PATIENT POSITIONING SYSTEM This application claims priority to U.S. Provisional Patent Application No. 63 / 237,513, filed August 26, 2021, the entire contents of which are incorporated herein by reference.

Abstract

Provided herein is technology relating to medical imaging and radiation therapy, and in particular, but not by way of limitation, technology relating to devices, methods and systems for imaging a patient relative to a radiation source for imaging and / or treating the patient by exposing the patient to a radiation beam produced by the radiation source.

Description

[Technical field]

[0001] Provided herein is technology relating to medical imaging and radiation therapy, and in particular, but not by way of limitation, technology relating to devices, methods and systems for imaging a patient relative to a radiation source for imaging and / or treating the patient by exposing the patient to a radiation beam produced by the radiation source. [Background technology]

[0002] Radiation sources have many applications in medicine, including medical imaging and radiation therapy. Typically, radiation sources are configured to move relative to a stationary patient, for example, to expose certain parts or regions of the patient to radiation generated by the radiation source. Additionally, while radiation therapy and related diagnostic and planning imaging are traditionally performed with the patient in a prone or supine position, some patients benefit from treatment while in non-traditional positions, such as an upright position. However, limitations in acquiring upright imaging data for planning upright treatments have hindered the adoption and use of beneficial upright radiation therapy methods. For example, upright positioning systems have been demonstrated to have reduced posture repeatability compared to horizontal patient positioning. See, for example, Rahim et al. (2020) Frontiers in Oncology 10, article 213, incorporated herein by reference. Some prior art developed to meet this need provides patient positioning systems configured to maintain the patient's position in an upright, stable position to maximize patient comfort and minimize patient motion that can degrade image quality. See, for example, U.S. Patent Application Publication No. 20200268327, which is incorporated by reference herein. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] US Patent Publication No. 20200268327 [Non-patent literature]

[0004] [Non-Patent Document 1] Rahim et al. (2020), Frontiers in Oncology 10, article 213 Summary of the Invention [Problem to be solved by the invention]

[0005] The technology provided herein relates to certain aspects of a patient positioning system for medical imaging and / or radiation therapy. In some embodiments, the technology described herein supplements and / or modifies patient positioning equipment and / or patient supports, for example, as described in US Patent Publication No. 20200268327, which is incorporated herein by reference. In some embodiments, the patient positioning system stabilizes and supports the patient in an upright (e.g., standing, sitting, kneeling, edge sitting) position. Imaging and / or treating the patient in an upright position provides the advantage of increased patient comfort. Furthermore, diagnosing and / or treating the patient in an upright position provides advantages over traditional diagnosis and / or treatment of the patient in a horizontal position for many indications (e.g., lung cancer, breast cancer). While imaging and / or treating the upright patient provides diagnostic and therapeutic advantages, medical imaging and treatment require improved patient positioning systems to stabilize and support the patient in a proper upright position for delivering therapeutic radiation doses to target areas and for planning treatment using medical imaging. [Means for solving the problem]

[0006] In an embodiment, the technology provides a patient support. For example, in an embodiment, the patient support includes a first support member configured to contact a patient, a second support member configured to contact a patient, and an actuation assembly coupled to the first support member and the second support member, the actuation assembly configured to move the first support member and the second support member between a first configuration and a second configuration. In an embodiment, the actuation assembly configured to simultaneously move the first support member and the second support member between the first configuration and the second configuration. In an embodiment, the first configuration and the second configuration are customized for a patient. In an embodiment, the first configuration is a patient entry state and the second configuration is a patient imaging or treatment state. In an embodiment, the first configuration is a patient entry state and the second configuration is a patient standby state. In an embodiment, the first configuration is a patient standby state and the second configuration is a patient imaging or treatment state. In some embodiments, the first configuration is a patient standby state and the second configuration is a patient exit state. In some embodiments, the first configuration is a patient imaging or treatment state and the second configuration is a patient exit state.

[0007] In some embodiments, the actuation assembly includes a motor and a microprocessor. In some embodiments, the first support member is a backrest, a headrest, an armrest, a seat member, a shin guard, or a foot brace (e.g., a heel stop). In some embodiments, the patient support further includes a dynamic configuration. In some embodiments, the dynamic configuration assists ingress of a patient into the patient support. In some embodiments, the dynamic configuration assists egress of a patient from the patient support.

[0008] In an embodiment, the present technology further provides a patient positioning system comprising a central beam axis, a support configured to support a patient, and an actuation assembly coupled to the support and configured to move the support, the support being movable along a first axis, a second axis orthogonal to the first axis, and a third axis orthogonal to the first and second axes, the support being rotatable about the first, second, and third axes, and a desired region of the patient is aligned with the central beam axis when the support is in a first position and a second position different from the first position. In an embodiment, the support moves a first compensation amount along the first axis and a second compensation amount along the second axis in response to a rotation of the support about any one of the first, second, and third axes. In an embodiment, a first amount of mechanical deflection in the support occurs at a first position and a second amount of mechanical deflection in the support occurs regardless of the size of the patient. In an embodiment, the patient positioning system further comprises a processor and a memory, the memory including a deflection correction table having multiple compensations for maintaining a desired region aligned with the central beam axis for the support at multiple positions and for multiple patient weights.

[0009] In some embodiments, the technology provides an adjustable seat assembly. For example, in some embodiments, the technology provides an adjustable seat assembly including a base including a slot, a seat movably coupled to the base between a first position and a second position, a rod coupled to the seat and positioned within the slot, and a pedestal coupled to the base, where the seat slides relative to the pedestal and the rod slides within the slot as the seat moves between the first position and the second position. In some embodiments, the seat includes a first surface configured to support a patient and a second surface opposite the first surface, the second surface coupled to the pedestal. In some embodiments, the second surface is an arcuate surface. In some embodiments, the rod is offset from a rotation axis of the seat. In some embodiments, the adjustable seat assembly further includes a cleat coupled to the seat, the cleat including a wing. In some embodiments, the pedestal includes a flange engageable with the wing of the cleat. In some embodiments, the cleat and the pedestal limit vertical movement of the seat. In some embodiments, the slot is arcuate.In some embodiments, the seat includes an arcuate surface that receives the sheet.

[0010] In an embodiment, the present technology provides a system including a patient support assembly in a first configuration and an adjuster configured to move the patient support assembly in a first direction while the patient support assembly remains in the first configuration. In an embodiment, the adjuster includes a first block and a second block movable relative to the first block. In an embodiment, the adjuster includes a first seat positioned between the first block and the second block and a second seat positioned on the second block. In an embodiment, the adjuster includes a groove defined between the first block and the second block, the groove configured to receive a wedge that adjusts a position of the second block relative to the first block. In an embodiment, the adjuster is a first adjuster and the system further includes a second adjuster and a third adjuster. In one embodiment, the first adjuster sets a first position of the patient support assembly in a first orientation, and the second adjuster and the third adjuster set a second position of the patient support assembly in a second orientation.

[0011] In an embodiment, the present technology provides a patient positioning system comprising: a platform; a load cell coupled to the platform, the load cell generating an output based on a weight of the platform and a weight supported on the platform; and a processor configured to receive the output and determine a weight supported on the platform. In an embodiment, the load cell comprises a strain gauge. In an embodiment, the load cell is positioned between the platform and a chain drive. In an embodiment, the chain drive comprises a chain and a support member coupled to an end of the chain, the support member configured to receive a portion of the load cell. In an embodiment, the support member comprises a notch for receiving a portion of the load cell. In an embodiment, the processor is further configured to determine a position on the platform where the weight is supported. In an embodiment, the processor is further configured to detect a change in the weight supported on the platform. In an embodiment, the processor controls a movement of a portion of the patient positioning system in response to the detected weight supported on the platform.

[0012] In an embodiment, the present technology provides a patient support assembly comprising: a base including a receptacle and a first pad positioned within the receptacle; and a support member including a tongue having a second pad, the tongue being removably received within the receptacle to couple the support member to the base, the second pad directly engaging the first pad when the tongue is received within the receptacle. In an embodiment, the first pad is nylon. In an embodiment, the second pad is nylon. In an embodiment, the first pad includes a first beveled edge and the second pad includes a second beveled edge. In an embodiment, the first pad is positioned on a first side of the receptacle, the receptacle further includes a third pad positioned on a second side of the receptacle opposite the first side, the tongue includes a fourth pad that directly engages the third pad when the tongue is received within the receptacle. In some embodiments, the support member further includes a first rod and a second rod. In some embodiments, the tongue is positioned between the first rod and the second rod. In some embodiments, the first rod and the second rod extend in a direction parallel to the tongue. In some embodiments, the base includes a first block having a first hole and a second block having a second hole, and when the tongue is received in the receptacle, the first rod is received in the first block and the second rod is received in the second block. In some embodiments, the first block allows adjustment in a first direction and the second block allows adjustment in a second direction orthogonal to the first direction.

[0013] In an embodiment, the present technology provides a patient positioning system comprising a base, a platform comprising a patient support, a scissor frame coupled to the base and the platform, and a chain drive coupled to the base and the platform, the chain drive configured to move the platform between a stored position and a deployed position. In an embodiment, the platform is a first distance from the base in the stored position, and the platform is a second distance from the base in the deployed position, the second distance being greater than the first distance. In an embodiment, the scissor frame includes a first upper pedestal and a second upper pedestal coupled to the platform, the first upper pedestal being slidable relative to the platform. In an embodiment, the scissor frame includes a first lower pedestal and a second lower pedestal coupled to the base, the first lower pedestal being slidable relative to the base. In an embodiment, the chain drive includes a chain having a plurality of links, the plurality of links including interlocking profiles. In one embodiment, the scissor frame is a first scissor frame, the chain drive is a first chain drive, and the patient positioning system further includes a second scissor frame coupled to the platform and a second chain drive coupled to the platform.

[0014] In some embodiments, the present technology provides a conformable patient support comprising an outer layer; an interior cavity including a first portion, a second portion, and a divider positioned between the first and second portions; a first plurality of beans (e.g., polymer beads or beans (e.g., polystyrene, expanded polystyrene (EPS), expanded polypropylene (EPP), STYROFOAM, etc.) having a diameter of about 2 mm to 10 mm) positioned within the first portion; and a second plurality of beans positioned within the second portion, the first portion being positioned above the second portion when the conformable patient support is oriented to conform to a patient in an upright position. In some embodiments, the present technology provides methods related to conformable patient supports. For example, in one embodiment, the technology provides a method of adapting a bag to a patient in an upright position, the method including evacuating a portion of the air in a bag containing a plurality of beans, orienting the bag vertically, pressing the bag against the patient in an upright position, and evacuating a second portion of the air in the bag.

[0015] In one embodiment, the present technology provides a patient positioning system comprising a moveable patient support, an actuator configured to move the moveable patient support, a main power source electrically coupled to the actuator, and a backup electrical circuit coupled to the actuator including a low voltage battery, a relay, and a brake, the backup electrical circuit configured to operate the actuator when the main power source is disabled.

[0016] In an embodiment, the present technology provides a patient positioning system comprising a floor panel with drainage holes and an integrated fluid-control cassette below the floor panel, the fluid-control cassette comprising an absorbent material. In an embodiment, the patient positioning system comprises a fluid-control receiving opening configured to receive the integrated fluid-control cassette. In an embodiment, the patient positioning system comprises a first rail and a second rail to guide insertion of the fluid-control cassette into the fluid-control cassette receiving opening and to support the inserted fluid-control cassette. In an embodiment, the fluid-control cassette is disposable or reusable. In an embodiment, the fluid-control cassette comprises an antimicrobial compound, an antiviral compound, an antibacterial compound, a disinfectant, a deodorant compound, and / or a superabsorbent polymer.

[0017] Further embodiments will be apparent to those skilled in the art based on the teachings contained herein.

[0018] The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.

[0019] These and other features, aspects, and advantages of the present technology will become better understood with regard to the following drawings. [Brief description of the drawings]

[0020] [Figure 1] FIG. 1 is a perspective view of a patient positioning system. [Diagram 2] FIG. 2 is a perspective view of the patient positioning system of FIG. 1 with components removed for clarity. [Diagram 3] FIG. 2 is a side view of the patient positioning system of FIG. [Figure 4] FIG. 2 is another side view of the patient positioning system of FIG. [Figure 5A] FIG. 2 is a perspective view of a patient in the patient positioning system of FIG. [Figure 5B]FIG. 5B is a side view of the patient in the patient positioning system of FIG. [Figure 5C] FIG. 5B is a front view of the patient in the patient positioning system of FIG. [Figure 6A] 2 is a side view of a patient in the patient positioning system of FIG. 1 in a first orientation in which a desired patient region is aligned with a treatment beam and / or an imaging beam. [Figure 6B] FIG. 6B is a side view of the patient and patient positioning system of FIG. 1 in a second orientation after the patient positioning system and patient shown in FIG. 6A have been rotated about an axis, thereby misaligning a desired patient region with the treatment beam and / or imaging beam. [Figure 6C] FIG. 6C is a side view of the patient and patient positioning system shown in FIG. 1 in a third orientation after the patient positioning system and patient shown in FIG. 6B have been translated to realign the treatment beam and / or imaging beam with a desired patient region. [Figure 7A] FIG. 2 is a perspective view of the patient positioning system of FIG. 1 in a folded, vertical position. [Figure 7B] FIG. 2 is a perspective view of the patient positioning system of FIG. 1 in a deployed vertical position. [Figure 8] FIG. 1 is a perspective view of a scissor lift mechanism, shown partially in transparency. [Figure 9] FIG. 9 is a partial perspective view of the chain drive actuator of the scissor lift mechanism of FIG. [Figure 10] FIG. 2 is a top view of the patient positioning system of FIG. 1 showing the weight sensing assembly. [Figure 11] FIG. 2 is a partial perspective view of a weight sensing assembly. [Figure 12] FIG. 2 is a partial cross-sectional view of a weight sensing assembly. [Figure 13A] FIG. 2 is a perspective view of a situation detected by a weight sensing assembly. [Figure 13B] FIG. 13B is a top view of the situation in FIG. 13A. [Figure 14] FIG. 2 is a partial perspective view of an adjustable seat assembly including a seat member. [Figure 15] FIG. 15 is a perspective view of the sheet member of FIG. [Figure 16] FIG. 15 is a perspective view of a cleat of the adjustable seat assembly of FIG. 14. [Figure 17] FIG. 15 is a perspective view of a base of the adjustable seat assembly of FIG. 14. [Figure 18] FIG. 13 is a partial perspective view of an adjustable seat assembly according to another embodiment. [Figure 19] FIG. [Figure 20] FIG. 2 is a bottom view of the patient positioning system of FIG. 1 having three adjusters for leveling and alignment. [Figure 21] FIG. 13 is a partial perspective cross-sectional view of a configurable patient support. [Figure 22] FIG. 13 is a partial cross-sectional view of a removable seat back including a tongue and two alignment rods. [Figure 23A] FIG. 13 is a color perspective view of the base of the configurable patient support. [Figure 23B] This is a black and white line drawing version of Figure 23A. [Figure 24] FIG. 23B is a partial perspective view of a portion of the base of FIG. 23A. [Diagram 25] FIG. 23 is a partial perspective cross-sectional view of the removable seat back of FIG. 22. [Figure 26] FIG. 26 is a cross-sectional view of the removable seat back of FIG. 25. [Figure 27] FIG. 2 is a partial cross-sectional view of a first rod block. [Figure 28] FIG. 4 is a partial cross-sectional view of a second rod block. [Figure 29] FIG. 13 is a partial cross-sectional view of a rod positioned within a block. [Diagram 30] 1 is a diagram of a conventional adaptive patient support. [Diagram 31] FIG. 1 is a perspective view of a vertical adaptive patient support. [Diagram 32] FIG. [Diagram 33] FIG. 1 is a perspective view of a removable fluid control cassette mounted on a floor panel. [Diagram 34] FIG. 34 is a perspective view of the removable fluid-control cassette of FIG. 33. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0021] It should be understood that the figures are not necessarily drawn to scale, and that objects in the figures are not necessarily drawn to scale in relation to each other. The figures are representations intended to provide clarity and understanding to the various embodiments of the devices, systems, and methods disclosed herein. Wherever possible, the same reference numbers are used throughout the drawings to refer to the same or similar parts. Furthermore, it should be understood that the drawings are not intended to limit the scope of the present teachings in any way.

[0022] Provided herein is technology relating to medical imaging and radiation therapy, and in particular, but not by way of limitation, technology relating to devices, methods and systems for imaging a patient relative to a radiation source for imaging and / or treating the patient by exposing the patient to a radiation beam produced by the radiation source.

[0023] In this detailed description of the various embodiments, for purposes of explanation, numerous specific details are set forth to provide a thorough understanding of the disclosed embodiments. However, those skilled in the art will appreciate that the various embodiments may be practiced without or with these specific details. In other instances, structures and devices are shown in block diagram form. Furthermore, those skilled in the art can readily appreciate that the particular order in which the methods are presented and performed is illustrative, and that the order can be changed and still be within the spirit and scope of the various embodiments disclosed herein.

[0024] All literature and similar materials cited in this application, including but not limited to patents, patent applications, articles, books, papers, and Internet web pages, are expressly incorporated by reference in their entirety for any purpose. Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by those skilled in the art to which the various embodiments described herein belong. If the definition of a term in the incorporated references appears to differ from the definition provided in the present teachings, the definition provided in the present teachings shall prevail. The section headings used herein are for organizational purposes only and should not be construed as limiting the subject matter described in any way.

[0025] definition To facilitate the understanding of the present technology, several terms and phrases are defined below. Further definitions are set forth throughout the detailed description.

[0026] Throughout the specification and claims, the following terms shall take the meanings expressly associated therewith, unless the context clearly dictates otherwise. The phrase "in one embodiment" as used herein may refer to the same embodiment, but not necessarily to the same embodiment. Additionally, the phrase "in another embodiment" as used herein may refer to different embodiments, but not necessarily to different embodiments. Thus, as described below, various embodiments of the present invention can be readily combined without departing from the scope or spirit of the present invention.

[0027] Additionally, as used herein, the term "or" is an inclusive "or" operator and is equivalent to the term "and / or" unless the context clearly dictates otherwise. The term "based on" is not exclusive and allows for based on additional unlisted factors unless the context clearly dictates otherwise. Additionally, throughout this specification, the meanings of "a," "an," and "the" include plural references. The meaning of "in" includes "in" and "on."

