Optical guidance and tracking for medical imaging

Abstract

With regard to medical imaging and radiotherapy, but in more detail, the following techniques are provided herein: methods and systems for monitoring the safe movement of a patient positioning system, verifying the settings of a patient positioning system, verifying the patient's position on a patient positioning system, and monitoring the patient's position during medical imaging and / or radiotherapy.

Description

Technical Field

[0001] This application claims the benefit of U.S. Provisional Application No. 63 / 462,563, filed Apr. 28, 2023, which is incorporated herein by reference in its entirety.

[0002] This document provides techniques related to, but not exclusive to, medical imaging and radiation therapy, and more particularly to methods and systems for monitoring the safe movement of a patient positioning system, validating the settings of a patient positioning system, validating the settings of a patient on a patient positioning system, and monitoring the patient's position during medical imaging and / or radiation therapy to detect patient movement.

Background Art

[0003] Medical imaging and radiation therapy are widely used in the medical diagnosis and treatment of diseases such as cancer. By precisely delivering radiation doses to the part of the body to be imaged or treated while avoiding exposure of healthy tissue to radiation, the therapeutic benefits of imaging and treatment are maximized and the risk of unnecessary radiation exposure is minimized. Thus, medical imaging and radiation therapy procedures typically involve immobilizing the patient in a suitable position such that the relevant area of the patient's body to be imaged and / or treated remains stationary. Comfortable immobilization of the patient can be provided by a patient positioning system that supports the patient's body in a fixed position for imaging and / or treatment. A patient positioning system is a configurable device having a plurality of movable components that support and immobilize the patient's torso, arms, legs, hands, feet, head, and neck in a fixed position for imaging and treatment. See, for example, U.S. Patent Application No. 17 / 894,335 and U.S. Patent Application Publication No. 20200268327, each of which is incorporated herein by reference. There is a need for techniques that assist medical personnel in positioning and monitoring patients to improve patient treatment outcomes and increase the safety and efficiency of medical imaging and radiation therapy.

Prior Art Documents

Patent Documents

[0004] [License 1] U.S. Patent and Trademark Office Publication No. 2020 / 0268327 [License 2] U.S. Patent No. 11529109 [License 3] U.S. Patent and Trademark Office Publication No. 2022 / 0183641 [Non-licensed literature]

[0005] [Non-licensed Document 1] Verhey(1982), "Precise Positioning of Patients for Radiation Therapy", Int.J.Radiation Oncology Biol.Phys.8:289-94 [Non-licensed Document 2] Brinkmann, "The Art and Science of Digital Compositing" (The Morgan Kaufmann Series in Computer Graphics, 2nd edition, Elsevier, 2008) [Non-licensed Document 3] Hartley Zisserman, "Multiple View Geometry in Computer Vision" (Cambridge University Press (New York), 2nd edition, 2003 [Non-licensed Document 4] Cocianu(2023), "Evolutionary Image Registration: A Review", Sensors 23, 967 [Non-licensed Document 5] Bierbrier (2022), “Estimating medical image registration error and confidence: A taxonomy and scoping review”, Medical Image Analysis 81:102531 [Non-Patent Document 6] John and John(2019), “A Review of Image Registration Methods in Medical Imaging”, International Journal of Computer Applications 178:38-45 [Non-Patent Document 7] Chen(2021), “Deep Learning in Medical Image Registration”, Progress in Medical Imaging 3:012003 [Overview of the Initiative] [Means for solving the problem]

[0006] Precise and reproducible positioning of the patient positioning system to a fixed location for imaging and treatment, and precise and reproducible positioning of the patient on the patient positioning system for imaging and treatment, are both crucial for achieving reliable therapeutic outcomes. See, for example, Verhey (1982), “Precise Positioning of Patients for Radiation Therapy,” Int. J. Radiation Oncology Biol. Phys. 8:289-94, incorporated herein by reference. Furthermore, monitoring the location of patient positioning components during movement and setup is important to avoid collisions with other objects and individuals that may be present near the patient positioning system during setup. In addition, monitoring the patient's location during imaging and / or treatment, and detecting patient movement during imaging and / or treatment, can improve the accuracy of imaging and / or treatment, reduce radiation exposure to healthy tissue, and improve patient safety (for example, by detecting misplacement or misalignment of the patient's healthy tissue in locations where it may be exposed to radiation).

[0007] For example, one neglected aspect of patient positioning for radiotherapy is surface guidance (SG). SG techniques provide a preliminary alignment of the patient's body by imaging and monitoring the patient's external surface before evaluating the position of internal organs. Detecting misalignment of the patient's external surface can be considered a good indicator that the patient's internal organs are also misaligned. Therefore, SG techniques provide a method to increase the accuracy and efficiency of patient imaging and treatment.

[0008] Therefore, in some embodiments, the technology provides an orthogonal implementation of three cameras (e.g., an overhead camera and two peripheral cameras orthogonal to each other). In some embodiments, the technology provides using these cameras to correct the position of an object (e.g., a patient), where, for example, the overhead camera indicates rotational errors around the vertical (Z) axis, as well as X and Y translations, and the peripheral cameras indicate vertical errors. In some embodiments, the technology provides a first camera directly opposite the object (e.g., a patient), where transverse movement of the object is detected within the first camera view, and longitudinal movement is detected by the other two cameras orthogonal to the first camera. In some embodiments, the technology provides the ability to obtain four-degree correction from three orthogonal cameras, where, for example, corrections for rotation in the X and Y directions and around the Z axis are determined by aligning a live view from the overhead camera with a reference image; and corrections for vertical position are determined by aligning a live view from the peripheral cameras with a reference image. In some embodiments, reference images are grouped into scenes, which can be recalled as needed. In some embodiments, the technology provides an interface that allows the user to select a region of interest from individual camera views to provide precise information about objects within the selected region. In some embodiments, the camera transmits only the data within the selected region of interest to the host computer, thereby reducing the amount of data transmitted to the computer and providing a fast frame rate. In some embodiments, the technology provides an interface that allows the user to select several cameras that provide the best view of an object (e.g., the patient) based on the patient's orientation and the camera's location. In some embodiments, the technology provides an interface that allows the user to draw reference lines (e.g., vertical and / or horizontal lines) on the camera image that do not move with the image. In some embodiments, these lines may be aligned to intersect reference points in the treatment room, such as isocenters. These lines can serve the same purpose as laser lines in the room.By moving the object until a point or marker on the object (visible in the live image) intersects with a fixed reference line on two cameras, it becomes possible to align the object with a reference point in the room. In some embodiments, the technique provides offsetting the reference image according to a positional correction (e.g., a correction vector) to be applied to the patient and / or patient support. If the correction vector is applied correctly, the discrepancy between the offset reference image and the live view is minimized and / or eliminated, thus providing a technique to verify the correct application of the correction vector.

[0009] For example, in some embodiments, the technology provides an optical guidance and tracking system (OGTS). In some embodiments, the OGTS comprises an overhead camera and a first peripheral camera, where the field of view of the overhead camera is orthogonal to the field of view of the first peripheral camera. In some embodiments, the OGTS further comprises a second peripheral camera, where the field of view of the second peripheral camera is orthogonal to the field of view of the overhead camera; and the field of view of the second peripheral camera is orthogonal to the field of view of the first peripheral camera. In some embodiments, the OGTS further comprises a third peripheral camera, where any two fields of view of the peripheral camera and the overhead camera are all orthogonal to each other. In some embodiments, the OGTS further comprises a fourth peripheral camera, where any two fields of view of the peripheral camera and the overhead camera are all orthogonal to each other.

[0010] In some embodiments, the OGTS further includes a patient support. In some embodiments, the patient support rotates around the vertical (Z) axis. In some embodiments, the field of view of the overhead camera is aligned with the vertical (Z) axis.

[0011] In some embodiments, the OGTS further comprises a radiotherapy apparatus. In some embodiments, the radiotherapy apparatus comprises a stationary source. In some embodiments, the OGTS further comprises a computed tomography (CT) scanner. In some embodiments, an overhead camera provides a view through a hole in the scanner ring of the CT scanner. In some embodiments, the overhead camera comprises a color sensor array, and the first peripheral camera comprises a color sensor array.

[0012] In some embodiments, the OGTS further comprises a processor and a non-temporary computer-readable medium. In some embodiments, the non-temporary computer-readable medium includes a program, and the processor executes the program to acquire a color image from an overhead camera and an image from a peripheral camera. In some embodiments, the OGTS further comprises a display. In some embodiments, the non-temporary computer-readable medium includes a program, and the processor executes the program to overlay live video onto a reference image on the display. In some embodiments, the non-temporary computer-readable medium includes a program, and the processor executes the program to provide a graphical user interface on the display. In some embodiments, the user interacts with the graphical user interface to identify a region of interest in the camera view. In some embodiments, the user interacts with the graphical user interface to align the live video and the reference image on the display. In some embodiments, the processor calculates real-space adjustments to properly position the patient for treatment. In some embodiments, the OGTS further comprises a database including stored scenes. In some embodiments, the stored scenes include an image, information identifying the camera that provided the image, and a region of interest for the image. In some embodiments, the first peripheral camera is located on the main Y-axis of the OGTS. In some embodiments, the first peripheral camera is located on the main Y-axis of the OGTS, and the second peripheral camera is located on the main X-axis of the OGTS. In some embodiments, the overhead camera is located on the main Z-axis of the OGTS.

[0013] The present invention further provides embodiments of the method. For example, in some embodiments, the method includes acquiring a first reference image of the patient support and / or patient; superimposing a first live image of the patient support and / or patient onto the reference image; aligning the first live image and the first reference image to determine displacement; and moving the patient support and / or patient according to the displacement. In some embodiments, the first reference image is provided by a first camera, and the first live image is provided by a first camera. In some embodiments, the method further includes acquiring a second reference image of the patient support and / or patient, and superimposing a second live image of the patient support and / or patient onto a second reference image. In some embodiments, the second reference image is provided by a second camera, and the second live image is provided by a second camera, with the field of view of the second camera being orthogonal to the field of view of the first camera. In some embodiments, the first camera is an overhead camera. In some embodiments, the first camera is a peripheral camera. In some embodiments, aligning a first live image and a first reference image includes the user interacting with a graphical user interface to align the first live image and the first reference image. In some embodiments, aligning a first live image and a first reference image includes using image alignment software to align the first live image and the first reference image. In some embodiments, a saved scene includes a first reference image. In some embodiments, a saved scene includes a first reference image, information identifying the camera that provided the first reference image, and a region of interest relative to the first reference image. In some embodiments, displacement includes translation in the X, Y, and / or Z directions, and / or rotation around the X, Y, and / or Z axes. In some embodiments, the method further includes determining the relationship between the pixel size of the first camera and distance in real space. In some embodiments, the method further includes exposing a patient to radiation. In some embodiments, the method further includes imaging a patient using computed tomography.

[0014] Further embodiments of the method include: acquiring a first reference image of the patient support and / or the patient; superimposing a first live image of the patient support and / or the patient onto the reference image; displacing the reference image according to a correction vector and applying the correction vector to the patient support and / or the patient; and verifying the correct application of the correction vector using the alignment of the first live image and the first reference image. In some embodiments, the application of the correction vector is correct when the first live image and the first reference image are substantially, maximally, or essentially aligned.

[0015] Several parts of this description describe embodiments of the technology in terms of algorithms and symbolic representations of operations on information. These algorithmic descriptions and representations are commonly used by data processing technicians to effectively communicate the substance of their work to other technicians. When these operations are described functionally, computationally, or logically, they are understood to be implemented by computer programs or equivalent electrical circuits, microcode, etc. Furthermore, without loss of generality, it has been found that it is sometimes convenient to refer to arrangements of these operations as modules. The operations and associated modules described may be embodied in software, firmware, hardware, or any combination thereof.

[0016] The specific steps, operations, or processes described herein may be performed or implemented by one or more hardware or software modules, either alone or in combination with other devices. In some embodiments, the software module is implemented by a computer program product comprising a computer-readable medium containing computer program code, which may be executed by a computer processor to perform any or all of the steps, operations, or processes described herein.

[0017] In some embodiments, the system comprises computers and / or data storage provided virtually (e.g., as cloud computing resources). In certain embodiments, the technology involves the use of cloud computing to provide virtual computer systems that comprise and / or perform the functions of the computer components described herein. Thus, in some embodiments, cloud computing provides the infrastructure, applications, and software described herein over a network and / or the Internet. In some embodiments, computing resources (e.g., data analysis, computing, data storage, application programs, file storage, etc.) are provided remotely over a network (e.g., the Internet and / or a cellular network).

[0018] Embodiments of the technology may also relate to an apparatus for performing the operations herein. The apparatus may be specially constructed for the required purposes and / or may comprise a general-purpose computing device selectively activated or reconfigured by a computer program stored in a computer. Such a computer program may be stored in a non-transitory tangible computer-readable storage medium or any type of medium suitable for storing electronic instructions, and such a medium may be coupled to a computer system bus. Further, any computing system referred to herein may comprise a single processor or may be an architecture that uses multiple processor designs for increased computing capability.

[0019] Additional embodiments will be apparent to those of ordinary skill in the relevant art based on the teachings contained herein.

[0020] The above and other features, aspects, and advantages of the technology will be better understood in connection with the following drawings. BRIEF DESCRIPTION OF THE DRAWINGS

[0021] [Figure 1A] A perspective view of a patient support showing the axes of a coordinate system. [Figure 1B] A side view of a patient support showing the axes of a coordinate system. [Figure 1C] A schematic diagram showing a data structure for a scene. [Figure 1D] A schematic diagram showing a data structure for a scene. [Figure 2A] A top view of a medical imaging and / or radiotherapy system comprising an optical guidance tracking system (comprising several cameras) and a patient positioning system (for example, comprising a patient support) including a patient. [Figure 2B] A side view of a medical imaging and / or radiotherapy system comprising an optical guidance tracking system (comprising several cameras) and a patient positioning system (for example, comprising a patient support) including a patient. [Figure 2C] A top view of a medical imaging and / or radiotherapy system comprising an optical guidance tracking system (comprising several cameras) and a patient positioning system (for example, comprising a patient support) including a patient. [Figure 2D] A side view of a medical imaging and / or radiotherapy system comprising an optical guidance tracking system (comprising several cameras) and a patient positioning system (for example, comprising a patient support) including a patient. [Figure 2E] A schematic diagram showing three mutually orthogonal cameras. [Figure 2F] A schematic diagram showing five cameras. Four cameras are arranged at 90° intervals in a plane, and a fifth camera is located above the plane of the four cameras and forms an angle of 90° with each of the four cameras arranged in the plane. [Figure 3] A schematic diagram showing three mutually orthogonal cameras, and corrections to the patient position (for example, translations in the X, Y, and / or Z directions, and / or rotations about the X, Y, and / or Z axes) that can be derived from each camera view. [Figure 4] This is a perspective view of a patient support, showing the possible components of the patient support. [Figure 5A] This is a rendering of a treatment room equipped with a vertical patient positioning and imaging system. [Figure 5B] This figure shows the clinical setup for the technology described herein. The figure shows a vertical imaging and / or treatment system, four orthogonal cameras in the horizontal plane, and an overhead camera above the isocenter. [Figure 5C] This figure shows the design of one embodiment of the OGTS system provided in the treatment room 710, the OGTS control room 720, and the OGTS technical room 730. [Figure 5D] This is a cross-sectional view A from Figure 5C, showing treatment room 710. [Figure 5E] This is a cross-sectional view B from Figure 5C, showing the control room 720 and the technical room 730. [Figure 6] This figure shows the graphical user interface (GUI) of the OGTS software as displayed on the client computer's screen. [Figure 7] This figure shows the GUI of the OGTS software, which displays a person in a patient support, with each camera zoomed in to a designated region of interest for that camera. [Figure 8] This diagram shows the GUI of the OGTS software displaying two scene selection panels. The left panel shows previously recorded setting scenes (e.g., including reference images) that may be retrieved for use. The right panel shows recorded treatment scenes (e.g., including reference images). [Figure 9] This figure shows the GUI of the OGTS software during a tracking session using reference and live tracking images. The left and top panels of the GUI indicate that the person's head was slightly rotated to the left around the vertical axis, causing a significant misalignment of the live position toward the front of the face compared to the previously recorded patient position shown in the reference image. Lateral alignment remained reasonable. [Figure 10A]This flowchart shows the steps of one embodiment of a method for immobilizing and imaging a patient before treatment. [Figure 10B] This flowchart illustrates the steps of one embodiment of a method for immobilizing an initial patient. The method for immobilizing an initial patient may be performed, for example, for a new patient, for a new treatment of a patient, for treatment of a new area of ​​the patient, or for treatment of a patient in a new patient posture. [Figure 10C] This flowchart illustrates the steps of one embodiment of a method for subsequent patient immobilization. The initial subsequent immobilization method may be performed when, for example, the patient position, PPA or patient support configuration, and / or imaging position are predetermined and saved in a configuration setting scene, a patient position setting scene, and / or imaging position scene, respectively. [Figure 10D] This flowchart illustrates the steps of one embodiment of a method for obtaining a pre-treatment CT scan of a patient. [Figure 11A] This is a flowchart illustrating the steps of one embodiment of a method for treating a patient with radiation. [Figure 11B] This flowchart illustrates the steps of one embodiment of a method for placing a patient on a PPA or patient support suitable for treating the patient. [Figure 11C] This flowchart illustrates the steps of one embodiment of a method for imaging a patient for treatment, for example, by obtaining a therapeutic CT scan of the patient. [Figure 11D] This is a flowchart illustrating the steps of one embodiment of a method for treating a patient with radiation. [Modes for carrying out the invention]

[0022] Please understand that these figures are not necessarily drawn to actual size, and the objects in the figures are not necessarily drawn to actual size relative to one another. These figures are intended to provide clarity and understanding of the various embodiments of the apparatus, systems, and methods disclosed herein. Wherever possible, the same reference numerals are used throughout the drawings to refer to the same or similar parts. Furthermore, please understand that these drawings are not intended to limit the scope of this teaching in any way.

[0023] With regard to medical imaging and radiotherapy, but in more detail, the following techniques are provided herein: methods and systems for monitoring the safe movement of a patient positioning system, verifying the settings of a patient positioning system, verifying the patient's position on a patient positioning system, and monitoring the patient's position during medical imaging and / or radiotherapy.

[0024] The technology provided herein is an optical guidance and tracking system (OGTS) comprising multiple (e.g., three, four, or five) high-resolution (e.g., approximately 20 megapixels) optical cameras, three or more of which are positioned orthogonally to one another. The OGTS simultaneously acquires multiple (e.g., at least three) high-resolution two-dimensional images of a patient from at least three directions, thereby providing a synchronized live view from at least three orthogonal directions. Thus, the use of orthogonal live images provides an improved imaging technique compared to conventional techniques that acquire an image and then construct a three-dimensional image.

[0025] OGTS is used in a method that includes recording reference images from multiple (e.g., two, three, four, or five) OGTS cameras when an object (e.g., a patient) is in a desired position and orientation. Furthermore, the method includes saving the reference images and providing saved reference images for each camera. The reference images may be grouped into scenes, and scenes may be recalled as needed. In some embodiments, the method includes tracking the position of an object (e.g., a patient) by acquiring live images from multiple cameras and overlaying the live images onto saved reference images for each camera. In some embodiments, the method for repositioning the object (e.g., a patient) includes retrieving the saved reference images from storage (e.g., as part of a saved scene), acquiring live images from multiple cameras, and overlaying the live images onto saved reference images for each camera. The difference between the live images and the overlaid images can be used to determine appropriate translations and rotations to reposition the object (e.g., a patient) to reproduce its position in the reference images.

