Traditionally, radiation for tumors subject to respiration-induced movement was either based on an estimated patient breathing pattern or delivered with significantly higher margins.

Today, Adaptive Gating enables the visualization of the exact location of a moving target in real-time, making respiration-triggered dose delivery possible. ExacTrac® delivers precise targeting for tumors that move or change size and shape over the course of treatment.

• Sparing of healthy tissue from radiation
• Reduced side effects and better treatment outcomes
• Millimeter accurate patient setup before gated delivery
• Continuous x-ray verification of internal tumor motion during delivery

Respiration Motion Management for Adaptive Gating

Internal and external breathing cycles do not correlate during treatment thus limiting external-only observation tracking capability

ExacTrac® Adaptive Gating addresses daily respiration pattern changes and intra-fraction variation, such as breathing baseline shifts. Due to continuous optical infrared tracking and x-ray verification of internal tumor position, ExacTrac® overcomes targeting limitations caused by breathing cycle inconsistencies.

Millimeter accurate patient setup before gated delivery Gating of Linac beam controlled by ExacTrac X-ray verification of internal tumor motion during delivery Enables delivery of dose escalation protocols

Automatic Updates for Adaptive Radiotherapy

With the tools of the iPlan® RT treatment planning software, Adaptive Radiotherapy makes periodic plan adaptations clinically and financially feasible. Automatically facilitating efficient, intuitive plan updates based on periodic CT scans are prompted by precise patient positioning using ExacTrac.

Automatic deformation of original contour to new CT  iPlan Dose template plan update Delivery of adapted plan with ExacTrac

Adaptive Gating with ExacTrac

ExacTrac® IGRT tracks tumor movement internally and externally, for consistent, highly precise targeted treatment delivery

ExacTrac Adaptive Gating combines x-ray imaging and infrared tracking to provide correlation of internal tumor motion with the patient's breathing cycle on a daily basis. This three-dimensional detection of tumor motion enables precise dose delivery to moving targets.

Permits dose escalation protocols beyond standard positioning Precise patient setup for gated delivery using robotic patient alignment Verification images possible at any time during treatment

Clinical Benefits of Adaptive Gating

ExacTrac® Adaptive Gating acquires intra- fraction verification images synchronized with the patient’s breathing pattern. Image courtesy of P. Kupelian, M. D. Anderson; Orlando, USA

ExacTrac Adaptive Gating enables a significant reduction of PTV margins for target motion while maintaining uniform dose distribution to the tumor. This results in the sparing of healthy tissue from radiation, potentially reducing side effects.

Fully automatic dose delivery improves clinical efficiency Free breathing during treatment; patient not required to breathe in a given fashion