Patent Description:
Treatment of a patient undergoing radiotherapy often involves precise imaging and treatment procedures. Patients are typically imaged (or "simulated") on an imaging modality (including, but not limited to, X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)) to aid the clinician in determining appropriate treatment plans. Patients will then undergo treatment on a radiotherapy modality (including, but not limited to, linear accelerator (Linac), proton therapy, heavy ion therapy, and photon therapy). In some instances, the imaging and treatment modalities may be combined into one unit, as in commercially available combination MR imaging/linear accelerator systems (MR-Linac), which combine a magnetic resonance imaging system with an on-board linear accelerator to deliver treatment.

Regardless of the chosen imaging and/or treatment modalities, it is critical that the patient is positioned in the same position for treatment as they were initially imaged, as margins and dosages of radiation to the tumor or other target pathologies are determined based on the images obtained in simulation, with an eye to destroy the tumor or other target pathology while limiting incidental damage to healthy tissues as a result of treatment. In particular, in radiotherapy, patients often require multiple treatment sessions over a period of weeks, and it is required that the patient is set up in the same position from one session to the next. Also key to smooth, accurate simulation and treatment, is patient comfort, as a patient who is uncomfortable may not be able to tolerate a particular position for the duration of a scan or treatment and may, as a result, inadvertently shift their position in a manner that is detrimental to the treatment plan.

Because of this, a patient's anatomy may further require additional adjustment or manipulation to ensure the patient is in the appropriate position. This can be cumbersome, as existing positioning devices may lack precision or capability for fine adjustment and may further require the patient's anatomy to be lifted off or otherwise removed from the device. For larger anatomical regions such as the lower extremities or for patients with limited strength or mobility to assist in these adjustments, the clinician may face further difficulty with manipulating the patient anatomy, requiring significant time to reposition the patient, severely impacting workflow efficiency. Accordingly, there is a need for patient positioning aids or supports where large manipulations of patient anatomy are limited and finer adjustments to positioning are accommodated, thereby enhancing clinical workflows and patient comfort.

A support apparatus configured to support a knee of a patient and comprising a height adjustment mechanism is known from <CIT>.

In accordance with an aspect of the invention, a support apparatus is provided, configured to support the anatomy of a patient, for example during radiotherapy and imaging procedures. Said support apparatus includes at least one locator configured to removably locate to corresponding indexing structures of a patient table of an imaging or treatment modality. The support apparatus additionally includes at least one directional guide running parallel to a direction relative to the patient table, said directional guide having a set distance. The support apparatus further includes at least one shuttle configured to slidably adjust the support apparatus along the at least one directional guide. The support apparatus further includes a releasable lock configured to resist the motion of the at least one shuttle in a first engaged position and enable motion of the at least one shuttle in the direction of the at least one directional guide in a second disengaged position. The support apparatus is so configured such that a clinician may select the gross position of the support apparatus by locating the at least one indexing structure with the patient table of the imaging or treatment modality. If further fine adjustment of the patient's anatomy is desired, the clinician is able to disengage the releasable lock and slidably adjust the support apparatus along the direction of the directional guide, without the need to lift or remove the patient's anatomy from the support apparatus or disturb the gross position of the support apparatus. This support apparatus further includes features which adjust the height of the support apparatus. This support apparatus may further include features which adjust the angle of the support apparatus, further accommodating additional fine adjustments to the position of the patient's anatomy. The at least one shuttle may also be configured to provide discrete adjustment increments along the direction of the at least one directional guide.

A support system is provided with a plurality of support devices, wherein at least one of the support devices is a support apparatus as described in the foregoing aspect of the present invention, with at least one support apparatus of the support system being capable of being adjusted with respect to at least one of gross position, fine adjustment, height, and/or angle of the patient's anatomy, which may further be independently adjusted.

In accordance with another aspect of the invention, the support apparatus is configured to support the lower extremities of a patient, for example a patient's knees or feet.

A knee support is provided which includes at least one support designed to support a patient's legs in the area surrounding the popliteal fossa. The knee support is further configured to accommodate at least one indexing structure which removably positions the knee support to the patient table of a modality. The knee support further includes at least one directional guide having a set distance running parallel to a direction relative to the patient table and at least one shuttle which allows the knee support to slidably adjust along the at least one directional guide. The knee support further includes at least one releasable lock configured to resist the motion of the at least one shuttle in a first engaged position and enable motion of the at least one shuttle in the direction of the at least one directional guide in second disengaged position. The knee support may also include a height adjustment feature. Further, the at least one shuttle may additionally be configured to provide discrete adjustment increments along the direction of the at least one directional guide. Independent adjustment of the directional position and/or height of each knee may be provided.

A foot support is provided which includes at least one support designed to support the patient's heels and soles of their feet. The foot support is further configured to accommodate at least one indexing structure which removably positions the foot support to the patient table of a modality. The foot support further includes at least one directional guide having a set distance running parallel to a direction relative to the patient table and at least one shuttle which allows the foot support to slidably adjust along the at least one directional guide. The foot support further includes at least one releasable lock configured to resist the motion of the at least one shuttle in a first engaged position and enable motion of the at least one shuttle in the direction of the at least one directional guide in second disengaged position. The foot support may also include an angular adjustment feature. Further, the at least one shuttle may additionally be configured to provide discrete adjustment increments along the direction of the at least one directional guide. Independent adjustment of directional position and/or angle of each foot may be provided.

A support system configured to support the anatomy of a patient, for example, the lower extremities of a patient is provided. An exemplary support system configured to support the lower extremities is described and includes both a knee support and foot support. The knee support and foot support may be used together or independently in order to customize the support needed for the particular procedure. Both the knee support and foot support are each configured to accommodate at least one indexing structure which removably positions the knee support to the patient table of a modality. The knee support includes at least one member designed to support a patient's legs in the area surrounding the popliteal fossa. The knee support further includes at least one directional guide having a set distance running parallel to a direction relative to the patient table and at least one shuttle which allows the knee support to slidably adjust along the at least one directional guide. The knee support further includes at least one releasable lock configured to resist the motion of the at least one shuttle in a first engaged position and enable motion of the at least one shuttle in the direction of the at least one directional guide in second disengaged position. The knee support may also include a height adjustment feature. Further, the at least one shuttle may additionally be configured to provide discrete adjustment increments along the direction of the at least one directional guide. The foot support is provided which includes at least one member designed to support the patient's heels and soles of their feet. The foot support includes an angular adjustment feature. The foot support may further include at least one directional guide having a set distance running parallel to a direction relative to the patient table, at least one shuttle which allows the foot support to slidably adjust along the at least one directional guide, and at least one releasable lock configured to resist the motion of the at least one shuttle in a first engaged position and enable motion of the at least one shuttle in the direction of the at least one directional guide in second disengaged position. Further, the at least one shuttle may additionally be configured to provide discrete adjustment increments along the direction of the at least one directional guide. Independent adjustment of the directional position of each knee and foot may be provided. Further, independent adjustment of the height of each knee and the angle of each foot may additionally be provided.

A support apparatus configured to support a patient's anatomy is provided. The support apparatus comprises:.

A gross position of the support apparatus may be selected by locating the at least one locator to a corresponding structure on the patient table of the target modality. A position of the support apparatus may be finely adjusted in discrete increments along the set distance of travel of the at least one directional guide.

The position of the support apparatus may be capable of being finely adjusted with minimal manipulation of the patient's anatomy.

