Radiation therapy is meant to treat tissues with cancer by applying ionizing radiation while protecting healthy tissue as far as possible. The balance between an effective radiation dose in the target area and clear differentiation from healthy cells is at the focus. The Robotic-Couch RPS automatic with six degrees of freedom permits positioning of the patient in the virtual isocenter. This is progress for stereotactic radiation, because the penumbra (half-shade) can be reduced this way. On the other hand, the virtual isocenter helps avoid collisions in non-coplanar radiation therapy. gkteso GmbH from Bobingen will present the RPS automatic at the ESTRO 2021 in Madrid from August 27th to 31th, 2021.
The virtual isocenter creates new dimensions in radiation therapy. The background for this is the option to either move the patient closer to the gantry with the radiation to match the demand and procedure, or to enlarge distances. Both are important: stereotactic radiation will profit from closer proximity to the gantry, while non-coplanar radiation therapy works with less collision at a larger distance.
Reducing the penumbra – ideal for stereotaxia
The range where the radiation dose drops from 80 to 20 percent at the sides of the field edge is called half-shade or penumbra. The narrower the half-shade, the more sharply and precisely can the radiation volume be limited. Surrounding healthy tissue or organs at risk can be protected better this way. In addition to the size of the radiation source and the properties of the blind system, the penumbra is also influenced by the distance between the collimator opening and the isocenter. A shorter distance between the blind opening and the isocenter reduces divergence, i.e. fanning open of the treatment beam, and thus reduces the half-shade.
Stereotactic irradiation and “source to virtual isocentre distance” (SVID)*
Varying “source to virtual isocentre distance” (SVID):*
*K.Bratengeier, submitted to ‘Radiation Oncology‘
“The virtual isocenter also permits much more precise stereotactic radiation therapy,” says Dr. Klaus Bratengeier, deputy department manager of medical physics at the university hospital of Würzburg. For treatment in the area of the head, the patient’s head is fixated with customized frames and masks for stereotactic radiation, to keep surrounding nerve tracks and brain areas out of the treatment beam. The synchronous movement of the RPS automatic and gantry makes it possible to reduce the distance between the gantry and the patient to a minimum. This improves focus of the radiation field, so that the tumor can be outlined very precisely and clearly by the treatment. The blinds of the multi-leaf collimator are mapped much more finely and precisely in the target area than was previously possible.
RPS automatic at ESTRO
The RPS automatic will be presented at ESTRO 2021 in Madrid from August 27th to 31th, 2021. Interested trade fair visitors can see the options of the RPS automatic on site. The mobility in six degrees of freedom is conducted with movements that are as precise as they are gentle. The very stiff lying surface prevents quality loss even at strong loads. RPS automatic can be coupled with any common linear accelerator and system.
The target of radiation therapy is to treat cancerous tissue with ionizing radiation. Healthy tissue should be protected as well as possible. The balance between an effective radiation dose in the target area and the clear differentiation from healthy cells are at the focus. The Robotic-Couch RPS automatic with eight degrees of freedom permits positioning of the patient in the virtual isocenter. This is important for stereotactic radiation, since it can reduce the penumbra (half-shadow). gkteso GmbH from Bobingen presents the RPS automatic at DEGRO in Berlin from June 15th to 18th, 2017.
The virtual isocenter creates new dimensions in stereotactic radiation therapy: Patients can be moved closer to the gantry in the virtual isocenter with the radiation bed than they can in classical radiation therapy. The benefit is that the penumbra can be clearly reduced. The half-shadow or penumbra is the area in which the radiation dose drops from 80 to 20 percent at the sides of the field edge. The narrower the half-shadow, the more sharply and precisely can the radiation volume be limited. Surrounding healthy tissue or high-risk organs are better protected. In addition to the dimensions of the radiation source and the properties of the shutter system, the penumbra is also influenced by the distance between the collimator opening and isocenter. A shorter distance between the shutter aperture and the isocenter reduces divergence, i.e. fanning open of the treatment beam, which reduces the half-shadow.
