Patent Description:
Radiation therapy has been employed to treat tumorous tissue. In radiation therapy, a high energy beam is applied from an external source towards the patient. The external source, which may be rotating (as in the case for arc therapy), produces a collimated beam of radiation that is directed into the patient to the target site. The dose and placement of the dose must be accurately controlled to ensure that the tumor receives sufficient radiation, and that damage to the surrounding healthy tissue is minimized.

Document <CIT> shows an apparatus for creating a radiation treatment plan with: a waypoint module to obtain the imaging waypoints at least partially defining one or more positions for obtaining images of a patient during a treatment session; treatment trajectory module to obtain treatment data defining a beam-on direction; and a treatment plan generator to create the radiation treatment plan based at least in part on the imaging waypoint data and the treatment data.

Generally, a radiation treatment plan is determined before the radiation therapy is performed. This allows an accurate and precise dosage of radiation to be delivered to a patient. Embodiments of methods and systems for determining treatment plans that include imaging consideration are described herein.

Also, methods and systems for operating a treatment system that consider patient loading and unloading are described herein.

According to a first aspect of the invention, there is provided an apparatus for creating a radiation treatment plan for execution by a radiation treatment machine, according to claim <NUM>.

Optionally, the imaging waypoint data defines a gantry position, a couch position, a couch orientation, an image energy source position, or any combination of the foregoing, for obtaining one or more of the images of the patient.

Optionally, the treatment data defines a gantry angle or a range of gantry angles for an energy source to deliver treatment energies.

Optionally, the waypoint module is configured to obtain the imaging waypoint data before the treatment trajectory module obtains the treatment data.

Optionally, the treatment trajectory module is configured to obtain the treatment data based on the imaging waypoint data.

Optionally, the imaging waypoint data comprises a user input indicating a desired position for imaging, wherein the treatment trajectory module is configured to obtain the treatment data based on the user input.

Optionally, the treatment trajectory module is configured to obtain the treatment data before the waypoint module obtains the imaging waypoint data.

Optionally, the apparatus further includes a direction proposal generator configured to generate proposed directions where imaging is possible based on the treatment data, wherein the waypoint module is configured to obtain the imaging waypoint data based on one or more of the proposed directions.

Optionally, the apparatus further includes a user interface configured to receive a user input indicating a selected one of the directions, wherein the waypoint module is configured to obtain the imaging waypoint data based on the user input.

Optionally, the treatment data defines a couch position, a couch orientation, a treatment energy source position, or any combination of the foregoing, for delivering one or more treatment energies to the patient.

Optionally, the treatment trajectory module is also configured to determine a set of possible trajectories.

Optionally, the treatment trajectory module is configured to determine the set of possible trajectories based on collision avoidance, imaging capability, or both.

Optionally, the apparatus further includes a user interface for receiving a user input representing a selected one or more of the possible trajectories.

According to a second aspect of the invention, there is provided a method for creating a radiation treatment plan for execution by a radiation treatment machine, according to claim <NUM>.

Optionally, the imaging waypoint data is obtained before the treatment data is obtained.

Optionally, the treatment data is obtained based on the imaging waypoint data.

Optionally, the imaging waypoint data comprises a user input indicating a desired position for imaging, wherein the treatment data is obtained based on the user input.

Optionally, the treatment data is obtained before the imaging waypoint data is obtained.

Optionally, the method further includes generating proposed directions where imaging is possible based on the treatment data, wherein the imaging waypoint data is obtained based on the proposed directions.

Optionally, the method further includes receiving a user input indicating a selected one of the directions, wherein the imaging waypoint data is obtained based on the user input.

Optionally, the method further includes determining a set of possible trajectories.

Optionally, the set of possible trajectories is determined based on collision avoidance, imaging capability, or both.

Optionally, the method further includes receiving a user input representing a selected one or more of the possible trajectories.

In an example (not claimed), there is described a method of operating a medical system comprising a treatment machine and a patient supporting device, that includes: obtaining a current position associated with the patient supporting device; obtaining a desired position associated with the patient supporting device to be achieved; determining, by a trajectory module, trajectories for one or more components of the treatment system, and an order of the trajectories, based on the current position and the desired position associated with the patient supporting device; and operating the one or more components of the treatment system based on the determined trajectories and the order of the trajectories.

Optionally, the trajectory module determines the trajectories and the order of the trajectories using a shortest-path algorithm.

Optionally, the current position occurs when a treatment is stopped, and the desired position is for unloading a patient.

Optionally, the current position is for loading a patient, and the desired position is for delivering treatment to the patient.

Optionally, the act of operating the one or more components of the treatment system comprises moving one or more components of the treatment machine to open up a path for one or more components of the patient supporting device, and moving one of the one or more components of the patient supporting device after the one or more components of the treatment machine is moved.

Other and further aspects and features will be evident from reading the following detailed description of the embodiments.

The drawings illustrate the design and utility of embodiments, in which similar elements are referred to by common reference numerals. These drawings are not necessarily drawn to scale. In order to better appreciate how the above-recited and other advantages and objects are obtained, a more particular description of the embodiments will be rendered, which are illustrated in the accompanying drawings. These drawings depict only typical embodiments and are not therefore to be considered limiting of its scope.

It should be noted that the figures are not drawn to scale and that elements of similar structures or functions are represented by like reference numerals throughout the figures. An aspect or an advantage described in conjunction with a particular embodiment is not necessarily limited to that embodiment and can be practiced in any other embodiments even if not so illustrated.

<FIG> illustrates a medical system <NUM> including a treatment machine <NUM> for delivering radiation. The treatment machine <NUM> includes a gantry <NUM> in a form of an arm. The treatment machine <NUM> also includes an energy output <NUM> that outputs a beam <NUM> of radiation towards a patient <NUM> while the patient <NUM> is supported on platform <NUM>, and a collimator system <NUM> for controlling a delivery of the radiation beam <NUM>. The energy output <NUM> can be configured to output a cone beam, a fan beam, or other types of radiation beams in different embodiments.

In the illustrated embodiments, the treatment machine <NUM> includes a treatment radiation source for providing treatment radiation energy. In other embodiments, in addition to being a treatment radiation source, the radiation source <NUM> can also be a diagnostic radiation source for providing diagnostic energy. In such cases, the treatment machine <NUM> will include an imager located at an operative position relative to the energy output <NUM> (e.g., under the platform <NUM>). In some embodiments, the treatment energy is generally those energies of <NUM> kilo-electron-volts (keV) or greater, and more typically <NUM> mega-electron-volts (MeV) or greater, and diagnostic energy is generally those energies below the high energy range, and more typically below <NUM> keV. In other embodiments, the treatment energy and the diagnostic energy can have other energy levels, and refer to energies that are used for treatment and diagnostic purposes, respectively. In some embodiments, the radiation source is able to generate X-ray radiation at a plurality of photon energy levels within a range anywhere between approximately <NUM> keV and approximately <NUM> MeV. Radiation sources capable of generating X-ray radiation at different energy levels are described in <CIT>, entitled "RADIOTHERAPY APPARATUS EQUIPPED WITH AN ARTICULABLE GANTRY FOR POSITIONING AN IMAGING UNIT," issued on May <NUM>, <NUM>, and <CIT>, entitled "MULTI-ENERGY X-RAY SOURCE," issued on January <NUM>, <NUM>. In further embodiments, the radiation source can be a diagnostic radiation source. In the illustrated embodiments, the energy output <NUM> is rotatably coupled to the gantry <NUM>. In other embodiments, the energy output <NUM> may be located within a bore (instead of being located at an arm).

The medical system <NUM> also includes a control system <NUM> for controlling an operation of the treatment machine <NUM>. In the illustrated embodiments, the control system <NUM> includes a processor <NUM>, such as a computer processor, coupled to a control <NUM>. The control system <NUM> may also include a monitor <NUM> for displaying data and an input device <NUM>, such as a keyboard or a mouse, for inputting data. In the illustrated embodiments, the gantry <NUM> is rotatable about the patient <NUM>, and during a treatment procedure, the gantry <NUM> rotates about the patient <NUM> (as in an arch-therapy). The operation of the radiation source, the collimator system <NUM>, and the gantry <NUM> (if the gantry <NUM> is rotatable), are controlled by the control <NUM>, which provides power and timing signals to the radiation source and the collimator system <NUM>, and controls a rotational speed and position of the gantry <NUM>, based on signals received from the processor <NUM>. Although the control <NUM> is shown as a separate component from the gantry <NUM> and the processor <NUM>, in alternative embodiments, the control <NUM> can be a part of the gantry <NUM> or the processor <NUM>.

As shown in the figure, the platform <NUM> is a part of a patient supporting device <NUM>. The patient supporting device includes a base <NUM>, a first member <NUM>, a second member <NUM>, and the platform <NUM>. The patient supporting device <NUM> will be described in further detail below.

In some embodiments, the treatment machine <NUM> may optionally include one or more imaging devices. For example, as shown in <FIG>, the treatment machine <NUM> may further include a x-ray source <NUM> and an imager <NUM> located opposite from the x-ray source <NUM>. The x-ray source <NUM> and the imager <NUM> may be configured to image the patient <NUM> before a delivery of treatment energy (e.g., for patient setup), and/or during a treatment energy delivery session (e.g., between deliveries of radiation beams). In other embodiments, the treatment machine <NUM> may not include the x-ray source <NUM> and the imager <NUM>.

It should be noted that the treatment machine <NUM> is not limited to the configuration described above, and that the treatment machine <NUM> may have other configurations in other embodiments. For example, in other embodiments, the treatment machine <NUM> may have a different shape. In other embodiments, the energy output <NUM> of the treatment machine <NUM> may have different ranges of motions and/or degrees of freedom. For example, in other embodiments, the energy output <NUM> may be rotatable about the patient <NUM> completely through a <NUM>° range, or partially through a range that is less than <NUM>°. Also, in other embodiments, the energy output <NUM> is translatable relative to the patient <NUM>. In further embodiments, the gantry <NUM> may be a ring gantry with a bore, and the energy output <NUM> may be located inside the bore of the gantry <NUM>.

<FIG> illustrates the patient supporting device <NUM> of <FIG>. As shown in the figure, the patient supporting device <NUM> has a base <NUM>, a first member <NUM> with a first end <NUM> and a second end <NUM>, a second member <NUM> with a first end <NUM> and a second end <NUM>, and a platform <NUM> (the platform <NUM> of <FIG>). The base <NUM> is optionally configured to move along a pre-determined path along a first rail <NUM> and a second rail <NUM>. The first end <NUM> of the first member <NUM> is rotatably coupled to the base <NUM> so that the first member is rotatable relative to the base <NUM> about a first vertical axis <NUM>. The first end <NUM> of the second member <NUM> is rotatably coupled to the second end <NUM> of the first member <NUM> so that the second member is rotatable relative to the first member <NUM> about a second vertical axis <NUM>. The platform <NUM> is rotatably coupled to the second end <NUM> of the second member <NUM> so that the platform is rotatable relative to the second member <NUM> about a third axis <NUM>.

