Arm support for medical imaging and treatment

Abstract

Provided herein is technology relating to radiological imaging and treatment and particularly, but not exclusively, to an arm support configured to support the arms of a patient positioned in an upright position during medical imaging and / or during medical treatment and to related methods, kits, and systems.

Description

[0001]ASTO-42132.601 ARM SUPPORT FOR MEDICAL IMAGING AND TREATMENT STATEMENT OF RELATED APPLICATIONS This application claims the benefit of U.S. Provisional Patent Application No. 63 / 538,571, filed September 15, 2023, the entire contents of which are incorporated herein by reference for all purposes. FIELD Provided herein is technology relating to radiological imaging and treatment and particularly, but not exclusively, to an arm support configured to support the arms of a patient positioned in an upright position during medical imaging and / or during medical treatment and to related methods, kits, and systems. BACKGROUND Radiation sources have many uses in medicine, including medical imaging and radiation therapy. Generally, radiation sources are configured to move in relation to a stationary patient, e.g., to expose a specific part or region of the patient to radiation produced by the source. Further, while radiation therapy and the associated diagnostic and planning imaging are conventionally performed with patients in prone or supine horizontal positions, some patients benefit from therapy while in an unconventional position, such as an upright position. Upright radiotherapy systems can also be simpler and more compact, bringing economic advantages. Some accessories used to position and support a patient include arm supports to position, support, and / or immobilize the patient’s arms during diagnosis, imaging, and / or treatment. For example, arm supports may aid in supporting the patient’s body in general or may place the patient’s arms in a position that minimizes attenuation of the beam by the arms, minimizes exposure of body regions that are not being imaged or treated, or that maximizes imaging and treatment quality for body regions that are being imaged or treated. However, limitations of patient accessories for supporting patients in upright positions have hindered adoption and use of beneficial upright radiotherapy methods. Upright body positioning for breast radiotherapy has not been studied extensively. By itself, a conventional chair is not sufficient to ensure adequate immobilization, reproducibility, and patient comfort. For example, for upright body positions, skin folds ASTO-42132.601 under the breast (inframammary skin folds (ISFs)) are likely to be more significant, as the breasts will naturally fall vertically down, rather than laterally, as occurs for supine body positioning. Historically, patients with large breast sizes have experienced more acute and late radiotherapy skin toxicities, particularly where their treated breast folds onto surrounding skin. Arms-up treatment positions widely adopted for conventional supine breast radiotherapy can in some cases be problematic for patients. Following surgery for breast cancer and routine physiotherapy, some patients are unable to maintain a satisfactory ‘arms up’, supine position for breast radiotherapy. For most patients, this conventional positioning is uncomfortable (especially as radiotherapy typically occurs around one month after breast cancer surgery). Some patients also experience impairments in shoulder flexion and abduction and require intense physiotherapy prior to radiotherapy to regain a sufficient range of shoulder motion – causing delays in treatment. SUMMARY Provided herein is technology relating to radiological imaging and treatment and particularly, but not exclusively, to an arm support configured to support the arms of a patient positioned in an upright position during medical imaging and / or during medical treatment and to related methods, kits, and systems. Some technologies for supporting a patient a patient in an upright, stable position are described in U.S. Pat. No. 11,529,109 and in U.S. Pat. App. Pub. No. 2023 / 0172566, each of which is incorporated herein by reference. In some embodiments, a patient positioning system stabilizes and supports a patent in an upright (e.g., standing, sitting, kneeling, perched) position. Imaging and / or treating patients in an upright position provides the benefits of increasing comfort for many patients. Further, diagnosis and / or treatment of patients in an upright position provides potential advantages over conventional diagnosis and / or treatment of patients in a horizontal position for many indications (e.g., lung cancer, breast cancer). While imaging and / or treating an upright patient provides diagnostic and therapeutic advantages, medical imaging and treatment needs improved patient positioning systems for stabilizing and supporting patients in a suitable upright position for delivering therapeutic radiation doses to target areas and for planning treatments using medical imaging. The technology ASTO-42132.601 provided herein relates to improved arm supports for a patient positioning system that supports a patient in an upright position. In one aspect, the disclosure provides an arm support comprising: a first linkage including a releasable attachment; a second linkage coupled to the first linkage and movable with respect to the first linkage about a first axis. The arm support further includes a third linkage coupled to the second linkage and movable with respect to the second linkage about a second axis. The third linkage includes a saddle portion configured to receive a portion of a patient arm. The arm support further includes a handle bar coupled to the third linkage. In some embodiments, the first axis is spaced from and parallel to the second axis. In some embodiments, the releasable attachment includes a channel configured to at least partially receive a support structure. In some embodiments, the second linkage is movable with respect to the first linkage about the first axis with a range of travel of at least 90 degrees. In some embodiments, the third linkage is movable with respect to the second linkage about the second axis with a range of travel of at least 90 degrees. In some embodiments, the second linkage is coupled to a first end of the third linkage, and the handle bar is coupled to a second end of the third linkage; and wherein the saddle portion is positioned between the first end and the second end. In some embodiments, the saddle portion includes a convex support surface. In some embodiments, the handle bar is coupled to the third linkage with a ball socket interface. In some embodiments, the handle bar is arcuate. In