The at least one directional guide may be selected from the group consisting of a track, a rail, a rack, a slot, and combinations thereof. The at least one locator may be configured to receive at least one pin or at least one disc located on the target modality. The at least one locator may be configured to receive pins of a conventional locating bar. The at least one shuttle may incorporate a series of locating features spaced according to the discrete increments of fine adjustments along the set distance of travel of the at least one directional guide. The at least one releasable lock may incorporate a detent which interfaces with the locating features incorporated in the at least one shuttle. The detent of the at least one releasable lock inhibits the motion of the at least one shuttle when the at least one releasable lock is in the first engaged configuration and does not inhibit motion of the at least one shuttle when the at least one releasable lock is in the second disengaged configuration.

The at least one releasable lock may further comprise at least one tensioner configured to return the at least one releasable lock to the first engaged configuration from the second disengaged configuration. The at least one tensioner is selected from of the group consisting of a spring, an elastic band, a belt, and combinations thereof. The components of the support apparatus may be composed of materials which are compatible with a magnetic resonance imaging (MRI) environment.

The support apparatus is additionally capable of height adjustment. The support apparatus may additionally be capable of adjusting an angle of a patient's anatomy. The support apparatus may be configured to support the lower extremities of the patient. The support apparatus may be configured to support at least one of the knee or the foot of the patient.

A knee support comprising the following components is provided.

The knee support may further comprise at least one top portion. The top portion may be configured to support the patient's legs at the area around the popliteal fossa. The knee support may further support at least one base portion. The base portion may be removably attached to the at least one top portion, and may further be additionally coupled to the at least one directional guide, the at least one locator, the at least one shuttle, and the at least one releasable lock. The at least one base portion may be configured to be oriented in at least a first orientation and a second orientation. The at least one base portion may be configured such that it will be at a first height in the first orientation and at a second height in the second orientation. The knee support may be composed of materials which are compatible with a magnetic resonance imaging (MRI) environment. The at least one top portion of the knee support may comprise protrusions to be received by corresponding apertures in the at least one base portion.

The at least one shuttle of the knee support may have at least five discrete increments along the set distance of travel of the at least one directional guide. The at least one shuttle may comprise a series of locating features spaced according to the discrete increments of fine adjustments along the set distance of travel of the at least one directional guide. The at least one releasable lock may incorporate a detent which interfaces with the locating features incorporated in the at least one shuttle. The detent of the at least one releasable lock inhibits the movement of the at least one shuttle when the at least one releasable lock is in the first engaged configuration and does not inhibit movement of the at least one shuttle when the at least one releasable lock is in the second disengaged configuration.

The knee support may be configured such that at least one of the gross position, or the fine position adjustment is individually adjustable for each knee of the patient. The knee support may further comprise at least one visual indicator for the fine adjustment position of the knee support. The visual indicator may be configured to be readable in the first orientation and in the second orientation.

Also provided is a method for configuring a support apparatus configured to support the lower extremities of a patient.

selecting an orientation for a base portion of the at least one support apparatus.

The invention is best understood from the following detailed description when read in connection with the accompanying drawings, with like elements having the same reference numerals. When a plurality of similar elements are present, a single reference numeral may be assigned to the plurality of similar elements with a small letter designation referring to specific elements. When referring to the elements collectively or to a non-specific one or more of the elements, the small letter designation may be dropped. It is emphasized that according to common practice, the various features of the drawings may not be drawn to scale unless otherwise indicated. On the contrary, the dimensions of the various features may be expanded or reduced for clarity. Included in the drawings are the following figures:.

Although the invention is illustrated and described herein with reference to specific embodiments, the invention is not intended to be limited to the details shown. Rather, various modifications may be made in the details within the scope of the claims and without departing from the invention.

Regardless of the chosen imaging and/or treatment modalities, it is critical that the patient is positioned in the same position for treatment as they were initially imaged, as margins and dosages of radiation to the tumor or other target pathologies are determined based on the images obtained in simulation, with an eye to destroy the tumor or other target pathology while limiting incidental damage to healthy tissues as a result of treatment. Also key to smooth, accurate simulation and treatment, is patient comfort, as a patient who is uncomfortable may not be able to tolerate a particular position for the duration of a scan or treatment and may, as a result, inadvertently shift their position in a manner that is detrimental to the treatment plan.

In radiotherapy procedures like stereotactic body radiation therapy (SBRT) and in imaging procedures used in connection with radiotherapy, like computed tomography (CT) and magnetic resonance imaging (MRI), it is common to provide positioning and immobilization for patient comfort and repeatable positioning. Positioning and immobilization devices are often designed to accommodate particular areas of anatomy, including support of the lower extremities, which may be used independently or in conjunction with positioning devices for other areas of the body.

In particular, in radiotherapy, patients often require multiple treatment sessions over a period of weeks. It is required that the patient is set up in the same position from one session to the next. For this reason, discrete locations of the positioning devices are necessary. To ensure consistency and repeatability of imaging and treatment setups, devices typically need to be positioned or indexed to discrete locations on the patient table of the particular treatment or imaging modality. As there exists a great deal of variation in sizes and proportions of patient anatomy, patient range of motion, and patient comfort preferences, particularly as it relates to large regions of anatomy such as the lower extremities, it is desirable to allow for adjustment of any positioning devices once the patient is on the table. Exemplary currently available devices generally primarily accommodate gross adjustability along the superior to inferior axis of the patient table by mating to the provided locations of the indexing features provided on the patient table. While this broadly accommodates a range of patients, if an adjustment is deemed appropriate, these devices need to be lifted on and off a series of indexing features in order to be repositioned along the superior-inferior axis of the patient table. This is cumbersome, as it is often a challenge for the clinician to see the mating indexing features on the underside of the positioning device. Further, in these instances, the patient's anatomy may need to be lifted or otherwise moved from the device; for larger anatomical regions such as the lower extremities or for patients with limited strength or mobility to assist in these adjustments, the clinician may face additional difficulty with manipulating the patient anatomy, requiring significant time to reposition the patient afterwards and determine if further adjustments are necessary, severely impacting workflow efficiency as a result. Furthermore, due to the limitations of the discrete locations of indexing features, fine adjustments to positions within said discrete locations are not possible to effect with the systems of the prior art. Accordingly there is a need for patient positioning aids or supports where large manipulations of patient anatomy are limited and finer adjustments to positioning are accommodated, thereby enhancing clinical workflows and patient comfort.

The various aspects of the present invention disclosed herein alleviate these issues by introducing features for fine adjustments along a direction of the table which may be used while minimizing large manipulations of the patient's anatomy. The support apparatus and system of the present invention may further include features for adjustment of height and/or angular adjustment of the target anatomy to ensure optimal patient position for the particular clinical needs of the patient's treatment. As the various aspects of the present invention require minimal patient movement during adjustment, they enhance patient comfort, patient position reproducibility, and workflow efficiency.

There are several aspects to the present invention: support apparatus and system configured to support the anatomy of a patient, for example during radiotherapy and imaging procedures, and methods for employing the same.

Turning now to the figures, <FIG> shows a perspective view of an embodiment <NUM> of the support apparatus configured to support a patient's anatomy. As shown in <FIG>, the support apparatus <NUM> includes the following components.

At least one support is configured to support a patient's anatomy. As shown in <FIG>, two such supports are shown; a knee support <NUM> and a foot support <NUM>. Each of the supports <NUM>, <NUM> includes at least one respective locator (not visible in the <FIG> view) configured to removably locate the support apparatus <NUM> to a patient table <NUM> of a target modality (not shown).

The at least one knee support <NUM>, and the at least one foot support <NUM>, define an area <NUM>, configured to accommodate lower portions of the patient's legs and feet, respectively. Also included in the support apparatus <NUM> is at least one directional guide (not visible in <FIG>) having a set distance of travel.

