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“Strict QA procedures for the imaging, planning and delivery of radiotherapy using respiratory management devices are required to ensure the safe and effective use of these devices.”

AAPM TG-76 reportThe management of respiratory

motion in radiation oncology

MRI-LINAC Dynamic Phantom

Tissue Simulation & Phantom Technology

2428 Almeda Avenue Suite 316 • Norfolk, Virginia 23513 • USA Tel: 800.617.1177 • 757.855.2765 • Fax: 757.857.0523

WWW.CIRSINC.COM

Model 008M

IMAGE ACQUISITION • TREATMENT PLANNING • DOSE DELIVERY

Patent # US 7,151,253 B2

IGR

T SCANPLANLOCALIZETREAT



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Overview

Computerized Imaging Reference Systems, Inc is recognized world wide for tissue simulation technology and is the leader in the manufacture of phantoms and simulators for medical imaging and radiotherapy.

www.cirsinc.com

The CIRS MRI-LINAC Dynamic Phantom is a precision instrument for assessing MRI image

quality and testing tumor localization and motion-capturing capabilities in modern radiation

therapy departments utilizing stand alone MRI simulators or integrated systems for IGRT,

Adaptive IMRT and VMAT. It provides known, accurate and repeatable three-dimensional

target motion inside an MRI-compatible phantom. It is designed for comprehensive analysis

of image acquisition, planning and dose delivery as MRI emerges as a useful tool in various

radiation therapy procedures.

The phantom body represents an average human thorax in shape and proportion. It is

comprised of a plastic shell with a cylindrical thru-hole to accommodate a moving rod with

simulated target. The embedded MRI/CT target is made of MRI gel that provides contrast

with respect to the background so as to allow tracking of tumor motion. The target can

receive an ion chamber or other MRI compatible dosimeter for treatment dose verification.

The body is connected to a motion actuator box that induces three-dimensional target mo-

tion through linear translation and rotation of the rod.

Target motion is independently controlled with CIRS Motion Control Software. The graphi-

cal user interface provides an unlimited variety of motions while simplifying the operation of

the MRI-LINAC Dynamic Phantom to an intuitive level. Patient specific profiles are easily

imported and there is no need to make hardware adjustments or have special programming

skills.

The MRI-LINAC Dynamic Phantom offers ease of use and portability as well as a flexible

selection of motion profiles. All components are packaged in a protective case. The sys-

tem requires minimal set-up and can be ready to use in minutes. The CIRS Model 008M

MRI-LINAC Dynamic Phantom presents a sophisticated solution for the complex challenges

and emerging technologies in Image-Guided Radiation Therapy.

CAPABILITIES

• Commission 4D imaging and 4D radiotherapy systems

• Test accuracy and reliability of real-time motion tracking through MRI imaging

• Test accuracy and consistency of tumor tracking and respiratory gating devices

• Evaluate static and dynamic target localization accuracy of onboard imaging systems

• Quantify volumetric and positional aliasing of CT in the presence of 3D target motion

• Assess dosimetric accuracy of temporally modulated radiation therapy

• Train and evaluate personnel during implementation of new equipment and techniques



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Proven MRI-CT-LINACPhantom Technology

EXTENSION RODThe actuator is positioned at an MRI-compatible distance from the phantom body by means of a modular extension rod. The extension rod is provided in 30 cm (1’) increments to account for variances in magnetic field strength between systems. Connecting bridges simplify set up and provide extra stiffness to the extension rod.

The phantom body, moving rod with target and extended rigid shaft connection are MRI-compatible with 1.5T magnets. Motors and motion controller electronics are located at a safe distance from the magnet to ensure MRI image quality.

The phantom body approximates the average human thorax in both size and shape using simplified geometries. It is comprised of a plastic shell with a cylindrical thru hole to accommodate a moving rod with simulated target. The shell may be filled with MRI signal-generating medium of users choosing.

The moving rod with simulated target consists of a cylindrical rod filled with proprietary MRI Signal-generating gel. The embedded MRI/CT target is made of MRI gel that provides contrast with respect to the background. This target can receive an ion chamber or other MRI-compatible dosimeters for treatment dose verification.

The Model 008M contains MRI QA targets that are compatible with ACR

accreditation program recommendations for MRI image spatial distortion and MRI field homogeneity.