In the illustrated embodiments, the second member <NUM> has a first member portion <NUM> and a second member portion <NUM>. The first member portion <NUM> is rotatably coupled to the second member portion <NUM> so that the first member portion <NUM> can rotate relative to the second member portion <NUM> about a first horizontal axis <NUM>. The platform <NUM> is rotatably coupled to the second member portion <NUM> so that the platform <NUM> can rotate relative to the second member portion <NUM> about a second horizontal axis <NUM>. During use, the platform <NUM> can rotate relative to the second member portion <NUM> about the second horizontal axis <NUM>, and the second member portion <NUM> can rotate relative to the first member portion <NUM> about the first horizontal axis <NUM>, in synchronization, so that the platform <NUM> can move vertically (e.g., up and/or down).

Also, in the illustrated example, the platform <NUM> may be configured to rotate about its longitudinal axis <NUM>.

In the example shown in the figure, the first member <NUM> is in a form of an arm, and the second member <NUM> is also in a form of an arm. Also, the first member portion <NUM> may be considered to be a part of an arm, and the second member portion <NUM> may be considered to be another part of the arm. In other embodiments, the first member <NUM> may have other form and/or shape, and may not necessarily be an arm. Similarly, in other embodiments, the second member <NUM> may have other form and/or shape, and may not necessarily be an arm.

In the illustrated embodiments, the base <NUM> is configured to move along a pre-determined path defined by the first rail <NUM> and/or the second rail <NUM>. The first rail <NUM> and the second rail <NUM> have a rectilinear configuration, and therefore the base <NUM> is configured to move in a rectilinear path. In other embodiments, the rails <NUM>, <NUM> may have a curvilinear configuration (e.g., an arc, a circular shape, etc.).

The configuration of the patient supporting device <NUM> is advantageous because it allows the platform <NUM> to be placed at different positions with respect to the treatment machine <NUM>. For example, as shown in <FIG>, the patient supporting device <NUM> may be operated to place the platform <NUM> at an orientation, where a longitudinal axis <NUM> of the platform <NUM> is perpendicular to a machine axis <NUM> extending from a front <NUM> of the treatment machine <NUM> to a back <NUM> of the treatment machine <NUM>. Also, having the platform <NUM> on rails is advantageous because it allows the platform <NUM> to be moved from one position to another position quickly.

Also, before treatment is initiated, or after treatment is completed, the patient supporting device <NUM> may have the configuration shown in <FIG>. In particular, the platform <NUM>, the first member <NUM>, the second member <NUM>, and the base <NUM> collectively form a S-configuration that minimizes the extent of the space occupied by the patient supporting device <NUM>. In such configuration, the patient supporting device <NUM> does not occupy significant space, and the patient supporting device <NUM> may allow the patient to conveniently get onto the platform <NUM> and/or to leave the platform <NUM>.

<FIG> illustrate examples of configurations that may be achieved by the patient supporting device <NUM> during a medical method. As shown in <FIG>, the patient supporting device <NUM> may be in a park position. While in the park position, the platform <NUM> is located above the second member <NUM>, and the second member <NUM> is located above the first member <NUM>. This configuration allows the patient supporting device <NUM> to be parked while minimizing the amount of space occupied by the patient supporting device <NUM>. In some embodiments, the patient may be placed at the platform <NUM> while the patient supporting device <NUM> is in such park position. In other embodiments, the platform <NUM> may be moved to a patient-loading position for loading the patient onto the platform <NUM>. For example, the base <NUM> of the patient supporting device <NUM> may be translated to move the platform <NUM> away from the park position to a patient-loading position. The patient may then be placed onto the platform <NUM>.

Next, the patient supporting device <NUM> may be operated to move the platform <NUM> so that the longitudinal axis <NUM> of the platform <NUM> corresponds with the machine axis <NUM> (<FIG>). For example, the base <NUM> may be translated along the rails, the first member <NUM> may be rotated relative to the base <NUM>, the second member <NUM> may be rotated relative to the first member <NUM>, the platform <NUM> may be rotated relative to the second member <NUM>, or any combination of the foregoing may be performed, in order to desirably position the platform <NUM>. While in the configuration shown, a patient setup procedure may be performed to align the patient with respect to the treatment machine <NUM>. For example, certain region of the patient may be placed at the treatment position (e.g., isocenter position) with respect to the treatment machine <NUM>.

After the patient setup procedure, the treatment machine <NUM> may then be operated to treat the patient. For example, as shown in <FIG>, the arm of the treatment machine <NUM> may be rotated to thereby place the energy output <NUM> at different gantry angles to deliver energies towards the patient from different angles.

In the example shown in <FIG>, the energy output <NUM> rotates around the treatment position while the platform <NUM> is at an orientation where the longitudinal axis <NUM> of the platform <NUM> corresponds with the machine axis <NUM> of the treatment machine <NUM>. In other embodiments, the platform <NUM> may be positioned such that the longitudinal axis <NUM> of the platform <NUM> is at an acute angle, at a <NUM>° angle, or at an angle that is larger than <NUM>° but less than <NUM>°, with respect to the machine axis <NUM>. While the platform <NUM> is at such position, the energy output <NUM> of the treatment machine <NUM> may be rotated around the treatment position to deliver energies towards the patient from different gantry angles.

In some cases, instead of rotating the energy output <NUM> around the treatment position while the platform <NUM> is stationary, the platform <NUM> may be positioned while the energy output <NUM> is stationary. For example, as shown in <FIG>, while the arm with the energy output <NUM> is stationary at the position shown, the patient supporting device <NUM> may be operated to rotate the platform <NUM> from the position shown in <FIG> to the position shown in <FIG>, and also from the position shown in <FIG> to the position shown in <FIG>. Such movement results in a portion of the platform <NUM> remaining in a field-of-view of the energy output <NUM> while the platform <NUM> is rotated within a horizontal plane. In some cases, a surface point of the platform <NUM> may remain stationary while the platform <NUM> is rotated about a vertical axis extending through the surface point.

In one implementation, the above movement of the platform <NUM> (from the position of <FIG> to the position of <FIG>, and then to the position of <FIG>) may be achieved by moving the platform <NUM> relative to the second member <NUM>, moving the second member <NUM> relative to the first member <NUM>, moving the first member <NUM> relative to the base <NUM>, moving the base <NUM>, or any combination of the foregoing. In some cases, if multiple components of the patient supporting device <NUM> are moved, the multiple components may be moved simultaneously. Alternatively, the multiple components may be moved in sequence such that one component is moved first, and then another component is moved afterwards. In either case, the energy output <NUM> may deliver treatment energy towards the patient while one or more of the components (e.g., the base <NUM>, the first member <NUM>, the second member, <NUM>, the platform <NUM>, etc.) of the patient supporting device <NUM> are moving, or when the components of the patient supporting device <NUM> have stopped moving. For example, when the platform <NUM> is moved along a path, the components of the patient supporting device <NUM> may stop moving at certain points along the path to allow the energy output <NUM> of the treatment machine <NUM> to deliver energies towards the patient.

In the above example, the energy output <NUM> is located below the elevation of the platform <NUM> while the platform <NUM> is rotated about a vertical axis extending through a field-of-view of the energy output <NUM>. In other embodiments, the energy output <NUM> may be at other positions while the platform <NUM> is rotated about the vertical axis. For example, the energy output <NUM> of the treatment machine <NUM> may be directly above the platform <NUM>, at the same elevation as that of the platform <NUM>, or may be at other positions that are above or below the elevation of the platform <NUM>.

In some cases, instead of moving (e.g., rotating) the platform <NUM> while the energy output <NUM> of the treatment machine <NUM> is stationary, both the platform <NUM> and the energy output <NUM> of the treatment machine <NUM> may be positioned. For example, as shown in <FIG>, the platform <NUM> and the energy output <NUM> of the treatment machine <NUM> may be moved simultaneously so that the platform <NUM> and the energy output <NUM> are moved from the respective positions shown in <FIG> to the respective positions in <FIG>, and then to the respective positions in <FIG>, and then to the respective positions in <FIG>, and then to the respective positions in <FIG>, and then to the respective positions in <FIG>.

In one implementation, the above movement of the platform <NUM> (from the position of <FIG> to the position of <FIG>, to the position of <FIG>, to the position of <FIG>, to the position of <FIG>, and to the position of <FIG>) may be achieved by moving the platform <NUM> relative to the second member <NUM>, moving the second member <NUM> relative to the first member <NUM>, moving the first member <NUM> relative to the base <NUM>, moving the base <NUM>, or any combination of the foregoing. In some cases, if multiple components of the patient supporting device <NUM> are moved, the multiple components may be moved simultaneously. Alternatively, the multiple components may be moved in sequence such that one component is moved first, and then another component is moved afterwards. In either case, the energy output <NUM> may deliver treatment energy towards the patient while one or more of the components (e.g., the base <NUM>, the first member <NUM>, the second member, <NUM>, the platform <NUM>, etc.) of the patient supporting device <NUM> are moving, and/or while the energy output <NUM> is moving. Alternatively, the energy output <NUM> may deliver treatment energy towards the patient when the components of the patient supporting device <NUM> have stopped moving, and when the energy output <NUM> has stopped moving. For example, when the platform <NUM> is moved along a path, the components of the patient supporting device <NUM> may stop moving at certain points along the path to allow the energy output <NUM> of the treatment machine <NUM> to deliver energies towards the patient. Similarly, when the energy output <NUM> of the treatment machine <NUM> is moved along a path, the energy output <NUM> may stop moving at certain points along the path to allow the energy output <NUM> to deliver energies towards the patient. Alternatively, the delivery of energies may occur simultaneously while the components of the patient supporting device <NUM> are moving, and/or while the energy output <NUM> of the treatment machine <NUM> is moving.

After the patient has been treated, the platform <NUM> may then be moved to a patient-unloading position to unload the patient. For example, the patient supporting device <NUM> may be operated to move the platform <NUM> to the position shown in <FIG>. Alternatively, the patient supporting device <NUM> may be operated to move the platform <NUM> to the position shown in <FIG>.

