Panther RealART

Dangers of Today's Treatment Techniques

A patient’s anatomy changes shape and varies between treatments. Doctors and physicists strive to find a solution that enables efficient and precise modification of the treatment plan. With the limited technology available now, patient safety and treatment effectiveness is often compromised.

In the case above, there is a significant deformation of the rectum over treatment time which causes the tumor to change its shape and position. This leads to significant underdose of the tumor and an overdose to healthy tissue. This is a situation patients face with the current treatment techniques – every day!

Treatment with the original plan misses the target,
causing overdose to the rectum which leads to unnecessary patient suffering

Today, doctors rely on conventional radiation therapy to deliver the same plan over the whole treatment. The introduction of advanced imaging techniques, such as CT-on-Rails and Cone Beam CT, have given doctors the ability to track the daily anatomical changes of a patient, but do not allow for the treatment plan to be adjusted to anatomy changes over the course of the treatment.

RealART Solution:

The innovative RealART solution from Prowess Inc. resolves this problem by providing real-time plan adaptation based on the inter-fractional anatomy variations. This treatment technique is based on the actual shape and position of the tumor which provides maximum effectiveness and safety for the patient. Furthermore, the process eliminates the need for patient re-positioning.

RealART Treatment Process:

This advanced technology is available only from Prowess and can be used in conjunction with CT-on-Rails systems.
*Image above indicates workflow with Siemens CTVision™ Solution.

Dose Volume Histogram Improvements

Benefits of RealART

Treat patients with plans based on the shape of the
anatomy on the day of treatment.
Optimize the plan to a particular treatment fraction.
Better dose coverage to targets.
Real Control over dose delivered to spare healthy tissues.
Patient re-positioning no longer needed.

Imaging

Image Import

DICOM 3.0 and DICOM RT compatible, ATC compliant.
Automatic CT/MR/PET image data acquisition in DICOM 3.0 format.
Supports multiple patient scanning orientation positions (HFS, HFP, FFS, FFP, FFDL, FFDR, HFDL, HFDR).
Supports images with uniform and non-uniform spacing.
Supports scanner and digitizer interface with image rescaling ability. Scanned images can be rotated in 90-degree increments, or flipped 180-degrees.

Image Fusion

Support for CT, MRI, PET, SPECT images in DICOM 3.0 format
Automatic and Manual Image Fusion methods supported
Numerical 'fit' suggests the accuracy in the image registration
Up to ten fiducial markers can be used for registration on either of the image series
Advanced automatic and manual comprehensive contouring tools
Easy to use editing and correction tools
Undo, Redo contouring utility
Multiple Boolean Operators
Multiple 3D image set support
Asymmetric Margins
Easy checking tools including Aperture, Checkerboard and transparency
Individual window width and level adjustments for the master, slave series.
Master/Slave series can be changed anytime before contouring from the Image Fusion window
Contours can be drawn on either the master or slave image series

Contouring

Contouring Features

Support up to 60 volumes
Contouring can be done in Full Screen mode
Advanced Automatic and Manual comprehensive contouring tools
Multi-slice auto contouring for external and differentiated internal contours
Image crop tool allows volumes to be contoured with automatic tools
Manual contouring tools via point-by-point and continuous modes
Can overlay contours in the previous/next slices to facilitate manual contouring
Easy to use editing, correction tools. Add/delete/replace/move/paint/copy/scale using simple mouse operations.
Supports interpolation of the contours in the intermediate slices
Undo, Redo contouring tool support
Powerful Boolean Operators that can generate new contours from the existing ones using Intersection, Difference and Union logics.
Supports multiple Boolean operations
Asymmetric Margins with organ avoid feature
Zoom and pan controls
Contours can be drawn with a digitizer
Multiple 3D image set support
User chosen density values can be assigned to a given transverse image with mouse operations. Can also fill any contoured organ with a chosen density value.
Density values are displayed in the status bar when moving the mouse over the CT images.
User can de-select any selected tool (Paint brush, zoom in/out, etc.) by pressing the ESC key.
Scroll through non-transverse (sagittal, coronal) slices.
Easy cleanup of small erroneous contours created by automatic contouring tool.
Volume decimation allows users to delete and modify contours on a few slices; the rest can then be interpolated.
Both calculation points and fiducial markers can be visualized in the beam's eye view and moved in any of the views.

