# US 10,500,418 B2 · System and method for patient-specific motion management for treatment > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,500,418 B2 - Document ID: US10500418B2 - Status: Granted - Kind: B2 - Application number: 15/398,683 - Filed: 2017-01-04 - Published: 2018-07-05 - Granted: 2019-12-10 - Earliest claimed: 2017-01-04 - Assignees: Varian Medical Systems International AG - Applicants: Varian Medical Systems International AG - Inventors: Reto W. Filiberti; Stefan G. Scheib; Michael Huber - Web page: https://patentgrep.com/patent/US10500418B2 ## CPC - A61N 5/1049: {for verifying the position of the patient with respect to the radiation beam} - A61B 5/113: occurring during breathing - A61B 5/1135: {by monitoring thoracic expansion} - A61B 90/39: {Markers, e.g. radio-opaque or breast lesions markers} - A61N 5/1065: {Beam adjustment} - A61N 5/1068: {Gating the beam as a function of a physiological signal} - A61N 5/1069: {Target adjustment, e.g. moving the patient support} - A61N 5/1081: {Rotating beam systems with a specific mechanical construction, e.g. gantries} - A61B 2090/3937: {Visible markers} - A61N 2005/1052: {using positron emission tomography [PET] single photon emission computer tomography [SPECT] imaging} - A61N 2005/1055: {using magnetic resonance imaging [MRI]} - A61N 2005/1058: {using ultrasound imaging} - A61N 2005/1059: {using cameras imaging the patient} - A61N 2005/1061: {using an x-ray imaging system having a separate imaging source} - A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B) - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract An apparatus for assisting a selection of motion management technique for use with a treatment machine having an energy source, comprises: one or more input for obtaining motion trace of a target to be treated, and/or for obtaining motion data of a fiducial; and a motion management processor configured to determine motion management data based at least in part on at least a portion of the motion trace of the target and/or at least a portion of the motion data of the fiducial, wherein the motion management data indicates desirability and/or undesirability of one or more motion management option(s); wherein the motion management processor is also configured to output the motion management data for assisting the selection of the motion management technique for use with the treatment machine. ## Claims ### Claim 1 An apparatus for assisting a selection of motion management technique for use with a treatment machine having an energy source, the apparatus comprising: one or more input for obtaining a motion trace of a target in a patient to be treated, and/or for obtaining motion data of a fiducial; and a motion management processor configured to determine motion management data based at least in part on at least a portion of the motion trace of the target and/or at least a portion of the motion data of the fiducial, wherein the motion management data indicates desirability and/or undesirability of one or more motion management option(s); wherein the motion management processor is also configured to output the motion management data for assisting the selection of the motion management technique for use with the treatment machine; and wherein the apparatus comprises a synchronous motion detector, a visibility detector, a distance analyzer, or a combination of the foregoing, coupled upstream with respect to the motion management processor to provide information to the motion management processor. ### Claim 2 (depends on 1) The apparatus of claim 1, further comprising a target motion analyzer configured to determine whether a motion of the target is more than a prescribed amount. ### Claim 3 (depends on 2) The apparatus of claim 2, wherein the motion management data indicates that no motion management option is desirable if the motion of the target is less than the prescribed amount. ### Claim 4 (depends on 1) The apparatus of claim 1, wherein the fiducial comprises a surrogate inside the patient. ### Claim 5 (depends on 4) The apparatus of claim 4, further comprising a surrogate motion analyzer configured to determine whether a motion of the surrogate is more than a prescribed amount, wherein the motion management data indicates that motion management is desirable if the motion of the surrogate is less than the prescribed amount. ### Claim 6 (depends on 1) The apparatus of claim 1, wherein the fiducial comprises a surrogate inside the patient, and wherein the synchronous motion detector is configured to determine whether the surrogate moves synchronously with the target. ### Claim 7 (depends on 6) The apparatus of claim 6, wherein the motion management data indicates motion management based on surrogate is undesirable if the surrogate does not move synchronously with the target. ### Claim 8 (depends on 1) The apparatus of claim 1, wherein the fiducial comprises a marker coupled to the patient, and wherein the synchronous motion detector is configured to determine whether the marker moves synchronously with the target. ### Claim 9 (depends on 8) The apparatus of claim 8, wherein the motion management data indicates that motion