Next-Gen Technology Enables Precision Radiotherapy with “On-The-Fly” X-Ray Confirmation

Deep Inspiration Breath Hold (DIBH) is a well-established technique and standard of care in treating breast cancer with radiation therapy. When a patient takes a deep breath, the distance between the heart and the chest cavity is increased, reducing the risk of cardiac toxicity during breast cancer treatment. Now, a new DIBH technology streamlines image guided and surface guided radiation therapy (IGRT and SGRT) and increases positioning confidence through “on-the-fly” X-ray confirmation to deliver the highest quality of care for breast cancer patients.

Brainlab’s (Munich, Germany) ExacTrac Dynamic DIBH takes traditional surface tracking methodology and augments it with a thermal signature, delivering a fourth dimension to reduce ambiguities otherwise associated with surface tracking systems. The all-in-one system’s revolutionary new thermal-surface camera technology works in tandem with real-time X-ray tracking for extraordinary accuracy. 4D Thermal Camera creates a highly accurate and reliable hybrid thermal surface by correlating the patient’s heat signature to their reconstructed 3D surface structure. To achieve this, 300,000 3D surface points are acquired and matched to the heat signal generated by the thermal camera, creating another dimension to track their position.

Larger panels show more anatomy for easier orientation and interpretation of X-ray images. At the same time, improved soft tissue contrast and enhanced read-out speed prevent motion blurring effects. Thanks to higher heat capacity, ExacTrac Dynamic X-ray tubes support more automated, high frequency imaging. Deep integration with Elekta Versa HD in combination with Hexapod and Varian Edge or TrueBeam with Perfect Pitch enable automated beam hold - repositioning and restarting treatment - from the linac console. Based on the indication, protocol or patient, X-rays can be automatically or manually triggered for greater freedom. Adding synchronized X-ray images to the workflow increases accuracy and clinician confidence by incorporating insights derived from internal bony anatomy. Brainlab DIBH workflow is CE marked and FDA cleared.

“The incorporation of ‘on-the-fly’ X-ray confirmation streamlines the process and delivers the confidence that the heart is outside of the treatment beam,” said Stefan Vilsmeier, President and CEO, Brainlab. “This solution delivers correlation between internal and external anatomy in one shot, revealing any misalignment that would otherwise remain undetected and could result in delivering excess dose to the heart.”

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