As illustrated in the above embodiments, the patient supporting device <NUM> is advantageous because the patient supporting platform <NUM> (and therefore the patient) to be placed at a variety of positons and orientations with respect to the treatment machine <NUM>. In combination with the movement of the energy output <NUM> of the treatment machine <NUM>, the various degrees of movement of the patient supporting device <NUM> allow treatment energies to be delivered to the patient from many different angles that were not possible in existing solutions. Also, the configuration of the patient supporting device <NUM> allows larger reach to other machines next to the treatment machine, and increases positional flexibility. Furthermore, because the patient supporting device <NUM> can be folded to assume a narrow profile, the patient supporting device <NUM> can be parked close to a wall. In addition, the length of the rail system (including the rails <NUM>, <NUM>) can be easily adapted according to treatment room size or usage of the system. This flexibility allows installations of the rail system and the patient supporting device <NUM> for various different room layouts.

Also, the movement of the base <NUM> along a path (e.g., along one or more rails) is advantageous because it may allow the platform <NUM> to be moved to a certain position faster and more effectively. If the base <NUM> is not moveable along a path, it may take longer for the platform <NUM> to reach certain positions because of the articulation of the arm relative to the room and the treatment machine.

It should be noted that the movements and positioning of the various components of the patient supporting device <NUM> should not be limited to the examples described, and that the patient supporting device <NUM> may achieve other types of movements and positioning. For example, in other embodiments, the platform <NUM> may be translated vertically (e.g., up and/or down) while the orientation of the platform <NUM> is maintained. Such may be accomplished by synchronously rotating the second member <NUM> relative to the first member <NUM> about the first horizontal axis in a first direction, and simultaneously rotating the platform <NUM> relative to the second member <NUM> about the second horizontal axis in a second direction that is opposite the first direction. In other embodiments, the platform <NUM> may be translated horizontally along a path that corresponds with (e.g., parallel to) the machine axis <NUM> of the treatment machine <NUM>. Such may be accomplished by synchronously rotating the first member <NUM> relative to the base <NUM> about the first axis <NUM> in a first direction, rotating the second member <NUM> relative to the first member <NUM> about the second axis <NUM> in a second direction opposite the first direction, and rotating the platform <NUM> relative to the second member <NUM> about the third axis <NUM> in the first direction. In still further embodiments, the platform <NUM> may be translated horizontally along a path that is parallel to the floor. Such may be accomplished by translating the base <NUM>.

Also, in any of the embodiments described herein, the patient supporting device <NUM> may be configured to move at a speed that is sufficient for dynamic treatment. For example, the patient supporting device <NUM> may be configured to move in a path with a speed that corresponds (e.g., complements) with a motion speed of the treatment machine <NUM> (e.g., the speed of the rotating energy output <NUM>) and/or the rate at which treatment energies are being delivered. Also, in some cases, the patient supporting device <NUM> may be configured to move with a sufficiently fast speed to allow the patient supporting device <NUM> to compensate for a breathing motion of the patient. For example, the patient supporting device <NUM> may be configured to move the patient in order to at least partially compensate for a breathing motion of the patient, thereby allowing breathing gating to be used to deliver treatment energies.

In addition, in any of the embodiments described herein, the patient supporting device <NUM> may be configured to move the platform <NUM> in synchronization or in correspondence with a movement or position of the energy output <NUM>. For example, the platform <NUM> may be moved so that a point at the patient (e.g., an isocenter) is maintained at a certain prescribed distance or a certain prescribed range of distances from the energy output <NUM>. Accordingly, regardless of the position of the energy output <NUM>, the isocenter is maintained at a fixed distance or within a fixed distance range from the energy output <NUM>. The movement of the platform <NUM> may be dynamically performed simultaneously with a movement of the energy output <NUM>. Alternatively, the movement of the platform <NUM> may be performed after the energy output <NUM> has moved, so that the movements of the platform <NUM> and the energy output <NUM> are staggered. Furthermore, in some cases, the source-axis-distance (SAD) may be extended compared to the scenario in which the platform <NUM> is stationary and the energy output <NUM> is rotated around the platform <NUM>. Such can be accomplished by moving the platform <NUM> in a direction that is away from the energy output <NUM>, thereby increasing the SAD. During treatment, as the energy output <NUM> rotates around a space, the patient supporting device <NUM> also rotates the platform <NUM> around the same space in synchronization or in correspondence with the energy output <NUM>. This allows the energy output <NUM> to always be aimed at a treatment target in the patient supported on the platform <NUM>, which both the energy output <NUM> and the platform <NUM> on opposite sides of the space are rotated in correspondence with each other.

In the above embodiments, the treatment machine <NUM> has been described as having a rotatable arm that includes an energy output <NUM> and a collimator. In other embodiments, instead of the rotatable arm, the treatment machine <NUM> may have a ring gantry that carries the energy output <NUM>. In such cases, during treatment, the patient supporting device <NUM> may be operated to place a part of the patient into a bore, and the ring gantry may be rotated around the patient to allow the energy output <NUM> to deliver treatment energies from different angles.

In addition, in any of the embodiments described herein, the platform <NUM> may be a removeable couch top. For example, the platform <NUM> may be detachably coupled to a connector that is at the second end of the second member <NUM>. In some cases, the platform <NUM> may be removed from the rest of the patient supporting device <NUM>, and the patient may be placed on top of the platform <NUM> for patient setup. The placement of the patient on the platform <NUM> may be performed in the treatment room where the patient supporting device <NUM> is located, or may be performed in another room. In one implementation, the patient may be positioned such that a reference location at the patient relative to the platform <NUM> is achieved. After that is set up, the platform <NUM> with the patient may then be attached to the connector at the patient supporting device <NUM>. Furthermore, in some embodiments, the movement of the platform <NUM> with the patient to attach the platform <NUM> with the rest of the patient supporting device <NUM> may be performed automatically using a robotic device (e.g., a tool-changer).

In further embodiments, the patient supporting device <NUM> may also include one or more positional indicators for allowing a position of the patient supporting device <NUM> to be determined. For example, the patient supporting device <NUM> may include a positioning system that allows its position relative to some global coordinate system be determined. The positioning system may include one or more components at the platform <NUM>, one or more components at the first member <NUM>, one or more components at the second member <NUM>, one or more components at the base <NUM>, or any combination of the foregoing. The component may be a signal emitter, a signal receiver, a fiducial, a marker, etc. In other embodiments, a component may be a sensor for sensing a signal, or may be a fiducial that is configured for sensing, that can be used to derive a position.

In another example, the patient supporting device <NUM> may include multiple positional indicators at the respective moving parts (e.g., the base <NUM>, the first member <NUM>, the first member portion <NUM> of the second member <NUM>, the second member portion <NUM> of the second member <NUM>, and the platform <NUM>). The positional indicators may have respective energy sources for emitting positional energies (beacons), and there may be one or more detectors in the treatment room for detecting such positional energies. Based on the detected positional energies, the processing unit may then determine the positions and orientations of the various components of the patient supporting device <NUM>. In other embodiments, the beacons may be passive devices.

In another example, the positional indicators may include one or more markers at the platform <NUM>, one or more markers at the first member <NUM>, one or more markers at the second member <NUM>, and one or more markers at the base <NUM>. The markers may be configured to be detected using one or more cameras, or other types of sensing device(s).

In further embodiments, the patient supporting device <NUM> may include an imaging system for imaging the patient. For example, the patient supporting device <NUM> may include an energy source for providing imaging energy, and an imager for generating an image of a patient (e.g., an internal part of the patient) based on the imaging energy after it has penetrated through the patient. By means of non-limiting examples, the imaging system at the patient supporting device <NUM> may be a radiation imaging system, an ultrasound imaging system, a MRI system, a fluoroscope, a CT system, a PET system, a SPECT system, a CT-PET system, etc. During use, the imaging system at the patient supporting device <NUM> may be used to image the patient to determine a position and/or a shape of target and/or critical organ. Such may be performed during a patient setup procedure, and/or during treatment (e.g., between deliveries of treatment energies).

Also, in any of the embodiments described herein, instead of having the platform <NUM> that is completely horizontal to support the entire patient horizontally, the platform <NUM> may have other configurations in other embodiments. For example, in other embodiments, the platform <NUM> may have a form of a chair to support the patient in an upright position. In one implementation, the platform <NUM> may have a first platform portion and a second platform portion that is rotatably coupled to the first platform portion. The platform portions may be operated so that both platform portions are oriented horizontally, thereby providing a completely horizontal supporting surface for supporting the patient horizontally. In another method of use, one of the platform portions may be rotated to be in an upright position, thereby creating a chair-like supporting structure for supporting the patient in an upright position.

Furthermore, in any of the embodiments described herein, the patient supporting device <NUM> may include one or more force and/or torque sensor for load measurement. In one implementation, the platform <NUM> may have a force sensor for measuring an amount of load being supported by the platform <NUM>. The measurement may be transmitted to a processing unit, which calculates an amount of deflection resulted from such load. The processing unit may then operate the patient supporting device <NUM> (e.g., rotate the platform <NUM> about a horizontal axis that is perpendicular to the longitudinal axis of the platform <NUM>) to compensate for such deflection. Because the patient supporting device <NUM> is configured to support load using cantilever-action, the amount of deflection due to heavy load supported by the platform <NUM> may be significant. The above feature may allow the deflection to be compensated. In other embodiments, the patient supporting device <NUM> may not support load using cantilever-action, and the deflection due to patient load on the platform <NUM> may not be significant.

In addition, in any of the embodiments described herein, the patient supporting device <NUM> and/or the treatment machine <NUM> may include one or more cameras for monitoring the patient. The one or more cameras may be used to sense one or more markers (e.g., one or more light emitting or light reflecting markers, one or more reference locations at the patient that function as marker(s), etc.). In some embodiments, the sensed markers may be used to determine a position of a patient part. For example, the sensed markers may be positionally related to a breathing movement of the patient. In such cases, the sensed markers may be processed by a processing unit, which determines one or more breathing phases of the patient. Also, in some embodiments, the one or more cameras may generate images for monitoring a position of the patient. The processing unit may process such images to ensure that the patient is at an intended position, and/or to provide collision detection and avoidance. It should be noted that one or more of the camera(s) may be a depth sensing camera. In one implementation, the patient supporting device <NUM> may include a depth sensing camera attached thereto. During use, the depth sensing camera detects a surface of the patient, and the processing unit generates a surface model representing the surface of the patient. While treatment is being performed, the patient supporting device <NUM> and the treatment machine <NUM> may move. The processing unit monitors objects next to the patient. If the processing unit determines that an object (e.g., the arm <NUM> of the treatment machine <NUM>) is getting too close to the patient (e.g., within a threshold distance from the surface model), the processing unit may then generate a warning signal and/or a control signal to stop or pause the treatment. For example, the processing unit may generate a control signal to stop a movement of the treatment machine <NUM> and/or a movement of the patient supporting device <NUM>. The processing unit may also generate a control signal to stop a delivery of treatment energies by the treatment machine <NUM>. In some cases, one or more proximity sensors may be employed to determine whether the patient is too close to component(s) of the treatment machine <NUM>.