The support apparatus <NUM> includes at least one shuttle (not visible in the <FIG> view) coupled to the support <NUM>. The shuttle <NUM> is configured to slidably adjust the support along the directional guide in the superior/inferior direction.

The support apparatus <NUM> includes at least one releasable lock <NUM>. The lock <NUM> is configured to restrict movement of the at least one shuttle along the directional guide in a first engaged configuration. The releasable lock <NUM> is also configured to enable movement of the shuttle along the directional guide (not visible in the <FIG> view) in a second disengaged configuration.

In use, a gross position of the support apparatus is selected by locating the locator to a corresponding structure <NUM> on the patient table <NUM> of the target modality. The corresponding structure <NUM> on the patient table <NUM> may be, for example, a two pin locating bar, as shown in <FIG>. Once the gross position is set in this manner, the position of the support apparatus <NUM> may be further finely adjusted as will be described in more detail in the following discussion.

The support apparatus <NUM> is capable of being finely adjusted in the superior/inferior direction with minimal manipulation of the patient's anatomy, while the patient is in position on the support apparatus. <FIG> is a view of the support apparatus <NUM> showing a patient's legs and feet in position on the knee support <NUM> and the foot support <NUM>. The superior/inferior fine adjustment of the support apparatus <NUM> may be performed while the patient is positioned on the support apparatus <NUM>. <FIG> also shows how the at least one knee support <NUM> and the at least one foot support <NUM> define an area <NUM> configured to accommodate lower portions of the patient's legs.

<FIG> shows that the foot support apparatus <NUM> also includes at least one tilting portion <NUM>, including the at least one support, and wherein the at least one foot support <NUM>, is further configured to be disposed at different discrete angles along a range, and comprises a lock <NUM>, configured to secure the at least one tilting portion <NUM>, at a desired discrete angle. At least one base portion <NUM> is coupled to the at least one tilting portion <NUM>, and is additionally coupled to the at least one directional guide <NUM>, the at least one locator <NUM>, the at least one shuttle <NUM>, and the at least one releasable lock <NUM>.

By comparison, <FIG> shows an example of a conventional support apparatus <NUM> including a conventional knee support <NUM> and a conventional foot support <NUM>, which are not capable of fine adjustment when a patient is in place on the conventional support apparatus <NUM>. In the case of this conventional support apparatus <NUM>, the knee support <NUM> and the foot support <NUM> each may include locators on their respective undersides (not shown in <FIG>. ) that are configured to attach to the corresponding structure <NUM>, such as a <NUM>-pin locating bar, on the patient table <NUM>. As is known in the art, attaching the knee support <NUM> and the foot support <NUM> to the locator bar <NUM> on the patient table <NUM> is the only possible adjustment for the conventional support apparatus <NUM>.

<FIG> shows another embodiment of a knee support <NUM>. This knee support <NUM> is capable of fine adjustment in the superior/inferior direction while the patient is in place on the support <NUM>, since this embodiment also includes a releasable lock <NUM>.

Turning now to <FIG>, the fine adjustment will be described and explained. <FIG> shows an exploded version of the support structure <NUM> intended for knee support. The following description is with respect to this knee support structure <NUM>, but a person skilled in the art would understand that the principles and components as described herein will also apply to a support structure intended to support a patient's feet, i.e. foot support <NUM> (not shown in <FIG>).

As shown in <FIG>, the support structure <NUM> includes a top portion <NUM> and base portion <NUM>. The top portion <NUM> is configured to support a patient's legs at an area around their popliteal fossa. The base portion <NUM>, is removably attached to the top portion <NUM>. As can be seen in <FIG>, the base portion <NUM> includes directional guides <NUM>. As shown in <FIG>, these directional guides <NUM> may optionally be directly molded in the base portion <NUM>. The directional guides <NUM> provide a set distance and direction of travel. Non-limiting examples of other types of such directional guides <NUM> include a track, a rail, a rack, or a slot.

As discussed above, the support apparatus <NUM> includes at least one shuttle <NUM>. The embodiment shown in <FIG> has two such shuttles <NUM> on the foot support structure <NUM> of the support apparatus, although only one is visible. The other shuttle is on the opposing side of the base portion <NUM> from the side that is visible in <FIG>. <FIG> show how an embodiment of the base portion <NUM> may be two-sided and thus include two such shuttles <NUM> or have a dual-sided shuttle <NUM>.

This embodiment of the base portion is therefore "flippable" as indicated by the arrows in <FIG>. These two possible orientations of the base portion <NUM> are shown in <FIG>, respectively. As may been seen in <FIG> and <FIG>, the base portion <NUM> includes feet <NUM>. In the orientation of <FIG>, the feet <NUM> are oriented away from the patient support table <NUM> (not shown), so that the top portion <NUM> is lower in height or elevation. When the base position <NUM> is flipped over (<FIG>), the feet <NUM> are oriented towards the patient table <NUM> and thus the top portion is at a higher elevation. Thus, by flipping the base portion <NUM>, the height of the support structure <NUM> may be adjusted. In <FIG>, it should also be appreciated that one of the two shuttles <NUM> is always facing the patient table <NUM> (not shown).

Turning next to FIGs 7A and 7B, the side of the base portion <NUM> facing the patient table <NUM> (not shown) is seen. The shuttles <NUM> include locators <NUM> which are configured to removably locate the support <NUM> with respect to the patient table <NUM> (<FIG>) of a target modality (not shown). According to embodiments, the at least one locator <NUM> may be configured to receive at least one pin or at least one disc located on the target modality. For example, the locator <NUM> may be an aperture that is configured to receive a pin on a two-pin locating bar. Alternatively, for example, the locator <NUM> may be a pin that is configured to be received into an aperture on a locating bar on the patient table of a target modality.

7A and 7B also show movement of the releasable lock <NUM>, which effects the fine adjustment of the support <NUM> with respect to the patient table <NUM>. As shown in FIG. 7A, the releasable lock <NUM> is in the first engaged configuration, where the base portion <NUM> is not able to slide with respect to the shuttle <NUM>. Since, as described above, the shuttle <NUM> is held in place in a gross position with respect to the patient table <NUM>, the entire support structure <NUM> is likewise held in position. As shown in FIG. 7B by the arrow, the releasable lock <NUM> may be pushed sideways, thus allowing the base portion <NUM> to slide in the inferior/superior direction along the directional guides <NUM> with respect to the shuttle <NUM>, since the shuttle <NUM> is held the gross position with respect to the patient table <NUM>.

<FIG> shows in partial cutaway, the base portion <NUM>, the releasable lock <NUM>, and the shuttle <NUM>. It should be understood that,in this embodiment, these components have bilateral symmetry along the line I-I in <FIG>. As can be seen in <FIG>, the shuttle <NUM> incorporates a series of locating features <NUM>. As shown in <FIG>, an exemplary embodiment of these locating features <NUM> is a series of projections that define a series of notches <NUM> therebetween. These locating features <NUM> are spaced so as to provide discrete increments of fine adjustments along the set distance of travel along the directional guides <NUM>.

Also shown in <FIG>. is a biasing element or a tensioner. In the embodiment shown in <FIG>, this tensioner is in the form of a spring <NUM>. Other non-limiting examples of suitable tensioners are an elastic band or a belt. More than one such tensioner type may be utilized or different types of tensioners may be present in the same support apparatus. This may also be accomplished with a compressible member or structure. The spring <NUM> is configured and arranged to return the releasable lock <NUM> to its first engaged position from the second disengaged position.

Turning next to <FIG>, the operation of the fine adjustment is shown in more detail. In <FIG>, the shuttle <NUM> is shown in cross section. In <FIG>, the releasable lock <NUM> is in the first engaged configuration. In this engaged configuration, a detent <NUM> (also referred to herein as a tooth) located on the releasable lock <NUM> is engaged in, or interfaces with one of the notches <NUM> located between two adjacent locating features <NUM>.

