2. Surface contour scanning system
- Improved accuracy and efficiency
High level of integration
Multiple applications

3. Laser-Camera Technology
Optical
triangulation

4. Sentinel, LS100 - Discrete installation
- Technical evaluation at Karolinska, Stockholm
- Clinical evaluation in Uppsala
- First installation in Uppsala

5. Sentinel, LS200 - Attractive design - Simpler installation
- Service friendly
- Design ready Q1 2007
- Delivery Q2 2007

6. Sentinel system – SW and HW
High level of user friendliness
Connectivity
Simplicity
Efficiency

7. Connectivity - Network support

8. Sentinel – multiple applications
Patient Positioning
Motion Detection
Respiratory Gating

9. Sentinel – Patient Positioning
cPOSITIONING
Improved accuracy
Efficient workflow
User friendly
No additional markers
No added radiation

10. User friendliness – Clinical mode

11. User friendliness – Advanced mode

12. Efficiency - Performance and Work flow
Scan time is typically 3-5 seconds
Surface matching takes typically 1 second
Sub-millimetre accuracy

13. Sentinel – Motion Detection
cMOTION
Does not require active supervision
Visualization
Recording
Alarm

14. cMOTION workflow cMOTION
Integrated workflow with cPOSITITION or Stand-alone functionality
Markerless solution
Alternative to manual supervision (camera + monitor), userfriendly solution.
cPOSITIONING
cMOTION

15. Sentinel – Respiratory Gating
cRESPIRATION
Respiratory gating
in the Sentinel system

16. Respiratory motion can affect the delivered dose distribution
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

17. 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%
Amplitude
Gating window

18. Inter- and intrafractional variations
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

19. The cRespiration workflow
3D CT study (gated)
Gated CT study
(retrospecive/
prospective)
Gated treatment planning and delivery
Gating parameters

20. Prospectively gated CT study
CT room CT
3D CT study (gated)
Establishing of gating parameters Real-time generation of gating signal
Gating parameters
Patient LS
Respiratory signal

21. Retrospectively gated CT study
CT room CT
Sorting of CT data according to respiratory phase
Selection of phases suitable for treatment
3D CT study (ungated)
3D CT study (gated)
4D CT study
Patient
Gating parameters LS
Respiratory signal

22. Gated treatment planning and delivery
Treatment room
Treatment planning
LINAC treatment delivery
3D CT study (gated)
RT plan
Gating enable (SW/HW)
Real-time generation of gating signal
Patient LS
Respiratory signal
Gating parameters

23. 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

24. Milestones June 2008: Clinical validation activities begin
In cooperation with the Academic hospital in Uppsala
Philips Big Bore CT
Elekta Precise Linac
July : 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

25. 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)