A Great Fiducial Marker
Brainlab ExacTrac Dynamic®
Fiducial marker tracking using fast, low-dose kV imaging
Brainlab ExacTrac Dynamic® with its Implanted Marker Workflow enables automatic fiducial marker tracking using kV imaging for high-accuracy intrafraction motion detection and combines it with surface tracking.
During treatment, low-dose X-ray images are automatically acquired at specified angles and compared to Digitally Reconstructed Radiographs (DRRs) from the planning CT to verify marker positions. This ensures precise tracking of fiducial-marked soft tissue targets, such as the prostate, which are prone to frequent and unpredictable motion during treatment.
Note: Trademark ExacTrac Dynamic is a registered trademark of Brainlab SE or an affiliated company, see www.brainlab.com/trademarks for details.
If significant movement is detected, ExacTrac Dynamic automatically holds the beam and allows for intrafraction re-positioning in six degrees of freedom (6DoF), ensuring accurate target alignment before resuming beam delivery.
These advanced IGRT capabilities support margin reduction and hypofractionated treatments, minimizing toxicity while maintaining sub-millimetric precision and treatment efficacy.
“Our SBRT prostate program in UZ Ghent has been enhanced with the introduction of the Gold Anchor Markers and Brainlab ExacTrac Dynamic, enabling PTV margin reduction with precise prostate motion tracking on a Varian FFF TrueBeam.
This enables the precise delivery of a motion-managed beam-on fraction in just a few minutes!”
Prof. Ben Vanneste, MD, PhD, UZ Ghent, Belgium
Brainlab ExacTrac Dynamic features:
- 6DoF Motion Management: ExacTrac Dynamic Implanted Marker Workflow automatically detects implanted fiducial markers, like Gold Anchor Markers for both patient positioning and treatment monitoring. Detection and correction occur in 6DoF, enabling precise couch shifts to actively manage target motion in SBRT treatments (e.g., prostate cancer).
- Enhanced Safety with Automatic Beam Hold: ExacTrac Dynamic ensures precise target irradiation by frequently imaging internal anatomy. Significant deviations from preset tolerances instantly trigger an automatic beam hold, enabled by automated X-ray imaging at small intervals for frequent marker detection, minimizing dose to healthy tissue.
- Flexible Imaging and Workflow Customization: ExacTrac Dynamic supports customized workflows with flexible pre-treatment imaging options
- CBCT based positioning: for comprehensive assessment of rectum and bladder filling.
- X-ray positioning: for minimal imaging dose and efficiency.
- Regardless of the positioning method, treatment monitoring is always performed with X-ray imaging – essential for high-precision prostate SBRT.
- Seamless IGRT and SGRT Integration: ExacTrac Dynamic combines image-guided radiation therapy (IGRT) with augmented surface-guided radiation therapy (SGRT), leveraging the precision of X-ray tracking of internal fiducials alongside real-time thermal-surface monitoring of the patientʼs body.
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Gold Anchor with Brainlab ExacTrac Dynamic® enables safe and accurate focal dose escalation:
“In conclusion, enhanced planning and coupling of dose delivery with periodic intrafraction imaging enabled robust and efficient treatment delivery, as well as improved geometric and delivered dose accuracy of prostate cancer focal dose-escalated SBRT.”