[0028] As used herein, the terms "about," "approximately," "substantially," and "significantly" are understood by those of ordinary skill in the art and will vary to some extent depending on the context in which they are used. If there are uses of these terms that are not clear to those of ordinary skill in the art given the context in which they are used, "about" and "approximately" mean plus or minus 10% or less of the particular term, and "substantially" and "significantly" mean plus or minus more than 10% of the particular term.

[0029] As used herein, the disclosure of a range includes the disclosure of all values ​​within the entire range and further divided ranges, including the endpoints and subranges given in the range.As used herein, the disclosure of a numerical range includes the endpoints and each intervening number therebetween with the same precision.For example, in the range of 6 to 9, the numbers 7 and 8 are contemplated in addition to 6 and 9, and in the range of 6.0 to 7.0, the numbers 6.0, 6.1, 6.2, 6.3, 6.4, 6.5, 6.6, 6.7, 6.8, 6.9, and 7.0 are expressly contemplated.

[0030] As used herein, the suffix "~free" refers to an embodiment of a technology that omits a feature of the base root of the word to which "free" is added. That is, the term "X-free" as used herein means "without X," where X is the feature of the technology that is omitted in the "X-free" technology. For example, a "calcium-free" composition does not contain calcium, a "mixing-free" method does not contain a mixing step, etc.

[0031] Terms such as "first", "second", "third", etc. are used herein to describe various steps, elements, compositions, components, regions, layers, and / or portions, but these steps, elements, compositions, components, regions, layers, and / or portions should not be limited by these terms unless otherwise specified. These terms are used to distinguish one step, element, composition, component, region, layer, and / or portion from another step, element, composition, component, region, layer, and / or portion. As used herein, terms such as "first", "second", etc., and other numerical terms, do not imply a sequence or order unless clearly indicated by the context. Thus, a first step, element, composition, component, region, layer, or portion discussed herein can be referred to as a second step, element, composition, component, region, layer, or portion without departing from the art.

[0032] As used herein, the terms "presence" or "absence" (or "present" or "absence") are used in a relative sense to describe the amount or level of a particular entity (e.g., a component, an action, an element). For example, when an entity is said to be "present", it means that the level or amount of this entity is above a predetermined threshold. Conversely, when an entity is said to be "absent", it means that the level or amount of this entity is below a predetermined threshold. The predetermined threshold is the threshold of detectability associated with the particular test used to detect the entity or any other threshold. If an entity is "detected", it is "present". If an entity is "not detected", it is "absent".

[0033] As used herein, "increase" or "decrease" refers to a detectable (e.g., measured) positive or negative change in the value of a variable relative to a previously measured value, a pre-established value, and / or a standard control value, respectively. An increase is a positive change of preferably at least 10%, more preferably 50%, even more preferably 2-fold, even more preferably at least 5-fold, and most preferably at least 10-fold relative to a previously measured value, a pre-established value, and / or a standard control value of a variable. Similarly, a decrease is a negative change of preferably at least 10%, more preferably 50%, even more preferably at least 80%, and most preferably at least 90% of a previously measured value, a pre-established value, and / or a standard control value of a variable. Other terms indicating quantitative changes or differences, such as "more" or "less", are used herein in the same manner as above.

[0034] As used herein, a "system" refers to multiple actual and / or abstract components that work together for a common purpose. In some embodiments, a "system" is an integrated collection of hardware and / or software components. In some embodiments, each component of a system interacts with and / or is associated with one or more other components. In some embodiments, a system refers to a combination of components and software for controlling and directing a method. For example, a "system" or a "subsystem" may include one or more, or any combination of, mechanical devices, hardware, hardware components, circuits, electrical circuitry, logic designs, logic components, software, software modules, components of software or software modules, software procedures, software instructions, software routines, software objects, software functions, software classes, software programs, files containing software, and the like, to perform the functions of the system or subsystem. Thus, the methods and apparatus of the embodiments, or certain aspects or portions thereof, may take the form of program code (e.g., instructions) embodied in a tangible medium, such as a floppy diskette, a CD-ROM, a hard drive, a flash memory, or any other machine-readable storage medium, which when loaded and executed by a machine, such as a computer, makes the machine an apparatus for implementing the embodiments. When executing the program code on a programmable computer, the computing device generally includes a processor, a storage medium readable by the processor (e.g., volatile and non-volatile memory and / or storage elements), at least one input device, and at least one output device. One or more programs may implement or utilize the processes described in connection with the embodiments, for example, through the use of an application programming interface (API), a reusable controller, or the like. Such programs are preferably implemented in a high-level procedural programming language or an object-oriented programming language to communicate with the computer system.However, the programs can be implemented in assembly or machine language, if desired. In any case, the language may be a compiled or interpreted language, and combined with hardware implementations.

[0035] As used herein, the term "computed tomography" is abbreviated to "CT" and refers to both tomography and non-tomography. For example, the term "CT" refers to multiple forms of CT, including but not limited to X-ray CT, positron emission tomography (PET), single photon emission computed tomography (SPECT), and photon counting computed tomography. In general, computed tomography (CT) involves the use of an X-ray source and a detector that rotates around the patient, followed by reconstruction of images into different planes. In the embodiments of CT (e.g., devices, apparatus, and methods provided for CT) described herein, the X-ray source is a stationary source, and the patient rotates relative to the stationary source. The current of the X-rays used in CT represents the current flow from the cathode to the anode, and is typically measured in milliamps (mA).

[0036] As used herein, the term "constructed to" means that the identified element or assembly has a structure that is shaped, sized, arranged, connected, and / or configured to perform the identified verb. For example, a member "constructed to move" is movably connected to another element, includes an element that moves the member, or is configured to move in response to another element or assembly. Thus, as used herein, "constructed to" recites structure, not function. Additionally, as used herein, "constructed to" means that the identified element or assembly is intended and designed to perform the identified verb.

[0037] As used herein, the term "associated" means that elements are part of the same assembly and / or work together or interact with one another in some way. For example, an automobile has four tires and four hubcaps. It is understood that while all the elements are connected as part of the automobile, each hubcap is "associated" with a particular tire.

[0038] As used herein, the term "coupled" refers to two or more components that are secured together by any suitable means. Thus, in an embodiment, a statement that two or more parts or components are "coupled" shall mean that the parts are joined or move together directly or indirectly, for example, through one or more intermediate parts or components. As used herein, "directly coupled" means that the two elements are in direct contact with each other. As used herein, "fixedly coupled" or "fixed" means that the two components are coupled so that they move as one while maintaining a constant orientation relative to each other. Thus, when two elements are coupled, all of the parts of the elements are coupled. However, a description of a particular part of a first element being coupled to a second element, for example, a first end of an axle being coupled to a first wheel, means that the particular part of the first element is located closer to the second element than the other parts. Additionally, an object resting on another object held in place by gravity alone is not "coupled" to the lower object unless the upper object is substantially maintained in place. That is, for example, a book on a table is not connected, and a book glued to a table is connected.

[0039] As used herein, the term "removably connected" or "temporarily connected" means that one component is connected to another component in an essentially temporary manner. That is, the two components are connected in a manner that allows for easy joining or separation of the components and does not damage the components. Thus, "removably connected" components are easily separated and reconnected without causing damage to the components.

[0040] As used herein, the term "operably coupled" means that multiple elements or assemblies, each movable between a first position and a second position or configuration, are coupled such that movement of a first element from one position / configuration to another position / configuration causes the second element to also move between positions / configurations. Note that a first element may be "operably coupled" to another element, but the reverse is not true.

[0041] As used herein, the term "rotatably coupled" refers to two or more components coupled such that at least one of the components is rotatable relative to the other.

[0042] As used herein, the term "translatably linked" refers to two or more components that are linked such that at least one of the components is translatable relative to the other.

[0043] As used herein, the term "temporarily disposed" means that a first element or assembly rests on a second element or assembly such that the first element / assembly can be moved without having to separate or manipulate the first element. For example, a book that simply rests on a table, such as the book is not glued or secured to the table, is "temporarily disposed" on the table.

[0044] As used herein, the term "corresponding" indicates that two structural components are sized and shaped to be similar to one another and to be connected with a minimal amount of friction. Thus, an opening that "corresponds" to a member is sized slightly larger than the member so that the member can pass through the opening with a minimal amount of friction. This definition is modified when two components fit "snugly" together, in which case the difference in size of the components is even smaller and the amount of friction increases. If the elements defining the opening and / or the components inserted into the opening are made from a deformable or compressible material, the opening may be slightly smaller than the components being inserted into the opening. With respect to surfaces, shapes, and lines, two or more "corresponding" surfaces, shapes, or lines generally have the same size, shape, and contour.

[0045] As used herein, a "path of travel" or "path," when used in reference to a moving element, includes the space that the element travels through as it moves. Thus, any element that moves inherently has a "path of travel" or "path."

[0046] As used herein, a statement that two or more parts or components "engage" each other shall mean that the elements exert a force or bias on each other, either directly or through one or more intermediate elements or components. Additionally, as used herein with respect to a movable part, the movable part may "engage" another element during movement from one position to another and / or may "engage" another element once in the described position. Thus, statements "when element A moves to element A's first position, element A engages element B" and "when element A is in element A's first position, element A engages element B" are understood to be equivalent statements and mean that element A engages element B while moving to element A's first position and / or that element A engages element B while element A is in element A's first position.

[0047] As used herein, the term "operably engage" means "engage and move." That is, "operably engage" when used in reference to a first component constructed to move a second component that is movable or rotatable means that the first component applies a force sufficient to move the second component. For example, a screwdriver is placed in contact with a screw. When no force is applied to the screwdriver, the screwdriver is simply "coupled" to the screw. When an axial force is applied to the screwdriver, the screwdriver presses against the screw and "engages" the screw. However, when a rotational force is applied to the screwdriver, the screwdriver "operably engages" the screw and rotates the screw. Additionally, in electronic components, "operably engage" means that one component controls another component by a control signal or current.

[0048] As used herein, the term "number" is intended to mean one or an integer greater than one (eg, a plurality).

[0049] As used herein, in the phrases "[x] moves between its first and second positions" or "[y] is constructed to move [x] between its first and second positions," "[x]" is the name of an element or assembly. Furthermore, when [x] is an element or assembly that moves between multiple positions, the pronoun "the" refers to "[x]," i.e., the named element or assembly that precedes the pronoun "the."

[0050] As used herein, a "radial side / surface" of a circular or cylindrical body is a side / surface that extends about or surrounds its center or a height line through its center. As used herein, an "axial side / surface" of a circular or cylindrical body is a side that extends in a plane that extends approximately perpendicular to a height line through its center. That is, generally, for a cylindrical soup can, the "radial side / surface" is the approximately circular side wall and the "axial side / surface" is the top and bottom of the soup can.

[0051] As used herein, a "diagnostic" test includes detecting or identifying a disease state or condition in a subject, determining the likelihood that a subject will suffer from a given disease or condition, determining the likelihood that a subject with a disease or condition will respond to a treatment, determining the prognosis of a subject with a disease or condition (or its possible progression or regression), and determining the effect of a treatment on a subject with a disease or condition. For example, a diagnostic can be used to detect whether a subject has or is likely to have cancer, or to detect the likelihood that such a subject will respond favorably to a compound (e.g., a pharmaceutical, e.g., a drug) or other treatment.

[0052] As used herein, the term "symptom" generally refers to a disease, illness, injury, event, or change in health status.

[0053] As used herein, the term "treating" or "treatment" with respect to a condition refers to preventing the condition, slowing the onset or rate of onset of the condition, reducing the risk of developing the condition, preventing or delaying the onset of symptoms associated with the condition, reducing or terminating symptoms associated with the condition, causing complete or partial regression of the condition, or any combination thereof. In some embodiments, "treatment" includes exposing the patient or a portion thereof (e.g., a tissue, organ, body part, or other localized region of the patient's body) to radiation (e.g., electromagnetic radiation, ionizing radiation).

[0054] As used herein, the term "beam" refers to a stream of radiation (e.g., electromagnetic waves and / or particle radiation). In some embodiments, the beam is generated by a light source and is confined to a small solid angle. In some embodiments, the beam is collimated. In some embodiments, the beam is generally unidirectional. In some embodiments, the beam is divergent.

[0055] As used herein, the term "patient" or "subject" refers to a mammalian animal that has been identified and / or selected for imaging and / or treatment with radiation. Thus, in some embodiments, the patient or subject is in contact with a radiation beam, e.g., a primary beam generated by a radiation source. In some embodiments, the patient or subject is a human. In some embodiments, the patient or subject is a veterinary or farm animal, a livestock or pet, or an animal used in clinical research. In some embodiments, the subject or patient has cancer and / or the subject or patient is identified as having or at risk of having cancer.

[0056] As used herein, the term "treatment volume" or "imaging volume" refers to a volume (e.g., tissue) of a patient selected for imaging and / or treatment with radiation. For example, in some embodiments, the "treatment volume" or "imaging volume" includes a tumor in a cancer patient. As used herein, the term "healthy tissue" refers to a volume (e.g., tissue) of a patient that is not and / or does not include a treatment volume. In some embodiments, the imaging volume is larger than the treatment volume and includes the treatment volume.

[0057] As used herein, the term "radiation source" or "ray source" refers to a device that generates radiation (e.g., ionizing radiation) in the form of photons (e.g., described as particles or waves). In some embodiments, the radiation source is a linear accelerator ("linac") that generates x-rays or electrons to treat cancer patients by contacting tumors with an x-ray beam or electron beam. In some embodiments, the radiation source generates particles (e.g., photons, electrons, neutrons, hadrons, ions (e.g., protons, carbon ions, other heavy ions)). In some embodiments, the radiation source generates electromagnetic waves (e.g., x-rays and gamma rays having wavelengths ranging from about 1 pm to about 1 nm). It is understood that radiation can be described as having both wave-like and particle-like aspects, although it is sometimes convenient to refer to radiation in terms of waves and sometimes to refer to radiation in terms of particles. Thus, both descriptions are used throughout, without limiting the present technology, with the understanding that the laws of quantum mechanics provide that all particles or quantum entities can be described as either particles or waves.

[0058] As used herein, the term "stationary source" refers to a source that does not rotate around a patient during use of the source for imaging or therapy. Specifically, the "stationary source" remains fixed relative to an axis that passes through the patient while the patient is being imaged or treated. The patient may rotate about said axis to generate a relative motion between the stationary source and the rotating patient equivalent to the relative motion of the source rotating around the stationary patient, but the stationary source does not move relative to a third object, frame of reference (e.g., the treatment room in which the patient is positioned), or axis of rotation of the patient that passes through said third object, frame of reference (e.g., the treatment room in which the patient is positioned), or patient during imaging or therapy. Thus, the stationary source is mounted on a moving platform, and thus the stationary source can move relative to the ground and the fixtures on the ground as the moving platform moves to transport the stationary source. Thus, the term "stationary source" can refer to a movable "stationary source" as long as the movable "stationary source" does not rotate about an axis of rotation that passes through the patient during imaging or therapy of the patient. Additionally, a stationary source may be translated and / or rotated around the patient to position the stationary source prior to imaging or treating the patient or after imaging or treating the patient. Thus, the term "stationary source" may refer to a source that is translated or rotated around the patient in non-imaging and non-treatment uses, for example, to position the source relative to the patient when the patient is not being imaged and / or treated. In some embodiments, the "stationary source" is a photon source, and is therefore referred to as a "stationary photon source."

[0059] Embodiments of the technology described herein relate to translation along and / or rotation around an axis. In an embodiment, a coordinate system is used that includes an X-axis, a Y-axis, and a Z-axis defined relative to the patient support and / or the patient. See FIG. 1. As shown in FIG. 1, the embodiment uses a coordinate system in which the X-axis and the Y-axis are both in and / or define a horizontal plane, and the Z-axis is a vertical axis and / or defines a vertical axis. With respect to a patient positioned on a patient support (e.g., a patient positioning device), the X-axis is a left-right, horizontal, or frontal axis, the Y-axis is an anterior-posterior, dorso-ventral, or sagittal axis, and the Z-axis is a sagittal or longitudinal axis. The X-axis and the Y-axis are both in and / or define a horizontal, transverse, and / or axial plane. The Y-axis and the Z-axis are both in and / or define a sagittal or longitudinal plane. The X-axis and the Z-axis are both in and / or define a frontal or coronal plane.

[0060] Thus, in one embodiment, descriptions of movement as "forward" or "backward" are movements along the Y axis, descriptions of movement as "left" or "right" are movements along the X axis, and descriptions of movement as "up" and "down" are movements along the Z axis. Additionally, rotations described as "roll" are rotations about the Y axis, rotations described as "pitch" are rotations about the X axis, and rotations described as "yaw" are rotations about the Z axis. Thus, in one embodiment, the technology is described as having six degrees of freedom, e.g., translation along one or more of the X, Y, and / or Z axes, and rotations about one or more of the X, Y, and / or Z axes.

[0061] explanation Although the disclosure herein refers to particular illustrated embodiments, it is to be understood that these embodiments are presented by way of example and not limitation.

[0062] Patient Positioning Systems The technology described herein relates to systems and associated methods for positioning a patient relative to a radiation source (e.g., a therapeutic treatment beam or a medical imaging beam). In some embodiments, the technology relates to a patient positioning system 10 for positioning a patient in a substantially upright position with the torso vertically aligned (e.g., standing, kneeling, sitting, etc.). In some embodiments, the radiation source is a stationary source. In some embodiments, the radiation source is movably mounted and moved to change the orientation of the radiation source.

[0063] In one embodiment, the patient positioning system 10 comprises a translatable member that is vertically translatable to articulate toward and outward from a surface on which the patient positioning system is supported. The translatable member is in the form of a carriage that is oriented vertically and comprises a body portion. In one embodiment, the translatable member is attached to a support structure, which is in turn attached to the surface. In one embodiment, the support structure provides stability to the patient positioning system and houses a drive mechanism that affects the vertical movement of the translatable member.

