Oncentra User Manual

Oncentra® External Beam v4.3

Oncentra® Brachy v4.3
170.730
User Manual

Doc.No. 192.729ENG-08
Copyright and Contact Information
Copyright
All rights reserved. No part of this manual may be reproduced or transmitted in any form whatsoever, including
photocopying and recording without written permission of the copyright holder: Nucletron B.V., PO Box 930,
3900 AX VEENENDAAL, The Netherlands.
Concerning this Publication

Information contained in this publication is subject to change without notice. Whenever the equipment is
delivered with a documentation medium such as a CD or DVD, the user shall always check the medium for
latest information. This information is part of Release Notes and Document Upgrade files.
Neither Nucletron B.V. and its subsidiaries nor anyone else who has been involved with the development,
production or delivery of the documentation be liable for any special, incidental or consequential damages,
whether based upon breach of warranty, breach of contract, negligence, strict liability in tort or any other legal
theory.
This manual was originally drafted in the English language.
Referenced Documents
Nucletron does not supply all documents that we refer to in this document with the equipment. Nucletron
reserves the right to make the decision on which of the documents it supplies with the equipment.
Oncentra External Beam and Oncentra Brachy 192.729ENG-08

User Manual iii
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192.729ENG-08 Oncentra External Beam and Oncentra Brachy

iv User Manual
Contact Information
TECHNICAL SUPPORT HELPDESK
Tel.: +31 318 557 111
Fax: +31 318 557 361
E-mail: oncosupport@nucletron.com
HEAD OFFICE AND MANUFACTURER
Nucletron B.V.
Waardgelder 1
3905 TH VEENENDAAL
The Netherlands
Tel.: +31 318 557 133
E-mail: info@nucletron.com
Website: www.nucletron.com
For other office locations visit www.elekta.com

User Manual v

vi User Manual
Table of Contents
1 Introduction and Description 1

1.1 Function of this Document 1
1.2 Disclaimer 1
1.3 Validity 1
1.4 Identification 2
1.5 Warnings, Cautions and Notes 2
1.6 Important Notices 2
1.7 Manufacturer 2
1.8 Intended Use 2
1.9 Compatibility 3
1.10 Classification 3
1.11 User 3
1.12 Training 3
1.13 Accompanying Documentation 3
1.14 Lifetime 4
1.15 Labels and Symbols 4
1.16 Abbreviations and Acronyms 5
1.17 Physical Description 6
1.17.1 Typical Setup 6
1.17.2 How Supplied 6
1.18 Third-party Software and Hardware 7
2 Safety Instructions 9
2.1 Precautions 9
2.1.1 Cautions and Warnings 9
2.1.2 Safety in Oncentra Workflow 10
2.2 Input 10
2.3 Program Safety 10
3 General Operating Instructions 13

3.1 Portal Concept 13
3.2 Connectivity Module 13
3.2.1 Connectivity Module Concept 13
3.2.2 Import Activity 13

User Manual vii
Table of Contents
3.2.3 Export Activity 14
4 Oncentra External Beam Operating Instructions 15

4.1 Oncentra Package 15
4.1.1 Package Concept – Oncentra 15
4.1.2 Package Contents – Oncentra 15
4.1.3 Oncentra Workflow 18
4.2 Anatomy Modeling Activities 18
4.2.1 Anatomy Modeling Concept 18
4.2.2 Target Definition Activity 19
4.2.3 Image Registration Activity 19
4.3 Beam Modeling Activity 19
4.4 Plan Manager Activity 21
4.5 Dose Calculation Activity 23
4.6 Plan Optimization Activity 23
4.6.1 Optimization Techniques 24
4.6.2 Objectives and Constraints 25
4.6.3 Pre-treated Plan 25
4.6.4 Library Plans 26
4.6.5 Starting from Previous Optimization Results 26
4.7 Plan Evaluation Activity 26
4.8 Plan Analysis Activity 27
5 Oncentra Brachy Operating Instructions 29

5.1 Oncentra Brachy Package 29
5.1.1 Package Concept - Oncentra Brachy 29
5.1.2 Package Contents - Oncentra Brachy 29
5.1.3 Brachy Workflow - Film-based (2D) 31
5.1.4 Brachy Workflow - Volume-based (3D) 31
5.3 Brachy Planning Activity 33

viii User Manual
Table of Contents
6 Oncentra Anatomy Operating Instructions 37

6.1 Oncentra Anatomy Package 37
6.1.1 Package Concept – Oncentra Anatomy 37
6.1.2 Package Contents – Oncentra Anatomy 37
6.1.3 Anatomy Workflow 38
7 Oncentra Evaluation Operating Instructions 41

7.1 Oncentra Evaluation Package 41
7.1.1 Package Concept – Oncentra Evaluation 41
7.1.2 Package Contents – Oncentra Evaluation 41
7.1.3 Evaluation Workflow 42
8 Troubleshooting and Maintenance 45

8.1 Troubleshooting 45
8.2 Maintenance 45
8.2.1 Quality Assurance 45
8.2.2 Maintenance 45
9 Appendix A: Technical Data 47

9.1 Specifications - External Beam 47
9.1.1 Accuracy 47
9.1.2 System Configurations 47
9.1.3 Data Limits for Treatment Planning 48
9.2 Specifications - Brachy 48
9.2.1 Accuracy 48
9.2.2 System Configurations 48
9.2.3 Data Limits for Treatment Planning 48
9.2.4 Afterloader Limits for Treatment Planning 48
9.2.5 Source Calibration 48
9.3 Coordinate Systems and Units - External Beam 49
9.3.1 Coordinate Systems 49

User Manual ix
Table of Contents
9.3.2 Units 49
9.4 Coordinate Systems and Units - Brachy 49
9.4.1 Coordinate Systems 49
9.4.2 Units 50
9.5 Standards 50
10 Appendix B: Messages 53
10.1 Messages 53
10.1.1 General 53
10.1.2 Required User Actions 53
10.1.3 Environment Related Error Messages 53
10.1.4 Data Related Error Messages 53
10.1.5 List of Error Messages and Types 53
11 Appendix C: Limits for Data Elements 55

11.1 General 55
11.2 Limits Portal 55
11.3 Limits Connectivity Module [CM] 57
11.4 Limits Anatomy Modeling [AM] 57
11.5 Limits Beam Modeling [BM] 59
11.6 Limits Plan Manager [PM] 63
11.7 Limits Dose Calculation [DC] 64
11.8 Limits Plan Evaluation [PE] 65
11.9 Limits Plan Analysis [PA] 67
11.10 Limits Brachy Planning [BP] 67
12 Appendix D: Installation Instructions 69

12.1 Installation Procedure 69
12.2 Upgrade Procedure 69

x User Manual
1 Introduction and Description
1.1 Function of this Document
This user document contains the instructions for use and is a guide for the operator of the system. In this
document it is assumed that the operator is a professional and trained user, w ho has gained sufficient
knowledge to operate the equipment safely. It is also assumed that the user has enough knowledge of the
Operating System (Windows©) to be able to use the relevant tools of the operating system correctly.
In particular this document describes the daily operation and interpretation of the user interface (hardware and
software). It also contains:
l A brief description of the system.
l Operating procedures.
l User maintenance procedures (including quality assurance and troubleshooting).
Please study this document carefully before using the system. Proper functioning of the equipment and the
software can be guaranteed only if the instructions in this document are adhered to.
This document was originally drafted in the English language (US).
Note! For detailed instructions, please refer to the online help. To open the online help, press the
F1 key or select the online help in the Help menu.
As the system is intended for qualified medical personnel trained in the system, the information in this manual
and the information on the screen (online help, menus, information and warnings) is sufficient for normal use
of the system. Some of the features described in these manuals require separate licenses. Upgrades are
accompanied by 'Release Notes', and special installation requirements and/or instructions as required.
1.2 Disclaimer
Nucletron assumes no liability for use of this document if any unauthorized changes to the content or format
have been made.
Every care has been taken to make sure that the information in this document is accurate. However, Nucletron
assumes no responsibility or liability for errors, inaccuracies or omissions that may appear in this document.
Nucletron reserves the right to change the product without further notice to improve reliability, function or
design.
This document is provided without warranty of any kind, either implied or expressed, including, but not limited
to, the implied warranties of merchantability and fitness for a particular purpose.
1.3 Validity
This manual is valid for the following part number: 170.730.

User Manual 1
1.4 Identification
Manuals are identified by a part number. There are two types of part numbers:
Example 1: 123.456ABC-78 Example 2: 777.12345AB-MAN-67
where: where:
l 123.456: part number body l 777.12345: part number body
l ABC: language; for example, ENG l AB: language; for example, FR (French); all languages
(English), FR (French) according to Internet protocol, except for English
l 78: version (ENG or no characters)
l 67: version
The part number is printed at the bottom of the title page. Numbers printed on other pages are for internal
revision control and may differ.
1.5 Warnings, Cautions and Notes

The following are samples of how warnings, cautions and notes appear throughout this document. The text
within the samples explains their intended use.
Warning! Designates a possibly dangerous situation. Non-observance may lead to death or the
most severe injuries
Caution! Designates a possibly harmful situation. Non-observance may lead to minor injuries or
damage to the product.
Note! Designates a possibly harmful situation. Non-observance may lead to damage to the product
or the environment.
1.6 Important Notices

Federal (U.S.) and State laws restrict the sale of this product to a physician or on a physician's order.
Only individuals authorized to perform treatment planning functions and appropriately trained in treatment
planning techniques should use this software. Carefully read all instructions prior to use. The user is responsible
for its proper clinical use and the prescribed radiation dose.
1.7 Manufacturer
See "Contact information" at the beginning of this manual for information about the manufacturer.
1.8 Intended Use

The Oncentra system is a radiation treatment planning software designed to analyze and plan radiation
treatments in three dimensions for the purpose of treating patients with cancer. The treatment plans provide
estimates of dose distributions expected during the proposed treatment, and may be used to administer
treatments after review and approval by qualified medical personnel.

2 User Manual
1.9 Compatibility
l DICOM compliant applications.
1.10 Classification
Manuals made for products that have been CE (Conformité Européenne) marked have the CE mark on the front
page. The number behind the CE Mark defines the responsible notified body.
Nucletron systems are classified according to IEC 60601-1 as Class I, type B. Nucletron systems meet the
relevant provisions of the European Medical Device Directive 93/42/EEC or the European Active Implantable
Medical Device Directive 90/385/EEC; this is based on conformity of the products and the quality system
according to ISO 9001:2008 and ISO 13485:2003.
For this reason mark is used.
1.11 User
The system is intended for use by qualified medical personnel in radiotherapy clinics, suitably trained by
Nucletron staff (or other competent people) in using the system. In addition to radiotherapy, the users must be
trained in general Windows usage – Nucletron does not provide specific training or documentation concerning
standard Windows functionality.
The Oncentra system should be configured locally and maintained by radiation physicists. It is a requirement
that the person responsible for the local configuration has been suitably trained in configuring and maintaining
the system.
1.12 Training
Different countries have different regulations for training. Make sure that you have the necessary training
before you operate, or do work on the system. Make sure that your training is in compliance with the laws and
regulations of the jurisdiction in which the system is installed.
The following types of courses are available:
l Application Training
l Clinical Training
l Webinars
l Workshops
1.13 Accompanying Documentation

The manuals for Oncentra can be opened from the Windows Start menu: Start > All Programs > Oncentra >
Documentation. The PDF files are opened in the Adobe Reader application installed with Oncentra.
The manuals are also delivered on a documentation DVD (REF 777.00254DVD).