management based on the marker is undesirable if the marker does not move synchronously with the target. ### Claim 10 (depends on 1) The apparatus of claim 1, wherein the fiducial comprises a marker, and wherein the visibility detector is configured to determine whether a motion of the marker is visible from an imaging direction; and wherein the motion management processor is configured to determine whether the motion management data based at least in part on the motion of the marker is visible from the imaging direction. ### Claim 11 (depends on 1) The apparatus of claim 1, further comprising a target motion analyzer configured to determine whether the target stays at an inhale phase for more than a prescribed duration, wherein the motion management processor is configured to determine the motion management data based at least in part on whether the target stays at the inhale phase for more than the prescribed duration. ### Claim 12 (depends on 11) The apparatus of claim 11, wherein the motion management data indicates that gating-at-inhale and breath-hold-at-inhale are desirable motion management options if the target stays at the inhale phase for more than the prescribed duration. ### Claim 13 (depends on 1) The apparatus of claim 1, further comprising a target motion analyzer configured to determine whether the target stays at an exhale phase for more than a prescribed duration, wherein the motion management processor is configured to determine the motion management data based at least in part on whether the target stays at the exhale phase for more than the prescribed duration. ### Claim 14 (depends on 13) The apparatus of claim 13, wherein the motion management data indicates that gating-at-exhale and breath-hold-at-exhale are desirable motion management options if the target stays at the exhale phase for more than the prescribed duration. ### Claim 15 (depends on 1) The apparatus of claim 1, wherein the distance analyzer is configured to determine whether a distance between the target and a critical organ is more than a first threshold. ### Claim 16 (depends on 15) The apparatus of claim 15, wherein the motion management data indicates that field-tracking and/or couch-tracking is desirable motion management option(s) or not if the distance between the target and the critical organ is not more than the first threshold. ### Claim 17 (depends on 15) The apparatus of claim 15, wherein the distance analyzer is configured to determine whether the distance between the target and the critical organ is more than a second threshold that is larger than the first threshold. ### Claim 18 (depends on 17) The apparatus of claim 17, wherein the motion management data indicates that field-tracking or couch-tracking is a desirable motion management option if the distance between the target and the critical organ is not more than the second threshold. ### Claim 19 (depends on 17) The apparatus of claim 17, wherein the motion management data indicates that field-tracking in combination with couch-tracking is a desirable motion management option if the distance between the target and the critical organ is more than the second threshold. ### Claim 20 (depends on 1) The apparatus of claim 1, further comprising a display for displaying the motion management data. ### Claim 21 (depends on 1) The apparatus of claim 1, wherein the motion trace comprises a segmentation of the target. ### Claim 22 (depends on 1) The apparatus of claim 1, wherein the motion management processor is configured to provide the motion management data to a treatment planning module. ### Claim 23 (depends on 1) The apparatus of claim 1, wherein the one or more input is also configured to obtain a signal input representing a change of one or more parameters involved in a treatment planning; and wherein the motion management processor is configured to perform calculation using the input to obtain new motion management data. ### Claim 24 (depends on 1) The apparatus of claim 1, wherein the motion trace of the target comprises a video formed by CT image data, MRI data, PET, ultrasound or x-ray image data. ### Claim 25 (depends on 1) The apparatus of claim 1, wherein the motion data represents a real motion or a simulated motion. ### Claim 26 (depends on 1) The apparatus of claim 1, wherein the motion trace, the motion data, or both, are data generated during a treatment session. ### Claim 27 (depends on 1) The apparatus of claim 1, wherein the motion management processor is configured to determine the motion management data based also on data generated during the treatment session. ### Claim 28 (depends on 1) The apparatus of claim 1, further comprising dosimetry analyzer configured to determine dosimetry impact of one or more of the motion management option(s). ### Claim 29 (depends on 1) The apparatus of claim 1, wherein the motion management processor is configured to analyze the motion trace and the motion data to determine whether a plurality of criteria is met; wherein the motion management processor is configured to determine the motion management data based on a result of the analyzing. ### Claim 30 (depends on 29) The apparatus of claim 29, wherein the