one aspect, the disclosure provides a patient support assembly comprising: an upright backrest; a first arm support adjustably coupled to the backrest along a first edge of the backrest; and a second arm support adjustably coupled to the backrest along a second edge of the backrest. In some embodiments, the first arm support includes at least one articulation and is movable between a first plurality of configurations; and wherein the second arm support includes at least one articulation and is movable between a second plurality of configurations. ASTO-42132.601 In some embodiments, one of the first plurality of configurations is a side configuration where at least a portion of the first arm support extends past the first edge of the backrest. In some embodiments, the first arm support includes a plurality of linkages with at least two axes of rotation. In some embodiments, the first arm support is releasably clamped to the first edge of the backrest. In some embodiments, the second arm support is adjustable relative to the backrest independent of the first arm support. In one aspect, the disclosure provides a method comprising: positioning an arm of a patient in an arm support in a lowered position and coupled to an upright backrest; raising the arm support to a raised position; and treating or imaging the patient with a beam intersecting the patient; and wherein the arm is spaced from the beam. In some embodiments, the method further includes raising the arm support to an intermediate position and pausing before raising the arm support to the raised position. In some embodiments, the method further includes adjusting the configuration of the arm support after the arm support is in the raised position. In some embodiments, the method further includes raising a handle bar of the arm support after positioning the arm of the patient in the arm support in the lowered position. In some embodiments, the method further includes positioning a second arm of the patient in a second arm support in a lowered position and coupled to the upright backrest, and raising the second arm support to a raised position. In some embodiments, the method further includes lowering the arm support to the lowered position after treating or imaging the patient. In one aspect, the disclosure provides an upright backrest comprising at least one cutout configured to receive a portion of an arm of a patient. In one aspect, the disclosure provides a method of treating a patient in an upright position with the patient arms down and back. In one aspect, the disclosure provides an arm support comprising: a releasable attachment; a saddle portion configured to receive a portion of a patient arm; a handle bar portion; and an indexing system that allows for repeatable locating of the arm support. In some embodiments, the arm support can be raised and lowered by an operator. In some embodiments, the arm support is removably coupled to a backrest. ASTO-42132.601 In some embodiments, the saddle portion includes a convex support surface. Certain steps, operations, or processes described herein may be performed or implemented with one or more hardware or software modules, alone or in combination with other devices. In some embodiments, a software module is implemented with a computer program product comprising a computer-readable medium containing computer program code, which can be executed by a computer processor for performing any or all steps, operations, or processes described. Additional embodiments will be apparent to persons skilled in the relevant art based on the teachings contained herein. BRIEF DESCRIPTION OF THE DRAWINGS These and other features, aspects, and advantages of the present technology will become better understood with regard to the following drawings. FIG. 1 is a perspective view of a patient in a patient support assembly with two arm supports, showing one arm support in a front configuration and supporting an arm in a raised position. FIG. 2 is a top view of the patient support assembly of FIG. 1. FIG. 3 is a perspective view of an arm support of the patient support assembly of FIG. 1, with the arm support shown in a front configuration. FIG. 4 is a perspective view of the patient support assembly of FIG. 1, showing one arm support in a side configuration supporting an arm in a raised position. FIG. 5 is a top view of the patient support assembly of FIG. 4. FIG. 6 is a perspective view of an arm support of the patent support assembly of FIG. 4, with the arm support shown in a side configuration. FIG. 7 is a perspective view of the patient support assembly of FIG. 1, showing one arm support in a loading configuration supporting an arm in a lowered position. FIG. 8 is a top view of the patient support assembly of FIG. 7. FIG. 9 is a perspective view of the patient support assembly of FIG. 1, shown with the upright backrest removed for clarify. FIG. 10 is a method positioning an arm of a patient for treatment or imaging. FIG. 11 is a perspective view of a patient support assembly including an upright backrest including cutouts to receive a portion of an arm of a patient. FIG. 12 is a side view of the patient support assembly of FIG.11. ASTO-42132.601 FIG. 13 is a perspective view of a patient support assembly including an upright backrest including cutouts to receive a portion of an arm of a patient. FIG. 14 is a side view of the patient support assembly of FIG.13. FIG. 15 is a perspective view of a patient in a patient support assembly with two arm supports, showing two arm supports each supporting an arm in a raised position. FIG. 16 is a front view of the patient support assembly of FIG. 15. FIG. 17 is a top view of the patient support assembly of FIG.15. FIG. 18 is a side view of the patient support assembly of FIG. 15. It is to be understood that the figures are not necessarily drawn to scale, nor are the objects in the figures necessarily drawn to scale in relationship to one another. The figures are depictions that are intended to bring clarity and understanding to various embodiments of apparatuses, systems, and methods disclosed herein. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts. Moreover, it should be appreciated that the drawings are not intended to limit the scope of the present teachings in any way. DETAILED DESCRIPTION Provided herein is technology relating to radiological imaging and treatment and particularly, but not exclusively, to an arm support configured to support the arms of a patient positioned in an upright position during medical imaging and / or during medical treatment and to related methods, kits, and systems. In this detailed description of the various embodiments, for purposes of explanation, numerous specific details are set forth to provide a thorough understanding of the embodiments disclosed. One skilled in the art will appreciate, however, that these various embodiments may be practiced with or without these specific details. In other instances, structures and devices are shown in block diagram form. Furthermore, one skilled in the art can readily appreciate that the specific sequences in which methods are presented and performed are illustrative and it is contemplated that the sequences can be varied and still remain within the spirit and scope of the various embodiments disclosed herein. All literature and similar materials cited in this application, including but not limited to, patents, patent applications, articles, books, treatises, and internet web pages are expressly incorporated by reference in their entirety for any purpose. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as is ASTO-42132.601 commonly understood by one of ordinary skill in the art to which the various embodiments described herein belongs. When definitions of terms in incorporated references appear to differ from the definitions provided in the present teachings, the definition provided in the present teachings shall control. The section headings used herein are for organizational purposes only and are not to be construed as limiting the described subject matter in any way. Definitions To facilitate an understanding of the present technology, a number of terms and phrases are defined below. Additional definitions are set forth throughout the detailed description. Throughout the specification and claims, the following terms take the meanings explicitly associated herein, unless the context clearly dictates otherwise. The phrase “in one embodiment” as used herein does not necessarily refer to the same embodiment, though it may. Furthermore, the phrase “in another embodiment” as used herein does not necessarily refer to a different embodiment, although it may. Thus, as described below, various embodiments of the invention is readily combined, without departing from the scope or spirit of the invention. In addition, as used herein, the term “or” is an inclusive “or” operator and is equivalent to the term “and / or” unless the context clearly dictates otherwise. The term “based on” is not exclusive and allows for being based on additional factors not described, unless the context clearly dictates otherwise. In addition, throughout the specification, the meaning of “a”, “an”, and “the” include plural references. The meaning of “in” includes “in” and “on.” As used herein, the terms “about”, “approximately”, “substantially”, and “significantly” are understood by persons of ordinary skill in the art and will vary to some extent on the context in which they are used. If there are uses of these terms that are not clear to persons of ordinary skill in the art given the context in which they are used, “about” and “approximately” mean plus or minus less than or equal to 10% of the particular term and “substantially” and “significantly” mean plus or minus greater than 10% of the particular term. As used herein, disclosure of ranges includes disclosure of all values and further divided ranges within the entire range, including endpoints and sub-ranges given for the ranges. As used herein, the disclosure of numeric ranges includes the endpoints and each ASTO-42132.601 intervening number therebetween with the same degree of precision. For example, for the range of 6–9, the numbers 7 and 8 are contemplated in addition to 6 and 9, and for 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. As used herein, the suffix “-free” refers to an embodiment of the technology that omits the feature of the base root of the word to which “-free” is appended. That is, the term “X-free” as used herein means “without X”, where X is a feature of the technology omitted in the “X-free” technology. For example, a “calcium-free” composition does not comprise calcium, a “mixing-free” method does not comprise a mixing step, etc. Although the terms “first”, “second”, “third”, etc. is used herein to describe various steps, elements, compositions, components, regions, layers, and / or sections, these steps, elements, compositions, components, regions, layers, and / or sections should not be limited by these terms, unless otherwise indicated. These terms are used to distinguish one step, element, composition, component, region, layer, and / or section from another step, element, composition, component, region, layer, and / or section. Terms such as “first”, “second”, and other numerical terms when used herein do not imply a sequence or order unless clearly indicated by the context. Thus, a first step, element, composition, component, region, layer, or section discussed herein could be termed a second step, element, composition, component, region, layer, or section without departing from technology. As used herein, the word “presence” or “absence” (or, alternatively, “present” or “absent”) is used in a relative sense to describe the amount or level of a particular entity (e.g., component, action, element). For example, when an entity is said to be “present”, it means the level or amount of this entity is above a pre-determined threshold; conversely, when an entity is said to be “absent”, it means the level or amount of this entity is below a pre-determined threshold. The pre-determined threshold is the threshold for detectability associated with the particular test used to detect the entity or any other threshold. When an entity is “detected” it is “present”; when an entity is “not detected” it is “absent”. As used herein, a “system” refers to a plurality of real and / or abstract components operating together for a common purpose. In some embodiments, a “system” is an integrated assemblage of hardware and / or software components. In some embodiments, each component of the system interacts with one or more other components and / or is related to one or more other components. In some embodiments, a system refers to a combination of components and software for controlling and directing methods. For ASTO-42132.601 example, a “system” or “subsystem” may comprise one or more of, or any combination of, the following: mechanical devices, hardware, components of hardware, circuits, circuitry, logic design, logical 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., to perform a function of the system or subsystem. Thus, the methods and apparatus of the embodiments, or certain aspects or portions thereof, may take the form of program code (e.g., instructions) embodied in tangible media, such as floppy diskettes, CD-ROMs, hard drives, flash memory, or any other machine-readable storage medium wherein, when the program code is loaded into and executed by