The MRI-LINAC Phantom also enables Laser to ISO Center coincidence QA. Laser marks are machined on the outside of the MRI Shell body for both the moving MRI/CT target and the MRI Distortion Grid. To facilitate MRI/CT Image fusion, there is a central fiducial aligned with the exterior laser marks, and in a known position with respect to 3D spatial distortion grid. External alignment marks and central fiducial facilitate rapid orienta-tion with positioning lasers and phantom image registration during MRI, CT and Linac positioning.

T2 Axial, Coronal, and Sagittal views of moving target

T2 images of MRI Distortion Grid and Central Fiducial


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The center of the target is positioned off central axis of the rod. Complex 3D motions can be achieved thru simultaneous, independently controlled linear translation and rotation.

Within the CIRS Motion Control software, the user inputs desired range of target motion in the inferior-superior (IS), anterior-posterior (AP) and the left/right (LR) directions. Using these inputs, the software computes the rotational angles based on known distance of the target center relative to the central axis of the rod. Rotation instruction is sent to the actuator by the software.

• Maximum IS motion is 50 mm • Maximum AP/LR motion is 10 mm via rotation • Minimum cycle time is 1 second • Maximum cycle time is unlimited

LR10.2º

2 mm

5 mm

Tumor

Moving Rod

AP

68º

True 3D Target Motion In an MRI-CT-LINAC Compatible Phantom

Separate use of MRI in concert with CT and LINAC makes ISO center coincidence checks critically important. To enable Laser to ISO center coincidence checks, laser marks are machined on the outside of the MRI shell body for both the moving MRI/CT target and the MRI Distortion Grid. To facilitate MRI/CT Image fusion, there is a central fiducial aligned with the exterior laser marks, and in a known position with respect to 3D spatial distortion grid. External alignment marks and central fiducial facilitate rapid orienta-tion with positioning lasers and phantom image registration.

Perform MRI QA Without Another Phantom Set-up

MRI Image vs. CAD Model of grid shows MRI distortion

MRI Image vs. CAD Model of target insert shows MRI distortion

008M MRI Distortion Grid

The moving insert with simulated target consists of a cylindrical rod filled with propri-etary MRI Signal-generating gel. The embedded MRI/CT target is made of MRI gel that provides contrast with respect to the background. This target can receive an ion chamber or other MRI-compatible dosimeters for treatment dose verification.

The Model 008M contains an MRI Distortion Grid in the superior apex of the phantom body. It consists of a radial grid pattern for use in assessing ACR accreditation pro-gram recommendations for:

• MRI image spatial distortion • MRI field homogeneity



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Easy To Use Software

Instantly Start, Stop, Pause or Loop motion

Adjust motion amplitude, cycle time and phase shift with pull down menus and slider bars

Graphical user interface simplifies operation of the Model 008M

Real-time display of target parameters

Research Mode to import 3D recorded waveforms

Dynamic PhantomMotion Control Selection(Thorax or Pelvis)

Data ColumnSelection

Smoothing(Un-smoothed Data = 0;Maximum SmoothingDegree = 100)

Sampling rate of recorded data by Motion Control Software (Used to reconstruct waveform)Range 1 to 100

Name of imported waveform(User or software assigned)

Mirror byamplitude = 0

The MRI-LINAC Dynamic Phantom is operated using CIRS Motion Control Software Suite, a user-friendly graphical user interface that can be installed on any computer running Windows OS. Upon installation, the user has the option to select the phantom that is to be controlled by the software.

Amplitude, cycle time and phase shift can be applied using slider bars or by entering desired values within the limits of the system. Five differ-ent waveforms are available from a standard pull down menu.

An unlimited number of clinically relevant and patient specific wave-forms or correlation models can be imported from tab delimited or comma separated file formats.

There are also waveform editing, smoothing and analyzing tools to ease the optimization of custom waveforms. All motion files can be saved for future use.

The software provides a convenient, real-time graphic display with relevant information about the waveform selected for each direction of simulated tumor. In addition, the ROI analyzing function provides the time spent by the target between two chosen amplitudes and the average time weighted position for that particular ROI.

Users can instantly start, stop or pause the motion at any time. New start positions can be graphically selected and applied making the device very useful for static test as well as dynamic testing. Users can also select the number of cycles to be looped by entering the desired value or choose continuous looping (1 million cycles).

USER FRIENDLY MOTION CONTROLThe Advanced Motion Parameters window contains a Research Mode that allows researchers to import 3D (x ,y, z) recorded waveforms. Once the research mode is selected, the software automatically calcu-lates the best scenario to simulate the real 3D waveform and simulated volume is achieved.



