Adding A new dimension to treAtment plAnning for rAdiAtion therApy

introdUCing rAystAtion
Highly intuitive IMRT planning with unique multi-criteria optimization Proven IMRT optimization using direct machine parameter optimization Versatile VMAT optimization for any linear accelerator

Optimize gantry, couch and collimators for conventional 3D-CRT

Fast automated contouring of multiple regions simultaneously with model-based segmentation

Ultrafast multipurpose optimization engine

Track delivered dose using deformable dose accumulation

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Comprehensive framework for four-dimensional adaptive radiation therapy

IMPT optimization accounting for range and position uncertainties

Proton dose calculation using Monte Carlo

Efficient workflow using latest GUI design techniques

Electron dose calculation using Monte Carlo

Powerful and fully supported scripting tools to automate and customize workflow

Works with Windows PCs on flexible network infrastructure with true floating licenses

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InTRODUCInG RAySTATIOn A brand new treatment planning system for radiation therapy, created from well proven algorithms. Built on a 4D platform, RayStation brings unique functionality that you wont find in any other treatment planning system. This comprehensive system handles 3D-CRT, IMRT, VMAT, proton therapy and 4D adaptive radiation therapy, for any treatment machine. It also contains all relevant advanced image processing tools such as automated segmentation and deformable registration and handles all imaging modalities. In brief: RayStation contains everything a stateof-the-art facility would need for treatment planning in one software platform. However, RayStation can also be packaged and licensed in a modular fashion to fit the needs of any radiation oncology clinic. RaySearchs goal is to further optimize the treatment planning process for radiation therapy, looking for tools to make the software safer, faster and better, while maintaining ease of use. The modern user interface is carefully designed to present only relevant and intelligible options and properties, while minimizing the effort for the user to complete any workflow. The core of the system is the well tested ORBIT software framework. This world leading optimization platform has been in clinical use as the underlying engine in various systems for more than a decade at over 1,800 clinics worldwide.Throughout, RayStation and the ORBIT framework are based on sound mathematical and physical properties. No corners have been cut in the design of the computational algorithms. This strong foundation makes it possible to combine all delivery techniques and all types of optimization functions. This also enables RayStation to quickly adapt to new developments in the delivery hardware such as VMAT. ADVAnCInG TREATMEnT PLAnnInG FOR THE BEnEFIT OF ALL PLAyERS Physicians can combine, compare and evaluate different treatment modalities on a single integrated RayStation system. They can also conveniently compare multiple plans. With multicriteria optimization (MCO) for IMRT, the radiation oncologist can even balance between different treatment tradeoffs instantly. Hospital management will find that the modular and open design of RayStation makes it possible to find the perfect combinations of capabilities without getting stuck with time-consuming transfers between systems. RayStation is also very flexible in terms of hardware requirements. It can be implemented as a stand-alone workstation on ordinary PCs, or on a network infrastructure with virtualized database, application servers and thin clients. The license model supports floating licenses to ensure cost effective installations. RayStation is also the perfect vehicle for research purposes. Its built-in research interface and Python scripting tools are designed to allow customization by direct interaction with core algorithms. Finally, physicists will find the commissioning and quality assurance tools simplified and straight forward. With transparent modeling, the commissioning process is highly automated, but still allows the physicists to control how the beam is characterized. CLInICALLy VALIDATED In nORTH AMERICA AnD EUROPE The first patient treatment with RayStation was carried out at the Massachusetts General Hospital Radiation Oncology Department in Boston and the first European patient was treated at RISO, The Radiotherapeutic Institute in Deventer, the Netherlands. RayStation is an entirely new system with a lot of interesting features and a modern workflow. We have validated the system thoroughly and are very happy with the accuracy and the quality of the plans generated. The system is fast and easy to use and gives us the possibility to create high quality IMRT plans, says Rik Westendorp, medical physicist at RISO. ADDInG A nEW DIMEnSIOn TO TREATMEnT PLAnnInG SEE FOR yOURSELF! RaySearchs foundation rests on innovation, and our commitment is always to deliver performance above the standard for our industry. We are constantly pushing the limits and RayStation is a big leap forward. RayStation is not only a new generation, it takes treatment planning to a whole new level. On the following pages, you will see some examples of the unique versatility of the RayStation system. To further explore what RayStation can do for you and your clinic please contact us for a demonstration.

