Accuray Precision®

Treatment Planning SystemFor CyberKnife® and Radixact®/TomoTherapy® Systems

Madhavi KapaDirector, Product StrategyAccuray Incorporated

Accuray Live Session at AAMDJune 9, 2021

2Proprietary and Confidential Property of Accuray

Fully integrated treatment planning, treatment delivery and data management systemsIntegrated Software Platform

3Proprietary and Confidential Property of Accuray

Enabling interoperability in Radiation Oncology departmentsBenefits of Accuray Precision® and iDMS®

Increased flexibility for treatment efficiencyIntegrated treatment planning and data access for all Accuray delivery systemsEnables plan sharing across TomoTherapy® / Radixact® systems

Integrated departmental workflowOIS connectivityAdaptive solutionsRayStation & RayCare connectivity

Peace of mindData security & privacyStorage capacity with disaster recovery

Reduce the cost of downtimeRemote machine diagnostics with iLink

4Proprietary and Confidential Property of Accuray 4Proprietary and Confidential Property of Accuray

OIS Interoperability with iDMS® OIS Connect™V A R I A N A R I A ® , E L E K T A M O S A I Q , R A Y S E A R C H R a y C a r e ®

Accuray Radixact, TomoTherapy & CyberKnife systems have vendor-neutral OIS connectivity

• Workflow integration with OIS– Varian ARIA, Elekta MOSAIQ, RaySearch

RayCare• Treatment scheduling on the OIS

• Automatic treatment capture on the OIS– Including dose recording and

accumulation• Charge capture and billing

• Offline review of TomoTherapy® and Radixact® System’s MVCT images and registrations (ARIA, RayCare)

• Integration with electronic medical records

iDMS®

• Vital Signs• Physician,

Clinician• Hospital• Insurance• Radiology

Reports• Laboratory

Data• Prescription• Treatment• Diagnosis• Investigations

Radiation Oncology Department

5Proprietary and Confidential Property of Accuray

Accuray Precision®

Treatment Planning & Adaptive Therapy Solutions

6Proprietary and Confidential Property of Accuray

Integrated and Powerful features and capabilitiesAccuray Precision® Treatment Planning

RegistrationStandard rigid and advanced deformable registration algorithmsManual registrationMulti-modality support: CT, PET-CT, MRI, 3D rotational angiography

ContouringAuto segmentation for Brain, Head & Neck, & Male PelvisIntuitive contouring toolsFull CT resolution supported

Plan creationRadixact®/TomoTherapy®: TomoHelical, TomoDirect, SBRT, IMRT, 3D CRT, Forward planningCyberKnife®: SRS, SBRT, IMRT

Motion SynchronizationTrack, Detect, Correct for motionPlanning for Synchrony® real-time delivery adaptation on CyberKnife and Radixact/TomoTherapy systems

Optimization & Dose calculation VOLOTM GPU based optimization for CyberKnife & Radixact/TomoTherapyRadixact/TomoTherapy: Collapsed Cone Convolution, Convolution SuperpositionCyberKnife: Finite Size Pencil Beam, RayTracing, Monte Carlo

Plan Review & ApprovalPlan comparisonAdvanced visualization toolsPlan summation

7Proprietary and Confidential Property of Accuray

PreciseART® Automated Adaptive Dose Trending & Replanning

• Dose to target may no longer meet plan objectives

Adapt to potentially improve tumor control

• Dose to sensitive structures may exceed constraints

Adapt to potentially reduce side effects

Images shown from Li, Allen. “Adaptive Radiation Therapy”, CRC Press, 2020

VOI Volume vs. Time

Automatic Deformation; Delivery Dashboard

Planning CT(Day 1)

Midcourse(3 weeks)

8Proprietary and Confidential Property of Accuray

Accuray Deformable Image Registration (DIR) algorithm• Used in auto-segmentation & image registration

applications for CT and MR image sets

Robust image matching even in the presence of intensity inhomogeneities and artifacts1

When applied to adaptive treatment management, algorithm can be expected to auto-propagate Head and Neck contours adequately within the recommended TG-132 tolerances2

Automates key processes for adaptive dose monitoringPreciseART® Adaptive Radiation Therapy

For patients enrolled in Adaptive Therapy

Generates trends/projected

data & user defined reports

Accumulates daily dose onto planning

CT

Calculates dose on daily image

Deforms planning VOIs onto daily

image

Generates merged daily image

Automated Workflow

Review and decide

1 Li, Allen, PreciseART white paper by Froedtert and Medical College of Wisconsin (Available from Accuray) 2 Boyd, Robert et al, “Validation of accuracy deformable image registration contour propagation using a benchmark

virtual HN phantom dataset”, Journal of Applied Clinical Medical Physics, 2021

9Proprietary and Confidential Property of Accuray

Ability to review results quickly to decide whether to adapt or not & replan as necessaryPreciseART® Adaptive Dose Monitoring & Replanning