User Manual 3
Manual Name REF Contents

User Manual 192.729 Intended use, regulatory information, precautions,
accuracy and performance of the system.
Log Book 777.00258MAN Customer acceptance protocol, preventive
maintenance, and user installation verification.
System Environment Introduction 192.737 System architecture, connectivity to other systems,
hardware and software specifications, and procedure
descriptions.
System Administrator Manual 192.738 Installing and configuring the operating system,
additional hardware and software, management,
installing and upgrading Oncentra, maintenance,
backing up and restoring data.
Physics and Algorithms 192.739 Geometry and volume representation, image
registration algorithms, dose calculation algorithms.
Radiation Commissioning and 192.740 External beam: measurement of radiation data for
Quality Assurance beam data submission (BDS), radiation data storage
(RDStore), treatment device configuration (TDC), beam
data tool (BDT). Brachytherapy: radiation data storage
(RDStore).
DICOM Conformance Statement 777.00089MAN Specifies the Oncentra DICOM Services compliance to
DICOM, and describes the supported DICOM SOP
classes and roles. Also accessible on the Nucletron
website.
Accuracy of Dose Calculations 777.00169MAN Accuracy of dose calculations for external beam
(photons and electrons).
Release Notes 555.00230CIB Improvements, solved issues, and known limitations.
1.14 Lifetime
The lifetime of Oncentra version 4.3 is 5 years.
1.15 Labels and Symbols

This section gives examples of the labels and symbols.
Symbol Name Meaning or Location
Safety label - Refer This label tells you that there is a safety risk and you must refer to the
to Instructions for Instructions for Use before you continue with the task or operation of the
Use equipment.
Disposal warning This label tells you that you must not use the domestic waste systems for
disposal of the equipment, or parts of the equipment.

4 User Manual
Symbol Name Meaning or Location

Legal manufacturer -
Warning Appears in the dialog field of the software.
Error Appears in the dialog field of the software.
Information Appears in the dialog field of the software.
1.16 Abbreviations and Acronyms

These are the conventions for the abbreviations and acronyms.
Abbreviation Definition
AC Active Case
AM Anatomy Modeling
BEV Beam's Eye View
BM Beam Modeling
BP Brachy Planning
CM Connectivity Module
DC Dose Calculation
DRR Digitally Reconstructed Radiograph
DSS Direct Step-and-Shoot
DVH Dose Volume Histogram
FFF Flattening Filter Free
FSDD Field Size Definition Distance
HIPO Hybrid Inverse Planning Optimization
IMRT Intensity Modulation Radiation Therapy
IPSA Inverse Planning Simulated Annealing
IR Image Registration
LOI Line Of Interest
MBS Model Based Segmentation
MLC Multi-Leaf Collimator
MPR Multi-Planar Reconstruction
NA Non-Active Case
OAR Organ At Risk
OEV Observer's Eye View

User Manual 5
Abbreviation Definition
PA Plan Analysis
PE Plan Evaluation
PM Plan Manager
PO Plan Optimization
POI Point Of Interest
PT Portal
QA Quality Assurance
RO Read-Only Case
ROI Region Of Interest
SAD Source-to-Axis Distance
SSD Source-to-Skin Distance
TD Target Definition
TPRP Treatment Plan Reference Point
VMAT Volume Modulated Arc Therapy
1.17 Physical Description

The Oncentra system consists of an application server, responsible for the database service and license
management service, and one or more application client(s). It is possible to have a configuration where the
application server and client run on the same computer, which is then known as a single workstation system.
1.17.1 Typical Setup

The typical Oncentra workstation consists of:
l Computer
l LCD monitor
l Printer
l Oncentra Treatment Planning software
l Third Party Software
The Oncentra server workstation also needs:
l Hasp key
l Un-interruptible Power Supply (UPS)
1.17.2 How Supplied

Oncentra is delivered on a DVD for installation by the customer. The Oncentra application server and client
software can be installed on hardware that has been obtained from Nucletron for this purpose. Oncentra
application server and client software must be installed on a PC that fulfills Nucletron's specifications regarding
hardware and operating system.
The hasp key is a small hardware device that must be attached to a USB port on the Oncentra application
server. The hasp key, which is used to protect against unauthorized use, has a unique ID and an internal

6 User Manual
memory that can be used for license purposes. It also has a built-in encrypt/decrypt functionality. Both the
Oncentra application server and the Oncentra clients use the same hasp key to ensure that there is a license
available for each activity to be started. The Oncentra server license connects the hasp ID to the installation ID.
All other licenses are connected to the installation ID.
The system requires an Oncentra system manager to be appointed and trained.
1.18 Third-party Software and Hardware

The Oncentra system includes the following third-party software:
Application Supplier Contact information

MIMER Mimer Information Technology AB http://www.mimer.se
Apache Apache Software Foundation http://www.apache.org
Etiam DICOM Toolkit Etiam http://www.etiam.com
Aladdin Aladdin Knowledge Systems Ltd. http://www.aladdin.com
Adobe Reader Adobe Systems Inc. http://www.adobe.com

User Manual 7

8 User Manual
2 Safety Instructions
2.1 Precautions
The user is expected to use the product (soft- and hardware) in accordance with the instructions given in this
manual, which must be read before the system is used. Any unauthorized deviation from the procedures laid
down in this manual can affect the contractual obligations between purchaser and vendor.
Warning! Do not modify any part of Nucletron supplied computer's hardware, software or software
configuration. Installing or running an application that has not explicitly been approved by
Nucletron may compromise patient safety and will result in termination of all warranty
and service contracts.
Warning! The Nucletron products are designed for use and maintenance using only parts available
from Nucletron. No liability for failure can be accepted by Nucletron through the use of
parts obtained from other suppliers unless written permission is obtained from
Nucletron.
The system manager at the clinic must make sure that individuals authorized to use treatment planning
functions have been suitably trained in using the system by Nucletron staff (or other competent people).
All treatment plan reports must be reviewed and electronically approved by a qualified person. Dosimetric
results must be checked through alternative calculations or by comparison to other results that are known to be
correct. Only treatment plans verified in this manner, and electronically approved in the system, must be used
to prescribe treatment.
The system manager must also make sure that each individual has the correct accesses to the system. The
system is designed to be used with individual users and passwords, for both the Windows© environment and
Oncentra. In Oncentra, individually configured access rights are strongly recommended, in particular the right
to electronically approve plans must only be given to staff with treatment prescribing authority. Group logons
with full access rights are strongly advised against.
The user must always be aware that the quality of the output depends critically on the quality of the input data,
and any irregularities or uncertainties about input data units, identification, or quality of any other nature must
be thoroughly investigated before the data is used.
Note! Only qualified staff may use the system.
Make sure that no custom settings in Windows© or Oncentra make information disappear or become illegible
(for instance when selecting color schemes for title bars, selecting font type and color, and so on).
It has been shown that parts of Oncentra are unable to run correctly w hen the computer is connected to a
network with a Virtual Private Network (VPN) client, in particular the Cisco System VPN Client. Therefore,
before running Oncentra, disconnect all VPN connections.
References to comprehensive instructions for the safe operation of Oncentra are listed in the "Accompanying
Documentation" section. All listed documents are either supplied in printed form and included in the delivery
or supplied electronically and installed together with the system.
2.1.1 Cautions and Warnings

Carefully read all the instructions before use. Observe all warnings and cautions throughout these instructions.

User Manual 9
This manual gives instructions for use of the system. It does not give information/advice on administering
treatment. The user is responsible to keep abreast of treatment procedures related to the system.
Warnings in user documentation are based on hazard analysis. The following major concerns are taken into
consideration:
l Incorrect patient identification or incorrect identification of patient images.
l Incorrect user input. Oncentra has a built-in check that alphanumeric data entered by the user is of the
correct type and within limits, but the accuracy and relevance of all input data relies on user input.
If data or program parts are manipulated (for example, by a computer virus), the user should contact Nucletron.
For information about how to take action on error messages and problems, see "Appendix B - Messages" in the
"User Manual".
2.1.2 Safety in Oncentra Workflow

Oncentra is designed with a lot of freedom for the individual user. However, it is very important to take into
consideration safety risks w hen designing the clinic's rules of procedure.
Caution! It is strongly recommended to use individually configured access rights to make sure that
critical Oncentra functions can only be used by staff trained for those particular
functions.
It is strongly recommended to use the approval function for both structure sets and plans
to make sure that the planning procedure is safe.
It is strongly recommended to use DICOM for transfer of plans to an R&V system to make
sure that the data is correct.
2.2 Input
Using the backslash character in alphanumeric input (for example, for labels) may cause malfunctioning in
Oncentra activities.
Using non-English alphabet characters (for example, Greek letters) may cause malfunctioning in Oncentra
activities.
Caution! Avoid using symbols (&, *, /, \, #, and so on) as input for names and labels.
For more information about input restrictions, see the "Limits for Data Elements" appendix in the "User
Manual".
2.3 Program Safety

An upgrade of software, hardware and/or radiation data at a clinical site requires that the user conduct a
verification test, whether or not Nucletron has performed a complete system validation according to regulatory
requirements.
Note! Backups of system data must be done frequently on a regular basis. It is recommended to
backup the Oncentra database daily.

10 User Manual
Note! Oncentra is not intended to be used as a long-term archive of patient data. Archiving must
be done in a separate DICOM archive or on an external medium (for example, CD, DVD).
To make sure that the installed software code and data are not partially deleted or unintentionally altered,
Oncentra has built-in, automatic control of checksums. This also ensures that any changes to the Oncentra code
using normal Windows© system tools will be detected, in which case the use of the system is blocked until the
change is corrected. The use of the Oncentra system is also protected through licenses and HASP keys.
Anti-virus software is required for all Oncentra systems that are connected to the Internet, directly or via the
hospital network. It is strongly recommended to install anti-virus software also on systems that do not have any
contact with the Internet. Any anti-virus software that the hospital IT department decides is appropriate for the
computer equipment in the hospital may be used. To prevent a negative impact on the performance of
Oncentra, the anti-virus software settings must be configured correctly (the settings may need to be different
than the default settings).
Note! Nucletron Service must be informed in all cases of system malfunction or errors.
Caution! The user is advised not to use utilities of the operating system nor other facilities for any
purpose related to the program code or data, other than procedures specified in this
manual.

User Manual 11

12 User Manual
3 General Operating Instructions
3.1 Portal Concept
The Oncentra Portal [PT] is the environment in which you view and modify patient data. The context in which
you view the data is determined by choice of activity. All activities run inside the Portal. When performing
different activities, new windows open inside the Portal.
All information on a specific case is shared among the activities coupled to the case, and a change made using
one activity is reflected in the other activities displaying the same information. You may view the data for a case
as well as a listing of the open cases (loaded in the cache) by selecting the Case Information dialog.
Caution! The main window for each activity contains the patient/case/plan, but dialogs for sub-
activities may not. When Oncentra dialogs and dialogs of other applications are open
simultaneously, make sure that the main activity window is visible so that the
patient/case/plan identity can be verified.
Warning! When creating a new external beam plan, make sure that you select the correct
treatment orientation (Head First or Feet First). Incorrect treatment orientation in the
plan may constitute a patient hazard.
3.2 Connectivity Module

3.2.1 Connectivity Module Concept
All communication between Oncentra and the "outer world" – such as image modalities (CT, MR, PET) and
DICOM compliant treatment planning systems, including TMS, TPP and PLATO – is based on DICOM.
The Connectivity Module [CM] handles such communication. Oncentra is a DICOM Storage Service Class
Provider (SCP), a DICOM Storage Service Class User (SCU), and a DICOM Query/Retrieve Service Class User (Q/R
SCU). The data model used in Oncentra is based on the DICOM data model, so all mapping of DICOM objects into
Oncentra objects is straightforward.
DICOM is one of the cornerstones of Oncentra. For details, see the Oncentra DICOM Conformance Statement.
The Connectivity Module operates in three modes: Import, E xport and Utilities. Import and Export modes
operate as an Oncentra Portal Activity. The Utilities mode operates as a stand-alone application.
Note! User preferences for CM Utilities, Import and Export are defined per local machine. The
preferences do not belong to any Oncentra user or Windows user.
3.2.2 Import Activity
The main task of the CM Import activity is to import DICOM objects, mainly images, from an optional directory
on the server/client network to the Oncentra patient database. Sub-tasks are dumping, viewing and deleting
DICOM objects on an optional directory.

