocenter
Position values in the Fields tab. See Figure 11.

Figure 11: Isocenter Position

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

13) Select the Structures tab and highlight PTV3. Then select the Move Viewing Plane to Structure Center
Point to move the viewing plan intersection to the center of the PTV3. See Figure 12.

Figure 12: Move Viewing Plane to Structure Center Point

6 6
14) Select the Fields tab and click Insert Arcs from Template tool .
15) Select an Arc Set Template from the list and choose a cone diameter. Click Insert. See Figure 13.

Figure 13: Select Arc Set Template

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

16) A message will appear asking if you want to change the isodose display. Selecting ‘Yes’ will set the
isodose display to 70/35. Selecting ‘No’ will leave the display at the default setting of 80/40. See Figure
14.

Figure 14: Switch Isodose Display Message

Note: If the viewing planes are not moved from current isocenter location prior to adding
Arc Set Template, fields from the new Arc Set Template will be listed under the first
isocenter.

17) When using multiple isocenters, automatic dose calculations may slow the application. To speed up the
process it may be helpful to turn off the Automatic Calculation. See Figure 15.

Figure 15: Automatic Calculation Toggle

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

B. Prescription Dose and Rebalancing Tool

1) Select the Prescription tab. Enter the Treatment Percentage and Number of Fractions. Select the
Target Volume for the highest prescription dose and enter the highest Dose/Fraction. See Figure 16.

6 6

Figure 16: Plan Prescription

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

Note: Multiple prescriptions are not currently available for Eclipse CDC algorithm. The
weighting tool can be used to scale the dose for different targets within the same plan.

2) Select the Calculation tab. Enter desired Arc Angle Resolution (default is 10 degrees), Dose Matrix
Resolution (default is 1 mm) and Dose Slice Interval (default is slice spacing of the CT image). Then
click Calculate 3D Dose. See Figure 17.

Figure 17: Calculation > Calculate 3D Dose

6
Caution: Verify the dose calculation and dose display against independent verification
methods, for example, manual calculations or measurements. This is to ensure that the
following is correct:

 MU data is correctly interpolated and calibrated.

 MU calculation is correct.

 Configuration of the dosimetric data is correct.

P1044593-001-A – Eclipse Photon and Electron Instruction for Use, Page 344.

DC-DOC-16-D EC16.1-CEM-12-A
For education purposes only pg 239 EC16.1-CEM-12-A
Multiple Targets Cone Planning

3) Under the Fields tab, select the Rebalancing tool. See Figure 18.

Figure 18: Fields > Rebalancing

4) Type in Desired weight to reflect the desired prescription and click Apply. Note that each isocenter will
correspond to a specific PTV target. Click Close when done. See Figure 19.

6 6

Figure 19: Rebalance Tool

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

Tip: For using the Rebalance tool:

a) Total is the current total relative dose for the isocenter; Direct + Indirect.
b) Direct is the relative dose attributed to the isocenter only from the arcs
associated with the isocenter.
c) Indirect is the relative dose attributed to the isocenter from arcs associated
with other isocenters.
d) Weight at DMax is the relative dose to the plan hot spot.
e) Always select Rebalance before closing the window. Close will not update
desired weight.
f) The maximum value that can be entered for a Field Weight or Desired weight
is 100
g) When isocenters have differing prescriptions, set the plan prescription equal
to the larger dose and weight the isocenters such that the ratio of the relative
isocenter dose equals the ratio of the dose prescriptions.

5) Calculate 3D Dose.

6) Review isodose lines in multiple slices on orthogonal views. Click to change to Absolute dose for
ease of evaluation. See Figure 20.

Figure 20: Relative / Absolute Dose Display

7) Click to save the plan.

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

C. Review the DVH for Contoured Structures

1) Select Cumulative DVH Chart display option. See Figure 21.

Figure 21: Cumulative DVH Chart

2) Under Select structures to show select desired structures to display DVH. See Figure 22.

6 6

Figure 22: Cumulative DVH – Select Structures

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

3) Select the Structures tab to display Dose Statistics for selected structures. See Figure 23.