a machine, such as a computer, the machine becomes an apparatus for practicing the embodiments. In the case of program code execution on programmable computers, the computing device generally includes a processor, a storage medium readable by the processor (e.g., volatile and non-volatile memory and / or storage elements), at least one input device, and at least one output device. One or more programs may implement or utilize the processes described in connection with the embodiments, e.g., through the use of an application programming interface (API), reusable controls, or the like. Such programs are preferably implemented in a high-level procedural or object-oriented programming language to communicate with a computer system. However, the program(s) can be implemented in assembly or machine language, if desired. In any case, the language is a compiled or interpreted language, and combined with hardware implementations. As used herein, the term “computed tomography” is abbreviated “CT” and refers both to tomographic and non-tomographic radiography. For instance, the term “CT” refers to numerous 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) comprises use of an X-ray source and a detector that rotates around a patient and subsequent reconstruction of images into different planes. In some embodiments of CT (e.g., devices, apparatuses, and methods provided for CT), the X-ray source is a static source and the patient is rotated with respect to the static source. Currents for X-rays used in CT describe the current flow from a cathode to an anode and are typically measured in milliamperes (mA). As used herein, the term “structured to [verb]” means that the identified element or assembly has a structure that is shaped, sized, disposed, coupled, and / or configured to ASTO-42132.601 perform the identified verb. For example, a member that is “structured to move” is movably coupled to another element and includes elements that cause the member to move or the member is otherwise configured to move in response to other elements or assemblies. As such, as used herein, “structured to [verb]” recites structure and not function. Further, as used herein, “structured to [verb]” means that the identified element or assembly is intended to, and is designed to, perform the identified verb. As used herein, the term “associated” means that the elements are part of the same assembly and / or operate together or act upon / with each other in some manner. For example, an automobile has four tires and four hub caps. While all the elements are coupled as part of the automobile, it is understood that each hubcap is “associated” with a specific tire. As used herein, the term “coupled” refers to two or more components that are secured, by any suitable means, together. Accordingly, in some embodiments, the statement that two or more parts or components are “coupled” shall mean that the parts are joined or operate together either directly or indirectly, e.g., through one or more intermediate parts or components. As used herein, “directly coupled” means that two elements are directly in contact with each other. As used herein, “fixedly coupled” or “fixed” means that two components are coupled so as to move as one while maintaining a constant orientation relative to each other. Accordingly, when two elements are coupled, all portions of those elements are coupled. A description, however, of a specific portion of a first element being coupled to a second element, e.g., an axle first end being coupled to a first wheel, means that the specific portion of the first element is disposed closer to the second element than the other portions thereof. Further, an object resting on another object held in place only by gravity is not “coupled” to the lower object unless the upper object is otherwise maintained substantially in place. That is, for example, a book on a table is not coupled thereto, but a book glued to a table is coupled thereto. As used herein, the term “removably coupled” or “temporarily coupled” means that one component is coupled with another component in an essentially temporary manner. That is, the two components are coupled in such a way that the joining or separation of the components is easy and does not damage the components. Accordingly, “removably coupled” components is readily uncoupled and recoupled without damage to the components. As used herein, the term “operatively coupled” means that a number of elements or assemblies, each of which is movable between a first position and a second position, or a ASTO-42132.601 first configuration and a second configuration, are coupled so that as the first element moves from one position / configuration to the other, the second element moves between positions / configurations as well. It is noted that a first element is “operatively coupled” to another without the opposite being true. As used herein, the term “rotatably coupled” refers to two or more components that are coupled in a manner such that at least one of the components is rotatable with respect to the other. As used herein, the term “translatably coupled” refers to two or more components that are coupled in a manner such that at least one of the components is translatable with respect to the other. As used herein, the term “temporarily disposed” means that a first element or assembly is resting on a second element or assembly in a manner that allows the first element / assembly to be moved without having to decouple or otherwise manipulate the first element. For example, a book simply resting on a table, e.g., the book is not glued or fastened to the table, is “temporarily disposed” on the table. As used herein, the term “correspond” indicates that two structural components are sized and shaped to be similar to each other and is coupled with a minimum amount of friction. Thus, an opening which “corresponds” to a member is sized slightly larger than the member so that the member may pass through the opening with a minimum amount of friction. This definition is modified if the two components are to fit “snugly” together. In that situation, the difference between the size of the components is even smaller whereby the amount of friction increases. If the element defining the opening and / or the component inserted into the opening are made from a deformable or compressible material, the opening may even be slightly smaller than the component being inserted into the opening. With regard to surfaces, shapes, and lines, two, or more, “corresponding” surfaces, shapes, or lines have generally the same size, shape, and contours. As used herein, a “path of travel” or “path,” when used in association with an element that moves, includes the space an element moves through when in