USER MANUAL PROGRAM VERSION 1.0.1
Contents
1. has been created Note every cone size will be saved as a separate csv file Continue gathering the data for each cone size and beam energy copying and pasting it into a spreadsheet with a name that is fully descriptive of the energy and cone size represented by the data it contains in the comma delimited format See Figure 7 This folder contains a set of PDD csv comma delimited files for one accelera tor prefixed with for convenience Figure 6 1 Five cones 6 x 6 10 x 10 15 x 15 20 x 20 and 25 x 25 cm 2 Eight energies 4 6 9 12 15 16 20 and 22 MeV You are now ready to create an APD file using the Trumpet elMRT Data Import Wizard Additional cone sizes or custom cut out PDD files can be added as needed as described on page 15 of this manual Look in E PDD amp A XxX Ci Tools PS JAI2MEY 10X10 csv S JAZOMEY 10X10 csv S JAGMEY 10X10 csv PS A12Mev 15x15 csvy Q AzoMev 15x15 csv SQ AeMEY 15x15 csv RS A12MEV 20X20 csv 4 a20ME 20x20 csv 4 A6MEY 20X20 csv RS A12MEv 25x25 csvy SQ Az0Mev 25x25 csv SY A6MEY 25x25 csv AS ai2Mev x csv Azomev 6x6 csv MY AeMEY 6x6 csv PS A1SMEY 10X10 csv Q az2mev 10X10 csv JAIME 10x10 csv AG AISMEY 15x15 csv 4 a22mev 15x15 csv PS AIME 15x15 csv RS A1SMEV 20X20 csv A22MEV 20x20 csv SY A9MEV 20x20 csv RS A1SMEY 25X25 csv SG Az2Mev 22X22 csv SY AOMEV 25x25 csv AS AisMev 6x6 csv azamevex csv Q AOMEY 6X6 csv AS ALeMEY 10X10 csv SS A4Me 10x102. Trumpet amer Selection and Importing PDD Data Continued Trumpet eIMRT Data Import Wizard xX Step 3 of 5 Percent Depth Dose Data Files Trumpet mar SS SS ELECTRO ITNT MOGULATIO RAGGA TION THERAPY CAL CULA TOR Add or Delete Depth Dose Data sets Delete 10410 l2hMe 1 000 10410 E Met 1 000 10410 3 Met 1 000 C Documents and Settings Mu D C Documents and Settings Mu D C Documents and Settings Mu D lt Back Next gt Cancel Step 3 of 5 Percent Depth Dose Data Files Part 4 When OK is selected the added PDD and associated cone size MeV and path appears Repeat the previous step until all needed depth dose data files have been added When the desired PDD files are added select Next Trumpet eIMRT Data Import Wizard s x Step 4 of 5 Trumpet L Destination Folder a ce meme ee me aaa m a a ELECTRON WTC TY MOGULATIO RAGLATION THERAPY CALCALATCA Enter a file name for this data set e Destination Folder C Program Files Standard Imaging T rumpet Browse Step 4 of 5 Destination Folder A default destination folder is displayed If this folder is acceptable select Next To select a different folder select Browse and additional destination folders are available Select the desired folder Then select Next Trumpet mer Trumpet eIMRT Data Import Wizard F x k Tr mMpet amar Selection Review ELECTRON TCS TY MGGULATIO RAMATIOM THERAPY CALCULATOR Insti
3. Biology and Physics This paper is entitled Inverse Planning Tool Offers Improved Conformal Dosing of Superficial Sites via Combined Energy and Intensity Modulation of Megavoltage Electron Beams and is written by John R Gentry M S Richard Steeves M D and Ph D BhudattA Paliwal Ph D of the Department of Human Oncology Comprehensive Cancer Care Center University of Wisconsin Madison Madison WI The authors report that use of single energy megavoltage electron beams often poses a clinical challenge when the target volume is anterior to other radiosensitive structures and has variable depth Ensuring that skin as well as the deepest extent of the planning target volume PTV receives the desired dose entails prescribing to a point beyond the depth of peak dose The inherent dose inhomogeneities result in heightened potential for tissue fibrosis scarring and possible soft tissue necrosis Selection of a higher energy in order to improve dose homogeneity results in increased dose to structures beyond the PTV as well as enlargement of the volume receiving the heightened dose The authors ultimately propose use of a powerful script that presents possible solutions on the central axis for composite electron beam creation using both intensity and energy modulation The script eliminates the need to create tens or hundreds of trials on a powerful treatment planning system in order to optimize the dose distribution and its use saves time a
4. Verify this is the proper information for your setup before proceeding to the plan tab See section below for more information Plan Tab This tab is where parameters are entered necessary for calculating the treatment solutions Modulation Energies Prescribed Depth amp Dose and Solutions Characteristics define the output of Trumpet elMRT calculations See page 11 for more information Results Tab This tab shows the results of the parameters entered in the Plan Tab A numerical description is shown on the tab of the currently selected solution while a graphical representation is shown as a curve in the to the right See page 14 for more information Calculating Composite Beam Solutions Accelerator Tab Institution Name Standard Imaging Four City Middleton State Ip ro Accelerator Make Gamma Model G amma Platinum Serial A unnber 1237 Trumpet elMRT Accelerator Tab 10 1 From the main Trumpet lt lt ee 21x elMRT Calculator Screen Look in EN ACCEL amp Mek Ge click on the Open icon the ja Std Imag Five apd i a Std Imag Four apd first icon on the toolbar A E anaran list of accelerators appears a Std Imag Three apd i B Std Imag Two apd in the Open APD acceler ator profile data file dialog box Double click the de een sired APD file or highlight it and select Open Files of type Accelerator Profile Data File apd Cancel 2 The Accelerato
5. Wizard l x Step 3 of 5 Trumpet Percent Depth Dose Data Files Add or Delete Depth Dose Data sets Add Delete Step 3 of 5 Percent Depth Dose Data Files Part 1 The Depth Dose Data File Screen Appears Select Add Trumpet eIMRT Calculator Data Import Wizard F3 AISMEV 15415 c5 F3 S16MeEy 20620 cs w a ALSMEv 2020 CS J A16MEY Soe COSY a ALSMEY aoe CSV ZJ ALSMEY GA ESY AJ ALSMEY EKG CSY 8 A20MEY LOK 10 cs a4 ALEMEY 10 10 csw 8 AZ0MEY 1Se13 cs a AL6MEY 15 19 C5 A20ME zis cS File name Files of type Percent Depth Dose csv Cancel Cancel Step 3 of 5 Percent Depth Dose Data Files Part 2 A directory list appears Select the folder where the PDD data is stored Select a PDD dose file to open Percent Depth Dose Data Properties File Name 412MEV 656 ces On amp to ha D Select the cone size associated with this data set Select the electron energy associated with this data Default Output Factor Step 3 of 5 Percent Depth Dose Data Files Part 3 Review the Depth Dose Data Properties to confirm they are correct Select the cone size associated with this data set Select the electron energy associated with this data Select the Default Output Factor Select OK to continue If the cone size or the MeV needed is not available from the pull down menu enter a new value manually The next time the pull down menu is selected the new cone size or MeV will be available
6. created from 9 and 12 MeV elec trons respectively is shown in comparison with single 9 MeV and 12 MeV electron depth dose distributions See Figure 1 The composite beam is similar to the practical range of the 9 MeV while displaying much improved dose homogeneity extending to 20 mm The dose from the 9 MeV beam varies by over 20 over the first 20 mm The composite beam varies by less than 6 Good agreement between the calculation of the dose and the actual dose distribution was found data points with error bars The error bars represent two standard deviations Fractional Depth Dose o 9 A O e fe CEN O O a O 00 o Depth mm Figure 1 First Step Preparation of PDD Data To begin using Trumpet elMRT Calculator unique Accelerator Pro Type Electron o Do o file Data APD files must be created to properly match the program Type Electron calculations to your specific linear accelerator s output Energy 6 Y Modulation Applicator The creation of these files is handled by the Trumpet elMRT Data Scan PD Import Wizard However before launching the wizard data from the linear accelerator must be provided in a specific Profile Depth SSD 1100 1 dure outlines how to properly create the necessary PDD tables from Offset 02 4 measured data Field Size _ Table T 01183 AB 01183 AE 01183 AH 01183 AJ Trumpet elMRT Data Import Utility requires that the data be i
