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)