Since the springs <NUM> (not visible) are configured to hold the releasable lock <NUM> in this first engaged configuration, the base portion <NUM> and thus the support structure <NUM> or <NUM> will be held in position on the patient table <NUM> of the target modality. Thus movement of the support structure <NUM> or <NUM> with respect to the patient table <NUM> is inhibited. To release the releasable lock <NUM>, it may be pushed or pulled against the bias of the tensioner in the direction shown by the arrow in <FIG>. This push or pull force disengages the detent <NUM> from the notch <NUM>.

As shown in <FIG>, the releasable lock is now is the second disengaged configuration and the base portion <NUM> may then be slidably adjusted with respect to the shuttle <NUM> along the directional guides <NUM> as shown by the arrow in <FIG>. Finally, in <FIG>, the push or pull force on the releasable lock <NUM> is removed and thus the tensioner urges the releasable lock <NUM> back to the first engaged configuration. However, as may be appreciated by comparing <FIG> with <FIG>, the base <NUM> (and thus the entire support structure) is finely adjusted to a different fine position. This fine adjustment may thus be seen as enabling smaller increments of movement than is possible by utilizing only the locator <NUM> and the corresponding structure <NUM>.

As may be seen in <FIG>, the locating features <NUM> and notches <NUM> are located at discrete increments along the set distance of travel of the at least one directional guide <NUM>. Any reasonable number of these locating features <NUM> and corresponding notches may be utilized, e.g., <NUM> locating features and <NUM> notches, <NUM> locating features and <NUM> notches, <NUM> locating features and <NUM> notches, or <NUM> locating features and <NUM> notches, etc. It will appreciated by a person having skill in the art that these projections <NUM> and notches <NUM> are not the only geometry possible. For example, a series of apertures may serve the same purpose.

<FIG> show another view of the fine adjustment capability of the shuttle <NUM>, but unlike <FIG>, <FIG> are not in cross section. In <FIG>, the locators <NUM> that are configured to accept the corresponding structure, such as pins on a two-pin locator bar, are visible. <FIG> shows the releasable lock <NUM> in the first engaged configuration and <FIG> shows releasable lock <NUM> in the second disengaged configuration.

<FIG> shows an exploded version of another embodiment of a support structure <NUM> for the knees of a patient. In this embodiment, the support structure <NUM> has a top portion <NUM> and a base portion <NUM>, but does not incorporate the releasable lock. In this embodiment <NUM>, the base portion <NUM> is flippable, as shown in <FIG>. Thus, the base portion incorporates feet <NUM>. As shown in <FIG>, the feet <NUM> are directed towards the top portion <NUM> and therefore the support <NUM> has a reduced height or elevation compared to a configuration (not shown) where the feet <NUM> are directed away from the top portion <NUM>.

<FIG> shows a view of a support structure <NUM> that is configured to support the feet of a patient. As shown in <FIG>, by the arrow, this foot support structure <NUM> is configured to move in a tilting motion. The foot support <NUM> is configured to support the soles and heels of the patient's feet. As may be seen in <FIG>, in this embodiment, the soles and heels may be supported in the depressions <NUM>. When the foot support <NUM> is tilted, the angle of the patient's feet may be adjusted.

<FIG> shows a perspective view of another embodiment <NUM> of the support apparatus configured to support a patient's anatomy. As shown in <FIG>, the support apparatus <NUM> includes the following components.

At least one support is configured to support a patient's anatomy. As shown in <FIG>, four such supports are shown; two knee supports <NUM> and two foot supports <NUM>. The at least one knee support <NUM> and the at least one foot support <NUM> define an area <NUM> configured to accommodate lower portions of the patient's legs. Each of the supports <NUM>, <NUM> includes at least one respective locator (not visible in the <FIG> view) configured to removably locate the support apparatus <NUM> to a patient table of a target modality (not shown).

Also included in the support apparatus <NUM> is at least one directional guide (not visible in <FIG>) having a set distance of travel. The support apparatus <NUM> includes at least one shuttle (not visible in the <FIG> view) coupled to the supports <NUM> and <NUM>. The shuttle is configured to slidably adjust the support along the directional guide in the superior/inferior direction.

The support apparatus <NUM> includes releasable locks <NUM> on each support structure <NUM>, <NUM>. As described above, the locks <NUM> are configured to restrict movement of the at least one shuttle along the directional guide in a first engaged configuration. The releasable lock <NUM> is also configured to enable movement of the shuttle along the directional guide (not visible in the <FIG> view) in a second disengaged configuration.

In use, a gross position of the support apparatus is selected by locating the locator to a corresponding structure on the patient table of the target modality. The corresponding structure on the patient table may be for example, a two-pin locating bar. Once the gross position is set in this manner, the position of the support apparatus <NUM> may be further finely adjusted as is described in more detail above. The support apparatus <NUM> is capable of being finely adjusted in the superior/inferior direction with minimal manipulation of the patient's anatomy, while the patient is in position on the support apparatus. It also permits separate and independent adjustment of the patient's legs and/or feet.

The internal mechanism of the support apparatus <NUM> corresponds to that of prior embodiments but is duplicated for each of the separately movable knee and foot supports. For example, <FIG> thus show the detent <NUM> of the at least one releasable lock <NUM> inhibits movement of the at least one shuttle <NUM> when the at least one releasable lock <NUM> is in the first engaged configuration and does not inhibit movement of the at least one shuttle <NUM> when the at least one releasable lock <NUM> is in the second disengaged configuration. These <FIG> also show that the at least one releasable lock <NUM> further comprises at least one tensioner <NUM> configured to return the at least one releasable lock <NUM> to the first engaged configuration from the second disengaged configuration. As discussed above, the at least one tensioner <NUM> may be selected from the group consisting of a spring, an elastic band a belt, and combinations thereof, or may be a compressible member or other biasing element.

<FIG> shows the knee support further comprising at least one visual indicator for the fine adjustment position of the knee support, wherein the visual indicator is configured to be readable in the first orientation and in the second orientation.

The at least one support structure <NUM>, <NUM>, <NUM>, <NUM> may be constructed of a rigid material. In another embodiment, the at least one support structure <NUM>, <NUM>, <NUM>, <NUM> may be constructed of a deformable material configured to conform to a patient's anatomy. In an embodiment, the components of the support apparatus <NUM>, <NUM> may be composed of materials which are compatible with a magnetic resonance imaging (MRI) environment.

As discussed above, the support apparatus <NUM>, <NUM> may be additionally capable of height adjustment. In an embodiment, the support apparatus <NUM>, <NUM> may additionally be capable of adjusting an angle of a patient's anatomy. This is shown in <FIG> and <FIG>, where the arrows show how the foot support <NUM>, <NUM> may be tilted. As may be seen in <FIG>, in this embodiment, the soles and heels may be supported in the depressions <NUM>. When the foot supports <NUM> or <NUM> are tilted, the angle of the patient's feet may be adjusted.

<FIG> show an embodiment of the knee support <NUM>, that is similar to the embodiment shown in <FIG>. This embodiment incorporates at least one visual indicator <NUM> for the fine adjustment position of the knee support <NUM>. In the embodiment shown, the visual indicator <NUM> is in the form of a label that may be attached to the releasable lock <NUM>. This embodiment has the "flippable" base portion <NUM> as is indicated by the arrows in <FIG>. These two possible orientations of the base portion <NUM> are shown in <FIG>, respectively. As may been seen in <FIG> and <FIG>, the base portion <NUM> includes feet <NUM>. In the orientation of <FIG>, the feet <NUM> are oriented away from the patient support table <NUM> (not shown), so that the top portion <NUM> is lower in height or elevation. When the base position <NUM> is flipped over (<FIG>), the feet <NUM> are oriented towards the patient table <NUM> and thus the top portion is at a higher elevation. Thus, by flipping the base portion <NUM>, the height of the support structure <NUM> may be adjusted.