motion. As such, any element that moves inherently has a “path of travel” or “path.” As used herein, the statement that two or more parts or components “engage” one another shall mean that the elements exert a force or bias against one another either directly or through one or more intermediate elements or components. Further, as used herein with regard to moving parts, a moving part may “engage” another element during ASTO-42132.601 the motion from one position to another and / or may “engage” another element once in the described position. Thus, it is understood that the statements, “when element A moves to element A first position, element A engages element B,” and “when element A is in element A first position, element A engages element B” are equivalent statements and mean that element A either engages element B while moving to element A first position and / or element A either engages element B while in element A first position. As used herein, the term “operatively engage” means “engage and move.” That is, “operatively engage” when used in relation to a first component that is structured to move a movable or rotatable second component means that the first component applies a force sufficient to cause the second component to move. For example, a screwdriver is placed into contact with a screw. When no force is applied to the screwdriver, the screwdriver is merely “coupled” to the screw. If an axial force is applied to the screwdriver, the screwdriver is pressed against the screw and “engages” the screw. However, when a rotational force is applied to the screwdriver, the screwdriver “operatively engages” the screw and causes the screw to rotate. Further, with electronic components, “operatively engage” means that one component controls another component by a control signal or current. As used herein, the term “number” shall mean one or an integer greater than one (e.g., a plurality). As used herein, in the phrase “[x] moves between its first position and second position,” or, “[y] is structured to move [x] between its first position and second position,” “[x]” is the name of an element or assembly. Further, when [x] is an element or assembly that moves between a number of positions, the pronoun “its” means “[x],” i.e., the named element or assembly that precedes the pronoun “its.” As used herein, a “radial side / surface” for a circular or cylindrical body is a side / surface that extends about, or encircles, the center thereof or a height line passing through the center thereof. As used herein, an “axial side / surface” for a circular or cylindrical body is a side that extends in a plane extending generally perpendicular to a height line passing through the center. That is, generally, for a cylindrical soup can, the “radial side / surface” is the generally circular sidewall and the “axial side(s) / surface(s)” are the top and bottom of the soup can. As used herein, a “diagnostic” test includes the detection or identification of a disease state or condition of a subject, determining the likelihood that a subject will contract a given disease or condition, determining the likelihood that a subject with a ASTO-42132.601 disease or condition will respond to therapy, determining the prognosis of a subject with a disease or condition (or its likely progression or regression), and determining the effect of a treatment on a subject with a disease or condition. For example, a diagnostic can be used for detecting the presence or likelihood of a subject having a cancer or the likelihood that such a subject will respond favorably to a compound (e.g., a pharmaceutical, e.g., a drug) or other treatment. As used herein, the term “condition” refers generally to a disease, malady, injury, event, or change in health status. As used herein, the term “treating” or “treatment” with respect to a condition refers to preventing the condition, slowing the onset or rate of development of the condition, reducing the risk of developing the condition, preventing or delaying the development of symptoms associated with the condition, reducing or ending symptoms associated with the condition, generating a complete or partial regression of the condition, or some combination thereof. In some embodiments, “treatment” comprises exposing a patient or a portion thereof (e.g., a tissue, organ, body part, or other localize region of a patient body) to radiation (e.g., electromagnetic radiation, ionizing radiation). As used herein, the term “beam” refers to a stream of radiation (e.g., electromagnetic wave and / or or particle radiation). In some embodiments, the beam is produced by a source and is restricted to a small-solid angle. In some embodiments, the beam is collimated. In some embodiments, the beam is generally unidirectional. In some embodiments, the beam is divergent. As used herein, the term “patient” or “subject” refers to a mammalian animal that is identified and / or selected for imaging and / or treatment with radiation. Accordingly, in some embodiments, a patient or subject is contacted with a beam of radiation, e.g., a primary beam produced by a radiation source. In some embodiments, the patient or subject is a human. In some embodiments, the patient or subject is a veterinary or farm animal, a domestic animal or pet, or animal used for clinical research. In some embodiments, the subject or patient has cancer and / or the subject or patient has either been recognized as having or at risk of having cancer. As used herein, the term “treatment volume” or “imaging volume” refers to the volume (e.g., tissue) of a patient that is selected for imaging and / or treatment with radiation. For example, in some embodiments, the “treatment volume” or “imaging volume” comprises a tumor in a cancer patient. As used herein, the term “healthy tissue” refers to ASTO-42132.601 the volume (e.g., tissue) of a patient that is not and / or does not comprise the treatment volume. In some embodiments, the imaging volume is larger than the treatment volume and comprises the treatment volume. As used herein, the term “radiation source” or “source” refers to an apparatus that produces radiation (e.g., ionizing radiation) in the form of photons (e.g., described as particles or waves). In some embodiments, a radiation source is a linear accelerator (“linac”) that produces x-rays or electrons to treat a cancer patient by contacting a tumor with the x- ray or electron beam. 