7. is 9 MeV with a peak dose of 20 mm and 12 MeV with a peak dose of 32 mm This combination may enable Trumpet elMRT Calculator to create solutions when the Range is 30 mm just within the 32 mm peak dose point of the 12 MeV energy Changing the 2 Dose Point may provide solutions If the 2 Dose Point is 8 mm and no solutions are found there may be solutions available at the 10 mm or 12 mm point Then increasing the 2 Dose Point to 15 mm would find solutions that are available from the 9 mm to the 15 mm point and display them on the Results Page Analysis of a Typical Case and Resulting Solution A patient requires an electron breast boost treatment A 10cm by 10 cm field will be used The planning target volume begins 3 mm past the skin surface The treatment is prescribed to begin at the skin surface The planning target volume extends to a depth of 12 mm The most desirable electron beam to use would be one that delivers a uniform dose from the skin surface to a depth of 12 mm The lung field starts at a depth of 50 mm therefore the plan requires the electron field to drop as close to 0 as possible before it reaches the 50 mm depth Trumpet mer Plan Tab Continued Referring to the Plan Page these parameters may be selected to enter into the fields Cone Size The cone size selected for the treatment is 10 x 10 cm so this option must be selected here MeV 1 and MeV 2 A uniform dose is required from 0 mm to 12 mm To ac
8. times simultaneous ly If comparing treatments with one accelerator profile is desired fio create a copy of the APD with an alternate name and open this file with your original APD file Hoeg 4 Rangelre Solution Chaat Captian USE Dome Sy O 1 6123 Frequently Asked Questions Q Why are the total MU values not always equal to 1 MU and is that acceptable A The total MU values will not always add up to 1 MU because there is some minimal inhomogeneity in the composite electron beam over the prescription area This may result in a total composite dose slightly above or below 1 MU Q What if a solution calls for a bolus thickness like 21 mm and don t have 1 mm bolus A Standard Imaging offers sheets of bolus material in 3 mm 5mm and 10 mm thicknesses To achieve a thickness of 21 mm simply combine four pieces of bolus material two pieces of 3 mm equal to 6 mm one piece of 5mm and one piece of 10 mm Another solution would be to enter 20 mm into your treatment planning program and the planning program will create a solution based on 20 mm of bolus The final treatment plan needs to be examined by the oncologist for approval Q What should do when a suggested bolus is larger than what have room for A Alarge bolus may require the patient to be moved further from the cone increasing the Source Subject Distance SSD to 105 cm or 110 cm This is a concession needed to achieve the desired dose homogene
9. value down prior to placing the disc into the CD ROM drive If autorun is enabled in the operating system the installation wizard will start automatically upon inserting the Trumpet elMRT program disc in the CD ROM drive If autorun is disabled browse to the program disc in Windows Explorer and double click setup exe to start the installation program Read through the software license agreement and if you agree to the enclosed terms click next to proceed with the installation A Trumpet elMRT Calculator program icon is placed within the Start Menu under the Standard Imag ing program group If prompted restart your computer to begin using the Trumpet elMRT Calculator To uninstall Trumpet elMRT go to Add Remove Programs under the Win dows Control Panel find elIMRT on the list click Change Remove and follow the on screen instructions Microsoft Windows 2000 Windows XP Choice of Electron Beam Energies Trumpet elMRT Calculator is designed to generate a number of composite beam dose distributions solutions created from two separate electron beam energies The user selects the two electron energies from which to calculate solutions From these solutions the user can choose the one that offers the most conformal dose distribution in the patient In general the electron beam energies should be chosen such that 1 The depth of the most distal edge of the target volume lies between the depths of peak dose for the two ener
10. 25e25 cov SR AQISMEY 6x cev SAZ0MEY 10 10 csv Sy azen SQ ALOMEY 10 10 cev SQ A20MEY 15 15 csy Sy azen BS A12MEY 6 6 cs A ALSMEY 10 10 cev SQ AQ16MEY 15e15 csv SQ A20MEY 20 20 csv By azen gt Files of type Percent Depth Doge csv Cancel File name cay A 4 To add PDD files select Add Adirectory list appears Go to the folder where the PDD data is stored Select a PDD dose file to add 5 When closing the APD file or exiting the program a prompt asks if these changes are to be permanently saved 15 Working with Multiple Open APD Files Using Window Tile with Trumpet eIMRT Two or more accelerator plans can be displayed at the same time within Trumpet elMRT Open two or more APD files and select Tile from the Window menu Moduleion Enesges Cons jmn jonj f x xl om To help identify which file is active the first field shown on the plan He i tab is labeled Selected File When preparing for a plan ensure you us Mev 2 have the proper file selected This can be useful when comparing ue M the results of two or more calculations side by side Selecled Fle Aiddiston Shanda Trairar Dress E Standard Imany Trussget ef Galt uleber Middieben Standard Treabmenbs One apd Fe er indie Hep kt Hemengoa Cuve Duat Fse Cut Fator 1 Output Fau Cit Factor Pere Depth LO ge Tak Dice Pont a m adOree Pani One accelerator file cannot be opened multiple
11. 3 1000 we 007 905 Depth mm 1 0 2 0 3 0 4 0 5 0 7 0 0 0 0 0 0 0 962 wo 961 060 1 2 3 4 5 T 1 0 1 1 1 2 1 3 1 4 14 90 987 989 986 Figure 3 All depths must be in mm and the depth dose must be a number less than 1 For example express 73 5 as 0 735 in the csv files for import into Trumpet elMRT Calculator This can be done in most spreadsheet ap plications In a group of cells to the right of the PDD data divide the values output of the scanning system by 100 Review for correctness and then copy and paste The proper format for the data is shown in the shaded section of Figure 3 Create a new blank spreadsheet for use as a template You can use this template repeatedly to create the comma delimited files for import into Trumpet elMRT Calculator Use the Save As from the File menu to give the spreadsheet a unique file name This way the template is preserved for the next use Start in the A1 cell with 0 mm and end at 100 mm or as many depths as you have measured See Figure 4 NOTE If you are copying and pasting data within Microsoft Excel and the cells are based on formulas referring to other parts of the spreadsheet you may get a REF error message To avoid this select Paste Special from the Edit menu when you are ready to paste do not select the Paste function At the next screen select Values If this is done the correct numbers will b