Also, in the above embodiments, the treatment machine <NUM> has been described with reference to providing treatment radiation. In other embodiments, the treatment machine <NUM> may be configured to provide other types of treatment energy. For examples, in other embodiments, the treatment machine <NUM> may be configured to provide proton beam for proton therapy, treatment ultrasound energy, radiofrequency energy, etc. In addition, in other embodiments, the radiation source may be a proton source for delivering protons to treat a patient, an electron source for delivering electrons, or other types of particle source for delivering other types of particles for treating patient.

In any of the embodiments described herein, the treatment system may optionally further include an imaging machine located next to the treatment machine <NUM>. <FIG> illustrates an example in which the treatment system includes an imaging machine <NUM> placed next to the treatment machine <NUM> in a side-by-side configuration. By means of non-limiting examples, the imaging machine <NUM> may be a CT machine, a x-ray machine, a fluoroscope, a MRI machine, an ultrasound device, a PET machine, a SPECT machine, or a PET-CT machine. In the side-by-side configuration, both a front of the treatment machine <NUM> and a front of the imaging machine <NUM> are facing the same direction. During use, the patient supporting device <NUM> may be configured to place the patient at a treatment position with respect to the treatment machine <NUM>, and also at an imaging position with respect to the imaging machine <NUM>. For example, before a treatment session begins, the patient supporting device <NUM> may place the patient at the imaging position to allow the imaging machine <NUM> to image the patient. The image(s) from the imaging machine <NUM> may be used to confirm the position and shape of target (e.g., tumorous tissue), and/or be used to perform patient setup. After the image(s) is obtained, the patient supporting device <NUM> may then move the patient from the imaging position to the treatment position, to thereby allow the treatment machine <NUM> to deliver treatment energies towards the patient. During treatment, if desired, the patient supporting device <NUM> may move the patient from the treatment position to the image position to allow the imaging machine <NUM> to obtain additional image(s) of the patient. The additional image(s) may be used to determine position and/or shape of target, which in turn, may be used to update or modify a treatment plan.

In some embodiments, the patient supporting device <NUM> may be configured to make motions in multiple different coordinate systems corresponding with respective different machines. For example, the control of the patient supporting device <NUM> may be configured to operate the patient supporting device <NUM> to move in a first path within a first coordinate system (e.g., one for the treatment machine <NUM>), and to operate the patient supporting device <NUM> to move in a second path different from the first path within a second coordinate system (e.g., one for the imaging machine <NUM>).

In other embodiments, instead of the side-by-side configuration, the treatment machine <NUM> and the imaging machine <NUM> may be placed next to each other in a back-to-back configuration (in which the back of the treatment machine <NUM> faces towards the back of the imaging machine <NUM>) (<FIG>), or in a front-to-front configuration (in which the front of the treatment machine <NUM> faces towards the front of the imaging machine <NUM>) (<FIG>). In further embodiments, the treatment machine <NUM> and the imaging machine <NUM> may be placed next to each other at <NUM>° (or other angles) with respect to each other (<FIG>).

In any of the embodiments described herein, the operation of the patient supporting device <NUM> may be achieved using a control that generates control signals for causing one or more of the components (e.g., base <NUM>, first member <NUM>, second member <NUM>, platform <NUM>) of the patient supporting device <NUM> to move. The control may include circuitry and/or algorithm for generating the control signals. In some cases, the control may include a processing unit configured to receive and process a treatment plan, which prescribes the condition and/or the manner for moving the platform <NUM>. The processing unit may generate the control signals based on parameters provided from the treatment plan. For example, the treatment plan may include parameters for indicating that the platform <NUM> be moved from position X to position Y when certain criteria are met. The criteria may be a position of the energy output of the treatment machine <NUM>, a total accumulated dose delivered to the patient, an amount of dose delivered to target, an amount of dose delivered to critical organ, etc. In some embodiments, the control for the patient supporting device <NUM> may include a member control module for controlling movement of the first member <NUM> and/or the second member, a base control module for controlling a movement of the base <NUM>, and a platform control module for controlling a movement of the platform <NUM> relative to the second member <NUM>. Also, in some embodiments, the treatment plan may prescribe the positions and orientations of the platform <NUM> to be accomplished at certain time points or certain conditions, and the control of the patient supporting device <NUM> may include an analysis module configured to determine which component(s) (e.g., the base <NUM>, the first member <NUM>, the second member <NUM>, the platform <NUM>) to move and amount(s) of movement to accomplish the prescribed positions and orientations of the platform <NUM>.

Also, in the above embodiments, the rails <NUM>, <NUM> are described as being at the floor (e.g., they can be mounted on or in the floor). In other embodiments, the rails <NUM>, <NUM> may be mounted at the ceiling of the operating room. In further embodiments, the rails <NUM>, <NUM> may be mounted to a wall of the operating room. Regardless of where the rails are mounted, the base <NUM> is configured to translate (e.g., in a rectilinear path, in a curvilinear path, or both) within a room. Furthermore, instead of two rails, in other embodiments, the base <NUM> may be configured to move along only one rail, or more than two rails. In still further embodiments, the rails <NUM>, <NUM> may not be required. For example, in other embodiments, the base <NUM> may include one or more wheels for allowing the base <NUM> to move in a room. In some cases, the base <NUM> may have multiple wheels and the base <NUM> is steerable. Also, in some embodiments, the moveable base <NUM> may allow the patient supporting device to be transported outside the treatment room into a hallway and/or to another room.

In addition, in other embodiments, instead of defining the path of the base <NUM> using rail(s), the base <NUM> may include wheels and the positioning of the base <NUM> may be accomplished by turning and/or steering the wheels. In one implementation, the base <NUM> may include omni-directional wheels. In other embodiments, the base <NUM> may include other types of wheels, such as tractor-type wheels.

In any of the embodiments described herein, the patient supporting device <NUM> may also include a control for allowing an operator to enter one or more commands to control a positioning and/or a movement of the platform <NUM>. For example, in some cases, the control may include a keyboard and/or a mouse for allowing a user to prescribe a coordinate and/or an orientation for the platform <NUM>. In response to the command(s) entered by the operator, a processing unit may then operate the platform <NUM>, the first member <NUM>, the second member <NUM>, the base <NUM>, or any combination of the foregoing, in order to place the platform <NUM> at the prescribed coordinate and/or orientation. As another example, the control may include a control-stick. In such cases, in response to the operator operating the control-stick in a certain direction (e.g., left, right, forward, backward), the platform <NUM> will move in the corresponding direction. In some embodiments, the control-stick may also include an up-button and a down-button for moving the platform <NUM> upward and downward, respectively. Furthermore, in some cases, the user-operable control may be implemented using an iphone, an ipad, a tablet, a laptop, or any of other communication devices. In some embodiments, the control may be in the same room with the patient supporting device <NUM>. In other embodiments, the control and the patient supporting device <NUM> may be in separate respective rooms. Also, the control may be implemented at the patient supporting device <NUM>, and may be a part of the patient supporting device <NUM>. Furthermore, the control may have a first control interface (e.g., keyboard, mouse, screen, touchscreen, buttons, joystick, or any combination of the foregoing) at the patient supporting device <NUM>, and a second control interface (e.g., keyboard, mouse, screen, touchscreen, buttons, joystick, or any combination of the foregoing) in a room that is different from the room in which the platform <NUM> is located. In such cases, an operator may selectively choose which of the control interfaces to use for controlling the positioning and/or the movement of the platform <NUM>.

It should be noted that as used in this specification, the term "vertical" refers to an orientation that is approximately <NUM>° (e.g., <NUM>° ± <NUM>°, and more preferably <NUM>° ± <NUM>°) with respect to a horizon or a horizontal floor. Also, as used in this specification, the term "horizontal" refers to an orientation that is approximately parallel (e.g., at <NUM>° ± <NUM>°, and more preferably <NUM>° ± <NUM>°) to a horizon or a horizontal floor.

In some embodiments, during a treatment session to treat the patient <NUM> using the treatment system <NUM>, one or more imaging process to obtain one or more images may be performed. For example, during a treatment session, and between deliveries of treatment energies towards the patient <NUM>, an imaging device may be operated to obtain one or more images of the patient <NUM>. The imaging device may be an imaging source (e.g., radiation source) coupled to the treatment machine <NUM>, a portal imager, or a separate imaging machine (such as an ultrasound machine, a MRI machine, a x-ray machine, a CT machine, etc.). The obtained image(s) may be used to confirm a position of a target region inside the patient <NUM>, to confirm a delivered dose to the patient <NUM>, to adjust a position of the patient <NUM>, to adjust a treatment plan, or any combination of the foregoing.

In accordance with some embodiments, imaging waypoints may be defined and may be incorporated as a part of a treatment plan. As used in this specification, an imaging waypoint may refer to an imaging position for obtaining one or more images, wherein the imaging position may be an image energy source position (e.g., a position of a gantry or an arm carrying an energy source for imaging,), a gantry of a treatment energy source, a position of the patient support <NUM>, an orientation of the patient support <NUM>, etc., or any combination of the foregoing. Accordingly, by means of non-limiting examples, the imaging waypoint data may define a gantry position (e.g., gantry of imaging source and/or treatment source), a couch (patient support) position, a couch orientation, an image energy source position (e.g., as defined by a gantry carrying the imaging energy source), or any combination of the foregoing, for obtaining one or more of the images of the patient <NUM>. In some embodiments, an imaging waypoint may be determined or expressed with respect to a plane within which an imaging energy source is rotated, with respect to a position and/or orientation of the patient support <NUM>, or with respect to both. Also, because one or more components (e.g., gantry, energy source, patient support <NUM>, etc.) involved during a medical procedure may have positions that are associated with respective time points, in some cases, imaging waypoints may refer to, represent, and/or associated with, those points in time where imaging is possible. An imaging waypoint, in some embodiments, may represent an instantaneous temporal opportunity to acquire image(s) or a time slot where images can be acquired over a period of time. Imaging based on imaging waypoints may be in parallel or sequential with respect to treatment beam delivery.