[0026] In this detailed description of various embodiments, for illustrative purposes, numerous specific details are given to provide a thorough understanding of the embodiments disclosed. However, it will be understood by those skilled in the art that these various embodiments may be carried out with or without these specific details. In other instances, structures and devices are shown in block diagram form. Furthermore, it will be readily understood by those skilled in the art that the specific sequences in which the methods are presented and carried out are illustrative, and such sequences may be modified, yet still remain within the spirit and scope of the various embodiments disclosed herein.

[0027] Without limitation, all documents 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 in their entirety by reference for any purpose. Unless otherwise defined, all technical and technical terms used herein have the same meaning as commonly understood by those skilled in the art to which the various embodiments described herein belong. Where the definition of a term in an incorporated reference is considered to differ from the definition provided in this instruction, the definition provided in this instruction shall prevail. The item names used herein are for organizational purposes only and should not be construed as limiting the subject matter described in any way.

[0028] definition To facilitate understanding of this technology, several terms and phrases are defined below. Additional definitions will be provided throughout the detailed explanation.

[0029] Throughout this specification and the claims, the following terms have the meanings expressly associated herein unless otherwise clearly indicated by the context. In this specification, the phrase "in one embodiment" may refer to the same embodiment, but not necessarily the same embodiment. Furthermore, in this specification, the phrase "in another embodiment" may refer to a different embodiment, but not necessarily a different embodiment. Thus, various embodiments of the present invention may be readily combined without departing from the scope or spirit of the invention, as described below.

[0030] In addition, in this specification, the term "or" is an inclusive "or" operator and equivalent to the term "and / or" unless otherwise explicitly indicated by the context. The term "based on" is not exclusive and may be based on additional factors not listed unless otherwise explicitly indicated by the context. In addition, throughout this specification, the meanings of "a," "an," and "the" include multiple references. The meaning of "in" includes "in" and "on."

[0031] In this specification, the terms “about,” “approximately,” “substantially,” and “significantly” are understood by those skilled in the art and vary to some extent depending on the context in which they are used. Where there are uses of these terms that are not obvious to those skilled in the art considering the context in which they are used, “about” and “approximately” mean within ±10% of the given term, and “substantially” and “significantly” mean more than ±10% of the given term.

[0032] In this specification, a disclosure of a range includes the disclosure of all values ​​within the range and any further subdivided ranges, including the endpoints and subranges given to those ranges. In this specification, a disclosure of a numerical range includes the endpoints and each intermediate number between them with equal precision. For example, in the range 6-9, the numbers 7 and 8 are contemplated in addition to 6 and 9, and in the range 6.0-7.0, 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 explicitly contemplated.

[0033] In this specification, the suffix "-free" refers to an embodiment of the technology in which the core characteristic of the word to which "-free" is attached is omitted. That is, in this specification, the term "X-free" means "without X," where X is the characteristic 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 include a mixing step, and so on.

[0034] In this specification, terms such as “first,” “second,” and “third” may be used to describe various steps, elements, compositions, components, areas, layers, and / or parts, but these steps, elements, compositions, components, areas, layers, and / or parts should not be limited by these terms unless otherwise indicated. These terms are used to distinguish one step, element, composition, component, area, layer, and / or part from another step, element, composition, component, area, layer, and / or part. Terms such as “first,” “second,” and other numerical terms, when used herein, do not imply a sequence or order unless explicitly indicated by the context. Thus, without departing from the art, the first step, element, composition, component, area, layer, or part discussed herein may be called the second step, element, composition, component, area, layer, or part.

[0035] In this specification, the words “presence” or “absence” (or alternatively, “present” or “absent”) are used in a relative sense to describe the quantity or level of a particular entity (e.g., a component, action, element). For example, when an entity is considered to “presence,” this means that the level or quantity of this entity is above a given threshold; conversely, when an entity is considered to “absent,” this means that the level or quantity of this entity is below a given threshold. The given threshold may be a threshold for detectability associated with a particular test used to detect the entity, or any other threshold. When an entity is “detected,” it “presence,” whereas when an entity is “not detected,” it “absent.”

[0036] In this specification, “increase” or “decrease” refers to a detectable (e.g., measured) positive or negative change in the value of an 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 at least 10%, more preferably 50%, even more preferably 2 times, even more preferably at least 5 times, and most preferably at least 10 times, relative to a previously measured value, a pre-established value, and / or a standard control value of the variable. Similarly, a decrease is a negative change of at least 10%, more preferably 50%, even more preferably at least 80%, and most preferably at least 90%, relative to a previously measured value, a pre-established value, and / or a standard control value of the variable. Other terms indicating quantitative change or difference, such as “more” or “less,” are used herein in the same manner as above.

[0037] In this specification, “system” refers to a set of real and / or abstract components that work together for a common purpose. In some embodiments, “system” is an integrated set of hardware and / or software components. In some embodiments, each component of a system interacts with and / or relates to one or more other components. In some embodiments, a system refers to a combination of components and software for control and induction methods. For example, a “system” or “subsystem” may include one or any combination of mechanical devices, hardware, hardware components, circuits, circuit mechanisms, 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, etc., in order to perform the functions of the system or subsystem. Accordingly, the methods and apparatus of the embodiments, or particular aspects or parts thereof, may take the form of program code (e.g., instructions) executed on a physical medium such as a floppy diskette, CD-ROM, hard drive, flash memory, or any other machine-readable storage medium, and when the program code is loaded into and executed on a machine such as a computer, the machine becomes an apparatus for embodying the embodiments. In the case of program code execution 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 relation to these embodiments, for example, by using an application programming interface (API), reusable controls, etc. Such programs are preferably implemented in a high-level procedural or object-oriented programming language for communicating with a computer system.However, the program may be implemented in assembly language or machine code, if desired. In any case, the language may be a compiled or interpreted language and may be combined with a hardware implementation.

[0038] In this specification, the term “computed tomography” is abbreviated as “CT” and refers to both tomographic and non-tomographic radiography. For example, the term “CT” refers to a number of 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. Generally, computed tomography (CT) involves the use of an X-ray source and a detector that rotates around the patient, as well as the subsequent reconstruction of images into different planes. In the embodiments of CT described herein (e.g., devices, apparatus, and methods provided for CT), the X-ray source is a stationary source, and the patient is rotated relative to the stationary source. The current for X-rays used in CT represents the flow of current from cathode to anode and is typically measured in milliamperes (mA).

[0039] In this specification, the term "[structured to]" means that the identified element or assembly has a structure that is molded, sized, positioned, joined, and / or configured to perform the identified verb. For example, a member "[structured to move]" is movably joined to another element, includes an element that moves the member, or the member is otherwise configured to move in response to another element or assembly. Thus, in this specification, "[structured to]" describes structure, not function. Furthermore, in this specification, "[structured to]" means that the identified element or assembly is intended to perform the identified verb and is designed to perform the identified verb.

[0040] In this specification, the term “associated” means that the elements are part of the same assembly and / or work together or interact with each other in some way. For example, a car has four tires and four hubcaps. While all the elements are combined as a whole, each hubcap will be understood as “associated” with a particular tire.

[0041] In this specification, the term “coupled” refers to two or more components fixed together by any preferred means. Therefore, in some embodiments, the statement that two or more parts or components are “coupled” means that those parts are joined or operate together, directly or indirectly, for example, through one or more intermediate parts or components. In this specification, “directly coupled” means that two elements are in direct contact with each other. In this specification, “fixedly coupled” or “fixed” means that two components are coupled so that they move as one while maintaining a constant orientation relative to each other. Therefore, when two elements are coupled, all parts of those elements are coupled. However, the statement that a specific part of a first element is coupled to a second element, for example, that the first end of an axle is coupled to a first wheel, means that the specific part of the first element is positioned closer to the second element than the other parts. Furthermore, an object that is held in place solely by gravity and resting on another object is not "bonded" to the object below unless the object above is otherwise substantially maintained in place. That is, for example, a book placed on a table is not bonded to the table, but a book glued to the table is bonded to the table.

[0042] In this specification, the terms “removably coupled” or “temporarily coupled” mean that one component is essentially temporarily coupled to another component. That is, the two components are coupled in such a way that joining or separating the components is easy and does not damage the components. Thus, components that are “removably coupled” can be easily separated and rejoined without damaging the components.

[0043] In this specification, the term “operatively coupled” means that multiple elements or assemblies, each movable between a first position and a second position or between a first configuration and a second configuration, are coupled such that when the first element moves from one position / configuration to the other, the second element also moves between the positions / configurations. Note that there are examples of the first element being “operatively coupled” to another element, but not the other way around.

[0044] In this specification, the term “rotatably coupled” refers to two or more components that are coupled so that at least one component is rotatable relative to the other components.

[0045] In this specification, the term “translatably coupled” refers to two or more coupled components such that at least one component is translatably coupled to the other components.

[0046] In this specification, the term “temporarily disposed” means that a first element or assembly is placed on a second element or assembly in such a way that it can be moved without detaching or otherwise manipulating the first element. For example, a book simply placed on a table, for instance, a book that is not glued or fastened to the table, is “temporarily disposed” on the table.

[0047] In this specification, the term “correspond” means that two structural components are sized and molded to be similar to each other and joined with minimal friction. Thus, an opening “corresponding” to a component is sized slightly larger than the component so that the component can pass through the opening with minimal friction. This definition is modified when the two components fit together “snugly.” In that situation, the difference in size between the components becomes even smaller, thereby increasing the amount of friction. If the elements defining the opening, and / or the components inserted into the opening, are made of a deformable or compressible material, the opening may be even slightly smaller than the components 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.

[0048] In this specification, when "path of travel" or "path" is used in relation to a moving element, it includes the space through which the element traverses during its motion. Therefore, a moving element inherently has a "path of travel" or "path."

[0049] In this specification, the statement that two or more parts or components “engage” with each other means that those elements exert force or bias on each other, either directly or through one or more intermediate elements or components. Furthermore, with respect to moving parts, in this specification, a moving part may “engage” with another element while moving from one position to another, and / or after arriving at a described position. Thus, the statements “When element A moves to a first position, element A engages with element B” and “When element A is in a first position, element A engages with element B” are equivalent and are understood to mean that element A engages with element B while moving to a first position, and / or that element A engages with element B while in a first position.

[0050] In this specification, the term “operatively engage” means “engaged and moving.” That is, when “operatively engage” is used in relation to a first component constructed to move a movable or rotatable second component, it means that the first component applies sufficient force to move the second component. For example, a screwdriver is positioned to make 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 is pressed against the screw and “engaged” with the screw. However, when a rotational force is applied to the screwdriver, the screwdriver “operatively engages” with the screw and rotates the screw. Furthermore, in the case of electronic components, “operatively engage” means that one component controls another component by a control signal or current.

[0051] In this specification, the term “orthogonal” means a right angle, essentially a right angle, or substantially a right angle. Two orthogonal components or elements (for example, objects, lines, line segments, vectors, or axes) intersect at a 90° angle at their intersection.

[0052] In this specification, the term "number" means an integer greater than 1 (for example, multiple integers).

[0053] In this specification, 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 "its" refers to "[x]," that is, the designated element or assembly preceding the pronoun "its."

[0054] In this specification, a “radial side / surface” for an annular or cylindrical body is a surface that extends around or surrounds its center or a height line passing through its center. In this specification, an “axial side / surface” for an annular or cylindrical body is a surface that extends within a plane that extends approximately perpendicular to the height line passing through its center. In other words, generally speaking, 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.

[0055] In this specification, a “diagnostic” test includes detecting or identifying a subject’s disease or condition, determining the subject’s likelihood of having a given disease or condition, determining the likelihood of a subject with a disease or condition responding to therapy, determining the prognosis (or possible progression or regression) of a subject with a disease or condition, and determining the effectiveness of a treatment for a subject with a disease or condition. For example, a diagnosis may be used to detect the presence or likelihood of a subject having cancer, or the likelihood of such a subject responding well to a compound (e.g., a drug, e.g., a medication) or other treatment.

[0056] In this specification, the term “condition” generally refers to a disease, ailment, injury, event, or change in health status.

[0057] In this specification, the terms “treating” or “treatment” in relation to a medical condition mean preventing a medical condition, slowing the onset or rate of onset of a medical condition, reducing the risk of developing a medical condition, preventing or delaying the onset of symptoms associated with a medical condition, reducing or ending symptoms associated with a medical condition, producing complete or partial regression of a medical condition, or any combination thereof. In some embodiments, “treatment” includes exposing a patient or a part of them (for example, a tissue, organ, body part, or other localized area of ​​the patient’s body) to radiation (for example, electromagnetic radiation, ionizing radiation).

[0058] In this specification, the term “beam” refers to a stream of radiation (e.g., electromagnetic waves and / or particle radiation). In some embodiments, the beam is brought forth by a 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 diverges.

[0059] In this specification, the terms “patient” or “subject” refer to a mammal identified and / or selected for radiographic imaging and / or treatment. Thus, in some embodiments, the patient or subject is exposed to a radiation beam, for example, a primary beam delivered by a radiation source. In some embodiments, the patient or subject is a human. In some embodiments, the patient or subject is a veterinary animal or livestock, a domestic animal or pet, or an animal used in clinical research. In some embodiments, the subject or patient has cancer and / or is recognized as having cancer or being at risk of developing cancer.

[0060] In this specification, the terms “treatment volume” or “imaging volume” refer to a volume of a patient (e.g., tissue) selected for radiographic imaging and / or treatment. For example, in some embodiments, the “treatment volume” or “imaging volume” includes a tumor in a cancer patient. In this specification, the term “healthy tissue” refers to a volume of a patient (e.g., tissue) that is not and / or does not include a treatment volume. In some embodiments, the imaging volume is greater than and includes a treatment volume.

[0061] In this specification, the terms “radiation source” or “source” refer to a device that produces radiation in the form of photons (for example, described as particles or waves) (e.g., ionizing radiation). In some embodiments, the radiation source is a linear accelerator ("linac") that produces X-rays or electrons, used to treat cancer patients by exposing tumors to X-rays or electron beams. In some embodiments, the source produces particles (e.g., photons, electrons, neutrons, hadrons, ions (e.g., protons, carbon ions, other heavy ions)). In some embodiments, the source produces electromagnetic waves (e.g., X-rays and gamma rays with wavelengths in the range of about 1 pm to about 1 nm). While it is understood that radiation can be described as having both wave-like and particulate aspects, it may be convenient to refer to radiation from a wave point, and it may be convenient to refer to radiation from a particle point. Therefore, without limiting this technology, both explanations are used throughout, based on the understanding that the laws of quantum mechanics stipulate that all particles or quantum entities can be described as either particles or waves.

[0062] In this specification, the term “static source” refers to a source that does not revolve around a patient during use for imaging or treatment. In particular, a “static source” remains fixed with respect to an axis through which the patient passes while the patient is being imaged or treated. The patient may rotate around the axis, resulting in relative motion between the static source and the rotating patient, which is equivalent to the relative motion of the source revolving around a stationary patient, whereas the static source does not move with respect to a third object, a reference frame (e.g., the treatment room in which the patient is positioned), or the patient's axis of rotation during imaging or treatment, whereas the patient is rotated with respect to an axis of rotation through the third object, the reference frame (e.g., the treatment room in which the patient is positioned), or the patient's axis of rotation during imaging or treatment. The static source may be mounted on a mobile platform, and as the mobile platform moves to transport the static source, the static source may move with respect to the earth and instruments on the earth. Therefore, the term “static source” may also refer to a moving “static source,” provided that the moving “static source” does not revolve around an axis of rotation passing through the patient during imaging or treatment of the patient. Furthermore, the static source may be translated and / or revolved around the patient in order to position the static source before or after imaging or treatment of the patient. Therefore, the term “static source” may also refer to a source that is translated or revolved around the patient in non-imaging and non-treatment applications, for example, in order to position the source relative to the patient when the patient is not being imaged and / or treated. In some embodiments, the “static source” is a photon source and is therefore called a “static photon source.”

[0063] Embodiments of the Art described herein relate to spatial positioning, translation along an axis, and / or rotation around an axis. In some embodiments, a three-dimensional coordinate system is used that includes the X, Y, and Z axes defined relative to a patient support and / or patient. See Figures 1A and 1B. As shown in Figures 1A and 1B, embodiments use a coordinate system in which the X and Y axes are both in the horizontal plane and / or define the horizontal plane, and the Z axis is the vertical axis and / or defines the vertical axis. For a patient positioned on a patient support (e.g., a patient positioning device or patient support in a patient positioning system), the X axis is the left-right axis, horizontal axis, or front axis; the Y axis is the front-back axis, dorsoventral axis, or sagittal axis; and the Z axis is the sagittal axis or longitudinal axis. Both the X and Y axes are in the horizontal plane, cross-sectional plane, and / or axial plane and / or define such planes. The Y and Z axes both lie within the sagittal plane or longitudinal section and / or define such a plane. The X and Z axes both lie within the anterior axis or frontal plane and / or define such a plane.

[0064] Therefore, in some embodiments, the description of movement as “forward” or “backward” is movement along the Y-axis, the description of movement as “left” or “right” is movement along the X-axis, and the descriptions of movement as “up” and “down” are movement along the Z-axis. Furthermore, a rotation described as “roll” is a rotation around the Y-axis, a rotation described as “pitch” is a rotation around the X-axis, and a rotation described as “yaw” is a rotation around the Z-axis. The angles of rotation around the X, Y, and Z axes are sometimes referred to as ψ (psi), φ (phi), and θ (theta), respectively. Therefore, in some embodiments, the technology is described as having six degrees of freedom, for example, translation along one or more of the X, Y, and / or Z axes; and / or rotation around one or more of the X, Y, and / or Z axes. Adjustments or changes in position by translation in the X, Y, and Z directions may be indicated by ΔX, ΔY, and ΔZ, respectively. Adjustments or changes in position due to rotation around the X, Y, and Z axes may be denoted by Δψ, Δφ, and Δθ, respectively.

[0065] In this specification, the term “scene” refers to a reference image and / or a set of reference images, information identifying the camera that acquired the reference image and / or set of reference images, and a region of interest setting for each camera that acquired the reference image and / or set of reference images. Scenes can be stored on a non-volatile storage medium and retrieved from the non-volatile storage medium to provide the retrieved scene. For example, a scene may be stored when a reference image is acquired and stored for patient positioning, patient positioner configuration, or imaging settings. Each image or set of reference images may be stored with associated scene information identifying the camera that acquired the reference image, and the region of interest of the camera at the time the reference image was acquired. The information used to identify the camera can be any information that clearly identifies the camera and is persistently or essentially persistently associated with the camera (for example, at least between the acquisition of the reference image by the camera and the use of the reference image and camera for patient positioning and / or patient alignment for imaging). In some embodiments, the information used to identify the camera is, for example, a hardware address (e.g., an Ethernet address, a Media Access Control (MAC) address, a Fixed Internet Protocol (IP) address, or other identifiers (e.g., "Camera 1", "Camera 2", "Camera 3", "Camera 4", "Camera 5", etc.). The camera's region of interest may indicate the zoom level of the camera's lens or identify a subset of camera sensor pixels shown or stored as an image (e.g., an area of ​​the sensor array containing a subset of pixels) (e.g., "digital zoom"). Thus, in some embodiments, the region of interest setting associated with the camera describes an area of ​​the camera sensor that provided the image pixels stored in a reference image. The region of interest setting can later be used to select the same area of ​​the camera sensor and provide live video to be overlaid on the stored reference image.