User Manual 13
3 General Operating Instructions
To access the Import activity, you need both:
l a license for CM Import (fixed or floating), and
l personal user or group access right to Import.
Imported data types:
l Images (DICOM)
l RT Structure Sets
l RT Plans
l RT Images
l RT Doses
l Spatial Registration.
Warning! When importing data, be very careful to map the correct patient and case in the
Oncentra database to the correct DICOM data. An erroneous mapping may constitute a
patient hazard.
3.2.3 Export Activity
The task of the CM Export activity is to export data from the Oncentra patient database as DICOM objects to an
optional DICOM Peer on the network.
To access the Export activity, you need both:
l a license for CM Export (fixed or floating), and
l personal user or group access right to CM Export.
Protecting patient confidentiality. Care should be taken when exporting DICOM data. Most DICOM files contain
some patient information that could violate patient confidentiality. If it is necessary to export DICOM data to a
destination outside the facility, consider anonymizing the data (reformat in the Export window) and/or
encrypting the data.

14 User Manual
4 Oncentra External Beam Operating Instructions
4.1 Oncentra Package
4.1.1 Package Concept – Oncentra
Oncentra is a treatment planning system comprising a suite of individual treatment planning modules for
external beam radiotherapy and brachytherapy. Oncentra is designed for DICOM integration, connectivity and
flexibility.
Oncentra is focused on user needs, whether the user in question is an oncologist, physicist or administrator.
The modules of the Oncentra External Beam package provide an array of tools for external beam treatment
planning using proven physics (see the "Physics and Algorithms" manual). The modules include dose calculation
algorithms for photon and electron beams (such as the Collapsed Cone for photons and Monte Carlo Electrons),
3D contouring and image-registration and fusion tools to define the target volume and critical organs, IMRT and
VMAT planning, and more.
The modules can also provide the treatment planning tools for brachytherapy: Anatomy Modeling, Brachy
Planning, Plan Analysis. There are several optimization methods. For example, IPSA is an anatomy-based inverse
planning optimization algorithm that enables an optimization process guided by organ-specific dose objectives.
After studying the optimization methods, you will know for each clinical case which one to take.
4.1.2 Package Contents – Oncentra

Modules for external beam radiotherapy: Portal, Connectivity Module, Anatomy Modeling, Beam Modeling,
Plan Manager, Dose Calculation, Plan Optimization, Plan Evaluation, Plan Analysis.
Modules for brachytherapy: Portal, Connectivity Module, Anatomy Modeling, Brachy Planning, Plan Analysis.
Standard Package
l Portal (PT)
The Portal is a framework in which different modules or activities can run. This is the interface for
managing activities and cases.

User Manual 15
l Connectivity Module (CM)

CM handles all forms of DICOM data input to the Oncentra system from external sources, and DICOM
data output from the system to external sources.
l Anatomy Modeling (AM)

AM is an advanced contouring and imaging package for defining structures (Regions of Interest, ROI)
related to the patient anatomy and target volumes for treatment planning. AM can be started in the
Target Definition activity (Image Registration is a separate license, not included in standard license
packages).
l Beam Modeling (BM)

BM handles specification of the beam shapes and other manipulation of the treatment plan.
l Plan Manager (PM)

PM combines the main functionality of BM, PE and PA. PM handles specification of the beam shapes and
other manipulation of photon and electron treatment plans. Calculated dose can be scaled by beam
weighting, normalization and prescription. PM also handles evaluation of plans (and of individual beams
and segments in external beam radiotherapy plans), as well as plan comparison and plan summation.
l Dose Calculation (DC)

DC handles the dose calculations.
l Plan Evaluation (PE)

PE handles the necessary tools for evaluating an external beam treatment plan that has a calculated
dose. Calculated dose can be scaled by beam weighting, normalization and prescription.
l Plan Analysis (PA)

PA handles evaluation of single plans (and of individual beams and segments in external beam
radiotherapy plans), as well as plan comparison and plan summation.
Separate Optional Licenses
Functionality not included in the standard package:
l Image Registration (IR)

IR is an Anatomy Modeling activity. The image registration (co-registration/correlation/match) sets up a
correlation matrix between two sets of images. IR allows the user to create and edit image registration
between image series so that image fusion tools can be utilized.
l Plan Optimization (PO) (Optimizer)

Supported techniques are Beam Weight Optimization, Intensity Modulation Optimization, Direct Step-
and-Shoot Optimization, Angle Optimization, and Volume Modulated Arc Therapy (VMAT) Optimization.
There are four different license modes:
l Oncentra Optimizer (Basic): Contains all basic features needed for inverse treatment planning

using physical objectives and intensity modulated optimization for Intensity Modulated Radiation
Therapy (IMRT).
l Oncentra Optimizer Direct Step-and-Shoot: Supports direct optimization of machine

parameters (MLC leaf positions), thus removing the segmentation step where the MLC sequence
is created. The license also provides support for defining constraints together with the objectives
thus adding another tool during optimization. The Oncentra Optimizer license is required for
running the Optimizer Direct Step-and-Shoot license.
l Oncentra Optimizer Angle Optimization: Supports gantry angle optimization, w hich can be

combined with Intensity Modulation Optimization or Direct Step-and-Shoot Optimization. The
gantry angle of the beam can be selected to be a part of the optimization thus helping the user to

16 User Manual
avoid critical structures. The Oncentra Optimizer license is required for running the Optimizer
Angle Optimization license.
l Oncentra Optimizer VMAT: Supports optimization of machine parameters (MLC leaf positions,

gantry speed, dose rate). The license also provides support for defining the objectives. The
Oncentra Optimizer and Optimizer Direct Step-and-Shoot licenses are required for running the
Optimizer VMAT license.
l Dose Calculation Options

The Dose Calculation license is required for the following optional licenses:
l Collapsed Cone: Enables the use of Collapsed Cone Convolution algorithm for photon beam dose
calculation.
l Monte Carlo Electron Dose Calculation: The Monte Carlo Electron algorithm allows very

accurate, high-speed dose calculations for electron beams.
l Brachy Planning (BP)

BP handles the creation of a brachy treatment plan, including source definition, catheter reconstruction
(Applicator Modeling is a separate optional license), source dwell position activation, dose normalization,
dose optimization (Inverse Planning Simulated Annealing, IPSA, is a separate optional license; Hybrid
Inverse Planning Optimization, HIPO, is a separate optional license), dose prescription, plan evaluation,
plan reporting and plan exporting.


User Manual 17
4.1.3 Oncentra Workflow
4.2 Anatomy Modeling Activities

4.2.1 Anatomy Modeling Concept
The input to Anatomy Modeling activities: DICOM images. The output from Anatomy Modeling activities: DICOM
RT Structure Set.
All activities provide:
l 2D and 3D viewing functionality of image series and drawn structures.
l Advanced 2D and 3D drawing tools. A bolus can be created independently or designed based on a
drawn structure. Points-of-interest can be defined.
The activities are: Target Definition and Image Registration.

18 User Manual
4.2.2 Target Definition Activity
In the Target Definition activity, you can create all types of Region Of Interest (ROI). A target ROI has a certain
DICOM ROI Interpreted Type, namely PTV (planning target volume), CTV (clinical target volume) or GTV (gross
tumor volume). Create margins. Change the patient coordinate system origin by defining TPRP (Treatment
Planning Reference Point).
You can also approve the structure set in the Target Definition activity. Although you cannot make image
registrations in the Target Definition activity, you can display fusions based on image registrations. For making
image registrations, see Image Registration Activity.
Warning! The quality and correctness of data exported from the Oncentra system is highly
dependent on user input. All created ROIs must be examined by experienced staff before
being used as a basis for treatment planning. This is particularly important when verifying
the orientation of imported images (CT, films, and so on) and when using automatized
contour defining tools, like Automatic Contouring, ROI Margin, MBS and 3D Magic Wand,
or when defining contours in a registered image series.
Caution! Oncentra does not model uncertainties in the positioning of Regions of Interest (ROI). It is
recommended to use margins even when evaluating dose to ROI at risk that may be
subject to positioning uncertainties. These ROI include serial organs, small volumes (in
relation to the resolution of the structure set and dose calculation grids) or elongated
volumes. The calculated dose-volume statistics should be carefully evaluated for small
ROI at risk and for ROI that are positioned close to high dose gradients. For
recommendations about setting grid spacing to obtain the most accurate results, see the
"Physics and Algorithms" manual.
4.2.3 Image Registration Activity
In the Image Registration activity, you can do everything you can do in Target Definition, and you can also make
image registrations.
The image registration (co-registration/correlation/match) sets up a correlation matrix between two sets of
images.
Note! Image Registration is not part of Anatomy Modeling standard functionality. To access the
Image Registration, you need a separate Image Registration license.
4.3 Beam Modeling Activity
The Beam Modeling [BM] activity allows you to create the basis for a treatment plan by applying photon and
electron beams. Block shaping is supported with the assistance of DRRs. Proprietary export formats are
supported from this activity: LAP PatPos and ACCESS (Impac RTP Connect). Bolus can be selected, or not, for use

User Manual 19
with particular beams. The input to Beam Modeling: DICOM images and DICOM RT Structure Set. The output
from Beam Modeling: DICOM RT Plan and DICOM RT Images.
Note! Only the supine and prone, head-first and feet-first patient positions are supported. The
decubitus left and right patient positions are not supported.
Beam Modeling includes the following functions:
l Create beams: create new beams, duplicate and oppose existing beams.
l View plan: display transverse slices, a coronal and sagittal multi-planar reconstruction and beam's eye
view and observer's eye view; change the center and width values.
l Change beam parameters: manipulate the physical parameters of the beam, such as gantry angle, field

position, jaw width and length as well as bolus correction.
l Modify beams: manipulate the dose distribution by placing a wedge in the beam.
l Shape fields: create apertures, shields or multileaf collimators.
Warning! Qualified personnel should review all dosimetric results and plan reports. Dosimetric
results should be evaluated in the 3D view, DVH graph and statistics, and in all image
slices. Dosimetric results should also be checked by alternative calculations or compared
to other results known to be correct. Oncentra does not restrict the set-up of unrealistic
parameters, for example, couch and gantry collision or odd SSD, FSDD, block-tray
distances, applicator distances with respect to patient anatomies, or clinically incorrect
extension limits.
Dose calculation is based on images of the patient volume that are usually limited to the treatment region. The
images may not cover the entire volume affected by the beam, so an external axial extension can be defined to
account for scatter dose from the missing volume.
Warning! Make sure that the extension limits are clinically correct; otherwise the dose calculation
can become erroneous.
Warning! The Dmax calculation point is created based on the current beam characteristics. The
point is NOT associated with the beam. Any change to the beam position, energy or unit
type will NOT update the calculation point position. If you are modifying the beam
position, changing applicators, changing energy or changing unit - you are advised to
remove all the Dmax points and re-create them with the modified beam.
Warning! Parameters in printed plan data and treatment printouts are represented in the
coordinates and labels of the treatment device, as configured and verified in TDC. These
coordinates and labels may be native or according to the IEC 61217 standard.
Note! The Source-to-Surface Distance (SSD) values for non-Oncentra generated plans that are
imported to an existing patient in Oncentra may be incorrectly specified by the creating
system. When a plan is loaded in Oncentra, the system validates that the SSD in the plan is in
agreement with the value calculated by Oncentra, based on the rendered external surface
of the patient. If these SSD values differ by more than a predefined value, the user will be

20 User Manual
informed and asked to either update the SSD value in the plan to the value calculated by
Oncentra or to continue with the SSD unchanged.
If the SSD is unchanged, it will not be possible to load the plan in Beam Modeling (BM) or
Plan Evaluation (PE). It is recommended to load these plans in Plan Manager (PM) to
evaluate and/or make modifications.
4.4 Plan Manager Activity
The Plan Manager [PM] activity allows you to create photon and electron plans for external beam treatment.
You select a plan template stored in the library and edit the plan. You can also evaluate the plans. PM combines
the main functionality of BM, PE and PA. The input to Plan Manager: DICOM images and DICOM RT Structure Set.
The output from Plan Manager: DICOM RT Plan and DICOM RT Images.
Note! The Plan Manager activity is for external beam plans.
Plan Manager includes the following features:
l Creating a new plan: selecting a plan template from the library or copying an existing plan. There are

different views for creating and viewing the plan (for example, Beam's Eye View, Observer's Eye View,
and 3D V iew).
l Editing properties:
Plans: adding beams to the plan, specifying the dose grid, editing plan information, defining dose points,
and specifying normalization / prescription / beam weighting (in the Beam Weighting Tool).
Beams: manipulating the physical parameters of beams, such as the treatment unit, gantry angle,
collimator angle, couch angle, isocenter, limiting device (jaws, MLC), apertures, inserts and applicators,
shielding blocks, wedge, bolus, and source surface distance.
l Evaluating plans: viewing dose distribution, DVH and ROI dose statistics for individual beams and plans,
including "foreign plans".
l Comparing plans: toggling between plans, displaying the dose difference, and simultaneous display of
DVH and live dose.
l Summing plans: combining dose distribution from multiple plans.
l Approving plans
l Printing and plotting: creating a treatment printout, plotting views, and exporting the dose grid for the

current slice.