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Advanced Electromechanical ComponentsACTUATORHoused within anodized aluminum enclosures, the actuator contains bipolar stepper motors that enable linear motion accuracy of 0.05 mm and rotational motion accuracy of 0.2°. Linear motion of the target in the (IS) direction can be isolated from rotational motion in the axial plane in both frequency and amplitude. Motions can be synchronized to one another with accuracy better than 20 msec. Motion cycle time accuracy is better than 5 msec. Optical sensors ensure pre-cise mechanical positioning. The actuator is designed for continuous operation. If not manually stopped and reset by the user, it will perform 1000000 (in continuous mode) cycles then stop automatically.

CONTROLLERMotions are generated through a three-axis motion controller. A USB port enables interfacing with most computers. The controller sends motion data and supplies power to the actuator thru a 25 pin se-rial cable. The motion controller can be fully operated through CIRS Motion Control Software (see page 5) from a distance of up to 75 feet with the Ethernet/USB cable provided.

Additional Options

DYNAMIC PELVIS PHANTOM BODYThe Model 008P-06 Dynamic Pelvis Phantom body represents an average human pelvis in shape, proportion and composition. A water-equivalent cube containing a prostate gland and/or various detectors is inserted into the pelvic cavity of the phantom. The cube is connect-ed to the motion actuator box to induce two-dimensional target mo-tion through rotation of the water-equivalent cube. The CIRS Motion Control Software has been pre-programmed to allow the user to select the phantom that is to be controlled by the software.

DYNAMIC THORAX PHANTOM BODYThe Model 008A-20 includes the Dynamic Thorax Phantom Body and Surrogate Platform. The Dynamic Thorax Phantom Body is inter-changed with the MRI-LINAC Dynamic Phantom Body while the Sur-rogate Platform is attached to the Motion Actuator Box. The Dynamic Thorax Phantom Body represents an average human thorax in shape, proportion and composition. Various lung equivalent rods containing a spherical target or various detectors are available and are inserted into the lung equivalent lobe of the phantom. The Model 008M can also accommodate many of the interchangeable inserts designed for the Model 008A. The body is connected to a motion actuator box that induces three-dimensional target motion through linear translation and rotation of the lung equivalent rod. The CIRS Motion Control Software has been pre-programmed to allow the user to select the phantom that is to be controlled by the software.

Model 008P-06

Model 008A-20

NOTE: Since the thorax and pelvis bodies are not MRI signal generating, they can be seen only in X-ray and CT imaging. For this reason, the thorax and pelvis bodies are mounted on the actuator based plate and the result-ing phantom (Model 008A and Model 008P, respectively) should not be used in MRI systems.



Part No. Qty Component Description

008M 1 MRI-LINAC Dynamic Phantom Body

1 Target Insert

1 Control unit with firmware installed (110 - 220V, 50 - 60Hz)

1 Motion actuator box

5 Extension Rods (1 x 58.5 cm, 4 x 30 cm)

1 Base plate

1 CIRS Motion Control Software CD-ROM

1 1/8 hex key wrench (magnetic)

1 Four in one screwdriver (magnetic)

1 Network cable CAT5e, 75’

2 DB 25 male to male double shielded cables

1 USB cable 1’ A/B male

2 USB extender terminals

1 Bag of miscellaneous replacement fasteners

2 2 Amp fast acting fuses

1 Power cord

1 User’s manual

1 Carry Case

INCLUDED WITH MODEL 008M

Ordering Information

Model 008M Specifications

Part No. Description

008A-20 Dynamic Thorax Body & Surrogate Platform

008P-06 Dynamic Pelvis Body

ADDITIONAL OPTIONS

MOTION CONTROLLER

PHANTOM BODY

OVERALL DIMENSIONS: 32.7 cm x Ø 6.3 cm

OVERALL WEIGHT: 1.5 kg

MOVING ROD

OVERALL DIMENSIONS: 67 cm x 32 cm x 20 cm

OVERALL WEIGHT: 10 kg (22 lb)

AMPLITUDE, IS: ± 25 mm

AMPLITUDE, AP/LR: ± 10 mm

MOTION ACCURACY: ± 0.1 mm

CYCLE TIME: 1 - ∞ (adjusted based on amplitude)