[0064] In an embodiment, the patient positioning system 10 comprises a configurable patient support 110 (e.g., a patient support, a patient support assembly, etc.). In an embodiment, the patient support 110 comprises a generally elongated structure. The patient support 110 is configured to receive and secure a patient in a generally upright position. The patient support 110 is rotatably mounted to the translatable member such that the patient support is rotatable about a vertical axis (e.g., an essentially vertical axis and / or a substantially vertical axis) relative to the translatable member. A lower end of the patient support is mounted to a rotating disk. In an embodiment, an upper end of the patient support is mounted to another rotating disk. With this configuration, the patient support is rotatably mounted to the translatable member such that the patient support is rotatable about a vertical axis. Also, because the translatable member can articulate vertically, the patient support attached to the translatable member can likewise articulate vertically.

[0065] The patient support 110 is adapted to receive a patient requiring exposure to the treatment beam and / or imaging beam. The patient support is offset from the vertical axis of rotation such that the patient's torso secured to the patient support is aligned with the vertical axis of rotation (e.g., the patient's vertical axis is aligned with the vertical axis of rotation). Thus, in an embodiment, the position of a patient supported by the patient support can be adjusted by rotational coupling of the patient support to the translatable member and / or vertical translation of the translatable member. With this configuration, the position of the patient can be adjusted relative to the treatment beam or imaging beam such that the treatment beam or imaging beam can target an area of ​​the patient requiring treatment or imaging.

[0066] In some embodiments, the patient is in a seated position and the patient's torso is in a vertical upright position about a vertical axis of rotation. In some embodiments, the fixed treatment beam source is supported by the same surface as the support structure and is therefore fixed in a fixed position to provide a stationary source. The treatment beam source is configured to direct a fixed treatment beam towards a patient positioned on the patient support. In some embodiments, the treatment beam source is a linac and the beam is shaped by a multi-leaf collimator. The source is positioned to direct the beam along a horizontal direction (e.g., an essentially horizontal and / or substantially horizontal direction). The detection panel is mounted to the support structure such that the detection panel is positionable in the path of the treatment beam. In some embodiments, the detection panel is adjustably mounted to an adjustable mount such that the position of the detection panel can be changed to facilitate patient access to the patient support for ingress and egress into and out of the patient positioning system. The adjustable mount is a pivotable mount such that the detection panel can be swung into and out of alignment with the treatment beam. In some embodiments, an additional detection panel is mounted to the housing of the treatment beam source (e.g., mounted to a support structure) for use with the imaging beam source. In some embodiments, the additional detection panel is adjustably mounted so that it can be moved to facilitate patient access to the patient support. In some embodiments, the imaging beam source is positioned in a horizontally orthogonal orientation to the treatment beam source such that the beam paths intersect at a region of the patient located on the patient support, although other orientations of the imaging beam source and / or treatment beam source are included in embodiments of the present technology. Both the treatment beam and the imaging beam are oriented to intersect with a vertical rotation axis.

[0067] In an embodiment, the translatable member is in a vertically downward position referred to as the first position. In an embodiment, the first position positions the translatable member and the patient support attached thereto proximate to a surface supporting the patient positioning system. Thus, the first position may allow for patient entry into the patient positioning system so that the patient may be secured to the patient support. In an embodiment, when the translatable member is in the first position, the translatable member is partially recessed into the surface such that the rotating disk is substantially flush with the surface, thus facilitating patient access to the patient support without the need to conform the patient to an uneven surface. In an embodiment, the first position is configured such that the fixed treatment beam is directed toward the head of the patient (e.g., a patient approximately 1900 mm tall) when the patient is secured to the patient support in a seated position. This height corresponds to the height of the 95th percentile American male patient, making the patient positioning system adaptable for use with a large portion of the population, although embodiments of the present technology include other configurations and are suitable for patients at the upper and lower ends of height and / or weight.

[0068] In an exemplary embodiment, fixing the patient to the patient support in a seated position allows the fixed treatment beam to target the patient in an area from the top of the patient's head to the general area of ​​the patient's abdomen (e.g., near the buttocks and / or navel). For example, the treatment beam is configured to align with the head of a seated patient (e.g., the head of a seated patient approximately 1900 mm tall). If the patient is shorter than approximately 1900 mm tall, the treatment beam is directed above the head of the seated patient in the first position. Thus, the embodiment provides for aligning the head of a patient less than approximately 1900 mm tall with the treatment beam by translating the translatable member vertically upwards away from the surface supporting the patient positioning system. Similarly, the patient is positioned vertically upwards by translation of the translatable member to align the fixed treatment beam with any portion of the torso up to the general area of ​​the patient's navel. The embodiments further provide for targeting a portion of the patient below the navel (e.g., the buttocks, legs, and / or feet) with a fixed treatment beam by providing the patient in a standing position by configuring a patient support to support the patient in a standing position.

[0069] For example, in an embodiment, a standing patient is supported by the patient support when the translatable member is in a first position. The vertical height of the patient support is configured to accommodate a patient approximately 1900 mm tall. Furthermore, in an embodiment, a standing patient is supported by the patient support when the translatable member is in a vertically upward position, referred to as the second position. When the translatable member is in the second position, the fixed treatment beam may be directed, in an embodiment, at the patient's feet and / or ankles, thus providing treatment to the feet and / or ankles. In an embodiment, the translatable member moves to an appropriate vertical position between the first position and the second position to align the fixed treatment beam with a portion of the patient between the patient's feet and navel. Thus, the present technology provides a fixed treatment beam that targets any portion of the patient, e.g., from the top of the head to the feet, while minimizing vertical movement of the translatable member. Thus, the patient positioning system provides a patient support suitable for standing and sitting patients of any height, e.g., a range of heights from a 95th percentile American male patient to a 5th percentile Japanese female patient. In some embodiments, the translatable member translates vertically about 3000-4000 mm (e.g., 3000, 3050, 3100, 3150, 3200, 3250, 3300, 3350, 3400, 3450, 3500, 3550, 3600, 3650, 3700, 3750, 3800, 3850, 3900, 3950, or 4000 mm) to target any portion of the body from head to foot of a 95th percentile American male patient. One advantage of minimizing the vertical movement of the translatable member is that it minimizes the vertical space required by the patient positioning system, thus allowing the patient positioning system to be placed in a smaller space than traditional treatment bunkers, reducing installation and assembly costs.

[0070] Where a portion of a patient in need of treatment may be targeted in either a standing or seated position, the position in which the patient is supported by the patient support can be selected (e.g., based on the patient's comfort, the patient's condition, and / or the treatment protocol). Further, in some embodiments, translation of the translatable member provides treatment of the patient in a sitting or standing position from the top of the patient's head to the patient's feet. Further, in some embodiments, movement of the translatable member provides treatment of the patient in a sitting or standing position from the top of the patient's head to the patient's abdominal and genital areas.

[0071] In an embodiment, the translatable member is adapted to move between a second vertically upward position and a first vertically downward position, and the translatable member is disposed in a recess in a surface supporting the patient positioning system such that a portion of the patient positioned on the translatable member is also disposed in the recess. In an embodiment, the patient positioning system is configured such that when the patient is secured to the patient support in the first position and disposing a portion of the patient in the recess, the fixed treatment beam is directed toward the head of a 95th percentile American male height. In an embodiment, the patient positioning system is configured such that the fixed treatment beam is directed toward the feet and / or ankles of a patient secured to the patient support in the second position. In an exemplary embodiment, this configuration reduces the vertical height of the patient support by constituting a portion of the vertical movement of the translatable member between the first and second positions into the surface supporting the patient support.

[0072] Thus, in some embodiments, translation of the translatable member provides treatment of the patient in a sitting or standing position in an area of ​​the patient's body that is anywhere from the top of the patient's head to the patient's feet. Furthermore, in some embodiments, translation of the translatable member provides treatment of the patient in a sitting or standing position in an area of ​​the patient's body that is anywhere from the top of the patient's head to the patient's abdominal and genital areas. Thus, embodiments of the present technology provide treatment of the patient's head, neck, chest, breasts, upper arms, elbows, lower arms, hands, abdomen, internal organs, genitals, anus, upper legs, knees, lower legs, ankles, and feet, for example. This list is exemplary and not limiting. Thus, other body parts and areas between the patient's head and feet and / or between the patient's head and genitals are all possible areas that can be treated by the present technology.

[0073] In an embodiment, the present technology provides an imaging system (e.g., a CT scanner) with a horizontal ring located vertically above a patient positioning system. See, for example, US Patent Publication No. 20220183641, which is incorporated herein by reference. By locating the patient positioning system vertically adjacent to the imaging system, the patient positioning system orients the patient with respect to both the fixed treatment beam and the imaging system. An embodiment including this configuration provides the patient in a position to be imaged by the imaging system in an upright position, thus providing the medical personnel with an image of the patient's anatomy in the same upright position that also receives the fixed treatment beam. Thus, the present technology reduces uncertainties that may arise from gravitational shifts of the patient's anatomy when imaging is performed at different patient positions relative to the treatment.

[0074] In some embodiments, for example as described above, the radiation source (e.g., treatment beam) is fixed in a fixed position such that the relative motion between the patient and the treatment beam is affected by the motion of the patient positioning system. In alternative embodiments, the position of the treatment beam is adjustable such that the relative motion between the patient and the treatment beam is achieved by movement of the patient positioning system and by adjusting the position of the treatment beam. For example, in some embodiments, the position of the treatment beam is adjustable between two vertically displaced positions such that the vertical movement required by the patient support is reduced and instead accounted for by vertical adjustment of the treatment beam. Furthermore, the present technique provides the advantage of reducing and / or minimizing the amount of shielding required since the degree of adjustment of the treatment beam is relatively small.

[0075] In some embodiments, the technology described herein includes a radiation source, e.g., a LINAC, that generates a beam shaped by a multi-deflection collimator, that is a treatment beam source. However, the technology is not limited to embodiments that include a treatment beam source, e.g., a LINAC, that generates a beam shaped by a multi-deflection collimator, and includes embodiments that include patient positioning systems for use with other forms of radiation sources, and with imaging techniques such as CT and MRI.

[0076] In some embodiments, the patient support 110 includes a patient immobilization system that is attached to the patient support for securely and comfortably immobilizing the patient to the patient support. In some embodiments, the patient immobilization system is configurable in a first orientation for immobilizing the patient to the patient support in a seated position and in a second orientation for immobilizing the patient to the patient support in an upright or substantially upright position.

[0077] As described herein, embodiments provide a patient positioning system that includes a patient support assembly. In some embodiments, the patient support assembly includes a backrest, a seat member, a shin rest, an arm rest, a head rest, and / or a foot brace. In some embodiments, the foot brace includes a heel stop. Embodiments provide that the backrest, the seat member, the shin rest, the arm rest, the head rest, and / or the foot brace (e.g., the heel stop) are configurable between multiple positions to accommodate patient ingress and / or egress from the patient support system (e.g., from the patient support assembly) and / or to support a patient in multiple positions for imaging or treatment.

[0078] For example, in some embodiments, the patient support assembly 110 can be configured to receive and support a patient whose torso is tilted at an angle relative to a vertical axis. With this configuration, the effect of gravity acting on the patient's tilted orientation relative to the vertical axis can help stabilize a patient received by the patient support assembly. Embodiments provide for the patient's torso to be tilted forward or backward. See, for example, U.S. Patent Application Publication No. 20200268327, incorporated herein by reference.

[0079] In an exemplary embodiment, the patient support 110 provides for a patient with a torso tilted forward relative to a vertical axis to facilitate targeting of the patient's breast by the radiation source. In an embodiment, the angle at which the patient's torso is configured to tilt is about ±0° to about 20°, about ±5° to about 15°, or about ±10°. The configurable patient support 110 is configured to accommodate a patient with a torso tilted at an angle in both a first orientation, i.e., a first configuration in which the patient is in a generally seated position, and a second orientation, i.e., a second configuration in which the patient is in a generally or substantially standing position. In an embodiment, the patient support assembly provides for a patient in an "edge seated position." As used herein, the term "edge seated position" refers to a patient in a generally standing position with a torso tilted backward relative to a vertical axis, optionally with knees bent.

[0080] In one embodiment, the patient support 110 is configured to accommodate a patient in a generally seated position in the first orientation. In one embodiment, the patient support assembly is configurable to support a wide range of patient populations in a seated position, for example, patients having heights ranging from the 95th percentile for American males to the 5th percentile for Japanese females.

[0081] In some embodiments, the patient support 110 comprises a backrest 12. In some embodiments, the backrest 12 is aligned or substantially or effectively aligned with a vertical axis. In some embodiments, the backrest 12 is inclined relative to the vertical axis, such that a patient leaning against the backrest is similarly inclined relative to the vertical axis (e.g., the patient's torso is inclined relative to the vertical axis). Additionally, in some embodiments, the patient support 110 in the first orientation comprises a seat member 511 that extends perpendicularly from a plane generally aligned with the backrest 12 to accommodate the buttocks or rear of the patient in a seated position. In some embodiments, the patient support 110 in the first orientation comprises a shin rest positioned toward the backrest to be behind the patient's ankles and thereby not contacting any part of the patient in a seated position. In some embodiments, the shin rest 13 is located below the seat member 12 when the patient support 110 is in the first orientation. In one embodiment, the patient support 110 includes arm rests that are adjustable in position along the axis of the backrest. Adjusting the vertical position of the arm rests along the axis of the backrest allows patients with varying anthropometric variations to rest their arms in a position that facilitates targeting of specific target areas by the radiation source.

[0082] In an embodiment, the patient support 110 in the second orientation is configured to receive a patient in a generally standing position. In an embodiment, the second orientation includes a backrest 12 that is tilted backward and displaced vertically upward to receive the back of a patient in a generally standing position with bent knees (e.g., a patient in a seated position). Thus, in an embodiment, configuring the patient support 110 in the second orientation includes displacing and / or removing the seat member from the assembly, e.g., by rotating the seat member downward to a position aligned with the plane of the backrest, or otherwise displacing the seat member from its position in the first orientation to a position that does not present an obstacle to the patient's entry into the patient support assembly in the second position and / or does not present an obstacle to the patient being received by the patient support in the second position. Additionally, in an embodiment, the patient support 110 in the second orientation includes a foot brace (e.g., a heel stop) positioned to contact the heels of the patient and support the patient in a generally standing position. In some embodiments, the foot brace (e.g., heel stop) is adjustably attached to a rotatable disk. In some embodiments, the foot brace (e.g., heel stop) is adjustable by translating the foot brace (e.g., heel stop).

[0083] In one embodiment, the seat member 511 is positioned behind the patient's thighs to support the patient's upper thighs when the patient is in a generally standing position with bent knees (e.g., a patient in a sitting position). In one embodiment, the patient support 110 in the second orientation includes a shin pad 13 in front of the patient's ankles, for example, to contact the patient's shin when the patient is in a generally standing position. In this configuration, the patient is supported by the shin pad 13 and the backrest 12. In one embodiment, the shin pad receives the patient's shin aligned generally vertically with the ankle, although other configurations are possible. In one embodiment, the shin pad is positioned such that a patient in a generally standing position (e.g., with a torso tilted about 10° relative to a vertical axis) is positioned with the hips flexed at an angle of about 150° measured between the torso and thighs. Such a configuration maintains the patient in a stable, comfortable position, for example, one that allows the patient to remain stationary and comfortable in a generally standing position with hips and knees flexed, while the patient's weight is supported by the backrest and shin rest. In some embodiments, the hips are flexed at between about 135° and about 165°, between about 145° and about 155°, or another suitable angle, measured between the torso and thighs. In some embodiments, the selection of the angle of the hips depends on factors including the size of the patient, the angle of posterior tilt of the patient's torso, and / or the patient's range of comfort and / or mobility. In some embodiments, the position of the adjustable armrest is selected such that the patient's upper arms are at an angle of about 25° relative to a horizontal plane perpendicular to the vertical axis of rotation. Such a position provides comfortable, stable support for a patient with arms above the chest, for example, to allow the chest area to be targeted by the radiation source.

[0084] In one embodiment, the patient support 110 in the second orientation comprises a shin pad 13 in front of the patient's ankle, for example for contacting the patient's shin when the patient is in a generally standing position, and a foot brace 14 (e.g., heel stop) behind the patient's foot, for example for contacting the patient's heel when the patient is in a generally standing position. In this configuration, the patient is supported by the shin pad 13, the foot brace 14 (e.g., heel stop), and the backrest 12. In one embodiment, the shin pad receives the patient's shin in approximately vertical alignment with the ankle, although other configurations are possible. In one embodiment, the shin pad is positioned such that the patient in a generally standing position (e.g., with a torso tilted about 10° relative to a vertical axis) is positioned with the hips flexed at an angle of about 150° measured between the torso and the thighs. Such a configuration maintains the patient in a stable and comfortable position, e.g., a position that allows the patient to remain stationary and comfortable in a generally standing position with hips and knees flexed, while the patient's weight is supported by the backrest, shin guards, and foot braces (e.g., heel stops). In some embodiments, the hips are flexed at between about 135° and about 165°, between about 145° and about 155°, or another suitable angle, measured between the torso and thighs. In some embodiments, the selection of the angle of the hips depends on factors including the size of the patient, the angle of posterior tilt of the patient's torso, and / or the patient's range of comfort and / or mobility. In some embodiments, the position of the adjustable armrest is selected such that the patient's upper arms are at an angle of about 25° relative to a horizontal plane perpendicular to the vertical axis of rotation. Such a position provides comfortable and stable support for a patient with arms above the chest, for example, to allow the chest area to be targeted by the radiation source.

[0085] In one embodiment, the configurable patient support 110 includes a generally elongated upright structure having an integral backrest including a padded material contoured to conform to the patient's anatomy, e.g., the curvature of the patient's back. In one embodiment, the integral backrest includes a contoured component provided by a rigid or semi-rigid cushion that is specifically shaped to complement the shape of the patient's body, e.g., the patient's back. In one embodiment, the contoured component is a cushion configured to mold to the patient's body and retain the molded shape when gas within the cushion is removed (e.g., by providing a vacuum that is drawn through a self-sealing quick release valve in the cushion). After gas is removed from the cushion, the cushion retains its shape (e.g., for 1-6 weeks or more). In one exemplary embodiment, the contoured component is provided by a VAC-LOK cushion available from CIVCO Radiotherapy. Similar products are available from other vendors.