User Manual 21
Plan Manager provides functionality for 3D conformal planning, but Plan Analysis is required for object
sequences.
extension limits.
Warning! Make sure that the extension limits are clinically correct; otherwise the dose calculation
can become erroneous.
Warning! The Dmax calculation points created in BM are based on the current beam
characteristics. The points are NOT associated with the beam. Any change to the beam
position, energy or unit type will NOT update the position of the calculation points. If you
are modifying the beam position, changing applicators, changing energy or changing unit,
then you are advised to remove all the Dmax points and re-create them in BM with the
modified beam.
Caution! If you open a previously saved plan, but the unit information has been changed, the
previously saved dose distribution is still displayed.
If the SDD valued is unchanged, this value will be displayed in Plan Manager (PM) when
loaded. If no changes are made to the plan, the SSD values specified in the plan are printed
in the Treatment Printout and exported in the DICOM files. A proprietary format export
(from the File > Export menu in the Portal) also uses the SSD values specified in the plan.

22 User Manual
4.5 Dose Calculation Activity
In the Dose Calculation [DC] activity you can make settings for optimized and non-optimized plans, and do a dose
calculation.
Calculation parameters can be set in Beam Modeling [BM], Plan Manager [PM], Plan Optimization [PO]
(Optimizer), and Dose Calculation [DC]. Calculation parameters set in BM, PM, PO or DC are saved, displayed and
used by any of the other activities. After plan adjustments in PO for IMRT or VMAT planning, a final dose
calculation is made. The dose is calculated by the same underlying calculation facility in Oncentra, wherever the
calculation settings have been made.
Note! The dose calculation in the Dose Calculation activity is for external beam plans.
Note! Plan optimization is not part of the standard dose calculation functionality. To access the Plan
Optimization activity, you need a separate Plan Optimization license.
The available dose calculation algorithms are Pencil Beam or Collapsed Cone for photons, and Voxel Monte
Carlo for electrons. You can achieve a higher dose calculation speed for Collapsed Cone calculation using a
computer with a supported Graphics Processing Unit (GPU).
Outline of calculation workflow:
1. Plan information from BM, PM, PO.
2. Calculation settings in BM, PM, PO, DC.
3. Background dose calculation.
4. Calculation result displayed in BM, PM, PE, PO, PA.
5. When necessary, plan and optimization adjustments in BM, PM, PO, DC and recalculation.
6. Validation in PM, PE and PA.
Main information and settings in Dose Calculation:
l Dose Calculation dialog: Concise plan information, dose status, and so on.
l Options tabs: Calculation specification (number of fractions, radiation types, and so on), beam weighting
(meterset value per fraction, dose per fraction, and so on), and QA options (export to ASCII file).
l Calculation Queue Manager: Calculation job list.
4.6 Plan Optimization Activity
In the Plan Optimization [PO] (Optimizer) activity for IMRT planning, you improve a plan by Beam Weight
optimization, Intensity Modulation optimization, Direct Step-and-Shoot optimization (Direct S&S), or VMAT
optimization. You can combine Intensity Modulation optimization or Direct Step-and-Shoot optimization with
Angle optimization.
To access the Plan Optimization activity, you need:

User Manual 23
l a license for Plan Optimization
l personal or group access right to Plan Optimization. (The access right to DC also gives the access right to
PO.)
When opening Plan Optimization, you need at least:
l a patient case
l a structure set with corresponding images
l a plan (an MLC must be applied to each beam for Intensity Modulation, Direct Step-and-Shoot and VMAT
optimization).
Note! If not already defined, Plan Optimization automatically adds a number of default
optimization parameters to the current plan when Plan Optimization is opened. These
parameters have no negative impact on the plan. However, if you want to avoid that
optimization parameters are unnecessarily stored in a plan that is not subject to
optimization, you are advised not to open Plan Optimization when such a plan is current.
Output from Plan Optimization comprises:
l a plan (with optimized beam gantry angles, MU, gantry speed, dose rate, segments)
l dose.
Caution! The treatment plan including dosimetric results obtained in Plan Optimization must be
verified in Plan Evaluation or Plan Analysis after final dose calculation. The plan should be
reviewed and approved by qualified personnel.
Plan Optimization is delivered in different license options. Direct Step-and-Shoot and Angle optimization are not
included in the basic Optimization license, but require extra add-on licenses. VMAT optimization requires an
extra license.
4.6.1 Optimization Techniques

There are four different types of optimization:
l Beam Weight optimization: Determines optimal beam weights (MU) based on existing beam geometry

(as defined by MLCs, wedges, and so on) and dose to fulfill user-defined objectives. Neither
segmentation, nor final dose calculation is performed. Requires pre-calculated dose. Any treatment unit
modality (photon or electron) is supported.
l Intensity Modulation optimization: Creates optimal fluences from which MLC settings and

corresponding weights are derived to as closely as possible fulfill the user-defined objectives. MLC-
settings and corresponding weights are generated in the separate segmentation step. Only MLCs are
allowed as beam modifiers (no wedges, blocks, and so on). The treatment unit modality must be photon.
l Direct Step-and-Shoot optimization: Optimizes the MLC settings and monitor units directly to as closely

as possible fulfill the user-defined objectives. The segmentation is part of the optimization process. Only
MLCs are allowed as beam modifiers (no wedges, blocks, and so on). The treatment unit modality must
be photon.
l Volume Modulated Arc Therapy (VMAT) optimization: Optimizes the MLC settings and monitor units to

as closely as possible fulfill the user-defined objectives. The beam continuously irradiates the target

24 User Manual
while the gantry rotates around the patient. Only MLCs are allowed as beam modifiers (no wedges,
blocks, and so on). The treatment unit modality must be photon.
In addition, you can optimize the gantry angle:
l Angle optimization: Can be combined with Intensity Modulation optimization or Direct Step-and-Shoot
optimization. The gantry angle is updated during the optimization to improve the plan. The External ROI
must be classified as an OAR (or Target), but objectives and/or constraints do not need to be defined for
the External, otherwise the gantry angle optimization cannot be started.
Note! The resolution of the dose calculation grid used during optimization and final dose
calculation should always be checked and specified through the Settings dialog. The
resolution of the dose grid in the y-direction (slice direction) should be equal to the smallest
slice spacing in the CT image series.
Note! Direct Step-and-Shoot optimization and Angle optimization require extra licenses. VMAT
Optimization requires an extra license.
Note! You can combine different optimization techniques (Beam Weight and Intensity Modulation,
Beam Weight and Direct Step-and-Shoot) for different beams within the same plan. The
optimization type is added to the individual beams of a plan not previously opened in the
Plan Optimization activity when launching Plan Optimization. As a consequence the plan is
modified when launched – indicated by ‘(*)’ for the case in the patient bar.
The plan optimization comprises three main steps: Optimization, Segmentation and Final Dose Calculation. Each
step can be repeated several times after adjustments to achieve a better result before you go on to the next
step. The user may also do the steps in one single maneuver without adjustments if all three steps are initially
selected after other necessary settings (segmentation and general). The steps needed depend on the selected
optimization type. Beam Weight optimization only requires the Optimization step. Intensity Modulation
optimization requires all three steps. Direct Step-and-Shoot optimization requires the Optimization and Final
Dose Calculation step. VMAT optimization requires the Optimization and Final Dose Calculation step.
When Angle optimization is selected, it is strongly recommended to do the optimization process twice. When
gantry angles are optimized, an approximate dose calculation is used for performance reasons. It is therefore
recommended to run the optimization process again without the Angle optimization option selected. In the
second optimization process, the new gantry angles (from first optimization) are used as is but the dose is
calculated the normal way using beamlets.
4.6.2 Objectives and Constraints

The optimization goals are defined using Dose Volume Objectives (DVO) and Dose Volume Constraints (DVC). All
defined DVOs are weighed together forming a composite objective function which is minimized during the
optimization. That means there is always a dependence between the objective functions during the
optimization.
Each defined constraint is handled independently in the optimization process, and any defined constraint is not
part of the total objective function. During optimization the total objective function is minimized while fulfilling
the constraints better and better. A solution is considered to be optimal when both the Optimality Tolerance is
achieved and each constraint is fulfilled within a numerical tolerance (corresponding to an objective function
value of 1E-07, which can also be noted as 1/10000000 or "one in ten million").
4.6.3 Pre-treated Plan

Optimization of a plan can be based on dose from another plan (thus taking the dose distribution of another
plan into account). This base plan, called 'pre-treated', can be any plan within the same case that has a valid

User Manual 25
dose distribution (the base plan dose might or might not be delivered to the patient). The optimization is
performed on the total dose, but the final plan contains only 'top' dose (the dose put on top of the 'base' dose).
During the optimization, the DVH displays both the pre-treated plan dose (from the 'base' plan) and the total
dose.
4.6.4 Library Plans

In the Oncentra Portal or Select Plan dialog, you can create a new plan based on defined library plans. When
Plan Optimization (Optimizer) is started with a library plan containing DVO and/or DVC, a dialog appears for
matching the DVO/DVC in the library plan to the ROI in the current structure set (in case there is a discrepancy
between the sets).
4.6.5 Starting from Previous Optimization Results

You can continue the planning in Plan Optimization (Optimizer) after closing one session and re-opening the
same plan. The state of the optimization is saved as part of the case. So, you can continue optimization from the
last fluence setting when PO is restarted. The segmentation can also be run based on the previous optimization
results when PO is restarted. To avoid starting from previous values, do Reset before performing the
optimization.
4.7 Plan Evaluation Activity
The Plan Evaluation [PE] activity allows you to evaluate the dose plan for external beam using various evaluation
tools.
The dose distribution of the plan can be modified through a beam weighting tool. Sagittal, coronal, and axial
dose displays are supported. For defined beam directions, selected lateral dose distributions can be overlayed
on DRRs. Dose Volume Histograms are supported for defined ROIs. Proprietary export formats are supported
from this activity: LAP PatPos and ACCESS (Impac RTP Connect). The input to Plan Evaluation: DICOM images, RT
Structure Set, RT Plan, RT Dose, and optionally RT Images.
Plan Evaluation includes the following options for evaluating and modifying the plan:
l Beam Weighting Tool displays meterset values (MU or minutes), weight factors, and dose contributions

to dose points for all beams. You can edit the values to shape the dose distribution, and you can make a
dose prescription to scale the dose. The tool also allows you to normalize the dose in different ways, to
select the dose displayed as the total dose or the dose per fraction, and to specify the number of
fractions. A dose specification point can also be selected.
l Plan Data provides a summary of the parameters of all the beams in the plan. Plan Data also displays the
meterset values (MU or minutes) for each beam. The number of fractions for each beam can be
modified here.
l Dose Grid Data displays the dose distribution in a spreadsheet format. The spreadsheet displays a dose

value for every dose point for the slice offset in the main view.
l DVH displays dose volume histograms as well as minimum, maximum and average dose for each ROI in
the anatomy.
l Approving a plan. An approved plan is locked for changes.

26 User Manual
extension limits.
Warning! Make sure that the extension limits are clinically correct; otherwise the plan can be in
error.
If the SSD is unchanged, it will not be possible to load the plan in Beam Modeling (BM) or
Plan Evaluation (PE). It is recommended to load these plans in Plan Manager (PM) to
evaluate and/or make modifications.
4.8 Plan Analysis Activity
The Plan Analysis [PA] activity allows you to evaluate plans, individual beams and segments. Plans for a case can
be evaluated side-by-side and compared. Summation and weighting of plans for a case is supported. The input
to Plan Analysis: DICOM images, RT Structure Set, RT Plan, RT Dose, and optionally RT Images. The output from
Plan Analysis: DICOM RT Plan.
PA can be open for a case without appointing a current plan. A plan can be made current and you can change
current plans in the activity. If there is a current plan when opening PA, that plan is displayed.
Caution! If plans in the same patient case have different patient treatment positions (head first
and feet first respectively), images are displayed according to the treatment position of
the current plan if any. Otherwise, the images are displayed as imported independently
of treatment position in any plan. The image orientation displayed cannot be changed in
a PA session.