Sharpened radiation field for precise radiation
“The virtual isocenter permits much more precise stereotactic radiation therapy”, says Dr. Klaus Bratengeier, deputy department manager of medical physics at the university hospital in Würzburg. For treatments at the head, the patient’s head is fixated for radiation with individually adjusted frames and masks in the scope of stereotactic radiation. The synchronous movement of the RPS automatic and gantry permits reduction of the distance between the gantry and patient to a minimum. This sharpens the radiation field, so that the tumor can be treated very precisely and clearly circumscribed. The shutters of the multileaf collimator are mapped much more finely and precisely in the target area than this was possible in the past.
RPS automatic at DEGRO
The RPS automatic will be presented at DEGRO in Berlin from June 15th to 18th, 2017. Interested trade fair visitors can see the options RPS automatic offers on site. Movement in eight degrees of freedom takes place in precise as well as gentle movements.
DEGRO in Berlin, June 15th to 18th, 2017
Stand A01a
gKteso GmbH
Guido Kübler
Hans-Böckler-Straße 3
D-86399 Bobingen
Tel: 08234 / 9663 841
Fax: 08234 / 9663 847
http://www.gkteso.com
Email: info@gkteso.com
Radiotherapy with linear accelerators is an established treatment program in many clinics and medical centers. Radiology and everything related to it is subject to highest technical quality criteria and extensive documentation obligation. At the same time it is important to consider patient comfort as well as commercial aspects.
RPS (Radiotherapy Patient System) by gKteso GmbH enables cli-ics to get a grip on these partially contradicting requirements. Guido Kübler, founder and Managing Director of the mid-size company, located in Bobingen near Augsburg, Germany, knows what he is talking about. “As long as 25 years ago, we started to develop and construct 6D-controlled patient platforms. From our continuous con-tact with clinics, we know which characteristics a modern patient platform needs to have.”
In addition to easy handling, multidimensional adjustment options, compatibility with add-ons and high comfort for the patient, especially reliable quality at sustainable cost is required. The certification according to ISO 9001 and the compliance with ISO 13485 proves that the company meets all conditions regarding design and production of medical devices.
“In the development of RPS, the company has applied all its experience connected with patient platforms”, explains Guido Kübler. RPS with its 6D-Robotic Couch as key element is available in two models, RPS base and RPS extended. Both models are equipped with an RFID-Reader which reads in all fixation aids applied, provi-ing those, together with the patient data, for further software. Once saved, the 6D-Robotic Couch will re-approach the desired position at the touch of a button. Storing the exact setting on an RFID-Chip makes multiple day treatment cycles less time-consuming for both medical personnel and patient.
Six degrees of freedom for precise patient positioning
The high precision platform RPS base, movable in 6D, features high rigidity and supports precise radiotherapy by means of 6D-control. The patient lies on it perfectly stable and exactly aligned.
The low entry height facilitates climbing onto the platform. Addition-al comfort is ensured by the large procedural area from head to pelvis.
The patient platform is adjustable in height from 64 to 151 cm (25 to 59“) at a velocity of 0 to 50 mm (0 to 2“) per second. In RPS base, the margin provided in the lateral alignment is of up to plus/minus 25 cm (+/- 10“) and in the length of up to plus/minus 57 cm (+/- 22”) at 0 to 80 mm (0 to 3”) per second. A large compensation angle of up to five degrees in any direction allows flexible adaptation to the radiation position.
RPS base also ensures pinpoint radiotherapy of the defined tissue by means of an additional external tracking procedure. An internal or external marker defines precisely both position and movement of an organ. Based on these coordinates, the patient platform will correct organ movements automatically.
Compatible with add-ons
RPS base is designed for the attachment of current add-ons, such as masks and vacuum mattresses. Here is one example: Radio-therapy in the head or neck area requires, aside from positioning aids, fixation by a mask in order to protect sensitive, adjacent or-gans such as thyroid, eyes, brain and spinal cord from being un-necessarily strained. The individually fitted mask made of special thermoplastic material may be attached as add-on to RPS base.
