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The Accuray PrecisionTM Treatment

Planning SystemColin Sims, M.Sc

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Put Precision into Practice™Treatment planning engineered to deliver powerful solutions

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Accuray Precision™ Treatment Planning SystemPut Precision into Practice™

Powerful Features and Tools AutoSegmentation™ autocontouring of Brain, Head and Neck, and Male Pelvis VoLO™ GPU-based optimization accelerator Proprietary Deformation Algorithm Automate planning with Plan Templates and Plan Scripts PreciseART™ Adaptive Radiation Therapy Option PreciseRTX™ Retreatment Option

PreciseART option adaptive monitoring trending graphs indicate this patient’s targets are decreasing in size over the

course of treatment

PreciseART option automatically deforms plan contours onto the daily MVCT, calculates dose, and deforms that dose back to the original kVCT

allowing the user to quickly review planned versus projected dose

MKT/TxPlg/0416/0014

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Accuray Precision™ Treatment Planning SystemPut Precision into Practice™

Integrated Offers a common and complete

treatment planning solution for all Radixact™, TomoTherapy® H™

Series, and CyberKnife® systems paired with an integrated database, the iDMS™ Data Management System

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Accuray Precision™ Treatment Planning SystemPut Precision into Practice™Complete treatment planning solution Multimodality image fusion with proprietary deformation, complete contouring

suite, plan comparison and review in an easy-to-use, task based workflow Plan for all case types on the Radixact™ or TomoTherapy® H-Series™

Treatment Delivery Systems plus a new Forward Planned option Plan for all case types on the CyberKnife® System including: Frameless

Intracranial SRS, Fiducial-Free Lung Tracking with Dynamic Motion compensation, SBRT, and IMRT

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New and Improved Algorithms• Proprietary, robust Deformable Image Registration (DIR) algorithm &

GPU-based implementation enableso Accurate, fast, fully automated AutoSegmentation™ packages for male

pelvis, brain and head & neck.o PreciseART™ & PreciseRTX ™o Smart 3D editing tools

• Improve lateral scatter correction in Finite Size Pencil Beam (FSPB) dose calculation for CyberKnife® InCise™ multi-leaf collimators.

• Support Monte Carlo dose calculation for InCise™ multi-leaf collimators.

• Speed up both GPU-based VoLO™ dose calculation and optimization for TomoTherapy and Monte Carol dose calculation for CyberKnife®

DIR White Paper MKT-TxPlg-0917-0050

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Improved User Experience: Faster Planning Time

Time saving with Precision Time saved (s)Lung: time to load 59% 81Lung: Time to optimise 8% 41Lung: Beam reduction 66% 456Lung: Evaluate 39% 1224Lung: Save (deliverable) 63% 141

Brain: time to load 52% 36Brain: Time to optimise 44% 58Brain: Beam reduction 67% 20Brain: Evaluate 34% 457Brain: Save (deliverable) 35% 20

Prostate: time to load 69% 63Prostate: Time to optimise 19% 235Prostate: Beam reduction 26% 83Prostate: Evaluate 45% 545Prostate: Save (deliverable) 46% 28

Customer experience with Precision:

• “Our clinicians particularly like the improvement in load time for all sites”.

• “Optimiser is much faster and can now actually be stopped mid-way. Able to cope with >50000 points.”

• “Much faster to switch between displays and selecting optimisation steps.”

• Fine tune option much faster.

• Generating reports is much faster.

• Faster to generate beams following collimator selection. “….

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Improved User Experience: Intuitive User Interface

• “Clinicians like how contours can easily be selected and toggled in display- ease of change is very quick.

• Very useful to be able to keep reduced calculation box in optimiser box whilst being able to do review calc on whole CT. Makes switching back to re-optimise much easier. Very much like the feature of being able to click once to set the calculation box to CT/Skin/VOI.

• Customisable display- particularly AAA view is appreciated. • Really like customisable Window levels and the R click options• Re-treat option is great.• Like that you can see dose and % next to each other for the isodose display.• Generating a structure from an isodose line is particularly useful for fine-tuning away

spikes.• Display much better- fewe 3D views….”