As can be seen in <FIG>, the visual indicator <NUM> is configured to be readable in the first orientation and in the second orientation. The letters A-E on one side of the outer edge and the letters V-Z on the opposite outer edge of the visual indicator <NUM> are spaced apart to correspond to the notches <NUM> between the locating features <NUM>. When the knee support is flipped, as indicated by the arrows in <FIG>, and/or slidably adjusted in the fine adjustment in the superior/inferior directions, the letters will indicate that the apparatus is positioned in one of the discrete fine adjustment increments of the support apparatus. In an embodiment, these indicators may line up with a landmark (not shown) on the patient table of the modality or on the support apparatus itself, for example. A convenient example of such landmark is the corresponding structure <NUM> on the patient table of the modality or on the support apparatus. This provides a visual indication of the location of the knee support <NUM> with respect to the patient table of the modality in both its height and its superior/inferior direction. <FIG> shows a larger view of the visual indicator <NUM>. Although not shown, a mirror image of this label may be affixed to the opposite side of the releasable lock <NUM> (not visible in <FIG>.

This visual indication makes it possible for the user of the apparatus to record the position (height and fine adjustment) so that it can be easily reproduced for subsequent imaging or treatment of the same patient. The visual indicator also facilitates the efficient and accurate repositioning of the apparatus, thus saving time and effort while improving treatment accuracy and precision. Accordingly, the indicator <NUM> makes it easy for the user of the system to visualize, monitor, and record in notes the actual position, in terms of height and/or fine adjustment, of the apparatus.

As shown in <FIG> a support system <NUM>, <NUM> configured to support the anatomy of a patient is provided. The support system <NUM>, <NUM> may comprise a plurality of support apparatus <NUM>, <NUM>, <NUM>, <NUM>. At least one of the support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality may include the following components:.

As shown particularly at <FIG>, <FIG>, and <FIG>, a gross position of the at least one support apparatus <NUM>, <NUM>, <NUM>, <NUM> is selected by locating the at least one locator <NUM> of each of the support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality to a corresponding structure <NUM> on the patient table <NUM> of the target modality and a position of at least one of the support apparatus <NUM>, <NUM>, <NUM>, <NUM> in said plurality may be further finely adjusted.

The position of the at least one of the support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality of support apparatus is capable of being finely adjusted with minimal manipulation of the patient's anatomy. As disclosed herein, "minimal manipulation" is understood to mean that the leg and or foot of the patient may remain in place on the support apparatus <NUM>, <NUM>, <NUM>, <NUM> while the fine adjustments as described above are performed.

According to embodiments, each one of the support apparatus in the plurality of support apparatus <NUM>, <NUM>, <NUM>, <NUM> may comprise at least one directional guide <NUM>, at least one shuttle <NUM>, and at least one releasable lock <NUM> and thus each one of the support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the said plurality may be capable of being finely adjusted.

The at least one directional guide <NUM> of at least one of the support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality of support apparatus may be selected from the group consisting of a track, a rail, a rack, a slot, and combinations thereof. The at least one locator <NUM> of the at least one support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality of support apparatus is configured to receive at least one corresponding structure <NUM> located on the target modality. Non-limiting examples of such corresponding structures are a pin or at least one disc located on the target modality. The at least one locator of the at least one support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality of support apparatus may be configured to receive pins of a conventional locating bar.

According to embodiments of the support system <NUM>, <NUM>, the at least one of the support apparatus in the plurality of support apparatus <NUM>, <NUM>, <NUM>, <NUM> may be finely adjusted in discrete increments along the set distance of travel of the at least one directional guide <NUM> of the at least one support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality of support apparatus.

In an embodiment of the support system, at least one of the at least one support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality of support apparatus may at least three discrete increments of fine adjustment. These discrete increments may be in the form of notches <NUM> in between projections or locating features <NUM> on the shuttle <NUM>. The at least one shuttle <NUM> may comprises a series of locating features <NUM> that are spaced according to the discrete increments of fine adjustments along the set distance of travel of the at least one directional guide <NUM> of the at least one support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality of support apparatus.

The at least one releasable lock <NUM> of the at least one support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality of support apparatus may incorporate a detent <NUM>, also referred to herein as a tooth which interfaces with the locating features <NUM> incorporated in the at least one shuttle <NUM> of the at least one support apparatus10, <NUM>, <NUM>, <NUM> in the plurality of support apparatus. According to an embodiment, the detent <NUM> inhibits movement of the at least one shuttle <NUM> when the at least one releasable lock <NUM> is in the first engaged configuration and does not inhibit movement of the at least one shuttle <NUM> when the at least one releasable lock <NUM> is in the second disengaged configuration. The at least one releasable lock <NUM> further comprises at least one tensioner <NUM> configured to return the at least one releasable lock <NUM> to the first engaged configuration from the second disengaged configuration. The at least one tensioner <NUM> may be selected from the group consisting of a spring, an elastic band, a belt, and combinations thereof.

The at least one support <NUM>, <NUM>, <NUM>, <NUM> may be constructed of a rigid material. The at least one support <NUM>, <NUM>, <NUM>, <NUM> may be constructed of a deformable material configured to conform to the patient's anatomy. The components of the support system <NUM>, <NUM> may be composed of materials which are compatible with a magnetic resonance imaging (MRI) environment. In an embodiment the at least one of the support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality of support apparatus may be additionally configured for at least one of height adjustment or angular adjustment. In an embodiment, each support apparatus <NUM>, <NUM>, <NUM>, <NUM> in the plurality of support apparatus may be configured such that at least one of the gross position, fine position, height, or angle of each support apparatus is capable of being adjusted independently of the gross position, fine position adjustment, height, or angle of at least one other support apparatus in the plurality of support apparatus.

According to an embodiment, a support system <NUM>, <NUM> configured to support the legs of a patient is provided. The support system may comprise the following components:.

The at least one knee support <NUM>, <NUM> and the at least one foot support <NUM>, <NUM> define an area <NUM>, <NUM> configured to accommodate lower portions of the patient's legs. A gross position of each of the at least one knee support <NUM>, <NUM> and the at least one foot support <NUM>, <NUM> is selected by locating the at least one locator <NUM> of each of the at least one knee support <NUM>, <NUM> and the at least one foot support <NUM>, <NUM> to at least one corresponding structure <NUM> on the patient table <NUM> of the target modality and wherein a position of each of the at least one knee support <NUM>, <NUM> and the at least one foot support <NUM>, <NUM> may be further finely adjusted.

The position of at least one of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> is capable of being finely adjusted with minimal manipulation of the patient's anatomy. The at least one directional guide <NUM> of each of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> may be selected from the group consisting of a track, a rail, a rack, a slot, and combinations thereof. The at least one locator <NUM> of each of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> is configured to receive at least one pin or at least one disc located on the target modality. The at least one locator <NUM> of each of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support <NUM>, <NUM> apparatus is configured to receive pins of a conventional locating bar <NUM>.

The at least one of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> is configured to be finely adjusted in discrete increments along the set distance of travel of the at least one directional guide of each of the at least one knee support apparatus and the at least one foot support apparatus. The at least one knee support apparatus <NUM>, <NUM> may have at least five discrete increments of fine adjustment and the at least one foot support apparatus <NUM>, <NUM> may have at least three discrete increments of fine adjustment. The at least one shuttle <NUM> of each of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support <NUM>, <NUM> apparatus comprises a series of locating features <NUM> spaced according to the discrete increments of fine adjustments along the set distance of travel of the at least one directional guide <NUM> of each of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM>.

