EQUIPMENT SPECIFICATIONS
Contents
1. dm Off Center Ratio x inverse square x Tissue Phantom Ratio x Output Factor Monitor Units Dose cGy from the Ray Trace algorithm Dose cGy from the Monte Carlo Dose Calculation algorithm SSISGSESSSSELERLEKRLESRVARLINASsasaassnssee ee ACCURAY 5 94 Animation View a graphical simulation of the selected treatment plan including robot motion Animation includes a proximity detection simulator COMMISSIONING TOOLS 5 10 1 Graphical Display Once beam data is imported into the CyberKnife System it is displayed graphically in the MultiPlan System Measured calculated and reference beam data are displayed for the following Off center ratio issue phantom ratio Output factor ACCURAY User approval of beam data is required meeeccecececcecc 555555585 esoooccol H SE ACCURAY CyberKnife 5obooooosonosooo Hiit foo2owopav HEPR 2 oof AIEEE EE PTL TH eH 23 ACCURAY CyberKnife 5 11 MONTE CARLO DOSE CALCULATION OPTIONAL The Monte Carlo dose calculation algorithm samples the interactions of photons entering the patient Sufficient photons are sampled to provide a statistically accurate calculation of the dose deposited in the patient The algorithm includes a source model that describes the distribution of the energies and trajectories of photons exiting the The pati2. AVIS TUIS ed hes engeas ne 9 23 2 Iris Variable Aperture Collimator isses HH eH hh he 9 2 2 9 XChange ROOOUC colimator Change sg qupd qae bl ORC eR red pe CREER ER eos Y qd FERE Der ard 10 24 TREATMENT DELIVERY SYSTEM CONTROL CONSOLE HARDWARE SPECIFICATION 10 IMAGING oss RU ooo A ESPERE EAS DEI ERR DER 11 Oo S DE 12 22 FRAY SOURCES oso emendi qd iet tones eda edem en me Ra a E IHE UHR RACER URS Re prp POPE 12 2 p c EEG PO 12 a TARGETTHACEING oS Lodo PAPEL ORE ERES Duae ddp biu Se deu Todd vu dd 13 4l SYNCHRONY RESPIRATORY TRACKING SYSTEM s qaia n edat d c ch m nth d eae er nen 14 42 INTEMPO ADAPTIVE IMAGING SYSTEM ccc ccc eH heme me eme n 15 LM bts Nos cmcT cC E 16 44 XSIGHITSPINETRACRING SISTEM cesis aenn IdmESrPTe EOS 18 AS SIGNO TRACKING S TEN rn nte cog quat T M 18 4O ODSKULL BRP S c 19 47 SUPPORTED TRACKING COMBINATIONS 445 dos epee sb EY E bes endeases vas 19 S TREATMENT FLANNIN DE PSU CEPIT oid eae ERE oes p PIE MEME 19 2 HARDWARE SPEGIFICAMON dd dde ton 594 PRAE EE arl ek pa cp Bt or ebria RS PRU Forster d ap 19
3. Repeatability 0 12 mm lt 004 in Footprint 1006 mm 39 61 in x 1006 mm 39 61 in Work Envelope 55 my 1942 ft 1257 4g 793 For detailed specifications of the configuration available in respective territories please contact the local Accuray representative For detailed installation requirements please contact the local Accuray representative ACCURAY CyberKnife The following diagram shows the volume that the robotic manipulator is capable of moving in Load Center of Gravity E5981 eec HP 3100 Interference Radius 1788 2700 The robotic manipulator is programmed to move in a fixed and pre determined workspace The designed workspace accounts for the positions of objects in the treatment suite including the treatment couch the imaging sources and detectors the floor and the ceiling and eliminates collision hazards by creating suitable paths for the robotic manipulator to move in Additionally the workspace is com prised of pre assigned points in space termed nodes where the manipulator is allowed to stop in order to deliver radiation dose At each node the linac can deliver radiation from multiple beam angles It may be noted that the representation above is conceptual as the workspace and the treatment paths adopted by the robotic manipulator are dependant on the location of the target and patient anatomy being treated 221 Workspace Robot Workspace 7 Imaging Sources
4. Robot Workspace Imaging Center Treatment Nodes eptual Diagram Imaging Detectors ACCURAY CyberKnife 2 2 2 Safety Zones The robot workspace also takes into consideration the position of the patient and is designed to avoid contact with the patient This is achieved by creation of a safety zone around the patient and the treatment couch As shown in the representation above the safety zone consists of two elements fixed and dynamic The fixed safety zone is rigidly attached to the imaging center and thereby the part of the patient body being treated while the dynamic safety zone is designed to encompass the entire patient body and always lies within the fixed safety zone The size of the dynamic safety zone is user selectable based on individual patient sizes Small Medium or Large Patient safety is further enhanced by the presence of a contact detection sensor at the distal end of the secondary collimator hous ing on the linac Contact with the sensor causes an Emergency Stop E STOP condition halting all motion of the system ACCURAY CyberKnife 2 3 SECONDARY COLLIMATOR SIZES The CyberKnife System uses multiple secondary collimator sizes that can be changed manually or automatically optional with the Xchange Robotic Collimator Changer to deliver beams as defined by the treatment plan Also available optionally is the lris Variable Aperture Collimator which allows the collimation aperture to au
5. PLANNING OPTIONAL 0 0000 00000 cece Re 25 5 13 SEQUENTIAL OPTIMIZATION OPTIONAL iiisssssssse Re ea 25 gA MULTIPLAN MO SUTE 26 5 15 MULTIPLAN QUICK REVIEW OPTIONAL 2 0 0 0 ccc ccc cece iaee 27 Dro ENO 0b ea A a E E EE E A E EE E E EEE A 27 Bel OIE a LESION 27 5 18 AUTOSEOMENTATION OPTIONAL gia teen oce 93d rte dra e mace PIG E 28 319 TREATMENT TIME REDUCTION TOOL iiid senri teskent cert wind eed otov ape rot Rt Rt EORR E e dem dote 28 S20 IMPROVED EL SUPE OR es ded quu un 2 28 B DAIA MANAGEMENT Par POPE CEPI QU SPORT RU TM Aube 29 61 CYBERKNIFE DATA MANAGEMENT SYSTEM 2 0 0 0 00 ccc cece cece e eee ed 29 Old at See Teee 29 6 1 2 Administrative Workstation n ee e ees 29 oA EE SUPPORT 29 7 PATIENT POSITIONING SUPPORT D RID IA 30 TA VEEN 30 FAs Standard Treatment Couch 2 0 ccc cnn ene ne nen nee een eee ence he ens al ela ROOOCOUCH Patient POSITIONING Sy AE s pergis 2 Fa TREATMENT TABLE TOP MEM 31 7 2 1 mue Ho eio T T o TUTTI 3 12 2 Seated Load Table Top Optional 0 HH m ens 31 8 REGULATORY CLASSIFICATION o iud eiii UP LORS d e RE UMP TA EUN ERR RE 33 LIST OF TABLE
6. each collimator are normalized to a value of 1 0 at a depth of 15 mm OCR values for each collimator are normalized to a value of 1 0 at a radius of O mm OF value for each collimator is normalized to the value of the OF for the 60 mm collimator at 800 mm SAD and 15mm depth which is defined to be 1 0 Tissue density corrections can be applied using the effective path length algorithm Surface obliquity can be corrected using a geometric ray tracing algorithm 57 3 2 Monte Carlo Dose Calculation see section 5 11 for details EVALUATION 5 8 1 Plan Statistics The following statistics are available for each plan generated in the MultiPlan System Dose Volume Histograms DVH can be displayed for each VOI Minimum Dose in centiGray cGy for each VOI Maximum Dose in cGy for each VOI Mean Dose in cGy for each VOI Conformality Index CI The ratio of tissue volume that receives the prescription isodose or more to tumor volume that receives the prescription isodose or more e New Conformality Index nCl the Cl multiplied by the ratio of the total tumor volume to the tumor volume that receives the prescription isodose or more Homogeneity Index HI the ratio of the maximum dose to the prescription dose Coverage the volume of the target that receives the prescription dose divided by the total volume of the target 5 8 2 Isodose Curves Once a plan is generated isodose curves are displayed on every 2D view Users can configure th