User Manual 27
Caution! If PA is opened for a plan where the patient treatment position is undefined (neither
head first nor feet first), PA assumes that the position is head first. This means that if a
feet first plan with related dose is imported that lacks the patient treatment position, the
dose is correctly displayed but the beam setup information is incorrect.
Note! In some situations there can be small dose differences between PE and PA when having
non-equidistant CT slices. This is caused by a mapping of the calculated dose grid coinciding
with the CT slices (thus being non-equidistant) to an equidistant dose grid used in PA.
PA is principally a read-only activity and produces no new data or modifications to the data for the case and the
plan(s). The only exception is approval of a plan, which results in an implicit save of the case (and ALL plans of
the case).
Single plan evaluation:
l Display of total plan dose in original and reconstructed images.
l Display of dose as a sequence of objects.
l Display of DVH in individual and total mode to view contributions from total plan or individual beams.
l Display of DVH statistics.
Plan comparison:
l Side-by-side display of total plan for selected plans in a case, shown as a sequence of objects.
l Inspection and comparison of individual objects for the plan in a case.
l Comparison of DVH and dose statistics for the plans in a case.
Plan summation:
l Summation of dose distributions for plans and display of summed dose.
l Set a display factor for plans in a case and display of total dose for selected plans.
l Display of DVH in individual and total mode to view contributions from summed or individual plans.
Approval of treatment plan and dose. An approved plan is locked for changes.
extension limits.

28 User Manual
5 Oncentra Brachy Operating Instructions
5.1 Oncentra Brachy Package
5.1.1 Package Concept - Oncentra Brachy
Oncentra Brachy provides tools for:
l contouring (in the Anatomy Modeling activity)
l image registration (in the Anatomy Modeling activity)
l source definition
l catheter reconstruction
l source dwell position activation
l dose normalization
l dose optimization
l dose prescription
l plan evaluation (also in the Plan Analysis activity)
l plan reporting
l plan exporting
5.1.2 Package Contents - Oncentra Brachy

There are three Oncentra Brachy packages: film-based, volume-based and advanced volume-based.
Film-based (2D) Package
l Portal (PT)
The Portal is a framework in which different modules or activities can execute. This is the GUI for

User Manual 29

l Brachy Planning (BP)

BP handles the creation of a brachy treatment plan, including source definition, catheter reconstruction
(Applicator Modeling is a separate optional licence), source dwell position activation, dose
normalization, dose optimization, dose prescription, plan evaluation, plan reporting and plan exporting.

PA handles evaluation of single plans, as well as plan comparison and plan summation.
Volume-based (3D) Package
This package has the same contents as the film-based package and also:

related to the patient anatomy and target volumes for treatment planning. AM allows the user to create
and edit image registration between image series so that image fusion tools can be utilized. AM can be
started in the Target Definition activity or Image Registration activity.
Advanced Volume-based (3D) Package
This package has the same contents as the volume-based package and also:
l Oncentra IPSA
The Inverse Planning Simulated Annealing (IPSA) optimization method for brachytherapy is guided by
dose objectives for each of the ROIs that are taken into consideration.
Separate Optional License
l Image Registration (IR)

IR is an Anatomy Modeling activity. The image registration (co-registration/correlation/match) sets up a
correlation matrix between two sets of images.
l Applicator Modeling
This is a license for applicator placement using applicator models from the Applicator Library Manager.
l Oncentra IPSA
The Inverse Planning Simulated Annealing (IPSA) optimization method for brachytherapy is guided by
l Oncentra HIPO
The Hybrid Inverse Planning Optimization (HIPO) optimization method for brachytherapy is guided by

30 User Manual
5.1.3 Brachy Workflow - Film-based (2D)
5.1.4 Brachy Workflow - Volume-based (3D)

User Manual 31

RT Structure Set.

32 User Manual
images.
5.3 Brachy Planning Activity
The Brachy Planning [BP] activity allows you to create a brachy treatment plan, which can be executed by a
Nucletron remote afterloading system with a specific radioactive source for PDR or HDR brachytherapy.
The catheters are placed in the patient. Patient images are acquired with an imaging device. In Oncentra the
acquired images are imported and attached to the patient data. Using the Anatomy Modeling activity, regions of
interest (target, organs at risk) can be defined on the images. In the Brachy Planning activity the brachy
treatment plan is made. The catheters are reconstructed on the image data set(s). The treatment plan is made
using a specific set of tools (for example, activation of source dwell positions, dose optimization, plan
evaluation). The final treatment plan is approved by an authorized person and exported to the remote
afterloading system.
To save time, you can save a plan as a library plan and re-load the library plan into another current plan.
Catheter reconstruction is not saved in a library plan. A library plan can be applied to manually reconstructed
catheters and applicator models from the Applicator Library Manager.
Brachy Planning includes the following functions:
l Source definition: select a Nucletron remote afterloading system with a specific calibrated radioactive
source for PDR or HDR brachytherapy.
l Catheter reconstruction: reconstruct the catheters using the acquired images. If the required
applicator model is available in the applicator library, you can use the applicator model for catheter
reconstruction (requires a separate license). You can apply shields to the following gynecological
applicators: Fletcher Williamson Applicator Set, Standard Applicator Set and Shielded Cylindrical
Applicator Set.
l Activation of source dwell positions: define which source dwell positions in the catheters should be

activated for treatment.
l Defining points: for dose reporting and normalization on patient, applicator or dose points.
l Dose normalization: set the reference isodose line with a selected dose normalization method.
l Dose optimization: optimize the homogeneity and shape of the target dose distribution w hile sparing

normal tissue.
l Dose prescription: assign an absolute dose (cGy) to a relative dose (%), typically 100 %.
l Plan evaluation: calculate and evaluate the DVH, including the DVH table with markers. View the dose
range display, live dose, and dose profile.
l Plan reporting: treatment printout.
l Plan exporting: the treatment plan can be exported to another treatment planning system (for
evaluation, comparison and approval), or to the afterloader (for treatment).

User Manual 33
to other results known to be correct. Oncentra does not restrict set-up of unrealistic
parameters, for example, incorrect system settings, incorrect catheter reconstruction,
inappropriate methods or parameters for planning the source dwell times and source
dwell positions.
dependent on user input. This is particularly important when verifying the orientation of
imported images (CT, films, and so on).
Caution! For export of the treatment plan, the system assumes that the treatment planning
system and afterloading system are both using an Air Kerma Rate Constant of 4.082 cGy
cm2/h/mCi (microSelectron afterloader) or 4.070 cGy cm2/h/mCi (Flexitron afterloader).
The user is responsible for configuring the systems correctly.
The Manual Optimize Dwell Weights option can be used to shape a dose distribution. Therefore, after manually
adjusting the dwell weights, return to the Normalization w indow to re-normalize the dose to the previously
specified points (if needed). You can interactively view the 3D isodose distribution and the 2D isodose
distribution in other images as you change the dwell weights or dwell times.
a PA session.

34 User Manual
the case).
Plan comparison:
Plan summation:
extension limits.

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36 User Manual
6 Oncentra Anatomy Operating Instructions
6.1 Oncentra Anatomy Package
6.1.1 Package Concept – Oncentra Anatomy
Oncentra Anatomy provides tools for:
l contouring
l segmentation
l multi-modality image registration
l fusion.
With Oncentra Anatomy you can define targets and organ structures using free-hand or advanced contouring
tools in any plane. The Magic Wand feature allows you to draw 3D structures automatically.
Oncentra Anatomy also includes automated and fully 3D contour interpolation and 3D margining tools, while
image fusion offers possibilities to define target volumes in multi-modality image settings.
Oncentra Anatomy is also fully DICOM-compliant. The level of connectivity contained within Oncentra Anatomy
ensures integration with other current and future systems and treatment devices within your clinic.
6.1.2 Package Contents – Oncentra Anatomy

l Portal (PT)



User Manual 37
related to the patient anatomy and target volumes for treatment planning. AM can be started in the
Target Definition activity. Image Registration (IR) allows the user to create and edit image registration
between image series so that image fusion tools can be utilized.

6.1.3 Anatomy Workflow

RT Structure Set.

38 User Manual
images.

User Manual 39

40 User Manual
7 Oncentra Evaluation Operating Instructions
7.1 Oncentra Evaluation Package
7.1.1 Package Concept – Oncentra Evaluation
Oncentra Evaluation provides options for reviewing planned treatments by:
l interactive dose shaping for 3D plan evaluation
l generated Dose Volume Histograms for all plans
l three-dimensional dosages displayed as a surface, or volumetrically rendered as a 3D dose cloud.
Many other viewing possibilities are also supported for fast and efficient plan evaluation. Oncentra Evaluation
can be accessed from any workstation using floating licenses.
7.1.2 Package Contents – Oncentra Evaluation

l Portal (PT)


PA handles evaluation of single plans and of individual beams and segments in plans, as well as plan
comparison and plan summation.

User Manual 41
7.1.3 Evaluation Workflow
a PA session.

42 User Manual
the case).
Plan comparison:
Plan summation:
extension limits.

User Manual 43

44 User Manual
8 Troubleshooting and Maintenance
8.1 Troubleshooting
For reporting errors in the software to the service organization, see "Contact Information" at the beginning of
the User Manual.
8.2 Maintenance
8.2.1 Quality Assurance
Note! Only qualified staff may use the system.
Please refer to the "Radiation Commissioning and Quality Assurance" manual.
8.2.2 Maintenance
Note! Backups of system data must be done frequently on a regular basis.
For general maintenance information, please refer to the "System E nvironment Introduction" manual.
For detailed maintenance procedures, please refer to the "System Administrator Manual".

User Manual 45
8 Troubleshooting and Maintenance

46 User Manual
9 Appendix A: Technical Data
9.1 Specifications - External Beam
9.1.1 Accuracy
The geometrical accuracy of all views displaying patient anatomy (images overlaid by structures) is within one
voxel for a 512x512x200 image data set. This includes image linearity, scaling, measuring tool and image fusion.
The transformation used when an image registration is defined is a linear transform that moves, rotates and
scales all voxel locations of two co-registered series, calculated to full machine precision. The accuracy of the
defined linear transform is situation dependent and several tools exist to evaluate its relevance at certain
application locations.
Actual dimensions and distances in all planar views of patient anatomy can be measured, using measuring tools.
The dose calculation module calculates dose distributions within accepted community standards for
radiotherapy as published in:
l AAPM TG 40 (Kutcher, et al.1994, AAPM report 46, "Comprehensive QA for radiation oncology")
l AAPM TG 53 (Fraass, et al.1998, AAPM report 62, "Quality assurance for radiotherapy treatment
planning")
l ICRU Reports 24 (1976) and 42 (1997).
In particular, for regular treatment conditions, the system has been proven to calculate dose to the below
stated accuracy given in % of calibration dose, or mm distance deviation to correct dose value, compared to a
pre-defined set of measurements or benchmark Monte Carlo calculations, for various regions as follows:
Central 80% of Treatment Field: +/- 3%
Shoulder Region: +/- 4%
Regions Outside the Field: +/-5%.
Regions of Sharp Gradient: +/-3 mm
Clinical Dose Delivery Process: Clinical dose delivery depends not only on the calculated dose accuracy

(including the limitations of the dose calculation algorithm and computer abilities), but depends also on all the
inherent treatment delivery sources of error such as patient movement, beam output deviations, treatment
unit accessories, and accuracy of input data. To calculate dose for a particular treatment machine, dosimetric
data valid for the actual machine must be acquired and processed to create parameters for that machine.
Before taken into clinical use, these parameters must be installed on the system and the resulting calculated
dose validated by the user according to clinical norms.
A computer produced dose distribution can be considered accurate if it is consistent with measured dose
distributions within these limits and in relevant points for the treatment.
9.1.2 System Configurations

By default, Oncentra displays the dose in the unit Gy. It is possible to configure Oncentra to display the dose in
cGy. On a case-by-case basis, it is possible to display the dose in a percentage of a user-defined normalization.
Upon DICOM export, the absolute dose in the unit Gy is always provided.

