ExacTrac Image Guided Radiotherapy ensures submillimetric precision during radiotherapy and radiosurgery treatments
ExacTrac® is an in-room X-Ray based monitoring system that detects intra-fractional tumor motion during treatment delivery, regardless of the couch angle or gantry position. Instantaneous X-Ray imaging with proprietary 6D fusion provides fast and highly accurate positioning information and reduces the possibility of geographical miss due to patient motion or internal anatomical shifts.
ExacTrac X-Ray monitoring provides clinicians with a unique position verification tool based on the patient’s internal anatomy. Deviations or unintended shifts from the prescribed treatment position are automatically detected during treatment delivery and immediately displayed to the user.
ExacTrac X-Ray monitoring complements existing IGRT solutions by providing the added possibility of detecting intra-fraction motion, regardless of couch and gantry angle. It allows the patient’s initial position, set by the linac-based IGRT system, to be continuously verified with X-Ray imaging throughout the entire treatment delivery. Even at non-coplanar couch angles and during beam-on, ExacTrac can detect potential misalignment of the patient.
The ExacTrac frameless radiosurgery system offers highly accurate delivery of single- or multi-fraction treatment without a conventional, invasive head ring. A patient-friendly head-to-shoulder mask facilitates a streamlined workflow, overcoming the restrictions of frame-based radiosurgery and improving scheduling flexibility for imaging, planning and treatment.
Efficiency is an important attribute for any IGRT system, especially given the ever growing demand on centers with increased patient referrals to radiation therapy departments. One method to improve efficiency is to provide a more automated approach to patient setup. The optional automatic positioning packages for ExacTrac allow the user to remotely position the patient from the control area. Positioning packages are available for either 4D or full 6D robotic alignment.
For more than a decade, Brainlab has been collaborating with Varian on the integration of ExacTrac. The system provides an integrated workflow with Varian linacs, ranging from Unique™ Performance, Clinac® and Trilogy® to the TrueBeam™ platform. ExacTrac software ensures that the same treatment plan is automatically loaded on both systems and provides DICOM RT export of the ExacTrac positioning data to ARIA®. This allows any detected patient setup errors to be corrected with the Varian couch and Brainlab Robotics in an integrated and automated process.
The enhanced partnership between Elekta and Brainlab combines the seamless integration of ExacTrac with Elekta linacs: Versa HD™, Axesse™, Infinity™, Synergy® and Precise. Integrated workflows offer automatic loading of the patient treatment plan to ExacTrac from MOSAIQ®, as well as the integration of the ExacTrac stereotactic frameless radiosurgery system in combination with the Elekta HexaPOD™ evo RT system for patient positioning in 6 degrees of freedom.
ExacTrac can provide a range of benefits to extend the capabilities of Siemens linacs. It allows for quick and efficient setup of cranial and extra cranial cases and offers the ability to detect intra-fractional motion, ensuring confidence in treatment delivery for each fraction. If a Siemens linac with ExacTrac is replaced by a Varian or Elekta device, the room based ExacTrac can easily be refitted to most linacs.
In treatment indications where there is difficulty visualizing the tumor or the need to compensate for tumor motion due to respiration or random motion, fiducial markers may be implanted prior to treatment. ExacTrac offers a simple, automated approach to visualize, detect and register implanted markers using a proprietary software solution and 6D fusion.
The Volume of Interest (VOI) tool improves clinical accuracy and confidence in image fusion by focusing on the most relevant anatomy. The user can exclude areas such as ribs, adjacent vertebrae or other non-rigidly correlated objects from the 6D fusion, ensuring precise patient setup. The defined VOI is automatically used for subsequent imaging during setup and to monitor intra-fractional motion.