7. information to the other secondary image series 5 6 CONTOUR DELINEATION The MultiPlan System provides the ability to delineate many types of contours for treatment planning purposes Gontour Align Plan Visualize Plan QA Settings Help CuberKnife MultiPlan Skin Spine Tracking Volume Ball cube Properties 5 61 VOI Volume of Interest Volumes of Interest include Targets anatomic volume where dose is prescribed e Critical structures anatomic volume where dose is constrained Shell structures planning volume that surrounds the target and is constrained to increase the Select Contour Set gradient outside the target volume Tuning structure planning volume that is constrained to further minimize dose to healthy tissue Cavity anatomic area encompassed by and subtracted from either a target or a critical structure Drawing Tools User options for delineation of VOI include e e Delineation of up to 22 Volumes of Interest VOI with any mix of targets and critical structures Delineation of up to 32 contour sets for each VOI to define non contiguous segment of the same structure in each slice o9o Delineation on axial sagittal or coronal planes o AutoSegmentation for Prostate optional See section 5 18 2D and 3D delineation tools include Pen or drawing tool Line segment tool Ellipse tool Options 2D Magic Wand uses high contrast to automatically delineate a VOI
8. mm Standard Treatment Couch Serial 5232 cable ommunication RoboCouch System Serial RS232 Infrared port Operating Range Camera Array vertical positioning approximately 2 m from the floor Camera Array in line with patient Manual e Modes User Defined Automatic system assisted Single click fully automated model building Modeling Linear Types Curvilinear Bi Curvilinear The optimal model type that achieves the minimum overall correlation error is automatically chosen Maximum allowable correlation error 5 mm Breathing model tracking markers waveform Algorithm parameter User Displays 99 Selected orre ation graphs Correlation error Error checking Hardware 4 2 INTEMPO ADAPTIVE IMAGING SYSTEM The InTempo System is a time based motion tracking technology used to compensate for non perodic intrafraction motion of the target The InTempo System has been designed specifically to account for the types of motion patterns typically encountered when delivering radiation to the prostate and can only be used to deliver treatment to the prostate Single patient use custom Synchrony vest 3 sizes S M L Single patient use fiber optic markers with harness Image Age The InTempo System makes use of the Image Age parameter to control treatment beam delivery Image Age is the time elapsed since the most recent image acquisition With the InTempo System the system modif
9. patient setup only During the treatment the system automatically corrects the linac position and thus radiation targeting for any patient motions within a specified tolerance see Table 8 for details Table 8 Treatment Correction Ranges RoboCouch Povo EM Standard Standard System with Treatment Couch Prostate Path couch with Prostate Path X Y rad o Z with Synchrony emm m qu E 25 mm E System Target tracking on the CyberKnife System is achieved by the use of one or more of the available tracking methods namely fiducial track ing the Xsight Spine Tracking System the Xsight Lung Tracking System and 6D skull tracking The Synchrony Respiratory Tracking System and the InTempo Adaptive Imaging System as described in later sections of this document are motion compensation technologies and are used in conjunction with applicable tracking methods The Synchrony System is used to compensate for repetitive motion such as that induced by breathing The InTempo System is used to compensate for rapid erratic motion and other patterns seen in the prostate Accuracy specifications for the various tracking methods are detailed in Table 9 Table 9 Targeting Accuracy with Various Targeting Methods re Without Synchrony Respiratory With Synchrony Respiratory Tracking System Tracking System Xsight Spine Tracking System 6D Skull Tracking Better than 0 95 mm RMS presented options may not be av
10. 2 TEM SOF VAR E spesso mra ERE EEUU aoe ne wad br 20 53 DISPLAY LAYOUTS AND CONTROLS ceria rea erkini nnn n ees e ae ens 20 54 USER PRVILESP AND SECURITY SETTINGS 20 55 FUSE MAGE REGISTRATION sake Exe RR RETERU e das d cave der ak PETER 20 sce pesorpis is mH Tren 2 561 scs erasure sse rRuRiTRERAXR RA Rid Ru ERE SC RETAPSRERRERMA TiSQERUSEPES 2 DO j Er 2 soc SOME Tae Uy TITTTTII 2 De c E E 21 57 22 TERT 22 Sa Fe MMU UG 22 Sie DOS 22 093 o e r A ca un AE A ae eee ier E 22 SOl Panoa per bett Loder quide par incor don Ao p ei dp Robbie de a dae 2 22 Dod AU ROGN va d Oria bd aegra d darva rdi prd ge ac a da 23 ACCURAY CyberKnife CES eee nC ete tee eer ee Ler etre eee eee heer re ern ee ae re E eee eT re ey 23 22 T Tm 23 2 v pe TODO EET Tm 23 cvm 23 so GE TMU icy E NE E E E E E EE E E 23 eM CHOSE N E E e Goon ei 23 23 5 11 MONTE CARLO DOSE CALCULATION ccc cece EEEE EEEE e ee eed 24 5 12 4D TREATMENT OPTIMIZATION AND
11. Plan System v3 5 is the availability of MultiPlan MD Suite as an option for remote review contouring fusion etc The primary difference between MultiPlan MD Suite and the InView station is that MD Suite is networked directly to the CyberKnife Data Management System Therefore any changes made to a patient directory while working in MD Suite are immediately available to the MultiPlan user without the need for a manual data transfer Contour Align Plan Visualize Reference Plan Beams MultiPlan MD Suite Plan QA tab MultiPlan MD Suite Summary Provides image fusion contour and delineation of critical structures ability to set treatment parameters review of treatment plans e Networked to the CyberKnife System Database e Can be located locally in the CyberKnife suite remotely at any distance Allows the referring physician to remotely access the patient database for pre planning tasks or for treatment plan review CyberKnife MultiPlan MD Suite entry page Plan QA Settings Help Plan QA Settings CyberKnife 145 147 196 98 2 I 0 120 124 196 9724 ACCURAY MultiPlan MD Suite Plan task ACCURAY CyberKnife 5 15 MULTIPLAN QUICK REVIEW OPTIONAL m MultiPlan Quick Review allows the user to run one primary and up to three secondary sessions of the MultiPlan System simultaneously The primary session has full functionality The secondary sessions cannot perform op
12. S Table 1 Robotic Manipulator Specifications ases ce net eb CR Xr OR eb o ER RR DER EUR RS eL aes 6 Table 2 Iris Variable Aperture Collimator Specifications 2 0 0 0 ccc cece eel 9 Table 3 Xchange Robotic Collimator Changer Specifications sisse 10 Table 4 X ray Generator Specifications 2 00 eme e eme ees 12 Table 5 12 Table 6 Xay Detector SOECIICATIONS Ime 12 Table 7 CI Requirements Tor Target Tracking assis is Table 8 Treatment Correction Ranges issus eto rere RO Pc S yeoman Aaa TE PRO c wm f v Pawnee oN 13 Table 9 Targeting Accuracy with Various Targeting ens 13 Table 10 Synchrony Respiratory Tracking System Specifications 20 cence nns 15 Table 11 InTempo System Features 2 I e e eene 16 Table 12 Fid cial Tracking Specifications nv s a we e Rx va Rn Re YE 16 Table 13 Approved Fiducials for Soft Tissue Tracking 2 0 nnn I ns 17 Table 14 Approved Fiducials for Bone or Spine Implantation 0 0 0 0 ccc mens 17 Table 15 Xsight Spine Tracking System Features 6 I ees 18 Table 16 Tracking System Peal ES cua debat d CR RR iawn eave eC E Ct EPA C iin eee dad eae OA ER AA Aes 18 Table 17 6D Skull Tracking System Features 00 ccc ccc cn ene
13. SS ACCURAY EQUIPMENT SPECIFICATIONS ACCURAY CyberKnife ACCURAY CyberKnife CyberKnife Robotic Radiosurgery System 6MV Linac X ray Sources amp o Nm s T yy RoboCouch Patient In floor X ray Support Table Detectors 6 Axis Manipulator Optional equipment shown Accuray reserves the right to update or change these specifications without notice ACCURAY CyberKnife TABLE OF CONTENTS OE 3 2 TREATMENT DELIVERY er INN RIP MOVES erg Ad pU 4 HEN 0 0282 019 1080 n EE 4 zi y eesriie pat chansetiaaadectarcds hae koedsacngess ka aester ikari ieir itir 4 PUR 4B coo Tru 4 Wee ale MTCT P 4 Dale PVCS EAE S I E E T AE E S E A ene E E EE ET 5 SU a aiak 5 NORTE 5 HER oun PMPCTTL 5 MENO 5 ON errr TTE EOD TO RA R An RE A RRR IRn 5 Sc Ose tye nsdn 5 2 11 T Feld GEOMCUY succurri E e DO IE HACK ERE bated ed des poa ie va duca ds aee CU ab REED EERE 3 6 da ORAN ROBOTIC MANIPULAT I R us ner E 6 DOM NOM 0 5 7 DDD Sa OMe MERLO TTE 8 2 SECONDARY COLUM 9 Dd