12. Calculator does not however electronically store any patient identification data or information Specific electron beam parameters are selected from the solution options provided by Trumpet elMRT Calculator for non direct manual input into the user s radiation treatment planning system The treatment planning system then creates a treatment plan based on the treatment objective for the patient which is reviewed by the attending oncologist for acceptability prior to implementation with a linear accelerator Overview The use of megavoltage electron beams often poses a clinical challenge when the planning target volume PTV is anterior to other radiosensitive structures and has variable depth The electron beam energies on a linear accelerator have depth dose characteristics which makes each suitable for dose prescription over a limited range of depths Trumpet elMRT Calculator employing energy and intensity modulation has been developed to permit the creation of patient specific dose distribu tions with user defined positions of peak dose and range Benefits include increased dose homogeneity within the target volume greater control over the dose to the skin and reduced dose to points beyond the dose prescrip tion point Using Trumpet elMRT Calculator the operator specifies the dose to the skin and to a second depth within the patient The program then searches for combinations of intensity modifications and energy modulations
13. act negligence or otherwise This warranty represents the current standard warranty of Standard Imag ing Inc Please refer to the labeling or instruction manual of your Standard Imaging Inc product or the Standard Imaging Inc web page for any war ranty conditions unique to the product 17 Software License Agreement Contains licensed program materials of Standard Imaging Inc Copyright Standard Imaging Inc Middleton Wisconsin USA This software is protected by U S copyright laws international treaties FDA regulations and other intellectual property laws and treaties This is a software license agreement to use the software product or products the product enclosed in this package and described in the applicable purchase order or other ordering document Standard Imaging Inc a Wisconsin corporation Standard Imaging hereby grants to the purchaser of the product Licensee the right to use the product together with its documentation and other related materials only in connection the com puters or computer network system located at the site of use the site previously designated as such by Licensee and only if in strict compliance with the terms and conditions set forth below Any purchase and installa tion or use of the product shall constitute acceptance of and agreement by Licensee to be bound by the terms and conditions hereof Licensee also agrees that the agreement terms and conditions
14. airing replacing free of charge or revising labeling and manual content on a product 1 which contains a defect covered by the above warranties 2 which are reported to Standard Imaging Inc not later than seven 7 days after the expiration date of the warranty period in the table 3 which are returned to Standard Imaging Inc promptly after discov ery of the defect and 4 which are found to be defective upon examination by Standard Imaging Inc Transportation related charges including but not limited to shipping customs tariffs taxes and brokerage fees to Standard Imaging are the buyer s responsibility This warranty extends to every part of the product except consumables fuses batteries or glass breakage Standard Imaging Inc shall not be otherwise liable for any damages including but not limited to incidental damages consequential damages or special damages Repaired or replaced products are warranted for the balance of the original warranty period or at least 90 days This warranty is in lieu of all other warranties expressed or implied whether statutory or otherwise including any implied warranty of fit ness for a particular purpose In no event shall Standard Imaging Inc be liable for any incidental or consequential damages resulting from the use misuse or abuse of the product or caused by any defect failure or malfunction of the product whether a claim of such dam ages is based upon the warranty contr
15. ansfer the software program of the product to another site or to a third party purchaser without the express written permission of Standard Imaging and agreement to all the terms and conditions of the then current software license agreement utilized by Standard Imaging by the authorized representative of the new site or such third party 18 The Licensee shall be solely responsible for the installation of the product and any updates provided by Standard Imaging Standard Imaging shall provide telephone technical support for the product for a period of 1 one year from the date of shipment Any updates upgrades and new releases to the product within the period of 1 year from date of shipment will be provided at no additional costs After the expiration of the period of 1 year from the date of shipment Standard Imaging will provide technical support and updates upgrades and new releases for an additional fee Standard Imaging shall not be liable for any amount in excess of the product costs actually paid by the Licensee giving rise to any claims hereunder In no event shall Standard Imaging be liable whether in contract tort or otherwise for any indirect incidental or consequential damages arising out of the subject matter of this agreement In the event of breach by Licensee of any of the terms and conditions of this software license agreement Standard Imaging shall be entitled to enforce all legal rights and remedies conferred upon
16. arranty herein set forth The warranty is extended only to the buyer purchasing the product directly from Standard Imaging Inc or as a new prod uct from an authorized dealer or distributor of Standard Imaging Inc For a period provided in the table below from the date of original delivery to the purchaser or a distributor this Standard Imaging Inc product provided in the table is warranted against functional defects in design materials and workmanship provided it is properly operated under conditions of normal use and that repairs and replacements are made in accordance herewith The foregoing warranty shall not apply if the product has been altered disassembled or repaired other than by Standard Imaging Inc or if the product has been subject to abuse misuse negligence or accident Product Warranty Period 7 Consumables Serviced Product 90 days As defined by the Original Equipment Manufacturer Resale Products 0 90 days 100 of ADCL Calibration Costs 91 182 days 75 of ADCL Calibration Costs 183 365 days 50 of ADCL Calibration Costs 366 639 days 25 of ADCL Calibration Costs days from date of shipment to customer ADCL Product Calibration Standard Imaging uses the UW ADCL for recalibrations required under warranty Standard Imaging s sole and exclusive obligation and the purchaser s sole and exclusive remedy under the above warranties are at Standard Imaging s option limited to rep