[0086] In an embodiment, the present technology provides a patient support assembly with an integrated patient support (and optionally a patient immobilization system). In an embodiment, the backrest is adapted to maintain the patient's back at an angle relative to a vertical axis. The patient-receiving side of the backrest is tilted backward relative to the vertical axis, and the patient-receiving side faces the vertical axis. The backrest is vertically adjustable to receive the patient's back in either a first orientation or a second orientation. In an embodiment, the backrest is configured to slide along an axis tilted at an angle relative to the vertical axis. In an embodiment, the backrest is vertically adjustable by about 400 mm between the first orientation and the second orientation to accommodate a patient having a height between the 95th percentile American male and the 5th percentile American female. Additionally, the patient support assembly is mounted to a rotatable structure (e.g., a rotatable disk, a rotatable platform) to provide rotation of the patient support assembly (and rotation of the patient, if the patient support assembly is supporting a patient) about a vertical axis.

[0087] In one embodiment, the backrest 12 is attached to the patient support 110 by a locking interface, as described further below.

[0088] In some embodiments, the vertical position of the backrest is adjustable independent of vertical movement of the patient. For example, in some embodiments, vertical movement of the patient is effected by a translatable member or by vertical movement of the patient support assembly relative to the translatable member (e.g., the patient support assembly is movably mounted to the translatable member such that the patient support assembly is adapted to rotate and / or move vertically relative to the translatable member). Thus, the patient's vertical position can be adjusted without affecting the patient's posture relative to the patient support assembly.

[0089] Adjusting the vertical position of the backrest may affect the patient's posture and cause undesired movements (e.g., changing the range of the patient's legs) and thus undesired movements of the patient's organs. Furthermore, if the treatment or imaging plan involves contacting the patient with a beam that impinges on the patient in a helical pattern, the patient is vertically moved and rotated during treatment or imaging while the patient's posture on the patient support assembly remains constant or unchanged. Thus, the embodiments provide for independent adjustment of the patient's posture relative to the patient support assembly and the vertical position relative to the patient support system and / or beamline. Thus, in an embodiment, a first actuator or a first set of actuators is provided to adjust the patient's posture relative to the patient support assembly by adjusting the vertical position of the backrest. In an embodiment, such movements are performed while the radiation source is off (e.g., to adjust the patient's posture for treatment or imaging or to improve the patient's comfort). Additionally, in some embodiments, a second actuator or a second set of actuators is provided to adjust the vertical position of the patient relative to the patient support system and / or the beamline, for example to move the patient while the radiation source is on or to move the patient into alignment with a treatment or imaging plan, isocenter, or beamline.

[0090] In an embodiment, the first and second actuators, or the first and second sets of actuators, operate (e.g., independently or simultaneously) to facilitate entry or exit of a patient from the patient positioning system, e.g., by moving components to a static configuration that facilitates entry and / or exit, and / or by operably engaging the patient and applying a force to the patient to facilitate entry and / or exit, e.g., as described further herein. In an embodiment, other elements of the patient positioning system are adjustable independent of the vertical movement of the patient. For example, in an embodiment, a third actuator or a third set of actuators is provided to adjust the tilt, orientation, or vertical position of the seat member, e.g., as described further below. For example, the seat member may be used to assist in positioning a non-ambulatory patient from a wheelchair into the patient positioning system. As a further example, adjusting the seat member can help adjust the vertical position of the patient.

[0091] In some embodiments, the shin pads are adjustably attached to the rotatable disks and are therefore configurable between a first position and a second position when the patient support assembly is in a first orientation and a second orientation, respectively. In some embodiments, the shin pads include a padded member aligned substantially vertically to receive the patient's shin. In some embodiments, the shin pads are adjustable to vary the width between the shin support for the left leg and the shin support for the right leg. For example, in some embodiments, the shin pads have an adjustable width to accommodate and comfortably and stably support a range of patients having a range of widths between their legs and / or shins. In some embodiments, the patient support includes interchangeable shin pads of different sizes to accommodate and comfortably and stably support patients having a range of widths between their legs and / or shins. In some embodiments, handrails (e.g., stabilizing bars) are attached to the patient support (e.g., to the shin pads) to provide support to the patient, e.g., to support the patient's entry into the patient support, to assist in positioning the patient on the patient support, and / or to support the patient's exit from the patient support.

[0092] In some embodiments, the shin rest is adjustably attached to the rotating disc, for example to provide an adjustable position relative to the backrest. In some embodiments, in a first orientation, the shin rest is positioned below the seat member so as not to contact a seated patient supported by the patient support assembly. In some embodiments, in a second orientation, the shin rest is positioned in front of the backrest to support the patient's shin when the patient's back is positioned against the backrest. Alternatively, embodiments provide that in both the first and second orientations, the shin rest portion may be adjustable and positioned relative to the patient's shin, thus supporting the patient's shin. In some embodiments, the shin rest may be slidably attached to the rotating disc and locked in place. In some embodiments, the shin rest further stabilizes the patient by providing a support surface against which the patient rests. The rotational speed of the patient support is low enough that centrifugal forces are negligible and do not destabilize the patient during imaging, but in some embodiments, the shin rest can provide stabilization of the patient during rotation.

[0093] In some embodiments, the patient support 110 includes a foot rest 14 (e.g., a heel stop) for maintaining the patient's foot in the second orientation. In some embodiments, the foot rest further maintains the patient's foot in both the first and second orientations of the patient support assembly. In some embodiments, the rotating disk to which the patient support assembly is attached is also the foot rest. In some embodiments, the foot rest (e.g., a raised foot rest and / or a heel stop) is provided as a separate component and is distinct from the rotating disk.

[0094] In some embodiments, the foot rest 14 is a heel stop. In some embodiments, the heel stop is adjustably mounted to the rotatable disk. In some embodiments, the heel stop comprises a padded member for receiving the heel of the patient. In some embodiments, the heel stop is adjustable by translating the heel stop. In some embodiments, the heel stop is slidably mounted relative to the rotating disk and may be locked in place. In some embodiments, a fourth actuator or a fourth set of actuators is provided to adjust the position of the heel stop. In some embodiments, the heel stop is adjusted to a position that facilitates ingress or egress of the patient from the patient positioning system, for example, by positioning the heel stop below a seat member.

[0095] In some embodiments, the patient support assembly described herein provides three points of contact with the patient, namely, a seat member, a back rest, and a shin rest. In some embodiments, the patient support assembly described herein in a first (e.g., sitting) orientation provides three points of contact with the patient, namely, a seat member, a back rest, and a shin rest. In some embodiments, the patient support assembly described herein in a second (e.g., standing or edge sitting) orientation provides three points of contact with the patient, namely, a seat member, a back rest, and a shin rest. In some embodiments, the patient support assembly described herein in a second (e.g., standing or edge sitting) orientation provides three points of contact with the patient, namely, a back rest, a shin rest, and a foot brace (e.g., a heel stop).

[0096] In some embodiments, the patient support assembly described herein provides four points of contact with the patient, namely, a foot rest (e.g., as provided by a rotating disk), a seat member, a back rest, and a shin rest. In some embodiments, the patient support assembly described herein in a first (e.g., sitting) orientation provides four points of contact with the patient, namely, a foot rest (e.g., as provided by a rotating disk), a seat member, a back rest, and a shin rest. In some embodiments, the patient support assembly described herein in a second (e.g., standing or edge sitting) orientation provides four points of contact with the patient, namely, a foot rest (e.g., as provided by a rotating disk), a seat member, a back rest, and a shin rest. In some embodiments, the patient support assembly described herein provides four points of contact with the patient, namely, a heel stop, a seat member, a back rest, and a shin rest. In some embodiments, the patient support assembly in a first (e.g., sitting) orientation described herein provides four contact points with the patient: a heel stop, a seat member, a backrest, and a shin rest. In some embodiments, the patient support assembly in a second (e.g., standing or edge sitting) orientation described herein provides four contact points with the patient: a heel stop, a seat member, a backrest, and a shin rest. All four contact points contact and support the patient in the first and second orientations of the patient support assembly, but in some embodiments the shin rest is less important for stabilizing the patient in the first (e.g., sitting) orientation and the seat member is less important for stabilizing the patient in the second (e.g., standing or edge sitting) orientation. Nevertheless, the shin pad in the first (e.g., sitting) orientation helps to rejuvenate the patient and prevent the patient from slouching over time (e.g., due to fatigue), and the seat member in the second (e.g., standing or edge-sitting) orientation helps to prevent lateral movement of the hips and index the patient (as well as support some of the weight).

[0097] Thus, the patient support assemblies described herein provide at least three primary contact points with the patient to support the patient, e.g., at least three of the foot rest (e.g., as provided by a rotating disk and / or heel stop), the seat member, the back rest, and / or the shin rest. The at least three contact points improve patient comfort by supporting or maintaining the patient by contacting three different areas of the patient's body. Thus, the patient is maintained in a comfortable position continuously for extended periods of time during imaging and / or treatment. Additionally, the at least three contact points improve patient stability by minimizing and / or eliminating patient movement, as compared to configurations having, e.g., less than three contact points. For example, in some conventional patient positioning techniques, less than three contact points may require the patient to apply force to maintain position, especially when in the second orientation. Repeatability of patient position may also be improved by providing at least three contact points as described herein.

[0098] However, depending on the patient's position, one or more components of the patient support assembly (e.g., the backrest, the seat member, the shin guards, the foot braces (e.g., heel stops), and / or the arm rests) may not need to maintain or support the patient (e.g., in either the first or second configuration). For example, in some embodiments, the patient support assembly supports the patient at three or more different points along the patient's body. In some embodiments, the at least three support areas of the patient include one or more end points of the patient (e.g., the patient's feet) or areas near the patient's mobile joints (e.g., knees, shoulders, hips). In this manner, the patient support assembly can help the patient maintain a predetermined position.

[0099] In one embodiment, the seat member is attached to the patient support assembly by a pivot base such that the seat member is positioned to extend outwardly from the backrest when the patient support assembly is in a first orientation, thereby providing support for the hips of a seated patient when the patient's back is positioned against the backrest, and such that the seat member is positioned downwardly about the pivot axis to lie toward the same plane as the backrest, and thus away from a patient received by the patient support assembly in the second position.

[0100] In some embodiments, the armrests are adjustably attached to the patient support assembly such that their position can be adjusted relative to the backrest to accommodate patients of different sizes. The adjustability of the armrests can also facilitate the patient's arms being supported in various positions to allow the radiation source to target specific portions of the patient's anatomy. For example, in some embodiments, positioning the armrests in a high vertical position relative to the backrest allows the armrests to accommodate the patient's arms above chest height and can help maintain the patient in a stable position by providing comfortable support. In some embodiments, the armrests support the weight of the patient's upper arms and help maintain and replicate a specific positional configuration for the patient's upper body. In some embodiments, the armrests further stabilize the patient during movement (translation and / or rotation) of the patient support assembly. In some embodiments, the armrests support the patient's arms in a position that does not interfere with the imaging beam and / or the treatment beam. For example, in some embodiments, the armrests position the arms in a comfortable position that is not between the radiation source and the treatment area. In certain embodiments (e.g., for treating the chest (e.g., breast)), one or both of the patient's arms are at an angle greater than 90 degrees to the torso (e.g., one or both arms are positioned at or above shoulder height) such that the beam contacts the treatment area without contacting the patient's arms. In other words, embodiments provide armrests that support the patient's arms in a comfortable, stable position that does not interfere with the treatment beam and / or imaging beam (e.g., above the patient's head), thus introducing minimal or no additional beam scatter.

[0101] In some embodiments, the patient positioning system includes a headrest whose position is vertically adjustable to accommodate patients of various sizes. In some embodiments, the headrest is slidably connected to the backrest to achieve a vertical position of the headrest relative to the backrest, e.g., to accommodate and provide comfortable support for patients of various sizes. In some embodiments, the patient positioning system in a first orientation is suitable for targeting the radiation source to the patient's head, neck, breasts, and / or lungs.

[0102] In some embodiments, the second orientation includes the seat member folded downward about its pivotable connection into alignment with the plane of the backrest, the backrest adjusted vertically upward along the backrest's inclined axis, the shin guard adjusted horizontally away from the backrest, and the armrest adjusted vertically relative to the backrest. In some embodiments, the second orientation further includes a heel stop adjusted horizontally (e.g., by translating the heel stop in the plane of the rotatable disk). In some embodiments, the heel stop is positioned to contact the patient's heel. In some embodiments, the second orientation further includes arm rests in various positions rotated along a generally lateral patient axis to comfortably accommodate the patient in various treatment positions.

[0103] For example, a patient positioning system adapted to receive a patient in a second orientation with the torso tilted backwards relative to a vertical axis and the ankles supported by shin guards (and in some embodiments by foot braces (e.g., heel stops)) is advantageous because the patient position is generally self-supporting and comfortable. Thus, the patient can comfortably maintain the required treatment position using the assembly for a significant period of time. Nevertheless, in addition to the main components of the patient support assembly (e.g., backrest, shin guards, seat member, armrests, foot braces (e.g., heel stops), and headrest), some embodiments further include additional components (e.g., harnesses, inflatable elements, elongated straps, etc.) for providing supplemental support, stability, and / or immobilization.

[0104] In one exemplary embodiment, a backrest (e.g., for supporting or supporting a patient's back) is attached to a pillar or support for supporting the backrest. The pillar itself is attached to a platform, base, or surface. The patient support assembly further comprises a seat member for supporting or supporting the patient's rear, buttocks, or thighs. The seat member is attached to the pillar adjacent to the backrest. In another example, the seat member is attached to the backrest. The backrest and seat member are pivotally attached to the pillar to adjust their respective inclinations. Also, the vertical height of the pillar is adjustable to adjust the vertical height of the backrest and seat member.

[0105] In an exemplary embodiment, the patient support assembly further comprises a shin guard for supporting or supporting the patient's shin (e.g., the front of the patient's leg, e.g., between the knee and the ankle). The shin guard is attached to a platform in front of the backrest and the seat member. The shin guard is offset from the backrest so as to face the patient's shin when the patient is positioned with his or her back against the backrest. In an embodiment, the platform comprises a plurality of holes for receiving complementary mating members of the shin guard mounting base. The holes are provided at a plurality of horizontal offsets relative to the backrest, and the horizontal distance between the backrest and the shin guard is adjusted by mounting the shin guard in the different holes. In an embodiment, a mechanism is provided for providing continuous adjustment of the horizontal distance between the shin guard and the backrest, for example, using a rail along which the shin guard can be moved and a corresponding locking mechanism for fixing the shin guard at a particular position along the rail.

[0106] The backrest, seat member, and shin pads may comprise substantially flat surfaces and may further comprise padding for accommodating respective areas of the patient's body.

[0107] In some embodiments, the patient support assembly further comprises a pair of foot braces (e.g., heel stops) for immobilizing the patient's feet. In some embodiments, the foot braces (e.g., heel stops) are attached to the platform between the backrest and the shin pad. In some embodiments, the foot braces (e.g., heel stops) are attached to a rotatable disk between the backrest and the shin pad.

[0108] In some embodiments, the foot brace includes a heel stop. In some embodiments, the heel stop is provided to provide a surface for contacting the patient's heel when the patient has his / her back positioned against the back rest. In some embodiments, the platform includes a plurality of holes for receiving complementary mating members of the heel stop. The holes are provided at a plurality of horizontal offsets relative to the back rest, and the horizontal distance between the back rest and the heel stop is adjusted by mounting the heel stop in the different holes. In some embodiments, a mechanism is provided for providing continuous adjustment of the horizontal distance between the heel stop and the back rest, for example, using a rail along which the heel stop can be moved and a corresponding locking mechanism for fixing the heel stop at a particular position along the rail. In some embodiments, the foot brace includes a strap, clasp, or other arch piece adapted to fasten over the top of the patient's foot to secure the patient's foot to the platform. In other examples, means other than a foot brace for securing the patient's foot to the platform are provided, for example, a foot-shaped recess or a raised foot stop.

[0109] In an embodiment, the patient support assembly further comprises one or two armrests or arm supports for maintaining one or both arms of the patient. One or both armrests are attached to the backrest at the left and right sides of the backrest to receive one or both left and right arms of the patient, respectively. The vertical heights of the armrests, as well as their positions relative to the backrest, are adjusted to accommodate patients of different sizes and different patient positions. Each armrest comprises a bent portion for receiving a portion of the patient's upper arm extending between the shoulder and elbow. The bent portion is pivotally attached to an arm connected to the backrest to orient the bent portion to conform to the patient's body dimensions. The armrests can maintain the patient's arms in a predetermined position, such as an overhead position as shown, or a downward lateral position, such that the arms are positioned to the left and right sides of the patient, respectively.

[0110] In one embodiment, the patient support assembly in the second configuration supports the patient in a generally standing position, and further, the armrests engage the patient's upper arms to maintain the arms in an overhead position, and the arms are tilted vertically upward and extend above the patient's head.

[0111] In an exemplary embodiment, the second configuration of the patient support assembly maintains the patient in a generally standing position with the patient's thighs extending at least partially along a vertical direction and the patient's knees bent relative to the thighs. Further, in some embodiments, the patient's back is supported by a backrest, the patient's buttocks are supported by a seat member, and the patient's shins are supported by shin pads. In some embodiments, the patient's back is supported by a backrest, the patient's shins are supported by shin pads, and the patient's feet (e.g., heels) are supported by foot braces (e.g., heel stops). In some embodiments, the patient's feet are not secured by foot braces positioned behind the patient's ankles. In some embodiments, the patient's feet (e.g., heels) are secured by foot braces (e.g., heel stops), and the patient's shins are not secured by shin pads that are moved away from the patient's shins. In some embodiments, the patient's arms are supported in an overhead position by arm rests. Alternatively, in some embodiments, the patient's arms are positioned to extend downward at the patient's sides.

[0112] In an exemplary embodiment, the first configuration of the patient support assembly maintains the patient in a seated position with the patient's thighs extending along a substantially horizontal direction and the patient's knees bent approximately perpendicular to the thighs. Additionally, in an embodiment, the patient's back is maintained by the backrest, the patient's buttocks are maintained by the seat member, and the patient's shins are maintained by the shin guards, thus minimizing and / or eliminating movement that may cause the patient to slide forward along the seat member. In an embodiment, the patient's feet (e.g., heels) are also maintained by foot braces (e.g., heel stops). In an embodiment, the patient's feet are not immobilized by foot braces positioned behind the patient's ankles. In an embodiment, the patient's feet (e.g., heels) are immobilized by foot braces (e.g., heel stops), and the shin guards are moved away from the patient's shins. In an embodiment, the patient's arms are positioned to extend downward at the patient's sides. In an embodiment, the patient's arms are maintained in an overhead position by arm rests.

