Imaging Technology News 9/08

I M A G E - G U I D E D R A D I AT I O N T H E R A P Y ( I G R T ) COMPARISON CHART Company name Accuray Inc. Using continual image guidance & the automatic ability to track, detect, & correct for target movement throughout the treatment, the CyberKnife System requires only minimal immobilization such as a thermoplastic mask or vacuum bag for all treatments. The combination of these unique capabilities have made stereotactic head & body frames & other cumbersome immobilization & abdominal compression techniques obsolete. As a result, the CyberKnife System requires significantly less patient set-up time while also providing a considerably more comfortable patient experience. BrainLAB COMPARISON CHART Calypso Medical Technologies Inc. CIRS Immobilization & patient positioning Image Guided Targeting & automated patient positioning for cranial, head & neck & body targets. Patient immobilization for single fraction SRS & fractionated SRT The Calypso System is a non-ionizing means to continuously measure & monitor the prostate or the prostatic bed location & motion throughout radiation therapy delivery in real time CIRS Model 064 CT Therapy Planning Board fits most CT couches w/out hardware. The top surface includes a peg system to accommodate most immobilization frames. Optional built-in density reference plugs available Imaging for treatment planning I M A G E - G U I D E D R A D I AT I O N T H E R A P Y ( I G R T ) The MultiPlan Treatment Planning System includes both automatic & manual image fusion from multiple modalities including CT, MR, PET & 3D angiography Imaging for treatment planning: CT, MR, fMRI, DTI, PET, SPECT, angiographic images Imaging for patient positioning: CT data from any TPS in DICOM RT format Beacon transponders are identified in x, y, z coordinates during treatment planning Model 008 Dynamic Phantom facilitates study of the effects of target (tumor) motion during the breathing cycle in the presence of temporally modulated radiation therapy delivery beams Treatment planning The MultiPlan Treatment Planning System includes forward & inverse planning capabilities & incorporates advanced contouring tools designed specifically for delivering radiosurgery w/ both isocentric & non-isocentric planning abilities. The MultiPlan System also includes Monte Carlo dose calculations, 4D treatment planning capabilities & enables the efficient delivery of large non-coplanar treatment plans iPlan RT Image & iPlan RT Dose w/ Image Fusion, Atlas-based Automatic Segmentation (cranial & extracranial), Smart Brush Segmentation, Dynamic Conformal Arc Planning, multiple choice IMRT, Monte Carlo works in progress The position of Beacon transponders relative to treatment isocenter is calculated to provide objective, real-time information on target positon during treatment Model 008 Dynamic Phantom can be used during image acquisition to improve tumor CTV-PTV margins Plan verification w/ imaging Prior to each delivered beam the CyberKnife System compares the "live" target position, via highresolution kV orthogonal imaging, to the prescribed treatment plan DRR target position. Treatment delivery is then automatically adapted as necessary to ensure radiosurgical accuracy. This process continually & seamlessly repeats throughout the treatment Treatment planning: 2D, 3D & threshold dose distributions / isodose displays, DVH, differential DVH, normal tissue graph Set-up: verification based on stereoscopic kV imaging for sub-millimeter planned isocenter set-up The Calypso System utilizes algorithms to check the implanted Beacon transponder positions during patient setup & treatment relative to the treatment plan to assess changes in the target position Model 008 Dynamic Phantom can be used to verify dose delivery to static & dynamic targets. Whole body adult & pediatric phantoms, slab phantoms & custom manufacturing also available Inter-fraction imaging To achieve maximum conformality w/ a corresponding steep dose gradient, the CyberKnife System utilizes large non-coplanar treatment plans typically consisting of hundreds of unique, nonisocentric beams per fraction. Treatment plans are configurable to allow imaging & the automatic ability to track, detect & correct for target movement for each unique delivered beam throughout each fraction. Unlike traditional IGRT, the radiosurgical targeting accuracy of the CyberKnife System is maintained not only for patient set-up, but from the first delivered beam to the last ExacTrac X-Ray 6D is a 2-minute process for X-ray image acquisition, correlation to DRRs & automated* patient set-up. Linac-independent, imaging is possible for all treatment fractions & at any time during treatment (*Varian couches) The Calypso System is the first product to provide non-ionizing, continuous, real-time target localization allowing the RTT to remain in the room during patient setup Model 008 Dynamic Phantom can be used to study the effects of tumor motion as a function of different CT scan parameters. The phantom is useful for evaluation of various tracking & gating systems Intra-fraction imaging The CyberKnife System utilizes continual image guidance & the automatic ability to track, detect & correct for target movement throughout the treatment for all delivered fractions, as configured via the treatment plan ExacTrac X-ray 6D infrared tracking for real-time