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versAtile vmAt optimizAtion

RAySEARCHS PROVEn VMAT treatment planning algorithm is the most flexible solution available today, allowing clinicians to create single or multiple-arc plans for Elekta, Varian and Siemens linear accelerators. By constraining the algorithm to use constant dose rate, it can even be used to optimize plans for VMAT delivery with linear accelerators that have not been upgraded for VMAT. By direct and simultaneous optimization of all available VMAT treatment parameters, such as dose rate and MLC leaf positions, while ensuring the fulfillment of accelerator constraints, such as maximum leaf speed, treatment plans with outstanding quality can be achieved. The advantage of the direct machine parameter optimization approach is that the plan remains feasible and deliverable throughout the optimization process, thus eliminating any quality-degrading post-processing step.

proven imrt optimizAtion

SOFTWARE FOR OPTIMIzATIOn of IMRT was the starting point of RaySearch. The first IMRT product was released in 2001 as a plug-in module to Philips Pinnacle3 treatment planning system and since 2004 RaySearchs IMRT solutions also exist in Nucletrons treatment planning system Oncentra. The proven IMRT technology from RaySearch provides clinicians in over 1,800 radiation therapy centers around the world, with state-of-the-art tools to design high quality IMRT treatment plans. The RayStation IMRT optimization module is the result of over two decades of advanced development and fine tuning. The clinical requirements on a treatment plan are specified by defining any feasible combination of dose volume and radiobiological objectives and constraints. Thanks to direct optimization of step-and-shoot segments, i.e. the aperture shape and weight of each segment, the delivery time can be significantly reduced without compromising the treatment quality. As the optimizer is aware of the physical limitations of the linear accelerator during the optimization process, it is able to make more effective compromises and can thereby reduce the number of required segments by as much as fifty percent. Furthermore, since the plan is always deliverable during optimization with no need for post processing, there will be fewer re-runs which in turn leads to a faster planning procedure.

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optimizing 3d-Crt
THE RAySTATIOn 3D-CRT optimization module brings inverse planning to conventional radiation therapy. It enables the clinician to simultaneously optimize all available degrees of freedom in three-dimensional conformal treatments: beam weights, aperture shapes, as well as collimator-, gantry-, couch- and wedge angles. The clinician can select any subset of parameters to be optimized while the others stay fixed according to the beam setup. With 3D-CRT optimization, a vast space of alternative beam configurations can be explored quickly and an optimal plan is produced within minutes.This makes it easy for the planner to achieve excellent plan quality with a high level of consistency.

mUltiCriteriA optimizAtion
THE MULTICRITERIA OPTIMIzATIOn (MCO) functionality in RayStation aims at making the treatment planning procedure more intuitive and time-efficient as well as providing tools for exploring the inherent trade-offs present in the treatment plans. MCO eliminates the need for importance weights in the objective function and the time-consuming iterative adjustments of these weights. Instead of having to perform a series of optimization runs to find the appropriate balance between different objectives, the user can explore the solution space in real time. With RayStation, this very powerful feature is now available for the first time in a commercial treatment planning system. The MCO planning procedure is carried out in the following way: based on the specified clinical criteria, a set of so-called Pareto plans are automatically generated. These plans are used as input to an interactive navigation tool where the planner or physician can manipulate sliders in real time to assess the impact of dose adjustments to relevant regions of interest. This enables clinical decisions during plan creation, which dramatically speeds up the planning process. The MCO functionality has been enhanced by the findings from a research collaboration on MCO with Massachusetts General Hospital.