In some embodiments, imaging waypoints may be defined before determining beam-on directions (treatment trajectories). A beam-on direction is the direction of treatment energy provided by a treatment energy source. In some cases, a beam-on direction may be at least partially defined by determining a gantry angle (i.e., an angle of the gantry carrying a treatment energy source) at which treatment energy is to be delivered. In some embodiments, the beam-on direction(s) may be at least partially defined with respect to a plane within which the treatment energy source is rotated, with respect to a position and/or orientation of the patient support <NUM>, or with respect to both. Defining imaging waypoints before beam-on directions are determined may be beneficial if a specific feature in the patient <NUM> is visible from a specific direction using a specific imaging method. For example 3D cone beam (CB) CT quality may depend on arc length (angle). If full rotation or a partial rotation for a CBCT image is desired, it may be set in advance using imaging waypoints. In another example, tumor may be visible from a specific angle. In this case the imaging direction may be set in advance. In one example, a lung tumor may be best visible from gantry angle = <NUM>°. As such, in this example, imaging waypoint(s) may be set at gantry angle = <NUM>°, or a range of imaging waypoints may be set at gantry angle range = <NUM>° to <NUM>° for allowing such imaging to be performed.

After imaging waypoints are determined, beam-on directions may then be determined. In some cases, the imaging waypoints may be taken into consideration when determining the beam-on directions. For example, if a patient support angle <NUM> of <NUM>° (which is an example of an imaging waypoint) is used for imaging, such orientation of the patient support <NUM> may also be used while delivering treatment energy from different gantry angles (<FIG>). This way, full treatment delivery may be performed without moving the patient support <NUM> between imaging position and treatment position (e.g., without rotating patient support <NUM> about a vertical axis in the above example to another position for treatment), thereby reducing the risk of patient movement. As shown in <FIG>, the angle <NUM> of the patient support <NUM> is measured relative to an arbitrary axis <NUM>, and the angle <NUM> is within a plane (e.g., a horizontal plane) that forms an angle (e.g., a <NUM>° angle) relative to a rotational plane of the gantry <NUM> / treatment source <NUM>. The rotational plane of the gantry <NUM> / treatment source <NUM> is the plane in which the gantry <NUM> / treatment source <NUM> rotates (as represented by arrow <NUM>).

In other cases, a user may select (through a user interface) a certain type of imaging with the patient support <NUM> at an angle <NUM> of <NUM>° (wherein the angle <NUM> is within a horizontal plane and is with respect to a certain horizontal axis). For example, the user may select kV-MV pair imaging (i.e., imaging using kV energy and MV energy to obtain a pair of images) to be performed while the patient support <NUM> is at the angle <NUM> of <NUM>°. The user may also choose a certain type of treatment technique. For example, the user may choose a volumetric modulated arc therapy with Rapid Arc® radiotherapy technology (available at Varian, Palo Alto). The apparatus may then determine beam-on directions and imaging direction(s) based on the orientation of the patient support <NUM> being at <NUM>°. Continuing with the above example, the apparatus may (based on the patient support angle <NUM> of <NUM>°, position, size, and/or shape of target region in the patient) determine a treatment plan with beam-on directions being from a range of gantry angles of <NUM>° to <NUM>°, and imaging directions being from a range of imaging angles from <NUM>° to <NUM>°.

In other embodiments, the apparatus may automatically determine imaging waypoints and beam-on directions based on user defined parameters. For example, a user may choose KV-MV pair at patient support angle <NUM> of <NUM>° (an example of imaging waypoint) and a volumetric modulated arc therapy with RapidArc® radiotherapy technology with full gantry rotation while the patient support angle is at <NUM>°. The apparatus may then create a treatment plan that contains (<NUM>) imaging while patient support <NUM> is at angle <NUM> of <NUM>°, and (<NUM>) full rotation arc for treatment while the patient support <NUM> is at angle <NUM> of <NUM>°.

In other embodiments, imaging waypoints may be defined after the beam-on trajectory definition. In some cases, after the beam-on trajectories are determined, an apparatus may be provided for proposing directions where imaging is possible. For example, it may be the case that a user selects a full rotation arc for treatment while the isocenter remains in the patient <NUM>. Based on the selection of full rotation arc treatment, and other information (such as the position, size, and/or shape of structures inside the patient <NUM>), the apparatus may determine that imaging is possible at each point along the treatment arc. The user may then choose any location of along the treatment arc to for planned imaging.

In another example, the user may select partial arc treatment with off-center isocenter. In this example, beam-on directions for the partial arc treatment is from gantry angles of <NUM>°-<NUM>°. Based on this information, and other information (such as the position, size, and/or shape of structures inside the patient <NUM>), the apparatus may determine that imaging without moving isocenter or patient support <NUM> is possible only at gantry angles <NUM>° - <NUM>°. Accordingly, the apparatus may allow the user to set imaging waypoints for planned imaging in this range.

As a further example, a user may select partial arc treatment with off-center isocenter. In such cases, the partial arc treatment involves a gantry rotation from <NUM>°-<NUM>°. The apparatus may determine that imaging without moving isocenter or the patient support <NUM> is possible only at gantry angles of <NUM>° to <NUM>°. However, user may want to image from angle <NUM>°. The apparatus may then notify that this requires an isocenter shift or a movement of the patient support <NUM>. The apparatus may create a treatment plan having both planned imaging and planned treatment with an isocenter shift. For example, the apparatus may determine that the partial arc treatment is to be performed with the patient support <NUM> being at angle <NUM> of <NUM>°, and planned imaging is to be performed with the patient support being at angle <NUM> of <NUM>°.

In further embodiments, the imaging waypoints may be defined as a class solution. In such cases, a sub-set of possible schemes (e.g., treatment schemes and/or imaging schemes) may be parametrized and proposed to a user. The sub-set of possible schemes may be designed for low collision risk, good imaging capabilities, and/or any of other treatment considerations.

For example, a user interface may be provided that allows a user to select half-arc CBCT imaging (gantry from <NUM> to <NUM> degrees) with an envelope of allowed isocenter locations. The envelope of allowed isocenter locations may be defined so that half-arc CBCT is possible. In this example, the user may select the half-arc CBCT imaging as a class solution. After the class solution is selected, the user may also choose, through the user interface, an isocenter location in the allowed range as defined by the envelope. In other embodiments, the user may choose a full-arc CBCT imaging as a class solution. In further embodiments, half-arc or full-arc CBCT imaging may be selected as a class action with corresponding envelope of allowed isocenter locations, and also with allowable range of patient support rotation (e.g., allowable angle <NUM> may be anywhere from -<NUM>° to <NUM>°; see <FIG>).

<FIG> illustrates a method <NUM> for creating a radiation treatment plan for execution by a radiation treatment machine in accordance with some embodiments. The method <NUM> includes obtaining imaging waypoint data representing imaging waypoints (item <NUM>), wherein the imaging waypoints at least partially define one or more positions for obtaining images of a patient. By means of non-limiting examples, the imaging waypoint data may define a couch position, a couch orientation, an image energy source position, or any combination of the foregoing, for obtaining one or more of the images of the patient. In one specific example, the imaging waypoint data may be an orientation of the patient support <NUM> with respect to a treatment machine <NUM>, such as the angle <NUM> shown in <FIG>.

In some embodiments, the act of obtaining the imaging waypoint data may be performed by an input of an apparatus, which receives the imaging waypoint data (e.g., from another device, or from a user interface). In other embodiments, the act of obtaining the imaging waypoint data may be performed by an apparatus, which retrieves the imaging waypoint data from a non-transitory medium. The non-transitory medium may be in the apparatus, or may be outside the apparatus that is in communication with the apparatus.

Returning to <FIG>, the method <NUM> also includes obtaining treatment data at least partially defining a beam-on direction (item <NUM>). By means of non-limiting examples, the treatment data may define a gantry angle or a range of gantry angles for an energy source to deliver treatment energies. In some cases, the treatment data may define a couch position, a couch orientation, a treatment energy source position, or any combination of the foregoing, for delivering one or more treatment energies to the patient. For example, the treatment data may indicate that treatment is to be performed with the patient support <NUM> being at a certain orientation and position with respect to the treatment machine <NUM>.

In some embodiments, the act of obtaining the treatment data may be performed by an input of an apparatus, which receives the treatment data (e.g., from another device, or from a user interface). In other embodiments, the act of obtaining the treatment data may be performed by an apparatus, which retrieves the treatment data from a non-transitory medium. The non-transitory medium may be in the apparatus, or may be outside the apparatus that is in communication with the apparatus.

The method <NUM> also includes creating the radiation treatment plan based at least in part on the imaging waypoint data and the treatment data (item <NUM>). In some embodiments, the created treatment plan includes treatment scheme and imaging scheme that are integrated with each other. For example, the treatment plan may prescribe that treatment energy be delivered while the patient support <NUM> is at an angle <NUM> that is <NUM>°, with the treatment energy source rotating from gantry angle of -<NUM>° to <NUM>° to deliver treatment energies in this range. After the treatment energy is delivered, the treatment plan may prescribe that the patient support <NUM> be rotated so that the angle <NUM> is <NUM>°. At that position, the treatment plan may prescribe that imaging be performed on the patient <NUM>, and that the energy source be rotated from gantry angle of -<NUM>° to <NUM>° to deliver treatment energies in this range. In some cases, the prescribed positional relationship between the patient support <NUM> and the treatment machine <NUM> for the various items in the operational sequence may be stored in a specialized data structure as a part of the treatment plan. During use, the data structure is executable or operable by a processing unit to thereby cause the items in the operational sequence to be performed.

In some embodiments, the imaging waypoint data may be obtained before the treatment data is obtained. In such cases, after the imaging waypoint data is obtained, the treatment data may be obtained based on the imaging waypoint data. Also, in some embodiments, the imaging waypoint data may comprise a user input indicating a desired position for imaging. In such cases, the treatment data may be obtained based on the user input. In other embodiments, the treatment data may be obtained before the imaging waypoint data is obtained.

In some cases, the method <NUM> may further include generating proposed directions where imaging is possible based on the treatment data, wherein the imaging waypoint data is obtained based on the proposed directions. The method <NUM> may further include receiving a user input indicating a selected one of the directions, wherein the imaging waypoint data is obtained based on the user input.

Optionally, the method <NUM> may further include determining a set of possible schemes for imaging and/or treatment. In some cases, the set of possible schemes may be determined based on collision avoidance, imaging capability, or both. The method <NUM> may further include receiving a user input representing a selected one or more of the possible schemes.

<FIG> illustrates an apparatus <NUM> for creating a radiation treatment plan for execution by a radiation treatment machine. In some cases, the apparatus <NUM> may be used to perform the method <NUM> of <FIG>. Referring to <FIG>, the apparatus <NUM> include: a waypoint module <NUM> configured to obtain imaging waypoint data representing imaging waypoints, the imaging waypoints at least partially defining one or more positions for obtaining images of a patient during a treatment session. The apparatus <NUM> also includes a treatment trajectory module <NUM> configured to obtain treatment data at least partially defining a beam-on trajectory, and a treatment plan generator <NUM> configured to create the radiation treatment plan based at least in part on the imaging waypoint data and the treatment data.