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 having a wavelength in the range of approximately 1 pm to approximately 1 nm). While it is understood that radiation can be described as having both wave-like and particle-like aspects, it is sometimes convenient to refer to radiation in terms of waves and sometimes convenient to refer to radiation in terms of particles. Accordingly, both descriptions are used throughout without limiting the technology and with an understanding that the laws of quantum mechanics provide that every particle or quantum entity is described as either a particle or a wave. As used herein, the term “static source” refers to a source that does not revolve around a patient during use of the source for imaging or therapy. In particular, a “static source” remains fixed with respect to an axis passing through the patient while the patient is being imaged or treated. While the patient may rotate around said axis to produce relative motion between the static source and rotating patient that is equivalent to the relative motion of a source revolving around a static patient, a static source does not move with reference to a third object, frame of reference (e.g., a treatment room in which a patient is positioned), or patient axis of rotation during imaging or treatment, while the patient is rotated with respect to said third object, said frame of reference (e.g., said treatment room in which said patient is positioned), or patient axis of rotation through the patient during imaging or treatment. Thus, a static source is installed on a mobile platform and thus the static source may move with respect to the Earth and fixtures on the Earth as the mobile platform moves to transport the static source. Thus, the term “static source” may refer to a mobile “static source” provided that the mobile “static source” does not revolve around an axis of rotation through the patient during imaging or treatment of the patient. Further, the static source may translate and / or revolve around the patient to position the ASTO-42132.601 static source prior to imaging or treatment of the patient or after imaging or treatment of the patient. Thus, the term “static source” may refer to a source that translates or revolves around the patient in non-imaging and non-treatment use, e.g., 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 thus is referred to as a “static photon source”. Description With reference to FIG.1, a patient support assembly 10 includes an upright backrest 14, a first arm support 18, and a second arm support 22. The first arm support 18 is adjustably coupled to the backrest 14 along a first edge 26 of the backrest 14. In some embodiments, the first arm support 18 is releasably clamped to the first edge 26 of the backrest 14. The second arm support 22 is adjustably coupled to the backrest 14 along a second edge 30 of the backrest 14. As detailed further herein, the arm supports 18, 22 are movable along the backrest 14 between a plurality of positions (e.g., a raised position (FIG. 1, FIG. 4) and a lowered position (FIG. 7)). In addition, the arm supports 18, 22 are movable between a plurality of configurations (e.g., a forward configuration (FIG. 1), a side configuration (FIG. 4), and a loading configuration (FIG.7)). With reference to FIGS. 1-3, the arm support 18 is shown in a raised position and a front configuration. With reference to FIG.3, the arm support 18 includes a first linkage 34 with a releasably attachment 38, a second linkage 42 coupled to the first linkage 34 and movable with respect to the first linkage 34 about a first axis 46. In some embodiments, the releasable attachment 38 includes a channel configured to at least partially receive a support structure (e.g., an edge of the backrest, a pole, etc.). In some embodiments, the second linkage 42 is movable with respect to the first linkage 34 about the first axis 46 with a range of travel of at least 90 degrees. In some embodiments, the second linkage 42 is movable with respect to the first linkage 34 about the first axis 46 with a range of travel of at least 180 degrees. In some embodiments, the first linkage 34 is releasably locked with respect to the second linkage 42 by a locking connection. In some embodiments, the locking connection is released (e.g., unlocked) in response to a user actuating a release actuator (e.g., a button, lever, slide, etc.). The arm support 18 further includes a third linkage 50 coupled to the second linkage 42 and movable with respect to the second linkage 42 about a second axis 54. In the illustrated embodiment, the first axis 46 is spaced from and parallel to the second axis 54. ASTO-42132.601 In the illustrated embodiment, the third linkage 50 includes a saddle portion 58 configured to receive a portion of a patient arm 62. In other words, the saddle portion 58 supports the patient arm 62 from underneath the patient arm 62. In some embodiments, the third linkage 50 is movable with respect to the second linkage 42 about the second axis 54 with a range of travel of at least 90 degrees. In some embodiments, the third linkage 50 is movable with respect to the second linkage 42 about the second axis 54 with a range of travel of at least 180 degrees. As such, the arm support 18 includes a plurality of linkages 34, 42, 50 with at least two axes of rotation 46, 54 for adjusting the configuration of the arm support 18. With continued reference to FIG. 3, the arm support 18 further includes a handle bar 66 coupled to the third linkage 50. In the illustrated embodiment, the second linkage 42 is coupled to a first end 70 of the third linkage 50, and the handle bar 66 is coupled to a second end 74 of the third linkage 50. In some embodiments, the handle bar 66 is coupled to the third linkage 50 with a ball socket interface. In the illustrated embodiment, the handle bar 66 is arcuate. In the illustrated embodiment, the saddle portion 58 is positioned between the first end 70 and the second end 74 of the third linkage 50. In the illustrated embodiment, the saddle portion 58 includes a convex support surface 78 configured to contact and support the patient arm 62. In the illustrated embodiment, the first arm support 18 includes at least one articulation and is movable between a first plurality of configurations, and the second arm support 22 includes at least one articulation and is movable between a second plurality of configurations. Advantageously, the second arm support 22 is adjustable relative to the backrest 14 independent of the first arm support 18. With reference to FIGS. 4-6, the arm support 18 is shown in a raised position and a side configuration. In the side configuration, at least a portion of the first arm support 18 extends sideways past the first edge 26 of the backrest 14 (FIG. 5). With reference to FIG.7-8, the arm support 18 is shown a lowered position and a loading configuration. Advantageously, the arm support 18 supports the full weight of the patient arm 62. Conventional supine systems require the patient to lift their arms over their head and grab hold of a