RPS extended enables preparation of up to three patients for radiotherapy
RPS extended features all advantages of RPS base, but with the addition of a satellite system it increases the efficiency of radiotherapy with linear accelerators. Up to three patients may be prepared for radiotherapy simultaneously. After the preparatory phase, auto-mated satellite arms gently move the patient to the room with the radiation system. This is where the medical staff will review the fine-tunings on the patient. Once radiotherapy is completed, the patient is transferred back to the cabin and may leave the patient platform.
With its innovative concept, especially RPS extended increases the cycle time of treatments with linear accelerators. “Our patient plat-form system RPS extended streamlines preparation processes significantly. Treatment costs may be reduced by more than 55 per-cent”, states Guido Kübler, adding: „Aside from the commercial aspect, also the human aspect should be considered. In the preparation room, the treatment team gains much more time for the individual patient, due to the stored settings of the platform.”
Simplified documentation
RPS offers many advantages for clinics and medical centers. „The integrated RFID Reader in RPS base and RPS extended simplifies the documentation of the preparation for radiotherapy. Clinics save time and money, as data no longer need to be recorded manually“, emphasizes Guido Kübler.
In modernization of radiological systems, clinics and radiotherapy centers also benefit from RPS. As the system is compatible with older linear accelerators, expenses for re-equipment are exactly calculable.
Radiation of cancer patients has become an important and wide-spread therapeutic option. Of particular importance here is medical experience, a great deal of tact and skill as well as best possible patient positioning. gKteso has developed the Radiotherapy Patient System RPS base, a 6D-Robotic-Couch for radiotherapy with linear accelerators, including latest technology for radiation as optimally as possible.
The patient platform is electronically controlled and does not require unnecessary corrections, due to stored patient data and its capabil-ity to re-approach the initially defined positioning at the touch of a button. “The flexible mobility of the platform, ensured by its six de-grees of freedom, is another quality feature of RPS“, explains Guido Kübler, Managing Director of gKteso.
Patient positioning from head to pelvis at the touch of a button
A patient can be optimally aligned and fixed from head to pelvis, as the patient platform is compatible with all fixation aids (add-ons). By means of dynamic tracking procedure, the patient platform corrects even organ movements automatically. In this tracking procedure, the position and movement of an organ is exactly determined by an internal or external marker, continuously conveying these data to the patient platform for any correction. “This is how pinpoint radio-therapy of the defined tissue is ensured”, Kübler emphasizes. It is necessary, inter alia, in treatments of prostate tumors, where the bowel movements constantly change the position of the diseased organ.
Central point of any rotational movement is the isocenter, which substantially facilitates operation. The patient platform, featuring high rigidity, is prepared for dynamic corrections. Further ad-vantage: Older linear accelerators can be upgraded with RPS as well. RPS base is adjustable in height from 64 to 151 cm (25” to 59”) at a velocity of zero to 50 mm (0 to 2”) per second. The margin provided in the lateral alignment is of up to plus/minus 25 cm (+/-10”) and in the length of up to plus/minus 57 cm (+/- 22”) at 0 to 80 mm (0-3”) per second. Another advantage is the large adjustment angle of up to five degrees in any direction.
RFID-Reader reads in patient data
Patient data as well as all data of applied supporting aids are read in by the integrated RFID-Reader, providing these for further soft-ware systems, for example, for documentation of the treatment. This makes preparation for radiotherapy verifiable. „Since data no longer need to be recorded manually, also documentation is facili-tated“, as Kübler describes this essential bonus for both clinics and radiotherapy centers. Last but not least, it will have a positive effect on expenses. RPS also meets and exceeds the safety require-ments, due to this technical feature.
