Step 1: Select or Upload an Input File
You may either select one of the provided scores or upload your own using the "Choose File" button. If you both select and upload a file, the uploaded file will be used.

If you choose to download a file from OpenScore, you will have to sign up for a free account:
Ignore the "Start Free Trial" button and click on "Log In" in the upper right corner. Then click "Create an Account" in the new window and fill in the form. This will set up a free account that will not expire.
When you find a file you want to download, select the blue download button and select the MusicXML format.
A MusicXML score is the only required input, so if you wish to run the program with default settings, you may click "Submit" after providing an input file.
Step 2: Optionally Select Annotation
Clicking the first checkbox tells the program to record where mutations occur in the sheet music. It will not affect the audio output.

Step 3: Select Therapy Options
Next, you can select whether or not to model cancer treatment.
- "None" will model tumor growth with no treatment.
- "Traditional cancer therapy" will simulate a single, large dose of medication.
- "Adaptive cancer therapy" will simulate smaller medication doses which are administered in response to tumor growth.

Clicking "Additional Therapy Options" will reveal two more settings.
- The first allows the frequency of adaptive therapy to be adjusted. The first dose of therapy is administered when the tumor reaches it's maximum allowable size. The remaining doses will be administered when the tumor reaches the given proportion of maximum size (i.e. if the maximum number of parts is 50 and the frequency is 0.1, additional doses will be administered when there are 5 tumor parts).
- "Chance of a cure" specifies the chance that any therapy event will eliminate the entire tumor.
Step 4: Select Conversion Options
By default, the program will return a compressed MusicXML file of the modeled score. These files can be viewed, played, and modified by a variety of programs. In addition, you may specify any combination of mp3, midi, or pdf. Any of these options can significantly extend the time it takes to run the program.
- "mp3" will return an audio file in mp3 format.
- "midi" will return a midi formatted file for use with synthesizer programs.
- "pdf" will return a pdf of the sheet music only.

Under "Additional Conversion Options," there are two more settings:
- The checkbox will convert the input file to the format(s) specified above without running a simulation.
- The second option sets the maximum amount of time to wait for each file conversion (by default, if it takes more than 5 minutes to convert a file, the program will return an error).
Step 5: Select Mutation Rates
The overall mutation rate sets the chance of any mutation happening at a reproduction event. The relative mutation rates will be adjusted to add up to the new total.
In addition, the chance of each type of mutation can be individually controlled. The remaining individual rates will be adjusted so that they add up to the overall mutation rate. If they exceed the overall mutation rate, it will be increased to a maximum of 100%.
- "Change in reproduction rate" changes the likelihood that reproduction will occur in a generation and also changes the instrument type for that part of the score. A higher reproduction rate means a higher susceptibility to treatment.
- Translocations copy a random portion of the score from any part into the cancer stem.
- Inversions reverse the order of measures in a subset of the cancer stem and the notes within those measures.
- Transpositions change all of notes in a subset of the cancer stem to either flat or sharp.
- Insertions copy a random note into the cancer stem.
- Deletions replace a random note with a rest.
- Substitutions randomly change the pitch, octave, or step of a random note.

Step 6: Additional Options
- The number of measures in each cancer stem can be adjusted from 1 to 10.
- The start of tumor growth can be be specified as a proportion of song length. (e.g. 0.1 for a 5 minute song will start the simulation at 30 seconds).
- The minimum number of measures can be specified to ensure a score is not too short. Short scores will be repeated until they reach the given length.
- The maximum number of parts limits the number of additional cancer parts that can be made. This prevents the final file size from becoming too large.
- The volume of cancer parts can be reduced to keep them from overwhelming original song parts.

Finally: Submit your simulation.