Planning

Plan Manager

Select, Copy, Delete, and Add plans.
Plan type: External, Brachytherapy, Composite, and Irregular.

Plan Template Manager

Some beam parameters can be edited during creation of a template or when imported.
New beams can be added or existing ones deleted in the plan template manager window.
Plan template allows the user to set the Isocenter of the beams to the Patient Origin, Center of Extents, Center of Mass, Cross Section of Markers, and Center of Markers.

Beam Setup

Beams can be added, edited, or deleted with quick, easy mouse operations.
Opposing beam creation (Copy Invert Beam).
MLC, Block shapes associated with the opposing beam are automatically inverted with one mouse click.
Beam summary can be displayed and updated in real time.
Display of current or all beams can be turned on or off.
All the parameters of the beams are available in the beam summary to view or quickly edit.
MUs are displayed for the calculated beams in the beam summary.
Support for hot-keys such as add, copy and delete beams.
Unlimited number of beams.
Real-time weighting and normalization

Other

Secured plan acceptance
Patient and planning data is file/folder based and can be sent back and forth via network or internet to satellite sites or laptops.
Overlap of the target volume with other volumes can be calculated and displayed in both cm3 and percentage of target volume.
Rotational beams and asymmetrical fields supported.

Visualization Tools

User-friendly graphical user interface, with a user-controlled screen layout displaying any of the four of the following views simultaneously

Room's Eye View
Transverse View
Coronal Reconstruction View
Sagittal Reconstruction View
Beam's Eye View (BEV)
Thumbnail (complete transverse image set)
3D View

Common Tools

Any of the views can be displayed in the main window and can be zoomed to Full Screen.
Transverse images can be seen consecutively as a movie loop.
Any contour can be displayed or turned off
Contours can be viewed in either of the following display modes : Wireframe, Fill, Transparent or Solid
Fiducial markers and calculation points can be viewed or turned off
Zoom in and out and view in full screen
Isocenter, patient origin, and slice reconstruction origin can be turned on or off
Customizable print and plot settings

Beam's Eye View (BEV)

Anatomical organs can be seen as wire frame or turned off.
The following can be easily edited in BEV:
- Beam size and shape
- Collimator jaw for symmetric and asymmetric units
- The position of the Isocenter
Real time display update of the current BEV when changing the collimator and gantry angles
Collimators can be "auto fit" to any selected organ with specified margin
Fiducial markers and calculation points can be displayed and moved in BEV
BEV display can be zoomed in and out and be viewed in full screen
BEV supports the display of DRR in real time
"Auto Fit" feature automatically fits to selected volume when a change is made to gantry or collimator angles.
Support for ruler tool in BEV
Beam's eye view region can be customized for printing
Current transverse slice position indicator in BEV

Digitally Reconstructed Radiograph (DRR)

DRR display can be set to dynamic or user-initiated for any change in the beam parameters
User selectable resolution : 128, 256, 512
Two interpolation options : Nearest Neighbor, Trilinear
Option to see any of the contoured organs in wire frame mode overlaid on the DRR
Window width and level adjustments for the DRR display
Advanced DRR control settings including :
- Film size (square)
- Ray Trace Step size
- Source to Film Distance
- Bone Threshold
- Metal Threshold
- Water Ratio
- Bone Ratio
- Metal Ratio
- Gamma Factor
Option to limit DRR to external volume
Anatomical organs can be seen as wire frame or turned off
Personal settings can be saved customizing use for individual preferences as 'DRR template/library files'

Room's Eye View (REV)

In REV, the user can easily visualize the actual treatment geometry
Relative positioning of the patient with respect to the treatment unit in three dimensions can be viewed
Treatment unit can be viewed in solid or wireframe displays or can be turned off
Display is real time and instantly reflects any changes in the machine parameters
3D view can be rotated or panned by simple mouse operations
Orientation glyph displays the current orientation of the patient. It can be turned on or off
Dose surface for any specified value can be viewed or turned off
3D View can be coupled with the reconstructed CT image data in any plane. The planar selection is very efficient through simple mouse/keyboard operations.