motion management processor is configured to classify a first subset of all available motion management options as desirable motion management option(s), and to classify a second subset of the available motion management options as undesirable motion management option(s) based on the result of the analyzing. ### Claim 31 (depends on 1) The apparatus of claim 1, wherein the motion management data also indicates one or more of: an amount of movement of the target over a breathing cycle, an amount of movement of the target inside a percentage of a breathing amplitude, an amount of movement of the target over a certain phase range of a breathing cycle, gantry angle(s) or a range of gantry angles at or over which a distance between the target and a critical structure is less than a prescribed value, a duration for which the target does not shift by more than a prescribed distance during an exhale phase, a duration for which the target does not shift by more than a prescribed distance during an inhale phase, motion information regarding an organ at risk, an amount of movement of a critical organ over a breathing cycle, an amount of movement of the critical organ inside a percentage of a breathing amplitude, an amount of movement of the critical organ over a certain phase range of the breathing cycle, a duration for which the critical organ does not shift by more than a prescribed distance during the exhale phase, a duration for which the critical organ does not shift by more than a prescribed distance during the inhale phase, dose volume parameter that depends on a chosen motion management scheme, an estimated treatment time, dose robustness measure based on motion variability, or any combination of the foregoing. ### Claim 32 (depends on 1) The apparatus of claim 1, wherein the motion management data comprises one or more setting recommendations selected from the group consisting of: gating window for performing gating of radiation deliveries, gating window at different gantry angles, a change in gating window(s) depending on angles or angle segments, tracking parameter(s) for MLC or couch, optimal collimator settings at different gantry positions, and parameter suggestion for predicting motion. ### Claim 33 (depends on 1) The apparatus of claim 1, wherein the motion management technique corresponds with one of the one or more motion management option(s). ### Claim 34 A processor-implemented method for assisting a selection of motion management technique for use with a treatment machine having an energy source, comprising: obtaining a motion trace of a target in a patient to be treated and/or motion data of a fiducial; determining, using a motion management processor of an apparatus, motion management data based at least in part on at least a portion of the motion trace of the target and/or at least a portion of the motion data of the fiducial, wherein the motion management data indicates desirability and/or undesirability of one or more motion management option(s); and outputting the motion management data for assisting the selection of the motion management technique for use with the treatment machine; wherein the apparatus comprises a synchronous motion detector, a visibility detector, a distance analyzer, or a combination of the foregoing, coupled upstream with respect to the motion management processor to provide information to the motion management processor. ### Claim 35 (depends on 34) The method of claim 34, further comprising determining whether a motion of the target is more than a prescribed amount. ### Claim 36 (depends on 35) The method of claim 35, wherein the motion management data indicates that no motion management option is desirable if the motion of the target is less than the prescribed amount. ### Claim 37 (depends on 34) The method of claim 34, wherein the fiducial comprises a surrogate inside the patient. ### Claim 38 (depends on 37) The method of claim 37, further comprising determining whether a motion of the surrogate is more than a prescribed amount, wherein the motion management data indicates that motion management is desirable if the motion of the surrogate is less than the prescribed amount. ### Claim 39 (depends on 34) The method of claim 34, wherein the fiducial comprises a surrogate inside the patient, and the method further comprises determining, by the synchronous motion detector, whether the surrogate moves synchronously with the target. ### Claim 40 (depends on 39) The method of claim 39, wherein the motion management data indicates motion management based on surrogate is undesirable if the surrogate does not move synchronously with the target. ### Claim 41 (depends on 34) The method of claim 34, wherein the fiducial comprises a marker coupled to the patient, and the method further comprises determining, by the synchronous motion detector, whether the marker moves synchronously with the target. ### Claim 42 (depends on 41) The method of claim 41, wherein the motion management data indicates that motion management based on the marker is undesirable if the marker does not move synchronously with the target. ### Claim 43 (depends on 34) The method of claim 34, wherein the