Real-time Position Management™ (RPM) System

Respiration synchronised imaging and treatment

The Real-time Position Management™ (RPM) system is a non-invasive, video based system that allows for clean imaging and treatment of lung, breast, and upper abdominal sites. The RPM system is accurate, easy to use and fast. It is comfortable for the patient and accommodates both breath hold and free breathing protocols.

The RPM system allows you to correlate where the tumor is in relation to the patients respiratory cycle. Using an infrared tracking camera and a reflective marker, the system measures the patients respiratory pattern and range of motion and displays them as a waveform. The gating thresholds are set when the tumor is in the desired portion of the respiratory cycle. These thresholds determine when the gating system turns the treatment beam on and off.

The RPM system facilitates the treatment of the lungs, liver and pancreas, and helps minimise dose to the heart in breast treatments. The system is designed to be used anywhere you encounter the effects of respiratory motion. It also provides clean images for planning, so that you can more clearly visualise the target with fewer of the image artefacts associated with respiratory motion.

Key features:

Only the Varian RPM system has clinically proven interfaces to CT and CT/PET scanners.
Lightweight marker ensures patient comfort.
Predictive filter – patented by Varian monitors and predicts the patient's breathing pattern and can account for patient's coughing or changes from the predicted breathing pattern.
Eclipse has immediate access to gated verification images from the On-Board Imager system during the course of the treatment. Recalculation of dose distributions may be necessary.
Superior Clinac® design means <100millisecond beam on times with accurate gated dose rates and uncompromised beam flatness and symmetry.
Pre-treatment verification can be performed by the on-board imager fluoroscopy mode.
Gated radiographic image acquisition using the On-Board Imager during the correct phase of the respiratory cycle.
Gated port film acquisition – acquires MV images during the correct phase of the respiratory cycle.
Automated process of image acquisition and gated treatments.
After treatment a record of the gating trace and image window can be stored for later analysis.
Treatment beam gating integrated with dynamic MLC leaf motion.

Phase Gating and Amplitude Gating

The RPM system supports both methods:

Phase based gating allows automatic gating of image acquisition and treatment delivery based on the same phase of the patients respiratory cycle. This image shows gating on the exhalation phase.

Amplitude based gating allows automatic gating based on the absolute position of the marker block on the patients thorax or abdomen, regardless of the phases in the patients respiratory cycle. This image shows gating at maximum inhalation.

Patient evaluation and post plan verification

Gating can be used on Acuity for patient evaluation and suitability for gating.

The Acuity system allows efficient pre-treatment verification of gating thresholds and anticipated gated treatment delivery before setting up the patient on the accelerator for treatment. If adjustments are required for the gating parameters, these can be done in advance of the treatment delivery. Acuity supports both 2D and 3D positioning verification and fluoroscopic evaluation of gating thresholds for post plan verification.

Clinical versatility:

All clinical breathing protocols, including free breathing are supported.
Allows you to monitor respiration without sacrificing accuracy and patient comfort.
The system can be used for retrospective and prospective gating.
Gating allows for patient specific treatment margins, rather than population based margins.
Gating may facilitate in dose escalation.
Accurate tumor tracking allows maximum dose to tumor and minimum dose to normal tissue
The RPM system is in routine use worldwide.

From simulation to treatment the RPM system allows you to accurately monitor and compensate for tumor movement.

Contact Varian Oncology

Varian Oncology Headquarters
Tel: 1.650.424.5700
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