Figure 23: Structures Tab – Dose Statistics

4) Select the Fields tab to review the calculated monitor units for each field. See Figure 24.

Figure 24: Fields Tab - MU

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

D. Approve the Plan

1) Select the Prescription tab and click Change Status. See Figure 25.

6 6

Figure 25: Change Status

DC-DOC-16-D EC16.1-CEM-12-A
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Multiple Targets Cone Planning

2) In the Plan Approval Status dialog, review warning and errors, change Set status to: Planning
Approved, enable Calculate treatment times and enter Multiply with factor value. Click Finish then
enter your password. See Figure 26.

Figure 26: Plan Approval

DC-DOC-16-D EC16.1-CEM-12-A
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6 6

For education purposes only pg 246 EC16.1-CEM-12-A
Appendix

Appendix TAB 7

Cone Planning GUI Overview

Single Target Multiple Isocenter Planning

Additional Cone Planning Exercices

Export Machine Config from 4DITC Administration

DC-DOC-11-D EC16.1-CEM-12-A
For education purposes only pg 247 EC16.1-CEM-12-A
CONE PLANNING GUI

EC16.1‐CEM‐12‐A

7 7

For education purposes only pg 248 EC16.1-CEM-12-A
OBJECTIVES

• Understand the GUI of Eclipse Cone

Planning workspace
• Review planning tools in Eclipse
Cone Planning

For education purposes only pg 249 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING

• Supports:
− Frame and Frameless planning with cones
− MRI Pre-planning
− Instant update of 2D isodose lines

• Only supports images scanned in “head-first supine” mode.

• In a given plan, all arc fields must use the same treatment unit, energy,
dose rate, and technique.
7 • Once a plan is created, none of the above parameters can be edited
7
in Eclipse Cone Planning.
• Open plan in External Beam Planning to make edits.

• A plan cannot contain both Arc and Static fields.

For education purposes only pg 250 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING – GUI
Menu Bar

For education purposes only pg 251 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING – GUI
Menu Bar

• Create and Copy Plans

• Save

• Open print menu

− Multiple print forms and reports

• Save Screenshot

• Patient Explorer
− Open a different patient

• Create new plan is available in Menu bar, Fields tab and Prescription tab.

• Plans do not auto-save.

7 • Print Menu:
7
• Plan Parameters Report
• Dosimetry Report
• Setup Form
• Instructions Form
• Images Report
• Print Multiple Reports and Forms

For education purposes only pg 252 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING – GUI
Menu Bar

• Object Explorer
− Open a different plan or image

• Configuration Menu
− Delete Arc Set Template
− Edit DCF Options

• Help Menu
− Eclipse Cone Planning Online Help

• DCF settings should be configured appropriately at time of installation.

• Plan must be reloaded before changes to the DCF will take effect.
7

For education purposes only pg 253 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Fields Tab

• Insert Arc
• Insert Arcs from template
• Edit treatment order
• Isocenter spacing
• Rebalancing
• Move viewing plane to 3D dose max

• When inserting an arc set from a template, the cone size can be adjusted by
holding the Shift key and scrolling the mouse wheel.

• Edit treatment order allows isocenters and fields to be rearranged for treatment.
7 • An option to rename fields is available in the Edit treatment order dialog box.
7
• This is recommended so that order and names of the fields match between
the OGP and R&V system.

• The isocenter spacing tool allows the user to move one isocenter relative to
another isocenter to a desired distance.
• The distance can be system determined automatically or user defined.

• Rebalance Weights allows the user to enter a desired relative weighting for a
given isocenter.
• The weights of the isocenters are not rebalanced until Rebalance is selected.
• The Rebalance Weights tool displays the Direct (relative dose from fields under
the isocenter), Indirect (relative dose from fields under a different isocenter) and
Total relative doses.

• Dose max or global maximum is represented as an orange circle in the 2D

views.

For education purposes only pg 254 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Fields Tab

• Create arc set template

• Delete Isocenter and fields

• Split Arc when MU exceed 6000

• When an Isocenter is selected:

− Cone size for all arcs under selected
isocenter can be adjusted

− The isocenter position can be edited

 An isocenter cannot exist without a field.

