# US 11,992,705 B2 · On-line adaptive deep inspiration breath-hold treatment > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 11,992,705 B2 - Document ID: US11992705B2 - Status: Granted - Kind: B2 - Application number: 17/488,878 - Filed: 2021-09-29 - Published: 2023-03-30 - Granted: 2024-05-28 - Earliest claimed: 2021-09-29 - Assignees: Siemens Healthineers International AG - Applicants: Siemens Healthineers International AG - Inventors: Carsten Wessels; Ekta Jhala; Anke Engbert - Web page: https://patentgrep.com/patent/US11992705B2 ## CPC - A61N 5/1037: {taking into account the movement of the target, e.g. 4D-image based planning} - A61N 5/103: {Treatment planning systems} - A61N 5/1031: {using a specific method of dose optimization} - A61N 5/1042: {with spatial modulation of the radiation beam within the treatment head} - A61N 5/1049: {for verifying the position of the patient with respect to the radiation beam} - A61N 5/1067: {in real time, i.e. during treatment} - 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} - A61N 2005/1051: {using an active marker} - A61N 2005/1054: {using a portal imaging system} - 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) ## Abstract A computer-implemented method of performing a radiation therapy process includes: while a patient is disposed in a first position and maintains a first inspiration level, acquiring a set of projection images of a target volume associated with the patient; based on a treatment planning digital volume associated with the radiation therapy process and the set of projection images, generating a synthetic digital volume that includes the target volume; based on a treatment plan associated with the treatment planning digital volume and on the synthetic digital volume, generating a modified treatment fraction; and while the patient remains in the first position and maintains at least the first inspiration level, performing the modified treatment fraction. ## Claims ### Claim 1 A computer-implemented method of performing a radiation therapy process, the method comprising: while a patient is disposed in a first position for a first treatment fraction of the radiation therapy process and maintains a first inspiration level, acquiring a first set of projection images of a target volume associated with the patient; based on a treatment planning digital volume associated with the radiation therapy process and the first set of projection images of the target volume associated with the patient, generating a synthetic digital volume that includes the target volume; based on a treatment plan associated with the treatment planning digital volume and on the synthetic digital volume, generating a second modified treatment fraction of the radiation therapy process that is based on the first treatment fraction of the radiation therapy process; and while the patient remains in the first position for the first treatment fraction of the radiation therapy process and maintains at least the first inspiration level, performing the second modified treatment fraction of the radiation therapy process. ### Claim 2 (depends on 1) The computer-implemented method of claim 1, wherein the treatment planning digital volume is based on a second set of projection images from a treatment planning CT scan of the target volume associated with the patient. ### Claim 3 (depends on 1) The computer-implemented method of claim 1, wherein acquiring the first set of projection images of the target volume associated with the patient comprises performing a cone-beam computed tomography scan of the target volume. ### Claim 4 (depends on 1) The computer-implemented method of claim 1, further comprising, prior to acquiring the first set of projection images of the target volume associated with the patient, determining that the patient cannot maintain an inspiration level that meets or exceeds a predetermined threshold. ### Claim 5 (depends on 4) The computer-implemented method of claim 4, wherein determining that the patient cannot maintain the inspiration level that meets or exceeds the predetermined threshold comprises receiving a breathing signal that indicates an inspiration level of the patient. ### Claim 6 (depends on 4) The computer-implemented method of claim 4, wherein determining that the patient cannot maintain the inspiration level that meets or exceeds the predetermined threshold is performed while the patient is disposed in the first position. ### Claim 7 (depends on 1) The computer-implemented method of claim 1, wherein generating the synthetic digital volume comprises deformably registering image data within the treatment planning digital volume onto corresponding image data associated with the first set of projection images of the target volume associated with the patient. ### Claim 8 (depends on 7) The computer-implemented method of claim 7, wherein generating the second modified treatment fraction comprises detecting anatomical structures within the treatment planning digital volume after the image data within the treatment planning digital volume are deformably registered onto the corresponding image data associated with the first set of projection images of the target volume associated with the patient. ### Claim 9 (depends on 8) The computer-implemented method of claim 8, wherein generating the second modified treatment fraction further comprises determining one or more treatment beam parameters for the second modified treatment fraction based on the anatomical structures detected within the treatment planning digital volume associated with the radiation therapy process. ### Claim 10 (depends on 1) The computer-implemented method of claim 1, further comprising, prior to acquiring the first set of projection images of the target volume associated with the patient, determining that the first inspiration level is less than a predetermined threshold level associated with the treatment plan. ### Claim 11 (depends on 10) The computer-implemented method of claim 10, wherein the treatment plan is based on the patient maintaining an inspiration level that is equal to or greater than the predetermined threshold level. ### Claim 12 (depends on 1) The computer-implemented method of claim 1, further comprising, prior to performing the second modified treatment fraction, determining that the patient maintains at least the first inspiration level. ### Claim 13 (depends on 12) The computer-implemented method of claim 12, wherein determining that the patient maintains at least the first inspiration level comprises receiving a breathing signal that indicates a current inspiration level of the patient. ### Claim 14 A system for performing treatment fractions of a radiation therapy process, the system comprising: an X-ray imager; a treatment-delivering X-ray source configured to direct treatment X-rays to a target volume of patient anatomy; an imaging X-ray source configured to direct imaging X-rays through the target volume and toward the X-ray imager; and a processor configured to: while a patient is disposed in a first position for a first treatment fraction of the radiation therapy process and maintains a first inspiration level, acquire a first set of projection images of a target volume associated with the patient; based on a treatment planning digital volume associated with the radiation therapy process and the first set of projection images of the target volume associated with the patient, generate a synthetic digital volume that includes the target volume; based on a treatment plan associated with the treatment planning digital volume and on the synthetic digital volume, generate a second modified treatment fraction of the radiation therapy process that is based on the first treatment fraction of the radiation therapy process; and while the patient remains in the first position for the first treatment fraction of the radiation therapy process and maintains at least the first inspiration level, cause the second modified treatment fraction of the radiation therapy process to be performed. ### Claim 15 (depends on 14) The system of claim 14, wherein the treatment planning digital volume is based on a second set of projection images of a treatment planning CT scan of the target volume. ### Claim 16 (depends on 14) The system of claim 14, wherein acquiring the first set of projection images of the target volume associated with the patient comprises performing a cone-beam computed tomography scan of the target volume. ### Claim 17 (depends on 14) The system of claim 14, further comprising, prior to acquiring the first set of projection images of the target volume associated with the patient, determining that the patient cannot maintain an inspiration level that meets or exceeds a predetermined threshold. ### Claim 18 (depends on 17) The system of claim 17, wherein determining that the patient cannot maintain the inspiration level that meets or exceeds the predetermined threshold comprises receiving a breathing signal that indicates a current inspiration level of the patient. ### Claim 19 (depends on 17) The system of claim 17, wherein determining that the patient cannot maintain the inspiration level that meets or exceeds the predetermined threshold is performed while the patient is disposed in the first position. ### Claim 20 (depends on 14) The system of claim 14, wherein generating the synthetic digital volume comprises deformably registering image data within the treatment planning digital volume onto corresponding image data associated with the first set of projection images of the target volume associated with the patient.