[0113] As described herein, embodiments provide that the patient support 110 is mounted to a rotatable structure, such as a rotating disk of a translatable member, to rotate the patient support assembly about a vertical axis. For example, in some embodiments, a platform is mounted to the rotating disk. In some embodiments, the platform is integrally formed with and forms part of the rotating disk.

[0114] In some embodiments, the patient support assembly is configured to move or translate along a vertical direction. For example, in some embodiments, the patient support assembly is mounted above a scissor dift mechanism 310, e.g., as described herein. Thus, the vertical position of the patient support assembly and the patient can be adjusted without affecting the configuration of the patient support assembly or the position of the patient relative to the patient support assembly. In some embodiments, the patient support assembly and the translatable member share the same vertical axis.

[0115] As described herein, the present technology provides a backrest with adjustable inclination relative to a vertical axis. In some embodiments, the plane of the backrest is parallel to the vertical axis of the patient support assembly, e.g., to provide the patient's torso in a predetermined position that is substantially vertically oriented. In some embodiments, the plane of the backrest is inclined clockwise relative to the vertical axis (e.g., the backrest is inclined backward relative to the vertical axis), e.g., to provide the patient's torso in a position that is inclined backward relative to the vertical axis. In some embodiments, the plane of the backrest is inclined counterclockwise relative to the vertical axis (e.g., the backrest is inclined forward relative to the vertical axis), e.g., to provide the patient's torso in a position that is inclined forward relative to the vertical axis.

[0116] In an embodiment, the configurable patient support 110 is adapted to tilt or pivot relative to the horizontal plane of the translatable member or any other fixed horizontal plane. In an embodiment, the platform 11 is pivotally mounted to the translatable member such that the patient support 110 tilts or pivots about a point on the platform, and the tilt point is the center point of the platform or any other point located within an area defined by the platform. For example, in an embodiment, the platform is mounted to a rounded member (including, for example, a sphere, hemisphere, a portion of a sphere, or other rounded surface shape), and the platform can tilt and rotate relative to the rounded member. Thus, pivoting the platform 11 about the rounded member provides two degrees of freedom for the pitch and roll of the platform relative to the rounded member. In an embodiment, this degree of freedom of movement is used to tilt the patient support 110 and the patient, for example, to adjust the angular position of the patient for alignment with a treatment plan or imaging plan, or to avoid irradiation of areas of the patient not intended for radiation treatment or imaging. Attachment of the platform to a rounded member (e.g., coupled to the front of the platform), such as a ball joint or other rounded joint, provides a fixed reference point in space about which angular motion is directed. In some embodiments, to improve the stability of the base, multiple actuators are provided to control the orientation and magnitude of tilt of the base relative to the rounded member. For example, in some embodiments, two actuators are provided at the rear of the base, such that moving both rear actuators together will pitch the base, and moving the rear actuators differently will roll the base. The base moves about a spherical joint at the center of the base, and a rounded member coupled to the front of the base allows pitch and roll motion, but prevents yaw motion.

[0117] In some embodiments, the patient support 110 comprises a pivotable base. In some embodiments, the pivotable base further comprises a platform to which the patient support assembly is mounted, the platform being pivotally connected to a stand by a spherical joint. The stand is attached to a fixed surface or rotating disk of the translatable member. In some embodiments, the pivotable base further comprises a plurality of actuators (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more actuators).

[0118] For example, in an embodiment, the pivotable base comprises three actuators connected between the platform and the stand, for example, to pivot the platform around the spherical joint relative to the stand. In an exemplary embodiment, the three actuators comprise one front actuator located proximate the spherical joint and engaging a first side of the platform, and two rear actuators located distal to the spherical joint and engaging a second side of the platform opposite the first side. In an embodiment, the actuators generate pitch motion of the platform, the front actuator providing a push-pull configuration with the rear actuator, for example, when the rear actuator expands, the front actuator contracts and vice versa. In an embodiment, the actuators generate roll motion of the platform, the rear actuators being in a push-pull configuration with each other without significant movement within the front actuator. The spherical joint (and thus the pivot point of the pivotable base) is located offset from the geometric center of the platform. In an embodiment, the pivot point of the pivotable base is displaced or offset from the center of the base and the isocenter of the treatment or imaging system. In certain embodiments, the actuators are arranged with three actuators in a triangular configuration with the pivot point located proximate to one of the actuators to reduce yaw motion resulting from a combination of pitch and roll relative to a configuration in which the pivot points are equidistant or substantially equidistant from all actuators. In an embodiment, the configuration of pivot points and actuators is such that the majority of the patient support assembly and patient weight is located between the spherical joint and the rear actuator.

[0119] For example, in one embodiment, the pivotable base includes two actuators connected between the platform and the stand, e.g., to pivot the platform around a spherical joint in the center of the base, and a rounded member (e.g., a second spherical joint) connected to the front of the base prevents yaw motion. In an exemplary embodiment, the front rounded member is located proximate to the central spherical joint and engages a first side of the platform, and the two rear actuators are located distal to the spherical joints and engage a second side of the platform opposite the first side. In one embodiment, the rear actuators generate pitch motion of the platform, and the rear actuators provide a push-push or pull-pull configuration, e.g., both rear actuators extend or both rear actuators retract. In one embodiment, the rear actuators generate roll motion of the platform, and the rear actuators are in a push-pull configuration with respect to each other, e.g., the first rear actuator extends and the second rear actuator retracts. The spherical joint (and thus the pivot point of the pivotable base) is positioned offset from the geometric center of the platform. In an embodiment, the pivot point of the pivotable base is displaced or offset from the center of the base and the isocenter of the treatment or imaging system. In a particular embodiment, the two rear actuators are arranged in a triangular configuration with the front rounded member, and the pivot point is located proximate to the rounded member to reduce and / or eliminate yaw motion resulting from a combination of pitch and roll, relative to a configuration in which the pivot point is equidistant or substantially equidistant from all points of the triangle (e.g., comprising the two rear actuators and the rounded member). In an embodiment, the configuration of the pivot points and actuators is such that the majority of the patient support assembly and the patient's weight is located between the spherical joint and the rear actuator.

[0120] In some embodiments, the patient support 110 is translatable in a horizontal plane, for example, in addition to being rotatable about a vertical axis. In some embodiments, the patient support 110 is translatable in a horizontal plane that is orthogonal to the vertical axis of rotation. In some embodiments, the patient support 110 comprises two pairs of parallel rails in an orthogonal relationship, with the patient support 110 slidably connected to a first pair of rails for translation in a first orthogonal direction, and the first set of rails slidably connected to a second pair of rails for translation in a second orthogonal direction.

[0121] Configurable Patent Support In an embodiment, the present technology provides a configurable patient support 110 that includes one or more configurable and movable components, such as a backrest 12 (e.g., a configurable and movable backrest), a headrest (e.g., a configurable and movable headrest), an armrest (e.g., a configurable and movable armrest), a seat member 511 (e.g., a configurable and movable seat member), a shin pad 13 (e.g., a configurable and movable shin pad), and / or a foot brace 14 (e.g., a configurable and movable foot brace). In an embodiment, the foot brace 14 is a heel stop. In some embodiments, the one or more configurable, moveable components of the configurable patient support 110 include one or more powered components, such as a powered backrest (e.g., a backrest operably engaged with a backrest motor), a powered headrest (e.g., a headrest operably engaged with a headrest motor), a powered armrest (e.g., an armrest operably engaged with an armrest motor), a powered seat member (e.g., a seat member operably engaged with a seat member motor), a powered shin guard (e.g., a shin guard operably engaged with a shin guard motor), and / or a powered foot brace (e.g., a foot brace operably engaged with a foot brace motor). In some embodiments, the powered foot brace is a powered heel stop (e.g., a heel stop operably engaged with a heel stop motor).

[0122] In an embodiment, the backrest motor is configured to move (e.g., translate and / or rotate) the backrest, the headrest motor is configured to move (e.g., translate and / or rotate) the headrest, the armrest motor is configured to move (e.g., translate and / or rotate) the armrest, the seat member motor is configured to move (e.g., translate and / or rotate) the seam member, the shin guard motor is configured to move (e.g., translate and / or rotate) the shin guard, and / or the foot brace motor (e.g., heel stop motor) is configured to move (e.g., translate and / or rotate) the foot brace (e.g., heel stop). In an embodiment, the present technology provides a configurable patient support 110 configured in a static configuration. In an embodiment, the present technology provides a configurable patient support 110 configured in a dynamic configuration (e.g., a configuration that moves to assist with patient movement for patient ingress and / or patient egress, etc.).

[0123] In an embodiment, the present technology provides components (e.g., computers, microcontrollers, and / or microprocessors) configured to coordinate control and / or movement of one or more powered components, e.g., a powered backrest, a powered headrest, a powered armrest, a powered seat member, a powered shin guard, and / or a powered foot brace (e.g., a powered heel stop) to provide the configurable patient support in one or more specific configurations with the powered backrest, the powered headrest, the powered armrest, the powered seat member, the powered shin guard, and / or the powered foot brace (e.g., a powered heel stop) in a specified position. In an embodiment, the configurable patient support 110 may be configured in specific configurations including, for example, a patient entry state configured for patient entry into the patient support, a patient wait state configured to support the patient after patient entry while the patient is waiting to be imaged and / or treated (e.g., prior to patient imaging and / or patient treatment), a patient imaging state / treatment state configured to support the patient while the patient is being imaged and / or treated, and / or a patient exit state configured for patient exit from the patient support.

[0124] In one embodiment, a component (e.g., a computer, microcontroller, and / or microprocessor) configured to coordinate the control and / or movement of motorized components (e.g., a motorized backrest, a motorized headrest, a motorized armrests, a motorized seat member, a motorized shin pad, and / or a motorized foot brace (e.g., a motorized heel stop)) to provide the configurable patient support 110 into one or more specific configurations is configured to operate and / or control the backrest motor, the headrest motor, the armrest motor, the seat member motor, the shin pad motor, and / or the foot brace motor (e.g., a heel stop motor). In one embodiment, activating one or more powered components (e.g., a powered backrest, a powered headrest, a powered armrest, a powered seat member, a powered shin guard, and / or a powered foot brace (e.g., a powered heel stop)) includes placing the one or more powered components in an “on” state (e.g., by supplying current and / or voltage to the one or more powered components (e.g., to a motor operably coupled to the powered components)) or setting the one or more powered components in an “off” state (e.g., by removing current and / or voltage to the one or more powered components (e.g., to a motor operably coupled to the powered components)). In one embodiment, actuating one or more of the powered components (e.g., a powered backrest, a powered headrest, a powered armrest, a powered seat member, a powered shin guard, and / or a powered foot brace (e.g., a powered heel stop)) includes controlling the linear and / or rotational velocity and / or controlling the linear and / or rotational acceleration of the one or more powered components (e.g., by controlling the linear and / or rotational velocity and / or by controlling the linear and / or rotational acceleration of a motor operably coupled to the powered component).

[0125] In an embodiment, the technology includes software (e.g., software objects) including instructions for a specified position and / or specified movement (e.g., coordinated movement) of one or more motorized components, e.g., a powered backrest, a powered headrest, a powered armrest, a powered seat member, a powered shin guard, and / or a powered foot brace (e.g., a powered heel stop), and an associated computer memory for storing the software and / or for storing data describing one or more positions of a configurable patient support and / or one or more positions of the motorized components of the configurable patient support. In an embodiment, a method is provided for moving one or more of the motorized components. In an embodiment, the data and / or data structures describing the positions and / or specified movements of the motorized components are provided as object data structures. An embodiment provides an object oriented pipeline for moving one or more motorized components, e.g., including one or more software objects, to move one or more motorized components.

[0126] In an embodiment, the position of the configurable patient support 110 and / or the positions of the motorized components of the configurable patient support are specific to an individual patient, specific to an individual imaging and / or treatment plan, and / or specific to an individual imaging and / or treatment plan for an individual patient. In an embodiment, data and / or data structures describing the positions of the motorized components of the configurable patient support are provided as object data structures.

[0127] In an embodiment, the configurable patient support 110 is configured for patient entry into the patient support, e.g., the configurable patient support is configured to move to a patient entry state, e.g., to provide a static configuration that is a patient entry state. The patient support configured in the patient entry state includes a backrest, a headrest, armrests, a seat member, shin rests, and / or a foot brace (e.g., heel stop) in a position that facilitates patient entry into the patient support. For example, the backrest, headrest, armrests, seat member, shin rests, and / or a foot brace (e.g., heel stop) are in a position that allows easy patient access to the patient support and does not impede patient entry into the patient support. In an embodiment, the patient entry state is configured to facilitate patient entry into a standing position. In an embodiment, the patient entry state is configured to facilitate patient entry into a sitting position.

[0128] In an embodiment, the configurable patient support 110 is configured to provide dynamic configurations to assist in patient entry onto the patient support, for example, by supporting the patient and / or by applying a force to the patient to guide, push, or pull the patient into position on the configurable patient support. For example, in an embodiment, the configurable patient support 110 is configured to contact, operably engage, and apply a force to at least a portion of the patient (e.g., arms, legs, torso, head, feet, hands, hips, knees, elbows) to facilitate entry onto the patient support. In an embodiment, one or more of the backrest, headrest, armrests, seat member, shin guards, and / or foot braces (e.g., heel stops) contact, operably engage, and apply a force to at least a portion of the patient (e.g., arms, legs, torso, head, feet, hands, hips, knees, elbows) to facilitate entry onto the patient support. In some embodiments, one or more of the backrest, headrest, armrests, seat member, shin rests, and / or foot braces (e.g., heel stops) move to guide the patient to facilitate the patient's entry into the patient support.

[0129] In an embodiment, the configurable patient support 110 is configured to move to a static configuration that is a patient wait state, e.g., to provide a stable, comfortable support for a patient who has entered the patient support and is awaiting imaging and / or treatment (e.g., a patient who has entered the patient support but is not yet in a final position to be imaged or treated). The patient wait state may be the same as or similar to the patient imaging / treatment state, and in an embodiment, the patient wait state is different from the patient imaging / treatment state. The patient wait state can include one or more of the backrest, headrest, armrests, seat member, shin rests, and / or foot brace (e.g., heel stop) in a wait position that is different from the position of the backrest, headrest, armrests, seat member, shin rests, and / or foot brace (e.g., heel stop) in the patient entry state. In an embodiment, the patient support configured in the patient standby state includes a backrest, a headrest, armrests, a seat member, a shin guard, and / or a foot brace (e.g., heel stop) in a position to provide comfortable support to the patient after patient entry and prior to imaging and / or treatment of the patient. For example, the backrest, headrest, armrests, seat member, shin guard, and / or foot brace (e.g., heel stop) are in a position to support the patient's body and provide a comfortable seated and / or standing position that minimizes patient movement prior to imaging and / or treatment. In an embodiment, the patient standby state includes one or more of the backrest, headrest, armrests, seat member, shin guard, and / or foot brace (e.g., heel stop) in a standby position that prevents exit from the patient support, although such prevention is a consequence of, and not necessarily required for, the patient standby configuration.

[0130] In one embodiment, the configurable patient support 110 is configured to move to a static configuration, which is a patient imaging / treatment state (FIGS. 5A-5B), for example, to provide a patient imaging / treatment state, which is a stable, comfortable support for maintaining the patient 15 in an imaging and / or treatment position (e.g., a stationary, substantially stationary, and / or effectively stationary position) for imaging and / or treatment.

[0131] In certain embodiments described herein, the radiation source (e.g., imaging beam and / or treatment beam) is fixed in a position such that relative motion between the patient and the treatment or imaging beam is provided by motion of the patient positioning system and / or patient support. Those skilled in the art of medical imaging and radiation therapy understand that any movement of the patient can adversely affect image quality and that any movement of the patient is included as part of the imaging process. Thus, as used herein, a "stationary position" of a patient (e.g., "substantially stationary" and / or "effectively stationary position") refers to a position of the patient where the patient is stationary relative to the patient positioning system and / or relative to the patient support. A patient in a "stationary position" (e.g., "substantially stationary" and / or "effectively stationary position") may, but is not necessarily stationary relative to the treatment or imaging beam, for example, when the patient and patient support are rotated and / or translated relative to the treatment or imaging beam.

[0132] In an embodiment, the configurable patient support 110 moves from a patient entry state to a patient imaging / treatment state. In an embodiment, the configurable patient support 110 moves from a patient standby state to a patient imaging / treatment state. The patient imaging / treatment state may be the same as or similar to the patient standby state, and in an embodiment, the patient imaging / treatment state is different from the patient standby state. The patient imaging / treatment state may include one or more of the backrest, headrest, armrests, seat member, shin rests, and / or foot brace (e.g., heel stop) in an imaging / treatment position that is different from the position of the backrest, headrest, armrests, seat member, shin rests, and / or foot brace (e.g., heel stop) in the patient entry state and / or the patient standby state. In an embodiment, the patient support configured for a patient imaging / treatment state comprises a backrest, a headrest, armrests, a seat member, shin pads, and / or a foot brace (e.g., heel stops) positioned to provide stable, comfortable support to maintain the patient in an imaging and / or treatment position (e.g., a stationary, substantially stationary, and / or effectively stationary position) for imaging the patient and / or treating the patient. For example, the backrest, headrest, armrests, seat member, shin pads, and / or foot brace (e.g., heel stops) in the patient imaging / treatment state are positioned to provide a comfortable seated and / or standing position that supports the patient's body and minimizes and / or eliminates patient movement during imaging and / or treatment.