 An isocenter will be deleted if the last field under that isocenter is
deleted.
7

For education purposes only pg 255 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Fields Tab

• The following can be edited when a field

is selected:
− Field name

− Cone size for selected field

− Field weighting

− Arc Start and Stop angles

− Arc direction can be reversed (CW vs

CCW)

− Field can be set to start “Extended”

• Gantry Start and Stop angles can be updated by dragging handles in the
Arc plane View.

• Default weights per isocenter = 1.

7 7
• If a field has invalid values, a red exclamation mark is displayed in front of
the field.

• Couch rotation can be graphically edited in the Frontal View.

For education purposes only pg 256 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Prescription Tab

• Plans can be created and deleted

• Target Volume and Protocol/Phase can
be selected
• Prescription details are entered here
• Change Status button used for plan
approval
• Isodose template selection

• If a primary reference point has been defined in the image in External Beam
Planning, that reference point is assigned as primary reference point automatically.

• If no reference points have been defined for the patient in External Beam
Planning, reference point “None” is assigned automatically. 7
• Plans can’t be opened in Cone Planning if they have no primary reference point or
if the primary reference point has a location.

• To add a protocol: External Beam Planning > Insert New Clinical Protocol > attach
to plan.

• To edit Isodose lines:

• Click on color to edit color, line width and visibility
• Click on number to edit isodose value
• Add/delete isodose levels by Delete and Add Isodose buttons
• Sort Isodose button will order values highest to lowest

• If you have added isodose levels in External Beam Planning, do not select any
isodose level template in Cone Planning as it removes all the isodose levels added
in External Beam Planning.

• Imported plans will display the Eclipse Default isodose template.

For education purposes only pg 257 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Imaging Tab

• Displays image set used in plan

• Select registered image to display as
blended
• Blended image slider bar at bottom of
vertical tool bar

7 7

For education purposes only pg 258 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING – PLAN APPROVAL
Prescription Tab

• Plan can be approved in Cone Planning.

For education purposes only pg 259 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Calculation Tab

• On/Off automatic 2D calculation update

• 3D dose calculation
• Show calculation VOI
• Set arc resolution
• Set Dose matrix
• Set Dose slice interval
• 3D dose statistics displayed in center

• The CDC starts calculating at the body surface.

• Turn off automatic 2D calculation update to speed up planning time, i.e.,

during isocenter placement.
7 7
• Show Calculation Volume displays the boundaries of the calculation
volume.
• The VOI is not editable.
• The VOI always covers the whole BODY

• Arc resolution (1 - 10 degrees) is the angular distance between calculated

static fields.
• Dose Matrix Resolution (X and Y) can be set from 0.5 - 5 mm.

• Dose slice interval (Z) resolution default is set to the slice thickness (0.5 -
5 mm).
• When entered manually, can enter only to 1 decimal place.
• Edit Options > Calculation grid resolution
• Sparse = 5 mm grid point separation
• Fine = 1 mm (or user selected) grid point separation

For education purposes only pg 260 EC16.1-CEM-12-A
ECLIPSE CONE PLANNING
Structures Tab

• Display structure attributes

• Display dose statistics following 3D
calculation
• Move viewing plane to center of
structure
• View DVH with cursor shows dose and
volume details
• Cursor displays isodose line in 2D views
for dose selected on DVH

• Structures are read only. To edit, return to Quick Links > Contouring.

• If there are objectives associated with structures, they are visualized with a
yellow exclamation next to the structure name.
7
• Equivalent Sphere Diameter is the diameter of a sphere with the same
volume as the structure.
• Conformity Index: Reflects the plan conformity. The closer to ideal value of
1, the more conformal the plan. Typically, larger than 1.)
CI=PIV /PTV
where PIV = Prescription Isodose line Volume
PTV = Planning Target structure Volume
• Gradient Measure: Gives dose gradient value in centimeters (defined as
the difference between the equivalent sphere radius of the prescription and
equivalent sphere radius of half the prescription isodose).
• Coverage: The percentage of the structure volume covered by the dose
matrix.
• Sampling Coverage: The percentage of the structure volume used for the
DVH calculation.