Up to three patients are prepared for radiotherapy
The RPS extended model, an expanded system of the 6D-Robotic-Couch, allows serial, comfortable and fast radiotherapy with linear accelerator. Here, up to three patients can be simultaneously pre-pared and fixed for radiotherapy in separate rooms. Cost savings of more than 55% can be achieved. Aside from increased cycle times, RPS extended provides the advantage of reducing the time pres-sure posed on medical technology assistants. “Time saved in treatment gives room for personal attention to the patient and posi-tively affects the irradiation process“, Kübler states. This may rep-resent an essential unique selling proposition for clinical radiothera-py centers that are increasingly exposed to an intense competitive situation.
In RPS extended, satellite arms gently move the patient to the sys-tem in order to be conveyed to the 6D-Robotic-Couch (RPS base) of the linear accelerator. This is where the medical technology as-sistant (MTA) reviews the fine tunings on the patient. As soon as radiotherapy is completed, RPS base will convey the patient back to RPS extended. Once back in the anteroom, the patient may leave the patient platform.
Compatible with all add-ons
Since radiotherapy, as for example in the head and neck area, re-quires specific fixation by means of masks in order to protect sensi-tive, adjacent organs such as salivary glands, eyes, brain and spi-nal cord from being unnecessarily strained, the patient platform by gKteso is prepared for all current add-ons. Vacuum mattresses as well as many other modular positioning aids may be attached to the Radiotherapy Patient System RPS extended.
In 50 to 60 percent of all patients with cancerous disease, radio-therapy is part of the therapy plan in the course of their treatment. One of several methods is irradiation with a linear accelerator. gKteso GmbH is a mid-size company located in Bobingen near Augsburg, Germany, specializing in the development of RPS (Radiotherapy Patient System).
About 25 years ago, Guido Kübler, mechanical engineer, founder and Managing Director of the com-pany, started with the development and manufacturing of electroni-cally controlled patient platforms for various applications. In distribu-tion, the company is classic OEM to distinguished international partners.
ESTRO 2016 in Turin: RPS is presented to the expert public
The Radiotherapy Patient System RPS from the German company gKteso located in Bobingen was presented at the 35th ESTRO in late April to around 3,000 expert visitors to Turin from around the world. In addition to numerous workshops and lectures about radiotherapy and oncology, ESTRO provides the opportunity for selected manufacturers to present their innovations. Interest in the Radiotherapy Patient system was great: the possibilities of the automatic treatment couch which can be moved in 6 dimensions sets new standards for radiation treatment.
In the basic version, the Radiotherapy Patient System is simply called “RPS base”. However this simple name belies the sophisticated technology that is “Made in Germany”: With six degrees of freedom (6 dof), patients up to a weight of 250 kilograms can be moved around on the treatment couch. This allows RPS to safeguard the quality of modern radiotherapy systems and efficiently enhance their technology: Cameras and tracking systems, as well as lasers, that are already integrated capture the patient’s position on the radiotherapy platform. The secured patient can now be moved to the ideal position with the RPS, with millimeter accuracy and flexibly in all six axes. This accuracy is especially important when a patient’s head is being treated with high-precision doses of radiation. This is because the more precisely the tumor cells are targeted, the better the chances of cure and the lower the side effects.
Cost advantage for hospitals and radiation treatment centers: Maximum utilization thanks to RPS extended
The Radiotherapy Patient System RPS extended is at the heart of a modern radiation therapy center. It allows the parallel preparation and treatment of three patients simultaneously. In separate rooms, patients can be prepared for radiation treatment on the treatment platform. This includes the alignment of the patient as well as any necessary measures for immobilization. This process requires great care and precision, so that during subsequent radiation therapy the tumors are irradiated as much as possible and healthy tissue is spared. Important time which so far has forced the linear accelerator to cease operation.