The at least one releasable lock of each of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> incorporates a detent <NUM> which interfaces with the series of locating features <NUM> incorporated in the at least one shuttle <NUM> of each of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM>. The detent <NUM> of the at least one releasable lock <NUM> of each of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> inhibits the motion of the at least one shuttle <NUM> of each of the at the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> when the at least one releasable lock <NUM> of each of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> is in the first engaged configuration and does not inhibit motion of the at least one shuttle <NUM> when the at least one releasable lock <NUM> of each of the at least one knee support apparatus10, <NUM> and the at least one foot support apparatus <NUM>, <NUM> is in the second disengaged configuration.

The least one releasable lock <NUM> further comprises at least one tensioner <NUM> configured to return the at least one releasable lock <NUM> to the first engaged configuration from the second disengaged configuration. The at least one tensioner <NUM> may be selected from the group consisting of a spring, an elastic band a belt and combinations thereof. The at least one knee support apparatus <NUM>, <NUM>, <NUM> further comprises: at least one top portion <NUM>, <NUM>, <NUM>. The top portion <NUM>, <NUM>, <NUM> is configured to support the patient's legs at the area around the popliteal fossa. The knee support also comprises least one base portion, <NUM>, <NUM>, <NUM> that is removably attached to the at least one top portion <NUM>, <NUM>, <NUM>, and is additionally coupled to the at least one directional guide <NUM>, the at least one locator <NUM>, the at least one shuttle <NUM>, and the at least one releasable lock <NUM>. The at least one base portion <NUM>, <NUM>, <NUM> is configured to be oriented in at least two different orientations. The at least one base portion <NUM>, <NUM>, <NUM> is configured to have a first height in a first orientation and a second height in a second orientation.

The at least one foot support apparatus <NUM>, <NUM> further comprises at least one tilting portion <NUM>, <NUM> including the at least one support and wherein the at least one foot support <NUM>, <NUM> is further configured to be disposed at different discrete angles along a range, and comprises a lock <NUM>, <NUM> configured to secure the at least one tilting portion <NUM>, <NUM> at a desired discrete angle; and at least one base portion <NUM>, <NUM> coupled to the at least one tilting portion, <NUM>, <NUM> and additionally coupled to the at least one directional guide <NUM>, the at least one locator <NUM>, the at least one shuttle <NUM>, and the at least one releasable lock <NUM>.

The at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> are configured such that at least one of the gross position, fine position adjustment, height, or angle of each of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> is capable of being selected independently of the gross position, fine position adjustment, height, or angle of the at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM>. The at least one knee support apparatus <NUM>, <NUM> and the at least one foot support apparatus <NUM>, <NUM> may be configured such that at least one of the gross position, the fine position adjustment, the height, or the angle is individually adjustable for each limb of the patient.

A knee support <NUM>, <NUM> comprising the following components is provided: At least one support <NUM>, <NUM> is configured to support the patient's legs at an area around the popliteal fossa. At least one locator <NUM> is configured to locate the knee support <NUM>, <NUM> to a patient table <NUM> of a target modality. At least one directional guide <NUM> having a set distance of travel is provided. At least one shuttle <NUM> coupled to the at least one support <NUM>, <NUM>, is configured to slidably adjust the support <NUM>, <NUM> along the at least one directional guide <NUM>. At least one releasable lock <NUM> is configured to restrict the movement of the at least one shuttle <NUM> along the at least one directional guide <NUM> in a first engaged configuration, and enable movement of the at least one shuttle along the at least one directional guide in a second disengaged configuration.

The knee support <NUM>, <NUM> may further comprise at least one top <NUM>, <NUM> wherein the top portion <NUM>, <NUM> is configured to support the patient's legs at the area around the popliteal fossa; and at least one base portion <NUM>, <NUM> wherein the base portion <NUM>, <NUM> is removably attached to the at least one top portion <NUM>, <NUM>, and is additionally coupled to the at least one directional guide <NUM> the at least one locator <NUM>, the at least one shuttle <NUM>, and the at least one releasable lock <NUM>. The knee support <NUM>, <NUM> may be composed of materials which are compatible with a magnetic resonance imaging (MRI) environment.

The at least one base portion <NUM>, <NUM> of the knee support <NUM>, <NUM> comprises protrusions <NUM> to be received by corresponding apertures <NUM> in the at least one top portion <NUM>, <NUM>. The knee support <NUM>, <NUM>, wherein the at least one base portion <NUM>, <NUM> of the knee support <NUM>, <NUM> is configured to be oriented in at least two different orientations. The at least one base portion <NUM>, <NUM> of the knee support <NUM>, <NUM> is configured such that it will be at a first height in a first orientation and at a second height in a second orientation.

A method for utilizing a support system <NUM>, <NUM> configured to support the lower extremities of a patient is provided.

Generally, this invention provides various aspects and embodiments. In accordance with one aspect of the present invention, a support apparatus configured to support the anatomy of a patient, for example during radiotherapy and imaging procedures, is provided. In a preferred embodiment, all the components of said support apparatus are composed of materials which are compatible with magnetic resonance imaging environments. The support apparatus first includes at least one support, configured to support the anatomy of the patient. In an embodiment, this support may be composed of a rigid material, such as a rigid polymer. In an alternate embodiment, the support may be composed of a deformable material for additional patient comfort and to further conform to the patient's anatomy. The support apparatus includes at least one indexing feature configured to removably locate to a patient table of an imaging or treatment modality. In preferred embodiments, the indexing feature may be configured to receive a conventional indexing structure of a patient table of a target imaging or treatment modality (for example, a locating bar and corresponding recess in the modality, integrated discs, and other attachment mechanisms known to a person having skill in the art).

The support apparatus additionally includes at least one directional guide running parallel to a direction relative to the patient table, said directional guide having a set distance of travel. In a preferred embodiment, the directional guide may be a track, a rail, a rack, or other similar structure known to a person having ordinary skill in the art. In a further preferred embodiment, the direction is in the superior/inferior or longitudinal direction of the patient table. The support apparatus further includes at least one shuttle configured to slidably adjust the support apparatus along the at least one directional guide. The support apparatus further includes a releasable lock configured to resist the motion of the at least one shuttle in a first engaged position and enable motion of the at least one shuttle in the direction of the at least one directional guide in a second disengaged position. In preferred embodiment, this releasable lock is operable with only one hand.

The support apparatus is so configured such that a clinician may select the gross position of the support apparatus by locating the at least one indexing structure on the patient table of the imaging or treatment modality. If further fine adjustment of the patient's anatomy is desired, the clinician is able to disengage the releasable lock and slidably adjust the support apparatus along the direction of the directional guide, with minimal need to manipulate the patient's anatomy from the support apparatus or disturb the gross position of the support apparatus. This support apparatus may further include features which adjust either the height of the support apparatus or the angle of the support apparatus, further accommodating additional fine adjustments to the position of the patient's anatomy. These fine adjustment capabilities of the support system enable enhanced patient comfort, setup reproducibility, and workflow efficiency.