[0066] Therefore, scene information identifying a list of selected cameras and the region of interest for each camera identifies the cameras and sensor pixels of each camera that should be used when acquiring and displaying live tracking images of the patient for alignment with previously acquired reference images using the list of selected cameras and the region of interest for each selected camera. Figure 1C is a schematic diagram showing an exemplary embodiment of data recording of scene 500, which includes several images (image 511, image 512, image 513, image 514, and image 515 (e.g., at least three showing mutually orthogonal views)), a list 520 of cameras used to record these images (e.g., a list of distinct identifiers, each one-to-one associated with a physical camera of the OGTS), and a list 530 of the region of interest for each camera in the list of cameras. A scene can be extracted to provide multiple reference images. Figure 1C shows a scene including five images, associated cameras, and ROI information for the five cameras, but the technique is not limited to a scene including five images. A scene may include one, two, three, four, or five images, associated information identifying one, two, three, four, or five cameras, and one, two, three, four, or five ROIs. For example, a particular embodiment relates to saving and retrieving a scene that includes three images taken from three mutually orthogonal cameras, a list of three mutually orthogonal cameras, and a list containing each ROI for each of the three mutually orthogonal cameras used to produce each of the three images. See Figure 1D.

[0067] Furthermore, while some embodiments described herein relate to OGTS systems with five cameras, embodiments are also conceivable that include six or more cameras, and the scene includes images, camera lists, and ROI information for six or more cameras.

[0068] The sensor comprises a pixel area containing a matrix of N × M elements called pixels or photosites, where N is the number of columns and M is the number of rows. Each pixel comprises a photosensitive region that stores incoming light energy in the form of an electric charge, and a transistor that controls the operation of the pixel and provides information from the pixel to a microprocessor and / or memory.

[0069] In this specification, the term “region of interest” is abbreviated as “ROI” and refers to a portion of a sensor selected to produce an image (for example, for display within a window in the OGTS GUI). A sensor has an array of pixels (also known as photosites), and the region of interest defines a subarray of the sensor's pixels (for example, a rectangular subarray) that is read by the processor to form an image. Selecting a subarray of the sensor's pixels is sometimes called “windowing.” Selecting an ROI is advantageous for providing a magnified image of an object (for example, a patient) or a portion of an object (for example, a portion of a patient). Selecting an ROI is also advantageous for increasing the frame rate for displaying and refreshing images within a window in the OGTS GUI. By selecting an ROI, the throughput for displaying images per unit time is increased, given a constant pixel throughput per unit time, by reducing the number of pixels to be read, transmitted, and displayed. Similarly, performing analysis or calculations on a subset of pixels increases the efficiency of performing analysis or calculations on the image. For example, gigabit-rate data transmission provides a frame rate of approximately 2 frames per second for a 20-megapixel image. However, selecting a 4,000,000-pixel ROI (for example, described by approximately 100 megabits of data) increases the frame rate to approximately 10 frames per second. In some embodiments, the region of interest is defined by indicating first and second pixels that define opposing corners of a rectangular subarray of pixels in the sensor. In some embodiments, the region of interest is defined by indicating a pixel that defines one corner of a rectangular subarray of pixels in the sensor, as well as the height and width of the pixel subarray. In some embodiments, the region of interest is a shape (e.g., regular or irregular) defined by indicating one or more pixels that define the periphery of the region of interest. In some embodiments, a selection circuit is used to provide control signals to selected pixels of the ROI.

[0070] In this specification, the term “spatial resolution” of a camera refers to the camera’s ability to resolve and reproduce the details of an object in which an image is captured. In other words, “spatial resolution” refers to the minimum distance at which different points of an object are distinguished as individual points by the camera within the image of the object.

[0071] Techniques for acquiring, storing, manipulating, and displaying images are incorporated herein by reference, for example, in Brinkmann, "The Art and Science of Digital Compositing" (The Morgan Kaufmann Series in Computer Graphics, 2nd edition, Elsevier, 2008).

[0072] Optical guidance tracking system The technology described herein provides an optical guided tracking system (OGTS). In some embodiments, the OGTS is used in a patient positioning device (e.g., as described in U.S. Patent No. 11,529,109, “PATIENT POSITIONING APPARATUS” which is incorporated herein by reference) and / or a patient positioning system that includes a patient support (e.g., as described in U.S. Patent Application No. 17 / 894,335, “PATIENT POSITIONING SYSTEM” which is incorporated herein by reference). In some embodiments, the technology provided herein is used in a patient support that is a component or subsystem of a patient positioning device or patient positioning system as described in U.S. Patent No. 11,529,109 and / or U.S. Patent Application No. 17 / 894,335. In some embodiments, the OGTS is used in a medical imaging device (e.g., a magnetic resonance imaging device, a CT scanner (e.g., as described in U.S. Patent Application No. 17 / 535,091 which is incorporated herein by reference)). In some embodiments, the OGTS is used in radiotherapy equipment (e.g., a radiation source (e.g., a stationary radiation source)) used in particle beam therapy (e.g., photon (e.g., X-ray) and / or hadron (e.g., proton) therapy). Exemplary patient positioning devices or patient supports are shown in Figures 1A and 1B, along with their associated coordinate systems. A medical imaging and treatment system comprising the patient positioning device or patient support, the patient, and components of the OGTS is shown in Figures 2A to 2D.

[0073] For example, as shown in Figures 2A to 2D, the embodiment provides an OGTS 200 comprising a patient positioning system 220 (including, for example, a patient 900) and a camera system. In some embodiments, the OGTS is used with a medical imaging device (e.g., a CT scanner 210). In some embodiments, the OGTS is used with a radiation source (e.g., a stationary radiation source) to deliver a beam of therapeutic particles (e.g., photons, protons) to a patient.

[0074] The OGTS has a main X-axis 801 (Figures 2A and 2C), a main Y-axis 802 (Figures 2A and 2C), and a main Z-axis 803 (Figures 2B and 2D). As further shown in Figures 2A to 2D, the camera system comprises an overhead camera 235 (Figures 2B and 2D) and one or more peripheral cameras 231, 232, 233, and / or 234 (Figures 2A and 2B). In some embodiments, any two, any three, or all four of the cameras 231, 232, 233, and / or 234 are provided within the system described herein. In some embodiments, the camera system comprises an overhead camera 235 and at least two peripheral cameras 231, 232, 233, and / or 234 (Figures 2A to 2D). In some embodiments, the camera system comprises an overhead camera 235 and four peripheral cameras 231, 232, 233, and 234 (Figures 2A to 2D). In some embodiments, the overhead camera 235 is positioned on the main Z-axis 803 of the patient positioning system 220 and / or the CT scanner 210. In some embodiments, the camera system comprises two (e.g., at least two (e.g., two, three, or four)) peripheral cameras spaced 90° (e.g., substantially and / or essentially 90°) apart around the patient positioning system 220 (e.g., including a patient 900) and / or the CT scanner 210 (Figures 2A and 2C).

[0075] In some embodiments, these cameras are used to monitor and / or correct the position of an object, for example, by using an overhead camera to check and / or correct rotational errors of the object around the Z axis, as well as translation errors in the X or Y direction, and by using one or more peripheral cameras to check and / or correct translation errors in the X, Y, or Z direction, as well as rotational errors around the X, Y, or Z axis. The advantage of this technique is the ability to obtain corrections to the position of an object (e.g., a 4-degree correction) using three orthogonal camera views and a previously saved reference image without requiring mathematical calculations to determine transformations in space. In some embodiments, the object is a patient.

[0076] As described herein, the technology is not limited to the arrangement of peripheral cameras, except that two of the peripheral cameras are orthogonal to each other and each of the peripheral cameras is orthogonal to the overhead camera. Embodiments with exemplary camera arrangements are described below. The camera arrangements may be adapted from these exemplary positions to address imaging systems, radiotherapy systems, or patient positioning components in which the OGTS is used.

[0077] For example, as shown in Figures 2A and 2C, the embodiment provides a camera system comprising two, three, or four peripheral cameras 231, 232, 233, and / or 234 spaced at 90° intervals (e.g., substantially and / or essentially 90°) around a patient positioning system 220 (e.g., including a patient 900) and / or a CT scanner 210.

[0078] In some embodiments, two, three, or four peripheral cameras 231, 232, 233, and / or 234 are positioned on the principal axes X and / or Y of the patient positioning system 220 (Figures 2C and 2D). In Figure 2C, one or two peripheral cameras 232 and / or 234 are obscured from view by components of the CT scanner 210 (for example, shown by dashed rectangles in Figure 2C). One or two peripheral cameras 231 and / or 233 are provided in front of and / or behind the patient positioning system 220. In Figure 2D, the rear peripheral camera 233, if any, is obscured from view by the patient positioning system 220 and / or the patient 900. Using this camera arrangement shown in Figures 2C and 2D, embodiments provide that an object of interest (e.g., the patient 900) can face one of the cameras. Therefore, the embodiment achieves detecting the transverse movement of an object using a camera facing the object, and detecting the longitudinal movement of the object in other cameras (e.g., two other cameras) orthogonal to the camera facing the object.

[0079] Furthermore, as shown in Figures 2A and 2B, the embodiment ensures that two, three, or four peripheral cameras 231, 232, 233, and / or 234 are positioned displaced from the main X-axis 801 or main Y-axis 802 of the patient positioning system 220 and / or CT scanner 210 by a 45° (e.g., substantially and / or essentially 45°) rotation in the XY plane around the main Z-axis 803.

[0080] The overhead camera 235 (Figures 2B and 2D) and one or more peripheral cameras 231, 232, 233, and / or 234 are positioned to image the patient positioning system 220 and the patient 900 when positioned on the patient positioning system 220. Thus, the overhead camera 235 (Figures 2B and 2D) and one or more peripheral cameras 231, 232, 233, and / or 234 provide several views of the patient positioning system 220 and the patient 900 when positioned on the patient positioning system 220. The overhead camera 235 is positioned to provide an overhead view of the patient positioning system 220 and / or the patient 900, for example, through the central opening (e.g., hole) of the scanner ring of the CT scanner 220. Figures 2A and 2C show illustrations of the patient positioning system 220 and the patient 900 as observed by the overhead camera 235 through the central opening of the scanner ring. In some embodiments, a pair of adjacent peripheral cameras (e.g., 231 and 232, 232 and 233, 233 and 234, or 234 and 231) provide two views (e.g., orthogonal views) of the patient positioning system 220 and / or patient 900, which are used to construct a three-dimensional image of the patient positioning system 220 and / or patient 900 (e.g., using triangulation). See, for example, Hartley and Zisserman, "Multiple View Geometry in Computer Vision" (Cambridge University Press (New York), 2nd edition, 2003), which is incorporated herein by reference. In some embodiments, three or four cameras 231, 232, 233, and / or 234 provide three or four views of the patient positioning system 220 and / or patient 900, which are used in conjunction with the view provided by the overhead camera 235 to construct a three-dimensional image (e.g., a surface drawing) of the patient positioning system 220 and / or patient 900.

[0081] In some embodiments, the overhead camera 235 and two adjacent peripheral cameras 231, 232, 233, and / or 234 are positioned in space such that the principal axes of the field of view for the three cameras (e.g., overhead camera 235, peripheral camera 231, and peripheral camera 232; overhead camera 235, peripheral camera 232, and peripheral camera 233; overhead camera 235, peripheral camera 233, and peripheral camera 234, or overhead camera 235, peripheral camera 234, and peripheral camera 231) are mutually orthogonal in three-dimensional space. See Figure 2E.

[0082] In some specific embodiments, the overhead camera 235 has a principal axis of its field of view that is perpendicular to the principal axis of each peripheral camera 231, 232, 233, and 234's field of view (for example, the principal axis of the overhead camera 235's field of view is perpendicular to the principal axis of the peripheral camera 231's field of view, the principal axis of the overhead camera 235's field of view is perpendicular to the principal axis of the peripheral camera 232's field of view, the principal axis of the overhead camera 235's field of view is perpendicular to the principal axis of the peripheral camera 233's field of view, and4. Camera 235 is positioned in space such that the principal axis of its field of view is perpendicular to the principal axis of the field of view of peripheral camera 234; and each pair of adjacent peripheral cameras (e.g., 231 and 232, 232 and 233, 233 and 234, and 234 and 231) is positioned in space such that the principal axes of their fields of view are perpendicular to each pair of adjacent peripheral cameras (e.g., 231 and 232, 232 and 233, 233 and 234, and 234 and 231). See Figure 2F.

[0083] In some embodiments, the OGTS comprises five cameras arranged as shown in Figure 2F, with an overhead camera 235 and four peripheral cameras 231, 232, 233, and 234 spaced at 90° intervals, each positioned 90° away from the overhead camera 235. The arrangement shown in Figure 2F may be modified to address components of the imaging and medical system that may interfere with the installation of the entire five-camera system. Thus, the technology comprises an OGTS system comprising an overhead camera 235 and two, three, or four peripheral cameras 231, 232, 233, and / or 234, with at least three cameras orthogonal to each other. The two-dimensional images provided from the three orthogonal views are realized to be individually aligned with the patient in the XY, XZ, and YZ planes. See Figure 3.

[0084] In some embodiments, cameras 231, 232, 233, 234, and / or 235 are typically positioned about 2.5 to 4.0 meters (for example, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, or 4.0 meters) away from the patient positioning system 220 and / or patient 900. In some embodiments, cameras 231, 232, 233, 234, and / or 235 are positioned about 2.5 to 4.0 meters (for example, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, or 4.0 meters) away from the isocenter of a medical imaging and / or radiotherapy system comprising a patient positioning system 220.

[0085] The camera system comprises several cameras. In some embodiments, the cameras have a spatial resolution of 1.0 mm or greater (for example, a spatial resolution of 1.00 mm, 0.95, 0.90, 0.85, 0.80, 0.75, 0.70, 0.65, 0.60, 0.55, 0.50, 0.45, 0.40, 0.35, 0.30, 0.25, 0.20, 0.15, or 0.10 mm), where better or higher resolution refers to a lower spatial resolution. In some embodiments, the camera has a spatial resolution of 0.5 mm or greater (for example, a spatial resolution of 0.50, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.40, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.30, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.20, 0.19, 0.18, 0.17, 0.16, 0.15, 0.14, 0.13, 0.12, 0.11, or 0.10 mm). In some embodiments, the camera has a spatial resolution of 0.5 mm or more in close-up zoom mode (for example, a spatial resolution of 0.50, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.40, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.30, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.20, 0.19, 0.18, 0.17, 0.16, 0.15, 0.14, 0.13, 0.12, 0.11, or 0.10 mm).

[0086] In some embodiments, the camera has a refresh rate of at least 5 Hz (for example, at least 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, or 30 Hz). However, in some embodiments of the Technology, a high refresh rate is not required, and the Technology is not limited to cameras having a refresh rate of about 5 to 30 Hz, but includes the use of cameras having higher refresh rates, such as 60 Hz, 120 Hz, or 240 Hz or higher.

[0087] In some embodiments, one or more cameras include an accelerometer and / or other components (e.g., gyroscope, magnetometer) that identify the orientation and / or location of the camera in space. In some embodiments, accelerometer and gyroscope data are used to provide a quaternion orientation solution that identifies the orientation and / or location of the camera. In some embodiments, the OGTS includes a stationary, known-location beacon used to determine the orientation and / or location of the camera.

[0088] In some embodiments, the camera has a color sensor containing approximately 20 megapixels. For example, in some embodiments, the camera has a 5,496-pixel × 3,672-pixel sensor array and therefore a sensor containing 20,181,312 pixels (also known as “photosite”) or approximately 20.2 megapixels. The technology is not limited to cameras containing approximately 20 megapixels. In some embodiments, the camera includes 5 to 10 megapixels (for example, 5.0, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 6.0, 6.1, 6.2, 6.3, 6.4, 6.5, 6.6, 6.7, 6.8, 6.9, 7.0, 7.1, 7.2, 7.3, 7.4, 7.5, 7.6, 7.7, 7.8, 7.9, 8.0, 8.1, 8.2, 8.3, 8.4, 8.5, 8.6, 8.7, 8.8, 8.9, 9.0, 9.1, 9.2, 9.3, 9.4, 9.5, 9.6, 9.7, 9.8, 9.9, or 10.0 megapixels). In some embodiments, the camera includes more than 20 megapixels. For example, embodiments include the use of a camera having 20 or more, 30 or more, 40 or more, 50 or more, or 60 or more megapixels. Each sensor pixel transmits an electrical signal corresponding to the number of photons that contact that sensor pixel. The electrical signal is converted into a luminance value for all sensor pixels. The luminance value of each sensor pixel provides a signal used to bring image pixels into the resulting image. Thus, a camera having a sensor with 5,496 sensor pixels × 3,672 sensor pixels will produce an image with 5,496 image pixels × 3,672 image pixels.

[0089] The embodiments include determining, or otherwise providing, a relationship between real-world distance and the number of pixels (e.g., sensor pixels or image pixels) corresponding to that real-world distance. For example, a camera with a horizontal field of view of 1.0 meter, captured by a sensor with 3,672 rows of pixels, has a relationship of 0.2723 mm per pixel in the horizontal direction. The same camera with a vertical field of view of 1.5 meters, captured by a sensor with 5,496 rows of pixels, has a relationship of 0.2729 mm per pixel in the vertical direction. Thus, in some embodiments, the relationship between real-world distance and the number of pixels is approximately 0.27 mm (e.g., approximately 0.3 mm) per pixel. That is, a shift of one pixel in the first image relative to the second image represents a translation of approximately 0.3 mm of an object in the real world.

[0090] The camera provides an image (e.g., an RGB image) that includes red, green, and blue channels. In some embodiments, the camera is a high-definition Gigabit Ethernet (GigE) camera. Thus, in some embodiments, the camera transmits Ethernet frames at a speed of at least 1 gigabit per second. In some embodiments, the camera is connected to a wireless communication module or a wired communication medium, such as optical fiber (e.g., 1000BASE-X), twisted-pair cable (e.g., 1000BASE-T), or shielded balanced copper cable (e.g., 1000BASE-CX). In some embodiments, the camera receives power over the same cable used for data transmission (e.g., twisted-pair Ethernet cable), for example, the camera receives power over an Ethernet cable (e.g., power over Ethernet (PoE)); in some embodiments, the camera is powered by a separate external power supply.

[0091] In some embodiments, the camera has several output interfaces (e.g., several GigE output interfaces), each output interface (e.g., each GigE output interface) providing an output to each of several image data channels. For example, in some embodiments, the camera outputs image data in a red channel (e.g., including image data corresponding to wavelengths of approximately 550–750 nm), a green channel (e.g., including image data corresponding to wavelengths of approximately 450–650 nm), and a blue channel (e.g., including image data corresponding to wavelengths of approximately 350–550 nm), and the camera has an output interface (e.g., a GigE output interface) for each of the red, green, and blue channels. That is, in some embodiments, the camera has a red image channel output (e.g., a red image channel GigE output), a green image channel output (e.g., a green image channel GigE output), and a blue image channel output (e.g., a blue image channel GigE output).