In some embodiments, the imaging waypoint data may define a couch position, a couch orientation, an image energy source position, or any combination of the foregoing, for obtaining one or more of the images of the patient <NUM>.

Also, in some embodiments, the treatment data may define a gantry angle or a range of gantry angles for an energy source to deliver treatment energies. In some cases, the treatment data may define a couch position, a couch orientation, a treatment energy source position, or any combination of the foregoing, for delivering one or more treatment energies to the patient. For example, the treatment data may indicate that treatment is to be performed with the patient support <NUM> being at a certain orientation and position with respect to the treatment machine <NUM>.

In some embodiments, the waypoint module <NUM> may be configured to obtain the imaging waypoint data before the trajectory module <NUM> obtains the treatment data. Also, in some cases, the treatment trajectory module <NUM> may be configured to obtain the treatment data based on the imaging waypoint data. In addition, in some cases, the imaging waypoint data comprises a user input indicating a desired position for imaging, wherein the treatment trajectory module <NUM> may be configured to obtain the treatment data based on the user input. In other embodiments, the treatment trajectory module <NUM> may be configured to obtain the treatment data before the waypoint module <NUM> obtains the imaging waypoint data.

Also, in some embodiments, the apparatus <NUM> further includes a direction proposal generator <NUM> configured to generate proposed directions where imaging is possible based on the treatment data, wherein the waypoint module <NUM> is configured to obtain the imaging waypoint data based on one or more of the proposed directions. For example, the treatment data may indicate that treatment is to be delivered while the patient support <NUM> is at a certain orientation with respect to the treatment machine <NUM>. Based on such information, and information regarding a position, size, and/or shape of structure(s) in the patient <NUM>, the direction proposal generator <NUM> may propose that imaging be performed at imaging angle from <NUM>° to <NUM>°, for example. In some cases, the direction proposal generator <NUM> may also propose that the position and/or orientation of the patient support <NUM> relative to the treatment machine <NUM> be varied from the treatment position for imaging. In some cases, the apparatus <NUM> may further include a user interface <NUM> configured to receive a user input indicating a selected one of the directions, wherein the waypoint module <NUM> is configured to obtain the imaging waypoint data based on the user input.

In some embodiments, the treatment trajectory module <NUM> may also be configured to determine a set of possible schemes for treatment and/or imaging. For example, the treatment trajectory module <NUM> may be configured to determine the set of possible schemes based on collision avoidance, imaging capability, or both. Optionally, the apparatus <NUM> may further include a user interface <NUM> for receiving a user input representing a selected one or more of the possible trajectories.

As shown in <FIG>, in some embodiments described herein, the apparatus <NUM> may further include one or more input(s) <NUM> for receiving information, such as treatment plan parameters, medical images (e.g., projection images, CT image, ultrasound image, PET image, SPECT image, PET-CT image, SPECT-CT image, x-ray, MRI image, etc.), machine model(s) (e.g., model of treatment machine, model of patient supporting device, etc.), or any combination of the foregoing.

It should be noted that the method <NUM> and the apparatus <NUM> are advantageous because they allow a user to integrate treatment trajectories with imaging, while considering the type of treatment and the type of imaging, and the geometry of the patient (e.g., locations, sizes, and/or shapes of the target region and surrounding organs). The method <NUM> and the apparatus <NUM> also provide immediate feedback, input, and/or suggestion (regarding possible treatment trajectories) for treatment planning, in response to a user's selection of imaging waypoints. The method <NUM> and the apparatus <NUM> also may alternatively provide immediate feedback, input, and/or suggestion (regarding possible imaging scheme) for treatment planning, in response to a user's selection of treatment trajectories. The method <NUM> and the apparatus <NUM> are technological improvements over existing treatment planning devices and methods because it is believed that existing treatment planning devices and methods do not involve the intelligence and processing functions provided in embodiments of the method <NUM> and apparatus <NUM>.

Furthermore, the apparatus <NUM> may be configured to determine at what machine states (e.g., angles) it is safe to deploy an imager (e.g., a kV imager) and to acquire image(s). By means of non-limiting example, allowable machine states for acquiring image(s) may include: the deployment state of the kV imager, such as an angle of the arm carrying the imager, the deployment state of an imaging source, etc. Accordingly, imager may be deployed "on the fly" during a treatment session.

In addition, in some embodiments, the apparatus <NUM> may be configured to determine where images have been successfully acquired in previous similar treatments. For example, the apparatus <NUM> may include an input for receiving information regarding how previous images were obtained (e.g., where was the imaging source, and/or the imager, etc.). In another example, the apparatus <NUM> may be configured to track previous imaging configurations, and store information about those imaging configurations in a non-transitory medium. The information may then be later used by the apparatus <NUM> to determine quickly whether imaging is possible at a certain machine configuration during treatment session. The information may also be used by the apparatus <NUM> to quickly determine a treatment plan that includes imaging consideration.

Sometimes treatment may be interrupted before full radiation dose for the specific fraction is delivered. For example, if the patient <NUM> is sick and vomits during a treatment session, the treatment may be interrupted. After clinical evaluation, the treatment may be later continued to deliver the remaining planned dose in the fraction, to deliver the remaining dose in a new fraction, or to deliver a completely re-planned dose.

In some cases, component(s) of the treatment machine <NUM>, the patient supporting device <NUM>, component(s) of the imaging device <NUM>/<NUM>/<NUM>, or any combination of the foregoing, may be in positions where patient unloading is difficult or impossible. For example, if the patient supporting device <NUM> is at a very high position, it may be difficult to unload the patient <NUM> when the treatment is interrupted. As another example, an arm carrying a treatment radiation source <NUM> and/or an imaging source may be below the patient support <NUM> so that lowering of the patient support <NUM> cannot be achieved to unload the patient <NUM>.

A similar problem exists for loading the patient <NUM> when continuing a treatment that has been interrupted. Decision may be made that the remaining dose is to be delivered to the patient <NUM>. In such cases, the patient <NUM> may be loaded onto the patient support <NUM> in a safe loading position. For example, the patient support <NUM> should be at an elevation that is not too high so as to allow the patient <NUM> to be placed, or to get, on the patient support <NUM>. The patient support <NUM> should also be at a position relative to other components (e.g., gantry <NUM> of the treatment machine <NUM>, component of imaging device <NUM>/<NUM>/<NUM>, etc.), so that when the patient <NUM> is being loaded onto the patient support <NUM>, the patient <NUM> will not collide with any of those components. After the patient <NUM> is loaded onto the patient support <NUM>, the patient supporting device <NUM> may then be operated to position the patient support <NUM> at a location where the treatment can be continued.

Sometimes, it may be desirable to perform an imaging (e.g., cone beam CT imaging) before continuing the treatment. In such cases, the patient <NUM> may be loaded when the patient support <NUM> is at safe loading position. The patient supporting device <NUM> may then be operated to move the patient support <NUM> to an imaging position (e.g., imaging position associated with the imaging device <NUM>) for performing imaging. After the imaging is performed, the patient supporting device <NUM> may then be operated to move the patient support <NUM> to a treatment position (e.g., treatment position associated with the treatment machine <NUM>) where treatment energy may be delivered to the patient <NUM>.

In some embodiments, one or more components of the treatment system <NUM> may be operated to position the patient support <NUM> to a safe patient loading or unloading position. For example, the gantry <NUM> of the treatment machine <NUM>, and/or a component of an imaging device (e.g., device <NUM>, <NUM>, or <NUM>), may need to be moved out of the way, so that patient support <NUM> can be lowered. In some cases, it may not be easy to quickly figure out how the various components involved in the treatment process should be moved so that the patient support <NUM> can reach a safe loading or unloading position. Accordingly, in accordance with some embodiments, the treatment system <NUM> may include an apparatus (e.g., control) configured to automatically operate one or more of the components (e.g., component(s) of the treatment machine <NUM>, component(s) of an imaging device <NUM>/<NUM>/<NUM>, component(s) of the patient supporting device <NUM>, or any combination of the foregoing) to move the patient support <NUM> to a safe patient loading or unloading position.

In some cases, when treatment is interrupted, and the operation of the treatment machine <NUM> and the patient supporting device <NUM> is stopped, the components of the treatment machine <NUM>, components of an imaging device, and the components (including the patient support <NUM>) of the patient supporting device <NUM> are at certain positions. Given a desired unloading position for the patient support <NUM> to be achieved for unloading the patient, there may be many ways to operate the treatment machine <NUM>, imaging device, and the patient supporting device <NUM> in order to move the patient support <NUM> from the initial position (when the treatment is interrupted) to the desired position (for unloading the patient <NUM>).

In some embodiments, an apparatus is provided to determine a sequence of operations to control components of the treatment machine <NUM>, components of an imaging device, and the patient supporting device <NUM> in order to move the patient support <NUM> from an initial position to a desired final position. In one implementation, the apparatus may employ a shortest path algorithm (such as A* or Dijksta algorithm) to determine which component(s) to move, amount(s) of movement(s), and a sequence (order) of the movement(s) of the component(s). The apparatus may be configured to receive an initial set of coordinates, which are the current coordinates of the various moveable components (e.g., the gantry, arm, patient support <NUM>, etc.). The initial set of coordinates may be the positions of the various components when the treatment session is interrupted. In some cases, the initial set of coordinates includes the position of the patient support <NUM> when the treatment is stopped. The apparatus may also receive a final desired position of the patient support <NUM> to be achieved for unloading the patient. The apparatus utilizes the shortest path algorithm to determine how to move the component(s) to transfer the patient support <NUM> from the current position to the desired position (a safe location) for unloading the patient.

Similarly, in another mode of operation, the initial set of coordinates may be the positions of the various components when the patient support <NUM> is at a safe position for loading the patient <NUM>. In such cases, the apparatus may receive a desired set of coordinates of the various components to be achieved, which may include a desired position of the patient support <NUM>, for delivering treatment energy to the patient <NUM>. The apparatus utilizes the shortest path algorithm to determine how to move the component(s) to transfer the patient support <NUM> from the current position (loading position) to the desired position (treatment position) for treating the patient. For example, when treatment was interrupted, the gantry <NUM> may be at <NUM>° angle, and the patient support <NUM> may be at position (x = <NUM>, y = <NUM>, z = <NUM>, θx = <NUM>°, θy = <NUM>°, θz = <NUM>°). To unload the patient <NUM>, the gantry <NUM> may be moved to <NUM>° angle, and the patient support <NUM> may be moved to position (x = <NUM>, y = <NUM>, z = <NUM>, θx = <NUM>°, θy = <NUM>°, θz = <NUM>°). To resume treatment, the patient <NUM> may be loaded back to the patient support <NUM>, and the apparatus then determines a sequence of actions to move the patient support <NUM> back to the treatment position (which, in the above example, is x = <NUM>, y = <NUM>, z = <NUM>, θx = <NUM>°, θy = <NUM>°, θz = <NUM>°). The sequence of actions in the above example will also involve moving the gantry <NUM> from <NUM>° angle back to <NUM>° angle.