14. ailable in every territory Please contact the local Accuray representative to learn more Rotational targeting accuracy for the Xsight Lung Tracking System is calculated by the Xsight Spine Tracking System 14 ACCURAY CyberKnife 41 SYNCHRONY RESPIRATORY TRACKING SYSTEM The Synchrony Respiratory Tracking System continuously synchronizes treatment beam delivery to the motion of a target that is moving with res piration The system operates by creating a correlation model between the patient s breathing pattern monitored in real time and the location of the target at various points in the respiration cycle The location of the target is determined by using X ray imaging to visualize the lesion or internal mark ers fiducials while the breathing pattern is tracked and monitored using external markers LED based fiber optic tracking markers in real time X ray images required for building the correlation model between external chest wall motion and internal target motion may be acquired manually in a User Defined sequence or by using the fully Automatic functionality available The system automatically determines the best correlation model type to be utilized for the particular treatment by choosing the model type that minimizes overall correlation error The model is chosen from linear curvilinear and bi curvilinear forms The model is based on the latest 15 sets of X ray images taken and is updated every time a new image is
15. arge focus 100 kW input power Small focus 40 kW Firing Modes Synchronous and Asynchronous Collimator Type Fixed Aperture 3 3 X RAY DETECTORS One pair of X ray Image Detectors is supplied with the CyberKnife System Table 6 X ray Sources Specifications X Ray Imaging Detectors Specifications detailed specifications and available configurations please contact Customer Service ACCURAY CyberKnife 4 TARGET TRACKING Accurate target tracking and compensating for target motion are an integral part of the CyberKnife System and its capabilities The target is tracked throughout the entire treatment and delivery is automatically altered to compensate for any motion CT requirements to achieve published accuracy specifications for all tracking systems are listed in Table 7 Table 7 CT Requirements for Target Tracking kV ms Scanner Maximum minimum 400 Slice Thickness Contiguous slices no gaps 1 5 mm slice thickness Target tracking and motion compensation are achieved through the use of the imaging system integrated with the treatment delivery system The image guidance system calculates the required adjustment to the patient s position During patient set up the operator has the option to allow the system to automatically align the patient or to manually adjust the patient on the treatment table as needed This process aligns the CT origin close to the imaging center and is required at the time of
16. ariable Aperture Collimator see Section 2 3 2 21 3 DoseRate Depending on territory the CyberKnife System is equipped with a linac operating at one of the following nominal dose rates a 1000 Monitor Units per minute MU min b 800 MU min C 600 MU min d 400 MU min The nominal dose rate is measured at a SAD of 800 mm and at a depth of 15mm in a water phantom for a field size of 60 mm diame ter Dose rate is measured with a standard calibrated ion chamber of 0 6 cm volume or less using the 60 mm fixed aperture collimator 21 4 Flatness The beam flatness measured along two orthogonal axes shall not exceed 1496 when measured using a stereotactic diode in a water phantom at an SAD of 800 mm and a depth of 50 mm with a 40 mm secondary collimator The flatness is defined as the maximum variation in the profile within the central 8096 region of the FWHM This is reported as the percentage difference between the maximum value 10096 by definition and the minimum value within this region O Figure 1 Illustration of the regions of dose measurement that are used in the flatness calculation See Accuray Physics Essentials Guide P N 029577 A 2 All presented configurations may not be available in all territories Please consult the local Accuray representative for more information ACCURAY CyberKnife 2 1 5 Asymmetry Photon therapy beam asymmetry is the percent difference in the area on the rig
17. ata Access Preferences and Plan Templates 5 5 FUSE IMAGE REGISTRATION The MultiPlan System allows the user to register the following imaging modalities to the primary CT 4D CT only with the 4D Treatment Optimization and Planning feature MR acquired in either the axial sagittal coronal or oblique up to 30 planes PET Colormap and grayscale 3DRA Registration of images can be performed using any or a combination of the following options Automatic registration using intensity values based on mutual information he user can choose to select a Fusion Region of Interest when fusing automatically Semiautomatic seed point registration allowing user selection of up to 8 seed points Manual registration with fine adjustment tools For ADCT only deformable registration using intensity values and user defined seed points ACCURAY ACCURAY CyberKnife If either the Automatic or Semiautomatic registration option is selected the System provides real time visual feedback of the registration during the process Feedback is displayed in the following views Split view Checkerboard view Merged view If multiple secondary image series are to be registered to the primary CT and if those secondary image series are already registered to each other then the MultiPlan System provides the option to register one secondary image series to the primary CT and then copy that registration
18. carbon fiber table top optional The RoboCouch System has five rotational axes and one linear axis The said linear axis is shrouded in a free standing cover RoboCouch System with Flat Couch Top Configuration Linear Axis 7 2 TREATMENT TABLE TOP There are three different tops available for use with CyberKnife System flat top for the Standard Treatment Couch flat top for the RoboCouch System and the Seated Load table top for the RoboCouch System 7 2 1 FlatTableTop Standard The flat table top included with the RoboCouch version of the patient support system is described in section 7 1 7 2 2 Seated Load Table Top Optional The RoboCouch System is also offered with an articulating couch top allowing patients to be loaded in a seated position The seated load table top converts to a flat table top to offer flexibility in positioning and loading the patient The patient can be treated either in a knees flat or a knees elevated position Table top characteristics are highlighted in section 7 2 66 26 Layout of RoboCouch with Seated Load table top WV p 2 Bs 69 66 51 38 F tho NO gL ran ael aL J 0 CU T Y E 38 45 Dimensions in inches 57 40 85 45 The Seated Load Table Top adds an additional rotational axis to the RoboCouch 31 32 ACCURAY CyberKnife Table 20 Treatment Couch Top Specifications Flat with Standard Flat with Seated Load Option w
19. dium resolution dose calculation Support for Accuray Treatment Planning Services ATPS New computation platform Dell T7500 Monte Carlo Dose Calculation at CT resolution 5 3 DISPLAY LAYOUTS AND CONTROLS The display of images and treatment plans in the MultiPlan System are controlled by the user Screen layouts can be modified as needed and individual images can be manipulated using the controls provided Layouts include the following 2D axial sagittal and coronal views 3D rendering of the CT Image controls include the following DVH Dose Volume Histogram Window and level controls Plan and Dose Statistics oom capability 3D DVH 3D DVH Side by side 3D view Pan capability A Dose S Dose Full screen single view socontour selection e Advanced Visualization allows additional layouts to Absolute or Relative dose display 3D DVH 3D be selected and allows layout to be changed atany Maximum dose display Dose S point in the planning process Uncertainty colorwash display only with the Monte Carlo Dose Calculation feature 5 4 USER PRIVILEGE AND SECURITY SETTINGS User Privileges for the MultiPlan System are defined in the CyberKnife Data Management System Assignable privileges include Load Treatment Plan Create Treatment Plan Create OA Delete Treatment Plan Save Deliverable Treatment Plan Access Commissioning Tools Approve Commissioning D
