SW Team Meeting.pptx

Radiotherapy across our portfolio

SW Meeting 2024, Marseille

©2023 Vision RT Ltd. All rights reserved.

SGRT

Use of surface guidance to help improve the safety, effectiveness and efficiency of the entire radiation therapy workflow

Surface Guided Radiation Therapy

DOSE

TREAT

PLAN

SIM

DOSE VISUALIZATION

CLEARANCE MAPPING

4D AND BREATH HOLD CT

MOTION MANAGEMENT

THE PATIENT PATHWAY

After the process of diagnosis, consultation with the Physician to explain the treatment and the goal of the radiotherapy

Patient QA and double validation of the treatment plan by the physicists

Radiotherapy scan for dose calculation and treatment position

Patient treatment in the same position as the scan under the accelerator but not the only one challenge

Delineation by the doctor and treatment planning by the dosimetrists / physicist in the TPS (Treatment Planning System)

©2023 Vision RT Ltd. All rights reserved.

DOSIMETRIC SCANNER AND SIM RT

Diagnosis scanner ≠ Dosimetric scanner How we define a good position for a treatment ? Few questions to answer

1. What we want to treat for this patient ? Which treatment technique ?
2. Is the position comfortable for the patient during 10 minutes (sometimes more) ?
3. Which information I need to have in my acquisition ?

What we offer to the customer with SimRT ? (When it’s working fine)

1. 4D Scanner : Scanner with the time dimension to capture body images in motion  Observe the tumor movement during the patient respiration = Reducing safety margins and exposing less healthy tissue to radiation.
2. DIBH Coaching

©2023 Vision RT Ltd. All rights reserved.

THE DOSIMETRIC CHALLENGE

In radiotherapy, accurate dosimetry is crucial to ensure the right dose is delivered to the tumor while minimizing exposure to surrounding healthy tissues. Challenges include :

• Precise calculation of dose distribution within the patient's body.

• Adjusting for patient movement and anatomical changes over the course of treatment.

• Integrating advanced imaging techniques to improve dosimetric accuracy.

• Ensuring the consistency and reproducibility of patient positioning.

©2023 Vision RT Ltd. All rights reserved.

What can we offer to the customer with MapRT ?

Collisions in radiotherapy

• Head of linac gantry passes close to the patient  Sometimes collision, especially with the elbows of the patient.

• Couch rotation is possible for noncoplanar treatment  Difficult to manage collision with the couch and the gantry  Limit the rotation angles of the table

• Studies show benefits in couch rotation  Non coplanar treatments allow higher dose to tumor while lowering dose to surrounding tissue. Higher tumor dose is associated with higher cure rates and lower organ at risk dose is associated with fewer complications.

MapRT offers advanced solutions for precise patient setup and treatment delivery, including:

• Comprehensive mapping of patient surface contours for accurate alignment.

• Real-time tracking of patient movement to ensure consistent positioning.

• Enhanced visualization of treatment areas to improve targeting accuracy.

• Integration with existing imaging and treatment planning systems for seamless workflow.

©2023 Vision RT Ltd. All rights reserved.

THE MAIN CHALLENGES IN RADIOTHERAPY ?

• Reproduce an identical positioning at the treatment site as the scanner
• Reduce inter-fraction and intra-fraction movement during the treatment

• Patient positioning and movement control – main sources of uncertainties

SOLUTION BEFORE ALIGNRT ?

• Tattoos: insufficient (no 6 Degrees of freedom)
• Restraint methods: invasive, unbearable for claustrophobic patients
• On-board imaging: no real-time information, additional patient exposure

©2023 Vision RT Ltd. All rights reserved.

ALIGNRT : THE MIRACLE SOLUTION ?

PATIENT SET UP

• Real-time quantified shifts/rotations

 Assists the operator and speeds up positioning

• Reduces the need for position verification images

• Reduces/eliminates the need for masks/restraints/tattoos

 Increases patient comfort / more precise positioning

• Monitoring of a region of interest (up to 20,000 points)

• Treatment stop automically if the patient move

• Fully adaptable tolerance threshold (1 mm in SRS)

REAL-TIME MONITORING / GATING

©2023 Vision RT Ltd. All rights reserved.

DIBH : The revolution

DIBH = Deep Inspiration Breath Hold Patient take a deep breath and hold it during a few second  Why ? The goal is to move the breast, the area being treated, away from the heart in order to protect it as much as possible. This is why the patient is asked to take a breath using the chest, not the abdomen. Benefits of DIBH in Reducing Cardiac Complications

• A study published in the "Journal of Clinical Oncology" reported that the mean heart dose was reduced by 50% when using DIBH compared to free breathing techniques.
• Another study found that the use of DIBH resulted in a significant decrease in the incidence of major coronary events

Clinical Outcomes

• Reduced Mean Heart Dose
• Lowered Risk of Cardiac Events
• Improved Long-term Survival

Breath Hold

Free Breathing

©2023 Vision RT Ltd. All rights reserved.

DOSE RT : Which Goals ?

The principle  Use Cherenkov imaging to improve the safety of treatments For which case ?

• Stray Radiation to the Contralateral Breast and Risk of Secondary Cancer  2.6% of breast cancer patients had secondary collateral cancer attributed to radiation
• Bolus Misplacement
• Irradiation in wrongs areas : Patient positioning

Treatment Plan Error

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©2023 Vision RT Ltd. All rights reserved.

THANK YOU

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©2023 Vision RT Ltd. All rights reserved.