In a preferred embodiment, the at least one shuttle may additionally be configured to provide discrete adjustment increments along the direction of the at least one directional guide. In a further preferred embodiment, the discrete adjustment increments are achieved through the use of locating features integrated into the at least one shuttle. In a still further preferred embodiment, the locating features are a system of projections and recesses which interface with at least one corresponding structure on the at least one releasable lock, for example a tooth or other projection. In a preferred embodiment, the number of locating features correspond with the number of discrete increments for adjustment in the direction provided by the at least one directional guide. When slidably adjusting the support apparatus in the direction provided by the at least one directional guide, the releasable lock is disengaged to permit the movement of the at least on shuttle along the at least one track. The clinician is then enabled to slidably adjust the support apparatus as desired. When the clinician is satisfied with the superior-inferior position, the clinician reengages the at least one releasable lock, which disposes the tooth into a discrete increment provided by recesses of the locating features, thereby securing support apparatus in the desired fine adjustment position. The interface between the tooth and the locating features provide haptic feedback to the clinician as to whether the shuttle is appropriately disposed in one of the discrete adjustment increments. In another preferred embodiment, the support apparatus additionally includes visual indication of the discrete adjustment increments. The releasable lock may additionally include at least one tensioner (for example a spring, an elastic band or belt, a compressible member, or other structure known to one having skill in the art) which resists the disengagement of the releasable lock, such that once the clinician finishes the fine adjustment they can discontinue manipulating the releasable lock in order to have the releasable lock return to its engaged configuration, which will also dispose a tooth into one of the locating features. In a further preferred embodiment, the releasable lock is configured such that it may be pulled or pushed by the clinician in order to disengage the releasable lock. In this embodiment, a plurality of tensioners would exist to resist the disengagement of the releasable lock in either direction of manipulation, with the same automatic return of the releasable lock to its engaged position which additionally disposes the tooth of the releasable lock into the locating features of the shuttle.

An exemplary support system is provided. This exemplary support system is configured to support the lower extremities of a patient. This support system includes at least one knee support apparatus and at least one foot support apparatus, each of which may be used together or independently in order to customize the support needed for the particular procedure. In a preferred embodiment, both the at least one knee support and at least one foot support are intended to separately removably locate to the patient table of the imaging or radiotherapy modality through locators disposed on each of the knee support apparatus and foot support apparatus which correspond to indexing structures appropriate to the target imaging or treatment modality. When used together to form the support system, the knee support and foot support define a space which accommodates the general length of the patient's lower legs. In a preferred embodiment, all components of the support system are compatible with a magnetic resonance imaging environment.

The knee support apparatus includes at least one support configured to support the patient's legs in the area surrounding the popliteal fossa. The knee support is further configured to accommodate at least one locator corresponding to an indexing structure on the patient table of the target modality, which removably locates the knee support apparatus to the patient table of the modality. The knee support apparatus further includes at least one directional guide which has a set distance of travel in a direction relative to the patient table of the target modality. The knee support apparatus also includes at least one shuttle, which allows the knee support apparatus to be slidably adjusted along the set distance of travel of the at least one directional guide. The knee support apparatus further includes at least one releasable lock which restricts motion of the knee support apparatus in a first engaged configuration and enables motion of the knee support apparatus in a second disengaged configuration. In a further preferred embodiment, the knee support apparatus may optionally enable the height of the knee support apparatus to be selected.

The foot support apparatus includes at least one base portion. The at least one base portion is configured to accommodate at least one indexing structure which removably secures the knee support to the patient table of the modality. The at least one base portion further has at least one tilting portion. The tilting portion further has a member configured to be disposed at different discrete angles along a range and having discrete indexing points defining those angles. The tilting portion is then configured to be releasably locked at the desired position. The tilting portion also has at least one heel support cup configured to support the heel and sole of the patient's foot while the device is in operation. In a preferred embodiment, the foot support apparatus is further configured to be slidably adjusted, and further comprises its own at least one directional guide which has a set distance of travel in a direction relative to the patient table of the target modality, at least one shuttle, which allows the foot support apparatus to be slidably adjusted along the set distance of travel of the at least one directional guide, and at least one releasable lock which restricts motion of the foot support apparatus in a first engaged configuration and enables motion of the foot support apparatus in a second disengaged configuration. The tilting portion of the foot support may be further adjusted along a range of discrete angles and releasably locked in order to maintain the desired position.

When used on the patient table of an appropriate imaging or treatment modality, the support system is configured to allow the clinician to independently adjust the knee support apparatus and foot support apparatus for optimal positioning of the patient for the target procedure. The gross position of the knee support apparatus and foot support apparatus are determined by the clinician and achieved via the use of the locators which correspond to indexing structures appropriate to the modality. The support system also allows the fine adjustment of each of the at least one knee support apparatus and at least one foot support apparatus without removal or addition of any components and with minimal manipulation of the patient's anatomy or gross position of the knee support apparatus and/or foot support apparatus on the modality. Both the knee support apparatus and the at least one tilting portion of the foot support apparatus may be slidably positioned along their respective set distances of travel in the direction of their respective directional guides, and then releasably locked in order to maintain their respective desired positions. The knee support features height adjustment capabilities. In a further preferred embodiment, the support system is configured such that at least one of the gross position, fine position adjustment, height adjustment, or angular adjustment is individually adjustable for each leg. These fine adjustment capabilities of the support system enable enhanced patient comfort, setup reproducibility, and workflow efficiency.

In a further preferred embodiment, the knee support apparatus and the foot support apparatus may further incorporate discrete adjustment increments along the direction of the at least one directional guide. In a further preferred embodiment, the discrete adjustment increments are achieved through the use of locating features integrated into the at least one shuttle of each of the knee support apparatus and/or the at least one foot support apparatus. In a still further preferred embodiment, the locating features are a system of projections and recesses which interface with at least one corresponding structure on the at least one releasable lock, for example a tooth or other projection. In a preferred embodiment, the number of locating features correspond with the number of discrete increments for adjustment in the direction provided by the at least one directional guide of each of the at least one knee support apparatus and/or the at least one foot support apparatus, preferably at least three discrete increments for either the at least one knee support apparatus and the at least one foot support apparatus. In yet a further preferred embodiment, the knee support apparatus features at least five discrete increments, and the foot support apparatus features at least three discrete increments. When slidably adjusting either the knee support apparatus or foot support apparatus in the direction provided by their respective at least one directional guide, their respective releasable lock is disengaged to permit the movement of their respective at least on shuttle along their respective at least one directional guide. The clinician is then enabled to slidably adjust the knee support apparatus and/or foot support apparatus as desired. When the clinician is satisfied with the fine position of the device, the clinician reengages the respective at least one releasable lock of the at least one knee support apparatus and/or foot support apparatus, which disposes its tooth into a discrete increment provided by recesses of the locating features of the respective shuttle, thereby securing the at least one knee support apparatus and/or foot support apparatus in the desired fine adjustment position. The interface between the tooth and the locating features provide haptic feedback to the clinician as to whether the shuttle is appropriately disposed in one of the discrete adjustment increments. In another preferred embodiment, the at least one knee support apparatus and/or foot support apparatus additionally includes visual indication of their respective discrete adjustment increments. The releasable lock of either or both the at least one knee support apparatus or the at least one foot support apparatus may additionally include at least one tensioner (for example a spring, an elastic band or belt, a compressible member, or other structure known to one having skill in the art) which resists the disengagement of the respective at least one releasable lock, such that once the clinician finishes the fine adjustment they can discontinue manipulating the releasable lock in order to have the releasable lock return to its engaged configuration, which will also dispose its tooth into one of the locating features. In a further preferred embodiment, the releasable lock is configured such that it may be pulled or pushed by the clinician in order to disengage the releasable lock. In this embodiment, a plurality of tensioners would exist to resist the disengagement of the releasable lock in either direction of manipulation, with the same automatic return of the releasable lock to its engaged position which additionally disposes the tooth of the releasable lock into the locating features of the respective shuttle.

A knee support and foot support configured to support the lower extremities of the patient is provided for use with the patient tables of various imaging and treatment modalities.

