— The Image Pumping Utility for BrainLAB ExacTrac and R&V system in Radiation Therapy Clinics (patent pending)

Figure 1 The Graphical User Interface of iPump.

What is iPump?

As the name implies, it is an image pumping utility that pumps images of some format from the local or the remote computer to the Record and Verify (R&V) system via DICOM connection in the radiation therapy clinic to make remote image reviewing feasible.

Image Guided Radiation Therapy (IGRT) is the next-generation of technology for high precision radiotherapy, a state-of-the-art technology that combines planning and in-room imaging of the patient’s anatomy in the treatment position, before treatment delivery, and the images can be examined on-line or off-line, for precise daily target localization. BrainLAB ExacTrac X-Ray 6D IGRT system is an automated image-guided radiation therapy system. It utilizes high-resolution stereoscopic kV x-rays to image the targets, before treatment, register the in-room images with the planning images to determine the degree of shifts needed for perfect alignment, robotically corrects patient set-up errors and tracks any patient and/or target movement throughout the treatment, all within a standard treatment time slot. Two kV x-ray units recessed into the floor and two ceiling-mounted amorphous silicon flat panel detectors enable imaging of targets or implanted markers in soft tissue tumors for extremely accurate set-up of the target volume to within 2mm of the planned isocenter position.

Unfortunately BrainLAB ExacTrac lacks the functionality to communicate with R&V system. Radiation oncologists are asked to approve the image registration at the console. iPump is actually an interfacing program that grabs JPEG images on ExacTrac IGRT system and sends them in DICOM format to the R&V system automatically.  It utilizes state-of-the-art technologies to bridge two currently incompatible systems.

Who needs iPump?
Since it is exclusively developed for BrainLAB ExacTrac IGRT system, any clinic in need for remote image reviewing feature for ExacTrac IGRT system should be the potential user.

How does iPump work?
As a pumping system, it consists of three main components shown in the above figure: the PUMP INLET, the PUMP OUTLET and the PUMP PANEL. The PUMP INLET is directed to the data directory of BrainLAB ExacTrac IGRT system where iPump periodically searches for new images. The PUMP OUTLET is pointed to the receiving DICOM server of the R&V system such as MOSAIQ (IMPAC) and ARIA (Varis). The PUMP PANEL is designed for system configuration herein the scanning interval, the associated field IDs and the types of images can be preset. Images sent to R&V system are encoded in DICOM format so that they are associated with patients automatically. No human intervention is needed. It can be installed locally on ExacTrac computer or installed remotely on any computer with read access to the data directory of the ExacTrac system.

When it is remotely installed, it utilizes a sentinel module to probe the presence of the targeted source and the destination and signal their states to the user through three indicators on the graphical user interface. It hibernates when either the targeted source or the destination DICOM server is not available and resumes working status when both “inlet” and “outlet” become reachable.

Instant Messaging

The built-in instant messaging mechanism automatically notifies, through pager and/or computer messenger, attending radiation oncologists immediately after images were sent to R&V system to allow on-line remote image reviewing with approval record.

Sample Images in IMPAC

BrainLAB ExacTrac system takes the planning CT and the treatment plan as the reference resources to calculate DRR images at the angles of KV x-ray imaging beams and register them with the detected KV portal images. When the position is reproduced, it creates two pairs of registered images. Please be advised that those raw ExacTrac JPEG images (Figure 2 through 5) do not have to be sent to R&V system due to lack of reference information for quantitative estimation of image registration though iPump is capable of doing so.

Figure 2 The sample DRR images of tube 1.

Figure 3 The sample KV x-ray portal image of tube 1.

Figure 4 The sample DRR image of tube 2.

Figure 5 The sample KV x-ray portal image of tube 2.

Figure 2 and 4 are planning images and figures 3 and 5 are in-room planar images that are supposed to be compared with figures 2 and 4 respectively. Putting the images side by side is the traditional way , in which radiation oncologists check and approve/disapprove the in-room images by approximation. However, IGRT requires very high precision such that adjustment can be made when planning and in-room images are off by more than 1.5 mm. To make quantitative estimation, paired images need to be fused in certain pattern to facilitate image reading. The correction shifts are also needed in the process of image review. That’s exactly what iPump can do to those planning/in-room image sets (Figure 6).

Figure 6 Fused sample images in IMPAC.

Download the latest upgrade

iPump is constantly evolving. The users are advised to check our website periodically and have your systems upgraded if there is a newer version. The latest version is 2.0, Build 400 released on November 29th 2009. Contact us to download the whole package.

Installation Steps

  1. Create a directory as the home directory for iPump, “C:\Clinic\iPump” for instance.
  2. Unzip the downloaded package in iPump directory.
  3. Double click the executable “iPump.exe” and follow the prompts to get a license.

Or you can download the dedicated installation instruction “Steps to Install iPump System_new.pdf” here.

License Types

There are two kinds of licenses as follows,

  1. Permanent license. That is what we strongly recommended. The user is provided with full unleashed functions plus free upgrades.
  2. Temporary license. It is time-limited license for two weeks. iPump functions exactly the same as the permanently licensed version as long as the license stays valid. Anyone who is interested in this product can request a time-limited license for temporary use.

How to Contact Us

For the license and technical support, please contact

Yulong Yan, Ph.D.
Tel: (214) 645 7636
Fax: (214) 645 2885
Email: Yulong.Yan@utsouthwestern.edu

For sales information, please contact

Brian Barnett
Tel: (501) 526 6157
Fax: (501) 686 7285
Email: bsbarnett2@uams.edu