User Manual 47
9.1.3 Data Limits for Treatment Planning

Data elements that are entered by the user are compared against pre-established limits. Operations are
prevented if the data are outside these limits. A list of limits is provided in Appendix C.
There is no limit to the maximum number of beams that can be created per plan in Beam Modeling. The
required performance for Oncentra is validated for 100 stationary beams per plan. The user should be aware
that the overall performance of Oncentra might be reduced if more than 100 stationary beams are defined for
a single treatment plan.
9.2 Specifications - Brachy

9.2.1 Accuracy
The geometrical accuracy of all views displaying patient anatomy (images overlaid by structures) is within one
voxel for a 512x512x200 image data set. This includes image linearity, scaling, measuring tool and image fusion.
The transformation used when an image registration is defined is a linear transform that moves, rotates and
scales all voxel locations of two co-registered series, calculated to full machine precision. The accuracy of the
defined linear transform is situation dependent and several tools exist to evaluate its relevance at certain
application locations.
Actual dimensions and distances in all planar views of patient anatomy can be measured, using measuring tools.
The Brachy Planning activity calculates dose distributions within accepted community standards for
radiotherapy as published in:
l AAPM TG 43 (Rivard, et al. 2004, Update of AAPM report 43, "A revised AAPM protocol for
brachytherapy dose calculations")
l ICRU Reports 38 (1985) and 58 (1997).
For further information about the algorithms used in the Brachy Planning activity (with references to literature),
please refer to the 'Physics and Algorithms' manual (part number 192.739).
9.2.2 System Configurations

By default, Oncentra displays the dose in the unit Gy. It is possible to configure Oncentra to display the dose in
cGy. On a case-by-case basis, it is possible to display the dose in a percentage of a user-defined normalization.
Upon DICOM export, the absolute dose in the unit Gy is always provided.
9.2.3 Data Limits for Treatment Planning

prevented if the data are outside these limits. A list of limits is provided in Appendix C.
9.2.4 Afterloader Limits for Treatment Planning

The maximum number of:
l Active source dwell positions is limited by the remote afterloading system.
l Radioactive sources that can be used in a treatment plan is 1.
9.2.5 Source Calibration

Information about source strength calibration is entered in the Radiation Data Storage (RDStore) tool. For
details, please refer to the 'Radiation Commissioning and Quality Assurance' manual (part number 192.740).

48 User Manual
9.3 Coordinate Systems and Units - External Beam

9.3.1 Coordinate Systems
In Oncentra for external beam, four different coordinate systems are used:
l C – The Fixed Coordinate System is fixed with respect to the treatment room and is used as a reference
F
for other coordinate systems.
l C – The Patient Coordinate System is related to an internal reference point in the patient and moves
P
with the patient.
l C – The Beam Coordinate System is related to the radiation beam.
B
l C – The Wedge Coordinate System is related to the beam wedge.
W
These coordinate systems are Cartesian right-handed and defined according to the conventions set by the IEC-
61217 standard and ICRU Report 42. When all coordinate system angles are set to zero, all coordinate system z-
axes are vertically upward. The coordinate systems are described in detail in 'Oncentra Help'.
9.3.2 Units
Oncentra is configured to display all linear units in centimeters. It is possible for the user to configure Anatomy
Modeling, Plan Manager and Plan Analysis activities to display linear units in millimeters, as this is often
preferred by physicians. N egative numbers are preceded by a minus sign (for example -1, -2) when used for
linear units and linear digital display. Positive numbers are not preceded by a sign.
Rotation units and angular digital displays are graduated in degrees, using positive numbers without signs, for
example: 0,1, 358, 359.
9.4 Coordinate Systems and Units - Brachy

9.4.1 Coordinate Systems
The coordinate systems are Cartesian right-handed. Different coordinate systems are used.
l Patient Coordinate System: defined with the image data by the original imaging method. This

coordinate system is related to a patient’s anatomy. It is defined according to the conventions set by the
IEC-61217 standard and ICRU Report 42.

User Manual 49
l Extra Coordinate System (ECS): the automatically defined Applicator Coordinate System (ACS) and

additional user-defined ECS views (displayed in the ECS Views tab of the Thumbnail Palette).
The ACS is used for catheter reconstruction. The initial orientation of the ACS is exactly the same as the
patient coordinate system, but the origin is located at the geometrical center of the scanned volume
(only one ACS can be defined). The ACS can be moved and rotated. Points can be defined, and then the
reconstructed applicator points also move and rotate to keep the same ACS coordinates.
Additional user-defined ECS views can be used for viewing and evaluation. The ECS can be moved and
rotated. Points can be defined, but the points do not move and rotate with the ECS.
9.4.2 Units
The user can configure Anatomy Modeling, Brachy Planning and Plan Analysis activities to display linear units in
millimeters or centimeters. Negative numbers are preceded by a minus sign (for example -1, -2) when used for
linear units and linear digital display. Positive numbers are not preceded by a sign.
Rotation units and angular digital displays are graduated in degrees, using positive numbers without signs, for
example: 0, 1, 358, 359.
The user can select the dose units (cGy or Gy).
For the Brachy Planning activity, the user can select the source strength quantity (air kerma strength or
reference air kerma rate) and units (cGy cm2/h, mGy m2/h or μGy m2/h). The user can also select an additional
- secondary - quantity (apparent source activity) and units (MBq, GBq, mCi or Ci).
9.5 Standards
The following standards have been applied.
Standard Revision Description

93/42/EEC 2007 Council directive of 14 June 1993 concerning medical devices ("MDD", Medical
Device Directive)
2004/108/EC 2001 Council directive concerning electromagnetic compatibility
IEC 60601-1-4 1999 General requirements for safety - Programmable electrical medical systems
IEC 60601-1-1 2000 Medical electrical equipment -- Part 1-1: General requirements for safety -
Collateral standard: Safety requirements for medical electrical systems
IEC 60601-1-2 2001 Medical electrical equipment - Part 1-2: General requirements for safety -

50 User Manual
Standard Revision Description

Collateral standard: Electromagnetic compatibility - Requirements and tests
IEC 60950-1 2005 Information technology equipment - Safety - Part 1: General requirements
ISO 14971 2007 Medical devices -- Application of risk management to medical devices
IEC 61217 2001 Radiotherapy equipment - Coordinates, movements and scales
IEC 62083 2007 Medical electrical equipment – Requirements for the safety of radiotherapy
treatment planning systems
EN 1041 2008 Information supplied by the manufacturer of medical devices
EN 980 2008 Symbols for use in the labeling of medical devices
IEC 62304 2006 Medical device software- Software life cycle processes
IEC 62366 2007 Medical device- Application of usability engineering to medical devices
ISO 80002-1 2009 Medical device software -- Part 1: Guidance on the application of ISO 14971 to
medical device software

User Manual 51

52 User Manual
10 Appendix B: Messages
10.1 Messages
10.1.1 General
The Oncentra system continuously checks its own integrity, the system environment, data consistency and data
integrity. When inconsistencies or defects are detected, the system will display error messages on the screen.
These error messages must be carefully read and understood before continuing to use the system. If in doubt
about an error message, please contact your Nucletron representative for clarification.
Error logs can be found in the Windows Start menu: All Programs > Oncentra > Logfiles:
l DicomServer.log
l Installation.log
l Oncentra.log
l OTP-Services.log
10.1.2 Required User Actions

Specific actions required by the user may be specified in the error message text. In addition, general
considerations for each of the error message type are listed below.
10.1.3 Environment Related Error Messages

When the system detects abnormalities in the system-environment, it will halt the operation of the system. The
user must then rectify the indicated issue and restart the system before continuing. See ‘Service Manual’.
10.1.4 Data Related Error Messages

When the system detects abnormalities in the data that is imported from other systems or entered by the user,
it will inform the user about the problems that were detected. The user must then rectify the indicated data
before continuing.
During dose calculation, a number of checks are performed on the data used as basis for the calculation. If
inconsistencies or defects are detected, the calculation is aborted and the error messages are listed in the log-
file for the calculation in question. Dose calculation error messages are not included in the list below as they
include detailed information about what the problem is and what data-element that caused it.
10.1.5 List of Error Messages and Types

The table below shows the most important error messages from the system. It also shows the type of the error
message in question.
Error message Type

An internal error has occurred! Operation could not be performed. Environment related
Beam parsing error has occurred Data related
Connection has been closed Environment related
Connection To BOM FAILED Environment related

User Manual 53
10 Appendix B: Messages
Error message Type

Contour not found with Sequence Number Data related
Data format error Data related
Database error Environment related
Database Exception occurred: Environment related
Database Read Error Environment related
Error reading the CASE. Data related
Failed to start the error log (OncentraLog) server Environment related
Logic error. UID > 64 characters Data related
No unit of measure defined for Dose Data related
ODBC Environment Failure Environment related
OTP product version number not found in Windows registry Environment related
OTP Services failed to configure the database client Environment related
OTP Services failed to configure the database server Environment related
OTP Services failed to start “WINSCP32.EXE” Environment related
Patient Id already exists Data related
Problem with parsing Rtplan object Data related
Program terminating due to exception Environment related
Program terminating due to unspecified exception Environment related
The number of bytes defining the image is too small Data related
The OTP software controller detected problems Environment related
The PatientSetup object creation failed Data related
UID and Case Uid must be defined Data related
Wedge not found with Sequence Number Data related

54 User Manual
11 Appendix C: Limits for Data Elements
11.1 General
prevented if the data are outside these limits. The following tables list the data elements and limits for each
Oncentra activity.
Acronyms used in the tables: LF (Line Feed), FF (Form Feed), CR (Carriage Return).
11.2 Limits Portal

Field Input Limits Comment
Portal –Oncentra Login dialog
Username 1 – 32 Required.
Password 6 – 32 Required. User input is displayed as ‘*’
Portal – Oncentra Locked dialog
Enter password to unlock 6 – 32 Required. User input is displayed as ‘*’
Portal – Save Case As dialog
Case label 1 – 64 Required. Illegal values: LF, CR, FF, ‘\’
Portal – Copy Plan dialog
Plan label 1 – 16 Required. Illegal values: LF, CR, FF, ‘\’
Portal –Create New Patient dialog
ID 1 – 64 Required. Illegal values: LF, CR, FF, ‘\’
First name 0 – 60 Illegal values: LF, CR, FF, ‘\’, ‘^’, ‘=’. Sum of all
characters for names, prefix and suffix in this dialog
cannot exceed 60.
Middle name 0 – 60 Illegal values: LF, CR, FF, ‘\’, ‘^’, ‘=’
Last name 1 – 60 Required. Illegal values: LF, CR, FF, ‘\’, ‘^’, ‘=’
Name prefix 0 – 60 Illegal values: LF, CR, FF, ‘\’, ‘^’, ‘=’
Name suffix 0 – 60 Illegal values: LF, CR, FF, ‘\’, ‘^’, ‘=’
Birth date 10 ‘yyyy-mm-dd’
Portal – Delete dialog – Search
ID 0 – 64 ‘*’ Used as search wildcard.
First name 0 – 60 ‘*’ Used as search wildcard.
Last name 0 – 60 ‘*’ Used as search wildcard.
Birth date 0 – 10 ‘*’ Used as search wildcard. Date in format ‘yyyy-mm-
dd’

