Frequently Asked Questions (FAQ)

FAQ Sections


FAQs: General

Our company called .decimal (pronounced “dot decimal”) is based in Sanford, FL, just north of Orlando. We were founded in 1986 by our current CEO, Richard Sweat.

Though we started as a distributor of radiation therapy accessories, over the last 25 years we have become the leading manufacturer of patient-specific, customized radiation therapy devices for photon, proton, and electron therapies. We currently serve about 1000 clinics across the US.

We offer on-demand, "pay-as-you-go" services. Simply put, you only order devices from .decimal when they will make a difference for your patients, and you only pay for what you order.

There are no minimums, so you may order as often (or as infrequently) as your needs dictate. Device-specific pricing is available upon request.

If your sole interest is copper electron cutouts, there is a one-time setup charge. This provides you with our ordering software, installation support, staff training, and a full set of clinical setup templates.

If you will be ordering custom boluses – uniform thickness for photons and/or variable thickness for electrons – there is an annual License & Support Fee. This fee covers the software you will need for bolus design and ordering, software installation assistance and license activation, staff training, and ongoing bolus technical support Monday - Friday, 8:00 AM – 5:00 PM (Eastern Time) via phone or online.

Custom device orders are transmitted electronically to our secure website using our visualization and ordering software called p.d.

All HIPAA protected patient information remains in your secure network. The only data transmitted to .decimal are these: the device type and material, a randomly generated part identification number, the device design coordinates, and contact details for the clinician and site placing the order.

Our default shipping method is FedEx Standard Overnight which provides delivery no later than 4:30 PM the following day. Expedited shipping (e.g., delivery next day by 10:30 AM) is available for a fee.

Turnaround time varies by product, and usually ranges from next-day to 3 business days.

See the device-specific FAQs in the sections below.

For silicone and blue wax boluses, the materials are nontoxic and may be discarded after use with normal clinic waste unless the patient wants it as a souvenir (many do!).

For electron cutouts, you can recycle these locally (see the FAQs for electron cutouts, below).

In most cases, .decimal devices are considered complex (77334) because each is customized for a specific patient. Coding documents are available upon request.

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FAQs: Electron Cutouts

Our cutouts are made from pure copper.

Unlike cerrobend, copper is a non-hazardous material and is therefore not regulated by OSHA or other government agencies. Replacing your local mold room with the .decimal virtual machine shop frees you from air monitoring, blood tests, hazardous material training, and the associated record keeping and audit preparation.

Copper apertures are easily and accurately handled by the major treatment planning systems (TPS). There should be no additional commissioning needed when switching from cerrobend to copper.

For custom cutouts for 3D-planned treatments, you will design your cutouts in your TPS as usual, then process the DICOM output (found in the RT Plan) to send to .decimal for ordering.

For clinical setups (i.e., without CT simulation or 3D planning), we provide a set of special acrylic templates with crosshairs to draw the treatment volume. The template is then scanned and imported to our software for digitizing and ordering. We also offer, as an option, a hand-held 3D scanner called decimal3D that allows you to design electron apertures and blocks directly by imaging your patient's surface and drawing the treatment region with the tablet device.

Electron cutout orders received by 3:00 PM (ET) will be manufactured and shipped the same day for next-day delivery.

The suggested method – and most profitable for your center – is to find a local metal recycler who will buy your copper. These centers will pay the going rate for pure copper, which is currently between $3.50 - $4.00 per pound. The money you can make recycling can really add up!

If you prefer to return the devices to .decimal, you can do that, too. Once you have accumulated five or more cutouts, we can send you a prepaid shipping label to return them. If you choose this method, however, you will not be paid for the recycling value, as that will be used to offset our return shipping and processing costs.

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FAQs: Custom Bolus and Bolus Sheets

We offer three bolus types:

[ 1 ] FlexiBol (silicone) or machined wax customized uniform thickness boluses, which are patient-specific and custom-fit,

[ 2 ] FlexiBol standard sheets, which are flat sheets of our silicone material, offered as a cost-effective alternative for very simple anatomical surfaces, and

[ 3 ] Variable thickness electron boluses, which optimize the dose distribution for Electron Conformal Therapy.

FlexiBols are uniform thickness boluses that are each precision-manufactured to fit a unique patient surface. They are made from a flexible silicone to provide comfort for the patient, best fit for accurate dosimetry, and adaptability with respect to small fraction-to-fraction changes in the patient shape.

To make each FlexiBol, we manufacture a 3D mold that maps to the patient’s anatomy and is the physician-prescribed thickness. Then, we inject the mold with silicone, let it cure, then post-process it (clean, trim, label, etc.) then ship it. Each FlexiBol is flexible and custom-shaped for your unique patient. As a result, it is comfortable for the patient, able to adapt to minor changes in the patient’s anatomy fraction-to-fraction, and efficient in terms of setup time. Therapists love them!

In some cases, the area of the patient surface that needs a bolus might be small and/or relatively flat with no complex topography. In these cases, a less expensive piece of flat sheet will do the job.

To accommodate this, we offer FlexiBol standard sheets, which are 30cm x 30cm uniform slabs made from the same silicone as our custom FlexiBols. These sheets are available in various thicknesses (refer to the table on the product page). Every clinic should have these in stock and available for simple cases.

Generally, your FlexiBol will ship on the third day after the order is received (2:00 PM ET is the cutoff to determine the receipt date).

For example, if you place your FlexiBol order before 2 PM ET on Monday, it should ship on Wednesday for a Thursday delivery. If the order is placed after 2 PM ET on Monday, it would ship on Thursday for Friday delivery.

A very complex bolus may take additional time. You will be contacted by customer service after the receipt and review of a bolus design that is found to be complex, and we will explain the estimated delivery time and other pertinent details.

Many cases to be treated with electrons have a tumor of varying depth and underlying critical structures to be avoided. There is usually complex anatomy involved, e.g., a nose treatment.

Electron dose can be shaped (i.e., made conformal) by using a variable thickness bolus and a single electron beam. One side of the bolus conforms to the patient shape, and the other is optimized to create the desired dose distribution inside the patient. By manipulating the thickness of the bolus across the treatment field, the clinician is able to control the depth of the 90% isodose line so that it conforms to the PTV. With this technique, you can avoid multiple beams and mixed energy plans.

A variable thickness electron bolus does for an electron beam what a range compensator does for a proton beam: it shapes the distal isodose lines in 3D to best conform to the target while sparing underlying tissues.

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