Fractionation schedule
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rAdiobiologiCAl optimizAtion
USInG RADIOBIOLOGICAL RESPOnSE MODELS brings the planning process closer to the original intent of the planner, i.e. to create the plan that has the highest probability of curing the patient while minimizing the risks of complications to the surrounding healthy tissue. The system may also be asked to maximize tumor control probability while keeping the risk of complications below certain levels. Furthermore, the radiobiological objectives and constraints can be combined with physical requirements on the dose distribution such as maximum dose or dose uniformity. The results can always be assessed with traditional tools such as DVHs to understand the implications of a solution. RayStation contains all relevant radiobiological models, including models for tissue repair and tumor growth. This makes it possible to evaluate the effects of different fractionation schedules as well as effects of unforeseen interruptions in the treatment delivery.
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proton therApy optimizAtion

InTRODUCInG PROTOn PLAnnInG In RAySTATIOn Advanced treatment planning tools play a key role in todays proton therapy. The RayStation proton therapy optimization module brings RaySearchs proven technology into the field of proton treatment planning. The powerful optimization engine and the four-dimensional architecture of RayStation make it an ideal platform to meet the substantial requirements that advanced proton therapy puts on a treatment planning system. RayStation is the perfect tool for creating photon/proton boost plans. The optimization of the boost can optionally be independent of the base dose, or use it as pretreated dose. COMPREHEnSIVE TOOL BOx The proton module in RayStation supports a variety of proton treatment modalities and beam lines, such as pencil beam scanning (PBS), uniform scanning, and double and single scattering. The dose calculation is performed either with a Monte Carlo algorithm, or with a Fermi-Eyges-based pencil beam algorithm, both of which can be used within the optimization loop and for final dose calculation. For PBS, the optimization tools include IMPT, single field uniform dose and distal edge tracking. For passively-scattered proton therapy, modern tools help the user create clinical treatment plans and subsequent milling machine instructions in an efficient manner, including the fully automated creation of compensators and blocks with the possibility of manual editing. A unique capability of RayStation is the possibility to create PBS treatment plans that are robust with respect to geometrical uncertainties, such as errors in patient positioning, and to patient-density uncertainties resulting from errors in CT interpretation. Robust optimization makes it possible to utilize the full potential of IMPT without sacrificing reliability of the resulting delivered dose. InTRODUCInG PROTOn OPTIMIzATIOn In THE CLInIC The first RayStation user is one of the worlds most advanced proton therapy clinics Westdeutsches Protonentherapiezentrum Essen (WPE) in Germany. The WPE facility is designed around the adaptive therapy concept with infrastructure for daily patient imaging and automated transportation of immobilized patients. WPE selected RayStation for its unique ability to create robust and adaptive plans for treatment of moving tumors, such as lung sarcoma, with proton PBS. We were looking for a modern treatment planning solution with full support for adaptive therapies taking full advantage of the latest 4D imaging technology. In the end RaySearch was the only supplier that could live up to our demands. We feel that they share our vision of the future of radiation therapy so I must say it feels very rewarding to collaborate with them to break new ground in our field, says Jonathan Farr, Chief Technical Physicist, WPE.

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AdAptive rAdiAtion therApy

Deformable registration to deform delivered dose each fraction to the same geometry and compute accumulated delivered dose.

Replanning using accumulated delivered dose as background dose.

Changing patient geometry.

Treatment delivery and image acquisition.