User Manual 55

Portal – Change Oncentra Password dialog
Old password Required. User input is displayed as ‘*’
New password 6 – 32 Required. User input is displayed as ‘*’
Confirm new password 6 – 32 Required. User input is displayed as ‘*’
Portal – Oncentra User dialog
Username 1 – 32 Required. Illegal values: LF, CR, FF, ‘\’, ‘^’, ‘=’
Full name 0 – 64
Password 6 – 32 Required. User input is displayed as ‘*’
Confirm new password 6 – 32 Required. User input is displayed as ‘*’
Description 0 – 128
Portal – New Oncentra Group dialog
Group name 1 – 32 Required. Illegal values: LF, CR, FF, ‘\’, ‘^’, ‘=’
Portal – Edit Oncentra User dialog
Full name 0 – 64
Password 6 – 32 User input is displayed as ‘*’
Verify password 6 – 32 User input is displayed as ‘*’
Portal – Edit Oncentra Group dialog
Portal – Select Case dialogs – Search
ID 0 – 64 ‘*’ Used as search wildcard.
First name 0 – 60 ‘*’ Used as search wildcard.
Last name 0 – 60 ‘*’ Used as search wildcard.
Birth date 0 – 10 ‘*’ Used as search wildcard. Date in format ‘yyyy-mm-
dd’
Portal - Oncentra LAP Export dialog
Patient First N ame 0 – 61 Sum of Patient Name (must be at least 1 character)
and Patient First Name must be less than or equal to
64 characters.
Patient Birth Date Free text.
Comment Free text.
X/Y/Z (cm) -999.99 – 999.99 Required.
Portal - Oncentra RTP Connect IEC Format dialog
IEC Couch Displacements - Lateral, -999.9 – 999.9 Required.
Longitudinal, Vertical (cm)

56 User Manual
11.3 Limits Connectivity Module [CM]

CM – Select New Patient for Import dialog
ID 1 – 64 Required. Illegal values: LF, CR, FF, ‘\’
First name 0 – 60 Illegal values: LF, CR, FF, ‘\’, ‘=’. Sum of all characters
for names, prefix and suffix in this dialog cannot
exceed 60.
Middle name 0 – 60 Illegal values: LF, CR, FF, ‘\’, ‘=’
Last name 1 – 60 Required. Illegal values: LF, CR, FF, ‘\’, ‘=’
Name prefix 0 – 60 Illegal values: LF, CR, FF, ‘\’, ‘=’
Name suffix 0 – 60 Illegal values: LF, CR, FF, ‘\’, ‘=’. Maximum size of the
full name is 60 characters.
Birth date 10 ‘yyyy-mm-dd’
CM - Anonymize Patient Information dialog
Patient name 1 - 64 Required. Illegal values: LF, CR, FF, ‘\’
Patient ID 1 - 64 Required. Illegal values: LF, CR, FF, ‘\’, ‘^’, ‘=’
Birth date 8 Required. Valid date in format ‘yyyymmdd’; digits 0-9
Patient sex Required. Must be M, F or O (or nothing).
11.4 Limits Anatomy Modeling [AM]

AM – Define Polygon dialog
X/Y/Z (mm) Min – Max Required. X is determined by minimum and
maximum dimensions of CT study.
AM – Properties DRR
Window size ≥ 1
AM - Object Properties pane
Structure - Name 1 - 64 Illegal values: LF, CR, FF, ‘\’
Visualization - Opacity (%) 0 - 100 Required
ROI Grid - Grid spacing (cm) 0.1 - 1.5 Required when set to ‘Manual’. Non-editable w hen
set to ‘Auto’.
AM - Save As ROI Set dialog
ROI Set - Name 1 – 64 Required. Illegal values: LF, CR, FF, ‘\’
ROI Set - Description 0 - 255
AM - ROI Catalog Manager dialog
ROI Set - Name 1 – 64 Required. Illegal values: LF, CR, FF, ‘\’

User Manual 57

ROI Set - Description 0 - 255
Structure - Name 1 – 64 Required. Illegal values: LF, CR, FF, ‘\’
Visualization - Opacity (%) 0 – 100 Required
Physics - Mass density (g/cm3) 0.001 – 10.00 - Undefined/no density. Oncentra dose calculation
can only handle mass density 0.001-2.83.
AM – Edit Available ROI Templates dialog
Structure - Name 1 – 64 Required. Illegal values: LF, CR, FF, ‘\’
Visualization - Opacity (%) 0 – 100 Required
Physics - Mass density (g/cm3) 0.001 – 10.00 - Undefined/no density. Oncentra dose calculation
can only handle mass density 0.001-2.83.
AM - Options dialog
Workspace name 1 – 20 May contain letters ‘a’-‘z’ and ‘A’-‘Z’, numbers 0-9 and
space.
AM – Resample ROI dialog
Number of contours 2 – 200 Required.
AM – Simplify ROI dialog
Vertices 10 – Max ‘Max’ is specified by a system setting
AM – ROI Margin dialog
±x/±y/±z (mm) -10.0 – 100.0
AM – Landmark Registration dialog
x/y/z Min – Max Determined by minimum and maximum dimensions
of CT study.
AM – MIR Using ITK Settings dialog
Levels 1 – 10
Fixed image shrink factors 1 – 512
Moving image shrink factors 1 – 512
Translation scale 1 – 10000
Iterations 1 – 10000
Learning rate 1e-17 – 1e-1
AM – Surface Registration dialog
Corresponding point (mm) Min – Max Determined by minimum and maximum dimensions
of CT study.
Samples 1 – 1000 Default 20
Iterations 1 – 500 Default 20
AM – Create Empty Image Series dialog
Slices 1 – 500
Dimension X/Y/Z (mm) 10 – 30000
AM – Create Artificial Image Series dialog

58 User Manual

Slices 1 – 500
AM – Circular Cursor Size
Size 0 – 200
AM - Pearl Tool Size
Size (radius) (mm) 1 - 300
AM – POI Properties pane
Structure - Name 1 – 64 Illegal values: LF, CR, FF, ‘\’
AM – New POI
POI name 1 – 64 Required. Illegal values: LF, CR, FF, ‘\’
AM - Structure Set Grid dialog
Spacing (cm) 0.1 - 1.5 Required when set to ‘Manual’. Non-editable w hen
set to ‘Auto’.
Position x/y/z (cm) -1000.00 - Required when set to ‘Manual’. Non-editable w hen
1000.00 set to ‘Auto’.
11.5 Limits Beam Modeling [BM]

BM – New Plan dialog
Label 1 – 16 Required. Illegal values: LF, CR, FF, ‘\’
Note 0 – 256
BM – New Beam dialog
Beam Label 1 – 24 Required. Illegal values: LF, CR, FF, ‘\’
Arc Start (deg) 0 – 359
Arc Angle (deg) 10 – 360
BM – Rename Beam dialog
Current Beam Name 1 – 24 Required. Illegal values: LF, CR, FF, ‘\’
BM – Beam Label dialog – Oppose or Duplicate beam
BM – Window Width/Center
Center Min CT – Max CT
Width 1 – Max Max = 2(Max CT - Min CT)
BM – DRR Settings
Resolution 256, 512, 1024 For the 'Edge' DRR creation method, 1024 is not a
setting.
Sampled points 20 – 512
Bone enhancement factor 1.0 – 20.0

User Manual 59

Bone threshold 0 – 1000
Min/Max CT data threshold -1000 – 3095
Center Min DRR – Max
DRR
Width 1 – Max Max = 2(Max DRR - Min DRR)
BM – Calculation Specification dialog
Calculation grid spacing (cm) 0.1 – 5
Inferior (External Axial Extension) 0 – 50 Default 0
Superior (External Axial Extension) 0 – 50 Default 0
BM – Plan Information
W (cm) Treatment unit dependent
-x Jaw (cm) Treatment unit dependent
+x Jaw (cm) Treatment unit dependent
L (cm) Treatment unit dependent
-y Jaw (cm) Treatment unit dependent
+y Jaw (cm) Treatment unit dependent
X/Y/Z (cm) -999.99 – 999.99 Y is not closer to the surface than the source to
diaphragm distance.
Y offset (cm) -999.99 – 999.99
Depth (cm) (FSDD - 999.98)
– (FSDD – SSD)
SSD (cm) ≤ 999.98 Greater than source to diaphragm distance or source
to tray distance.
Gantry (deg) -360 – 360 Only positive value of angle is displayed (0 – 360).
Collimator (deg) -360 – 360 Only positive value displayed.
Couch (deg) -360 – 360 Only positive value displayed.
BM – Plan Data dialog
Width (cm) Treatment unit dependent
+ Jaw (cm) Treatment unit dependent
Length (cm) Treatment unit dependent
diaphragm distance
to tray distance
– (FSDD – SSD)

60 User Manual

Gantry (degrees) -360 – 360 Only positive value of angle is displayed (0 – 360).
Collimator (degrees) -360 – 360 Only positive value displayed.
Couch (degrees) -360 – 360 Only positive value displayed.
BM – Fields Settings at FSDD dialog
Width (cm) Treatment unit dependent
+x Jaw (cm) Treatment unit dependent
Length (cm) Treatment unit dependent
diaphragm distance.
Y offset (cm) -999.99 – 999.99
to tray distance
– (FSDD – SSD)
BM – Plan Dose Point dialog
Label 1 – 64 Illegal values: LF, CR, FF, ‘\’
X/Y/Z (cm) -999.99 – 999.99
BM – Print Scale dialog
Scale > 0
≤ Max scale
BM – Projection Distance dialog
BEV Projection Distance (cm) 0 – 300
BM – Manual Field Shaping dialog
Percentage Transmission (%) 0 – 20
Thickness (cm) 3 - 20
BM – Keyboard Field Shaping dialog
X/Y (cm) > -1000000
< 100000
BM – Automatic Field Shaping dialog
Margin (cm) 0 – 5

User Manual 61

BM – Rotate All Shields dialog
Angle (°) -360 – 360 Only positive value of angle is displayed (0 – 360).
BM – Rotate Aperture dialog
Angle (°) -360 – 360 Only positive value of angle is displayed (0 – 360).
BM – MLC Edit dialog
Left (cm)
Right (cm)
Margin (cm) 0 – 5
BM – Auto MLC dialog
FX, FY (cm) Treatment unit dependent
X1, X2, Y1, Y2 (cm) Treatment unit dependent
Margin (cm) 0 – 5
Increment (deg) 0.01 – 359.99
BM – ACCESS Specific Information dialog
Patient’s First Name 0 – 20
Patient’s Last Name 1 – 20 Required.
Prescription Site 1 – 20 Required.
BM – LAP Patient Positioning dialog
Patient First Name 0 – 61 Sum of Patient Name (must be at least 1 character)
64 characters.
Patient Birth Date Free text
Comment Free text
X/Y/Z (cm) -999.99 – 999.99 Required.
BM – Arc Settings dialog
Arc Start (deg) 0 – 359
Arc Angle (deg) 10 – 360
BM – Plan Label (Rename) dialog
Note 0 – 256
BM – Select Wedge dialog
Effective Wedge Angle (deg) min. wedge
angle – max.
wedge angle

62 User Manual
11.6 Limits Plan Manager [PM]

PM – New Plan dialog
Search 0 - 255
New plan label 1 - 16 Required. Illegal values: LF, CR, FF, ‘\’
New plan note 0 - 255
PM – Plan Properties, Dose Calculation Specification dialog
Calculation grid spacing (cm) 0.1 – 5
Inferior (External Axial Extension) 0 – 50 Default 0
Superior (External Axial Extension) 0 – 50 Default 0
PM – Plan Properties, Plan Info dialog
Label 1 – 16
Plan note 0 – 255
PM – Plan Properties, Dose Points dialog
Label 1 – 64
Coordinates X/Y/Z (cm) -1000 – 1000
PM – Beam Properties, Gantry Angle dialog
Angle (degrees) -360 – 360
PM – Beam Properties, Collimator Angle dialog
PM – Beam Properties, Couch Angle dialog
PM – Beam Properties, Isocenter dialog
Coordinates X/Y/Z (cm) -1000 – 1000
PM – Beam Properties, Conformance dialog
Margins - Uniform (cm) 0.0 – 5.0
Margins - Beam (cm) 0.0 – 5.0
Margins - Collimator (cm) 0.0 – 5.0
PM – Beam Properties, Wedge dialog
Effective angle (degrees) Treatment unit dependent.
PM - Beam Properties, Blocks dialog
Transmission (%) 0.0 - 20.0
Thickness (cm) 3.0 - 20.0
PM - Beam Properties, Aperture dialog
Transmission (%) 0.0 - 20.0
Thickness (cm) 3.0 - 20.0
PM – Isolines dialog