handle and gravity helps keep the arms in a fixed position. However, since gravity is working against maintaining a position in an upright system, the arm support 18 is designed to take the full weight of the arm 62 as gravity is now acting against the arm 62 remaining in place. ASTO-42132.601 The arm support 18 is further advantageous because someone other than the patient (e.g., a medical provider, a technician, etc.) can raise the weight of the arm into a raised position, without the patient expending muscle energy. In other words, the patient arm 62 can be loaded into the arm support 18 in a lowered position (FIG. 7) and raised by someone other than the patient into the raised position (FIGS. 1 and 4). Patients usually will have undergone surgery prior to radiotherapy and the incision sites, for example, can make it painful to raise their arm. With reference to FIG.9, a frame 82 supports the first arm support 18 and the second arm support 22. Specifically, the first arm support 18 is slidably coupled to a first upright pipe 86 and the second arm support 22 is slidably coupled to a second upright pipe 90. With reference to FIG.10, a method 100 includes: (STEP 101) positioning an arm of a patient in an arm support in a lowered position and coupled to an upright backrest (e.g., FIG. 7). In some embodiments, the method 100 further includes raising a handle bar of the arm support after positioning the arm of the patient in the arm support in the lowered position. The method 100 further includes (STEP 102) raising the arm support to a raised position (e.g., FIGS. 1 and 4). In some embodiments, the method 100 includes raising the arm support to an intermediate position and pausing before raising the arm support to the raised position in (STEP 102). In some embodiments, the method 100 further includes adjusting the configuration of the arm support after the arm support is in the raised position. In some embodiments, the method 100 further includes positioning a second arm of the patient in a second arm support in a lowered position and coupled to the upright backrest, and raising the second arm support to a raised position. The method 100 further includes (STEP 103) treating or imaging the patient with a beam intersecting the patient, wherein the arm is spaced from the beam. In other words, the beam does not intersect the arm of the patient. In some embodiments, the method 100 further includes lowering the arm support to the lowered position after treating or imaging the patient. With reference to FIGS. 11 and 12, a patient support assembly 150 includes an upright backrest 154 and handle grips 158. The upright backrest 154 includes cutouts 162 configured to receive a portion of an arm of a patient. In other words, the cutouts 162 allow ASTO-42132.601 the patient to position their arms and hands “down and back”. In the illustrated embodiment, the handle grips 158 extend from a rear surface 166 of the backrest 154. With the patient support assembly 150, the patient can be imaged or treated in an upright position, while positioning their arms backwards and away from the treatment or imaging beam. In some embodiments, the patient support assembly 150 includes protruding arm rests that extend in a sideways direction from the backrest 154 (one from each side) to support patient arms in a down and behind position. In some embodiments, the protruding arm rest is configured to be positioned between a patient back and a patient arm. In some embodiments, the backrest 154 is curved. In some embodiments, the handle grips 158 have at least a portion that extends parallel to the backrest 154. With reference to FIGS. 13 and 14, a patient support assembly 200 includes an upright backrest 204 and handle grips 208. The upright backrest 204 includes cutouts 212 configured to receive a portion of an arm of a patient. In other words, the cutouts 212 allow the patient to position their arms “down and back.” In the illustrated embodiment, the handle grips 208 extend from a front surface 216 of the backrest 204. With the patient support assembly 200, the patient can be imaged or treated in an upright position, while positioning their arms backwards and away from the treatment or imaging beam. The present disclosure provides a method of treating a patient in an upright position with the patient arms down and back. With reference to FIGS. 15-18, a patient support assembly 250 includes an upright backrest 254, a first arm support 258, and a second arm support 262. The first arm support 258 is adjustably coupled to the backrest 254 along a first edge 266 of the backrest 254. In some embodiments, the first arm support 258 is releasably clamped to the first edge 266 of the backrest 254. The second arm support 262 is adjustably coupled to the backrest 254 along a second edge 270 of the backrest 254, opposite the first edge 266. Similar to the other arm supports detailed herein, the arm supports 258, 262 are movable along the backrest 254 between a plurality of positions (e.g., a raised position, a lowered position, an intermediate position, etc.)). In the illustrated embodiment, the arm support 258, 262 have no articulations and no interconnected linkages. In some embodiments, the patient places their arm in the support and the therapist raises the support, without the patient needing to put in any effort. The arm support 258 includes a releasable attachment; a saddle portion configured to receive a portion of a patient arm; a handle bar portion; and an indexing system that ASTO-42132.601 allows for repeatable locating of the arm support. In some embodiments, the arm support can be raised and lowered by an operator. In some embodiments, the arm support 258 is removably coupled to a backrest 254. In some embodiments, the saddle portion includes a convex support surface. Although the disclosure herein refers to certain illustrated embodiments, it is to be understood that these embodiments are presented by way of example and not by way of limitation. All publications and patents mentioned in the above specification are herein incorporated by reference in their entirety for all purposes. Various modifications and variations of the described compositions, methods, and uses of the technology will be apparent to those skilled in the art without departing from the scope and spirit of the technology as described. Although the technology has been described in connection with specific exemplary embodiments, it should be understood that the invention as claimed should not be unduly limited to such specific embodiments. Indeed, various modifications of the described modes for carrying out the invention that are obvious to those skilled in the art are intended to be within the scope of the following claims.