20. e altered For a detailed description of AutoSegmentation and the protocol for placement of initialization points please see the user s manual AutoSegmentation allows automatic contouring of prostate rectum bladder seminal vesicles and femoral heads 5 19 TREATMENT TIME REDUCTION TOOL MultiPlan will calculate an estimated treatment time for all plans generated The Treatment Time Reduction tool can be used to reduce estimated treat ment time for both radiosurgery and conventionally fractionated treatment plans Robotic IMRT Once the initial optimization completes the user can enter their desired treatment time The Treatment Time Reduction tool also utilizes smart targeting algorithms when removing beams For a detailed de scription of the Treatment Time Reduction Tool please see the user s manual The MultiPlan System will then generate a family of treatment plans by suc cessive iterations of beam reductions node reductions and re optimizations As the iterations proceed the trend for the predicted treatment times will decrease until the user specified treatment times is achieved Soi Hohiohed a Orewa load Solution History Reduce and Optimize Cancel Time minutes The treatment time reduction tool is accessed in the Sequential Optimization tab 5 20 IMPROVED PET SUPPORT MultiPlan supports both grayscale and colormap PET images These images can be displayed in 2D and 3D The user is provided wit
21. en added to allow the user to perform a beam reduction only Colimators Script Mosnes vorum Reduce and Optimize Cencel Relaxed Convergence When the Relaxed Convergence box is checked a set of predetermined parameters are activated which will cause optimization of a particular objective to stop if it is within a certain range of the specified goal Optimization of this step will complete and the Sequential Optimization algorithm will proceed to the next step Optimization user interface 25 26 ACCURAY CyberKnife Dose Statistics for Shell Structures Min Mean cGy cGy Urethra Prostate PTV Penis Bladder Rectum Seminal Vessels Bowel Max cGy 4475 91 7034 61 7034 61 3292 37 4483 54 3698 98 5132 09 1384 92 Sequential Optimization Shell statistics are shown in the Dose Statistics table on all steps except for the Reference CI Plan step Note a hollow square indicates a shell HI Coverage 61 56 86 77 E Pubic bones 281 77 CIPTV Shell1 203422 OPTY Shell 2 275 87 4688 13 4092 92 1825 77 5 14 MULTIPLAN MD SUITE OPTIONAL Prior to version 3 5 of the MultiPlan System the tool usually used by the CyberKnife physician for remote review of treat ment plans contouring fusion set treatment parameters was the InView Image Fusion and Contouring Station Concurrent with the release of the Multi
22. ent geometry is modeled as 3D arrays of mass density and material type Photons interact with the patient volume to form particles such as electrons and positrons and deposit energy Each particle is tracked and for each voxel the deposition of its energy is calculated The total dose recorded at each voxel is an estimate of the dose deposited by all photons in the actual treatment beam The Monte Carlo dose calculation algorithm carries out the necessary computations in a matter of minutes rather than hours without compromising dose calculation accuracy The algorithm uses a beam commissioning procedure to derive source model parameters automatically based on measured beam data The Monte Carlo commissioning procedure requires several days of computation time however it is only performed during the commissioning process and can be broken up into few hours at a time The Monte Carlo dose calculation can be enabled for both fixed collimators and the Iris Variable Aperture Collimator Prerequisites The system has both Monte Carlo and Iris licenses installed Monte Carlo commissioning for Iris has been performed If the user selects the Iris Collimator in the Treatment Parameter of the Align tab Monte Carlo will be available as a dose calculation method See figures below Dose Calculation Monte Carlo x Low e Calculate In addition to enabling Monte Carlo dose calculation for the Iris Variable Aperture Collimator the foll
23. ers Sterile placement needles single or 3 pack with 1 x 5 mm soft tissue marker CyberMark Coupled MI NW 887 710 1 0x 3 mm Sterile placement needle with two 3mm Marker MT NW 887 709 gold soft tissue markers attached at a fixed Coiled gold soft tissue marker on a carrier FP 0755 for transport and easy to deploy into most Visicoi 075x5mm needle hubs RADIOMED coiled gold Moms O 075 005 PL Coiled gold soft tissue marker in a preload markers ed needle with bone wax at the tip Coiled gold soft tissue marker in a preload VERUS ed needle with bone wax at the tip ALPHA 25 gold seeds per vial packaged non sterile OMEGA Gold Seed SMG0242 025 0 8x 5mm 19G thin walled biopsy needle 10 11 cm or 15 cm length FIDUCIALS APPROVED FOR IMPLANTATION IN BONE OR SPINE The fiducials listed below have been validated for use with the CyberKnife System for purposes of implantation in and tracking of bony structures Table 14 Approved Fiducials for Bone or Spine Implantation Manufacturer Type Manufacturer s Part Number Dimensions Description BIOMET FIXATION Stainless Self drilling marker for use in spine or bone formerly Steel Screw 10 Lorenz Surgical 019005 Single self drilling marker per pack ACCURAY 5tainless 0190062 BO Five 5 self drilling markers per pack Steel Screw 019007 Ten 10 self drilling markers per pack Fiducial in ACCURAY l 018985 N A strument kit Not all listed fiducial types
24. geting Accuracy See Table 9 4 5 XSIGHT LUNG TRACKING SYSTEM The Xsight Lung Tracking System tracks tumors in the lung directly and without the use of fiducials by using image intensity differences between the lesion and the background The Xsight Lung System works in conjunction with the Xsight Spine Tracking System to track translational motions of the lesion Patient alignment is accomplished with the use of the Xsight Spine System s spinal segmentation capabilities while during the treatment Xsight Lung Tracking System tracks the translational motion of the tumor User Accessible Features Table 16 Xsight Lung Tracking System Features Xsight Lung Tracking System Features Tracking Mode Direct tracking of lung lesions without the use of fiducials Minimum 15 mm across all dimensions Lesion Eligibility ocated in the peripheral lung region Visible in both live X ray projections and both DRR images Requisites Xsight Spine Tracking ystem Synchrony Respiratory Tracking System arget dxAB threshold mm racking range in X mm racking range in Y mm Confidence threshold 96 Live contrast factor Preferred Projection ON OFF umor Region ON OFF n Plane Rotation ON OFF Live image contrast factor automatic independent manual override for Image A and B Targeting Accuracy See Table 9 User Accessible Features ACCURAY CyberKnife 4 6 60 SKULL TRACKING The 6D S
25. h in a phantom 2 1 8 Collimator Transmission The X ray transmission through the secondary collimator absorber no hole shall not exceed 196 compared to the dose rate with a 60 mm collimator when the nominal dose rate is used 2 1 9 Dosimetry System A two channel primary secondary dosimetry system is provided The following specifications apply for both of the dosimetry channels Reproducibility with Linac Orientation Reproducibility of the dose delivered with the different orientations of the linac is less than 2 compared to the Beam Down orientation when 100 MU is delivered Linearity The linearity shall be within 1 or 1 MU whichever is greater of accumulated doses between 10 and 1 000 MU 2 1 10 Absolute Dose Calibration An MU is nominally one centiGray delivered to a tissue equivalent material at a depth of 15 mm and 800 mm SAD with a 60 mm fixed aperture collimator ACCURAY CyberKnife 2 1 11 Field Geometry 800 mm ry 1 Mb dE SSS eM h 33 3 400 mm 60 mm fixed collimator X ray source D 2 2 SIX AXIS ROBOTIC MANIPULATOR The CyberKnife System utilizes a 6 DOF robotic manipulator to position the linac in soace and deliver dose Relevant specifications of the manipulator are provided in Table 1 Table 1 Robotic Manipulator Specifications Six Axis Manipulator Specifications Selected Payload 240 kg 528 Ib 3100 mm 22i Number of Axes CO
