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Real-time Position Management™ (RPM) System

Respiration synchronized imaging and treatment

The Varian® Real-time Position Management™ (RPM) system is a non-invasive, video-based system that allows for clean imaging and treatment of lung, breast, and upper abdominal sites. The RPM system is accurate, easy to use, and fast. It is comfortable for the patient and accommodates both breath hold and free breathing protocols.

The RPM system allows clinicians to correlate tumor position in relation to the patient's respiratory cycle. Using an infrared tracking camera and a reflective marker, the system measures the patient's respiratory pattern and range of motion and displays them as a waveform. The gating thresholds are set when the tumor is in the desired portion of the respiratory cycle. These thresholds determine when the gating system turns the treatment beam on and off.

The RPM system facilitates the treatment of the lungs, liver, and pancreas, and helps minimize the dose to the heart in breast treatments. The system provides clean images for planning so that you can more clearly visualize the target with fewer of the image artifacts associated with respiratory motion.

Key Features:
  • Only Varian RPM has clinically proven interfaces to CT and CT/positron emission tomography scanners.
  • A lightweight marker ensures patient comfort.
  • The specially designed predictive filter monitors and predicts the patient's breathing pattern and can account for patient's coughing or changes from the predicted breathing pattern.
  • Eclipse™ has immediate access to gated verification images from the On-Board Imager® (OBI) system during the course of the treatment. Recalculation of dose distributions may be necessary.
  • Superior Clinac® design means a <100 millisecond beam on time, with accurate gated dose rates and uncompromised beam flatness and symmetry.
  • Pretreatment verification can be performed by the OBI fluoroscopy mode.
  • Gated radiographic image acquisition uses the OBI during the correct phase of the respiratory cycle.
  • Gated port film acquisition acquires megavoltage images during the correct phase of the respiratory cycle.
  • The process of image acquisition and gated treatments is fully automated.
  • After treatment, a record of the gating trace and image window can be stored for later analysis.
  • Treatment beam gating is fully integrated with dynamic MLC leaf motion.

Phase Gating and Amplitude Gating

The RPM system supports both methods:

Phase-based gating allows automatic gating of image acquisition and treatment delivery based on the same phase of the patient's respiratory cycle. This image shows gating on the exhalation phase.

Amplitude-based gating allows automatic gating based on the absolute position of the marker block on the patient's thorax or abdomen, regardless of the phases in the patient's respiratory cycle. This image shows gating at maximum inhalation.

Patient Evaluation and Post Plan Verification

Gating can be used on Acuity for patient evaluation and suitability for gating.

The Acuity™ system allows efficient pretreatment verification of gating thresholds and anticipated gated treatment delivery before setting up the patient on the accelerator for treatment. If adjustments are required for the gating parameters, these can be made in advance of treatment delivery. Acuity supports both 2D and 3D positioning verification, and fluoroscopic evaluation of gating thresholds for post plan verification.

Clinical Versatility:
  • Supports all clinical breathing protocols, including free breathing,
  • Allows clinicians to monitor respiration without sacrificing accuracy and patient comfort.
  • The RPM system can be used for retrospective and prospective gating.
  • Gating allows for patient specific treatment margins, rather than population-based margins.
  • Gating may facilitate in dose escalation.
  • Accurate tumor tracking allows maximum dose to tumor and minimum dose to normal tissue
  • The RPM system is in routine use worldwide.

From simulation to treatment, the RPM system allows clinicians to accurately monitor and compensate for tumor movement.

 

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Tel: 1.650.424.5700
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