Claims

ASTO-42132.601 CLAIMS What is claimed is:

1. An arm support comprising: a first linkage including a releasable attachment; a second linkage coupled to the first linkage and movable with respect to the first linkage about a first axis; a third linkage coupled to the second linkage and movable with respect to the second linkage about a second axis; wherein the third linkage includes a saddle portion configured to receive a portion of a patient arm; and a handle bar coupled to the third linkage.

2. The arm support of claim 1, wherein the first axis is spaced from and parallel to the second axis.

3. The arm support of claim 1, wherein the releasable attachment includes a channel configured to at least partially receive a support structure.

4. The arm support of claim 1, wherein the second linkage is movable with respect to the first linkage about the first axis with a range of travel of at least 90 degrees.

5. The arm support of claim 4, wherein the third linkage is movable with respect to the second linkage about the second axis with a range of travel of at least 90 degrees.

6. The arm support of claim 1, wherein the second linkage is coupled to a first end of the third linkage, and the handle bar is coupled to a second end of the third linkage; and wherein the saddle portion is positioned between the first end and the second end.

7. The arm support of claim 1, wherein the saddle portion includes a convex support surface.

8. The arm support of claim 1, wherein the handle bar is coupled to the third linkage with a ball socket interface.ASTO-42132.601 9. The arm support of claim 1, wherein the handle bar is arcuate.

10. A patient support assembly comprising: an upright backrest; a first arm support adjustably coupled to the backrest along a first edge of the backrest; and a second arm support adjustably coupled to the backrest along a second edge of the backrest.

11. The patient support assembly of claim 10, wherein the first arm support includes at least one articulation and is movable between a first plurality of configurations; and wherein the second arm support includes at least one articulation and is movable between a second plurality of configurations.

12. The patient support assembly of claim 11, wherein one of the first plurality of configurations is a side configuration where at least a portion of the first arm support extends past the first edge of the backrest.

13. The patient support assembly of claim 11, wherein the first arm support includes a plurality of linkages with at least two axes of rotation.

14. The patient support assembly of claim 10, wherein the first arm support is releasably clamped to the first edge of the backrest.

15. The patient support assembly of claim 11, wherein the second arm support is adjustable relative to the backrest independent of the first arm support.

16. A method comprising: positioning an arm of a patient in an arm support in a lowered position and coupled to an upright backrest; raising the arm support to a raised position; and treating or imaging the patient with a beam intersecting the patient; andASTO-42132.601 wherein the arm is spaced from the beam.

17. The method of claim 16, further including raising the arm support to an intermediate position and pausing before raising the arm support to the raised position.

18. The method of claim 16, further including adjusting the configuration of the arm support after the arm support is in the raised position.

19. The method of claim 16, further including raising a handle bar of the arm support after positioning the arm of the patient in the arm support in the lowered position.

20. The method of claim 16, further including positioning a second arm of the patient in a second arm support in a lowered position and coupled to the upright brackrest, and raising the second arm support to a raised position.

21. The method of claim 16, further including lowering the arm support to the lowered position after treating or imaging the patient.

22. An upright backrest comprising at least one cutout configured to receive a portion of an arm of a patient.

23. A method of treating a patient in an upright position with the patient arms down and back.

24. An arm support comprising: a releasable attachment; a saddle portion configured to receive a portion of a patient arm; a handle bar portion; and an indexing system that allows for repeatable locating of the arm support.

25. The arm support of claim 24, wherein the arm support can be raised and lowered by an operator.ASTO-42132.601 26. The arm support of claim 24, wherein the arm support is removably coupled to a backrest.

27. The arm support of claim 24, wherein the saddle portion includes a convex support surface.

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