17. csv RS lA16ME 15x15 csv SQ A4MEV 15x15 csv RS AL6MEV 20x20 csv 4 A4MEV 20 20 csv RS A16MEY 25x25 csv SQ A4MEV 25x25 csv AS a1emev 6X6 csv PS AdMEV 6x6 csv Favorites My Network Places Files of type paaa sates File name Gi Open Cancel Figure 7 Trumpet mer Selecting and Importing PDD Data a cas Standard Imaging Tr File View Help pen Or Data Import Wizard Program Icon Open Workspace Save Workspace From the main Trumpet elMRT Screen select File and then Import or click on the icon shown above from the Start Menu The Trumpet elMRT Data Import Wizard screen appears Select Next Trumpet eIMRT Calculator Data Import Wizard 60 408000 50 5 Back Cancel Help Step 1 of 5 Institution Trumpet eIMRT Calculator Data Import Wizard X Step 1 of 5 TP D hu Li Institution rum SMART Institution Hame ip Code ee City State x Back Cancel Help Fill in Institution Name City State Zip Code Select Next Selection and Importing PDD Data Continued Trumpet eIMRT Calculator Data Import Wizard X j T Step 2 of 5 Trumpet Accelerator ELECTRON INTC YS MOGLLATEO RARATON THERAPY CALCULATOR Accelerator Make Accelerator Model ee Accelerator Serial Number M Back Cancel Help Step 2 of 5 Accelerator Fill in Accelerator Make Accelerator Model Accelerator Serial Number Select Next Trumpet eIMRT Calculator Data Import
18. d depth dose point and the range fields all require inputs in millimeters mm The dose field at the first depth dose point and the dose field at the second depth dose point all require inputs in Gray Gy CAUTION The PDD data files to be used with Trumpet elIMRT Calcu lator must sequence from 0 mm in the A1 cell to the final measurement point in exact mm increments Ifthe PDD data does not have a in each mm increment the user must extrapolate between measured points to fill in the missing percent values No millimeter can be skipped Cells can not be left blank Trumpet elMRT Calculator does not interpolate for cells left blank CAUTION To minimize the potential for computer issues do not run Trumpet elMRT Calculator concurrently with other software programs CAUTION Trumpet elMRT Calculator is intended to be used on a personal computer with the required specifications Use on other operating systems or with less than required speci fications may hinder proper operation CAUTION To provide the user with multiple solutions Trumpet elMRT Calculator is designed to be used with bolus with at least 1 electron energy It will not provide solutions where no bolus is desired for both energies CAUTION Due to the increased impact and constraints of lateral scat ter when using small or custom field sizes specific percent depth dose measurements must be completed for each small or custom field CAUTION Federal law in
19. dose in Gy that is required at the 1t Dose Point typically the skin surface For new operators it is sug gested that the dose is normalized to 1 Gy When solutions are presented on the Results Page they will be represented as a percent of 1 Gy for the two energies being mixed i e 40 of 6 MeV and 60 of 9 MeV A percent for the two energies allows easy input into the treatment planning programs 2 Dose Point This is the second point on the patient where the operator needs to pre scribe a dose For most typical cases the goal is to have a uniform dose through the central axis for a specific distance Therefore the 2 Dose 11 Calculating Composite Beam Solutions Plan Tab Continued Point is the depth in the patient where the dose is required to be the same as it is at the 1 Dose Point For example if this specific case requires a uniform dose from the skin to 10 mm into the patient 10 mm is entered as the 2 Dose Point Dose The Dose entered at the 2 Dose Point is the dose in Gy that is required at the 2 Dose Point Because a uniform dose is usually required this dose is usually the same as that entered for 1 Dose Point For new operators it is suggested that the dose is normalized to 1 Gy Monitor Unit Definitions Trumpet elMRT uses the following definitions 1 MU 1 Gy 1 mu 1 cGy Example If the treatment delivery value indicates 0 196 deliver 19 6 cGy or 0 196 Gy 3 Solution Characterist
20. e beyond the planning target volume Reducing the Homogeneity in Percent from 5 to 2 will eliminate solutions that are displayed on the Results Page to only those that have a dose less than or equal to 1 02 of the Dose prescribed at the 1 Dose Point This should result in solutions which have a flatter more uniform dose through the planning target volume therefore delivering a more uniform dose to the patient In general decreasing the values of the Range Range Dose in Percent and Homogeneity in Percent fields will reduce the number of solutions presented on the Results Page No Solutions In general increasing the values of the Range Range Dose in Percent and Homogeneity in Percent fields will increase the number of solutions presented on the Results Page This changes can be done alone or simul taneously If the operator wants to maintain the two selected MeV energies and the prescribed Dose Points and Doses the parameters to change are the Range Range Dose in Percent and Homogeneity in Percent Changing the two MeV energies selected may provide other solutions If a Range of 30 mm is selected and the two MeV energies are 6 MeV and 9 MeV the peak dose of these two energies may occur before the 30 mm point The peak dose of 6 MeV may be 12 mm and the peak dose of 9 MeV may be 20 mm Therefore Trumpet elMRT Calculator may not be able to create a composite dose that extends to 30 mm Another possible combination of MeV energies
21. e copied Figure 4 140 0 99 0 987 0 989 0 986 For this example we ll create a import able csv file for a 6 MeV beam with a 6 x 6cm cone size Copy the percent depth dose data from the 6 x 6 cm into the column beside the depths See Figure 5 The first 15 data points of the data from the 6 MeV and 6 x 6cm cone sizes are shown in Figure 5 NOTE The mm column must begin with O If it begins with 1 or any number other than 0 Trumpet elMRT will not find a solution Save the data into a comma delimited format Name this file 6MEV 6x6 cone or a similar name that will readily iden tify the MeV and cone The file name is not critical to the data import wizard however using this naming convention will make file selection much easier later in the process Save the file to a specific folder for ease of finding later Check the folder where these files are kept to see that a file has been saved as 6MEV 6x6 Cone csv Make sure the extension is csv Proceed to the next cone size pO 0 785 6f 0 897 p 8 0 942 E 0 99 Figure 5 Trumpet ear Preparation of PDD Data Continued e Find the 10 x 10 cm data for the 6 MeV beam and copy and paste it into the spreadsheet See Figure 6 Save this spreadsheet as a file named 6MeV 10x10 cone in the file delimited format discussed earlier Check in the folder holding the depth dose data to see that a file called 6MeV 10x10 cone csv
22. e www Standard Imaging com Standard a REF 92730 92731 Trumpet mar ELECTRON INTENSITY MODULATED RADIATION THERAPY CALCULATOR USER MANUAL PROGRAM VERSION 1 0 1 STANDARD IMAGING INC TEL 800 261 4446 7601 Murphy Drive TEL 608 831 0025 lt Standan o Middleton WI 53562 2532 FAX 608 831 2202 Imaging Dec 2004 2004 Standard Imaging Inc DOC 80464 01 General Precautions Warnings and Cautions alert users to dangerous conditions that can occur if instructions in the manual are not obeyed Warnings are conditions that can cause injury to the operator while Cautions can cause damage to the equipment WARNING Be certain to have the patient chart containing the dose prescription available and verify the physician order before proceeding WARNING To help ensure proper application and validation the output solutions of Trumpet elMRT Calculator should be used as inputs into a treatment planning system WARNING Trumpet elMRT Calculator is intended for use in target regions where the peak dose is relatively flat It should not be used for target regions significantly beyond the es tablished depth of peak dose The steeply declining dose gradient beyond peak dose will contribute to the difference between the calculated dose and the measured dose WARNING Trumpet elMRT Calculator requires the input of data with proper units of measure to function correctly The first depth dose point the secon