26. h three methods for SUV calculation body weight body surface area lean body mass or the value for SUV in the DICOM header can be used ACCURAY CyberKnife 6 DATA MANAGEMENT 6 1 6 2 CYBERKNIFE DATA MANAGEMENT SYSTEM 6 1 1 Data Server The data server hosts the CyberKnife System database and processes requests received by the MultiPlan System the CyberKnife Treatment Delivery System and the administration workstations The data server resides in a rack mounted PC in the equipment room Data server hardware specifications Dual processor with each processor having a clock speed 2 GHz 4 GB of memory Set of SCSI 15K rpm disk drives in a RAID 5 configuration providing approximately 500 GB Set of SATA 7 2K rpm disk drives setup in a RAID 5 configuration providing approximately 1 TB of storage Two Gigabit Network Interface Cards NIC Redundant power supplies 6 1 2 Administrative Workstation The administration workstation houses data management applications and archived patient records Applications on the workstation include Patient Record Archive and Restore mage Review and Import Patient Administration DICOM Administration Plan Administration Beam Data Import User Administration System Administration Report Administration Administration Workstation specifications Single processor 3 GHz or 2 3 GHz Dual Core e gt 1 GB of memory Set of SATA 7 2K rpm disk d
27. hange without notice ACCURAY CyberKnife 33 S ACCURAY Our Business Begins with Patients Accuray Worldwide Headquarters Accuray Europe Accuray Asia Ltd Accuray Japan K K 1310 Chesapeake Terrace Tour Atlantique 25 Suites 1702 1704 Tower 6 Daini Tekko Building 6F Sunnyvale CA 94089 USA 1 Place de la Pyramide The Gateway Harbour City 1 8 2 Marunouchi Chiyoda ku Tel 1 408 716 4600 92911 Paris La D fense Cedex 9 Canton Road T S T Tokyo 100 0005 Toll Free 1 888 522 3740 ext 4337 France Hong Kong Japan Fax 1 408 716 4601 Tel 33 1 55 23 20 20 Tel 852 2247 8688 Tel 81 3 6269 9556 Email sales accuray com Fax 33 1 55 23 20 39 Fax 852 2175 5799 Fax 81 3 3217 0337 2009 Accuray Incorporated All Rights Reserved Accuray the stylized logo CyberKnife Synchrony Xsight Xchange and RoboCouch are among the trademarks and or registered trademarks of Accuray Incorporated in the United States and other countries 500022 E
28. he delivered dose rate Mechanical less than 0 1 mm Reproducibilit Treatment field size lt 0 2 mm at the nominal treatment distance of 800 mm Effective collimation sizes 5 7 5 10 12 5 15 20 25 30 35 40 50 and 60 mm field sizes at 800 mm SAD Available Apertures See the Iris Variable Aperture Collimator white paper for additional information 10 ACCURAY CyberKnife 2 3 3 Robotic Collimator Changer The Xchange Robotic Collimator Changer automatically changes collimators before and during patient treatment This eliminates the need to stop treatment and enter the room minimizing patient disturbance and possible need for adjustment to patient setup The Xchange System is compatible with all the fixed secondary collimators provided by Accuray and the Iris Variable Aperture Collimator Xchange Robotic Collimator Changer Table 3 Xchange Robotic Colllimator Changer Specifications Xchange System Specifications Accommodates two secondary collimator housings one for Fixed Collimators and one for the Iris Variable Aperture Collimator 12 Fixed Collimators ris Variable Aperture Collimator Secondary Collimators Iis varia Stored in individual housing receptacle in Xchange Collimator table Aperture Collimator Presence sensor for all collimators in respective collimator cup and housing receptacle Laser alignment sensors in each cup e Three Xchange calibration Is
29. ht and left sides of the dose profile curve divided by the sum of the left and right areas under the dose profile curve within the central 50 field width Asymmetry is less than 2 This measurement is made in a water phantom for the collimator field size of 40 mm diameter at SAD of 800 mm and at a depth of 50 mm with a stereotactic diode Formula for asymmetry calculation x 100 0 a b 100 50 Figure 2 Illustration of the regions of dose measurement that are used in the asymmetry calculation 2 1 6 Leakage The leakage dose measured anywhere in the patient plane outside of the maximum useful beam is less than 0 1 of the absorbed dose at the reference treatment distance of 800 mm SAD In all other directions the absorbed dose 1 m from the path of the elec trons between the electron gun and the target is less than 0 1 of the absorbed dose at the reference treatment distance The patient plane is defined as a plane circular surface of radius 2 m centered on and perpendicular to the axis of the beam at the reference treatment distance The X ray measurements may be averaged over an area not to exceed 100 mm 2 1 7 Penumbra The radial distance between the 8096 and 2096 intensity points will not exceed 4 5 mm with a 40 mm fixed secondary collimator Measurements shall be taken with a stereotactic diode detector in a water phantom at 50 mm depth and at SAD of 800 mm or by using film with the same beam and an equivalent dept
30. ies guidance imaging parameters to ensure that no treatment beam is delivered based on an image that is older than a user specified value Adaptive Imaging With the InTempo System the user may optionally allow the system to trigger adaptive imaging in the event that the assessed rate of target motion is greater than a user defined threshold Breach of this threshold causes the system to automatically reduce the maximum allowable image age The user may also optionally choose to allow the system to continue treatment delivery at this increased resolution without triggering an E stop Data on file 16 ACCURAY CyberKnife Table 11 InTempo System Features Adaptive Imaging System Features Time based imaging Automatic and adaptive imaging based on detected target motion Graphical time based display of target position Graphical time based display of target orientation General Allowable Image Age 15 150 seconds Target excursion thresholds for translational mm and rotational deg target shifts System response on target shift beyond any one of user specified thresholds Adaptive Imaging triggered Pause Treatment No Action Fiducial tracking algorithm parameters User Accessible Features Compact generators Oil cooled X ray sources Fiducial tracking CyberKnife System software version 8 5 or higher MultiPlan Treatment Planning System version 3 5 or higher CyberKn
31. ife Data Management System version 1 5 or higher Targeting Accuracy See Table 9 4 3 FIDUCIAL TRACKING For lesions that are located extra cranially target tracking can be carried out with the use of fiducials The system specifications are detailed in Table 12 Requisites Table 12 Fiducial Tracking Specifications Fiducial Tracking Specifications General Minimum 3 fiducials required for accurate target tracking including corrections for both translations and rotations e Output to User Fiducial Location s Probability measure for extracted fiducial combination Rigid body distance threshold mm Fiducial spacing threshold mm Collinearity threshold deg X axis pairing tolerance mm Confidence threshold 96 Tracking range mm Targeting Accuracy See Table 9 User Accessible Features The list of fiducials that may be used with the CyberKnife System is provided in the following section ACCURAY CyberKnife FIDUCIALS APPROVED FOR SOFT TISSUE TRACKING The fiducials listed below have been validated for use with the CyberKnife System for purposes of soft tissue tracking Table 13 Approved Fiducials for Soft Tissue Tracking Manufacturer Type Manufacturer s Part Number Dimensions UT lt MT NW 887 808 0 8x 3mm 3 sterile soft tissue gold markers Gold Seed MT NW 887 809 0 9x 3mm 3 sterile soft tissue gold markers MT NW 887 812 1 2 x 3 mmm 3 sterile soft tissue gold mark
32. ife System clinically relevant accuracy which may be termed the overall average CyberKnife error lt gt 3 E 2n The CyberKnife VSI System shown with the RoboCouch Patient Positioning System optional The overall average CyberKnife System error is less than 0 95 mm RMS when CT slice spacing of 1 25 mm or less is used When used with the Synchrony Respiratory Tracking option the overall average CyberKnife System error is less than 1 5 mm RMS for CT slice spacing of 1 25 mm or less ACCURAY CyberKnife 2 TREATMENT DELIVERY The CyberKnife treatment delivery system is comprised of an X band linear accelerator mounted on a 6 degree of freedom DOF robotic manipulator An imaging system consisting of two kV X ray sources and detectors takes images of the patient throughout the treatment 2 1 X Ray Energy The X ray energy is 6 MV nominal photon The quality index is 0 62 to 0 67 for a field size of 60 mm diameter with a source to axis distance SAD of 800 mm with an ion chamber The depth of maximum dose Dmax is 15 mm 2mm for a fixed field size of 40 mm 2 1 2 Field Size Secondary collimators are provided to produce circular fields at a reference treatment distance of 800 mm source axis distance SAD with nominal diameters of 5 7 5 10 12 5 15 20 25 30 35 40 50 and 60 mm There are two types of secondary collimators available fixed aperture collimators and the Iris V