fiducial comprises a marker, and the method further comprises determining, by the visibility detector, whether a motion of the marker is visible from an imaging direction; and wherein the motion management data is determined based at least in part on whether the motion of the marker is visible from the imaging direction. ### Claim 44 (depends on 34) The method of claim 34, further comprising determining whether the target stays at an inhale phase for more than a prescribed duration, wherein the motion management data is determined based at least in part on whether the target stays at the inhale phase for more than the prescribed duration. ### Claim 45 (depends on 44) The method of claim 44, wherein the motion management data indicates that gating-at-inhale and breath-hold-at-inhale are desirable motion management options if the target stays at the inhale phase for more than the prescribed duration. ### Claim 46 (depends on 34) The method of claim 34, further comprising determining whether the target stays at an exhale phase for more than a prescribed duration, wherein the motion management data is determined based at least in part on whether the target stays at the exhale phase for more than the prescribed duration. ### Claim 47 (depends on 46) The method of claim 46, wherein the motion management data indicates that gating-at-exhale and breath-hold-at-exhale are desirable motion management options if the target stays at the exhale phase for more than the prescribed duration. ### Claim 48 (depends on 34) The method of claim 34, further comprising determining, by the distance analyzer, whether a distance between the target and a critical organ is more than a first threshold. ### Claim 49 (depends on 48) The method of claim 48, wherein the motion management data indicates that field-tracking and/or couch-tracking is desirable motion management option(s) or not if the distance between the target and the critical organ is not more than the first threshold. ### Claim 50 (depends on 48) The method of claim 48, further comprising determining, by the distance analyzer, whether the distance between the target and the critical organ is more than a second threshold that is larger than the first threshold. ### Claim 51 (depends on 50) The method of claim 50, wherein the motion management data indicates that field-tracking or couch-tracking is a desirable motion management option if the distance between the target and the critical organ is not more than the second threshold. ### Claim 52 (depends on 50) The method of claim 50, wherein the motion management data indicates that field-tracking in combination with couch-tracking is a desirable motion management option if the distance between the target and the critical organ is more than the second threshold. ### Claim 53 (depends on 34) The method of claim 34, further comprising displaying the motion management data. ### Claim 54 (depends on 34) The method of claim 34, wherein the motion trace comprises a segmentation of the target. ### Claim 55 (depends on 34) The method of claim 34, further comprising providing the motion management data, by a motion management module, to a treatment planning module. ### Claim 56 (depends on 34) The method of claim 34, further comprising: obtaining input representing a change of one or more parameters involved in a treatment planning; and performing calculation using the input to obtain new motion management data. ### Claim 57 (depends on 56) The method of claim 56, wherein the act of obtaining input and the act of performing calculation using the input are repeated. ### Claim 58 (depends on 34) The method of claim 34, wherein the motion trace comprises a video formed by CT image data, MRI data, PET, ultrasound or x-ray image data. ### Claim 59 (depends on 34) The method of claim 34, wherein the motion data represents a real motion or a simulated motion. ### Claim 60 (depends on 34) The method of claim 34, wherein the motion trace, the motion data, or both, are data generated during a treatment session. ### Claim 61 (depends on 34) The method of claim 34, further comprising obtaining data generated during a treatment session, wherein the motion management data is determined based also on the data generated during the treatment session. ### Claim 62 (depends on 34) The method of claim 34, further comprising determining dosimetry impact of one or more of the motion management option(s). ### Claim 63 (depends on 34) The method of claim 34, further comprising analyzing the motion trace and the motion data to determine whether a plurality of criteria is met; wherein the motion management data is determined based on a result of the analyzing. ### Claim 64 (depends on 63) The method of claim 63, further comprising classifying a first subset of all available motion management options as desirable motion management option(s), and classifying a second subset of the available motion management options as undesirable motion management option(s) based on the result of the analyzing. ### Claim 65 (depends on 34) The method of claim 34, wherein the motion management data also indicates one or more of: an amount of movement of the target over a breathing