Use of robots to improve patients' treatment and throughput
Reporter: Arpi Thukral, MD MPH
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: May 12, 2011
Presenter: Regis Ferrand Presenter's Affiliation: Institut Curie-Centre de Protontherapie d'Orsay
The purpose of this presentation was to provide an overview of the 15-20 year history of the use of robotic couches at Institut Curie-Centre de Protontherapie d'Orsay (CPO).
In the past 15 years, use of robotic positioning has developed tremendously in radiation therapy, particularly in particle therapy.
The challenge of robotic positioning is that it must be fast and precise.
Need 6 degrees of freedom, long range motion <0.5 mm, with smooth trajectories
Need high repeatibility for QA checks and calibration
Short range of motion: 0.2 mm
Ability to load/unload patient
Need to use a combination of fields
Fast detection of unexpected motion
Collision avoidance/back to safe position
History of robots
Before 1990: prototypes: MGH/HCL chair or eye chairs (CPO, PSI, MGH, Nice)
1995-2003 – 6 axis robot based (ex. MPRI)
2003-2009 – Scara-based, hexapode based
2010 – new hybrid designs (Poros PPS, Toshiba PPS)
Extended use of robots besides patient postioning:
MPRI snouth changer
Trolleys (PSI, automated in Essen)
Use of robots to calibrate devices inside the treatment room
Chair and couch
The CPO modest experience of 20 years:
The CPO has been working on 4 different robots since 1990. These include:
Hexapodes (original in 1991 and new version in 2006)
accuracy <0.2 mm with limited range through +/- 10 degrees
2006 version has 360 degree vertical rotation
not ideal for long range motion
6 axis based (1995)
accuracy approx 3 mm
The biggest advantage of this type is repeatibility.
Scara based (Forte/Procure)
Approx 0.5 mm precision
New pit free prototype
Developed within the frame of a research project.
Intrinisic high precision (+/- 0.5 mm accuracy over long range movements)
Ability to align patient inside and outside room
Water tank permanently ready to use
Lessons learned from 20 year experience at CPO:
Except for hexapode, the intrinsic precision is NOT sufficient
Calibration is mandatory and takes time.
Robot has high potential and is designed for guidance.
Has incredible robustness (only 3 problems in 15 years at CPO, likely due to neutrons)
New robotic concepts: (ex. Poros prototype, patented):
Increased working envelope
Intrinsic precision enhanced
Reduced cycle (20 ms) – dynamic motion
Hardware redundant saftely systems
Natural ability for: alignment inside/outside and adaptive therapy
Simultaneous multi-PAS guidance
Definition of true postioning strategy at the OIS level.
To compare proton and proton treatment, we need to dramatically improve the treatment process for protons (and not only the beam).
Robotic patient positioners have proven their potential to play a key role in this process.
However, there are still many advances that need to be made in this field for proton therapy.
The author of this presentation clearly highlighted the history and advances made in the last 2 decades regarding the use of robotic technology to improve patient treatment and throughput in the proton arena.
Robots play a key role in patient positioning, which in turn translates to greater efficiency in patient throughput.
From this overview, we are able to assess the value and limitations of robotic patient positioning. This will help guide the development of future robotic technology for particle therapy.
Future studies may focus not only on improving this technology, but also advancing it in terms of image guidance, safety and dynamic motion.
Furthermore, efforts to adapt a global positioning process to specific clinical protocols are underway.
Mar 7, 2014 - Robot-assisted radical prostatectomy is associated with improved surgical margin status compared with open radical prostatectomy for intermediate- and high-risk disease and with less use of additional cancer therapy, according to a study published online March 4 in European Urology.