33. is display as follows ine color and line thickness can be adjusted Display either Absolute Dose or Relative Dose Display or hide each curve individually Display or hide minimum and maximum dose points for all VOls 5 9 5 10 5 8 3 3D Rendering View rendering of patient beams delineated structures and calculated dose in 3D MultiPlan has the capability to render image data VOls and dose in 3D Image data can be rendered in 3D at native resolution The user is provided with anatomic specific filters for image data rendered in 3D The user also has the abil ity to create and save custom filters Layout of 2D and 3D images is customizable Advanced Visualization tools are available at any point in the planning workflow CyberKnife QA TOOLS 5 9 1 Plan Comparison Using the Reference Plan feature compare two treatment plans for the same patient using the same CT series side by side to determine the best plan for the patient 5 9 2 Plan Summation Using the Sum Plans feature add dose from two or more plans using the same CT series together 5 93 Beam List View a list of all beams and parameters in the selected treatment plan Parameters displayed include Beam number Template Path ID Node ID Collimator size Source to Axis Distance SAD Depth cax euclidean measure of depth along the central axis of the beam Depth effective equivalent depth through water of the beam Radius at 800 mm
34. ith Treatment Couch RoboCouch System RoboCouch System Radiolucency e Maximum lt 1 1 mm Aluminum equivalence at 120 kVp for the length of at least 62 inches from the superior most point e Alpha Cradle e Vacuum Lock Bags e Thermoplastic masks Indexing e Compatible with Civco Prodigy indexing systems Carbon fiber with structural foam core Color Gray Immobilization Compatibilty e Carbon fiber with structural foam core Color Black e lt 45 cm 17 9 in seated load Minimum Load Height 64cm 25 in lt 56 cm 22 in e lt 58cm 23 in horizontal load ength 213 cm 84 in Length 206 cm 81 in Length 212 cm 83 4 in Width 53 cm 21 in Width 53 cm 21 in Width 53 cm 21 in Thickness 7 6 cm 3 in Thickness 5 7 cm 2 25 in Thickness 6 4 cm 2 5 in Maximum width as measured edge to edge at the hand cushion is 82 cm 32 4 in 8 REGULATORY CLASSIFICATION The CyberKnife System is classified as follows Protection against electric shock Class permanently connected Applied part Patient treatment table only Type B Protection against harmful ingress of water IPXO no protection against ingress of water Methods of sterilization or disinfection Not required Degree of safety in the presence of flammable mixtures Not suitable for use in the presence of flammable mixtures Mode of operation Continuous All specifications are subject to c
35. kstation e Remote workstation Contro Local hand pendant Local hand pendant Repeatability Translational 0 3 mm Rotational 03 Most Degrees of Freedom are All Degrees of Freedom are Motion Corrections corrected serially corrected simultaneously Fixed determined by mechanical assem Variable all axes can move simultaneously Pont of Rotation D bly of the actuators about a set point in space 7 1 1 Standard Treatment Couch The Standard Treatment Couch is the standard patient support system of the CyberKnife System It provides the user with flexibility in patient positioning by providing 5 DOF motion capabilities 2240 PATIENT SUPPORT TABLE DIMENSION mm WEIGHT 256 kg ACCURAY CyberKnife 7 1 2 RoboCouch Patient Positioning System The RoboCouch System provides a highly flexible 6 DOF mechanism for automatically positioning the patient The combination of the RoboCouch System and the robotic manipulator for linac positioning enables the CyberKnife System to deliver dose precisely and to the right location The upper manipulator arm between axes A2 and A3 as shown integrates a contact sensor on its outer surface and an E STOP is triggered if an object comes in contact with it Both versions of the couch top are described in sections 7 2 1 and 7 2 2 respectively The RoboCouch System is available with either a flat carbon fiber couch top standard with the RoboCouch System or a seated load
36. kull Tracking feature in the CyberKnife System allows direct and non invasive tracking of intracranial lesions Target tracking and motion compensation are accomplished by identifying and tracking rigid skull anatomy by using image intensity and brightness gradients between the DRR and live images Patient setup alignment and lesion tracking is done non invasively and without the use of rigid head mounted frames Table 17 6D Skull Tracking System Features 6D Skull Tracking System Features Tracking Mode Direct tracking of intracranial lesions without the use of fiducials User Accessible Brightness window 96 Enabled Disabled Features Gradient window 96 Enabled Disabled Targeting Accuracy See Table 9 4 SUPPORTED TRACKING COMBINATIONS Table 18 Selectable YES and Non Selectable NO c E ERE Mode Patient Position Combinations Head First Feet First Head First Feet First 9 HFS FFS HFP FFP Yes Fiducial Tracking Fiducial Tracking with Synchrony Respiratory Tracking System Fiducial Tracking with Infempo Adaptive Imaging System m Xsight Lung Tracking with Synchrony Respiratory Tracking System 5 TREATMENT PLANNING The MultiPlan Treatment Planning System is a dedicated planning system for use with the CyberKnife Robotic Radiosurgery System The MultiPlan System is provided with both hardware and software The MultiPlan System provides the tools necessary to perform a complete range of
37. may be available in all territories Please contact the manufacturer for availability in your territory manufacturer s part numbers listed above are valid as of March 2009 Please contact the manufacturer for equivalent part numbers in the event of obsolescence 18 ACCURAY CyberKnife 44 XSIGHT SPINE TRACKING SYSTEM The Xsight Spine Tracking System enables the tracking of skeletal structures in the cervical thoracic lumbar and sacral regions of the spine for accurate patient positioning and radiation beam delivery using the CyberKnife System without implanting fiducials Target tracking with the Xsight Spine System is accomplished using 2D 3D registrations on a hierarchical mesh where local displacements at each of the mesh points are estimated and combined to provide 6D corrections to the treatment manipulator The treatment manipula tor uses these corrections to automatically deliver radiation to the displaced position of the target Table 15 Xsight Spine Tracking System Features Xsight Spine Tracking System Features Tracking Mode Direct tracking of spine lesions without the use of fiducials Eligibile Regions Cervical Thoracic Sacral and Lumbar arget dxAB threshold mm arget drAB threshold deg False nodes threshold 96 ROI height mm racking range in X and Y mm Confidence threshold 96 Live image contrast factor automatic independent manual override for Image A and B Tar
38. ng System Set up kV X ray Sources SEE DETAIL A i Imaging Center 2200 0 4100mm 1655 274 7 1556mm i 2794mm 1 n SEE DETAIL B P3 1420 E SR 1 920 5mm 999 3mm 3 A 4 1 lt fr Y lt LH ir i i 4 l a 5 Y ueri i Am 1009mm REFERENCE Amorphous Si X ray Detectors When used with the RoboCouch System the range is 1 5 for all rotations ACCURAY CyberKnife 3 1 X RAY GENERATORS Dependant on system configuration one from amongst the following X ray Generators is supplied with the CyberKnife System Table 4 X ray Generator Specifications Tall X ray Generators Compact X ray Generators 40 120 5 1 kVp 40 150 5 1 kVp 1 1 mA RANGE AND STATIONS 25 50 75 100 150 200 250 300 0 12 5 16 20 25 32 40 50 64 5 1 mA 80 100 125 160 200 250 320 400 500 640 5 1 mA POWER OUTPUT 300 mA 125 kVp 640 mA 78 kVp 500 mA 100 kVp 400 mA 125 kVp 320 mA 150 kVp EXPOSURE TIME 0 001 5 seconds 10 0 001 10 seconds 1 0 1 1 100ms ms 3 2 X RAY SOURCES Table 5 X ray Sources Specifications X Ray Sources Specifications Nominal tube voltage 40 150 kV Ad p ciue d Large focus 1 2 mm EEN Earp ai Nominal Anode L