feedback of consistency of set-up. X-ray imaging possible at any time during treatment for further verification of set-up The Calypso System provides continuous, realtime, objective tracking, allowing therapy delivery to be managed more effectively Model 008 Dynamic Phantom facilitates study of the effects of target (tumor) motion in the lung during the breathing cycle in the presence of temporally modulated radiation therapy delivery beams Patient information & image management Patient information & images are managed on the local CyberKnife System database, where all planning & “live” images acquired during the course of each treatment delivery are saved. The CyberKnife System also includes a dedicated Patient Archive & Restore System where patient information, including all image sets, can be archived to offline media (i.e., DVD) & restored from that media for future treatments TPS Integration to VARiS, Impac or Lantis Record & Verify Systems. Dicom RT connectivity to third party planning applications The system’s database enables clinicians to review & archive inter-fraction & intra-fraction motion data for the entire treatment course. Electronic & printed reports are generated for daily review N/A Web site address www.accuray.com www.radio.brainlab.com www.calypsomedical.com www.cirsinc.com Company name Philips Radiation Oncology Systems Radiological Imaging Technology Inc. Resonant Medical Inc. Siemens Medical Solutions Immobilization & patient positioning Treatment Planning Pinnacle3 supports major stereotactic localization/immobilization systems; Philips imaging modalities (CT, MR, SPECT/CT, CT/PET) can be provided w/ carbon fiber indexed patient positioning tabletops N/A N/S N/A Imaging for treatment planning 16-slice big bore CT scanner w/prospective & retrospective gating, CT/PET, CT/SPECT, MRI; dedicated software for virtual simulation (AcQSim3) & image registration (Syntegra) N/A At the time of planning, Clarity’s implicit registration enables automatic fusion of 3D ultrasound w/ CT, providing the physician better visualization for more accurate planning for breast , prostate & other soft tissue targets Siemens Medical Solutions provides a full line of modalities for pre-plan imaging, including SOMATOM Sensation Open large bore, multi-slice CT scanner; Biograph PET/CT, Symbia SPECT/CT & the MAGNETOM family of MRI scanners Treatment planning Pinnacle3 Treatment Planning System N/A Electron breast boost treatment fields can be planned w/ Clarity alone including localization of lumpectomy cavity, design of applicator insert & verification of cavity depth for correct electron energy selection COHERENCE Dosimetrist Workspace enables virtual simulation, geometric treatment planning & interactive inverse planning; sensitive to both intensity levels & number of segments. The COHERENCE Suite for Oncology is currently being rebranded to syngo Suite for Oncology. Features mentioned in this piece may be purchased under the COHERENCE name brand Plan verification w/ imaging Exportation of 2D dose calculations for film &/or EPID images comparison RIT113 Dosimetry System. A test for "Treatment to Imaging Plane Alignment", is included in the RIT113 tools. The IGRT test compares the treatment isocenter w/ the imaging isocenter to ensure correct spatial positioning of the 2 systems Daily 3D image-based position verification w/ documentation N/A Inter-fraction imaging Import of multiple CTBCT & CT & automated region of interest propogation between fractions using model-based segmentation in Pinnacle3 N/A Rapid 3D imaging for pre-treatment position verificaton & documentation Siemens Medical Solutions, Oncology Care Systems division supports several technologies that enable image acquisition & decision making processes required for IGRT in various clinical settings. Siemens technology integrates a traditional, multi-slice, gold standard computed tomography (CT) scanner that travels on 2 parallel rails in the treatment room (called “ CT- on-rails”); & the unique, fast megavoltage (MV) electronic portal imaging device capable of clinical MV cone beam CT (MVCB CT) + Intra-fraction imaging Generation of 4D multiphased CT studies & composite images (MIP, MinIP, Average w/CT Briliance Extended Workspace N/A N/S Siemens Gated Therapy package improves the detection of internal anatomy movements & opens a new area of treatment delivery. Siemens Respiratory-Correlated CT images reveal tumor shifts while the patient is breathing, allowing the physician to define the gross target volume w/ much more precision. In addition, the option of triggering the therapeutic http://new.reillycomm.com/imaging/comparisonchart.php http://www.accuray.com http://www.radio.brainlab.com http://www.calypsomedical.com http://www.cirsinc.com http://www.medical.philips.com/main/products/ros http://www.radimage.com http://www.resonantmedical.com http://www.usa.siemens.com/medical

Table of Contents Feed for the Digital Edition of Imaging Technology News 9/08

Imaging Technology News 9/08 Contents IGRT How IGRT Targets the Prostate ASTRO Oncology Information Management Systems (OIMS) Imaging Leading the Intense Race Against Cancer SBRT - The New Treatment of Choice Top IMRT/IGRT Centers to Watch Molecular Imaging: Ready for the Limelight CR or DR in the ER? Have You Hit the Glass Ceiling?

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