[0092] In some embodiments, a pixel includes three elements to provide red, green, and blue signals, respectively, to the light that contacts the pixel. Each color element is digitized to provide a range of intensity. In some embodiments, the intensity of each color is described as using 8 bits (1 byte) to produce a range of 256 intensity values ​​for each color. Thus, according to this example, each pixel provides 3 bytes of data or 24 bits of data. As a result, one frame of a 20-megapixel image is described by 20 megapixels × 24 bits / pixel = 480 megabits of data. Therefore, gigabit-rate data transmission provides a frame rate of approximately 2 frames per second for a full 20-megapixel image.

[0093] In some embodiments, the camera is a mirrorless camera conforming to the MICRO FOUR THIRDS (MFT) SYSTEM. In some embodiments, the camera is equipped with an MFT lens. In some embodiments, the camera is equipped with an electrically operated zoom / focus / aperture MFT lens for, for example, to provide control of the field of view, to provide sufficient imaging detail, and / or to image all or most of the patient and / or the patient positioning system. In some embodiments, the camera is mounted on a pan-tilt component that has a mechanism for panning and / or tilting the camera. In some embodiments, the OGTS is equipped with a virtual pan-tilt module that crops the image accordingly and thus replaces the mechanical pan-tilt mechanism. In some embodiments, the OGTS is equipped with a thermal (e.g., infrared) camera. In some embodiments, the thermal camera is used to monitor and / or detect the patient's respiratory cycle.

[0094] In some embodiments, the OGTS comprises a computer. An exemplary computer used in the embodiments of the Art described herein is an industrial computer comprising an INTEL CORE I9 central processing unit, 32 gigabytes of random access memory, one or more non-volatile memory express (NVMe) solid-state drives (SSDs) for storing data and instructions, and a graphics processing unit (e.g., an NVIDIA GPU). In some embodiments, the computer communicates with the camera via an application programming interface, for example, using a generic programming interface. In some embodiments, the generic programming interface conforms to the GENICAM standard (e.g., GENICAM Version 2.1.1, incorporated herein by reference).

[0095] system In some embodiments, the technology relates to a system. In some embodiments, the system comprises an OGTS as described herein and a computer as described above and in examples. In some embodiments, the system comprises a patient positioning system comprising an OGTS, a computer, and a patient support or patient positioning device. In some embodiments, the system comprises an OGTS as described herein and software and / or hardware components constructed to rotate and / or translate the patient positioning system, patient positioning device, and / or patient support, or these configurable components. For example, in some embodiments, the system comprises a motor engaged with the patient positioning system, patient positioning device, and / or patient support, or these configurable components, a power supply, and software configured to power the motor to translate and / or rotate the patient positioning system, patient positioning device, and / or patient support, or these configurable components. In some embodiments, the system includes software components constructed to perform the methods described herein for, for example, determining adjustments (e.g., one or more of ΔX, ΔY, ΔZ, Δψ, Δφ, and / or Δθ), and / or moving (e.g., translating and / or rotating) patient positioning systems, patient positioning devices, patient support devices, and / or configurable components thereof.

[0096] In some embodiments, the system comprises an OGTS as described herein and a controller. In some embodiments, the OGTS communicates with the controller. In some embodiments, the controller activates the OGTS (e.g., activates one or more cameras of the OGTS) and collects one or more images from one or more cameras. In some embodiments, the controller controls the region of interest displayed by one or more cameras. In some embodiments, the controller communicates with a graphic display terminal for displaying live images from one or more cameras. In some embodiments, the controller communicates with a graphic display terminal for displaying previously saved reference images (e.g., from a scene). In some embodiments, the controller communicates with a user input device, such as a keyboard, for receiving commands from the user. In some embodiments, the controller has a general computer architecture including one or more processors that communicate with memory for storing non-temporary control programs. In some embodiments, the controller communicates with memory to store images from one or more cameras, to retrieve reference images previously acquired by one or more cameras, to store scenes that identify one or more cameras and the region of interest settings of one or more cameras, and / or to retrieve scenes that identify one or more cameras and the region of interest settings of one or more cameras.

[0097] In some embodiments, the system includes software configured to perform image recording, image analysis, image storage, image manipulation, image overlay, and / or image comparison methods. In some embodiments, the system includes hardware components such as a microprocessor, graphics processor, and / or communication bus configured to communicate, record, analyze, store, manipulate, and / or compare images.

[0098] Furthermore, in some embodiments, the system includes a graphical display with a graphical user interface (GUI). In some embodiments, the GUI includes viewing elements that display images from a camera. In some embodiments, the GUI includes several viewing elements, each displaying images from a camera. See Figures 6 and 7.

[0099] The GUI includes several control elements. For example, the GUI may include a control element used to select a camera (e.g., one, two, three, or four peripheral cameras) to provide images within the GUI's viewing element. Thus, in some embodiments, the user can select one or more cameras (e.g., one, two, or three of the five cameras in an embodiment with five cameras) to provide a useful camera view of the patient, based on the patient's orientation and which camera provides the best view of the patient.

[0100] In some embodiments, the GUI includes a zoom control element for setting the region of interest of the cameras providing images within the GUI's viewing element. Thus, the GUI allows the user to select a region of interest within the view provided by individual cameras to obtain more precise information about objects within the selected region. Furthermore, in some embodiments, the system controls the data transmitted by the cameras so that only data collected within the selected region of interest is sent to the computer so that it is displayed on the GUI, thus reducing the amount of data transmitted from the cameras to the computer and providing an increased frame rate (e.g., greater than or equal to 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 Hz).

[0101] The GUI may include a capture button that can be clicked by the user to prompt the camera to provide an image, to record an image from a camera, or to record images from several cameras simultaneously. The GUI may include an image retrieval control element for selecting and retrieving a reference image and / or a set of reference images. The GUI may include a scene selection control element for selecting and retrieving a saved scene that includes a reference image and / or a set of reference images, information identifying the camera that captured the reference image and / or set of reference images, and the region of interest setting for each camera that captured the reference image and / or set of reference images. See Figure 8.

[0102] In some embodiments, the GUI provides a button to initiate tracking mode. In tracking mode, a set of reference images is displayed within a viewing element on the display. A live image provided by the same camera, using the same region of interest setting as used to acquire the reference images, is superimposed on the reference images within the appropriate viewing element. The user can interact with the viewing element using a pointing device (e.g., mouse, trackball, trackpad, finger or stylus and touchscreen, eye-tracking, etc.) and manipulate a cursor displayed on the display. Interacting with the viewing element may include translating and / or rotating the reference images to align them with the position of the live tracking image superimposed on the reference images.

[0103] In some embodiments, the green and blue RGB components of a reference image are displayed within a viewing element on the display, and the respective red RGB channels of the associated live tracking image are superimposed on the green and blue RGB components of the reference image within the viewing element on the display. In some embodiments, the red and blue RGB components of a reference image are displayed within a viewing element on the display, and the respective green RGB channels of the associated live tracking image are superimposed on the red and blue RGB components of the reference image within the viewing element on the display. In some embodiments, the green and red RGB components of a reference image are displayed within a viewing element on the display, and the respective blue RGB channels of the associated live tracking image are superimposed on the green and red RGB components of the reference image within the viewing element on the display. See Figure 9. The user can manipulate (e.g., transform and / or rotate) the reference image provided within the viewing element on the display to align the reference and live tracking images. Increased alignment accuracy is indicated by a reduction in the amount of unaligned red and green / blue (or green and red / blue or blue and green / red) portions within the viewing element.

[0104] In some embodiments, the user can interact with a GUI to draw a reference line or reference mark on a reference image and / or a live tracking image, for example, by placing the reference line or mark on a viewing element on a display. See, for example, Figure 9. For example, a reference line can be provided on the GUI so as to intersect with a reference point in the treatment room seen within the viewing element on the display, for example, a treatment isocenter. Thus, in some embodiments, the reference line performs a function similar to a laser line used in the treatment room. Thus, in some embodiments, the reference line can provide a virtual laser line. After setting a reference image or reference mark on one or more viewing elements on the display, the reference image or reference mark provides a fixed reference point that does not move with the image provided on the viewing element. Thus, a technique is provided for aligning an object with a fixed reference point in the room by moving the object until a point or marker on the object seen in the live tracking image intersects with a fixed reference point on two cameras.

[0105] method In some embodiments, the technology relates to embodiments of a method. In some embodiments, the technology provides a method for imaging a patient. In some embodiments, the technology provides a method for treating a patient. In some embodiments, the method for treating a patient includes a method for imaging a patient. In some embodiments, the method for treating a patient includes a pre-treatment patient immobilization and imaging step 1000 (Figures 10A-10D) and a treatment step 2000 (Figures 11A-11D).

[0106] For example, as shown in Figure 10A, the technology provides a pre-treatment patient immobilization and imaging method 1000 (also known as the “simulation” stage). The pre-treatment patient immobilization and imaging method 1000 includes initiating an optical guided tracking system (OGTS) session 1100. In some embodiments, initiating an OGTS session 1100 includes moving a patient positioning device or patient support (e.g., a patient support which is a component of a patient positioning system) to a patient position. Furthermore, the pre-treatment patient immobilization and imaging method 1000 includes determining whether initial patient immobilization is required 1200. Initial patient immobilization may be required, for example, for a new patient, a new treatment for a patient, treatment of a new area of ​​the patient, or treatment of a patient in a new patient posture. If initial patient immobilization is required (YES), as shown in Figure 10A, the pre-treatment patient immobilization and imaging method 1000 includes performing an initial patient immobilization method 1300 (Figure 10B). If immobilization of the first patient is not required (NO), the pre-treatment patient immobilization and imaging method 1000 includes performing the subsequent patient immobilization method 1400 (Figure 10C). After performing the first patient immobilization method 1300 or the subsequent patient immobilization method 1400, the pre-treatment patient immobilization method includes obtaining a CT scan of the patient 1500 (Figure 10D).

[0107] Figure 10B shows one embodiment of the initial patient immobilization method 1300. As shown in Figure 10B, an embodiment of the initial patient immobilization method 1300 includes an initialization and tracking initiation step 1310. The initialization and tracking initiation step 1310 includes setting up cameras and preparing the OGTS to image patient positioning and / or configuration settings, as described below. As shown in Figure 10B, the initialization and tracking initiation step 1310 includes selecting a number of cameras to be used when imaging patient positioning and / or configuration settings 1311. In some embodiments, at least three cameras (e.g., an overhead camera and two peripheral cameras orthogonal to each other) are selected for use when imaging patient positioning and / or configuration settings. In some embodiments, four or five cameras (e.g., comprising at least an overhead camera and two peripheral cameras orthogonal to each other) are selected for use when imaging patient positioning and / or configuration settings. As further shown in Figure 10B, an embodiment of the initialization and tracking initiation step 1310 includes resetting the region of interest 1312. In some embodiments, the initialization and tracking start step 1310 includes resetting a baseline or reference mark.

[0108] Furthermore, the initialization and tracking initiation step 1310 includes initiating tracking 1313 by acquiring video provided by the selected cameras. Tracking 1313 may also include displaying the live images provided by each of the selected cameras on a display in a separate window so that each live image is visible to the user. The live images show real-time video of patient positioning and / or configuration settings from multiple orthogonal views (e.g., apex and at least two peripheral views) provided by the selected cameras. In some embodiments, embodiments of the method include drawing a baseline or reference mark on the live tracking image so that the baseline or reference mark is placed on a viewing element on the display, for example. In some embodiments, the baseline or reference mark intersects a reference point in the treatment room, such as a treatment isocenter, as seen within the viewing element on the display.

[0109] An embodiment of the first patient immobilization method 1300 further includes placing the patient on a patient positioning device (PPA) or patient support (e.g., positioning the patient) 1320.

[0110] Embodiments of the initial patient immobilization method 1300 further include configuring a patient positioning device (PPA) or patient support 1330 to determine a patient position and support the patient position by supporting the patient's body to a comfortable and stable position suitable for treatment, for example. Determining a patient position 1330 may include manipulating, guiding, and / or applying force to the patient (for example, by a technician or the patient positioning device or patient support) to provide the patient in a position suitable for treatment. Configuring a PPA or patient support may include moving the entire PPA or patient support (e.g., translating and / or rotating) or moving one or more components of the PPA or patient support (e.g., one or more of a backrest, seat pan, shin rest, armrest, headrest, and / or foot brace or heel stop) (e.g., translating and / or rotating). In some embodiments, the method includes viewing the patient posture and / or position of the PPA or patient support on a live tracking image and adjusting the patient posture and / or position of the PPA or patient support using reference lines or reference marks that mark reference points within the treatment room, such as treatment isocenters, provided on the live tracking image.

[0111] Next, an embodiment of the initial patient immobilization method 1300 includes determining whether the patient is ready to continue 1340. Determining whether the patient is ready to continue 1340 may include asking the patient if they are comfortable, determining that the patient is in a stable position, determining that the patient is in a position suitable for treatment, and / or otherwise confirming that it is appropriate to proceed to the subsequent steps of the initial patient immobilization method 1300. If the patient is not ready to continue (NO), the steps of determining the patient position and configuring the patient positioning device (PPA) or patient support to support the patient position and determining whether the patient is ready to continue 1340 are repeated. If the patient is ready to continue (YES), the method proceeds to saving the patient positioning scene 1350.

[0112] Saving the patient positioning scene 1350 primarily records the patient's posture (e.g., patient position) at a position suitable for the next treatment. Saving the patient positioning scene 1350 includes saving a list of selected cameras that provide images of the patient position, saving each of the images of the patient position provided by each of the selected cameras, and saving regions of interest saved as images for each of the selected cameras during image acquisition. In some embodiments, saving the patient positioning scene 1350 optionally includes saving patient identification information, saving the date and time the patient positioning scene was saved, saving the type of treatment to be performed on the patient in the next treatment stage, and saving information that identifies the OGTS user performing the initial patient immobilization method 1300.

[0113] Next, an embodiment of the first patient immobilization method 1300 includes selecting several cameras for use when imaging the patient and PPA or patient support at the imaging position 1360. In some embodiments, at least three cameras (e.g., an overhead camera and two peripheral cameras orthogonal to each other) are selected for use when imaging the patient and PPA or patient support at the imaging position. In some embodiments, four or five cameras (e.g., comprising at least an overhead camera and two peripheral cameras orthogonal to each other) are selected for use when imaging the patient and PPA or patient support at the imaging position.

[0114] Embodiments of the initial patient immobilization method 1300 include moving the PPA or patient support to the imaging position 1370. Moving the PPA or patient support 1370 may include translating the PPA or patient support along the X, Y, or Z axis and / or rotating the PPA or patient support around one or more of the X, Y, or Z axes. In some embodiments, selecting multiple cameras for use when imaging the patient and / or PPA or patient support at the imaging position 1360 is performed before moving the PPA or patient support to the imaging position 1370. In some embodiments, moving the PPA or patient support to the imaging position 1370 is performed before selecting multiple cameras for use when imaging the patient and / or PPA or patient support at the imaging position 1360. In some embodiments, the method includes drawing reference lines or reference marks on the live tracking image to mark reference points in the room, such as the treatment isocenter or the imaging position. In some embodiments, the method includes viewing the PPA or patient support on a live tracking image and adjusting the PPA or patient support using a reference line or reference mark that marks a reference point provided on the live tracking image.

[0115] Next, an embodiment of the initial patient immobilization method 1300 includes determining whether the patient is ready for imaging 1380. Determining whether the patient is ready for imaging 1380 may include determining that the PPA or patient support and the patient are in the correct position for imaging. In some embodiments, determining whether the patient is ready for imaging 1380 may optionally include notifying the patient that the patient is being positioned for imaging, asking the patient if they are comfortable, determining that the patient is in a stable position, determining that the patient is in a position suitable for treatment, and / or otherwise confirming that it is appropriate to proceed to the subsequent steps of the initial patient immobilization method 1300. If the patient is not ready for imaging (NO), the steps of moving the PPA or patient support to the imaging position 1370 and determining whether the patient is ready for imaging 1380 may be repeated. If the patient is ready for imaging (YES), the method proceeds to saving the imaging positioning scene 1390.

[0116] Saving the imaging position setting scene 1390 includes saving a list of selected cameras that provide images of the imaging position, saving each of the images of the imaging position provided by each of the selected cameras, and saving each of the regions of interest of each of the selected cameras. In some embodiments, saving the imaging position setting scene 1390 optionally includes saving patient identification information, saving the date and time the imaging position setting scene was saved, saving the type of treatment to be performed on the patient in the next treatment stage, saving information identifying the OGTS user performing the initial patient immobilization method 1300, and so on. After saving the imaging position setting scene 1390, the method includes acquiring a CT scan 1500 (Figure 10D), as described below, for example.

[0117] Figure 10C shows one embodiment of the subsequent patient immobilization method 1400 (for example, reproducing previously saved PPA or patient support configuration, patient position, and / or imaging position within a patient support configuration setting scene, patient position setting scene, and / or imaging position setting scene). As shown in Figure 10C, an embodiment of the subsequent patient immobilization method 1400 includes retrieving a saved configuration setting scene and providing the retrieved configuration setting scene 1411. In some embodiments, the saved configuration setting scene is one that was previously saved when a method 1500 (for example, including saving a configuration setting scene 1560) is performed after the initial patient immobilization method 1300 is performed, as described below, for example. The retrieved configuration setting scene includes saved images of the PPA or patient support configuration (for example, images showing views of the PPA or patient support from at least three orthogonal directions), a list of cameras that provided saved images of the PPA or patient support configuration, and each of the selected cameras that provided images during image acquisition. In some embodiments, the method further includes displaying each of the saved images showing views of the PPA or patient support from at least three orthogonal directions on a display in a separate window, so that each orthogonal view is visible to the user in each of the separate windows. Each saved and displayed image shows a view of the configuration provided by the selected camera listed in the saved configuration scene. The images of the retrieved configuration scene (for example, displayed on the display) provide a reference image for accurately configuring the PPA patient support.

[0118] Next, in some embodiments, the method includes configuring a patient positioning device or patient support 1412. In some embodiments, the retrieved configuration setting scene includes information describing the configuration of the PPA or patient support for use in configuring the patient positioning device or patient support 1412. For example, in some embodiments, the retrieved configuration setting scene includes information describing the location of the PPA or patient support and / or the location of one or more components of the PPA or patient support (e.g., the location of the backrest, seat base, shin rest, armrest, headrest, and / or one or more footrests or heel stops). In some embodiments, configuring the patient positioning device or patient support 1412 includes configuring the PPA or patient support according to a standard preset that describes the approximate location of the PPA or patient support and / or the approximate location of one or more components of the PPA or patient support (e.g., the location of the backrest, seat base, shin rest, armrest, headrest, and / or one or more footrests or heel stops).

[0119] Next, embodiments of the subsequent patient immobilization method 1400 provided herein include determining whether the PPA or patient support is correctly configured 1420. In some embodiments, determining whether the PPA or patient support is correctly configured 1420 includes using an image of a configuration setting scene (e.g., displayed on a display) retrieved as a reference image, and live video of the PPA or patient support, in order to correctly configure the PPA or patient support. Specifically, using a list of cameras that provided saved images of the PPA or patient support configuration, and information stored in the configuration setting scene that provides the region of interest used for each of the cameras selected during image acquisition, the same cameras are selected to provide live video of the PPA or patient support, and the region of interest for each of the selected cameras is set to the same region of interest that was stored for each of the cameras in the saved configuration setting scene. Thus, the live video provided by the selected cameras shows the same view (e.g., the same orthogonal view) of the same region of interest of the PPA or patient support provided in the retrieved configuration setting scene that was stored in the saved configuration setting scene. The user interacts with the GUI of the OGTS software to initiate tracking, thereby obtaining live video from each of the selected cameras. In some embodiments, the method includes drawing reference lines or reference marks on the live tracking image to mark reference points in the room, such as the treatment isocenter or imaging position. In some embodiments, the method includes viewing the PPA or patient support on the live tracking image and adjusting the PPA or patient support using the reference lines or reference marks that mark reference points provided on the live tracking image.