WAVEFORMS: sin (t), 1-2cos4(t), 1-2cos6(t), sawtooth, sharkfin

CIRS MOTION CONTROLSOFTWARE SYSTEM REQUIREMENTS

Windows XP® / Vista / Windows 7 (32 or 64 bit)Pentium 3® or equivalent 512 MB RAM 2 MB of available disk space

OVERALL DIMENSIONS: 25.6 cm x 32 cm x 20 cm

OVERALL WEIGHT: 17 kg (38 lb)

MODEL 008MFEATURES

• MRI-CT-LINAC Compatibility

• Complex 3D tumor motion within the thorax

• Sub-millimeter accuracy and reproducibility

• Motion software enables different cycles, amplitudes and wave forms

• MRI QA

• Gated and adaptive RT plan verification

• End-to-End commissioning

Model 008A-20



LIMITED WARRANTYAll standard CIRS products and accessories are warranted by CIRS against defects in material and workmanship for a period as specified below. During the warranty period, the manufacturer will repair or, at its option, replace, at no charge, a product containing such defect provided it is returned, transportation prepaid, to the manufacturer. Products repaired in warranty will be returned transportation prepaid.

There are no warranties, expressed or implied, including without limitation any implied warranty of merchantability or fitness, which extend beyond the description on the face hereof. This expressed warranty excludes coverage of, and does not provide relief for, incidental or consequential damages of any kind or nature, including but not limited to loss of use, loss of sales or inconve-nience. The exclusive remedy of the purchaser is limited to repair, recalibration, or replacement of the product at manufacturer’s option.

This warranty does not apply if the product, as determined by the manufacturer, is defective because of normal wear, accident, misuse, or modification.

Non-Warranty ServiceIf repairs or replacement not covered by this warranty are required, a repair estimate will be submitted for approval before proceeding with said repair or replacement.

REFERENCES:Munoz, C., et al., Evaluation of Positional Accuracy in Moving Tumors Using a CIRS Dynamic Phantom. Poster presented, Cyberknife User’s Meeting January 2007.

Tanyi, James, A., et al., Phantom investigation of 3D motion-dependent volume aliasing during CT simula-tion for radiation therapy planning. Radiation Oncology, 2007, 2:10.

Chuang, C., et al., The use of a new dynamic motion phantom for patient specific QA in tracking therapy. 2006 AAPM Abstract ID No. 4639.

Wang, Z., et al., Verifying Internal Target Volume using Cone-Beam CT for Stereotactic Body Radiotherapy Treatment. 2006 AAPM Abstract ID No. 5263, Poster #: SU-EE-A1-4.

Tanyi, James, A., et al., Dosimetric Evaluation of Target Dose in Stereotactic Body Radiation Therapy (SBRT) of Lung Lesions Using a Dynamic Motion Anthropomorphic Phantom. 2004 AAPM PO-T-143 Poster.

Tanyi, James, A., et al., Phantom Investigation of Three-Dimensional, Motion-Induced Dose Discrepancy During Intensity Modulated Radiation Therapy Dose Delivery. Poster presented at 2006 annual AAPM meeting, Orlando FL, July 2006.

Tanyi, James, A., et al., Phantom Investigation of Three-Dimensional Motion Dependent Volume Aliasing During CT Simulation for Radiation Therapy Planning. Poster presented at 2006 annual AAPM meeting, Orlando FL, July 2006.

Varchena, V., et al., A novel Dynamic Thorax phantom for 3D-CRT and IMRT of lung lesions. Radiothera-py & Oncology at Meeting, Vol. 76, Supplement 2, September 2005.

Product Warranty Period

Non-Standard or customized products 3 months

Training Phantoms and Disposable Products 6 months

Electrical Products and Dynamic Phantoms 12 months

All other standard products 48 months

Plastic Water 60 months

COMPUTERIZED IMAGINGREFERENCE SYSTEMS, INC.2428 Almeda Avenue Suite 316Norfolk, Virginia 23513 USA

Toll Free: 800.617.1177Tel: 757.855.2765Fax: 757.857.0523E-mail [email protected]

Technical Assistance1.800.617.1177

©2015 Computerized Imaging Reference Systems, Inc. All rights reserved. All brand names, product names or trademarks belong to their respective holders. Specifications subject to change without notice.Publication: 008M PB 082015

Computerized Imaging Reference Systems, Inc. has been Certified by UL DQS Inc. to (ISO) 9001:2008. Certificate Registration No. 10000905-QM08

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