surface contour scanning system - improved accuracy and efficiency -high level of integration...
TRANSCRIPT
Surface contour scanning system
- Improved accuracy and efficiency-High level of integration-Multiple applications
Laser-Camera Technology
Optical
triangulation
Sentinel, LS100
- Discrete installation
- Technical evaluation at Karolinska, Stockholm
- Clinical evaluation in Uppsala
- First installation in Uppsala
Sentinel, LS200
- Attractive design
- Simpler installation
- Service friendly
- Design ready Q1 2007
- Delivery Q2 2007
Connectivity - Network support
Sentinel – multiple applications
- Patient Positioning
- Motion Detection
- Respiratory Gating
Sentinel – Patient Positioning
cPOSITIONING
- Improved accuracy
- Efficient workflow
- User friendly
- No additional markers
- No added radiation
User friendliness – Clinical mode
User friendliness – Advanced mode
Efficiency - Performance and Work flow
• Scan time is typically 3-5 seconds
• Surface matching takes typically 1 second
• Sub-millimetre accuracy
Sentinel – Motion Detection
cMOTION- Does not require active supervision
- Visualization
- Recording
- Alarm
cMOTION workflow
cMOTION- Integrated workflow with cPOSITITION or
Stand-alone functionality
- Markerless solution
- Alternative to manual supervision (camera + monitor), userfriendly solution.
cPOSITIONING cMOTION
Sentinel – Respiratory Gating
cRESPIRATION
Respiratory gating in the Sentinel system
Background
• Respiratory motion can affect the delivered dose distribution– Especially in the thorax/abdominal region
• Available solutions– Increased margins
• More dose will be delivered to the surrounding healthy tissue
• Organs at risk must still be protected, which may be very difficult if they move near or into the desired target volume
– Gated treatment
• Dose delivery is synchronized with respiratory motion
• Potential for dose escalation, resulting in higher delivered dose to the tumor while healthy tissue is spared
• The correlation between internal and external (surrogate) motion must be known
Establishing correlation
• How can we establish the correlation between internal and external motion?– 4D CT study– Gated fluoroscopy (on a conventional simulator)
End exhale
End inhale
0%
100%
Am
pli
tud
eG
ating w
ind
ow
Breathing patterns
• Inter- and intrafractional variations– Changes in frequency and amplitude– Thoraxic vs. abdominal breathing– Irregularities (coughing, unexpected breath hold, patient
movement)
• Solution– Coached breathing/biofeedback– Parallel monitoring of both thoraxic and abdominal
respiratory motion– Algorithms for detecting irregularities
The cRespiration workflow
Gated CT study(retrospecive/prospective)
Gated treatment planning and
delivery
3D CT study (gated)
Gating parameters
Prospectively gated CT study
CT
CT room
3D CT study (gated)
LS Respiratory signal
Patient Establishing of gating
parameters
Real-time generation of gating signal
Gating parameters
CT
CT room
4D CT study
3D CT study (ungated)
LS Respiratory signal
Patient
Sorting of CT data
according to
respiratory phase
Selection of phases suitable
for treatment
3D CT study (gated)
Gating parameters
Retrospectively gated CT study
Gated treatment planning and delivery
Gatingenable
(SW/HW)
LINAC treatment delivery
Treatment room
LS Respiratory signal
Patient
Real-time generation of gating
signal
3D CT study (gated)
Gating parameters
Treatment planning
RT plan
The cRespiration concept
• Simplicity– No markers to be placed
– Integrated workflow through the whole process
• Confidence– No additional dose
– Sub-millimeter accuracy, measured at the same locations every fraction without manual guidance
– Parallel monitoring of thoraxic and abdominal breathing
– Immediate detection of irregular breathing or patient motion
• Versatility– Support for several modes of operation – deep inspiration/end
expiration breath hold, as well as coached and free breathing
– Tight integration with CT and Linac equipment from major vendors
Milestones
• June 2008:Clinical validation activities begin
– In cooperation with the Academic hospital in Uppsala– Philips Big Bore CT– Elekta Precise Linac
• July 27-30 2008:AAPM in Houston, Texas
– First public demo of the cRespiration module
• Q4 2008:– Commercial release to all markets
• 2009:– Support for additional CT and Linac equipment, e.g. Varian, GE, Siemens
Sentinel - Integration in a RT clinic, c4D software
• System modules– Patient alignment– Full network support– Motion detection (available Q2 2008)– Gating functionality (available Q4 2008)
• Interfaces– DICOM-RT interface for patient setup– Interface to Elekta iCOM– Interface to Varian 4D console– Interface to Visir R&V– Interface to Hexapod couch (Q2 2008)