Customer experience:

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Accuray Precision™ Treatment Planning SystemDeformable Image Registration

CT and T1 MR: Not Registered

With the Accuray Precision™ Treatment Planning system, Accuray introduces a powerful, new, proprietary deformable registration algorithm

Rigid Registration to Planning CT

Deformable Registration to Planning CT

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Accuray Precision™ Treatment Planning SystemAutoSegmentation™ – Head and Neck

Features• Fully Automated*• Leverages GPU power to complete process in minutes• 3D smart editing for fast revisions• Accurate, multi-atlas approach

Structures• Brainstem• Spinal cord/canal• Eyes, lenses• Optic nerves• Optic chiasm• Parotids• Larynx• Mandible• Whole brain

*The user acknowledges the autosegmented VOIs when saving as a deliverable.

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Accuray Precision™ Treatment Planning SystemAutoSegmentation™ – Male Pelvis

Features• Fully Automated*

• Leverages GPU power to complete process in minutes

• 3D smart editing for fast revisions

• Accurate, model-based approach

Structures• Prostate

• Bladder

• Rectum

• Seminal vesicles

• Urethra

• Femoral head/neck

*The user acknowledges the autosegmented VOIs when saving as a deliverable.

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Accuray Precision™ Treatment Planning SystemAutoSegmentation™ -- Brain

Features• Fully Automated*

• Leverages GPU power to complete process in minutes

• 3D smart editing for fast revisions

Structures• Brainstem

• Optic Chiasm

• Optic Nerves

• Eyes

• Lenses

• Pituitary Gland

• Whole brain

• Cerebellum

• Cortex, left and right

• White matter

• Hippocampus

• Any many more…

*The user acknowledges the autosegmented VOIs when saving as a deliverable.

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Accuray Precision™ Treatment Planning SystemImproved User Interface for TomoTherapy users

Intuitive, easy-to-use

tabular based workflow allows for

quick navigation

and access to any planning

function

• Fuse• Contour• Setup• Plan• Evaluate

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Accuray Precision™ Treatment Planning SystemIntuitive User Interface

Common planning tools, features, and functions are always instantly available via tabs, the global toolbar, mouse and hotkeys.

TomoTherapy Planning Station users will experience the same straightforward workflow and settings, with substantial enhancements in features and functionality.

MultiPlan® users will experience dramatic improvements in overall treatment planning times.

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Accuray Precision™ Treatment Planning SystemPlan Comparison

Review dose difference color

maps and overlaid DVHs

Review plan trials with side-by-side plan comparison

feature

Sum multiple plans together

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PreciseART™ Adaptive Radiation Therapy Option

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PreciseART™ Option Makes Adaptive Treatment Feasible

Plan and enroll Patient

Acquire daily image

Calculate planned dose on

daily Image

Deform the contours on daily

image

Accumulate Dose Over the course

of Treatment

Review and Decide

If necessary re-plan with

PreciseRTX™

“75% of our cases were enrolled in PreciseART™, of which 33% were re-planned (PreciseRTX™) : it was mainly head and neck, breast, and gynecology cases“*

Dr. Allen Li FroedtertMedical College Wisconsin

AERO User Meeting Chicago – April 2017

“Enrolling all (100%) patients because it was not more work because of automation, of which 16% were re-planned (PreciseRTX™)”

Adaptive White Paper – September 2017

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PreciseART™ Adaptive Radiation TherapyFully integrated adaptive solution

Accuray takes adaptive radiation therapy to the next level by integrating the delivery and planning systems to support the easy, efficient, and accurate monitoring of the effects of anatomical changes and the efficient generation of a modified treatment plan as necessary

• Quantitative MVCT images for treatment-plan-quality dose calculations using the daily MVCT

• PreciseART™ Adaptive software, created in partnership with MIM Software, largely automates the process of offline adaptive monitoring helping clinicians quickly and easily determine when they may need to modify a treatment

Reviewing the daily registration of a treatment planning CT and Fan Beam MVCT we see anatomical changes have taken place

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PreciseART™ Adaptive Radiation TherapyAutomated and efficient

Automated features• Deforms the planning VOIs onto the daily image• Calculates the dose on the daily image• Deforms and accumulates the daily dose on the treatment planning CT

• Generates user-defined reports• Flags the fraction for review if any delineated structure exceeds user-defined dose or dose-volume tolerances

Efficient Evaluation• Quickly and easily review the daily dose, cumulative dose, dose differences and trending data relative to the original treatment plan to determine when re-planning is necessary