[0120] Live video from each selected camera showing the PPA or patient support is superimposed on the display onto an associated reference image of the PPA or patient support previously saved by the same camera. When in tracking mode, the OGTS software displays the respective red component of the reference image superimposed (e.g., added) to the respective green and blue components of the associated live image provided by each camera. When the reference image and live image are aligned, the red and green in the image are aligned to provide an accurate RGB image of the exact colors within the area where the image is aligned. Unaligned areas appear as green or red areas, indicating that the PPA or patient support is not in the same position or configuration as shown in the reference image. As illustrated in the example, OGTS is used to calculate misalignment between the reference image and the live image. The camera is calibrated to provide a defined pixel size relationship per millimeter in the isocenter plane in actual space (for example, approximately 1 to 5 pixels / mm (e.g., approximately 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, or 5.0 pixels / mm)). Therefore, PPA or patient support or its components The appropriate displacements of ΔX, ΔY, and / or ΔZ for positioning and / or configuring the live and reference images to their real-space positions recorded by the reference images are obtained by aligning the live and reference images within each camera view, determining the distances within image pixels required to align the live and reference images, and calculating the displacements of ΔX, ΔY, and / or ΔZ according to the relationship of pixel size per millimeter. Furthermore, the OGTS software also allows for rotating the images to determine Δψ, Δφ, and Δθ to compensate for the patient's rotation around the X, Y, and Z axes relative to previously acquired reference images.Accordingly, the embodiment includes using OGTS to determine whether the PPA or patient support is accurately configured and / or positioned 1420. If the PPA or patient support is not accurately configured or positioned (NO), the user may use information from OGTS regarding displacements of ΔX, ΔY, and / or ΔZ, and / or rotations of Δψ, Δφ, and Δθ, which are suitable for accurately configuring the PPA or patient support, and the steps of configuring the PPA or patient support 1412 and determining whether the PPA is accurately configured 1420 may be repeated. If the PPA or patient support is accurately configured and / or positioned (YES), the subsequent patient immobilization method 1400 proceeds to the next step 1431, which retrieves the saved patient positioning scene.

[0121] As shown in Figure 10C, an embodiment of the subsequent patient immobilization method 1400 includes retrieving a saved patient positioning scene and providing the retrieved patient positioning scene 1431. In some embodiments, the saved patient positioning scene is one previously saved when the initial patient immobilization method 1300 (e.g., including saving a patient positioning scene 1350) is being performed. The retrieved patient positioning scene includes saved images of the patient position (e.g., images showing views of the patient from at least three orthogonal directions), a list of cameras that provided saved images of the patient position, and the respective regions of interest of the selected cameras that provided images during image acquisition. These images show orthogonal views of the patient positioned on a PPA or patient support in a posture suitable for patient treatment. In some embodiments, the method further includes displaying each of the saved images showing views of the patient position from at least three orthogonal directions on a display in a separate window, so that each orthogonal view is visible to the user in each of the separate windows. Each saved and displayed image shows a view of the patient positioning provided by the selected cameras listed in the retrieved positioning scene. The retrieved patient positioning scene image (for example, displayed on a screen) provides a reference image for accurately positioning the patient in an appropriate patient position (for example, patient posture).

[0122] Next, in some embodiments, the method includes placing the patient on the PPA or patient support 1432 and positioning the patient on the PPA or patient support 1433. In some embodiments, the retrieved patient positioning scene includes information describing the patient position (e.g., patient posture) and / or the configuration of the PPA or patient support for use in positioning the patient in the correct patient position 1433. For example, in some embodiments, the retrieved patient positioning scene includes information describing the location and / or position of one or more components of the PPA or patient support for providing a suitable patient position (e.g., the position of one or more of the backrest, seat base, shin rest, armrest, headrest, and / or footrest or heel stop). In some embodiments, positioning the patient 1433 includes positioning the patient in a standard patient position (e.g., a standard patient posture) which may be modified as needed by adjusting the configuration of the PPA or patient support (e.g., by adjusting the position of one or more of the backrest, seat base, shin rest, armrest, headrest, and / or footrest or heel stop).

[0123] Next, embodiments of the subsequent patient immobilization method 1400 provided herein include determining whether the patient is accurately positioned 1440. In some embodiments, determining whether the patient is accurately positioned 1440 includes using an image (e.g., displayed on a display) of a retrieved patient positioning scene as a reference image, and a reference image live video of the positioned patient, to accurately position the patient (e.g., by configuring a PPA or patient support). Specifically, using a list of cameras that provided saved images of the patient position, and information in the retrieved patient positioning scene that provides the region of interest used for each of the selected cameras during image acquisition, the same cameras are selected to provide live video of the patient, and the region of interest for each of the selected cameras is set to the same region of interest as saved for each of the images in the saved patient positioning scene. Thus, the live video provided by the selected cameras shows the same view (e.g., the same orthogonal view) of the patient and patient position provided in the retrieved patient positioning scene as saved in the saved patient positioning scene. The user interacts with the GUI of the OGTS software to begin tracking, thereby acquiring live video from each of the selected cameras. In some embodiments, the method includes drawing reference lines or reference marks on the live tracking image to mark reference points within the room, such as a therapeutic isocenter or imaging position. In some embodiments, the method includes viewing the patient on the PPA or patient support on the live tracking image and adjusting the patient and / or the PPA or patient support using reference lines or reference marks to mark reference points provided on the live tracking image.

[0124] Live video from each of the selected cameras indicating the patient's position is overlaid on the display onto an associated saved reference image of the patient's position previously saved by the same camera. When in tracking mode, the OGTS software displays the respective red components of the reference image overlaid (e.g., added) to the respective green and blue components of the associated live image provided by each camera. When the reference image and live image are aligned, the red and green in the image are aligned to provide an accurate RGB image of the correct colors within the area where the image is aligned. Unaligned areas appear as green or red areas, indicating that the patient is not in the same position as shown in the reference image. As illustrated in the example, OGTS is used to calculate misalignment between the reference image and the live image. The camera is calibrated to provide a defined pixel size relationship per millimeter in the isocenter plane in real space (for example, approximately 1 to 5 pixels / mm (e.g., approximately 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, or 5.0 pixels / mm)). Therefore, the patient is positioned in real space to match the position recorded by the reference image. The appropriate displacements of ΔX, ΔY, and / or ΔZ are obtained by aligning the live and reference images within each camera view, determining the distance within the image pixels required to align the live and reference images, and calculating the displacements of ΔX, ΔY, and / or ΔZ according to the relationship of pixel size per 1 mm. Furthermore, the OGTS software also allows the image to be rotated to determine Δψ, Δφ, and Δθ to compensate for the patient's rotation around the X, Y, and Z axes relative to a previously acquired reference image. Thus, the embodiment includes using OGTS to determine whether the patient is accurately positioned.If the patient is not precisely positioned (NO), the user may use information from the OGTS regarding displacements of ΔX, ΔY, and / or ΔZ, and / or rotations of Δψ, Δφ, and Δθ, which are appropriate for precisely positioning the patient, and the patient positioning step 1443 and the step 1440 for determining whether the patient is precisely positioned may be repeated. If the patient is precisely positioned (YES), the subsequent patient immobilization method 1400 proceeds to the next step 1450 for retrieving the saved imaging positioning scene.

[0125] As shown in Figure 10C, an embodiment of the subsequent patient immobilization method 1400 includes retrieving a saved imaging positioning scene and providing the retrieved imaging positioning scene 1450. In some embodiments, the saved imaging positioning scene is one previously saved when the initial patient immobilization method 1300 (e.g., including saving an imaging positioning scene 1390) is being performed. The retrieved imaging positioning scene includes saved images of the patient and PPA or patient support at the imaging position (e.g., images showing views of the patient and PPA or patient support at the imaging position from at least three orthogonal directions), a list of cameras that provided saved images of the patient and PPA or patient support at the imaging position, and each selected camera's region of interest that provided images during image acquisition. These images show orthogonal views of the positioned patient on the PPA or patient support at a posture and appropriate imaging position suitable for patient treatment. In some embodiments, the method further includes displaying each of the saved images showing views of the patient and PPA or patient support at imaging positions from at least three orthogonal directions on a display in a separate window, such that each orthogonal view is visible to the user in each of the separate windows. Each saved and displayed image shows a view of the imaging position provided by the selected camera listed in the retrieved imaging positioning scene. The images of the imaging positioning scene (for example, displayed on the display) provide reference images for accurately positioning the patient at the appropriate imaging position.

[0126] Next, in some embodiments, the method includes moving the patient and PPA or patient support to the imaging position 1460. In some embodiments, the retrieved imaging position setting scene includes information describing the imaging position for use in moving the patient and PPA or patient support to the correct imaging position 1460.

[0127] Next, embodiments of the subsequent patient immobilization method 1400 provided herein include determining whether the patient is ready for imaging 1470. In some embodiments, determining whether the patient is ready for imaging 1470 includes using an image of an imaging positioning scene (e.g., displayed on a display) taken out as a reference image, and live video of the patient positioned on the PPA or patient support, in order to precisely position the patient on the PPA or patient support for imaging. In particular, using a list of cameras that provided saved images of the imaging position and information in the taken imaging positioning scene that provides the region of interest used for each of the selected cameras during image acquisition, the same cameras are selected to provide live video of the patient on the PPA or patient support, and the region of interest for each of the selected cameras is set to the same region of interest as saved for each of the images in the imaging positioning scene. Thus, the live video provided by the selected cameras shows the same view (e.g., the same orthogonal view) of the patient on the PPA or patient support provided in the taken imaging positioning scene, which is saved in the imaging positioning scene. The user interacts with the GUI of the OGTS software to initiate tracking, thereby obtaining live video from each of the selected cameras. In some embodiments, the method includes drawing reference lines or reference marks on the live tracking image to mark reference points in the room, such as the treatment isocenter or imaging position. In some embodiments, the method includes viewing the patient and PPA or patient support on the live tracking image and adjusting the patient and / or PPA or patient support using reference lines or reference marks that mark reference points provided on the live tracking image.

[0128] Live video from each of the selected cameras indicating the imaging position is overlaid on the display with the associated saved reference image of the imaging position previously saved by the same camera. When in tracking mode, the OGTS software displays the respective red component of the reference image overlaid (e.g., added) to the respective green and blue components of the associated live image provided by each camera. When the reference image and live image are aligned, the red and green in the image are aligned to provide an accurate RGB image of the correct colors within the area where the image is aligned. Unaligned areas appear as green or red areas, indicating that the patient is not at the same imaging position as shown in the reference image. As illustrated in the example, OGTS is used to calculate misalignment between the reference image and the live image. The camera is calibrated to provide a defined pixel size relationship per millimeter in the isocenter plane in real space (for example, approximately 1 to 5 pixels / mm (e.g., approximately 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, or 5.0 pixels / mm)). Thus, the patient and PPA or patient support are positioned in real space to match the imaging position recorded by the reference image. The appropriate displacements of ΔX, ΔY, and / or ΔZ for positioning within the image are obtained by aligning the live and reference images within each camera view, determining the distance within the image pixels required to align the live and reference images, and calculating the displacements of ΔX, ΔY, and / or ΔZ according to the relationship of pixel size per 1 mm. Furthermore, the OGTS software also allows the image to be rotated to determine Δψ, Δφ, and Δθ to compensate for the patient's rotation around the X, Y, and Z axes relative to a previously acquired reference image. Thus, the embodiment includes using the OGTS to determine whether the patient is ready for imaging.If the patient is not ready for imaging (NO), the user may use information from the OGTS regarding displacements of ΔX, ΔY, and / or ΔZ, and / or rotations of Δψ, Δφ, and Δθ, which are appropriate for precisely positioning the patient and PPA or patient support for imaging, and step 1460 of moving the patient and PPA or patient support, and step 1470 of determining whether the patient is ready for imaging may be repeated. If the patient is ready for imaging (YES), the subsequent patient immobilization method 1400 proceeds to the next step 1500 of acquiring the CT scan.

[0129] Figure 10D shows one embodiment of method 1500 for obtaining a patient CT scan (e.g., a pre-treatment CT scan) after, for example, performing the initial patient immobilization method 1300 (Figure 10B) or after performing the subsequent patient immobilization method 1400 (Figure 10C). As shown in Figure 10D, an embodiment of method 1500 for obtaining a patient CT scan includes, for example, initiating a CT scan 1510 to obtain a patient CT scan. In some embodiments, the CT scan is obtained using a multi-axis medical imaging device described in U.S. Patent Application Publication No. 2022 / 0183641, which is incorporated herein by reference. Next, method 1500 for obtaining a patient CT scan includes determining whether the CT scan is complete 1520. In some embodiments, determining whether the CT scan is complete 1520 includes determining whether the CT scan is of sufficient quality for the patient's treatment plan and treatment. If the CT scan is not complete (NO), the steps of initiating the CT scan 1510 and determining whether the CT scan is complete 1520 are repeated. If the CT scan is complete (YES), method 1500 for obtaining the patient's CT scan includes saving the CT scan as a pre-treatment CT scan of the patient to be used later for treatment planning and treatment. The method then proceeds to moving the PPA or patient support to a lowered position 1530 and lowering the patient from the PPA or patient support 1540. If method 1500 for obtaining the patient's CT scan is performed after the initial patient immobilization method 1300 has been performed, special care is taken during lowering 1540 to minimize interference with the PPA or patient support and thus maintain the configuration of the PPA or patient support previously determined in step 1330 of the initial patient immobilization method 1300.

[0130] Next, if method 1500 for obtaining a patient's CT scan is performed after a subsequent patient immobilization method 1400 (SUBSEQUENT) has been performed, the OGTS session is terminated. If method 1500 for obtaining a patient's CT scan is performed after the initial patient immobilization method 1300 has been performed, the method includes saving a configuration setting scene 1560. Saving a configuration setting scene 1560 primarily records the PPA or patient support configuration for subsequent use when supporting the patient during treatment. Saving a configuration setting scene 1560 includes saving a list of selected cameras that provide images of the PPA or patient support configuration, saving each image of the PPA or patient support configuration provided by each of the selected cameras, and saving each of the regions of interest of the selected cameras during image acquisition. In some embodiments, saving a configuration setting scene 1560 optionally includes saving patient identification information, saving the date and time the configuration setting scene was saved, saving the type of treatment to be performed on the patient in the next treatment stage, saving information identifying the OGTS user who performs the pre-treatment patient immobilization and imaging method 1000, and saving information describing the position of the PPA or patient support or its components.

[0131] Furthermore, embodiments of the technology provided herein relate to methods of treating a patient with radiation. For example, as shown in Figure 11A, a method of treating a patient includes treating a patient using an OGTS system described herein. The method shown in Figure 11A includes initiating an OGTS session, placing the patient on a PPA or patient support in a position suitable for treatment, imaging the patient, treating the patient, and ending the OGTS session.

[0132] As shown in Figure 11B, an embodiment of method 2200 for placing a patient on a PPA or patient support in a position suitable for treatment includes moving the PPA or patient support to the loading position 2210. Next, method 2200 for placing a patient on a PPA or patient support in a position suitable for treatment includes retrieving a saved configuration scene and providing the retrieved configuration scene 2220. In some embodiments, the saved configuration scene is one that was previously saved when performing method 1500 (e.g., including saving the configuration scene 1560) to acquire a CT scan of the patient after performing the initial patient immobilization method 1300. The retrieved configuration scene includes saved images of the PPA or patient support configuration (e.g., images showing views of the PPA or patient support from at least three orthogonal directions), a list of cameras that provided saved images of the PPA or patient support configuration, and each of the selected cameras that provided images during image acquisition. In some embodiments, the method further includes displaying each of the saved images showing views of the PPA or patient support from at least three orthogonal directions on a display in a separate window, so that each orthogonal view is visible to the user in each of the separate windows. Each saved and displayed image shows a view of the configuration setting provided by the selected camera listed in the saved configuration setting scene. The images of the retrieved configuration setting scene (e.g., displayed on the display) provide a reference image for accurately configuring the PPA patient support. In some embodiments, the method includes drawing reference lines or reference marks on the live tracking image to mark reference points in the room, e.g., the therapeutic isocenter. In some embodiments, the method includes viewing the PPA or patient support on the live tracking image and adjusting the PPA or patient support using the reference lines or reference marks marking reference points provided on the live tracking image.

[0133] Next, in some embodiments, the method 2200 for placing a patient on a PPA or patient support in a position suitable for treatment includes configuring the PPA or patient support 2230. In some embodiments, the retrieved configuration setting scene includes information describing the configuration of the PPA or patient support for use in configuring the PPA or patient support 2230. For example, in some embodiments, the retrieved configuration setting scene includes information describing the location of the PPA or patient support and / or the location of one or more components of the PPA or patient support (e.g., the location of one or more of the backrest, seat base, shin rest, armrest, headrest, and / or footrest or heel stop). In some embodiments, configuring a PPA or patient support 2230 includes configuring the PPA or patient support according to a standard preset that describes the approximate location of the PPA or patient support and / or the approximate location of one or more components of the PPA or patient support (e.g., the location of one or more of the backrest, seat base, shin rest, armrest, headrest, and / or footrest or heel stop).

[0134] Next, embodiments of the method 2200 for placing a patient on a PPA or patient support in a position suitable for treatment include determining whether the PPA or patient support is properly configured 2240. In some embodiments, determining whether the PPA or patient support is properly configured 2240 includes using an image of a configuration setting scene (e.g., displayed on a display) retrieved as a reference image, and live video of the PPA or patient support, to properly configure the PPA patient support. Specifically, using a list of cameras that provided saved images of the PPA or patient support configuration, and information stored in the configuration setting scene that provides the region of interest used for each of the selected cameras during image acquisition, the same cameras are selected to provide live video of the PPA or patient support, and the region of interest for each of the selected cameras is set to the same region of interest as that stored for each of the cameras in the saved configuration setting scene. Thus, the live video provided by the selected cameras shows the same view (e.g., the same orthogonal view) of the same region of interest of the PPA or patient support provided in the retrieved configuration setting scene that is stored in the saved configuration setting scene. The user interacts with the GUI of the OGTS software to initiate tracking, thereby obtaining live video from each of the selected cameras. In some embodiments, the method includes drawing reference lines or reference marks on the live tracking image to mark reference points in the room, such as the treatment isocenter or imaging position. In some embodiments, the method includes viewing the PPA or patient support on the live tracking image and adjusting the PPA or patient support using the reference lines or reference marks that mark reference points provided on the live tracking image.