39. o posts Safety sensors located in each receptacle Instrumentation 2 4 TREATMENT DELIVERY SYSTEM CONTROL CONSOLE HARDWARE SPECIFICATION e Dual processor with each processor having a clock speed gt 2 GHz 4 GB of memory e Set of SAS 15K RPM disk drives in a RAID 0 Mirrored configuration providing approximately 130 GB of storage e Two Gigabit Network Interface Cards NIC e Redundant power supplies ACCURAY CyberKnife 3 IMAGING The CyberKnife System employs kV X ray imaging to provide target localization during treatment The imaging system consists of two X ray sources mounted to the ceiling and corresponding image detectors mounted in the floor The X ray sources are positioned such that the generated beams intersect orthogonally and create an imaging center located 92 cm 36 22 in from the floor All treatments on the CyberKnife System are based around the imaging field of view The live images are digitized and compared to images synthesized from the patient s CT data Digitally Reconstructed Radiograph or DRR This technique allows for determination of intra fraction target shifts and automatic compensation by the treatment manipulator during treatment delivery See Table 8 for the ranges of motion that can be compensated for without moving the patient When used with the Synchrony Respiratory Tracking System the system can compensate for target translation over a range of 25 mm in any direction Typical Imagi
40. on a single image slice 3D Magic Wand uses high contrast to automatically delineate a VOI on all image slices Rescale tool move or re size a drawn delineation Smart Curve adjusts a user drawn delineation to match a border identified by high contrast Bumper Tool nudge a drawn delineation in any direction Auto interpolation interpolates delineations on image slices between two image slices that have a drawn delineation 3D copy copy all the drawn and interpolated contour sets into another contour set ACCURAY 3D dilation erosion 3D isotropic or anisotropic expansion or contraction of a critical or target volume 5 6 2 Skin Provides automatic delineation of the external border of the patient anatomy The skin structure defines the boundary between where dose is displayed inside the skin and where dose is not displayed outside the skin 5 6 3 Spine Tracking Volume The Spine Tracking Volume defines the gross extent of the spine for use with Xsight Spine Tracking System and Xsight Lung Track ing System During treatment delivery the delineated Spine Tracking Volume can be displayed or suppressed on the DRR Digitally Reconstructed Image display to assist with visualization of the target 5 6 4 Ball cube Provides automatic delineation of a sphere such as in the Ball cube Quality Assurance QA tool to assist with treatment planning for QA tasks such as end to end testing 21 22 ACCURAY Cybe
41. owing Monte Carlo enhancements are included in v3 5 of the MultiPlan System Monte Carlo In Air Output Factor measurement is optional The user can fit a Gaussian Source Distribution both for Fixed and Iris Collimators in the Monte Carlo commissioning procedure FWHM of the Gaussian source distribution can be adjusted to change the penumbra slope of the Monte Carlo OCR curves to match the measured OCR curves Select Monte Carlo Source Model Lo ji omm jJ Dialog to choose between In Air Output Factor or Gaussian source model See Monte Carlo Dose Calculation white paper Accuray P N 500317 for additional technical specifications 24 ACCURAY CyberKnife 5 12 4D TREATMENT OPTIMIZATION AND PLANNING OPTIONAL AD Treatment Optimization and Planning utilizes 4D CT scans for treatment planning Target centric alignment of all the phases of the AD CT provides beams eye view of the motion and deformation of not only the target but also the surrounding critical structures The planning optimization takes this motion and deformation into account when calculating dose to these volumes of interest Treatment plans generated using the 4D Treatment Optimization and Planning option can be delivered using the Synchrony Respiratory Tracking System in combination with either Fiducial Tracking or Xsight Lung Tracking System To ensure compatibility of each individual 4D CT scanner with the MultiPlan Treatment Planning System a
42. rKnife 9 7 5 8 TREATMENT PLANNING 5 7 1 lsocentric Planning Two planning options are available in the Isocentric Planning feature of the MultiPlan System Forward planning provides the option to generate a set of beams that are isocentrically targeted and evenly weighted nverse planning provides the option to generate a set of beams that are isocentrically targeted and non evenly weighted 5 7 2 Conformal Planning Conformal planning produces a plan by optimizing the beam weights for a given beam set In conformal planning beams are aimed at randomly selected points on the target boundary surface and then the dose distribution is optimized by adjusting the weighting number of MUs of the beams according to user set dose constraints e Simplex optimization algorithm minimizes the total number of MU for the plan as well as the deviations above the maximum dose constraints and below the minimum dose constraints terative optimization algorithm optimizes deviations above the maximum dose constraints and below the minimum dose constraints e Sequential Optimization algorithm see section 5 13 for details 5 7 3 Dose Calculation Algorithms 5 7 3 1 Tracing Dose Calculation The ray tracing dose calculation algorithm uses three system specific beam description tables comprised of data measured using a water phantom The tables are Tissue Phantom Ratio TPR Off Center Ratios OCR and Output Factor OF TPR values for
43. rives setup in a RAID 10 configuration providing approximately 1 TB of storage One gigabit NIC DVD Recorder capable of writing to a DVD with either DVD R or DVD R DL format e 21 Flat Panel LCD Monitor HIPAA COMPLIANCE SUPPORT The following are the policies enforced and capabilities provided by the CyberKnife Data Management System to help users implement internal Health Insurance Portability and Accountability Act of 1996 HIPAA compliance programs Provides user profile management capabilities enabling a system administrator to limit actions available to a user account Provides user management policies enabling a system administrator to force a user to change his her password every configurable amount of days Secures transfer of user login information over hospital network Records actions performed on a patient record by a user account 29 30 ACCURAY CyberKnife 7 PATIENT POSITIONING SUPPORT 7 1 TREATMENT COUCH Two types of patient positioning support systems are available with the CyberKnife System the Standard Treatment Couch and the RoboCouch Patient Positioning System optional Table 19 Patient Positioning System Specifications Standard Treatment Couch System RoboCouch Patient Positioning System Payload 159 kg 350 Ib 227 kg 500 Ib Range of Motion Anterior Posterior Right Left Superior Inferior Head Up Head Down Pitch Right Left Tilt Roll Yaw CW CCW N A e Remote wor
44. sample image set isrequired by Accuray 5 13 SEQUENTIAL OPTIMIZATION OPTIONAL Treatment planning with Sequential Optimization begins with a series of user defined clinical objectives as input Examples of clinical objectives may be For targets Dose maximization Conformality Homogeneity Coverage For critical structures Dose minimization For the whole treatment plan Total number of monitor units MU delivered Clinical objectives established for each target and critical structure are sequenced together to make up steps in a script and are optimized one at a time until every objective is optimized Enhancements to Sequential Optimization for the MultiPlan System v3 5 include Beam reduction enhancements Relaxed convergence Dose statistics for shell structures Node Reduction Treatment time reduction see section 5 19 Beam reduction dialog box for the MultiPlan System v3 5 Beam Reduction Beam Reduction Enhancements In the MultiPlan System v3 0 3 1 the beam reduction dialog box only had an OK and Cancel button Clicking the OK button meant performing a beam reduction immediately followed by restarting optimization In this release we introduce another beam reduction option which is to perform beam reduction only followed by a dose calcula tion As shown in the dialog below the OK button has been re placed with the Reduce and Optimize button while a Reduce button has be