• Review daily registrations• Compare fractions• Review the original and the deformed contours on the daily merged image

• Evaluate deformation using included QA tools

Review the results of the daily dose (plan re-calculated on the MVCT with deformed contours) relative to the planned dose

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PreciseART™ Adaptive Radiation TherapyWorkflow - dashboard

The Dashboard allows for quick review of each enrolled patient’s treatment and status of each delivered fraction

Patients

Fractions

Green = Fulfilled all user constraintsYellow = Marginal pass Red = Failed 1 or more constraints

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PreciseART™ Adaptive Radiation TherapyWorkflows - Dose and Registration review

Customizable daily summary report Daily dose statistics versus plan, trending data,

volumes, dose (maximum, mean, V95, etc.), and treatment offsets

Daily registration review Evaluate the results of the daily MVCT registration

Daily dose review Treatment image with calculated dose and VOIs

warped from the planning image and dose difference versus scaled plan

Cumulative and projected dose reviews Dose summed back to the planning KVCT with

isodose curves, DVHs, dose statistics, and dose difference compared to either scaled plan or projected plan

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Fraction 15 Review

From treatment plan Dose Difference (parotid in high dose region)

Daily Registration

Planned and deformed (thin line) contours

Earlier (Fx 3) <-----------Fraction Comparison----------- Later (Fx 15)

From daily CT

Observe increase target dose due to tumor shrinkageDaily CT

Planning CT

106%100%90%80%70%60%

106%100%90%80%70%60%

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PreciseART™ Adaptive Radiation TherapyWorkflows - adapting the plan

If re-planning is indicated• Create a new “adapted” plan utilizing

original plan data mapped to a new treatment planning CT

‒ Deform original plan contours ‒ Use Plan Template from original

treatment plan to help efficiently develop the new adapted plan

Continue the adaptive monitoring workflow process• Software accumulates dose across original

and all new re-plans

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PreciseRTX™ Retreatment Option

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PreciseRTX™ Retreatment OptionMake Re-planning More Efficient and Effective

Retreatment• Cancer patients are living longer, while often maintaining a good

quality of life• Many patients will experience a recurrence or new cancers • With use of appropriate therapies and technologies, many believe

we can move some advanced/recurring cancers into a “chronic disease” status*

• Radiation therapy patients undergoing “retreatment” represent an expanding segment of the radiotherapy market

Precision Matters• Accuray treatment technologies deliver precise radiation therapy

that maximizes dose to targets while minimizing dose to surrounding healthy tissues

• Due to the precise nature of these devices, Accuray products are frequently used to treat patients with recurrent disease

• The new PreciseRTX™ Retreatment Option is designed to add the functionality to make this process more efficient and effective

*American Technion Society. "Treating cancer as a chronic disease?." ScienceDaily. ScienceDaily, 29 March 2012. New research could someday lead to treatments that transform cancer from a lethal disease to a chronic, manageable one.

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PreciseRTX™ Retreatment OptionWorkflow: select original plan data

• The Retreatment Option is found in the Accuray Precision™ Treatment Planning System main screen

• The user starts the process by selecting the original (previous) treatment plan files. This may include images, contours, and/or dose

‒ DICOM compatible treatment plans created on both Accuray and non-Accuray systems may be imported

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PreciseRTX™ Retreatment OptionWorkflow: select new plan data

This data set is now available for:• Creating a new patient treatment plan

incorporating the original plan data

• Evaluating prior dose deformed to the new planning image

• Summing old and new plans

Select the new treatment plan data:• New treatment planning CT, possibly

a new contour set

• The system automatically deforms previous treatment plan contours and dose onto the new treatment planning CT

Contours and Dose deformed from original treatment plan onto new treatment planning CT

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PreciseRTX™ Retreatment OptionMake Re-planning More Efficient and Effective

Import patient plan data from Accuray and non-Accuray treatment delivery systems

Workflow-oriented features:

Deform the original plan contours onto a new treatment planning CT

Add previously delivered dose to a new treatment planning CT

Utilize the deformed treatment planning CT images, contours, and dose to assist in generating a new treatment plan

Sum the new plan with the original plan

Create reports based on the summation of the previous and newly generated treatment plans

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Thank you!