HEALTHCARE case study
CLIENT
Elekta (Medical Intelligence)
PRODUCT
iGUIDE ™
CHALLENGE
One of the obstacles to achieving accuracy in the delivery of radiation therapy is patient
positioning under linear accelerator. While modern 3D volume imaging can remove
uncertainties arising from organ motion, it takes patient positioning system to complete
the IGRT localization chain by enabling accurate and remote geometric correction of any
discrepancies observed. Our challenge was to design and implement control software
which can drive the robotic patient positioning system and achieve sub-millimeter 6D
conformal positioning accuracy, thereby allowing clinicians to reduce margins with
confidence, escalate dose and move towards hypofractionated treatment regimes.
RESULT
Visual and intuitive iGUIDE software aids the user with clinical workflows and ensures
accurate positioning of the robotic couch to the defined isocenter co-ordinates based
on correctional data received from on-board 3D volume imaging system, using all six
degrees of freedom. iGUIDE uses high-precision real-time optical tracking camera to
monitor treatment room and validate the absolute table position, and inhibits treatment
if tolerances are exceeded. R&D prototype extension to iGUIDE has been developed,
which enables radiation therapy of moving target in the lung area.
TESTIMONIAL
“What has been started as a cooperation with strong research focus about a decade ago
meanwhile has transformed into a firm and trustful collaboration on software development
for use in medical devices with all subsequent consequences (such as ensuring compliance
to key regulatory standards). The iGUIDE software is a key component of our HexaPOD evo
RT System now since 2006, meaning that worldwide several hundred of hospitals are using
the system on a daily basis. One of Elekta key values is long-term relationships – this is with
the focus to our customers but internally also includes suppliers and partners. We see Rubedo
Sistemos as a reliable and mature long-term partner to Elekta for further development and
continuous maintenance of tailored application software in the context of Radiotherapy
treatment, esp. patient positioning aspects.”
DR. MICHAEL ROTH
Director of R&D, Elekta PSC Schwabmünchen
Elekta | Medical Intelligence Medizintechnik GmbH
ESTIMATED DEATHS
294 120
MEN
90 810
lung & bronchus
28 660
271 530
ALL SITES
31%
WOMEN
26%
lung & bronchus
71 030
40 480
10%
15%
8%
9%
colon & rectum
6%
6%
pancreas
12 570
4%
6%
ovary
12 460
4%
3%
non-hodgkin lymphoma
11 250
4%
3%
leukemia
9 790
3%
3%
uterine corpus
8 100
3%
2%
liver & intrahepatic bile duct
3%
2%
brain & other nervous system
prostate
24 260
colon & rectum
17 500
pancreas
liver & intrahepatic bile duct
leukemia
esophagus
urinary bladder
non-hodgkin lymphoma
950
kidney & renal pelvis
100%
100%
breast
25 000
16 790
15 520
9 370
9 250
7 470
5 840
5 650
CA: A Cancer Journal for Clinicians, Volume 58, Issue 2, 2008
HEALTHCARE case study
iGUIDE
1
iGUIDE
Patient Alignment
Patient’s prescription is selected
on iGUIDE software; the patient lies
down on the treatment couch and
gets aligned to their body markers
using the room lasers.
2
Prepositioning in 3D
Once aligned to body markers,
the iGUIDE software registers the
patient and automatically
prepositions them in 3D bringing
tumor roughly into the isocentre.
iGUIDE
iGUIDE
3
Imaging in 6D
Tumor image is acquired using
an integrated volume imaging
system (or equivalent);
6D positional error (translational
and rotational offset) is calculated
and sent to the iGUIDE software
for positional error correction.
4
Positioning in 6D
iGUIDE software automatically
moves the robotic couch to the
corrected isocentre position as
defined by the imaging system
and monitors the ultimate
position for deviations until
actual treatment starts.
iGUIDE
HEALTHCARE case study
iGUIDE
iGUIDE
5
Moving Target
Compensation*
iGUIDE software monitors patient’s
chest as they breathe freely during
treatment delivery and compensates
against tumor excursion caused by
organ (lung) motion in real-time.
* Prototype implementation
10 mm
0 mm
-10 mm
~30 s
iGUIDE monitors and
learns breathing pattern
SOLUTION /
PROCESS
BUDGET
DURATION
iGUIDE compensates target motion
(positional error <4mm)
Design management process is ISO 9001:2008 certified, ISO 12207:2008 and SW 68
compliant, and is based on Rational Unified Process. SysML/UML was used on all
modeling domains: business and system requirements, architecture and test cases.
All modeling domains can be traced from each other. Formal design reviews and risk
management were performed. R&D part of the project was partially funded by the EU
through the National Support Programme.
1 000 000 EUR
> 36 months
www.rubedos.com