For education purposes only pg 261 EC16.1-CEM-12-A
Thank you

References:

• P1044593-001-A – Eclipse Photon and Electron Instruction for Use –

7 Chapter 19 7

For education purposes only pg 262 EC16.1-CEM-12-A
EC16.1‐CEM‐12‐A
DC-DOC-20-F

For education purposes only pg 263 EC16.1-CEM-12-A
Single Target Multiple Isocenter Planning

Single Target Multiple Isocenter

Planning
Procedure

Objectives
1) Following along with your instructor, you will use the (old) sphere-packing technique to create a cone
plan, with multiple isocenters to treat a large/complex (single) target (for which dose coverage cannot be
achieved using a single isocenter).

Procedure Contents
1) For a CT data set with large/complex (single) target, use the cone planning workspace tools to create a
single isocenter plan.
2) To the same plan, add the beams for a second isocenter and use the cone planning workspace tools to
review and adjust the plan accordingly to ensure coverage for the entire target.
7 3) Discuss and demo the use of the isocenter spacing tool to avoid hot spots. 7

References
1) P1044593-001-A – Eclipse Photon and Electron Instruction for Use – Cone Planning Chapter

DC-DOC-16-D EC16.1-CEM-12-A
For education purposes only pg 264 EC16.1-CEM-12-A
Varian Confidential
Single Target Multiple Isocenter Planning

A. Open Patient

Note: The following procedure assumes the image sets have been imported and the
contoured.

1) Login to UserHome( ).
2) Select QuickLinks > Treatment Planning > Cone Planning. See Figure 1.

Figure 1: QuickLinks > Treatment Planning > Cone Planning

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Single Target Multiple Isocenter Planning

3) Select patient (SRS, Frameless) from list of Recent Patients or click More Patients to open Patient
Explorer. See Figure 2.

7 “More Patients” 7
opens Patient
Explorer

Figure 2: Recent Patients List

DC-DOC-16-D EC16.1-CEM-12-A
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Single Target Multiple Isocenter Planning

4) From the Object Explorer, select the CT image set. See Figure 3.

Figure 3: Object Explorer

DC-DOC-16-D EC16.1-CEM-12-A
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Single Target Multiple Isocenter Planning

B. Create Plan
1) Under the Fields tab, select Create New Plan. See Figure 4.

Figure 4: Create New Plan

2) In the Plan Wizard, select Create new plan to the current image. Click Next. See Figure 5.

7 7
Figure 5: Plan Wizard - Select Operation

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Single Target Multiple Isocenter Planning

3) In Plan Information, enter Plan ID and select or enter a Course ID. Select a Protocol/Phase if desired.
Click Next. See Figure 6.

Figure 6: Plan Wizard - Plan Information

4) In Treatment Unit, select desired Technique/Energy, Dose Rate and Tolerance. Click Finish. See
Figure 7.

Figure 7: Plan Wizard - Treatment Unit

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Single Target Multiple Isocenter Planning

Note: Above plan parameters cannot be changed in Cone Planning. Open the plan in
Eclipse to change the name, energy or dose rate.

5) Slide the image blend tool to select the MR. See Figure 8.

7 7

Figure 8: CT-MR Blend Tool

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Single Target Multiple Isocenter Planning

6) Select the Structures Tab and highlight PTV2. Click the Move Viewing Plane to Structure Center

Point button ( ) to move the viewing plane intersection to the center of the PTV2. See Figure 9.

Figure 9: Move Viewing Plane to Structure Center Point

7) Adjust the light blue viewing plane slider bars to select the largest portion of the target that could be
covered with one isocenter. See Figure 10.

Figure 10: Move Slider Bars

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Single Target Multiple Isocenter Planning

8) Select the Fields tab. Click Insert Arcs from Template tool. This tool can be found at two locations. See
Figure 11.

Figure 11: Insert Arcs from Template

9) Select an Arc Set Template from the list, choose a cone diameter, and enter a Desired Weight if
needed. Click Insert. See Figure 12.