[0135] Live video from each selected camera showing the PPA or patient support is superimposed on the display onto an associated reference image of the PPA or patient support previously saved by the same camera. When in tracking mode, the OGTS software displays the respective red component of the reference image superimposed (e.g., added) to the respective green and blue components of the associated live image provided by each camera. When the reference image and live image are aligned, the red and green in the image are aligned to provide an accurate RGB image of the exact colors within the area where the image is aligned. Unaligned areas appear as green or red areas, indicating that the PPA or patient support is not in the same position or configuration as shown in the reference image. As illustrated in the example, OGTS is used to calculate misalignment between the reference image and the live image. The camera is calibrated to provide a defined pixel size relationship per millimeter in the isocenter plane in actual space (for example, approximately 1 to 5 pixels / mm (e.g., approximately 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, or 5.0 pixels / mm)). Therefore, PPA or patient support or its components The appropriate displacements of ΔX, ΔY, and / or ΔZ for positioning and / or configuring the live and reference images in real space are obtained by aligning the live and reference images within each camera view, determining the distance within the image pixels required to align the live and reference images, and calculating the displacements of ΔX, ΔY, and / or ΔZ according to the relationship of pixel size per millimeter. Furthermore, the OGTS software also allows the images to be rotated to determine Δψ, Δφ, and Δθ to compensate for the patient's rotation around the X, Y, and Z axes relative to the previously acquired reference image.Accordingly, the embodiment includes using OGTS to determine whether the PPA or patient support is accurately configured and / or positioned 2240. If the PPA or patient support is not accurately configured or positioned (NO), the user may use information from OGTS regarding displacements of ΔX, ΔY, and / or ΔZ, and / or rotations of Δψ, Δφ, and Δθ, which are appropriate for accurately configuring the PPA or patient support, and the steps of configuring the PPA or patient support 2230 and determining whether the PPA is accurately configured 2240 may be repeated. If the PPA or patient support is accurately configured and / or positioned (YES), the method 2200 of placing the patient on the PPA or patient support in a position appropriate for treatment proceeds to the next step 2250 of retrieving the saved patient positioning scene.

[0136] As shown in Figure 11B, an embodiment of method 2200 for positioning a patient on a PPA or patient support in a position suitable for treatment includes retrieving a saved patient positioning scene and providing the retrieved patient positioning scene 2250. In some embodiments, the saved patient positioning scene is one previously saved when performing the initial patient immobilization method 1300 (e.g., including saving a patient positioning scene 1350). The retrieved patient positioning scene includes saved images of the patient position (e.g., images showing views of the patient from at least three orthogonal directions), a list of cameras that provided saved images of the patient position, and the respective regions of interest of the selected cameras that provided images during image acquisition. These images show orthogonal views of the patient positioned on the PPA or patient support in a position suitable for patient treatment. In some embodiments, the method further includes displaying each of the saved images showing views of the patient position from at least three orthogonal directions on a display in a separate window, so that each orthogonal view is visible to the user in each of the separate windows. Each saved and displayed image represents a view of the patient positioning provided by the selected camera listed in the retrieved configuration scene. The images in the retrieved patient positioning scene (e.g., displayed on the display) provide reference images for accurately positioning the patient in an appropriate patient position (e.g., patient posture).

[0137] Next, in some embodiments, the method includes placing a patient on a PPA or patient support 2260 and positioning the patient on the PPA or patient support 2270. In some embodiments, the retrieved patient positioning scene includes information describing the configuration of the PPA or patient support for use in positioning the patient in the correct patient position (e.g., patient posture) and / or for use in positioning the patient in the correct patient position 2270. For example, in some embodiments, the retrieved patient positioning scene includes information describing the location and / or position of one or more components of the PPA or patient support for providing a suitable patient position (e.g., the position of one or more of the backrest, seat base, shin rest, armrest, headrest, and / or footrest or heel stop). In some embodiments, positioning the patient 2270 includes positioning the patient in a standard patient position (e.g., a standard patient posture) which may be modified as needed by adjusting the configuration of the PPA or patient support (e.g., by adjusting the position of one or more of the backrest, seat base, shin rest, armrest, headrest, and / or footrest or heel stop).

[0138] Next, embodiments of method 2200 for placing a patient on a PPA or patient support in a position suitable for treatment include determining whether the patient is accurately positioned 2280. In some embodiments, determining whether the patient is accurately positioned 2280 includes using an image (e.g., displayed on a display) of a retrieved patient positioning scene as a reference image and live video of the positioned patient to accurately position the patient (e.g., by configuring a PPA or patient support). Specifically, using a list of cameras that provided saved images of the patient position and information in the retrieved patient positioning scene that provides the region of interest used for each of the selected cameras during image acquisition, the same cameras are selected to provide live video of the patient and the region of interest for each of the selected cameras is set to the same region of interest as saved for each of the images in the saved patient positioning scene. Thus, the live video provided by the selected cameras shows the same view (e.g., the same orthogonal view) of the patient and patient position provided in the retrieved patient positioning scene as saved in the saved patient positioning scene. The user interacts with the GUI of the OGTS software to begin tracking, thereby acquiring live video from each of the selected cameras. In some embodiments, the method includes drawing reference lines or reference marks on the live tracking image to mark reference points within the room, such as a therapeutic isocenter or imaging position. In some embodiments, the method includes viewing the patient on the PPA or patient support on the live tracking image and adjusting the patient and / or the PPA or patient support using reference lines or reference marks to mark reference points provided on the live tracking image.

[0139] Live video from each of the selected cameras indicating the patient's position is overlaid on the display onto an associated saved reference image of the patient's position previously saved by the same camera. When in tracking mode, the OGTS software displays the respective red components of the reference image overlaid (e.g., added) to the respective green and blue components of the associated live image provided by each camera. When the reference image and live image are aligned, the red and green in the image are aligned to provide an accurate RGB image of the correct colors within the area where the image is aligned. Unaligned areas appear as green or red areas, indicating that the patient is not in the same position as shown in the reference image. As illustrated in the example, OGTS is used to calculate misalignment between the reference image and the live image. The camera is calibrated to provide a defined pixel size relationship per millimeter in the isocenter plane in real space (for example, approximately 1 to 5 pixels / mm (e.g., approximately 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, or 5.0 pixels / mm)). Therefore, the patient is positioned in real space to match the position recorded by the reference image. The appropriate displacements of ΔX, ΔY, and / or ΔZ are obtained by aligning the live and reference images within each camera view, determining the distance within the image pixels required to align the live and reference images, and calculating the displacements of ΔX, ΔY, and / or ΔZ according to the relationship of pixel size per 1 mm. Furthermore, the OGTS software also allows the image to be rotated to determine Δψ, Δφ, and Δθ to compensate for the patient's rotation around the X, Y, and Z axes relative to a previously acquired reference image. Thus, the embodiment includes using OGTS to determine whether the patient is accurately positioned.If the patient is not precisely positioned (NO), the user may use information from the OGTS regarding displacements of ΔX, ΔY, and / or ΔZ, and / or rotations of Δψ, Δφ, and Δθ, which are appropriate for precisely positioning the patient, and step 2270 of positioning the patient and step 2280 of determining whether the patient is precisely positioned may be repeated. If the patient is precisely positioned (YES), method 2200 of placing the patient on the PPA or patient support in a position suitable for treatment proceeds to the next step 2300 of imaging the patient for treatment.

[0140] As shown in Figure 11C, an embodiment of the method 2300 for imaging a patient for treatment includes retrieving a saved imaging positioning scene and providing the retrieved imaging positioning scene 2310. In some embodiments, the saved imaging positioning scene is one previously saved when performing the initial patient immobilization method 1300 (e.g., including saving the imaging positioning scene 1390). The retrieved imaging positioning scene includes saved images of the patient and PPA or patient support at the imaging position (e.g., images showing views of the patient and PPA or patient support at the imaging position from at least three orthogonal directions), a list of cameras that provided saved images of the patient and PPA or patient support at the imaging position, and each selected camera's region of interest that provided images during image acquisition. These images show orthogonal views of the patient positioned on the PPA or patient support in a posture and appropriate imaging position suitable for patient treatment. In some embodiments, the method further includes displaying each of the saved images showing views of the patient and PPA or patient support at imaging positions from at least three orthogonal directions on a display in a separate window, such that each orthogonal view is visible to the user in each of the separate windows. Each saved and displayed image shows a view of the imaging position provided by the selected camera listed in the retrieved imaging positioning scene. The images of the imaging positioning scene (for example, displayed on the display) provide reference images for accurately positioning the patient at the appropriate imaging position.

[0141] Next, in some embodiments, the method 2300 for imaging a patient for treatment includes moving the patient and PPA or patient support to the imaging position 2320. In some embodiments, the retrieved imaging position setting scene includes information describing the imaging position for use in moving the patient and PPA or patient support to the correct imaging position 2320.

[0142] Next, embodiments of the method 2300 for imaging a patient for treatment include determining whether the patient is ready for imaging 2230. In some embodiments, determining whether the patient is ready for imaging 2230 includes using an image of the retrieved imaging positioning scene (e.g., displayed on a display) and a live video of the patient positioned on the PPA or patient support, in order to precisely position the patient on the PPA or patient support for imaging. Specifically, using a list of cameras that provided saved images of the imaging position and information in the retrieved imaging positioning scene that provides the region of interest used for each of the selected cameras during image acquisition, the same cameras are selected to provide live video of the patient on the PPA or patient support, and the region of interest for each of the selected cameras is set to the same region of interest saved for each of the images in the imaging positioning scene. Thus, the live video provided by the selected cameras shows the same view (e.g., the same orthogonal view) of the same region of interest of the patient on the PPA or patient support provided in the retrieved imaging positioning scene, which is saved in the imaging positioning scene. The user interacts with the GUI of the OGTS software to begin tracking, thereby acquiring live video from each of the selected cameras. In some embodiments, the method includes drawing a reference line or reference mark on a live tracking image to mark an intra-intra

[0143] Live video from each of the selected cameras indicating the imaging position is overlaid on the display with the associated saved reference image of the imaging position previously saved by the same camera. When in tracking mode, the OGTS software displays the respective red component of the reference image overlaid (e.g., added) to the respective green and blue components of the associated live image provided by each camera. When the reference image and live image are aligned, the red and green in the image are aligned to provide an accurate RGB image of the correct colors within the area where the image is aligned. Unaligned areas appear as green or red areas, indicating that the patient is not at the same imaging position as shown in the reference image. As illustrated in the example, OGTS is used to calculate misalignment between the reference image and the live image. The camera is calibrated to provide a defined pixel size relationship per millimeter in the isocenter plane in real space (for example, approximately 1 to 5 pixels / mm (e.g., approximately 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, or 5.0 pixels / mm)). Thus, the patient and PPA or patient support are positioned in real space to match the imaging position recorded by the reference image. The appropriate displacements of ΔX, ΔY, and / or ΔZ for positioning within the image are obtained by aligning the live and reference images within each camera view, determining the distance within the image pixels required to align the live and reference images, and calculating the displacements of ΔX, ΔY, and / or ΔZ according to the relationship of pixel size per 1 mm. Furthermore, the OGTS software also allows the image to be rotated to determine Δψ, Δφ, and Δθ to compensate for the patient's rotation around the X, Y, and Z axes relative to a previously acquired reference image. Thus, the embodiment includes using the OGTS to determine whether the patient is ready for imaging.2230If the patient is not ready for imaging (NO), the user may use information from the OGTS regarding displacements of ΔX, ΔY, and / or ΔZ, and / or rotations of Δψ, Δφ, and Δθ, which are appropriate for precisely positioning the patient and PPA or patient support for imaging, and step 2320 of moving the patient and PPA or patient support, and step 2230 of determining whether the patient is ready for imaging may be repeated. If the patient is ready for imaging (YES), the method 2300 of imaging the patient for treatment proceeds to the next step of obtaining a CT scan.

[0144] As shown in Figure 11C, embodiments of the method 2300 for imaging a patient for treatment include obtaining a CT scan (e.g., a therapeutic CT scan). In particular, the method 2300 for imaging a patient for treatment includes initiating a CT scan 2240 to obtain, for example, a CT scan of the patient. In some embodiments, the CT scan is obtained using a multi-axis medical imaging device described in U.S. Patent Application Publication No. 2022 / 0183641, which is incorporated herein by reference. The method 2300 for imaging a patient for treatment then includes determining whether the CT scan is complete 2250. In some embodiments, determining whether the CT scan is complete 2250 includes determining whether the CT scan is of sufficient quality for the treatment of the patient. If the CT scan is not complete (NO), the steps of initiating the CT scan 2240 and determining whether the CT scan is complete 2250 are repeated. If the CT scan is complete (YES), the method 2300 for imaging the patient for treatment includes overlaying it with the pre-treatment CT scan and saving the patient's CT scan as a treatment CT scan of the patient to be used after the next treatment. The method 2000 for treating the patient with radiation then proceeds to treating the patient with radiation 2400.

[0145] As shown in Figure 11D, a method 2440 for treating a patient with radiation includes acquiring a pre-treatment CT scan (for example, provided by a method 1500 for acquiring a patient CT scan during pre-treatment patient immobilization and imaging phase 1000, which includes saving the CT scan as the patient's pre-treatment CT scan) and acquiring a treatment CT scan (for example, provided by a method 2300 for imaging the patient during treatment phase 2000, which includes saving the patient's CT scan as the patient's treatment CT scan). The method then includes registering the treatment CT scan and pre-treatment CT scan and acquiring a correction vector 2410. In some embodiments, registering the treatment CT scan and pre-treatment CT scan 2410 enables aligning the treatment plan with the treatment volume of interest within the patient's body so that the radiation therapy is accurately delivered to the treatment volume of interest. In some embodiments, registering the treatment CT scan and pre-treatment CT scan 2410 enables detecting and evaluating any anatomical changes that may have occurred before the treatment phase after acquiring the pre-treatment scan. Therefore, registering the treatment CT scan and the pre-treatment scan provides important information for the patient's treatment. The difference between the pre-treatment CT scan and the treatment CT scan is used to determine a correction vector for aligning the treatment plan (e.g., the treatment beam) to contact the treatment volume of interest within the patient's body. In some embodiments, the method includes verifying the correct application of the correction vector for positioning the patient, as described below, for example.

[0146] This technique is used to treat multiple treatment fields f (e.g., 1, 2, 3, 4, 5, ..., f treatment fields) containing a treatment volume of interest within the patient's body. Thus, the method comprises treating treatment fields n, where n is repeated from 1 (treatment field 1) up to the number of treatment fields to be treated f (treatment fields f). Next, the method 2440 for treating the patient with radiation comprises selecting treatment field n 2420, moving the positioned patient on a PPA or patient support, and applying the correction vector obtained in step 2410 to the radiation treatment plan 2430.

[0147] Next, the method 2400 for treating a patient with radiation includes determining whether the treatment of the patient in treatment field n is the first instance of treating a patient in treatment field n 2440. If the treatment of the patient in treatment field n is the first instance of treating a patient in treatment field n (YES), the method 2440 for treating a patient with radiation includes saving the treatment scene for field n 2460. If the treatment of the patient in treatment field n is not the first instance of treating a patient in treatment field n (NO), the method 2440 for treating a patient with radiation includes retrieving the treatment scene for treatment field n 2450.

[0148] Saving a treatment scene for a treatment field n 2460 includes saving a list of selected cameras that provide images of the patient and PPA or patient support in a fixed position for treatment in the treatment field n, saving each of the images of the patient and PPA or patient support in a fixed position for treatment in the treatment field n provided by each of the selected cameras, and saving each of the regions of interest of each of the selected cameras. In some embodiments, saving a treatment scene for a treatment field n 2460 optionally includes saving patient identification information, saving the date and time the treatment scene for the treatment field n was saved, saving the type of treatment to be performed on the patient, saving information that identifies the OGTS user performing the method 2440 of treating the patient, and the like. After saving a treatment scene for a treatment field n 2460, the method includes determining whether the patient is ready for treatment 2470, as described below.

[0149] Retrieving a saved treatment scene for the treatment field n 2450 provides a saved treatment scene for the treatment field n. In some embodiments, the saved treatment scene for the treatment field n is one previously saved while performing a method 2400 of treating a patient with radiation (for example, including saving a saved treatment scene for the treatment field n 2460). The saved treatment scene for the treatment field n includes saved images of the patient and PPA or patient support positioned for treatment in the treatment field n (for example, images showing views of the patient and PPA or patient support positioned for treatment in the treatment field n from at least three orthogonal directions), a list of cameras that provided saved images of the patient and PPA or patient support positioned for treatment in the treatment field n, and each of the selected cameras that provided images during image acquisition. These images show orthogonal views of the patient and PPA or patient support positioned for treatment in the treatment field n. In some embodiments, the method further includes displaying each of the stored images showing views of the patient and PPA or patient support in a fixed position for treatment of the treatment field n from at least three orthogonal directions on a display in a separate window, such that each orthogonal view is visible to the user in each of the separate windows. Each stored and displayed image shows a view of the patient and PPA or patient support in a fixed position for treatment of the treatment field n provided by a selected camera listed in the extracted treatment scene for the treatment field n. The images of the extracted treatment scene for the treatment field n (e.g., displayed on the display) provide a reference image for precisely positioning the patient and PPA or patient support in a suitable location and / or position for treatment of the treatment field n.

[0150] Next, embodiments of the method 2400 for treating a patient with radiation include determining whether the patient is ready for treatment 2470. In some embodiments, determining whether the patient is ready for treatment 2470 includes using, as reference images, an image (e.g., displayed on a display) of the treatment scene taken out relative to the treatment field n, and live video of the patient and the PPA or patient support, in order to precisely position the patient and the PPA or patient support in a suitable location and / or position for treatment in the treatment field n.

[0151] In particular, using information within the treatment scene for treatment field n, which provides a list of cameras that provided saved images of the patient and PPA or patient support positioned for treatment in treatment field n, and the region of interest used for each of the selected cameras during image acquisition, the same cameras are selected to provide live video of the patient on the PPA or patient support positioned for treatment in treatment field n, and the region of interest for each of the selected cameras is set to the same region of interest as that saved for each of the images in the treatment scene for treatment field n. Thus, the live video provided by the selected cameras shows the same view (e.g., the same orthogonal view) of the patient and PPA or patient support positioned for treatment in treatment field n provided in the retrieved treatment scene for treatment field n, as saved within the treatment scene for treatment field n. The user interacts with the GUI of the OGTS software to start tracking, thereby acquiring live video from each of the selected cameras.

[0152] Live video from each of the selected cameras showing the patient and PPA or patient support in the treatment position for treatment field n is superimposed on the display onto the associated saved reference image of the patient and PPA or patient support in the treatment position for treatment field n, previously saved by the same camera. When in tracking mode, the OGTS software displays the respective red component of the reference image superimposed (e.g., added) to the respective green and blue components of the associated live image provided by each camera. When the reference image and live image are aligned, the red and green in the image are aligned to provide an accurate RGB image of the exact colors within the area where the image is aligned. Unaligned areas appear as green or red areas, indicating that the patient is not in the same treatment position for treatment field n as shown in the reference image. As illustrated in the example, OGTS is used to calculate misalignment between the reference image and the live image. The camera defines the relationship of the defined pixel size per 1 mm in the isocenter plane in actual space (for example, approximately 1 to 5 pixels / mm (for example, approximately 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, or 5) It is calibrated to provide 0 pixels / mm). Thus, the ΔX, ΔY, and / or ΔZ displacements appropriate for positioning the patient and PPA or patient support in real space to align with the imaging position recorded by the reference image are obtained by aligning the live and reference images in each camera view, determining the distance within the image pixels required to align the live and reference images, and calculating the ΔX, ΔY, and / or ΔZ displacements according to the relationship of pixel size per 1 mm.Furthermore, the OGTS software also allows the image to be rotated to determine Δψ, Δφ, and Δθ to compensate for the patient's rotation around the X, Y, and Z axes relative to a previously acquired reference image. Thus, the embodiment includes using the OGTS to determine whether the patient is ready for treatment 2470. If the patient is not ready for treatment (NO), the user can use the information from the OGTS regarding displacements of ΔX, ΔY, and / or ΔZ, as well as rotations of Δψ, Δφ, and Δθ, that are appropriate for precisely positioning the patient and the PPA or patient support for treatment. Thus, if the patient is not ready for treatment (NO), the appropriate steps of moving the patient and the PPA or patient support and / or applying correction vectors 2430, determining whether the treatment of the patient in treatment field n is the first instance of treating a patient in treatment field n 2440, saving the treatment scene for treatment field n 2460, or retrieving the treatment scene for treatment field n 2450, and determining whether the patient is ready for treatment 2470 are repeated. If the patient is ready for treatment (YES), the method 2400 for treating the patient with radiation proceeds to the next step of treating the treatment field n. In some embodiments, treating the treatment field n involves irradiating a region of the patient's body within the treatment field n with radiation known in this art, such as photons (e.g., X-rays, electrons) or hadrons (e.g., protons, neutrons), or heavy ions (e.g., carbon ions). 4 This includes contact with He ions, neon ions, etc.

