Transcript
To start, the patient is loaded on the LINAC which prompts ExacTrac Dynamic to open the same patient. Once the patient is open in ExacTrac, the confirmation page pops up where the user can check that the correct patient and plan were indeed opened. After confirming the patient, ExacTrac will take you to the prepositioning screen. To begin, ExacTrac will automatically preposition the patient in the treatment isocenter by aligning a 3D representation of the real-time patient's surface picked up by the structuralized eye cameras [inaudible 00:01:05.996] the outer contour generated from the treatment planning KCT.
The calculated shifts are sent to the LINAC and applied by the couch. Once the shift are made, the user can proceed with the finding of area of interest of the patient that is to be tracked by the thermal camera. Thermal camera tracks the patient's position throughout the entire treatment using the heat signature of the patient's body. After the ahead of interest is defined, the user will proceed with the acquisition of x-ray images to verify the position of the patient.
Once the x-ray images are acquired, the software automatically fuses the images to the DRRs generated by the software from the treatment planning CT. ExacTrac Dynamic has some cool new tools for the user to analyze the fusion before shifts are made. Here, you can see an example of the blending of the x-rays and DRRs using the toggle button. Next, you can see an example of the rubber band feature where the DRR is slightly displaced from the x-ray and bounces back into position.
Another nice feature is the region of interest. Here, the user can paint out any anatomy that they don't want the software to consider during fusion. After a region of interest is defined, the user will redo the fusion of the modified x-ray and DRRs, and analyze the fusion using the rubber band feature. This can be done in amber blues modes or gray value modes. Once the user is happy with the fusion, the calculated shifts are once again sent to the LINAC and applied.
After the shifts are applied, a set of verification x-ray images are taken to check that the shift was completed correctly, and also, that the patient didn't move during the shifts. Here, the user will verify the fusion using the rubber band feature. After the patient's position has been verified with x-ray images, monitoring of the patient's treatment can begin, and you can see here the patient's monitoring screen. On the upper left-hand side is where you will see the x-ray images that will be automatically triggered by the software.
Automatic x-ray imaging can either be triggered from the amount of units delivered or gantry position, and these are always user-defined settings. To the right of the screen, you see the live surface tracking of the patient. Once the surface is in the position, and the software indicates this in the bottom right-hand of the screen, the user can beam on and monitor the patient. On the bottom middle of the screen, you can monitor the patient's real-time motion graph throughout the entire first arch.
As long as the patient remains in that treatment position, and no deviations are detected on the surface or x-ray images, the beam will remain on. After the first beam is treated, the software will prompt the user to move the couch to the next treatment position, and a pair of x-ray verification images will be acquired to check the position of the patient at the new couch angle. The fusion is analyzed and modifications are made to the x-rays using the ROI feature.
Then, the fusion is completed again automatically with the modified x-rays. After the x-ray position is verified, the user is ready to monitor the patient during treatment and a beam-on signal is sent from ExacTrac Dynamic to the LINAC. This is a short arch treatment. So a set of x-ray images will be taken at the first cardinal angle. All looks good, both on surface and for the internal anatomy. So, the beam continues on until the treatment is completed. After all the beams have been treated, the patient is closed, and the treatment data is automatically saved.
The calculated shifts are sent to the LINAC and applied by the couch. Once the shift are made, the user can proceed with the finding of area of interest of the patient that is to be tracked by the thermal camera. Thermal camera tracks the patient's position throughout the entire treatment using the heat signature of the patient's body. After the ahead of interest is defined, the user will proceed with the acquisition of x-ray images to verify the position of the patient.
Once the x-ray images are acquired, the software automatically fuses the images to the DRRs generated by the software from the treatment planning CT. ExacTrac Dynamic has some cool new tools for the user to analyze the fusion before shifts are made. Here, you can see an example of the blending of the x-rays and DRRs using the toggle button. Next, you can see an example of the rubber band feature where the DRR is slightly displaced from the x-ray and bounces back into position.
Another nice feature is the region of interest. Here, the user can paint out any anatomy that they don't want the software to consider during fusion. After a region of interest is defined, the user will redo the fusion of the modified x-ray and DRRs, and analyze the fusion using the rubber band feature. This can be done in amber blues modes or gray value modes. Once the user is happy with the fusion, the calculated shifts are once again sent to the LINAC and applied.
After the shifts are applied, a set of verification x-ray images are taken to check that the shift was completed correctly, and also, that the patient didn't move during the shifts. Here, the user will verify the fusion using the rubber band feature. After the patient's position has been verified with x-ray images, monitoring of the patient's treatment can begin, and you can see here the patient's monitoring screen. On the upper left-hand side is where you will see the x-ray images that will be automatically triggered by the software.
Automatic x-ray imaging can either be triggered from the amount of units delivered or gantry position, and these are always user-defined settings. To the right of the screen, you see the live surface tracking of the patient. Once the surface is in the position, and the software indicates this in the bottom right-hand of the screen, the user can beam on and monitor the patient. On the bottom middle of the screen, you can monitor the patient's real-time motion graph throughout the entire first arch.
As long as the patient remains in that treatment position, and no deviations are detected on the surface or x-ray images, the beam will remain on. After the first beam is treated, the software will prompt the user to move the couch to the next treatment position, and a pair of x-ray verification images will be acquired to check the position of the patient at the new couch angle. The fusion is analyzed and modifications are made to the x-rays using the ROI feature.
Then, the fusion is completed again automatically with the modified x-rays. After the x-ray position is verified, the user is ready to monitor the patient during treatment and a beam-on signal is sent from ExacTrac Dynamic to the LINAC. This is a short arch treatment. So a set of x-ray images will be taken at the first cardinal angle. All looks good, both on surface and for the internal anatomy. So, the beam continues on until the treatment is completed. After all the beams have been treated, the patient is closed, and the treatment data is automatically saved.