23. energy Bolus Me 1 mm Me 2 mm Displays the re quired bolus values for treatment Dose Gy Mev 1 Me 2 Composite Displays the Dose in Gy for each energy Solution Results Data Table Dose Gy Shows the tabular data that defines the solution curve Use this checkbox to turn reference curves on or off This table displays the parameters that define the currently selected solution Accelerator Pran e en Rs AE z 3 4 5 z use the scroll bar to view hidden entries Depth mm 0 043554 Dose Gy 0 200000 This area shows the location of Selecting the first tab will show all the cursor as defined by the X solutions found on the graph at and Y axis or depth as it relates once Each following tab represents to dose an individual solution Click on it to view its properties Anatomy of the Results Page 4 Review Composite Beam Solutions When the calculation is complete the Results Screen will appear The composite beam solu tions that meet the dose range and homogeneity constraints imposed by the user are displayed in the Results Screen In the example appearing above six solutions have been found Each numerical tab at the bottom of the Results Screen represents the detailed information for one composite beam solution Selecting a tab will show the details for that particular composite beam see screenshot to right This figure shows the nu
24. er General Operation Continued 6 Range Dose in Percent Figure 1 is from Inverse Planning Tool Offers Improved Conformal Dosing of Select a percent At the specified range value the dose at Superficial Sites via Combined Energy and Intensity Modulation of Megavolt the range point can be no more than this of the dose at the First age Electron Beams written by John R Gentry M S Richard Steeves M D Dose Constraint Point All beams which have a value below this Ph D Bhudatt A Paliwal Ph D of the Department of Human Oncology of the dose at the First Dose Constraint Point can be considered Comprehensive Cancer Care Center University of Wisconsin Madison as possible solutions Madison WI 7 Dose Homogeneity Composite Beam vs Single Energy Depth Dose Specify the dose homogeneity as a Any composite beam 9 MeV 0 5 cm bolus 9 cGy 100 cm SSD to Patient 12 MeV 1 lus 94 cGy 1 D to Patient solutions which have doses above this of the dose at the First ov Mes clos eo Cray TOO EM SEP O RANSA Dose Constraint Point Dose will be excluded from the solution sets For example if the First Dose Constraint Point is 1 00 Gy and the Dose Homogeneity is 5 no composite beams which have a dose above 1 05 Gy will be considered as a solution All composite beams below 1 05 Gy will be considered as a solu tion a Composite Beam o 12 MeV ONLY e 9 MeV ONLY O Treatment Planning System An example of a composite beam solution
25. gies and 2 The highest energy chosen minimizes the dose beyond the most distal edge of the planning target volume PTV Dose Constraints 1 Specifying the First Dose Constraint Position Trumpet elMRT Calculator works by specifying positions at which the dose distribution must have certain values Typically one begins by specifying the dose at the skin This depth is usually zero 0 mm so zero 0 is entered as the depth to use as the first dose constraint point Trumpet elMRT Calculator requires depth to be given in mm millimeters 2 Specify the Dose at the First Dose Constraint Point Enter the dose prescribed by the physician at the first dose con straint position Trumpet elMRT Calculator program requires the dose be entered in Gy Gray One Gy may be used to provide a convenient multiplier for the dose in Gy to be entered into the treatment planning program The unit in Gy is rounded to two decimal points so a selection of 1 00 Gy will include solutions within 0 995 to 1 004 Gy 3 Position of the Second Dose Point Specify the depth of the most distal edge of the target volume in mm 4 Specify the Dose at the Second Dose Constraint Point Specify the dose in Gy at the second point deepest within the patient to which the prescribed dose must be delivered To de liver a uniform dose over the PTV the dose at the second point is typically equal to the first dose 5 Range Specify the Range in mm Trumpet am
26. he 1 Dose Point is 1 Gy and the Homogeneity Percent is 5 then the only solutions displayed on the Results Page will be those less than or equal to 1 05 Gy at the 1 Dose Point For example if the Dose at the 1 Dose Point is 1 Gy and the Homogeneity Percent is 10 then the only solutions displayed on the Results Page will be those that have a dose less than or equal to 1 10 Gy at the 1 Dose Point Managing the Number of Composite Solutions Available for Review The Range Range Dose in Percent and Homogeneity in Percent are all interconnected and define constrain the composite beam solutions that are displayed on the Results Page 12 Too Many Solutions If values entered on the Plan Page result in too many solutions some entries will present hundreds of solutions the values in these fields can be changed to give fewer and better solutions for review Examples Reducing the Range from 50 mm to 30 mm will eliminate solutions that have a dose which extends past 30 mm This may be better for the patient in a specific case as it will reduce dose beyond the planning target volume Reducing the Range Dose in Percent from 5 to 2 will eliminate solu tions which are above 2 of the 15 Dose Point at the specified range If the Range is 40 mm changing the Range Dose in Percent for 5 to 2 will eliminate those solutions that have a dose at 40 mm which are above 2 of the 15 Dose Point at 40 mm This again will reduce the dos
27. hieve this one needs to select MeV energies which have peak depth doses close to these depth and one of which is past the 12 mm depth The 6 MeV energy has a peak depth at 12 mm and the 9 MeV energy has a peak depth at 20 mm These two energies are good selections to use for this case MeV 1 is 6 MeV and MeV 2 is 9 MeV Output factors and Cutout Factors These values are dictated by charac teristics of the beams chosen 15 Dose Point This is 0 mm skin surface The Dose at the 1 Dose Point is 1 Gy 2 Dose Point This is 12 mm the extent of the planning target volume The Dose at the 2 Dose Point is 1 Gy Range In this case the dose should drop off to close to 0 before the lung field begins at the 50 mm depth To achieve this it is reasonable to enter 30 mm for the Range If no solutions are found the range value can be increased i e to 40 mm and recalculated Range Dose Percent Enter 10 percent to indicate that solutions must be no more than 0 1 Gy at the 30 mm depth Homogeneity Percent Enter 5 percent to indicate that solutions must be less than 1 05 Gy at any place on the central dose axis When these values were selected for the fields a good solution was found Trumpet mer Saving and Opening Workspaces When using Trumpet elMRT Calculator you may find it useful to save the parameters entered on the Plan Tab if a successful result is found It is pos sible to save the contents of the Pla