In other embodiments, instead of utilizing a shortest path algorithm, the apparatus may obtain a predetermined sequence of actions to be performed for moving the patient support <NUM> from an initial position to a desired position. For example, the predetermined sequence of actions may be:.

<FIG> illustrates a method <NUM> of operating a medical system in accordance with some embodiments. The medical system includes a treatment machine and a patient supporting device, such as the example shown in <FIG>. The method <NUM> may be performed by an apparatus configured to move the patient support <NUM> from an initial positon to a desired position. The method <NUM> of <FIG> includes obtaining a current position associated with the patient supporting device <NUM> (item <NUM>). In some embodiments, the current position may be the position of the patient support <NUM> when a treatment is interrupted. In other embodiments, the current position associated with the patient supporting device <NUM> may be the position of the patient support <NUM> when the patient <NUM> is being loaded at a safe location. In other embodiments, the current position may be one or more coordinates of one or more respective components of the patient supporting device <NUM>, when treatment is stopped (e.g., interrupted), or when the patient <NUM> is being loaded. In further embodiments, the current position may be a position Pp (e.g., with respect to a coordinate system, such as the coordinate system of the treatment machine <NUM> or the treatment system <NUM>) of a part of the patient <NUM> that is supported on the patient support <NUM>. The position P1 of the part of the patient <NUM> relative to a position Ps of the patient support <NUM> may be known in advance (i.e., Pp = Ps + p1). As such, the part of the patient <NUM> may be later positioned back to the position Pp by moving the patient support <NUM> to the position Ps (which is equal to Pp - P1).

Also, in some embodiments, the act of obtaining the current position may be performed by an input of an apparatus, which receives data representative of the current position. The data may be received from a device, which includes a user interface for allowing a user to enter the data. Alternatively, the data may be received from a position sensor or a position indicator, which is configured to determine the current position. It should be noted that as used in this specification, the term "position" may refer to one or more position(s), such as a position of a component of the patient supporting device <NUM>, or multiple positions of different components of the patient supporting device <NUM>.

Referring to <FIG>, the method <NUM> also includes obtaining a desired position associated with the patient supporting device <NUM> to be achieved (item <NUM>). In some embodiments, the desired position may be the position of the patient support <NUM> when treatment energy may be delivered to the patient <NUM>. In other embodiments, the desired position associated with the patient supporting device <NUM> may be the position of the patient support <NUM> when the patient <NUM> is being loaded or unloaded at a safe location. In other embodiments, the desired position may be one or more coordinates of one or more respective components of the patient supporting device <NUM>, when treatment is resumed, or when the patient <NUM> is being loaded or unloaded. In further embodiments, the desired position may be a position Pp (e.g., with respect to a coordinate system, such as the coordinate system of the treatment machine <NUM> or the treatment system <NUM>) of a part of the patient <NUM> that is supported on the patient support <NUM>. The position P1 of the part of the patient <NUM> relative to a position Ps of the patient support <NUM> may be known in advance (i.e., Pp = Ps + p1). As such, the part of the patient <NUM> may be later positioned to the position Pp by moving the patient support <NUM> to the position Ps (which is equal to Pp - P1).

Also, in some embodiments, the act of obtaining the desired position may be performed by an input of an apparatus, which receives data representative of the desired position. The data may be received from a device, which includes a user interface for allowing a user to enter the data. Alternatively, the data may be stored in a non-transitory medium. For example, the data may be stored in association with a treatment plan. In such cases, the act of obtaining the desired position may be performed by the apparatus that retrieves the data from the non-transitory medium.

Continuing with <FIG>, the method <NUM> further includes determining, by the apparatus (e.g., a trajectory module in the apparatus), trajectories for one or more components of the treatment system <NUM>, and an order of the trajectories, based on the current position and the desired position associated with the patient supporting device <NUM> (item <NUM>). For example, the apparatus may determine trajectories for the treatment machine <NUM> and for one or more components of the patient supporting device <NUM>, and an order of the trajectories, based on the current position and the desired position associated with the patient supporting device <NUM>. As used in this specification, the term "trajectory" may refer to a direction of movement for one or more components, an amount of the movement, or both. For example, a trajectory may be a rotation of an arm of the patient supporting device <NUM> by a certain angular range. As another example, a trajectory may be a translation of the patient support <NUM> in the x-direction by a certain distance. As a further example, a trajectory may be a rotation of the patient support <NUM> about a vertical axis by a certain angular range. In still a further example, a trajectory may be a rotation of the gantry <NUM> of the treatment machine <NUM> by a certain angular range.

In some cases, the trajectory module determines the trajectories and the order of the trajectories using a shortest-path algorithm. The trajectory module may be configured to obtain one or more parameters for determining the trajectories and the order of the trajectories. By means of non-limiting examples, the parameter(s) may include degrees of freedoms of the various components, movement speeds of the various components, movement constraint(s) of one or more of the components, or any combination of the foregoing. The components may be any of the components in the treatment system <NUM>, such as any of the components of the treatment machine <NUM>, any of the components of the patient positioning device <NUM>, any of the components of an imaging device, or any combination of the foregoing.

Also, in some embodiments, the trajectory module may be configured to perform an optimization to determine the trajectories and the order of the trajectories. The optimization may be performed with respect to one or more optimization objective(s). For example, the trajectory module may be configured to perform the optimization to determine the trajectories and the order of the trajectories that would result in the least amount of time to move the patient support <NUM> from the initial position to the desired position. As another example, the trajectory module may be configured to perform the optimization to determine the trajectories and the order of the trajectories that would result in the least amount of traveling distance and/or angular motion required by all of the components, or by one or more of the components, to move the patient support <NUM> from the initial position to the desired position. As another example, the trajectory module may be configured to perform the optimization to determine the trajectories and the order of the trajectories that would result in a reduced or a minimal number of stop-and-go movements for all of the components, or for one or more of the components of the treatment system <NUM>.

In addition, in some embodiments, the trajectory module may be configured to determine whether two or more components of the treatment system <NUM> may be simultaneously operated to move along two paths without interfering with each other. If so, the trajectory module may prescribe the two or more components be moved simultaneously in the order of the trajectories. Such technique may have the benefit of reducing the time it takes to move the patient support <NUM> from an initial position to a desired position.

Furthermore, in some embodiments, when performing the optimization, weights may be assigned to different components. For example, it may be desirable to reduce or minimize the amount of time that the patient support <NUM> moves, and/or the amount of distance to be travelled by the patient support <NUM>. In such cases, the patient support <NUM> may be assigned a relatively lower weight compared to other components.

After the trajectories for one or more components of the treatment machine <NUM> and for one or more components of the patient supporting device <NUM>, and an order of the trajectories have been determined, the trajectories and the order of the trajectories may be stored in a non-transitory medium. During use, the apparatus may retrieve the trajectories and the order of the trajectories, and use such information to control movements of the corresponding components.

Referring to <FIG>, the method <NUM> also includes operating the one or more components of the treatment system <NUM> based on the determined trajectories and the order of the trajectories (item <NUM>). For example, the apparatus may generate one or more control signals to operate one or more components of the treatment machine <NUM> and the one or more components of the patient supporting device <NUM>. In some embodiments, the act of operating the one or more components may include generating one or more control signals for operating the one or more components. The control signal(s) may cause one component to be operated after another component is operated (i.e., in sequence). Alternatively, the control signal(s) may cause two or more components to be operated simultaneously. In further embodiments, the control signal(s) may cause two or more components to be operated simultaneously during a part of an operation sequence, and may cause a component to be operated in sequence after another component is operated during another part of an operation sequence. Furthermore, in some embodiments, the act of operating the one or more components is performed in correspondence with the trajectories and order of the trajectories determined in item <NUM>.

In some cases, the act of operating the one or more components of the treatment machine <NUM> and the one or more components of the patient supporting device <NUM> may include moving one of the one or more components of the treatment machine <NUM> to open up a path for the one or more components of the patient supporting device <NUM>, and moving one of the one or more components of the patient supporting device <NUM> after the one of the one or more components of the treatment machine <NUM> is moved.

<FIG> illustrates an apparatus <NUM> for controlling a medical system in accordance with some embodiments. The medical system may comprise a treatment machine and a patient supporting device, such as the example shown in <FIG>. In some embodiments, the apparatus <NUM> may be used to perform the method <NUM> of <FIG>. Also, in some embodiments, the apparatus <NUM> may be a component of the processing unit <NUM>.

Referring to <FIG>, the apparatus <NUM> includes one or more input(s) <NUM> for obtaining a current position associated with the patient supporting device <NUM>, and a desired position associated with the patient supporting device <NUM> to be achieved. In some embodiments, the current position occurs when a treatment is stopped (e.g., interrupted), and the desired position is for unloading the patient <NUM> from the patient support <NUM>. In other embodiments, the current position is for loading the patient <NUM> onto the patient support <NUM>, and the desired position is for delivering treatment to the patient <NUM>. The apparatus <NUM> also includes a trajectory module <NUM> configured to determine trajectories for one or more components of the treatment system <NUM> (e.g., one or more components of the treatment machine <NUM>, one or more components of the patient supporting device <NUM>, one or more components of an imaging device, or any combination of the foregoing), and an order of the trajectories, based on the current position and the desired position associated with the patient supporting device <NUM> (e.g., a desired position of the patient support <NUM>). The apparatus <NUM> further includes a control signal generator <NUM> for outputting one or more control signal(s) to operate the one or more components of the treatment system <NUM> (e.g., one or more components of the treatment machine <NUM>, one or more components of the patient supporting device <NUM>, one or more components of an imaging device, or any combination of the foregoing) based on the determined trajectories and the order of the trajectories.

In some embodiments, the one or more input(s) may be configured to perform item <NUM> and/or item <NUM> of the method <NUM>.

Also, in some embodiments, the trajectory module <NUM> may be configured to perform item <NUM> of the method <NUM>. In some cases, the trajectory module <NUM> may be configured to determine the trajectories and the order of the trajectories using a shortest-path algorithm.