[0133] In an embodiment, the configurable patient support 110 is configured to move to a static configuration that is a pre-patient exit state, for example to provide a pre-patient exit state that is a stable and comfortable support for a patient who has been imaged and / or treated and is awaiting exit from the patient support. The pre-patient exit state may be the same as or similar to the patient imaging / treatment state, and in an embodiment, the pre-patient exit state is different from the patient imaging / treatment state. In an embodiment, the pre-patient exit state is the same as or similar to the patient waiting state. The pre-patient exit state can include one or more of the backrest, headrest, armrest, seat member, shin rest, and / or foot brace (e.g., heel stop) in a pre-exit position that is different from the position of the backrest, headrest, armrest, seat member, shin rest, and / or foot brace (e.g., heel stop) in the patient imaging / treatment state. The pre-patient exit state can include one or more of the backrest, headrest, armrest, seat member, shin rest, and / or foot brace (e.g., heel stop) in a pre-exit position that is different from the position of the backrest, headrest, armrest, seat member, shin rest, and / or foot brace (e.g., heel stop) in the patient exit state. In an embodiment, the patient support configured in the pre-patient exit state includes the backrest, headrest, armrest, seat member, shin rest, and / or foot brace (e.g., heel stop) in a position that provides comfortable support to the patient after imaging and / or treatment of the patient and before exit of the patient from the patient support. For example, the backrest, headrest, armrest, seat member, shin rest, and / or foot brace (e.g., heel stop) are in a position that provides a comfortable seated and / or standing position that supports the patient's body and minimizes patient movement while the patient awaits exit. In some embodiments, the pre-patient exit state includes one or more of the backrest, headrest, armrests, seat member, shin rests, and / or foot braces (e.g., heel stops) in a pre-exit position that prevents exit from the patient support, although such prevention is a result of the pre-patient exit configuration and is not necessarily required for the pre-patient exit configuration.

[0134] In an embodiment, the configurable patient support 110 is configured to provide dynamic configurations to assist in egress of the patient from the patient support, for example, by providing support for the patient and / or by applying a force to the patient to guide, push, or pull the patient from the patient support and / or from the patient positioning assembly. For example, in an embodiment, the configurable patient support is configured to contact, operably engage, and apply a force to at least a portion of the patient (e.g., arms, legs, torso, head, feet, hands, hips, knees, elbows) to facilitate egress of the patient from the patient support and / or from the patient positioning assembly. In an embodiment, one or more of the backrest, headrest, armrests, seat member, shin guards, and / or foot braces (e.g., heel stops) contact, operably engage, and apply a force to at least a portion of the patient (e.g., arms, legs, torso, head, feet, hands, hips, knees, elbows) to facilitate egress of the patient from the patient support and / or from the patient support assembly. In some embodiments, one or more of the backrest, headrest, armrests, seat member, shin rests, and / or foot braces (e.g., heel stops) move to guide the patient and facilitate egress of the patient from the patient support and / or from the patient support assembly.

[0135] In an embodiment, the configurable patient support 110 is configured to move to a static configuration for patient exit from the patient support and / or from the patient support assembly, e.g., the configurable patient support is configured to move to a patient exit state to provide a static configuration, e.g., a patient exit state. The patient support configured in the patient exit state includes a backrest, a headrest, armrests, a seat member, shin rests, and / or a foot brace (e.g., heel stop) in a position that facilitates patient exit from the patient support and / or from the patient support assembly. For example, the backrest, headrest, armrests, seat member, shin rests, and / or a foot brace (e.g., heel stop) are in a position that allows easy transfer of the patient from the patient support and does not impede the patient exit from the patient support. In an embodiment, the patient exit state is configured to facilitate patient exit in a standing position. In an embodiment, the patient exit state is configured to facilitate patient exit in a sitting position, e.g., by assisting the patient to stand and move away from the patient support and / or away from the patient support assembly.

[0136] As described above, embodiments of the present technology may include a powered seat cushion comprising a powered backrest (e.g., a backrest operably engaged with a backrest motor), a powered headrest (e.g., a headrest operably engaged with a headrest motor), a powered armrest (e.g., an armrest operably engaged with an armrest motor), a powered seat member (e.g., a seat member operably engaged with a seat member motor), a powered shin guard (e.g., a shin guard operably engaged with a shin guard motor), and / or a powered foot brace (e.g., a foot brace operably engaged with a foot brace motor)) and a powered component (e.g., a powered backrest (e.g., a backrest operably engaged with a backrest motor), a powered headrest (e.g., a headrest operably engaged with a headrest motor), a powered armrest (e.g., an armrest operably engaged with an armrest motor), a powered seat member (e.g., a seat member operably engaged with a seat member motor), a powered shin guard (e.g., a shin guard operably engaged with a shin guard motor), and / or a powered foot brace (e.g., a foot brace operably engaged with a foot brace motor)). and a component (e.g., a computer, microcontroller, and / or microprocessor) configured to coordinate the control and / or movement of one or more of the motorized components, software including instructions for the position and / or movement (e.g., coordinated motion) of one or more of the motorized components, and an associated computer memory (e.g., a non-transitory computer readable medium) for storing the software and / or for storing data describing the one or more positions of the configurable patient support and / or the one or more positions of the motorized components of the configurable patient support. In one embodiment, the powered foot brace is a powered heel stop (e.g., a heel stop operatively engaged with a heel stop motor).

[0137] Thus, embodiments of the present technology provide automated, repeatable configuration of a configurable patient support (e.g., automated, repeatable configuration of one or more of a backrest, headrest, armrest, seat member, shin pad, and / or foot brace (e.g., heel stop)). For example, embodiments of the present technology provide customized configurations for individual patients, individual treatment plans, and / or individual imaging plans described by parameters stored in computer memory that can be recalled to reproduce individual configurations for any particular patient and / or treatment plan. The parameters describe the position, path of movement, speed, and / or acceleration of one or more of a backrest, headrest, armrest, seat member, shin pad, and / or foot brace (e.g., heel stop) to provide any of the static and / or dynamic configurations described herein (e.g., a patient entry state, a dynamic configuration to assist in patient entry into the patient support, a patient standby state, a patient imaging / treatment state, a pre-patient exit state, a dynamic configuration to assist in patient exit from the patient support, and / or a patient exit state). In some embodiments, predefined standardized configurations are provided for a particular class of patients (e.g., demographics based on height, weight, imaging or treatment area, gender, race, or other demographic data). In some embodiments, the predefined standardized configurations provide base configurations that are modified to accommodate particular individualized patient characteristics and / or a patient's particular individualized imaging and / or treatment plan.

[0138] Thus, the present technology offers advantages over previous technologies, for example, by providing automated settings that reduce setup time, and by providing reproducible settings that increase the efficacy and safety of treatment.

[0139] 6 degrees of freedom movement and compensation In some embodiments, the patient support 110 is configured to move in six degrees of freedom and further comprises active compensation in at least one degree of freedom while another degree of freedom is adjusted. In some embodiments, active compensation is utilized to keep a desired patient region (e.g., treatment zone, imaging zone) aligned with a treatment or imaging beam. In other words, the compensation ensures that the patient's treatment zone is aligned with the isocenter.

[0140] For example, when a patient 15 is positioned in a patient support 110 that moves in pitch (rotation about the X axis) or roll (rotation about the Y axis), the patient support also translates in the X or Y direction to maintain a desired patient region aligned with a treatment or imaging beam. In other words, rotation of the patient support assembly can move a portion of the patient away from the isocenter beam, and such movement can be compensated for by a corresponding translation to realign. The amount of compensation depends on the amount of rotation and where the desired patient region is located. In some embodiments, a combination of translations in the X and Y directions compensates for the desired patient region moving in an arc trajectory away from the isocenter beam. In some embodiments, the present technology provides a configurable patient support 110 that is movable with a multi-axis actuator system. See, for example, U.S. Patent Application Serial No. 16 / 649,337, published as U.S. Patent Application Publication No. 20200268327, which is incorporated herein by reference.

[0141] 6A-6C, the compensation is shown as successive steps. Figure 6A shows the patient 15 in the patient positioning system 10 in a first orientation. The imaging and / or treatment beam 220 generated by the source 230 is aligned with the desired patient region 210.

[0142] Figure 6B shows the patient 15 in the patient positioning system 10 in a second orientation that has been rotated 235 about axis 240 (e.g., to generate a pitch or roll of the patient positioning system and the patient). As a result of the rotation (e.g., pitch and / or roll) shown in Figure 6B, the desired patient region 210 has moved out of alignment with the imaging beam and / or treatment beam 220 (e.g., the desired patient region 210 has moved out of alignment with the isocenter).

[0143] 6C illustrates the patient 15 in the patient positioning system 10 in a compensated third orientation (e.g., by translating 250 the patient positioning system 10 and the patient 15). Specifically, the patient positioning system 10 is translated 250 to realign the desired patient region 210 with the imaging beam and / or treatment beam 220 (e.g., to realign the desired patient region 210 with the isocenter). In other words, the patient positioning system 10 and the patient 15 positioned thereon are translated to compensate for rotation (e.g., pitch and / or roll) and thus to maintain the desired patient region 210 in alignment with the imaging beam and / or treatment beam 220 (e.g., with the isocenter) as the patient positioning system 10 is rotated or pivoted.

[0144] The technology is not limited to the embodiment shown in FIGS. 6A-6C where the rotation is from a vertical position to a reclined position and the translation is forward and upward. The technology includes compensation for rotation about any axis or axes and appropriate compensation in one, two, and / or three dimensions. In some embodiments, a first rotation is compensated using a second rotation. In some embodiments, a first translation is compensated by a second translation. In some embodiments, a rotation is compensated by a translation. In some embodiments, a translation is compensated by a rotation. In some embodiments, compensation (e.g., translation and / or rotation) occurs simultaneously or substantially simultaneously with the motion (e.g., translation and / or rotation) being compensated for.

[0145] In some embodiments, the compensation is based on a known, fixed isocenter height. For example, for a short (e.g., sitting) patient on a low seat that is positioned by placing the platform high to raise it to the beam height, the radius of the circle from the isocenter to the platform is small, so a small translation is required to compensate for the platform tilt. On the other hand, for a taller patient on a higher seat, the platform is lower to place the treatment site at the isocenter. Thus, the radius between the platform and the isocenter is larger, thus requiring more compensation. The platform height is known, and the seat height is known, which together define the amount of compensation required for any measured pitch and / or roll.

[0146] Techniques for alignment of patient positioning systems, patient positioning equipment, patient supports, patients, quality assurance equipment, and the like, as well as compensation for rotation and translation, are also described in U.S. patent application Ser. No. 63 / 399,862, which is incorporated herein by reference.

[0147] Conventional adjustment systems require an iterative process to move the various cross-coupled axes to achieve the desired compensation, in other words, conventional approaches to compensation involve iterative trial and error.

[0148] Advantageously, the patient positioning system 10 has less mechanical deflection compared to conventional systems. In conventional systems, mechanical deflection of components can cause variations in patient positioning relative to the beamline, resulting in an inaccurate system isocenter. The deflection of the system is typically dependent on the patient positioning and the patient's weight. Conventional systems (e.g., robotic arms) have a large mass that overhangs from the base. For example, in some conventional systems, a large gantry rotates around the patient, and mechanical deflection reduces the precision and / or accuracy of locating the isocenter. The further the patient is from the base, the larger the resulting mechanical deflection. Additionally, the patient's weight provides an additional variable to the amount of mechanical deflection that occurs in conventional systems. Conventional approaches to align and compensate for mechanical deflection include less accurate lasers, and portal imaging, which presents an additional radiation dose to the patient. Conventional approaches to compensate for mechanical deflection must be repeated for each session, increasing the complexity and time of the setup. In contrast, the techniques provided herein that include a patient positioning system define (e.g., locate) the isocenter of the system much more precisely and / or accurately. For example, a treatment may include repositioning a tumor to the isocenter of the system relative to the movement of the patient positioning system. The techniques described herein provide for precise and accurate repositioning because the accuracy of rotation and / or translation of the patient positioning system is improved compared to conventional techniques.

[0149] In the illustrated embodiment, the six degrees of freedom are designed such that the amount of unsupported overhang does not change and remains constant regardless of the patient's position. Thus, the amount of mechanical deflection in the patient positioning system disclosed herein is eliminated and / or minimized when the patient is repositioned within the patient positioning system. An embodiment of the present technology minimizes deflection by minimizing the amount of unsupported overhang. In other words, the patient positioning system moves with the patient in a manner that decouples the variable weight of different patients from the amount of mechanical deflection that occurs.

[0150] In some embodiments, the amount of mechanical deflection that occurs is characterized by a model that combines flexion measurements for a range of positions (without a patient) and flexion measurements with various loads. In some embodiments, a deflection correction table is created based on the model and is automatically applied as the patient positioning system moves. In some embodiments, data for such a model is acquired by an image guidance system or suitable quality assurance tools. See, for example, U.S. Patent Application Serial No. 63 / 396,444, incorporated herein by reference.

[0151] Advantageously, the patient positioning system disclosed herein automatically compensates for mechanical deflection for different patient weights in different patient positions. Conventional designs require imaging of the patient in the treatment position to account for mechanical deflection, which increases patient imaging dose and set-up time.

[0152] In a conventional CT scan, x-rays are produced by an x-ray tube and an x-ray detector is mounted opposite the x-ray tube. Acquiring CT image data involves recording multiple x-ray pictures as a gantry holding the tube and detector rotates in a 360 degree rotation. Due to the mass of a conventional gantry, gravity can cause mechanical deflections in the gantry support arms of the source and / or detector, causing the gantry rotation axis to move. Thus, conventional CT scanning systems often require correction of the CT scan images to compensate for geometric non-idealities in the rotation of the gantry system caused by gravity. Deflection is less of a problem in CT scanners because they conventionally include a balanced ring, but it remains problematic because cone beam CT (CBCT) scanners often have substantial deflections caused by large overhanging arms.

[0153] In certain embodiments, the scanner does not move the imaging source or detector and does not create mechanical deflections that impair image quality, in other words, by not having a rotating source or detector, complex corrections for mechanical deflections of the source or detector are not required.

[0154] Chain Drive and Scissor Lifts In one embodiment, the patient positioning system 10 includes a scissor lift mechanism 310 for, for example, translating the patient support assembly 10 along a vertical direction. In one embodiment, the patient support assembly 10 is mounted above the scissor lift mechanism 310. In the illustrated embodiment, the patient positioning system 10 includes two scissor lift mechanisms 310 disposed on opposite sides.

[0155] 7A and 7B, a scissor lift mechanism 310 is shown in a fully stored (folded) position (FIG. 7A) and a fully deployed position (FIG. 7B). The scissor lift mechanism 310 disclosed herein includes a scissor frame 311 and a chain drive actuator 312 configured to move the scissor lift mechanism 310 between the stored and deployed positions. In the illustrated embodiment, a front side 317 of the scissor frame 311 includes a fixed end 318 that is fixed relative to the platform 11, and a rear side 319 of the scissor frame 311 includes a movable end 320 that is slidable relative to the platform 11.

[0156] 8 and 9, in one embodiment, the chain drive actuator 312 is a push chain drive that includes a housing 317 and a chain 313. The chain 313 includes individual links 314 with interlocking profiles 315 that allow the chain 313 to roll and fold in one direction to form a rigid thrust device. Specifically, an end 316 of the chain 313 is coupled to the platform 11 and applies a normal force to the platform 11 as the chain 313 is driven upward from the housing 317.

[0157] Conventional scissor lifts include conventional actuators designed for peak loads that occur at the end of the scissor frame's travel. For example, the force required with the scissor frame in a folded configuration is greater than when the scissor frame is partially deployed. Conventional actuator designs are either over-designed to handle the peak load conditions (being inefficient at other load conditions) or struggle to lift the platform when it is at its lowest point and peak load.

[0158] 8, the chain drive actuator 312 is positioned at a midpoint 321 of the scissor frame 311 when the scissor frame 311 is in the folded position. Thus, the force required by the chain drive actuator 312 is approximately constant throughout the entire travel of the frame 311. In other words, there is a fixed relationship between the force required by the chain drive actuator 312 and the distance traveled within the scissor frame 311. Weight distribution through the disclosed scissor assembly 310 is also improved as compared to conventional scissor lift mechanisms.

[0159] Advantageously, the disclosed scissor lift assembly 310 is compact. Specifically, the chain drive actuator 312 is a compact actuator capable of the necessary movement between a fully folded position and a fully deployed position. Unlike conventional actuators that have a long overall package to provide the desired movement, the chain drive actuator 312 disclosed herein provides the necessary movement for the scissor frame 311 in a compact form. In one embodiment, the chain drive actuator 312 provides a force of approximately 1 ton.

[0160] Weight detection In one embodiment, the patient positioning system 10 includes a weight sensing assembly 410 having at least one load cell 411. In the illustrated embodiment, the weight sensing assembly 410 includes four load cells 411. In one embodiment, the load cell 411 is a strain-based load cell. In one embodiment, the load cell is an SSM11 Load Cell available from Variohm Eurosensor.

[0161] 10 and 11, the entire vertical load of the platform 11 and the configurable patient support 110 passes through and is detected by the load cell 411. Specifically, the load cell 411 is mounted between the platform 11 and the chain drive actuator 312. In other words, a first end 412 of the load cell 411 is coupled to the platform 11 and a second end 413 of the load cell 411 is coupled to the chain 313 of the chain drive actuator 312. The weight of the platform and the positioning system and / or the patient causes a deflection of the load cell 411, and the strain of the load cell 411 is converted into an electrical output signal that is received by a processor, for example, to detect the amount of weight supported on the platform 11.

[0162] 11 and 12, a support member 414 is coupled to the end 316 of the chain 313, and the load cell 411 is positioned on the support member 414. In the illustrated embodiment, the support member 414 is oriented approximately perpendicular (e.g., horizontally) to the extension direction (e.g., perpendicular) of the chain 313. A notch 415 formed in the support member 414 receives a second end 413 of a corresponding load cell 411. In the illustrated embodiment, each support member 414 includes two notches 415 for receiving two load cells 411.

[0163] The patient positioning system 10 utilizes the information detected by the load cells 411 for a variety of applications. For example, the detected weight can be monitored with respect to the amount of weight, the location of the weight, whether the weight should or should not be present, and whether the weight is changing or moving.

[0164] In one embodiment, when the seat, foot rest (e.g., heel stop), back rest, etc. are moved into one of various positions / configurations, and when the components are applying force to the patient to aid in ingress, egress, etc., information from the load cell 411 is used to determine the patient's weight, which can then be utilized to determine the amount of force desired or needed to push or pull the patient (e.g., by a dynamic configuration to assist ingress and egress of the patient from the patient support).