28. hould not be used Parts which may be broken or missing or are clearly worn distorted or contaminated should be replaced immediately with genuine replacement parts manufactured by or made available from Standard Imaging Inc A CAUTION Federal law in the U S A and Canadian law restrict the sale distribution or use of this product to by or on the order of a licensed medical practitioner The use of this product should be restricted to the supervision of a qualified medical physicist Measurement of high activity radioactive sources is potentially hazardous and should be performed by qualified personnel Should repair or replacement of this product become necessary after the warranty period the customer should seek advice from Standard Imaging Inc prior to such repair or replacement If this product is in need of repair it should not be used until all repairs have been made and the product is functioning properly and ready for use After repair the product may need to be calibrated The owner of this product has sole responsibility for any malfunction resulting from abuse improper use or maintenance or repair by anyone other than Standard Imaging Inc The information in this manual is subject to change without notice No part of this manual may be copied or reproduced in any form or by any means without prior written consent of Standard Imaging Inc Trumpet mar Warranty Standard Imaging Inc sells this product under the w
29. ics Range mm The range in millimeters is the depth within the patient where the operator would like the dose entered at the 15 Dose Point to drop off to a certain percent of the dose at the 1 Dose point For example the operator may specify this point to be 40 mm Then at 40 mm the dose must be no more than a certain percent i e 5 or 10 of the dose entered at the 1 Dose Point The percent will be determined in the next field For a more detailed explanation of Range please consult a medical physicist Range Dose in Percent This percent field value entered by the operator related to the Range entered at the previous filed At the Range depth entered the composite dose may be no more than this percent of the 1 Dose Point For example if 40 mm is entered as the range and 5 is entered as the Range Dose in Percent then at 40 mm from the 1 Dose Point the composite dose must be 5 or less than the Dose at the 1 Dose Point No solutions having a dose at 40 mm which are above 5 of the 1 Dose Point are presented for review on the Results Page All solutions which are 5 or less will be displayed on the Results Page Homogeneity in Percent This percent value entered by the operator is related to the Dose at the 1 Dose Point The value entered in this field indicates the composite dose solutions with dose values above the dose at the 1 Dose Point which will be displayed on the Results page For example if the Dose at t
30. it by State of Wisconsin federal and or international law Standard Imaging and Licensee acknowledge that because breach by Licensee of any of the terms or conditions of this agreement will likely cause irreparable harm to Standard Imaging injunc tive relief would be an appropriate remedy for Standard Imaging resulting from any such breach by Licensee In the event that action suit or legal proceedings are initiated or brought to enforce any or all of the provisions of this agreement the prevailing party shall be entitled to such attorney s fees costs and disbursements as are deemed reasonable and proper by a court of law or an arbitrator In the event of an appeal of an initial decision of a court or of an arbitrator the prevailing party shall be entitled to such attorney s fees costs and disbursements as are deemed reasonable and proper by such appellate court Notwithstanding the foregoing in the event of any breach by Licensee of the terms and conditions of this agreement Standard Imaging may upon reasonable advance written notice to Licensee which in no event shall be less than thirty days terminate this license Upon such termination by Standard Imaging Licensee shall furnish Standard Imaging with a sworn affidavit stating that all of the product including without limitation its soft ware program s documentation and other related material and any copies thereof have been returned by certified mail return receipt reque
31. ity Selecting a lower electron energy value may reduce the amount of bolus required Q How do get the percent depth dose PDD data for my linear ac celerator into the Trumpet elMRT Calculator A Aroutine for importing the percent depth dose PDD data for your linear accelerator is included with the Trumpet elMRT software Q Why can t I save a calculated solution as a workspace A plan can be saved as a workspace but not as a calculated solution This is to assure a solution is always calculated with the most current Percent Depth Dose PDD data If an accelerator is serviced or updated new PDD files may have to be calculated If the PDD files are re calculated they must be reformatted following the instructions in the section Preparation of PDD Data When a plan saved as a workspace is retrieved and calculated the solutions are always based on the current PDD data Pinnacle3 is a registered trademark of Philips Electronics 16 Q What is the Trumpet elMRT algorithm based on A The computation is based on measured data and matrix algebra It is verified by Hogstrom s pencil beam algorithms as implemented in the Philips Pinnacle3 Treatment Planning System Q Were dosimetric results from Trumpet eIMRT compared to dosimet ric results from a treatment planning program A Yes the dosimetric results from Trumpet elMRT were compared to do simetric results from a treatment planning program Q Does the SSD a
32. lected When MeV 1 and MeV 2 are selected the PDD curve relating to each MeV is shown in the solutions graph This feature can be turned on or off with the check box labeled Reference Curves Output Factor There are default Output Factors for standard cone sizes If the operator chooses to use a different Output Factor this can be entered here Existing default Output Factors can also be deleted When the operator exits the program they will be asked if changes to this accelerator set up parameters should be saved If the operator selects yes the new Output Factor will be saved and will be available in the future from the drop down menu Cutout Factor The default Cutout Factor is one If a different Cutout Factor is to be used it is entered here The entered Cutout Factor is only applicable to this specific calculation When a new Cutout Factor is used this Cutout Factor is not saved by the program For every new calculation the default Cutout Factor is always presented as one 2 Prescribed Depth amp Dose 15 Dose Point This is the first point on the patient where the operator needs to prescribe a dose For most typical cases this will be at the skin so 0 mm is usually entered here After the operator becomes familiar with the program they may occasionally select a point other than 0 mm for some special cases Initially 0 mm is suggested as a beginning value to use Dose The Dose entered at the 1 Dose Point is the