InTEGRATED TOOLS FOR ADAPTIVE THERAPy During the treatment course, the patient anatomy will change as the target and surrounding organs at risk move and deform, both from interfractional and intrafractional motion. RayStation was designed from the very beginning with a strong focus on handling these dynamic aspects of radiation therapy. By explicitly representing the time dimension throughout the domain model, RayStation provides the ultimate framework for planning and managing adaptive radiation therapy. DEFORMABLE REGISTRATIOn & DOSE EVALUATIOn The patient geometry is monitored by acquiring images of the patient in treatment position, for example by using cone-beam CT, during the treatment course. As the surface models of the regions of interest are propagated and adapted to the acquired data sets, a four-dimensional representation of the patient geometry can quickly be obtained. Dose can be calculated on any geometry and, by comparing with the dose distribution in the original treatment

plan, the system detects and makes the user aware of deviations that require action. The dose delivered in each fraction is mapped to a reference CT-dataset by deformable registration. Having a common frame of reference for the patient geometry makes it possible to correctly accumulate doses from different fractions. TREATMEnT ADAPTATIOn The system provides several ways to compensate for setup errors and organ motion. Based on matching bony structures, target center-of-mass, marker positions etc., simple offline or online couch corrections can be calculated. In addition, a wide range of adaptive offline or online replanning options are available that take into account the accumulated dose, observed deviations and prediction of future patient geometry. The replanning options range from simple adaptations such as adjustments of beam weights to complete replanning that involves reoptimization of the beam orientations and intensity modulation.

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rAystAtion A Complete treAtment plAnning system

Patient Data Management Patient Modeling Plan Creation

PATIEnT DATA MAnAGEMEnT DICOM IMPORT/ExPORT RayStations data model is fully compatible with the DICOM standard, allowing the system to easily import and export any DICOM RT object. This includes multiple CT, MR and PET image series, 4D-CT, structure sets, doses and RT Plan and RT Ion treatment plans. In addition, RayStation communicates with other data sources such as DICOM senders and receivers or DICOM archives, using either file transfer, DICOM storage service classes or DICOM query/retrieve.

PLAn CREATIOn 3D-CRT RayStation provides the user with a set of modern, interactive and user-friendly tools for forward planning of 3D-CRT and passive proton plans. The system automatically computes MLC or block apertures and jaw settings based on targets, avoidance regions and flexible margin tools. For passively-scattered proton plans, RayStation also determines the nozzle settings and extracts the optimal compensator shapes. The user can manually edit all computed settings and device geometries, as well as define shielding blocks. Tools for beam weighting are also provided. DOSE CALCULATIOn/BEAM COMMISSIOnInG RayStation includes accurate and fast dose calculation services for any external photon beam treatment plan, using either the collapsedcone convolution algorithm for high accuracy or the singular-value decomposition algorithm for instantaneous presentation. All dose calculation algorithms support parallel execution on multiple cores or on GPUs. In order for the user to be able to commission and perform quality assurance of the clinical dose calculation, the system includes a graphical user interface giving the user complete control of the process.

PATIEnT MODELInG EFFICIEnT COnTOURInG TOOLS The system includes a comprehensive tool set for manual contouring such as polygon, freehand, paintbrush/2D rollerball and local deformations (push-andpull). Furthermore, RayStation contains a set of semi-automatic tools based on live threshold searching and specific functions for margin and bolus generation. Finally, RayStation supports regions-of-interest (ROIs) with voxelbased triangulation, 3D visualization, protocol-based attributes, bifurcated and detached ROIs, and boolean algebra for combining ROIs. Templates can also be saved with or without the geometries included, which can then be recalled on future patients.

MODEL-BASED SEGMEnTATIOn MBS is a semi-automatic tool for delineation of regions-ofinterest based on biomechanical and statistical information about organs. Volumetric images are segmented semiautomatically, utilizing a combination of grey-scale gradients and models with knowledge of how organs may change shape. With MBS, it is possible to delineate multiple regions of interest simultaneously, which increases throughput, accuracy and reproducibility.

IMAGE REGISTRATIOn/FUSIOn Several methods for rigid and deformable registration are available using combinations of landmark, surface and gray level information. Deformable and rigid registrations can be used for showing fused images as refererence while contouring, and for mapping regions or points of interests between image sets. Available image fusion display techniques include: chess-board, vertical or horizontal split, color blends and spyglass.

