Accurate and reproducible patient positioning is the essential first step in any optimized radiation therapy workflow, allowing the clinical team to plan and deliver high-precision radiation dose to the tumour while minimizing damage to adjacent healthy tissue and organs at risk. Operational success starts with the lasers used for patient alignment and marking during CT imaging in the treatment position (the basis of treatment planning and dose optimization). These lasers are also essential for patient positioning and marking in the MRI systems increasingly employed to visualize the tumour target, as well as its surrounding anatomy, with exceptional soft-tissue contrast – both prior to and during treatment. The same goes for the delivery of radiation treatment, with lasers ensuring accurate, repeatable positioning of the patient versus the linac isocentre.

In this way, positioning laser systems underpin robust and precise registration of CT/MRI data for treatment planning, while minimizing the stress experienced by the patient during subsequent radiotherapy fractions in a conventional linac or MR-Linac. “Our lasers enable fast and repeatable positioning of the patient in the imaging and treatment unit – increasing patient safety and streamlining the radiotherapy workflow,” explains Torsten Hartmann, director of product management (healthcare) at LAP, the German laser and radiotherapy QA specialist.

As for specifics, LAP supplies more than 5000 room lasers each year for patient positioning and marking in CT, PET/CT, MRI and linac installations – an offering that’s complemented by a portfolio of phantoms that enables medical physicists, dosimetrists and technicians to carry out regular QA checks on their imaging systems and linac machines. “The room lasers are a fundamental component of manufacturer-independent QA,” Hartmann adds, “guaranteeing precise orientation of the phantom in a range of testing set-ups.”

Collaborate, innovate, accumulate

Right now, Hartmann and his colleagues are busy working on LAP’s next-generation laser offering for the radiation oncology market. It’s a product roadmap that, in large part, will be shaped by an ambitious R&D collaboration with the Institute of Product and Process Innovation at Leuphana University in Lüneburg, Germany. Dubbed “Innovative Support for Reproducible Patient Positioning”, the project runs till summer 2022 and is backed with funding of €700,000 from the state of Lower Saxony and the European Regional Development Fund.

Within the collaboration, LAP is developing its laser portfolio while exploring broader opportunities around workflow automation, cybersecurity and big data. Near-term, the partners are focused on enhanced integration and interoperability between LAP’s lasers and the imaging and treatment systems within the radiation oncology clinic – innovations that will simplify the networking of clinical devices and the import/export of machine and patient data. In this way, it will be possible to integrate functionality in one system to control another – for example, QA tools that interact directly with the positioning lasers to improve patient safety.

A big driver here is the development of open interfaces between LAP’s lasers and imaging and radiotherapy systems from multiple OEMs. “Ultimately,” notes Hartmann, “that will mean enhanced usability, saving the medical physicist time during the positioning of the patient in the imaging suite or on the treatment couch – all of which means improved patient experience, increased patient throughput and reduced cost of care.”

Another area of interest for LAP is intelligent laser systems. “With built-in intelligence,” argues Hartmann, “our lasers could help to track and adjust for geometric deformations in patient anatomy between treatment sessions – for example, when they gain or lose weight or when the stomach, bladder and bowel contents change.”

Taken together, these efforts represent a logical progression for LAP. The manufacturer has worked previously with Siemens Healthineers, for example, to create a unified user interface for the latter’s syngo.via RT Image Suite. This multimodality imaging system allows clinicians to access CT, MR, PET/CT and cone-beam CT imaging data to support organ contouring, treatment planning and response assessment via a single interface.

Significantly, the syngo.via RT user interface was extended to incorporate direct steering of LAP’s DORADOnova room lasers via an integrated “virtual laser view” based on LAP’s CARINAnav control software (see the animation, below). “The collaboration with Siemens Healthineers demonstrates the benefits of open interfaces and interoperability,” says Hartmann. “As a result of this collaboration, the clinical end-user is able to control our lasers with just a few clicks via a single user interface within the syngo.via RT Image Suite.”

Listening to the customer

Alongside these flagship R&D partnerships, LAP is also casting the net wider in an effort to facilitate bottom-up, customer-driven product innovation. With this in mind, the regional sales teams are front-and-centre in the vendor’s collective conversation with the clinical user base – and a productive conduit for requirements-gathering at scale.

“For any promising idea, the product management team will first work up a set of user stories to flesh out the clinical and commercial opportunities,” says Hartmann. “Our ‘lighthouse customers’ are invaluable in this regard, helping us to iterate our thinking and articulate the best way forward.” A case in point is Strahlentherapie Singen-Friedrichshafen, which has teamed up with LAP on various workflow questions and the evaluation of industry 4.0 concepts to support embedding of next-generation laser systems in the radiotherapy equipment chain.

Those close links are replicated into LAP’s global service organization, with Hartmann and his team disseminating the latest product know-how and training so that LAP service engineers have the information they need to support clinical customers out in the field. That training is especially important given that LAP treats every laser installation as unique, with customers benefiting from upfront room planning and design support from their LAP service team.

“There are various possibilities for combining wall-, ceiling- or floor-mounted laser units,” Hartmann adds. “Different attachment systems and flexible, adjustable retainers allow us to adapt the laser system to the specifics of the customer’s imaging suite or treatment room.”

Post-pandemic, Hartmann is looking forward to re-engaging directly – not just over Zoom – with LAP’s diverse clinical customer base. “For the product management function,” he concludes, “the priority is more dialogue, more often, with more customers – which is especially tricky just now. Down the line, it’ll be nice to spend more time with customers out in the clinic again, working with them to understand the day-to-day challenges they face in the imaging suite and the treatment room.”