In addition, in some embodiments, the control signal generator <NUM> may be configured to perform item <NUM> of the method <NUM>. In some cases, the control signal generator <NUM> is configured to output the one or more control signal(s) to move one of the one or more components of the treatment machine <NUM> to open up a path for the one or more components of the patient supporting device <NUM>, and to move one of the one or more components of the patient supporting device <NUM> after the one of the one or more components of the treatment machine <NUM> is moved.

In some embodiments, the apparatus <NUM> may also include a non-transitory medium <NUM> for storing the current position associated with the patient supporting device <NUM>, the desired position associated with the patient supporting device <NUM>, the trajectories determined by the trajectory module <NUM>, the order of the trajectories, or any combination of the foregoing. Although the non-transitory medium <NUM> is illustrated to be in the apparatus <NUM>, in other embodiments, the non-transitory medium <NUM> may be outside the apparatus <NUM> and is communicatively coupled to the apparatus <NUM>.

Also, in some embodiments, the apparatus <NUM> may include a user interface <NUM> for receiving one or more input from a user. For example, a user may use the user interface <NUM> to enter desired position for the patient support <NUM>. The user may also use the user interface <NUM> to input one or more parameters for allowing the apparatus <NUM> to perform an optimization to determine trajectories for the one or more components of the treatment system <NUM> and an order of the trajectories.

In addition, in some embodiments, the user interface <NUM> may include one or more control for allowing a user to stop a treatment (e.g., to interrupt a treatment).

After the treatment is stopped, and after the trajectory module <NUM> determines the trajectories for the component(s) of the treatment system <NUM> and the order of the trajectories, the user interface <NUM> may then allow a user to enter a command to operate the treatment system <NUM> so that the determined trajectories may be executed in accordance with the determined order of the trajectories. For example, the user interface <NUM> may ask the user whether to move the patient support <NUM> to a safe loading position. If the user selects a control to indicate that such is desired, the control signal generator <NUM> may then execute the trajectories to move the patient support <NUM> from its initial position when treatment is stopped to a desired position. Thus, the user does not need to specify which component(s) of the treatment system <NUM> to move, does not need to specify which direction(s) to move the component(s), does not need to specify range(s) of motion(s) for the component(s), and does not need to specify the order of the movements of the components. In other words, the user operation is independent of the direction(s) and range(s) of movement of the component(s).

In the above embodiments, the user interface <NUM> allows the user to enter a single command for executing all of the trajectories in the sequence. In other embodiments, the user interface <NUM> may allow a user to enter multiple commands for executing the trajectories. For example, assuming that the trajectories and the order of the trajectories are determined by the trajectory module <NUM> as follow:.

Following the above example, the user interface <NUM> may allow a user to enter a first command to execute trajectories (<NUM>), a second command to execute trajectories (<NUM>), and a third command to execute the trajectory (<NUM>). In one implementation, the first command may be a selection of a "proceed" option, which when selected, will cause the apparatus <NUM> to operate the treatment system <NUM> to perform the trajectories (<NUM>). After the trajectories (<NUM>) above have been performed, the operation of the treatment system <NUM> to move its components is stopped, and will not continue until the user enters a second command through the user interface <NUM>. In response to the user entering the second command, the apparatus <NUM> then operates the treatment system <NUM> to perform the trajectories (<NUM>) in the above example. After the trajectories (<NUM>) above have been performed, the operation of the treatment system <NUM> to move its component is again stopped, and will not continue until the user enters a third command through the user interface <NUM>. In response to the user entering the third command, the apparatus <NUM> then operates the treatment system <NUM> to perform the trajectory (<NUM>) in the above example. In this example, each of the user commands is independent of the corresponding trajectory / trajectories in the sense that the user command does not specify the direction(s) and range(s) of motion for the trajectory / trajectories. Also, the above feature of allowing a user to approve one or more trajectories before executing them is advantageous because if the user notices that a certain trajectory may be undesirable, the user will have the option of terminating the operation of the treatment system <NUM>.

In the above examples, the trajectories were described with reference to moving the patient support <NUM> from an initial position where treatment is stopped to a desired position for unloading the patient <NUM>. Alternative, the trajectories may be for moving the patient support <NUM> from an initial position where the patient <NUM> is loaded onto the patient support <NUM> to a desired position where treatment can be delivered to the patient <NUM>.

It should be noted that the automatic movement feature of the patient supporting device <NUM> is advantageous because it obviates the need for a user to determine which components of the patient supporting device <NUM> to move, it obviates the need for a user to determine the direction and extent of the movement of the component(s) of the patient supporting device <NUM>, and/or it obviates the need for a user to determine an order of movements for the various components of the patient supporting device <NUM>. The patient supporting device <NUM> is a technological improvement over existing patient supporting devices because it is believed that existing patient supporting devices do not have the intelligence and processing functions provided in embodiments of the patient supporting device <NUM>.

<FIG> is a block diagram illustrating an embodiment of a specialized processing system <NUM> that can be used to implement various embodiments described herein. For example, the processing system <NUM> may be configured to operate the patient supporting device <NUM> in accordance with some embodiments. Also, in some embodiments, the processing system <NUM> may be used to implement the control for the patient supporting device <NUM> and/or the processing unit <NUM> of <FIG>. The processing system <NUM> may also be an example of the apparatus <NUM> and/or the apparatus <NUM>. The processing system <NUM> may also be any processor described herein.

Processing system <NUM> includes a bus <NUM> or other communication mechanism for communicating information, and a processor <NUM> coupled with the bus <NUM> for processing information. The processor system <NUM> also includes a main memory <NUM>, such as a random access memory (RAM) or other dynamic storage device, coupled to the bus <NUM> for storing information and instructions to be executed by the processor <NUM>. The main memory <NUM> also may be used for storing temporary variables or other intermediate information during execution of instructions to be executed by the processor <NUM>. The processor system <NUM> further includes a read only memory (ROM) <NUM> or other static storage device coupled to the bus <NUM> for storing static information and instructions for the processor <NUM>. A data storage device <NUM>, such as a magnetic disk or optical disk, is provided and coupled to the bus <NUM> for storing information and instructions.

The processor system <NUM> may be coupled via the bus <NUM> to a display <NUM>, such as a cathode ray tube (CRT), for displaying information to a user. An input device <NUM>, including alphanumeric and other keys, is coupled to the bus <NUM> for communicating information and command selections to processor <NUM>.

In some embodiments, the processor system <NUM> can be used to perform various functions described herein. According to some embodiments, such use is provided by processor system <NUM> in response to processor <NUM> executing one or more sequences of one or more instructions contained in the main memory <NUM>. Those skilled in the art will know how to prepare such instructions based on the functions and methods described herein. Such instructions may be read into the main memory <NUM> from another processor-readable medium, such as storage device <NUM>. Execution of the sequences of instructions contained in the main memory <NUM> causes the processor <NUM> to perform the process steps described herein. One or more processors in a multiprocessing arrangement may also be employed to execute the sequences of instructions contained in the main memory <NUM>. In alternative embodiments, hard-wired circuitry may be used in place of or in combination with software instructions to implement the various embodiments described herein. Thus, embodiments are not limited to any specific combination of hardware circuitry and software.

The term "processor-readable medium" as used herein refers to any medium that participates in providing instructions to the processor <NUM> for execution. Such a medium may take many forms, including but not limited to, non-volatile media, volatile media, and transmission media. Non-volatile media includes, for example, optical or magnetic disks, such as the storage device <NUM>. A non-volatile medium may be considered an example of non-transitory medium. Volatile media includes dynamic memory, such as the main memory <NUM>. A volatile medium may be considered an example of non-transitory medium. Transmission media includes coaxial cables, copper wire and fiber optics, including the wires that comprise the bus <NUM>. Transmission media can also take the form of acoustic or light waves, such as those generated during radio wave and infrared data communications.

Common forms of processor-readable media include, for example, a floppy disk, a flexible disk, hard disk, magnetic tape, or any other magnetic medium, a CD-ROM, any other optical medium, punch cards, paper tape, any other physical medium with patterns of holes, a RAM, a PROM, and EPROM, a FLASH-EPROM, any other memory chip or cartridge, a carrier wave as described hereinafter, or any other medium from which a processor can read.

Various forms of processor-readable media may be involved in carrying one or more sequences of one or more instructions to the processor <NUM> for execution. For example, the instructions may initially be carried on a magnetic disk of a remote computer. A modem local to the processing system <NUM> can receive the data on the telephone line and use an infrared transmitter to convert the data to an infrared signal. An infrared detector coupled to the bus <NUM> can receive the data carried in the infrared signal and place the data on the bus <NUM>. The bus <NUM> carries the data to the main memory <NUM>, from which the processor <NUM> retrieves and executes the instructions. The instructions received by the main memory <NUM> may optionally be stored on the storage device <NUM> either before or after execution by the processor <NUM>.

The processing system <NUM> also includes a communication interface <NUM> coupled to the bus <NUM>. The communication interface <NUM> provides a two-way data communication coupling to a network link <NUM> that is connected to a local network <NUM>. For example, the communication interface <NUM> may be an integrated services digital network (ISDN) card or a modem to provide a data communication connection to a corresponding type of telephone line. As another example, the communication interface <NUM> may be a local area network (LAN) card to provide a data communication connection to a compatible LAN. In any such implementation, the communication interface <NUM> sends and receives electrical, electromagnetic or optical signals that carry data streams representing various types of information.

The network link <NUM> typically provides data communication through one or more networks to other devices. For example, the network link <NUM> may provide a connection through local network <NUM> to a host computer <NUM> or to equipment <NUM> such as a radiation beam source or a switch operatively coupled to a radiation beam source. The data streams transported over the network link <NUM> can comprise electrical, electromagnetic or optical signals. The signals through the various networks and the signals on the network link <NUM> and through the communication interface <NUM>, which carry data to and from the processing system <NUM>, are exemplary forms of carrier waves transporting the information. The processing system <NUM> can send messages and receive data, including program code, through the network(s), the network link <NUM>, and the communication interface <NUM>.

Claim 1:
An apparatus for creating a radiation treatment plan for execution by a radiation treatment machine, comprising:
a waypoint module configured to obtain imaging waypoint data representing imaging waypoints;
a treatment trajectory module configured to obtain treatment data at least partially defining a beam-on direction; and
a treatment plan generator configured to create the radiation treatment plan based at least in part on the imaging waypoint data and the treatment data;
characterized in that:
at least one of the imaging waypoints:
(i) refers to, represents and/or is associated with a point in time where imaging is possible; or
(ii) represents an instantaneous temporal opportunity to acquire one or more images.