33. lways have to be 100 cm A The Trumpet elMRT Calculator assumes the SSD is 100 cm If the SSD is not 100 cm a cut out measurement has to be made at the different SSD Then the two final MU values are arithmetically adjusted according to the dose at the new SSD Q Can there be one correction factor for a combined Output Factor and Cutout Factor A No the Trumpet elMRT Calculator does not have an option for one cor rection factor for a combined Output Factor and Cutout Factor The Output Factor is a value determined for an energy during commissioning of the accelerator This should be constant for all Cutout Factors The value for Cutout Factors changes with the shape of each cut out and is unique for that cutout Q How do I tile two solution options for the same accelerator A When an accelerator apd file is opened you can save it and all the prop erties associated with that accelerator under another name in a second file Then the two apd files can be opened and tiled for comparison A continually updated frequently asked questions page is available on our website See this address for the latest version of our FAQ www standardimaging com products extbeam Trumpet_elIMRT html Trumpet mer Customer Responsibility This product and its components will perform properly and reliably only when operated and maintained in accordance with the instructions contained in this manual and accompanying labels A defective device s
34. merical details of the composite beam solution the composite curve and the PDD of the original 6 and 9 MeV beams which were used to create this composite beam solution An option is available to show only the composite beam solutions without the two original MeV beams used to create the composite beam solutions De select Show Reference Curves on the Results Tab Print Composite beam Solutions Select the print option available at the top of the Results screen Follow the steps to select the number of copies required The print out will show the composite beam the contribution of each selected MeV energy to the composite beam and any bolus that need to be added to either beam It will also include basic institution and accelerator information This hard copy may be added to the patient file for future reference When the calculation session closes no patient information is retained within Trumpet elMRT Calculator files 14 Graphical Solution Display Depth mm Showing one selected solution Trumpet amer Results Tab Continued Using the Zoom Tools While viewing the results screen click on magnifying lens icon from the toolbar to use the Zoom tool By clicking and dragging horizontally on the graph an area is highlighted When the mouse click is released the graph view adjusts to show the highlighted width across the entire graph view This can be done until a maximum zoom is reached NOTE Only the depth value
35. n csv Depth cm xd RE 20x20 format where all data is comma delimited Therefore the central 00 785 784 788 792 axis depth dose data from the electron beams of the accelerator must clipe ie oy vee ase application such as Microsoft Excel Most scanning systems such as the Blue Phantom from Welhoffer Scanditronix will allow the creation of spreadsheet application editable files containing the depth dose for The PDD tables used with Trumpet elMRT Calculator must sequence 06 897 895 897 898 from 0 mm in the first cell to the final measurement point in exact mm increments If the PDD data does not have a in each mm incre 08 942 940 941 941 ment the user must extrapolate between measured points to fill in the missing percent values 09 92 960 961 960 The millimeter column must begin wih i p ean torany 11 093 98 9 99 0 9 100 0 996 997 996 Figure 2 Standard Imaging 5 Trumpet amer Preparation of PDD Data Continued PDD Data Formatted for Use with Trumpet elMRT Calculator eus ns Example of PDD Data 0 785 0797 07 08 0803 ect ie 20 30 40 0 85 0 849 0 853 0 854 50 60 w 80 corse oo on 12 os s2 so s4 s6 oa so mo 053 054 os es e2 srs srs os ser ss sor 08 017 08 019 o2 0 96 0961 0 96 o o 30 0 mo 0 993 0 989 0 99 0 989 12 1000 we 007 996 1
36. n Tab as a Workspace A workspace takes a snapshot of the values that are entered in the Plan Tab prior to performing a calculation A plan can be saved as a workspace to be retrieved and used again This can be useful when a plan provides a solution that can be applied to mul tiple patients To save a plan select Save Workspace under File or select the blue W icon from the tool bar Give the workspace a unique name NOTE A workspace name cannot contain any spaces Workspace toolbar icon NOTE The icon on the toolbar is used only for opening a workspace To save a workspace use Save Workspace from the file menu The new workspace button shown below will only appear if Save Workspace from the file manual is selected Save Workspace Active Workspace lt None gt Workspaces Open Save Click here to create a new workspace Done Cancel Help Save Workspace Dialog Box To retrieve a workspace select Open Workspace under File or select the blue W icon from the toolbar On the workspace browser select a name and click Open However a calculated solution cannot be stored as a workspace snapshot This is to prevent inaccurate calculations in the event of a change in the accelerator PDD 13 Calculating Composite Beam Solutions Results Page Trumpet eIMRT Calculator File Edit View Window Help 8 S 2X 8 19 B 2 x MU MeV 1 Me 2 Displays the moni tor units of each
37. nd improves results for patients Trumpet ver TT di S Standard Imaging Tru rumpet cae elMRT ELECTRON INTENSITY MODULATED RADIATION THERAPY Shee N nn Le ey Standard Imaging wl 7601 MURPHY DRIVE MIDDLETON WI 53562 2532 USA WWW STANDARDIMAGING COM Indications for Use Trumpet elMRT Calculator is a simple stand alone software program provided on a CD ROM for use on an appropriately configured personal computer It is intended to assist the oncologist or medical physicist in creating an optimum electron treatment plan based on the treatment objec tive for the patient Using previously established mathematical equations Trumpet elMRT Calculator suggests several potential electron beam treatment energy solutions within user selected parameters by combining several discrete energies typically available on the linear accelerator s It uses previously user gathered or generated depth dose data sets for each electron energy available 4 6 9 12 15 16 18 20 or 22 MeV on the user s specific linear accelerator s as its primary input Other inputs involve the identification of the facility specific linear accelerator s and bolus used The output of Trumpet elMRT Calculator is a hardcopy printout of the sug gested electron beam treatment energies in both numeric and graphical formats The site linear accelerator and bolus information are also provided on this printout Trumpet el MRT
38. r Insti OPNAR TITE aad ex tution Information Screen opens as shown to the left Verify that the correct APD file was opened by confirming the information shown matches the desired accelerator for which you are preparing to calculate a solution 3 Select the Plan Tab to begin the calculation process Trumpet amer Calculating Composite Beam Solutions Plan Tab Modulation Energies Cone Size cm fiox10 cm Me 1 E Mev Mev 2 9 MeV m Prescribed Depth amp Dose i Reference Curves Cutout Factor FT Cutout Factor Output Factor ne Output Factor qat Dose Point 0 af mm and Dose Pont Solution Characteristics Range Dose fio Range mm aU mm Homogeneity CS Calculate Trumpet elMRT Plan Tab The parameters entered on the Plan Tab define the solutions generated by Trumpet elMRT Calculator The following is a detailed description of each of the three main categories required for completing for a successful calculation 1 Modulation Energies Cone Size This field displays the cone sizes available for the specific accelerator being used The cone sizes available were chosen in the section Preparation of PDD Data An example set of cones and associated PDD values is shown in Figure 7 Trumpet mer MeV 1 and MeV 2 At these fields the operator selects the two electron energies to be mixed it does not matter the order in which these are se