[0165] In an embodiment, the load cell 411 is used to determine the position and placement of the patient and / or technician. The position of the detected weight can be used to determine whether an action (e.g., applying beam energy, moving the support, translating and / or rotating the patient, etc.) is safe to perform. In other words, in an embodiment, the output from the load cell 411 is monitored to provide a safety lockout to prevent action if the detected weight does not match the expected value of the weight. For example, if the weight of the technician 16 (FIGS. 13A and 13B) is detected on the platform 11, movement of the platform (e.g., movement in one or more of the six degrees of freedom axes: X, Y, Z, pitch, roll, and / or yaw) and / or energization of the imaging beam or treatment beam is locked out until the technician is no longer detected on the platform. As another example, weight detected at a location other than on the patient support can indicate that an object is located on the platform and therefore the platform should not be moved until the object is removed.

[0166] In one embodiment, the load cells 411 are used to detect a sudden change in weight and / or weight distribution on the patient support and / or a sudden increase in weight on the platform in an area other than the patient support, which can indicate a patient tipping onto or off the patient support system. Similarly, a sudden increase in weight detected by the load cells 411 can indicate a component of the patient support colliding with something during movement.

[0167] In one embodiment, the load cell 411 is used to detect a change in the position of the weight on the patient support during imaging, which may indicate that the patient has moved during imaging and that the quality of the patient image may be degraded (e.g., relative to images of a patient that did not move). Detecting patient movement may indicate that imaging should be repeated to obtain an image of adequate and / or improved quality.

[0168] In one embodiment, the load cell 411 is used to identify and / or confirm the identity of the patient using the patient's weight and / or verifying that the detected weight is appropriate and / or expected. For example, the patient's weight detected by the load cell is compared to an expected patient weight based on previous encounters and / or patient records are used, at least in part, to verify the patient's identity.

[0169] In one embodiment, the load cells 411 are used to compensate for deflection of the platform, for example, the mass of one side of the platform can be compensated for by actuating the actuators described herein (e.g., one, two, or three actuators in a three actuator embodiment, one or two actuators in a two actuator embodiment) to move the platform to compensate for the mass.

[0170] Seat tilt axis 14, the configurable patient support 110 includes an adjustable seat assembly 510 including a seat member 511 having two offset rods 512. This configuration positions the seat member 511 to extend outward from the backrest when the adjustable seat assembly 510 is in a first orientation, thereby providing support for the hips of a seated patient when the patient's back is positioned against the backrest. This configuration also positions the seat member 511 downward (rotated about a rotation axis 513) to lie toward the same plane as the backrest, and thus away from the patient received by the patient support assembly in the second position. Conventional adjustable seats include a large metal axle aligned with the seat's rotation axis, which creates problems because the metal axle is positioned near the imaging or treatment beamline. The adjustable seat assembly 510 does not include a metal axle or shaft aligned with the rotation axis 513 of the seat member 511. In contrast, the rod 512 has an axis 513 that is offset from the axis of rotation 513 of the seat member 511 .

[0171] 14 and 15, the seat member 511 includes two lugs 514 configured to receive the offset rod 512. The seat member 511 includes an arcuate surface 515 slidably coupled to arcuate surfaces 516 of two pedestals 517 (FIG. 17). In one embodiment, the seat member 511 is P-shaped. In the illustrated embodiment, the arcuate surface 515 of the seat member 511 is positioned between the two lugs 514.

[0172] 14, a portion of the rod 512 is received in an arcuate slot 518 formed in a frame member 519. As the sheet member 511 rotates about a rotation axis 513, the rod 512 moves within the slot 518 and the arcuate surface 515 slides against the base 517. In the illustrated embodiment, the rod 512 is offset in a first direction (e.g., Y direction) and a second direction (e.g., Z direction) from the rotation axis 513 of the sheet member 511. Thus, the sheet member 511 is rotatable about the rotation axis 513 but does not include a metal shaft along the rotation axis 513 that would interfere with the beam.

[0173] 14, the adjustable seat assembly 510 includes a cleat 520 coupled to the seat member 511 and configured to inhibit and / or prevent vertical movement of the seat member 511 as the seat member 511 moves between positions. With reference to FIG. 16, the cleat 520 includes a central portion 521 coupled to an arcuate surface 515 of the seat member 511. The cleat 520 also includes two wings 522 (arms) configured to be received under corresponding flanges 523 formed on the pedestal 517. In other words, the wings 522 of the cleat 520 engage the flanges 523 of the pedestal 517 to limit the vertical movement of the seat member 511.

[0174] 18, an adjustable seat assembly 550 according to another embodiment includes a seat member 511 that rotates about an axis 513 and a non-metallic shaft 524 aligned with the rotation axis 513. In other words, the conventional metallic shaft is replaced with a non-metallic shaft 524 aligned with the rotation axis 513 of the seat member 511 such that the non-metallic shaft 524 does not interfere with the imaging beam or the treatment beam. In one embodiment, the non-metallic shaft is made of a polymer or fiberglass (e.g., G-10).

[0175] Installation leveling adjustment During installation, it is important that the patient positioning system's axis of rotation is aligned with the beam axis. Also, projecting the axis over long distances where the surface is uneven makes alignment difficult. In some embodiments, the beam defines the origin of the coordinate system, so alignment of the patient positioning system with the beam and / or beam coordinate system is important. Conventional patient positioning systems are not rotated or moved during treatment delivery, and therefore no adjustment of conventional systems is required.

[0176] In some embodiments, the patient positioning systems disclosed herein do not use a gantry, and therefore precise alignment to the beam isocenter is desirable, for example, a patient positioning system that allows the patient to walk up to the patient positioning system would result in a large projection to the isocenter (e.g., approximately 148 cm).

[0177] In an embodiment, multiple adjusters 610 are utilized to level the patient positioning system 10 during installation. Each adjuster 610 has X, Y, and Z adjustments for leveling. For example, the adjuster 610 can be adjusted in the Z direction and then adjusted radially to provide X and / or Y adjustments. In an embodiment, the X and Y adjustments are independent of (do not affect) the Z adjustment. The adjusters 610 are of a compact design that does not increase pit depth. In an embodiment, the adjusters 610 are positioned below the bearings of the patient positioning system 10 for three-point axis adjustment.

[0178] 20, three adjusters 610 are coupled to a bottom 611 of the patient positioning system 10. In the illustrated embodiment, the adjusters 610 are equally spaced circumferentially. In other words, the three adjusters 610 are approximately 120 degrees apart. In the illustrated embodiment, the adjusters 610 are positioned in the pit between the patient positioning system 10 and the bottom of the pit.

[0179] 19, the adjuster 610 includes a first block 612 and a second block 613 that is movable relative to the first block 612. The adjuster 610 includes a first low friction sheet 614 positioned between the first block 612 and the second block 613, and a second low friction sheet 615 positioned on the second block 613. In an embodiment, the low friction sheets 614, 615 are a low friction IGUS sheet material (e.g., a material such as IGLIDUR G, commercially available at igus.com). A portion 616 (FIG. 20) of the patient positioning system 10 is positioned on the second low friction sheet 615 on the second block 613. In an embodiment, the portion 616 is part of a bottom bearing.

[0180] 19 , a groove 617 is defined between the first block 612 and the second block 613, the groove 617 being configured to receive a leveling wedge to adjust the position of the second block 613 relative to the first block 612. As the leveling wedge is inserted into the groove 617, the second block 613 slides along the first low friction sheet 614 relative to the first block 612.

[0181] During installation, the adjusters 610 are positioned within the pit to define a horizontal plane in the vertical direction (e.g., Z direction). One adjuster 610 is then moved to a desired position in a first direction (e.g., X direction) and the other two adjusters 610 are moved to a desired position in a second direction (e.g., Y direction). In one embodiment, the adjusters 610 achieve an adjustment range of about + / - 2.5 mm (e.g., about 2-3 mm (e.g., 2.00, 2.05, 2.10, 2.15, 2.20, 2.25, 2.30, 2.35, 2.40, 2.45, 2.50, 2.55, 2.60, 2.65, 2.70, 2.75, 2.80, 2.85, 2.90, 2.95, or 3.00 mm)).

[0182] Patient Support Interface Lock 23A, 23B, and 24, a tilt and translate interface 710 for a patient positioning system 10 receives modules (collectively referred to as support members) for a backrest (for a patient in a vertical seated position), a horizontal table (for a patient in a prone / supine position), and a mini table (for QC purposes). The interface 710 includes a base 714 having a receptacle 715 that includes a first low friction pad 716A and a second low friction pad 716B positioned within the receptacle 715. In the illustrated embodiment, the first pad 716A is positioned on a first side (front side) of the receptacle 715 and the second pad 716B is positioned on a second side (rear side) opposite the first side of the receptacle 715. In an embodiment, the first pad 716A and / or the section pad 716B are nylon.

[0183] 21 and 22, in the illustrated embodiment, the support member (e.g., backrest 12) includes a mechanical tongue and rod interface 711 that corresponds to interface 710. The tongue and rod interface 711 ensures that the backrest 12 (or any other modular component) is fully and accurately inserted relative to the base 714. For alignment purposes, it is important that no interface allows movement of the installed backrest while still accommodating manufacturing and assembly tolerances.

[0184] The embodiment disclosed herein includes a tongue and rod interface 711 having two support means, a tongue 712 and two rods 713A, 713B. As described herein, the disclosed modular backrest is interchangeable with the interface 710 by a typical user, is repeatable, and does not flex when installed.

[0185] Similar to the receptacle 715, the tongue 712 includes at least one low friction (e.g., nylon) pad 717A-717D. In the illustrated embodiment, the tongue 712 includes four pads 717A-717D, ​​one on each side of the tongue 712. In one embodiment, the low friction pads 717A-717D are nylon. The tongue 712 is removably received within the receptacle 715 for connecting a support member (e.g., a seat back, table top, etc.) to the base 714. The pads 717A-717D on the tongue 712 directly engage the pads 716A-716B in the receptacle 715 when the tongue 712 is received within the receptacle 715. The precision fit between the low friction pads 716A-716B and the pads 717A-717D facilitates insertion while maintaining low deflection.

[0186] 25 and 26, pads 716A-716B in receptacle 715 include forward beveled edges 718, and pads 717A-717D on tongue 712 include corresponding forward beveled edges 719. The corresponding beveled edges 718, 719 help ensure that tongue 712 is properly aligned when it is inserted into receptacle 715.

[0187] 22, the tongue 712 is positioned between a first rod 713A and a second rod 713B. In the illustrated embodiment, the rods 713A, 713B extend in a direction parallel to the tongue 712. The interface 710 further includes a first block 720 (FIG. 28) having a first hole 721 and a second block 722 (FIG. 27) having a second hole 723. When the tongue 712 is received within the receptacle 715, the first rod 713A is received within the first hole 721 of the first block 720 and the second rod 713B is received within the second hole 723 of the second block 722.

[0188] In some embodiments, each block 720, 722 constrains the corresponding rod 713A, 713B (and ultimately the backrest 12) in either the X or Y direction. In other words, the first block 720 allows adjustment in a first direction (X direction) and the second block 722 allows adjustment in a second direction (Y direction) that is orthogonal to the first direction. In other embodiments, either one of the blocks 720, 722 can constrain the backrest position in both the X and Y directions.

[0189] In one embodiment, the first block 720 or 722 includes a precisely sized hole configured to receive a corresponding rod 713A or 713B, and the second block 720 or 722 includes a precisely sized hole configured to receive a corresponding rod 713A or 713B, and the second block 720 or 722 is configured to move (e.g., slide) freely toward and away from the first block 720 or 722 to accommodate a width between the two rods 713A and 713B of the backrest that does not precisely match the width between the holes in the blocks 720 and 722. Thus, in one embodiment, the first block is fixed and the second block can slide toward and away from the first block 720 or 722 to match the width of the rods of the backrest.

[0190] 29, in one embodiment, rods 713A, 713B each include a circumferential groove 724 positioned about an exterior thereof. A corresponding ball detent 725 extends at least partially into the bore and is received in groove 724. In other words, ball detent 725 and groove 724 form a Z-direction set point for seat back 12.

[0191] In some embodiments, a switch (e.g., a microswitch) is positioned at the bottom of the holes 721, 723. In some embodiments, more than one switch is included. In some embodiments, the switch is mechanically actuated when the rod is fully positioned within the hole, and the switch output ensures that the seat rest is seated, fully seated, and / or properly seated.

[0192] In some embodiments, the indexing knob or resistor uniquely identifies each accessory. Traditional benchtops and accessories rely on the operator to ensure the correct parts are properly attached and properly installed. The indexing knob or resistor allows the operator to verify that the correct accessory is attached, thereby mitigating operator error. In some embodiments, the attachment of a particular accessory may result in the automatic execution or preparation of a particular workflow.

[0193] Vacuum Bag Referring to FIG. 30, conventional vacuum bags are used for seats, backs, and arm rests. Conventional vacuum bags are bags containing "beans" (e.g., polymer spheres (such as Styrofoam) like those in bean bags) that are squashed and flexible before being vacuumed. Anatomical structures are pressed into the vacuum bag and a vacuum is drawn to lock the beans in place (e.g., mold the vacuum bag to the patient to provide a custom-fitting contour). The custom vacuum bag can then be removed, stored, and later reused. However, conventional vacuum bags do not form well on vertically oriented patients. Specifically, when the vacuum bag is positioned vertically, the beans settle to the bottom of the bag, and as a result, the vacuum bag is unable to form a contour at the top of the bag.

[0194] 31, a vertical adaptable patient support 810 (e.g., vertical vacuum bag) disclosed herein includes a segmented compartment for the beans. In an embodiment, the adaptable patient support includes an outer layer and an interior cavity including a first portion 811, a second portion 812, and a divider member 813 positioned between the first and second portions. A first plurality of beans are positioned within the first portion 811 and a second plurality of beans are positioned within the second portion 812. The first section is positioned above the second section when the adaptable patient support is oriented to accommodate a patient in an upright position.

[0195] The method of conforming a bag to an upright patient as disclosed herein includes evacuating a portion of the air in a bag containing a plurality of beans, orienting the bag vertically, pressing the bag against the upright patient, and evacuating a second portion of the air in the vacuum bag. In other words, in some embodiments, the vertical vacuum bag disclosed herein includes a bag that is partially evacuated prior to contouring to the patient. The partial vacuum helps to hold the beans in a suitable position to contour to the patient when oriented vertically.

[0196] In some embodiments, the personalized contoured vacuum bag includes a keyed interface (e.g., a key and groove) to ensure proper repositioning of the vacuum bag. For example, in some embodiments, the bottom of the bag includes a key that is positioned within a corresponding notch formed in the sheet.

[0197] Fluid Control Cassette In some embodiments, the patient positioning system 10 includes a fluid-control cassette 900 (FIGS. 32-34). In some embodiments, a rotating disk (e.g., underlying and supporting a patient support) includes the fluid-control cassette 900. In some embodiments, the patient positioning system 10 and / or the rotating disk includes a floor panel 910 having a top and bottom surface, the floor panel 910 including drain holes 920 that allow fluid contacting the top surface of the floor panel 910 to flow. In some embodiments, the floor panel 910 includes a fluid-control cassette receiving opening constructed to receive the fluid-control cassette 900 and removably couple the fluid-control cassette 900 to a location below the floor panel 910. In some embodiments, the fluid-control cassette 900 and the fluid-control cassette receiving opening are constructed such that the fluid-control cassette 900 can be inserted into the fluid-control cassette receiving opening by sliding the fluid-control cassette 900 into the fluid-control cassette receiving opening. In one embodiment, the fluid-control cassette receiving opening includes first and second rails that engage with first and second edges, respectively, of the fluid-control cassette 900 to guide insertion of the fluid-control cassette 900 into the fluid-control cassette receiving opening and to support the inserted fluid-control cassette 900.

[0198] When the fluid-control cassette 900 is inserted into the fluid-control-cassette receiving opening, the fluid-control cassette 900 is positioned to contact and thus control (e.g., absorb and retain) fluid flowing through the drain holes 920 of the floor panel 910. In some embodiments, the floor panel 910 includes a fluid-resistant (e.g., hydrophobic) coating that facilitates fluid evacuation and drainage through the drain holes 920. In some embodiments, the floor panel 910 includes grooves or other structural guide features that guide fluid to, into, and through the drain holes 920. In some embodiments, the floor panel 910 is angled relative to the horizontal to facilitate movement of fluid toward and through the drain holes 920.

[0199] In one embodiment, the fluid-control cassette 900 and the fluid-control cassette receiving opening are constructed such that the fluid-control cassette 900 can be removed from the fluid-control cassette receiving opening by sliding the fluid-control cassette 900 out of the fluid-control cassette receiving opening. After removal, the fluid-control cassette 900 can be discarded, cleaned, and / or reused.

[0200] In one embodiment, the fluid-control cassette includes a handle 930 that facilitates a user's insertion of the fluid-control cassette 900 into the fluid-control cassette receiving opening and / or facilitates a user's removal of the fluid-control cassette 900 from the fluid-control cassette receiving opening.

[0201] In some embodiments, the fluid control cassette 900 comprises a support plate 901 and an absorbent pad 902 (e.g., comprising an absorbent material). In some embodiments, the fluid control cassette 900 further comprises a peripheral sealing gasket (e.g., comprising a flexible and / or compressible material). In some embodiments, the peripheral sealing gasket seals the fluid control cassette 900 within the patient positioning system 10, thus integrating the fluid control cassette 900 to the patient positioning system 10 for fluid control. In some embodiments, the peripheral sealing gasket minimizes and / or eliminates the flow of liquid away from the absorbent pad 902, thus providing fluid containment. In some embodiments, the absorbent pad 902 contains antimicrobial compounds, antiviral compounds, antibacterial compounds, disinfectants, deodorant compounds, and / or superabsorbent polymers (SAPs) (including, for example, sodium salts of polyacrylic acid, polyacrylamide copolymers, ethylene maleic anhydride copolymers, cross-linked carboxymethylcellulose, polyvinyl alcohol copolymers, cross-linked polyethylene oxide, and / or copolymers of polyacrylonitrile).