[0153] Next, the method 2400 for treating a patient with radiation includes determining 2491 whether the treatment of treatment field n is complete. In some embodiments, determining 2491 whether the treatment of treatment field n is complete includes determining whether the treatment has delivered the correct amount of radiation to treatment field n. If the treatment of treatment field n is not complete (NO), the step 2480 for treating treatment field n and the step 2491 for determining whether the treatment of treatment field n is complete are repeated. If the treatment of treatment field n is complete (YES), the method 2400 for treating a patient with radiation includes determining 2492 whether the treatment plan includes treating another treatment field. If the treatment plan includes treating another treatment field (YES), n is incremented by 1 (for example, n = n + 1), and the method returns to step 2420 of the method 2400 for treating a patient with radiation, which includes selecting the next treatment field n (having the updated value of n). If the treatment plan does not involve treating another treatment field (NO), the method includes ending the OGTS session.

[0154] Methods for monitoring patient movement In some embodiments, the technology provides a method for monitoring patient movement, for example, during treatment. This method is used to identify patient movement during treatment phases that may cause the treatment field to move outside the treatment area or introduce healthy tissue into the radiation path. It is also used to monitor rhythmic changes in the patient's body movement, for example, due to respiratory movements.

[0155] For example, a method for monitoring patient movement includes monitoring and / or identifying patient movement using reference images and live video during a treatment phase, which may require intervention by a technician to correct the position of the patient and PPA or patient support. In some embodiments, a method for monitoring patient movement includes providing images of the patient and PPA or patient support in a treatment position for use as reference images. In some embodiments, the reference images are provided by a retrieved treatment scene, for example, provided by a method for retrieving a saved treatment scene or by step 2450. In some embodiments, the reference images are provided by acquiring images of the patient and PPA or patient support in a treatment position, for example, provided by a method for saving a treatment scene or by step 2460. Thus, the reference images provide images of the patient and PPA or patient support in a treatment position, for example, images showing views of the patient and PPA or patient support in a treatment position from at least three orthogonal directions. In some embodiments, the method further includes displaying each of the saved images showing views of the patient and PPA or patient support in a treatment position from at least three orthogonal directions on a display in a separate window, so that each orthogonal view is visible to the user in each of the separate windows. Each saved and displayed image shows a view of the patient and PPA or patient support at the treatment location provided by the selected camera listed in the retrieved treatment scene.

[0156] Images of the treatment scene (e.g., displayed on a screen) provide a reference image for monitoring patient movement. In some embodiments, monitoring patient movement includes monitoring the patient's position relative to the reference image using reference images and live video of the patient and PPA or patient support. In particular, in some embodiments, information associated with the images of the treatment scene is used to select the same cameras to provide live video of the patient on the PPA or patient support in a fixed position, and to set the region of interest for each of the selected cameras to the same region of interest as that saved for each of the images of the treatment scene. Thus, the live video provided by the selected cameras shows the same view (e.g., the same orthogonal view) of the same region of interest of the patient and PPA or patient support in the treatment position saved within the treatment scene. The user interacts with the GUI of the OGTS software to initiate tracking, thereby acquiring live video from each of the selected cameras.

[0157] Live video from each of the selected cameras showing the patient and the PPA or patient support is superimposed on the associated reference image of the patient and PPA or patient support in the treatment position on the display. When in tracking mode, the OGTS software displays the respective red component of the reference image superimposed (e.g., added) to the respective green and blue components of the associated live image provided by each camera. When the reference image and live image are aligned, the red and green in the image are aligned to provide an accurate RGB image of the exact colors within the area where the image is aligned. Unaligned areas appear as green or red areas, indicating that the patient is not in the same treatment position as shown in the reference image. As illustrated in the example, OGTS is used to determine misalignment between the reference image and the live image. The camera is calibrated to provide a defined pixel size relationship per millimeter in the isocenter plane in actual space (for example, approximately 1 to 5 pixels / mm (e.g., approximately 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, or 5.0 pixels / mm)). Therefore, the image is aligned to the imaging position recorded by the reference image. The appropriate ΔX, ΔY, and / or ΔZ displacements for positioning the patient and PPA or patient support in real space are obtained by aligning the live and reference images within each camera view, determining the distance within the image pixels required to align the live and reference images, and calculating the ΔX, ΔY, and / or ΔZ displacements according to the relationship of pixel size per millimeter. Furthermore, the OGTS software also allows for rotating the images to determine Δψ, Δφ, and Δθ to compensate for the patient's rotation around the X, Y, and Z axes relative to the previously acquired reference image.

[0158] Therefore, embodiments include monitoring patient motion by using OGTS to monitor the alignment of a reference image and a live video. In some embodiments, the user can observe the alignment of the reference image and the live video and determine whether the reference image and the live video are aligned or misaligned. If the reference image and the live video are misaligned, the user can determine whether intervention is needed to stop treatment and / or realign the patient. In some embodiments, an image registration method (e.g., the Lucas-Kanade image registration algorithm, the Baker-Dellaert-Matthews image registration algorithm, or the OpenCV image registration package) is used to determine whether the reference image and the live video are aligned or misaligned. In some embodiments, the threshold for mismatch is (for example, 1 to 50 mm (for example, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, 10.0, 10.5, 11.0, 11.5, 12.0, 12.5, 13.0, 13.5, 14.0, 14.5, 15.0, 15.5, 16.0, 16.5, 17.0, 17.5, 18.0, 18.5, 19.0, 19.5, 20.0, 20.5, 21.0, 21.5, 22.0, 22.5, 23.0, 23.5, 24.0, 24.5, 25) 0, 25.5, 26.0, 26.5, 27.0, 27.5, 28.0, 28.5, 29.0, 29.5, 30.0, 30.5, 31.0, 31.5, 32.0, 32.5, 33.0, 33.5, 34.0, 34.5, 35.0, 35.5, 36.0, 36.5, 37.0, 37.5, 38.0, Set to 38.5, 39.0, 39.5, 40.0, 40.5, 41.0, 41.5, 42.0, 42.5, 43.0, 43.5, 44.0, 44.5, 45.0, 45.5, 46.0, 46.5, 47.0, 47.5, 48.0, 48.5, 49.0, 49.5, or 50.0 mm.In some embodiments, the method includes providing an alert or alarm (e.g., a visual, audible, or tactile alert) if the position of the reference image and live video deviates significantly from a threshold. In some embodiments, the method includes suggesting corrections (e.g., translation and / or rotation) to precisely position the patient so that treatment can proceed. For example, the user can use information from the OGTS regarding translations of ΔX, ΔY, and / or ΔZ, and / or rotations of Δψ, Δφ, and Δθ, that are appropriate for precisely positioning the patient and the PPA or patient support for treatment. In some embodiments, the method includes determining the patient's respiratory cycle and determining rhythmic translations and / or rotations for appropriate compensation of the patient, which are automatically generated by automated translation and / or rotation of the PPA or patient support.

[0159] How to verify the correct application of correction vectors In some embodiments, the technology provides a method for verifying the correct application of a correction vector. For example, the method includes obtaining a correction vector (for example, by obtaining a pre-treatment CT scan as described herein (for example, provided by method 1500 of obtaining a patient CT scan during pre-treatment patient immobilization and imaging stage 1000, which includes saving the CT scan as the patient's pre-treatment CT scan)), obtaining a treatment CT scan (for example, provided by method 2300 of imaging the patient during treatment stage 2000, which includes saving the patient's CT scan as the patient's treatment CT scan), and registering the treatment CT scan and pre-treatment CT scan to obtain a correction vector 2410.

[0160] Next, a method for verifying the correct application of the correction vector includes providing a reference image. In some embodiments, the reference image is provided by a retrieved treatment scene, for example, by a method for retrieving a saved treatment scene or by step 2450. In some embodiments, the reference image is provided by acquiring an image of the patient and PPA or patient support in position for patient treatment, for example, by a method for saving a treatment scene or by step 2460.

[0161] Furthermore, the method includes using correction vectors to calculate displacements of ΔX, ΔY, and / or ΔZ in real space, as well as rotations of Δψ, Δφ, and / or Δθ in real space, that are appropriate for aligning the volume of interest in the patient's body to the treatment plan, so that the radiotherapy is accurately delivered to the volume of interest.

[0162] Next, using the relationship of pixel size per 1 mm in the isocenter plane in actual space (for example, about 1 to 5 pixels / mm (for example, about 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, or 5.0 pixels / mm) to calculate the offset relative to the reference image on the display (for example, translation and / or The method involves calculating the offset (or rotation). The method includes applying the offset to a reference image to provide an offset reference image on a display, indicating the proper position of the patient and PPA or patient support for treatment. Thus, the offset reference image provides an image of the patient and PPA or patient support in the proper position for treatment when the correction vector is applied. The live video is aligned with the displaced reference image by appropriately applying the correction vector and moving the patient and PPA or patient support in real space according to the correction vector, thus providing verification that the correction vector has been applied correctly.

[0163] How to align images As described herein, the method includes aligning a reference image with a live video image, for example, a reference image of a PPA or patient support configuration with a live video image of a PPA or patient support configuration, a reference image of a patient position with a live video image of a patient position, a reference image of an imaging position with a live video image of an imaging position, and / or a reference image of the location and / or position of the patient and PPA or patient support for treatment in the treatment field n with a live video image of the location and / or position of the patient and PPA or patient support for treatment in the treatment field n.

[0164] In some embodiments, the method includes drawing reference lines or reference marks on the live tracking image to mark reference points within the room, such as the treatment isocenter or imaging position. In some embodiments, the method includes viewing the patient and / or PPA or patient support on the live tracking image and adjusting the patient and / or PPA or patient support using reference lines or reference marks that mark reference points provided on the live tracking image. See, for example, Figure 9.

[0165] Furthermore, for convenience, certain embodiments of the Technology will be described herein in terms of a method that includes superimposing and aligning the red component of a reference image with the green and blue components of an associated live image provided by a camera, but the Technology is not limited to such embodiments. The Technology also encompasses essentially equivalent embodiments of a method that includes superimposing and aligning the green element of a reference image with the red and blue components of an associated live image provided by a camera, as well as embodiments that include superimposing and aligning the blue component of a reference image with the red and green components of an associated live image provided by a camera.

[0166] In some embodiments, the alignment of the live image and the reference image is performed manually by the user interacting with the computer via an input device (e.g., mouse, keyboard, touchscreen, trackball, virtual reality device, etc.) to manipulate (e.g., translate and / or rotate) the live image displayed on the screen and align the live image with the reference image. The user can use their eyes to align the live image and the reference image and determine sufficient alignment between the live image and the reference image. However, in some embodiments, the alignment of the live image and the reference image is performed by an image registration method, such as the Lucas-Kanade image alignment algorithm, the Baker-Dellaert-Matthews image alignment algorithm, or the OpenCV image alignment package. In some embodiments, the images are aligned using automated feature-based alignment, automated pixel-based alignment, or Fast Fourier Transform, which is performed by software-encoded methods and by the computer.Additional image overlay techniques are provided by Cocianu (2023), "Evolutionary Image Registration: A Review," Sensors 23, 967; Bierbrier (2022), "Estimating medical image registration error and confidence: A taxonomy and scoping review," Medical Image Analysis 81:102531; John and John (2019), "A Review of Image Registration Methods in Medical Imaging," International Journal of Computer Applications 178:38-45; and Chen (2021), "Deep Learning in Medical Image Registration," Progress in Medical Imaging 3:012003, each incorporated herein by reference.

[0167] In some embodiments, the steps of the image alignment method described are implemented by software code, for example, a series of procedural steps that instruct a computer and / or microprocessor to create and / or transform data as described above. In some embodiments, the software instructions are encoded in a programming language such as BASIC, C, C++, Java, MATLAB, Mathematica, Perl, Python, or R.

[0168] In some embodiments, one or more steps or components are provided within individual software objects connected within a modular system. In some embodiments, the software objects are extensible and portable. In some embodiments, the objects include data structures and operations that transform object data. In some embodiments, the objects are used by manipulating their data and calling their methods. Thus, embodiments provide software objects that mimic, model, or provide operable concrete entities for, for example, numbers, shapes, or data structures. In some embodiments, the software objects are operable on a computer or microprocessor. In some embodiments, the software objects are stored on a computer-readable medium.

[0169] In some embodiments, the steps of the methods described herein are provided as object methods. In some embodiments, the data and / or data structures described herein are provided as object data structures.

[0170] Embodiments include, but are not limited to, the use of code to create and manipulate software objects, encoded using languages ​​such as Java, C++, C#, Python, PHP, Ruby, Perl, Object Pascal, Objective-C, Swift, Scala, Common Lisp, and Smalltalk.

[0171] Movable and configurable patient positioning system In some embodiments, the technology relates to a patient positioning system comprising a movable, configurable patient support. In some embodiments, the technology relates to a patient positioning system comprising a movable, configurable, electrically operated patient support. See U.S. Patent No. 11,529,109, U.S. Patent Application No. 17 / 894,335, and U.S. Provisional Patent Application No. 63 / 438,978, each incorporated herein by reference. Specific aspects of embodiments of patient positioning systems and patient support technologies are described below.

[0172] In some embodiments, the patient support is constructed to translate in the X, Y, and / or Z directions. In some embodiments, the patient support is constructed to rotate around the X, Y, and / or Z axes. In some embodiments, the patient support is configured to move with six degrees of freedom, for example, the patient support is constructed to translate in the X, Y, and / or Z directions, and furthermore, the patient support is constructed to rotate around the X, Y, and / or Z axes.

[0173] For example, in some embodiments, the patient support has a swivel base, and the patient support is constructed to swivel around the X, Y, and / or Z axes to provide pitch, roll, and yaw rotation. Thus, in embodiments with a swivel base, the configurable patient support is constructed to tilt or swivel relative to the horizontal plane of a translatable member or any other fixed horizontal plane. Embodiments include motors and drive mechanisms engaged with the patient positioning system and / or the patient support to translate and / or rotate the patient positioning system, and / or the patient support.

[0174] As a further example, in some embodiments, the patient positioning system comprises a vertically movable member, which articulates back and forth relative to the surface on which the patient positioning system is supported. In some embodiments, the movable member is mounted to a support structure, which is mounted to this surface. In some embodiments, the support structure provides stability to the patient positioning system, accommodates the drive mechanism, and causes the vertical movement of the movable member. The patient support is configured to receive and secure the patient in a generally upright position. In some embodiments, the patient support is rotatably mounted to the movable member, and the patient support is rotatable around a vertical axis (e.g., an axis that is essentially vertical and / or substantially vertical) relative to the movable member. In some embodiments, the lower end of the patient support is mounted to a rotating plate. In some embodiments, the upper end of the patient support is mounted to another rotating plate. This arrangement allows the patient support to be rotatably mounted to the movable member and to be rotatable around a vertical axis. Furthermore, when a translatable member is capable of articulating vertical movement, a patient support attached to the translatable member can similarly be articulated vertically. In addition, in some embodiments, the patient support is translatable in a horizontal (e.g., XY) plane, in addition to being rotatable, for example, around a vertical axis. In some embodiments, the patient support is translatable in a horizontal plane perpendicular to the vertical axis of rotation. In some embodiments, the patient support comprises two pairs of parallel rails in an orthogonal relationship, with the patient support slidably connected to a first pair of rails to translate in a first orthogonal direction, and the first pair of rails slidably connected to a second pair of rails to translate in a second orthogonal direction. In some embodiments, a motor and drive mechanism are engaged with each pair of rails to translate the patient support in the X and Y directions.

[0175] In some embodiments, the patient support comprises a backrest, seat base, shin rest, armrests, headrest, and / or footrests or heel stop. Embodiments realize that the backrest, seat base, shin rest, armrests, headrest, and / or footrests or heel stop are configurable in multiple positions to accommodate the patient's entry and / or exit from the patient support system (e.g., patient support assembly) and / or to support the patient in multiple positions for imaging or treatment. Figure 4 shows a configurable patient support 100 comprising one or more configurable movable components, such as a backrest 110 (e.g., a configurable movable backrest), an armrest 170 (e.g., a configurable movable armrest), a seat base 140 (e.g., a configurable movable seat base), a shin rest 150 (e.g., a configurable movable shin rest), and / or footrests (e.g., a configurable movable footrest), or heel stop 160 (e.g., a configurable movable heel stop). In some embodiments, the patient support (e.g., an integrated patient support or a non-integrated patient support) further comprises a headrest (e.g., a configurable adjustable headrest).

[0176] In some embodiments, each component (e.g., backrest 110, armrest 170, seat base 140, shin rest 150, footrest or heel stop 160, and headrest) is operable by the user to position the component in a suitable location for a desired configuration. In some embodiments, each component (e.g., backrest 110, armrest 170, seat base 140, shin rest 150, footrest or heel stop 160, and headrest) is movable (e.g., translated and / or rotated) using only the typical force provided by an average human being by applying force to the component using their hands.

[0177] In some embodiments, the patient support 100 comprises one or more electrically operated components, such as an electrically operated backrest (e.g., a backrest 110 operably engaged with a backrest motor), an electrically operated headrest (e.g., a headrest operably engaged with a headrest motor), an electrically operated armrest (e.g., an armrest 170 operably engaged with an armrest motor), an electrically operated seat base (e.g., a seat base 140 operably engaged with a seat base motor), an electrically operated shin rest (e.g., a shin rest 150 operably engaged with a shin rest motor), and / or an electrically operated footrest (e.g., a footrest operably engaged with a footrest motor), or an electrically operated heel stop (e.g., a heel stop 160 operably engaged with a heel stop motor). Therefore, a backrest motor is constructed to move the backrest 110 (for example, by translating and / or rotating it), a headrest motor is constructed to move the headrest (for example, by translating and / or rotating it), an armrest motor is constructed to move the armrest 170 (for example, by translating and / or rotating it), a seat base motor is constructed to move the seam member 140 (for example, by translating and / or rotating it), a shin rest motor is constructed to move the shin rest 150 (for example, by translating and / or rotating it), and / or a footrest motor or heel stop motor is constructed to move the footrest (for example, by translating and / or rotating it), or a heel stop motor is constructed to move the heel stop (for example, by translating and / or rotating it).