RPS extended ensures that the radiation therapy system is used optimally: A mobile arm transports the treatment platform with the prepared patient in a smooth manner right under the linear accelerator and hands the patient over to the RPS. Equipped with six degrees of freedom, RPS moves patients into the calculated position for radiation treatment. With the aid of additional camera systems or tracking methods, the patient’s respiratory movements or peristalsis can be detected by the Radiotherapy Patient System and compensated. And while the radiation treatment is taking place, two further patients can be already prepared.
RPS base also modernizes older systems
While the RPS extended is intended especially for the construction of new hospitals and radiation therapy centers, the expert visitors to ESTRO were interested in the basic variant, RPS base. This is so older radiation therapy systems can be modernized and improved. Thus, the RPS, due to its six-dimensional mobility, compensates for deficient set-up options of older systems. The integrated RFID reader (radio frequency identification) improves safety by comparing the patient’s position with the pre-defined target data. “ESTRO has brought our innovative RPS into contact with the people who work daily in the field of radiotherapy. The great interest and many contacts have shown us that RPS can further improve safety and comfort for patients. We see clearly the future after the expert discussions in modern radiation therapy centers, which bring several partners together to create cost advantages. Here, the RPS extended will play an important role in the efficient use of the linear accelerator while improving the procedure for the patient”, concluded Guido Kübler.
Radiotherapy Patient System – the advantages at a glance
– Improved patient comfort as a result of a low entry height, which can be also be managed by wheelchair users.
– Improved patient safety through reliable and reproducible storing of the individual patient positioning and of all relevant data.
– Integrated RFID reader (radio frequency identification): Data on the patient’s wristband or from fixing apparatus can be read in and transferred, safeguarding both treatment and documentation.
detects the position of the patient and transports them when deviations occur to
the pre-defined location
– In combination with optical methods or tracking of fiducial markers, body movements such as breathing or peristalsis can be compensated.
Radiotherapy with a linear accelerator has become indispensable in cancer treatment. For 50 to 60 percent of all patients with cancerous disease it is included in the therapy plan. Medical experience, a great deal of tact and, in particular, best possible patient positioning are of essential importance. gKteso has developed the Radiotherapy Patient System RPS base, a 6-D Robotic Couch for radiotherapy with linear accelerators providing latest technology to safeguard the treatment to the maximum. One benefit is that RPS is compatible with all contemporary fixation aids (add-ons) necessary for the positioning and fixation of a patient.
Radiotherapy will be revolutionized
The patient platform is a new development by gKteso revolutionizing the preparatory works before radiotherapy. RPS base is electronically con-trolled and does not require unnecessary corrections, due to stored patient data and its capability to re-approach the initially defined positioning at the touch of a button. All data of the supporting aids applied are read in by an integrated RFID-Reader, providing these, together with the patient data, for further software systems such as for the documentation of the treatment. The preparation for the irradiation is therefore verifiable.
RPS base and add-ons for pinpoint radiotherapy
“The add-ons are easily and safely applied to the patient platform“, explains Guido Kübler, Managing Director of gKteso. In combination with RPS base, a pinpoint treatment of the defined tissue will be ensured. Since radiotherapy, for example in the head and neck area, requires specific fixation by masks in order to protect sensitive, adjacent organs such as salivary glands, eyes, brain and spinal cord from being unnecessarily strained, it is indispensable to prepare a contemporary patient platform for all current add-ons. “Also vacuum mattresses and many other modu-lar positioning products can be attached to the Radiotherapy Patient System RPS“, emphasizes Kübler.
By means of a dynamic tracking procedure, the patient platform can even correct organ movements automatically. During this tracking procedure, an internal or external marker exactly determines the position and movement of an organ, continuously conveying these data to the patient platform for possible corrections. This is necessary, inter alia, in treat-ments of prostate tumors, where the bowel movements constantly change the position of the diseased organ.
RPS extended for serial radiotherapy
RPS extended is an expanded system of the 6D-Robotic Couch, allowing serial, comfortable and fast radiotherapy with a linear accelerator. Fact is that up to three patients can be simultaneously prepared and fixed for radiotherapy in separate anterooms.
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