cycle, an amount of movement of the target inside a percentage of a breathing amplitude, an amount of movement of the target over a certain phase range of a breathing cycle, gantry angle(s) or a range of gantry angles at or over which a distance between the target and a critical structure is less than a prescribed value, a duration for which the target does not shift by more than a prescribed distance during an exhale phase, a duration for which the target does not shift by more than a prescribed distance during an inhale phase, motion information regarding an organ at risk, an amount of movement of a critical organ over a breathing cycle, an amount of movement of the critical organ inside a percentage of a breathing amplitude, an amount of movement of the critical organ over a certain phase range of the breathing cycle, a duration for which the critical organ does not shift by more than a prescribed distance during the exhale phase, a duration for which the critical organ does not shift by more than a prescribed distance during the inhale phase, dose volume parameter that depends on a chosen motion management scheme, an estimated treatment time, dose robustness measure based on motion variability, or any combination of the foregoing. ### Claim 66 (depends on 34) The method of claim 34, wherein the motion management data comprises one or more setting recommendations selected from the group consisting of: gating window for performing gating of radiation deliveries, gating window at different gantry angles, a change in gating window(s) depending on angles or angle segments, tracking parameter(s) for MLC or couch, optimal collimator settings at different gantry positions, and parameter suggestion for predicting motion. ### Claim 67 (depends on 34) The method of claim 34, wherein the motion management technique corresponds with one of the one or more motion management option(s). ### Claim 68 An apparatus for assisting a selection of motion management technique for use with a treatment machine having an energy source, the apparatus comprising: one or more input for obtaining a motion trace of a target in a patient to be treated, and/or for obtaining motion data of a fiducial; and a motion management processor configured to determine motion management data based at least in part on at least a portion of the motion trace of the target and/or at least a portion of the motion data of the fiducial, wherein the motion management data indicates desirability and/or undesirability of one or more motion management option(s); wherein the motion management processor is also configured to output the motion management data for assisting the selection of the motion management technique for use with the treatment machine; wherein the fiducial comprises a surrogate inside the patient or a marker coupled to the patient, and wherein the apparatus further comprises: a distance analyzer configured to determine whether a distance between the target and a critical organ is more than a first threshold; a target motion analyzer configured to determine whether a motion of the target is more than a prescribed amount, wherein the motion is due at least in part to a breathing of the patient, the breathing having an inhale phase and an exhale phase; a surrogate motion analyzer configured to determine whether a motion of the fiducial is more than a prescribed amount; a synchronous motion detector configured to determine if the fiducial moves synchronously with the target; and a visibility detector configured to determine whether the motion of the fiducial is visible from an imaging direction. ### Claim 69 A processor-implemented method for assisting a selection of motion management technique for use with a treatment machine having an energy source, comprising: obtaining a motion trace of a target in a patient to be treated and/or motion data of a fiducial; determining, using a motion management processor, motion management data based at least in part on at least a portion of the motion trace of the target and/or at least a portion of the motion data of the fiducial, wherein the motion management data indicates desirability and/or undesirability of one or more motion management option(s); and outputting the motion management data for assisting the selection of the motion management technique for use with the treatment machine; wherein the fiducial comprises a surrogate inside the patient or a marker coupled to the patient, and wherein the method further comprises: determining, by a distance analyzer, whether a distance between the target and a critical organ is more than a first threshold; determining, by a target motion analyzer, whether a motion of the target is more than a prescribed amount, wherein the motion is due at least in part to a breathing of the patient, the breathing having an inhale phase and an exhale phase; determining, by a surrogate motion analyzer, whether a motion of the fiducial is more than a prescribed amount; determining, by a synchronous motion detector, if the fiducial moves synchronously with the target; and determining, by a visibility detector, whether the motion of the fiducial is visible from an imaging direction.