[0178] In some embodiments, the OGTS provides components (e.g., a computer, microcontroller, and / or microprocessor) configured to coordinate the control and / or movement (e.g., translation) of the patient support in the X, Y, and / or Z directions. In some embodiments, the OGTS provides components (e.g., a computer, microcontroller, and / or microprocessor) configured to coordinate the control and / or movement (e.g., rotation) of the patient support around the X, Y, and / or Z axes. In some embodiments, the OGTS provides components (e.g., a computer, microcontroller, and / or microprocessor) configured to coordinate the control and / or movement (e.g., translation) of the patient support in the X, Y, and / or Z directions, and to coordinate the control and / or movement (e.g., rotation) of the patient support around the X, Y, and / or Z axes. In some embodiments, the OGTS provides a configuration (e.g., a computer, microcontroller, and / or microprocessor) configured to adjust the control and / or movement of one or more motorized components, such as a motorized backrest, motorized headrest, motorized armrest, motorized seat base, motorized shin rest, and / or motorized footrest or motorized heel stop, to provide a patient support in one or more specific configurations comprising a motorized backrest, motorized headrest, motorized armrest, motorized seat base, motorized shin rest, and / or motorized footrest or motorized heel stop in designated positions. Adjusting the control and / or movement (e.g., translation and / or rotation) of the patient support or one or more configurable components of the patient support includes supplying or removing current or voltage from a power source to a motor engaged with the patient support and / or one or more configurable components of the patient support, so as to move the patient support and / or one or more configurable components of the patient support to a suitable position.

[0179] As described above, when determining one or more of ΔX, ΔY, ΔZ, Δψ, Δφ, and / or Δθ, the patient positioning system, patient support, and / or one or more of the backrest, seat base, shin rest, armrest, headrest, and / or foot brace or heel stop are appropriately translated and / or rotated to move the patient support and / or the patient to a suitable position for imaging or treatment. In some embodiments, moving (e.g., translating and / or rotating) the patient positioning system, patient support, and / or one or more of the backrest, seat base, shin rest, armrest, headrest, and / or foot brace or heel stop is done by motors and drive mechanisms engaged with one or more of the patient positioning system, patient support, and / or backrest, seat base, shin rest, armrest, headrest, and / or foot brace or heel stop (e.g., by providing current and / or voltage to one or more motors). In some embodiments, moving (e.g., translating and / or rotating) the patient positioning system, patient support, and / or one or more of the backrest, seat base, shin rest, armrest, headrest, and / or footrest or heel stop is done by the user engaging and moving the patient positioning system, patient support, and / or one or more of the backrest, seat base, shin rest, armrest, headrest, and / or footrest or heel stop.

[0180] While this disclosure refers to certain exemplary embodiments, it should be understood that these embodiments are presented as examples only and not as limitations.

[0181] example Example 1 - Optical guidance and tracking system As shown in the schematic diagram provided in Figure 3, an OGTS with three cameras is provided. Camera 1 ("front") and Camera 2 ("side") are mounted 90 degrees apart in the horizontal plane (XY plane). The patient is positioned facing Camera 1. A mismatch in translation in the left-right (X) and up-down (Z) directions, as well as / or a mismatch in rotation around the Camera 1 axis (Y), between the live image and the reference image, is observed in Camera 1.

[0182] Camera2 is provided at a 90-degree angle to Camera1, and therefore Camera2 provides a lateral view of the patient. A mismatch in translation in the anterior-posterior (Y) and posterior-posterior (Z) directions, as well as / or a mismatch in rotation around the Camera2 axis (X) between the live image and the reference image, is observed in Camera2.

[0183] Camera 3 is provided at a position orthogonal to both Camera 1 and Camera 2. Thus, Camera 3 is provided at a position on a line normal to the horizontal (XY) plane (i.e., above or below the patient). In practical terms, Camera 3 is positioned above the patient and provides an overhead view of the patient. Mismatches in translation in the front-to-back (Y) and left-to-right (X) directions between the live image and the reference image, as well as / or mismatches in rotation around the Camera 3 axis (Z) between the live image and the reference image, are observed in Camera 3.

[0184] Assuming the patient is merely translated in space, aligning the live image and reference image in each camera view provides the appropriate real-space displacements of ΔX, ΔY, and / or ΔZ to position the object (e.g., the patient) at the same location where it was positioned when the reference image was acquired and saved. Furthermore, rotation in space can be calculated by analyzing the difference between the live camera views from the three cameras and the saved images.

[0185] Example 2 - Vertical Imaging and Positioning System This technology relates to an imaging system comprising a vertical patient positioning device or patient positioner of a patient positioning system (see, for example, Figures 1A and 1B) and a vertical helical CT scanner (see, for example, Figures 2A to 2D). For example, see U.S. Patent Application Publication 2022 / 0183641, "MULTI-AXIS MEDICAL IMAGING" (U.S. Patent Application 17 / 535,091), which is expressly incorporated herein by reference. The vertical patient positioning device or patient positioner of the patient positioning system enables the positioning of the patient in a seated or elevated (semi-upright) position while the CT acquires a diagnostic-quality CT image of the patient in a therapeutic orientation. See Figure 5A. The beam delivery system is typically located behind the posterior wall and includes a high-energy X-ray or electron beam delivery system, or a particle beam therapy beam delivery system.

[0186] A vertical imaging and positioning system allows for the installation of an OGTS with five cameras. A typical camera setup in the treatment room is shown in Figure 5B. Cameras 1, 2, 4, and 5 are positioned in the horizontal plane, and Camera 3 is positioned directly above the isocenter. As discussed above, cameras 1, 2, and 3 are orthogonal to each other. The technology is not limited to this arrangement. For example, the technology also envisions an embodiment in which cameras 4 and 5 are also orthogonal to each other, and each is orthogonal to camera 3.

[0187] In the embodiment shown in Figure 5B, Camera 1 and Camera 2 are closest to the room entrance, and together with Camera 3, they are used to capture a reference image of the patient at the set position and to verify the patient at the set position during subsequent imaging and treatment procedures. Cameras 4 and 5 are used to verify and track the patient's position in various treatment fields acquired by rotating the patient around the vertical (Z) axis during imaging.

[0188] Figure 5C shows the design of one embodiment of the treatment room 710, control room 720, and technical room 730 of the OGTS system. Sectional A showing the treatment room 710 and sectional B showing the control room 720 and technical room 730 are shown in Figures 5D and 5E, respectively. The treatment room 710 is equipped with an OGTS, which includes an overhead camera E(235) and four peripheral cameras A, B, C, and D(231, 232, 233, and 234) in exemplary, not limiting, positions. The treatment room further includes a patient positioning system. A technician 901 is shown inside the treatment room 710. One insert shows a keyboard, mouse, and display in the treatment room 710 used by the technician 901, for example, to control the OGTS and carry out the method described herein, and a second insert shows a keyboard, mouse, and display in the control room 720, for example, to control the OGTS and carry out the method described herein. The treatment room and control room may each be equipped with a desk or shelf, network sockets, and single-phase power outlets. The technical room may be equipped with a computer for data analysis, data storage, computing power, system diagnostics, and / or other computer assistance for the OGTS system. The technical room may be equipped with multiple network sockets for connecting to the OGTS components in the treatment room and control room.

[0189] In some embodiments, the four peripheral cameras A, B, C, and D (231, 232, 233, and 234) are positioned at a height that is the height of the treatment room isocenter, for example, with a tolerance of ±50 mm. In some embodiments, each of the four peripheral cameras A, B, C, and D (231, 232, 233, and 234) is positioned between 2300 mm and 6800 mm from the treatment room isocenter. In some embodiments, the cameras have lens ranges of 2300-3400 mm, 3200-4800 mm, or 4600-6800 mm to show an 80% to 120% field of view.

[0190] In some embodiments, the OGTS is a 20.2-megapixel camera with a resolution of 5,496 × 3,672 pixels and a high-quality lens (e.g., SVS Vistek EXO 183). A TR, 1” sensor format is used. In some embodiments, the camera has exemplary focal lengths of 25 mm, 35 mm, or 50 mm. The camera is positioned at a defined distance from the treatment room isocenter, and the lens is selected to acquire a field of view of the isocenter plane, which is approximately 1.5 m (vertical) × 1.0 m (horizontal), depending on the distance between the camera and the treatment room isocenter. Thus, in some embodiments, the ratio between the real-world distance and the pixel-level distance (e.g., the pixel-level distance in the camera sensor and / or the pixel-level distance in the image created by this camera) is approximately 1500 mm / 5496 pixels = 0.273 mm / pixel. This is equivalent to a real-world distance of 1 mm or a distance of approximately 3.7 pixels in the sensor per translation. Or, in other words, one pixel in the image recorded by the camera represents a distance of approximately 300 μm in the real world.

[0191] All cameras are connected to a central computer ("Host Computer") using a dedicated Ethernet port and a fixed IP address for each camera. The Host Computer processes the images and communicates them to an unlimited number of client computers, which then provide a graphical user interface to the user. One client computer can act as a master client, used to start new OGTS sessions and stop open sessions on all clients. All other clients can be used to monitor OGTS activity.

[0192] Figure 6 shows the graphical user interface (GUI) of the OGTS software displayed on the client computer. Camera configuration, settings, operating parameters, and / or camera calibration (e.g., pixel-to-real-world distance conversion) are set on the host GUI and described in the OGTS user manual. The GUI allows selection of two to four cameras positioned in the horizontal plane, as shown in the left and right windows. See Figure 6. The top camera is always selected and displayed in the upper center window. As shown in Figure 6, Camera1 and Camera3 are selected, with Camera1 facing the patient positioning device or patient positioner, and Camera2 showing the patient positioning device or patient positioner from the left. Camera3 is above the patient positioning device or patient positioner. The software control buttons are shown on the left side of the image in Figure 6. These software control buttons are used by the user to start and stop tracking, to start tracking with a new reference image, and to save the current viewing configuration as a new recording scene.

[0193] The camera images shown in Figure 6 are images provided by the cameras when they are fully zoomed out to provide the full field of view for each camera. These fields of view can be used to capture and verify information describing the configuration of the patient positioning device or patient positioner, for example, the initial positioning of the patient positioning device or patient positioner before the patient is placed in the device or patient positioner and immobilized in a suitable posture for imaging or treatment. The initial positioning of the patient positioning device or patient positioner may include information describing the positions of the seat base, footrest or heel stop, shin rest, backrest, and / or armrests.

[0194] A region of interest (ROI) may be selected within each camera view to zoom in on a specific area within the image (for example, by selecting a subset of the camera sensor array to display as an image). ROIs can be used to zoom in on a patient's specific region of interest, typically during patient treatment. Once an ROI is selected for a specific camera, the camera transmits information to the host computer, thereby providing a faster data transfer rate and therefore a faster monitoring repetition rate. Recorded scenes contain information that identifies the specific viewing environment (e.g., the selected camera and the region of interest for each camera). Figure 7 shows a person positioned within a patient positioning device or patient positioner with the cameras zoomed in according to different ROIs for each camera. A zoomed-out view of the patient (see Figure 6) is used to capture the patient posture immobilization device, while zoomed-in or specific ROI views are used to focus on a specific region of interest (e.g., an anatomical area to be treated). Zoomed-in views provide a higher frame rate from the camera because the camera transmits less information over the network.

[0195] The OGTS can record and save scenes for later use. After the patient is in a specific position, the OGTS configuration (e.g., selected camera and ROI) may be saved as a setup scene or treatment scene using software controls in the left panel on the GUI. Camera images of the patient and / or patient positioning device or patient positioner are saved as reference images. Scenes and reference images can be retrieved later to recreate the patient position. The scene selection panel is shown in Figure 8. Thumbnails of the actual images containing the scenes are shown in the selection dialog. The left panel shows recorded setup scenes; the right panel shows some recorded treatment scenes. Any of these scenes can be selected during the workflow. Setup scenes are used in the initial stages of the workflow and typically use a reduced view to provide more information. Treatment scenes are used in later stages of the workflow and use a magnified view.

[0196] The scene selection is shown in the right panel of Figure 8. The result of selecting the scene named "treat7" is shown in Figure 9. Selecting a scene automatically starts the tracking routine. When in tracking mode, the OGTS software displays the sum of the red component of the RGB reference image and the green and blue components of the live RGB image in each of the camera views. When the reference and live images are aligned, all parts of the RGB image are aligned, providing an accurate RGB image of color (at least within the area where the image is aligned), so the red and green in the image disappear. As can be seen in the left and top panels of the GUI shown in Figure 9, the patient's head is slightly rotated to the left around the vertical axis, resulting in a significant misalignment toward the front of the patient's face. Lateral alignment remained reasonable.

[0197] OGTS is used to calculate misalignment between the reference image and the live scenario image. The camera is calibrated to provide a defined pixel size relationship per millimeter in the isocenter plane in real space. For example, as discussed above, the ratio of the real-world distance of the camera used during deployment of embodiments of the art described herein to the camera sensor pixels and / or image pixels is approximately 0.2723 mm / pixel horizontally and approximately 0.2729 mm / pixel vertically (e.g., approximately 0.3 mm / pixel), which is equivalent to 3.672 pixels / mm horizontally and 3.6620 pixels / mm vertically (e.g., approximately 3.7 pixels / mm). Therefore, a live image that is, for example, 100 pixels out of position relative to the reference image indicates that the patient must be translated in space by approximately 30 mm in the appropriate plane being imaged by the camera in order to reproduce the set position recorded in the reference image.

[0198] Therefore, the appropriate displacements of ΔX, ΔY, and / or ΔZ to move the patient to a real-space position recorded by the reference image can be obtained by aligning the live and reference images within each camera view, determining the distance within the image pixels required to align the live and reference images, and calculating the displacements of ΔX, ΔY, and / or ΔZ according to the relationship of pixel size per millimeter.

[0199] Furthermore, the OGTS software also allows for image rotation to determine Δψ, Δφ, and Δθ to compensate for patient rotation around the X, Y, and Z axes relative to previously acquired reference images.

[0200] All publications and patents described in the above specification are incorporated herein by reference in their entirety for all purposes. Various modifications and changes to the compositions, methods, and uses described in the Art will be apparent to those skilled in the art without departing from the scope and spirit of the Art described herein. Although the Art has been described in relation to specific exemplary embodiments, it should be understood that the claimed invention should not be unduly limited to such specific embodiments. In practice, various modifications to the described forms for carrying out the Invention, which will be apparent to those skilled in the art, are intended to fall within the scope of the following claims.

Claims

1. Overhead camera and Equipped with a first peripheral camera, The field of view of the overhead camera is perpendicular to the field of view of the first peripheral camera. Optical guidance and tracking system (OGTS).

2. It is further equipped with a second peripheral camera, The OGTS according to claim 1, wherein the field of view of the second peripheral camera is orthogonal to the field of view of the overhead camera, and the field of view of the second peripheral camera is orthogonal to the field of view of the first peripheral camera.

3. The OGTS according to claim 2, further comprising a third peripheral camera, wherein the fields of view of any two peripheral cameras and overhead cameras are all orthogonal to each other.

4. The OGTS according to claim 3, further comprising a fourth peripheral camera, wherein the fields of view of any two peripheral cameras and overhead cameras are all orthogonal to each other.

5. The OGTS according to claim 1, further comprising a patient support device.

6. The OGTS according to claim 5, wherein the patient support rotates around the vertical (Z) axis.

7. The OGTS according to claim 6, wherein the field of view of the overhead camera is aligned with the vertical (Z) axis.

8. The OGTS according to claim 1, further comprising a radiation therapy device.

9. The OGTS according to claim 8, wherein the radiation therapy device is equipped with a static source.

10. The OGTS according to claim 1, further comprising a computed tomography (CT) scanner.

11. The OGTS according to claim 10, wherein an overhead camera provides a view through a hole in the scanner ring of a CT scanner.

12. The OGTS according to claim 1, wherein the overhead camera comprises a color sensor array, and the first peripheral camera comprises a color sensor array.

13. The OGTS according to claim 1, further comprising a processor and a non-temporary computer-readable medium.

14. The OGTS according to claim 13, wherein a non-temporary computer-readable medium contains a program, and a processor executes the program to acquire a color image from an overhead camera and an image from a peripheral camera.

15. The OGTS according to claim 13, further comprising a display.

16. The OGTS according to claim 15, wherein a non-temporary computer-readable medium includes a program, and a processor executes the program to overlay live video onto a reference image on a display.

17. The OGTS according to claim 16, wherein a non-temporary computer-readable medium contains a program, and a processor executes the program to provide a graphical user interface on a display.

18. The OGTS according to claim 17, wherein the user interacts with a graphical user interface to identify a region of interest in the camera view.

19. The OGTS according to claim 17, wherein the user interacts with a graphical user interface to align live video and a reference image on a display.

20. The OGTS according to claim 19, wherein the processor calculates real-space adjustments to properly position the patient for treatment.

21. The OGTS according to claim 13, further comprising a database containing saved scenes.

22. The OGTS according to claim 21, wherein the saved scene includes an image, information identifying the camera that provided the image, and a region of interest for the image.

23. The OGTS according to claim 1, wherein the first peripheral camera is located on the main Y axis of the OGTS.

24. The OGTS according to claim 2, wherein the first peripheral camera is located on the main Y axis of the OGTS and the second peripheral camera is located on the main X axis of the OGTS.

25. The OGTS according to claim 1, wherein the overhead camera is positioned on the main Z axis of the OGTS.

26. A method for positioning a patient, To obtain a first reference image of the patient support and / or the patient, Overlaying the patient support and / or the patient's first live image onto the reference image, The first live image and the first reference image are aligned to determine the displacement, Moving the patient support and / or the patient in accordance with the displacement A method that includes this.

27. The method according to claim 26, wherein a first reference image is provided by a first camera and a first live image is provided by the first camera.

28. The method according to claim 26, further comprising acquiring a second reference image of the patient support and / or the patient, and superimposing a second live image of the patient support and / or the patient onto the second reference image.

29. The method according to claim 28, wherein a second reference image is provided by a second camera, a second live image is provided by a second camera, and the field of view of the second camera is orthogonal to the field of view of the first camera.

30. The method according to claim 26, wherein the first camera is an overhead camera.

31. The method according to claim 26, wherein the first camera is a peripheral camera.

32. The method according to claim 26, wherein aligning a first live image and a first reference image includes the user aligning the first live image and the first reference image by interacting with a graphical user interface.

33. The method according to claim 26, wherein aligning a first live image and a first reference image includes aligning a first live image and a first reference image using image alignment software.

34. The method according to claim 26, wherein the saved scene includes a first reference image.

35. The method according to claim 34, wherein the saved scene includes a first reference image, information identifying the camera that provided the first reference image, and a region of interest relative to the first reference image.

36. The method according to claim 26, wherein the displacement includes translation in the X, Y, and / or Z directions, and / or rotation around the X, Y, and / or Z axes.

37. The method according to claim 26, further comprising determining the relationship between the pixel size of a first camera and distance in real space.

38. The method according to claim 26, further comprising exposing a patient to radiation.

39. The method according to claim 26, further comprising imaging a patient using computed tomography.

40. A method for positioning a patient, To obtain a first reference image of the patient support and / or the patient, Overlaying the patient support and / or the patient's first live image onto the reference image, Displacing the reference image according to the correction vector, Applying a correction vector to the patient support and / or the patient, The correct application of the correction vector is verified using the alignment of the first live image and the first reference image. A method that includes this.

41. The method according to claim 40, wherein the application of the correction vector is correct when the first live image and the first reference image are substantially, to the maximum extent, or essentially aligned.

Images