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Plan Optimization

Plan Evaluation

QA Preparation

Treatment Adaptation

PLAn OPTIMIzATIOn Optimization is our core. RaySearchs software framework ORBIT contains an ultrafast multi-purpose optimization engine, that solves virtually any posed optimization problem within radiation therapy, using, when applicable, direct and concurrent optimization of all degrees of freedom of the treatment unit. The optimization engine utilizes a sequential quadratic programming method to minimize or maximize a composite objective function while rigorously maintaining linear and non-linear constraints. Treatment techniques that can be optimized include: 3D-CRT, IMRT (step-and-shoot and sliding window), VMAT and PBS (IMPT or SFUD). In addition to the traditional optimization procedure, RayStation also provides multi criteria optimization, MCO, which allows for real-time manipulation and evaluation of clinical trade-offs.

Day 1 Day 2 Day 3 ... Day 30

TREATMEnT ADAPTATIOn This is the control center for delivering and managing adaptive radiation therapy. The workspace is used for monitoring and replanning the treatment once it has commenced. It includes fraction-to-fraction evaluation, dose tracking, online and offline patient setup corrections and full adaptive replanning. A more detailed description of RayStations adaptive functionality is found on page 9.

PLAn EVALUATIOn This module is a comprehensive toolbox for evaluation and comparison of treatment plans and dose distributions. It also includes clinical approval, plan summation and dose computation on auxiliary image data sets. The user can select from a number of predefined layouts containing different combinations of dose displays, dose volume histograms and dose statistics.

QA PREPARATIOn The module for quality-assurance preparation allows the user to easily transfer the clinical plan to a phantom and recalculate dose, either beam-by-beam or for the entire plan. The output from the module is the dose distribution in DICOM format, a QA report and optionally a new treatment plan with collapsed gantry angles.

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REGULATORY NOTE RayStation has regulatory approval in the US, Canada and the European Union. In the US and Canada, the new features proton planning, electron planning and dose tracking are pending clearance, while they are cleared for clinical use, shown with the CE-mark, in the EU. ABOUT RAYSEARCH RaySearch Laboratories is a medical technology company that develops advanced software solutions for improved radiation therapy of cancer. RaySearchs products are mainly sold through license agreements with leading partners such as Philips, Nucletron, IBA Dosimetry, Varian, Accuray and Siemens. To date, 15 partner products have been launched and RaySearchs software is used at some 1,800 clinics in more than 30 countries. In addition, RaySearch offers the proprietary treatment planning system RayStation directly to clinics. RaySearch was founded in 2000 as a spin-off from Karolinska Institutet in Stockholm and the company is listed in the Small Cap segment on NASDAQ OMX Stockholm. For more information about RaySearch, visit www.raysearchlabs.com. CUSTOMER CONTACT: For further information regarding RayStation or to get a demonstration please contact one of our sales representatives or send questions by e-mail on: sales@raysearchlabs.com SALES REPRESENTATIVES: North America David McPhail, VP of Sales RaySearch Americas Inc. Telephone: +1 877 778 3849 david.mcphail@raysearchlabs.com China Frank Qian CEO, Kang Li Da Trading Corporation Telephone: +86 10 88877943 kldkld@263.net RaySearch Laboratories (publ) Sveavgen 25 111 34 Stockholm Tel +46 8 545 061 30 Fax +46 8 545 061 39 info@raysearchlabs.com www.raysearchlabs.com

BeNeLux Annelies Zimmermann Business Director, RaySearch Belgium Sprl. Telephone: +32 2 213 83 65 annelies.zimmermann@raysearchlabs.com South Korea Heung Won, Jang CEO, Oncology Total Solutions Co. Ltd. Telephone: +82 2 2024 2024 hwjang@otskorea.co.kr

Italy Guido Catolla President, Tecnologie Avanzate T.A. Telephone: +39 11 6600101 118 guido.catolla@tecnologieavanzate.com Rest of the world Johan Lf President and CEO, RaySearch Laboratories AB Telephone: +46 8 545 061 30 johan.lof@raysearchlabs.com