39. s x axis are scaled when zooming the dose values y axis remain at full scale To scale back one level click the magnify lens on the toolbar To restore the zoom level to the original scale click the 1 1 icon A File View Window Help Trumpet mer Editing an APD File Editing Insititution amp Accelerator Info Adding PDD files to a Profile 1 From the main Trumpet elMRT Calculator screen click on the Open icon on the far left under File Highlight the desired accelerator and select Open A File View Window Help 2 The Accelerator page will appear Select the blue P Icon from the toolbar Accelerator Profile Properties 1x General Percent Depth Dose Data Sets Institution Name Add Middleton Standard Treatments Inc Delete City M iddleton Output Factor State Zip 53562 0001 wl v Accelerator Make Standard Imaging Accelerator Model lt K9 Accelerator Serial Number fi 23456 3 The Accelerator Profile Properties screen appears At this screen you can edit the general information about the institution and accelerator Additional output factors can also be added to individual percent depth dose sets Look in POD PS A12MEY 10X10 csy A AISMEY 15 15 csv SR ALSMEY 20K20 csv a PQ A12Mey 15e15 csv SQ A1SMEY 20K20 cov SQ AL6MEY 25x25 cev A az0M AG A12MEv 20e20 csv SA ALSMEY 25e25 cev BR ALeMEY ox cev Sy azen PG A12MEv
40. sted to Standard Imaging or destroyed by Licensee This agreement shall be deemed executed in the State of Wisconsin and shall be interpreted and construed in accordance with the laws of the State of Wisconsin If any provision of this agreement is judicially declared to be invalid unenforceable or void by a court of competent jurisdiction such decision shall not have the effect of invalidating or voiding the remainder of this agreement and the part or parts of this agreement so held to be invalid unenforceable or void shall be deemed to be deleted from this agreement and the remainder of this agreement shall have the same force and effect as if such part or parts had never been included Trumpet amer
41. the U S A and Canadian law restricts the sale distribution or use of this product to by or on the order of a licensed medical practitioner This product should be used under the guidance of a medical physicist Trumpet amer Table of Contents 2 General Precautions 3 Table of Contents 3 Background 3 Indications for Use 4 Overview 4 Operation Overview 4 Installation 5 First Step Preparation of PDD Data 7 Selecting and Importing PDD Data 10 Interface Description 10 Calculating Composite Beam Solutions Accelerator Tab 11 Calculating Composite Beam Solutions Plan Tab 13 Saving and Opening Workspaces 14 Calculating Composite Beam Solutions Results Page 15 Editing an APD File 16 Working with Multiple Open APD Files 16 Frequently Asked Questions 17 Customer Responsibility 17 Warranty 18 Software License Agreement Background Trumpet elMRT Calculator is a tool that utilizes existing electron beam data to model new composite electron beam dose distributions that better meet the medical goals of delivering conformal homogeneous dose distributions while reducing the dose to surrounding normal tissue and critical structures Trumpet elMRT Calculator product concept and mathematical equations are licensed from the University of Wisconsin Madison by Standard Imag ing The basis for Trumpet elMRT Calculator is based on a paper recently submitted for publication to the International Journal of Radiation Oncology
42. to achieve the dose at the skin and at the second point The number of solutions re turned by the first pass of Trumpet elMRT Calculator is further reduced by the operator s specification of appropriate ranges that will be allowed Then application of dose homogeneity requirements further reduces the number of treatment solutions The most optimal solutions are then available for the user to review The user can view the composite solution beams alone or choose to also view the two standard beams for comparison All calcula tions are done on the central axis Outputs of Trumpet elMRT Calculator are then manually entered into a standard treatment planning program for creation of a treatment plan System Requirements Operating System Processor Intel or AMD 500 MHz or greater Memory 256 MB 512 MB recommended Hard Drive 50 MB or greater Screen Resolution 1024 x 768 or higher recommended CD ROM Drive 2X speed or greater Other Spreadsheet editing application Windows is a registered trademark of Microsoft Corporation Product Standards Operation Overview Designed to meet IEC 60601 1 4 C Installation Installation of Trumpet elMRT Calculator is accomplished by using the installation wizard included on the program CD ROM The required Trumpet elMRT serial number is affixed to the program instal lation disc Since the installation program will prompt for this serial number during installation it is advised write this
43. tution Hospital Somewhere AK 12345 Accelerator Depth Dose Data Sets q2 Me 1 000 BMeY 1 000 dMe 1 000 lt Back Cancel Step 5 of 5 Selection Review Review the information to confirm the data selected If satisfied select Next the finish page will appear Finish At this point it is possible to go back and add or delete depth dose data sets by selecting Back until the Percent Depth Dose Data Files screen appears When satisfied select Finish Interface Description E File wiew Window Help Accelerator zju 6 2 a a la el Open an Accelerator Profile Data file APD mj Save the current Accelerator Profile Data file APD E Prints the currently selected calculated result Load Trumpet elMRT Calculator Help Context Sensitive Help Tool Loads the Trumpet elIMRT Import Wizard See page 7 P Loads PDD Properties Dialog Box See page 15 1 Zoom Restore Tool See page 15 Zoom Tool See page 15 Loads the Workspace Manager See page 13 Using Trumpet elMRT Calculator involves three steps represented by tabs as shown above and as described briefly below Refer to the pages following this section for detailed explanations Accelerator Tab This tab displays the properties of the currently loaded Trumpet elMRT APD file Specifically the location of the institution in which the accelerator resides as well as the make model and serial number of that accelerator is shown
44. will prevail in the event of any conflict between the agreement applicable purchase order or other ordering document All rights not specifically granted to licensee under this software license agreement are reserved by Standard Imaging The Standard Imaging documented Warranty and Customer Responsibility statements shall be considered to be part of this agreement The term of this agreement and the licenses granted hereunder will continue in perpetuity unless sooner terminated by Standard Imaging Licensee may a Use the product only on a single computer or single network system at the site of use and b Make backup copies of the product only for back up recovery and ar chival purposes Licensee may not and shall not a Make copies of the product except as otherwise permitted herein b Rent lease sub lease or otherwise permit any third party to use the product c Redistribute any portion of the product its software programs documenta tion or other related materials d Other than as set forth in section 1 b above copy the product any of its software programs documentation or other related materials without the express written permission of Standard Imaging e Remove or obscure copyright and or trademark notices appearing on the product f Reverse engineer the product in order to derive or appropriate for any reason or purpose the source code or any other trade secret or other pro prietary information or g Tr
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