45. taken with the oldest image being discarded The allowable error in the correla tion model can be modified by the user and the violation of these set limits causes a pause in the treatment delivery Treating barker Corrie Dies MR SUPH LFT spRGTH ANT s PCS Tim iiri Haben Jipin Ll Made 1 f o Make 2 M El Mate 3 Data Fate Hey 21 3 User Interface showing the Respiratory Model Correlation Graphs and Correlation Error Model Imaging Timing Control Selection of Respiratory Phase Manual User Defined Automatic Respiratory Phase of Nest Image Cancel Building the Correlation Model 1514 Mier 3 peter cere 04 Op iae Coca ji ODO Sade DO 14 14 pe 1 m 0 cor m 0 CO maio n 15 14 1 E D OO cer 0 00 mete e 000 ela OHHH T pes nO OC cet er 000 anale er lj ACCURAY CyberKnife Table 10 Synchrony Respiratory Tracking System Specifications Accomplished by the use of LED based fiber optic markers 3 markers ideal 1 marker minimum required for tracking Synchrony Respiratory Tracking System Specifications Marker tracking frequency gt 25 Hz Compensation range Spherical space of diameter 50 mm Tracking Acquisition accomplished by three 1D charge coupled device CCD sensors Accuracy e Targeting centroid accuracy better than 1 5
46. tented ehe ehe hh hee eee ess 19 Table 18 Selectable YES and Non Selectable NO Tracking Mode Patient Position 19 Table 19 Patient Positioning System Specifications 2 0 00 ence enn eee 30 Table 20 Treatment Couch Top ors DP FED UM RECHT des 32 CyberKnife 1 SYSTEM OVERVIEW The Accuray CyberKnife Robotic Radiosurgery System consists of the following major functional sub systems e Treatment Delivery e Target Tracking e Data Management e Imaging Treatment Planning e Patient Support This specification document includes components of both the CyberKnife Robotic Radiosurgery System as well as the CyberKnife VSI System Contact a local Accuray representative for details on the products and configurations that are available in your region This document provides a technical description and manufacturer s specifications of the CyberKnife System It is not intended as a substitute for clinical training or to provide guidelines for clinical use System Targeting Accuracy System targeting accuracy accounts for the inaccuracies in all components of the system as it applies to a particular treatment delivery modality This may be understood as a combination of mechanical targeting tracking and clinical accuracy and includes error sources from the CT scan treatment planning patient tracking and dose delivery systems All these elements comprise the CyberKn
47. timization Sessions can be started through the desktop or the session manager interface The session manager interface is accessible on the bottom right corner of the splash page or on any subsequent screen during the planning process The Multiple Sessions feature allows the user to run one MultiPlan session along with three Quick Review sessions all at the same time Session manager interface The Quick Review sessions allow fusion contouring treatment plan review change of prescription and dose calculation Secondary sessions can be either initiated through the MultiPlan icon on the desktop from the start up menu or from the session man ager interface A green button on the session manager interface indicates the active session If the user places the mouse over an active session button a tooltip will appear indicating the patient and plan name 5 16 DENSITY OVERRIDE The density override feature allows the user to assign a density to any contoured VOI Typically this tool can be used to correct for an artifact produced by a metallic object or to assign a density to a region in the patient that was present at the time of scan but not present at the time of treatment e g contrast in the bladder or Relative Electron Density Mass Density g cc 0 The density override tool can be accessed in the Plan tab under the Setup menu When VOls with assigned densities overlap the density of the VOI higher on the list
48. tomatically change for each beam if necessary 2 3 1 Fixed Collimators The CyberKnife System is supplied with fixed secondary collimators delivering circular field sizes of 5 7 5 10 12 5 15 20 25 30 35 40 50 and 60 mm diameter at 800 mm SAD These collimators can be changed to vary the beam size as generated by the treatment plan For each fixed collimator the manipulator traverses a separate path Iris Variable Aperture Collimator Collimator Changer Interface Lower Tungsten l b Upper Tungsten Segment Bank 7 as Segment Bank Drive Motor 2 3 2 lris Variable Aperture Collimator The Iris Variable Aperture Collimator creates beams with characteristics virtually identical to those of fixed collimators It consists of two banks of 6 tungsten segments each with each bank creating a hexagonal aperture The two are offset by 30 relative to each other resulting in a dodecahedral 12 sided aperture when viewed from one end of the collimator to the other The Iris Variable Aperture Collimator replicates the existing 12 fixed collimator sizes Table 2 Iris Variable Aperture Collimator Specifications lris Variable Aperture Collimator Specifications The standard deviation of the radial distance from the beam axis to the 50 dose level is less than Circularity a 2 of the average radial distance Collimator Transmission Maximum lt 0 2 of the delivered dose rate Dose Rate Average 0 1 of t
49. treatment planning tasks from image registration target and critical structure delineation through dose optimization calculation and plan review The planning system uses measured beam data imported into the Data Management System to accurately calculate dose in a patient s treatment plan Several updates have been made to the MultiPlan System as part of Accuray s continuing effort to respond to customer feedback In addition to these updates purchasable options are available that add further functionality to the MultiPlan System 5 1 HARDWARE SPECIFICATION New MultiPlan Systems include the following hardware configurations Windows Server 64 bit OS Dual quad core 3Ghz processor e 24GB memory 512 MB Graphics card PThe use of the InTempo System is restricted to treatment delivery to the prostate 20 ACCURAY CyberKnife 5 2 MULTIPLAN SYSTEM SOFTWARE Depending on your MultiPlan System software may include the following features and enhancements AutoSegmentation option Automatic segmentation for prostate and associated VOls QuickPlan option Automation of the plan generation process e Treatment time reduction feature Smart reduction of treatment time Enables Robotic IMRT Advanced Visualization Enhanced 3D rendering of image data VOls and dose Support for colormap PET image data Enhanced plan QA tools Improved dose memory handling Support for the CDMS reporting package Me
50. will be used in the region of intersection NET Lo Density Override dialog VOIs are listed in order of priority 5 17 QUICKPLAN OPTIONAL QuickPlan can completely automate all aspects of treatment plan E generation The user selects a QuickPlan template and starts the appli e cation All steps of the plan generation process fusion fiducial location Emme contouring in the case of prostate setting of plan parameters optimi a zation and dose calculation proceed automatically Note fusion and AutoSegmentation for prostate require minimal user input The user is presented with a completed treatment plan for review Prior to saving a plan as deliverable the user will be prompted to review all elements of the treatment plan that were generated automatically For a detailed description of QuickPlan please see the user s manual 7 e m Sample 4 Prostate QuickPtan Validation Summary ACCURAY The QuickPlan tab 27 ACCURAY CyberKnife 5 18 AUTOSEGMENTATION OPTIONAL AutoSegmentation allows automatic contouring of prostate rectum seminal vesicles bladder and femoral heads Minimal user input is required Before running the algo rithm the user must provide initialization points for all structures except femoral heads Initialization points can be placed on either CT or MR image data 3D editing tools are provided if the results of the algorithm need to b
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