7 7

Figure 12: Select Arc Set Template

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Single Target Multiple Isocenter Planning

10) Reposition Isocenter, if necessary, using the Move Isocenter tool or manually entering Isocenter
Position values. See Figure 13.

Figure 13: Move Isocenter Tool

11) Select the Arc Plane View, edit the Gantry Start and Stop angles, and Couch Rotation, if necessary. It
is possible to also edit Cone Size and Field Weight for each arc, if needed. See Figure 14.

Figure 14: Arc Field Parameters

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Single Target Multiple Isocenter Planning

12) Manually move viewing plan intersections to location of second isocenter using light blue viewing plane
slider bars. See Figure 15.

Figure 15: Manually move viewing plane intersections

13) Select the Fields tab and click Insert Arcs from Template button.
14) Select the Arc Set Template from the list, choose a cone diameter, and enter a Desired Weight. Click
Insert.

7 7
Note: A message will appear asking if you want to change the isodose display. Selecting
Yes will set the isodose display to 70/35. Selecting No will leave the display at the default
setting of 80/40; and selecting YES will change the display to 70/35. See Figure 16.

Figure 16: Switch isodose levels

Note: If the viewing planes are not moved from current isocenter location prior to adding
Arc Set Template, fields from the new Arc Set Template will be listed under the first
isocenter.

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Single Target Multiple Isocenter Planning

15) If the isocenters are placed too close to each other, a Hot Spot Warning will be displayed. Click OK.
See Figure 17.

Figure 17: Hot Spot Warning

16) Reposition Isocenter, if necessary, using the Move Isocenter tool or manually entering Isocenter
Position values.
17) When placing multiple isocenters, automatic 2D calculations may slow down the process. To avoid this, it
may be helpful to turn off the automatic 2D calculations. This can be done by clicking Turn automatic
calculation OFF button under Calculation tab. See Figure 18.

Figure 18: 2D Calculation update toggle

7
18) In the Fields tab, select the Isocenter Spacing tool. See Figure 19.

Figure 19: Isocenter Spacing tool

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Single Target Multiple Isocenter Planning

19) Select the isocenter to move relative to the isocenter that will remain fixed. On the left, the current
distance is displayed. The Hot spot threshold value is the minimum distance from the table. Selecting
Auto will automatically move the isocenter to Hot spot threshold value + 0.5 cm. Click Apply and then
click OK. See Figure 20.

Figure 20: Isocenter Spacing tool

Note: The Isocenter Spacing tool defaults to move Isocenter 1 relative to Isocenter 2. Verify
which Isocenter should be moved and select it from the drop-down list prior to applying the
spacing tool.

20) Select Auto or move slider bar to adjust desired spacing. See Figure 21.

7 7

Figure 21: Adjust Spacing

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21) Click Apply to move isocenter to set distance. Click OK to close window.

22) Select Move all isocenters tool to adjust the position of all isocenters while keeping the relative
spacing between each isocenter constant. The tool can also be used with a single isocenter to allow
shifting of the isocenter while visualizing the isodose display.

23) Select Rebalance tool ( ) to visualize isocenter weighting details and change relative weighting
between isocenters. Type in Desired weight and select Rebalance. Click Close. See Figure 22.

7
Figure 22: Rebalance tool

Tip: For using the Rebalance tool:

a) Total is the current total relative dose for the isocenter; Direct + Indirect.
b) Direct is the relative dose attributed to the isocenter only from the arcs associated with
the isocenter.
c) Indirect is the relative dose attributed to the isocenter from arcs associated with other
isocenters.
d) Weight at DMax is the relative dose to the plan hot spot.
e) Always select Rebalance before closing the window. Close will not update desired
weight.
f) The maximum value that can be entered for a Field Weight or Desired weight is 100.
g) When isocenters have differing prescriptions, set the plan prescription equal to the larger
dose and weight the isocenters such that the ratio of the relative isocenter dose equals
the ratio of the dose prescriptions.

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Single Target Multiple Isocenter Planning

24) Add additional isocenters and/or arcs to improve isodose coverage.