[0202] In some embodiments, the fluid control cassette 900 is integrated into the patient positioning system 10 (e.g., in a rotating disk). Thus, in some embodiments, the floor panel 910 is contacted by the patient (e.g., the patient is positioned so that the feet are in contact with the floor panel 910).

[0203] In some embodiments, the fluid control cassette 900 is a consumable fluid control cassette 900 that is removable by a person operating the patient positioning assembly (e.g., a user (e.g., a technician, therapist, or cleaner)) and replaceable (e.g., with another (e.g., dried, cleaned, and / or new) fluid control cassette 900) by a person operating or cleaning the patient positioning system 10 (e.g., a user (e.g., a technician, therapist, or cleaner)). In some embodiments, the fluid control cassette 900 is a washable and / or sterilizable fluid control cassette 900 that is removable by a person operating or cleaning the patient positioning system 10 (e.g., a user (e.g., a technician, therapist, or cleaner)), reusable (e.g., after cleaning and / or sterilizing the removed fluid control cassette 900), and replaceable by a person operating or cleaning the patient positioning system 10 (e.g., a user (e.g., a technician, therapist, or cleaner)).

[0204] Thus, the fluid control cassette 900 provides containment and / or absorption of fluids contacting the rotating disk and / or floor panel 910, for example, when a patient positioned on the patient support assembly expels bodily fluids (e.g., urine, vomit, diarrhea, etc.) while positioned on the patient support. The fluid control cassette 900 prevents and / or minimizes fluids from soiling the floor (e.g., rotating disk and / or floor panel 920) of the patient positioning system 10. Additionally, the fluid control cassette 900 prevents and / or minimizes fluids expelled on the rotating disk and / or floor panel 900 from contacting mechanical and / or electrical components below the patient support (e.g., below the rotating disk) and causing malfunction or non-functioning of the mechanical and / or electrical components and subsequent malfunction or non-functioning of the patient positioning system 10.

[0205] emergency patient evacuation In the event of power loss, patient evacuation is still required. Traditional approaches use traditional high voltage uninterruptible power supplies (UPS). UPS maintain high voltages within the system that can pose hazards (e.g., considering water damage) and rely on motion control electronics. Traditional alternatives include manual cranks (e.g., hand cranks) to facilitate patient movement. Traditional mechanical or manual solutions are cumbersome and time consuming.

[0206] The emergency patient evacuation system disclosed herein includes a low voltage battery in electrical communication with at least one relay to power the actuators and brakes necessary to assist in patient evacuation. The disclosed design reduces risk by eliminating high voltages and improves robustness because no operating electronics are required.

[0207] In some embodiments, the potential energy of the platform is used to operate the electronics of the patient evacuation system (e.g., with a dynamo, etc.), for example, by initiating a controlled descent of the platform that converts the kinetic energy of the platform descent into an electrical potential (e.g., energy), which is used to power and move the components of the patient support to enable safe patient evacuation. In some embodiments, both the potential energy of the platform (e.g., converted to kinetic energy and then converted to an electrical potential) and a low voltage battery are used to power the emergency patient evacuation system.

[0208] In some embodiments, axes that require a controlled release after power loss (e.g., lowering a platform vertically) electrically connect a braking resistor across the motor terminals to control the slowdown of the platform.

[0209] In an embodiment, the configurable patient support 110 is configured to provide dynamic configurations to assist in emergency egress of a patient from the patient support, e.g., by providing support for the patient and / or by applying a force to the patient to guide, push, or pull the patient from the patient support and / or from the patient positioning assembly in the event of a power loss or other emergency. For example, in an embodiment, the configurable patient support is configured to contact, operatively engage, and apply a force to at least a portion of the patient (e.g., arms, legs, torso, head, feet, hands, hips, knees, elbows) to facilitate emergency egress from the patient support and / or from the patient positioning assembly in the event of a power loss or other emergency. In an embodiment, one or more of the backrest, headrest, armrests, seat member, shin guards, and / or foot braces (e.g., heel stops) contact and operably engage the patient and apply a force to at least a portion of the patient (e.g., arms, legs, torso, head, feet, hands, hips, knees, elbows) to facilitate emergency egress of the patient from the patient support and / or from the patient support assembly. In an embodiment, one or more of the backrest, headrest, armrests, seat member, shin guards, and / or foot braces (e.g., heel stops) move to guide the patient and facilitate emergency egress of the patient from the patient support and / or from the patient support assembly. An emergency patient evacuation system disclosed herein (e.g., comprising a low voltage battery electrically coupled with at least one relay) electrically powers actuators and brakes to assist in emergency egress of the patient from the patient support.

[0210] In an embodiment, the configurable patient support 110 is configured to move to a static configuration for emergency exit of the patient from the patient support and / or from the patient support assembly, e.g., the configurable patient support is configured to move to a patient emergency exit state to provide a static configuration that is, for example, a patient emergency exit state. The patient support configured in the patient emergency exit state includes a backrest, headrest, armrests, seat member, shin guards, and / or foot braces (e.g., heel stops) in a position that facilitates emergency exit of the patient from the patient support and / or from the patient support assembly in the event of a power loss or other emergency. For example, the backrest, headrest, armrests, seat member, shin guards, and / or foot braces (e.g., heel stops) are in a position that allows easy transfer of the patient from the patient support and does not impede emergency exit of the patient from the patient support. In an embodiment, the patient emergency exit state is configured to facilitate emergency exit of the patient in a standing position. In an embodiment, the patient emergency exit state is configured to facilitate emergency exit of a patient in a seated position, for example, by assisting the patient to stand and move away from the patient support and / or off the patient support assembly. An emergency patient evacuation system disclosed herein (e.g., comprising a low voltage battery in electrical communication with at least one relay) electrically powers actuators and brakes to provide patient support in the emergency exit configuration.

[0211] All publications and patents mentioned in the above specification are incorporated herein by reference in their entirety for all purposes.Various modifications and variations of the described compositions, methods and uses of the technology will be apparent to those skilled in the art without departing from the scope and spirit of the described technology.Although the technology has been described in connection with specific exemplary embodiments, it should be understood that the invention claimed should not be unduly limited to such specific embodiments.Indeed, various modifications of the described modes for carrying out the invention that are apparent to those skilled in the art are intended to be within the scope of the following claims.

Claims

1. A patient support, comprising: a first support member configured to contact a patient; a second support member configured to contact the patient; an actuation assembly coupled to the first support member and the second support member; wherein the actuation assembly is configured to move the first support member and the second support member between a first configuration and a second configuration, the patient support.

2. The patient support according to claim 1, wherein the actuation assembly is configured to simultaneously move the first support member and the second support member between the first configuration and the second configuration.

3. The patient support according to claim 1, wherein the first configuration and the second configuration are customized according to the patient.

4. The patient support according to claim 1, wherein the first configuration is a patient entry state and the second configuration is a patient imaging or treatment state.

5. The patient support according to claim 4, wherein the first configuration is a patient entry state and the second configuration is a patient standby state.

6. The patient support according to claim 1, wherein the first configuration is a patient standby state and the second configuration is a patient imaging or treatment state.

7. The patient support according to claim 1, wherein the first configuration is a patient standby state and the second configuration is a patient exit state.

8. The patient support according to claim 1, wherein the first configuration is a patient imaging or treatment state and the second configuration is a patient exit state.

9. The patient support according to claim 1, wherein the actuation assembly includes a motor and a microprocessor.

10. The patient support according to claim 1, wherein the first support member is a backrest, a headrest, an armrest, a seat member, a shin rest, or a foot brace.

11. The patient support according to claim 1, further comprising a dynamic configuration.

12. The patient support according to claim 11, wherein the dynamic configuration assists a patient's entry into the patient support.

13. The patient support according to claim 11, wherein the dynamic configuration assists a patient's exit from the patient support.

14. A patient positioning system, comprising: a central beam axis; a support configured to support a patient; an actuation assembly coupled to the support and configured to move the support; wherein The support is movable along a first axis, movable along a second axis orthogonal to the first axis, and movable along a third axis orthogonal to the first axis and the second axis, and the support is rotatable about the first axis, the second axis, and the third axis. A patient positioning system in which a desired region of a patient is aligned with a central beam axis when the support is in a first position and a second position different from the first position.

15. The patient positioning system according to claim 14, wherein the support moves a first compensation amount along the first axis and a second compensation amount along the second axis in response to rotation of the support about any one of the first axis, the second axis, and the third axis.

16. The patient positioning system according to claim 14, wherein a first amount of mechanical deflection in the support occurs at the first position, and a second amount of mechanical deflection in the support occurs regardless of the patient's size.

17. The patient positioning system according to claim 14, further comprising a processor and a memory, the memory including a deflection correction table having a plurality of compensations for maintaining a desired region aligned with the central beam axis for the support at a plurality of positions and for a plurality of patient weights.

18. An adjustable seat assembly, A base including slots, A seat movably connected to the base between a first position and a second position, A rod connected to the seat and positioned within the slots, A pedestal connected to the base, An adjustable seat assembly comprising a seat that slides relative to the pedestal and the rod slides within the slots as the seat moves between the first position and the second position.

19. The adjustable seat assembly according to claim 18, wherein the seat includes a first surface configured to support a patient and a second surface opposite the first surface, the second surface being connected to the pedestal.

20. The adjustable seat assembly according to claim 19, wherein the second surface is an arcuate surface.

21. The adjustable seat assembly according to claim 18, wherein the rod is offset from the axis of rotation of the seat.

22. The adjustable seat assembly according to claim , further comprising a cleat connected to the seat, the cleat including wings.

23. The adjustable seat assembly according to claim 22, wherein the pedestal includes a flange engageable with the wing of the concrete.

24. The adjustable seat assembly according to claim 23, wherein the concrete and the pedestal limit the vertical movement of the seat.

25. The adjustable seat assembly according to claim 18, wherein the slots are arcuate.

26. The adjustable seat assembly according to claim 18, wherein the pedestal includes an arcuate surface for receiving the seat.

27. A system comprising: a patient support assembly of a first configuration; an adjuster configured to move the patient support assembly in a first direction while the patient support assembly remains in the first configuration; The system provided.

28. The system according to claim 27, wherein the adjuster includes a first block and a second block movable relative to the first block.

29. The system according to claim 28, wherein the adjuster includes a first seat positioned between the first block and the second block and a second seat positioned on the second block.

30. The system according to claim 29, wherein the adjuster includes a groove defined between the first block and the second block, and the groove is configured to receive a wedge for adjusting the position of the second block relative to the first block.

31. The system according to claim 27, wherein the adjuster is a first adjuster, and the system further includes a second adjuster and a third adjuster.

32. The system according to claim 31, wherein the first adjuster sets a first position of the patient support assembly in a first direction, and the second adjuster and the third adjuster set a second position of the patient support assembly in a second direction.

33. A patient positioning system comprising: a platform; a load cell coupled to the platform, the load cell generating an output based on the weight of the platform and the weight supported on the platform; a processor configured to receive the output and determine the weight supported on the platform; The patient positioning system provided.

34. The patient positioning system according to claim 33, wherein the load cell includes a strain gauge.

35. The patient positioning system according to claim 33, wherein the load cell is positioned between the platform and a chain drive.

36. The chain drive includes a chain and a support member coupled to an end of the chain, the support member being configured to receive a portion of a load cell, the patient positioning system of claim 35.

37. The support member includes a notch for receiving a portion of a load cell, the patient positioning system of claim 36.

38. The processor is further configured to determine a position on a platform on which a weight is supported, the patient positioning system of claim 33.

39. The processor is further configured to detect a change in weight supported on the platform, the patient positioning system of claim 33.

40. The processor controls movement of a portion of the patient positioning system in response to a detected weight supported on the platform, the patient positioning system of claim 33.

41. A patient support assembly, A base including a receptacle and a first pad positioned within the receptacle, A support member including a tongue having a second pad, A support member in which the tongue is removably received within the receptacle for connecting the support member to the base, Comprising, The second pad directly engages the first pad when the tongue is received within the receptacle, the patient support assembly.

42. The first pad is nylon, the patient support assembly of claim 41.

43. The second pad is nylon, the patient support assembly of claim 42.

44. The first pad includes a first beveled edge, and the second pad includes a second beveled edge, the patient support assembly of claim 41.

45. The first pad is positioned on a first side of the receptacle, the receptacle further including a third pad positioned on a second side of the receptacle opposite the first side, the tongue including a fourth pad that directly engages the third pad when the tongue is received within the receptacle, the patient support assembly of claim 41.

46. The support member further includes a first rod and a second rod, the patient support assembly of claim 41.

47. The tongue is positioned between the first rod and the second rod, the patient support assembly of claim 46.

48. The first rod and the second rod extend in a direction parallel to the tongue portion, the patient support assembly according to claim 46.

49. The base includes a first block having a first hole and a second block having a second hole. When the tongue portion is received within the receptacle, the first rod is received within the first block and the second rod is received within the second block, the patient support assembly according to claim 46.

50. The first block allows adjustment in a first direction and the second block allows adjustment in a second direction orthogonal to the first direction, the patient support assembly according to claim 49.

51. A patient positioning system, comprising: a base; a platform having a patient support; a scissor frame coupled to the base and the platform; a chain drive coupled to the base and the platform; wherein the chain drive is configured to move the platform between a retracted position and a deployed position; the patient positioning system.

52. The platform is at a first distance from the base in the retracted position, and the platform is at a second distance from the base in the deployed position, the second distance being greater than the first distance, the patient positioning system according to claim 51.

53. The scissor frame includes a first upper pedestal and a second upper pedestal coupled to the platform, the first upper pedestal being slidable relative to the platform, the patient positioning system according to claim 51.

54. The scissor frame includes a first lower pedestal and a second lower pedestal coupled to the base, the first lower pedestal being slidable relative to the base, the patient positioning system according to claim 53.

55. The chain drive includes a chain having a plurality of links, the plurality of links including an interlock profile, the patient positioning system according to claim 51.

56. The scissor frame is a first scissor frame and the chain drive is a first chain drive, the patient positioning system further including a second scissor frame coupled to the platform and a second chain drive coupled to the platform, the patient positioning system according to claim 51.

57. A conformable patient support, comprising: an outer layer; An internal cavity including a first portion, a second portion, and a dividing member positioned between the first portion and the second portion, a first plurality of vanes positioned within the first portion, a second plurality of vanes positioned within the second portion, comprising, the first portion being positioned above the second portion when a conformable patient support is oriented such that it conforms to a patient in an upright position, a conformable patient support. **Claim 58** A method of fitting a bag to a patient in an upright position, comprising evacuating a portion of the air within a bag including a plurality of vanes, orienting the bag vertically, pressing the bag against a patient in an upright position, and evacuating a second portion of the air within the vacuum bag. **Claim 59** A patient positioning system, comprising a movable patient support, an actuator configured to move the movable patient support, a main power source electrically coupled to the actuator, a backup electrical circuit coupled to the actuator, the backup electrical circuit including a low voltage battery, a relay, and a brake, comprising, the backup electrical circuit being configured to operate the actuator when the main power source is inoperable. **Claim 60** A patient positioning system, comprising a floor panel having a drain hole, an integral fluid control cassette below the floor panel, comprising, the fluid control cassette including absorbent material **Claim 61** The patient positioning system of claim 60, comprising a fluid control receiving opening configured to receive the integral fluid control cassette. **Claim 62** The patient positioning system of claim 61, comprising a first rail and a second rail that guide insertion of the fluid control cassette into the fluid control cassette receiving opening and support the inserted fluid control cassette. **Claim 63** The patient positioning system of claim 60, wherein the fluid control cassette is disposable or reusable. **Claim 64** The patient positioning system of claim 60, wherein the fluid control cassette contains an antibacterial compound, an antiviral compound, an antibacterial compound, a disinfectant, a deodorizing compound, and / or a superabsorbent polymer. A patient positioning system comprising a configurable patient support having a backrest, a seat member, a shin rest, and / or a heel stop. The patient positioning system of claim 65, wherein the configurable patient support comprises at least three of a backrest, a seat member, a shin rest, and / or a heel stop. The patient positioning system of claim 65, wherein the configurable patient support comprises a backrest, a seat member, a shin rest, and a heel stop. The patient positioning system of claim 65, wherein the configurable patient support is provided in a configuration related to a specific patient or patient class. The patient positioning system of claim 65, wherein the configurable patient support is provided in a configuration related to a specific imaging or treatment plan. The patient positioning system of claim 65, wherein the configurable patient support is provided in a configuration for patient access. The patient positioning system of claim 65, wherein the configurable patient support is provided in a configuration for patient egress. The patient positioning system of claim 65, wherein the configurable patient support is provided in a configuration for patient imaging and / or treatment. The patient positioning system of claim 65, wherein the configurable patient support is provided in a standby configuration. The patient positioning system of claim 65, wherein the configurable patient support is configured to support the patient in an upright position. The patient positioning system of claim 74, wherein the upright position is a standing position, a sitting position, or a semi-reclined position. The patient positioning system of claim 65, wherein the configurable patient support further comprises armrests. The patient positioning system of claim 65, wherein the backrest is operably engaged with a backrest motor to provide a powered backrest, the seat member is operably engaged with a seat member motor to provide a powered seat member, the shin rest is operably engaged with a shin rest motor to provide a powered shin rest, and / or the heel stop is operably engaged with a heel stop motor to provide a powered heel stop. The patient positioning system according to claim 77, further comprising a microprocessor configured to adjust the movement of the electric backrest, the electric seat member, the electric shin rest, and / or the electric heel stop. The patient positioning system according to claim 78, further comprising a non-volatile memory medium readable by the microprocessor. The patient positioning system according to claim 79, wherein the patient positioning system is configured according to a stored configuration previously recorded in the non-volatile memory medium. The patient positioning system according to claim 77, wherein the electric backrest, the electric seat member, the electric shin rest, and / or the electric heel stop are operably engaged with the patient to apply a force to the patient to facilitate the patient's movement. The patient positioning system further comprises a weight sensor. The patient positioning system according to claim 81, wherein the force applied to the patient is calculated using the weight of the patient measured by the weight sensor. The patient support. The patient positioning system according to claim 65, configured to rotate the patient about an axis perpendicular or substantially perpendicular to the stationary radiation source. The patient positioning system according to claim 65, wherein the patient support is offset from the vertical rotation axis such that the patient's torso fixed to the configurable patient support is aligned with the vertical rotation axis.

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