Organ motion and daily patient setup variations can result in inter-fraction target location discrepancies. ACCULOC uses image guidance to achieve sub-millimeter target localization, allowing unparalleled tumor control and sparing of surrounding healthy tissue.
ACCULOC pioneered IGRT with the introduction of this technology for stereotactic radiotherapy precision localization in 1991. Now there are over one hundred SRS/SRT and IMRT users of this system in the U.S. and worldwide.
 Using either implanted gold markers or anatomic landmarks and your choice of imaging modalities, the systems ISOLOC™ software utilizes a true 3D algorithm to calculate the precise couch shifts necessary – in all three axes – to move the target into isocenter just prior to treatment delivery.
• ISOLOC™ software utilizes a true 3D algorithm, providing rotational data and accurate three-dimensional target location information.
• ISOLOC software utilizes the user’s choice of two localization methods, implanted gold fiduciary markers or anatomic landmarks to fit the application:
• Implanted Gold Fiduciary Markers - Markers are particularly useful for organs that move with respect to bony anatomy (e.g. liver, prostate) and for high-precision cranial applications (e.g. stereotactic radiotherapy). ISOLOC allows the user to simply identify the markers in a pair of images with a click of the mouse, which are then used to calculate the couch shifts. A variety of soft tissue, bone, and suture-type markers are available, see page 5 LN for details.
• Anatomic Landmarks - Anatomic landmarks provide a less invasive method, and are useful for tumors that are fixed in respect to bony anatomy (e.g. head/neck/brain). It allows the user to designate unique anatomic landmarks in the treatment planning system’s digitally reconstructed radiograph (DRR). These points are then identified daily on the portal images and used to calculate the couch shifts.
• ACCULOC accommodates a range of imaging modalities, including EPID (electronic portal imaging devices), conventional film, and CR (computed radiography). Future developments will include a kV option.
• Image pairs imported into the ISOLOC software for pre-treatment localization do not have to be orthogonal – for example, images may be taken at any angle to better accommodate larger patients or patients with implants, etc.
• ISOLOC’s couch translation feature outputs sub-millimeter table shifts, providing the exact couch coordinates necessary for precise patient/target location.
• The entire process adds less than two minutes to the patient’s daily treatment delivery time. | | |  |  | | Cranium | Spine |  |  | | Liver | Prostate |
Upcoming enhancements to ACCULOC’s software, available as options with ISOLOC 6.1 include:
• Auto centering - once a point on the EPID image is identified by the user with the click of the mouse, the software will automatically center on the brightest spot, reducing any potential inter-user and daily digitization offsets.
• Point dose information, available in the dual panel window.
• Ability to input coordinate information at a separate or networked PC without starting the software.
• Ability to utilize more than three implanted gold markers at a tumor location.
• Automatic DRR-EPID registration.
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