Note: When adding additional arcs to an existing isocenter, the new field may have the
same beam geometry as another field. Take care to adjust field parameters to desired
settings.

25) Review isodose lines in multiple slices on orthogonal views.

26) Click Save ( ).

7 7

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Single Target Multiple Isocenter Planning

C. Enter Prescription and Calculate 3D Dose

1) Select the Prescription tab ( ) and enter the treatment prescription. See Figure 23.

Figure 23: Enter Treatment Prescription

2) Select the Calculation tab. Ensure that the correct Calculation Model is selected. Enter desired Arc
Angle Resolution (default is 10 degrees), Dose Matrix Resolution (default is 1 mm), and Dose Slice
Interval (default value is set to slice spacing of the CT image). Click the Calculate 3D Dose button. See
Figure 24.

Figure 24: Calculate Dose

Caution: Verify the dose calculation and dose display against independent verification
methods, for example, manual calculations or measurements. This is to ensure that the
following is correct:

 MU data is correctly interpolated and calibrated.

 MU calculation is correct.

 Configuration of the dosimetric data is correct.

P1044593-001-A – Eclipse Photon and Electron Instruction for Use, Page 344.

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Single Target Multiple Isocenter Planning

D. Review the DVH for Contoured Structures

1) Select Cumulative DVH Chart display option.
2) Under Select structures to show select desired structures to display DVH.
3) Select the Structures tab to display Dose Statistics for selected structures.
4) Select the Fields tab to review the calculated monitor units for each field.

7 7

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Single Target Multiple Isocenter Planning

E. Save and Approve Plan

1) Click Save ( ).
2) Under the Prescription Tab, click Change Status. See Figure 25.

Figure 25: Change Status

3) The Plan Approval Status window will appear. In the Approval section, select Planning Approved
under Set Status to section. If desired, select the Calculate treatment times checkbox and enter the
desired value in Multiply with factor box. See Figure 26.

Figure 26: Plan Approval Status 7

4) Enter Password and click Finish. See Figure 26 above.

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Cone Planning Exercise

Additional Cone Planning Exercises

Exercise

Objectives
1) Following along with your instructor, you will create multiple cone plans for the patients listed in this
exercise.

Procedure Contents
1) This section is a placeholder for additional student exercises as time allows.
2) Different patients are available in the demo database for the student to practice cone planning.

References
1) P1044593-001-A – Eclipse Photon and Electron Instruction for Use – Cone Planning Chapter
7 7

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Cone Planning Exercise

A. Instructions
1) Create multiple plans for the following patients:
a) Cones, SRS (US-SRS-05)
b) BRAIN, MULTI METS (US-EC-2050)
c) Brain mets, Multiple (US-EC-034)

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Export Machine config from 4DITC Administration

Export Machine Configuration from

4DITC Administration
Procedure

Objectives
1) Following along with your instructor Export machine configuration .xml file from 4DITC Administration for
C-Series type machine.

Procedure Contents
1) Access 4DITC Treatment Administration application at the C-Series machine navigate to the
Synchronization section and export the machine definition .xml file

References
7 2) P1006122-002-B 4D – Integrated Treatment Console Administration Reference Guide
7
3) P1005983-005-E 4D – Integrated Treatment Console Reference Guide

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Export Machine config from 4DITC Administration

A. Export of treatment unit configuration from 4DITC Administration

Note: The Treatment unit configuration .xml file can be exported from the 4D Console
Administration application on the treatment workstation.

1) On the 4DITC computer open Treatment Administration ( ) application.

2) Select View>Synchronization, select the Export tab and define the Export Destination. Select the
Vision Export checkbox and click the Start Export button. See Figure 1.

Figure 1: Machine Configuration Export

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Export Machine config from 4DITC Administration

3) The Machine Configuration export to Vision was successful message will appear.
Click OK to confirm. See Figure 2.

Figure 2: Success Message

4) Following along with your instructor, you will perform.xml file will be created at the selected destination.
See figure 3.

Figure 3 : Machineconfigvision.xml File at Selected Destination

7 7

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