Color wash and Isofill

Support for advanced color wash feature
Advanced color wash can be turned on or off
The lowest dose value is in deep blue and the highest in dark red
Dose values assigned to a specific color are user selectable (in adsolute dose or relative)
Selectable in either absolute dose values or relative
Option to have the Isodose curves over laid on the color wash
System supports color Isofill option where the dose between intermediate dose values can be filled with one color
Any two calculated plans can be compared side by side
Plans can be selected from a drop down list for comparison
Comparison can be in transverse, sagittal, coronal, 3D, REV, BEV, color wash or Isofill.
Both transverse planes can be simultaneously navigated through key board operation

Dose Calculation

Dose Calculation Features

Supports two dose calculation algorithms
- Fast Photon
- Collapsed Cone convolution with or without heterogeneity correction
Dose display can be in absolute units or relative.
Non-coplanar beam calculations supported
Ray tracing to build effective depth tables
Calculation of output for Monitor Units
Dose grid can be overlaid on transverse sections
User defined dose grid. Its size can be increased or decreased by click and drag mouse operation
Multiple beam weight options: Isocenter, Dmax and MU. Support for Individual fractions for each beam.
Multiple normalization options: Un-Normalized, Isocenter, Max dose, Isodose
Dose can be prescribed to any user specified Isodose line
Points of interest can be placed with mouse operation or by entering co-ordinates and are reported in the dose summary print outs
User-defined machine and energy parameters
User-editable gray scale for density calibration
Detailed Plot/Hardcopy Outputs
Graphical output for all display windows
Complete beam parameter descriptions
Selection of plan summary system reports
User-defined plot magnification factor
Detailed physics summary
Dose contribution from each beam is displayed in the calc point summary.

Dose Volume Histogram

Dose Volume Histogram (DVH) Features

Supports Comprehensive DVH analysis
All important DVH information is represented in one single window that represents both graphically and statistically.
DVH graph in either Integral and Differential mode display
The background color for the DVH graph can be changed to white or black at any time
User can enter the DVH Prescription, Dose Plot Maximum and Dose level values or alter them graphically
Volumes can be included or excluded into the DVH graphical analysis by simply clicking them
DVH can be compared between two plans. All calculated plans are available in a dropdown list.
Minimum, maximum, mean, median, modal, and EUD data are available in the DVH table as the entered percent volume value
Displays the percent volume that receives the entered dose value or greater
Support for a grid background, relative values, mouse tool tip and printing of multiple dose levels

Exporting

Exporting Features

DICOM RT export of the patient's contours, treatment plans, DRRs and dose information
File name can be automatically changed during DICOM RT export through RTP
Can interface directly with VARiS (Varian), LANTIS (Siemens) and IMPAC record and verify systems
Can export all beams from a plan to reference the same patient setup
Add Reference Dose Sequence to RT Plan
Export MU per fraction for all plans
Export the interpolated dose value at the Isocenter

RealART – Additional features

Copy relevant patient volumes from another patient model. This provides a starting point for the RealART process, as the user can quickly adjust the volumes to the current day's image series.

Copy plan for the new patient model. The purpose of this feature is to perform the copying of the original IMRT plan into the new patient model, associate the target volumes, and generate the necessary information needed for aperture morphing.

Adjust (morphing) beam/segment apertures based on differences between planning contours and the contours on the treatment day.

Segment weight optimization: only optimizing the monitor units of the segments. The MLC segment shapes acquired from the aperture morphing will stay unchanged.

Recommended Hardware Requirements

2 x Quad-Core Xeon X5450 3GHz
RAM Memory: 4 GB Minimum
DVD±RW (±R DL) / DVD-RAM
Hard Disk: 250GB or larger (depending on storage needs)
Video Card: ATI FireGL™ V3600
Ethernet Card: Gigabit Ethernet
Monitor: 32 Bit Color, 1280 x 1024 pixels

Optional Monitor: WACOM 21UX Touch Screen