Dashboard for fast, easy review of each enrolled patient, including status of each delivered fraction

Green = Fulfilled all user constraintsYellow = Marginal pass Red = Failed 1 or more constraints

Patients

Fractions

Review the daily dose (plan re-calculated on the daily registration image with deformed

contours), relative to the planned dose

If a need to adapt is indicated• Create a new adapted plan with

PreciseRTX® module, using original plan data mapped to a new planning CT

o Deform original plan contours

o Export accumulated dose as isodose contours to inform new plan

o Use Plan Template from original treatment plan to efficiently develop the new adapted plan

Continue the adaptive monitoring workflow process• Software accumulates dose across

original and all new re-plans

Patient Dashboard Review Results Adaptive Replanning

10Proprietary and Confidential Property of Accuray

CyberKnife® Treatment PlanningFor SRS, SBRT and IMRT treatments

Overview and Demo

11Proprietary and Confidential Property of Accuray

The CyberKnife® S7™ System Differentiators

Robotic systemNon-coplanar delivery, sub-

millimeter accuracy and widest range

of motion

Intra-fraction imaging

Knowledge of tumor position throughout

treatment

True dynamic tracking and

correctionAutomatic

real-time adaptation to target motion

Maximizedelivered dose

to targetMinimize dose

to healthy tissueMaximize patient

comfort

+ + =

12Proprietary and Confidential Property of Accuray

CyberKnife® Indications

Powered by VOLOTM with GPU based optimizationCyberKnife® Treatment Planning (SRS, SBRT, IMRT)

• Shorter treatment times • Familiar planning technique with

non-coplanar beams advantage• Smaller margins with Synchrony®

tracking• Fast converging plan optimization

for MLC, Iris™ and fixed cones• Interactive, real-time tradeoff

exploration• Monte Carlo dose computation• Latest release supports

• Dose fall off function (NTO)• Mean dose objective for OARs• Plan quality criteria (Plan scorecard)

Non-coplanar beams: Brain mets example

13Proprietary and Confidential Property of Accuray

• Center in central Pennsylvania providing radiosurgery treatments

• Case Mix• Cancerous and non-cancerous tumors anywhere in the body,

when surgery is not appropriate or desirable• Including: Head and neck, Spine, Liver, Pancreas, Prostate, Lung,

and other soft tissues

• Benefits of the Accuray Precision® upgrade• Optimization is faster than sequential optimization• Increased patient volume by ~60%• Increased planning efficiency and department efficiency• Improved patient comfort

Benefits of Faster planning and Faster treatment timesCyberKnife® VOLOTM Customer Experiences

Courtesy of Hong F. Xiang, Ph.D. Penn Medicine/Lancaster General Health

• Dedicated SRS, SBRT, SABR center• Serving Nevada, Southern Utah and Northern Arizona

• Case Mix• Lung, Liver, Pancreas, Kidney, Thoracic, Abdomen & Pelvic lymph

nodes, Prostate, Malignant brain tumors, Spine, and various intracranial benign conditions

• Benefits of the Accuray Precision upgrade1

• Ability to treat almost twice the patients within the same time window

• Planning time reduced to 20-30 minutes from hours• Planning accuracy increased with deformable fusion • Retreatment planning efficiency increased by PreciseRTX®

1 Case Study Las Vegas CyberKnife Experience with CyberKnife VOLO Optimization: Increase in patient throughput & daily volumes (Available from Accuray)

14Proprietary and Confidential Property of Accuray

Planning with Monte Carlo calculation is fasterStanford CyberKnife® Experience

“Typically, 15-30 minutes including optimization and final dose calculation”

Lung: 50 Gy in 4 fractions

Treatment time: 18 minutes

Courtesy of Lei Wang, Stanford University

15Proprietary and Confidential Property of Accuray

CyberKnife® System with InCise™ 2 MLCEpic Care CyberKnife® Experience

PET/CT prior to Treatment

PET/CT 6 weeks after

Treatment

• 88-year-old female patient with history of smoking and multiple co-morbidities

• Not considered surgical candidate

• 33 robotically-delivered non-coplanar beams• Synchrony® Respiratory Tracking• 34Gy delivered in a single fraction• Patient had no side effects

Courtesy of Gautam Prasad, MD. Epic Care CyberKnife

Inoperable Lung Cancer

16Proprietary and Confidential Property of Accuray

CyberKnife® System with InCise™ 2 MLCEpic Care CyberKnife® Experience

• 79-year-old male with a highly active lifestyle• Patient opted for CyberKnife® due to convenience

• 45 robotically-delivered non-coplanar beams• Five treatments taking ~ 15 min each• Injection of hydrogel between rectum/prostate

helps minimize toxicity

Courtesy of Gautam Prasad, MD. Epic Care CyberKnife

Intermediate Risk Prostate Cancer

Thank you