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Auto Fill - From (Gy) -1000 – 1000 For relative x10. For cGy x100.
Auto Fill - To (Gy) -1000 – 1000 For relative x10. For cGy x100.
Auto Fill - Step (Gy) 0.00 – 500 For relative x10. For cGy x100.
Edit isoline value (Gy) -1000 – 1000 For relative x10. For cGy x100.
PM – Beam Weighting dialog
MU or min / Fx 0 – 50 000
Weight ≥ 0 Editable only in Relative – Normalized mode
Total Abs. Dose ≥ 0 Editable only in Absolute – Unnormalized mode
<dose point> dose ≥ 0
Effective wedge angle (deg) 0 – max. wedge This control is displayed only for beams having a
angle motorized wedge
Normalization dose ≥ 0 Editable only in Absolute – Normalized mode
Prescription dose ≥ 0 Editable only in Relative – Normalized mode
Prescription level ≥ 0 Editable only in Relative – Normalized mode
Number of fractions 1 – 100
X/Y/Z (cm) The normalization dose at the position must be > 0
PM – View Properties, DRR
Create preset - Name 1 - 40
Rename preset - Name 1 - 40
Projection distance (cm) 5.00 - 300.00
PM – Case Explorer
Plan label 1 - 16
Beam label 1- 24
SSD (cm) Min - 1000 'Min' is treatment unit dependent.
FX, FY (cm) Treatment unit dependent.
X1, X2, Y1, Y2 (cm) Treatment unit dependent.
Display factor 0.01 - 1000
11.7 Limits Dose Calculation [DC]

DC – Dose Calculation dialog
Job Label 0 – 40
DC – Dose Calculation – Options dialog – Beam Weighting
Meterset/Fx 0 - 50000 MU
0.0 – 100
minutes

64 User Manual

Dose/Fx 0.0 – 100 Gy
0.0 - 10000 cGy
DC – Dose Calculation – Options dialog – Calculation Specification
Superior extension (cm) 0.0 – 50.0
Inferior extension (cm) 0.0 – 50.0
Number of histories per cm2 1000 – 1000000
DC – Dose Calculation – Options – Weight Selected Beam(s) dialog
Meterset/Fx 0 - 50000 MU
0.0 – 100
minutes
Dose/Fx 0.0 – 100 Gy
0.0 - 10000 cGy
11.8 Limits Plan Evaluation [PE]

PE – Window Width/Center
Center Min CT – Max CT
Width 1 – Max Max = 2(Max CT - Min CT)
PE – DRR Settings
Resolution 256, 512, 1024 For the 'Edge' DRR creation method, 1024 is not a
setting.
Sampled points 20 – 512
Bone enhancement factor 1.0 – 20.0
Bone threshold 0 – 1000
Min/Max CT data threshold -1000 – 3095
Center Min DRR – Max
DRR
Width 1 – Max Max = 2(Max DRR - Min DRR)
PE – ACCESS Specific Information dialog
Patient’s First Name 0 – 20
Patient’s Last Name 1 – 20 Required.
Prescription Site 1 – 20 Required.
PE – LAP Patient Positioning dialog
Patient First Name 0 – 61 Sum of Patient Name (must be at least 1 character)
64 characters.

User Manual 65

Patient Birth Date (mm/dd/yy)
Comment
X (cm) -999.99 – 999.99 Required.
Y (cm) Required. Lowest slice offset – Highest slice offset
Z (cm) -999.99 – 999.99 Required.
PE – Print Scale dialog
Scale > 0
≤ Max scale
PE – Projection Distance dialog
BEV Projection Distance (cm) 0 – 300
PE – Isoline Setup (Gy) dialog
Start 0.01 – 500000
End 0.01 – 500000
Step 0.01 – 500000
User defined isolines 1 – 31
PE – Beam Weighting dialog
MU or min / Fx 0 – 50 000
Weight > 0 Editable only in Relative – Normalized mode
Total Abs. Dose > 0 Editable only in Absolute – Unnormalized mode
<dose point> dose > 0
Effective wedge angle (deg) 0 – max. wedge This control is displayed only for beams with a
angle motorized wedge
Normalization dose > 0 Editable only in Absolute – Normalized mode
Prescription dose > 0 Editable only in Relative – Normalized mode
Prescription level > 0 Editable only in Relative – Normalized mode
X/Y/Z (cm) The normalization dose at the position must be > 0
PE – Plan Data dialog
PE – Intensity Map Viewer dialog
MU min 0 – MU Max
MU max MU min – MU of
beam
Projection distance 0 – 300
PE – Plan Label (Rename) dialog

66 User Manual
11.9 Limits Plan Analysis [PA]

PA – Isolines dialog
11.10 Limits Brachy Planning [BP]

BP - Plan Label And Note dialog
Plan Label 1 - 16 Must be unique.
Plan Note 0 - 256
BP - Catheter Reconstruction - Projective - Variable Angle
Magnification 1.0 - 3.0
Focus-Isocenter Distance (mm) 500.0 - 1500.0
Gantry Angle (degrees) -360.0 - 360.0
BP - Catheter Reconstruction - Projective - Orthogonal
Magnification Factor 1.0 - 3.0
BP - Catheter Reconstruction - Projective - Isocentric
Isocenter-Film Distance (mm) 0.0 - 2000.0
Reconstruction Angle (degrees) -10.0 - -50.0,
10.0 - 50.0,
310.0 - 350.0
BP - Catheter Reconstruction - Projective - IBU
L-arm Angle (degrees) -360.0 - 360.0
C-arm Angle (degrees) -135.0 - 135.0,
225.0 - 360.0
Isocenter-Film Distance (mm) 100.0 - 500.0
BP - Catheter Reconstruction
Number of catheters 1 - 90 The maximum number of catheters is limited by the
selected afterloader in the plan.
BP - Automatic Catheter Reconstruction - Advanced

User Manual 67

HU Thresholds (Metal and Plastic) -1500 – 5000
Curvature radius (mm) ≥ 0.0, ≤ 999.9
In-plane noise (mm) 0.0 – 100.0
Points used for extrapolation ≥ 2, ≤ 99999
In volume searching: Max. relative ≥ 0.0, ≤ 999.9
spot area
In volume searching: Search radius 0.0 – 10.0
per distance (mm/mm)
In plane searching: Min. length ≥ 0.0, ≤ 999.9
In plane searching: Point spacing 1.0 – 200.0
BP - Catheter Shielding
Transmission factor 0.00 - 1.00
Rotation steps (degrees) 0.00 - 360.00
BP - Source Activation (Case Explorer)
Indexer (channel) length (mm) 995 - 1500 The default indexer (channel) length depends on the
(microSelectron) selected afterloader.
1001 - 1400
(Flexitron)
Dwell position 1 - 48 The number of possible dwell positions depends on
(microSelectron) the selected afterloader.
1 - 400
(Flexitron)
Dwell weight 0.00 - 9.99
BP - Dose Normalization
F-factor 0.010 - 10.000
BP - Export Treatment Data
Patient ID Max. 15
BP - Isolines dialog

68 User Manual
12 Appendix D: Installation Instructions
The main documents for guidance during installation are the 'System Environment Introduction' and ‘System
Administrator Manual’.
12.1 Installation Procedure

All detailed instructions for installing an Oncentra system are found in the System Administrator Manual, which
should be carefully studied before starting the installation. Here is a list of the main steps:
1. Unless already provided with your computer, install the operating system (including the required
service pack).
2. Configure the operating system.
3. There may be additional hardware that requires software that is not included in the operating system.
Such hardware may be a UPS. Install and/or configure the necessary software for the additional
hardware.
4. Besides the operating system, a few other software products are used to service and maintain the
Oncentra software package. They must be installed and configured.
5. Install the Oncentra software, using the Oncentra Installation DVD (software and documentation).
6. Configure which license mechanism to use, and install the necessary Oncentra licenses.
7. Perform any final configuration steps. Most of the Oncentra software setup is managed from the
Oncentra software, but some steps are done from the Windows environment.
8. Verify that the installation of the Oncentra software was successful. This is done by inspecting some log
files.
9. Back up the Oncentra system
10. Finally, verify that the installed system works as intended. Follow the instructions of the User Installation
Verification in the Oncentra Log Book.
To install an Oncentra client workstation the same procedure can be used with a few minor changes. It is
recommended to perform the installation using a client-kit provided on a net share on the Oncentra application
server, rather than using the Oncentra Installation DVD. Note that the user documentation is automatically
distributed from the server to the clients when later using the system.
12.2 Upgrade Procedure

All detailed instructions for upgrading an Oncentra system are found in the System Administrator Manual,
which should be carefully studied before starting the upgrade. Here is a list of the main steps:
1. Back up the existing Oncentra application server. You need both a system disk backup and a database
backup before the upgrade procedure may be started.
2. The Oncentra application server is based on Windows, so your service pack level might require an
upgrade.
3. Upgrade the Oncentra software on the Oncentra application server, using the Oncentra Installation DVD

User Manual 69
12 Appendix D: Installation Instructions
(software and documentation).
4. Verify that the upgrade of the Oncentra software was successful. This is done by inspecting some log
files.
5. Back up the newly upgraded Oncentra application server. Do not overwrite the media used in step 1
here!
6. Finally, verify that the installed system works as intended. Follow the instructions of the User Installation
Verification in the Oncentra Log Book.
To upgrade an Oncentra client workstation the same procedure can be used with a few minor changes. In
particular the backup of the Oncentra clients is not required. It is recommended to perform the upgrade using
a client-kit provided on a net share on the Oncentra application server, rather than using the Oncentra
Installation DVD. Note that the user documentation is automatically distributed from the server to the clients
when later using the system.

70 User Manual

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Oncentra® External Beam v4.3

Concerning this Publication

Oncentra External Beam and Oncentra Brachy 192.729ENG-08

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192.729ENG-08 Oncentra External Beam and Oncentra Brachy

HEAD OFFICE AND MANUFACTURER

Oncentra External Beam and Oncentra Brachy 192.729ENG-08

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192.729ENG-08 Oncentra External Beam and Oncentra Brachy

1 Introduction and Description 1

3 General Operating Instructions 13

Oncentra External Beam and Oncentra Brachy 192.729ENG-08

4 Oncentra External Beam Operating Instructions 15

5 Oncentra Brachy Operating Instructions 29

192.729ENG-08 Oncentra External Beam and Oncentra Brachy

6 Oncentra Anatomy Operating Instructions 37

7 Oncentra Evaluation Operating Instructions 41

8 Troubleshooting and Maintenance 45

9 Appendix A: Technical Data 47

Oncentra External Beam and Oncentra Brachy 192.729ENG-08

11 Appendix C: Limits for Data Elements 55

12 Appendix D: Installation Instructions 69

192.729ENG-08 Oncentra External Beam and Oncentra Brachy

Oncentra External Beam and Oncentra Brachy 192.729ENG-08

1.5 Warnings, Cautions and Notes

1.6 Important Notices

1.8 Intended Use

192.729ENG-08 Oncentra External Beam and Oncentra Brachy

1.13 Accompanying Documentation

Oncentra External Beam and Oncentra Brachy 192.729ENG-08

Manual Name REF Contents

1.15 Labels and Symbols

192.729ENG-08 Oncentra External Beam and Oncentra Brachy

Symbol Name Meaning or Location

1.16 Abbreviations and Acronyms

Oncentra External Beam and Oncentra Brachy 192.729ENG-08

1.17 Physical Description

1.17.1 Typical Setup

1.17.2 How Supplied

192.729ENG-08 Oncentra External Beam and Oncentra Brachy

1.18 Third-party Software and Hardware

Application Supplier Contact information

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2.1.1 Cautions and Warnings

Oncentra External Beam and Oncentra Brachy 192.729ENG-08

2.1.2 Safety in Oncentra Workflow

2.3 Program Safety

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Oncentra External Beam and Oncentra Brachy 192.729ENG-08

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3.2 Connectivity Module

3.2.2 Import Activity

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3.2.3 Export Activity

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4.1.2 Package Contents – Oncentra

Oncentra External Beam and Oncentra Brachy 192.729ENG-08

l Connectivity Module (CM)

l Anatomy Modeling (AM)

l Beam Modeling (BM)