The knee support includes at least one top portion configured to support the patient's legs in the area surrounding the popliteal fossa. The knee support is further configured to accommodate at least one indexing structure which removably secures the knee support to the patient table of the modality. The knee support further includes at least one directional guide mechanism, which allows the knee support to slide in discrete increments along a set distance in the superior-inferior direction relative to the at least one indexing structure. The knee support further includes at least one releasable lock which releasably locks the knee support along the superior-inferior direction.

The knee support includes at least one top portion and at least on base portion. The at least one top member is configured to support the patient's legs in the area surrounding the popliteal fossa. The at least one top member is optionally removably attached to the at least one bottom member. The at least one bottom member is further configured to accommodate at least one indexing structure, which removably secures the knee support to the patient table of the modality. The knee support further includes at least one track mechanism allowing the at least one top member and the at least one bottom member to slide in discrete increments along a set distance in the superior-inferior direction. The knee support further includes at least one releasable lock, which releasably locks the knee support at the desired position along the superior-inferior direction.

In a further preferred embodiment, the at least one bottom member features protrusions to be received by corresponding holes in the at least one top member. In this embodiment, the at least one bottom member is configured to be oriented multiple different ways. Changing the orientation of the bottom member results in adjustment of the height of the support. In a preferred embodiment, the bottom member has at least two orientations, such that it will be a first height in a first configuration and a second height in a second configuration. In a further preferred embodiment, the bottom member is a single molded piece where the two orientations can be alternately selected by flipping the structure over. The at least one bottom member is further configured to accommodate at least one indexing structure which removably secures the knee support to the patient table of the modality. In a preferred embodiment, the locating structures are at least two recesses to accommodate pins from a bar attached to the target modality. The knee support further has at least one track of a set distance and at least one shuttle allowing the at least one bottom member to slide in multiple discrete increments along a set distance in the superior-inferior direction. In a preferred embodiment the at least one track and at least one shuttle allow at least five discrete increments along its set distance in the superior-inferior direction. In a further preferred embodiment, the at least five discrete increments are approximately <NUM> millimeters apart.

The knee support further has at least one releasable lock, which releasably locks the knee support at the desired position along the superior-inferior direction. The at least one releasable lock, in a preferred embodiment, is configured to be easily operable with only one hand. The releasable lock interacts with the at least one shuttle by restricting its motion in a first engaged configuration and releasing the at least one shuttle to move along the direction defined by the at least one track in a second disengaged configuration. The at least one shuttle has a number of locating features. The locating features are a system of projections and recesses which interface with at least one corresponding structure on the at least one releasable lock. In a preferred embodiment, the number of locating features correspond with the number of discrete increments for adjustment in the superior-inferior direction. When slidably adjusting the knee support in the superior-inferior direction, the releasable lock is disengaged to permit the movement of the at least on shuttle along the at least one track. The locating features provide haptic feedback to the clinician as to whether the shuttle is appropriately disposed in one of the discrete adjustment increments. In another preferred embodiment, the knee support additionally includes visual indication of the discrete adjustment increments which is usable regardless of height orientation of the at least one bottom member. When the clinician is satisfied with the superior-inferior position, the clinician reengages the at least one releasable lock, securing the knee support in the desired position.

The foot support includes at least one base portion. The at least one base portion is configured to accommodate at least one indexing structure which removably secures the foot support to the patient table of the modality. The at least one base portion further includes at least one tilting portion. The tilting portion further has a member configured to be disposed at different discrete angles along a range. In a preferred embodiment, the tilting portion has at least <NUM> discrete indexing points defining those angles. In a further preferred embodiment, the at least three indexing points are configured to be <NUM> degrees apart. The tilting portion is then configured to be releasably locked at the desired discrete angle position. The tilting portion further comprises at least one heel support cup configured to support the heel and sole of the patient's foot while the device is in operation. The base portion further includes at least one track of a set distance and at least one shuttle to slide the whole tilting portion in discrete increments along said set distance in the superior-inferior direction. In a preferred embodiment, the track includes at least three discrete increments for superior-inferior adjustment. The base portion further includes a releasable lock to secure the tilting portion in the superior-inferior direction.

When used on the patient table of an appropriate imaging or treatment modality, the support system is configured to allow the clinician to adjust the knee support and foot support for optimal positioning of the patient for the target procedure. The knee support and foot support preferably are able be used independently of one another to further customization of the patient positioning. The gross position of the knee support and foot support are achieved via the use of the indexing structures appropriate to the modality (for example a locating bar and corresponding recess in the modality, integrated discs, and other attachment mechanisms known to a person having skill in the art). The height of the knee support is then selected from one of the multiple configurations of the bottom member. The support system also allows the fine adjustment of each of the knee support and foot support without removal or addition of any components and without changing the gross position of the knee support and/or foot support on the modality. Both the knee support and the at least one tilting portion of the foot support may be slidably positioned in discrete increments along a range in the superior-inferior direction and then releasably locked in order to maintain the desired position. The tilting portion of the foot support may be further adjusted along a range of discrete angles and releasably locked in order to maintain the desired position. These fine adjustment capabilities of the support system enable enhanced patient comfort, setup reproducibility, and workflow efficiency.

In accordance with yet another aspect of the invention, a method for configuring the support system of the present invention is provided. The method includes the following steps:.

The method further comprises additional steps of selecting an orientation for a base portion of the at least one support apparatus and then placing at least one top portion configured to support the patient's anatomy onto the base portion of the at least one support apparatus.

According to another embodiment, a fine adjustment of the support apparatus may be accomplished without removing the anatomy of the patient from the support apparatus and the fine adjustment may be accomplished without changing a gross position of the support apparatus.

Claim 1:
A support apparatus (<NUM>, <NUM>) configured to support a patient's anatomy, the support apparatus (<NUM>, <NUM>) comprising:
at least one support (<NUM>, <NUM>, <NUM>, <NUM>) configured to support a patient's anatomy, the at least one support (<NUM>, <NUM>, <NUM>, <NUM>) comprising:
at least one top portion (<NUM>); and
at least one base portion (<NUM>);
at least one locator (<NUM>) configured to removably locate the support apparatus (<NUM>, <NUM>) to a patient table of a target modality;
at least one directional guide (<NUM>) having a set distance of travel;
at least one shuttle (<NUM>) coupled to the at least one support (<NUM>, <NUM>, <NUM>, <NUM>), the shuttle (<NUM>) being configured to slidably adjust the support (<NUM>, <NUM>, <NUM>, <NUM>) along the at least one directional guide (<NUM>);
at least one releasable lock (<NUM>) configured to restrict movement of the at least one shuttle (<NUM>) along the at least one directional guide (<NUM>) in a first engaged configuration, and enable movement of the at least one shuttle (<NUM>) along the at least one directional guide (<NUM>) in a second disengaged configuration;
wherein a gross position of the support apparatus (<NUM>, <NUM>) is selected by locating the at least one locator (<NUM>) to a corresponding structure on the patient table of the target modality and wherein a position of the support apparatus (<NUM>, <NUM>) may be finely adjusted in discrete increments along the set distance of travel of the at least one directional guide (<NUM>); and
wherein the base portion (<NUM>) is removably attached to the at least one top portion (<NUM>), and is additionally coupled to the at least one directional guide (<NUM>), the at least one locator (<NUM>), the at least one shuttle (<NUM>), and the at least one releasable lock (<NUM>), wherein the at least one base portion (<NUM>) is configured to be oriented in at least a first orientation and a second orientation, and wherein the at least one base portion (<NUM>) is configured such that it will be at a first height in the first orientation and at a second height in the second orientation.