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The New More in SGRT

Dose-aware Surface Guided Radiation Therapy – patient-specific insight from planning to delivery.

Dosimetric unknowns in patient setup

Treatment planning is performed on a static CT dataset, capturing a single snapshot. Surface Guided Radiation Therapy (SGRT) technologies have become instrumental in helping position patients consistently, using surface metrics to guide alignment. Yet, typical SGRT tolerances – often set generically at 3–5 mm and 3 degrees – are rarely customized to individual patients and their unique anatomical presentation. These thresholds don't reflect the actual dosimetric consequences of deviations for a given patient.

Limited mobility and challenges in reproducibility

Limited mobility and challenges in reproducibility

Restricted movement makes setups harder to reproduce. Even small inconsistencies can shift dose into healthy tissue – often noticed only after treatment.

Changing patient anatomy before and after treatment

Changing patient anatomy before and after treatment

Anatomy evolves across fractions – swelling, organ filling, daily motion. Even with IGRT, the true dose impact of these changes often remains hidden.

Paired with RadCalc’s 3D QA suite, we’re creating an integrated workflow to expose potential errors, before delivery.

The challenge is recognized – but not universally solved

Unseen dosimetric uncertainty is now widely recognized across the field. Modern radiotherapy systems increasingly incorporate online adaptive workflows that account for daily anatomical variations by aligning the day’s image to a reference and adjusting the treatment plan accordingly. However, these solutions require significant infrastructure. Many clinics lack such technology, yet still face the same challenges of anatomy-driven dose variability. 

"With over 40 years of German engineering behind us, LAP brings micrometer precision from the harshest industrial environments to radiotherapy. LUNA 3D delivers continuous SGRT accuracy and Monte Carlo–based independent dose verification from simulation through delivery."

Carlos Bohorquez, Product Manager RadCalc

Integrating SGRT and dose evaluation workflows​

Pre-treatment ​dose evaluation​

Pre-treatment ​dose evaluation​

By using RadCalc’s fast Monte Carlo engine on the anatomy of the day—constructed from a synthetic CT derived from the planning CT and updated with patient position and surface data from LUNA 3D—clinics can efficiently evaluate the dosimetric impact prior to beam-on. 

Rapid DVH and dose-difference checks would provide clear feedback to the therapists directly at the treatment console, while physicists would review remotely, enabling quick decisions to proceed, adjust, or reschedule before unintended doses could be delivered.

Intra-treatment QA​

Intra-treatment QA​

By coupling LUNA 3D’s continuous surface tracking with RadCalc’s dose models, we envision accumulating dose live during treatment. ​

If motion occurs within the SGRT tolerances but outside the bounds of clinical acceptability – for example, in unmonitored regions or in ways that impact internal geometry – the system could trigger a dosimetric alert or even pause the beam, delivering an unprecedented intra-fraction safeguard.​

Post-fraction analysis​

Post-fraction analysis​

Combining 3D EPID in-vivo measurements on the patient’s anatomy of the day with accumulated dose summation would build a comprehensive picture of the true delivered dose across all fractions.​

This would not only support offline adaptive decisions but could also feed into BED-based tools for multi-course and multimodality treatment summations, ensuring slow, progressive anatomical changes don’t go unnoticed.​

Redefining quality assurance

With integrated SGRT and dose evaluation, RadCalc’s future centers on combining SGRT and adaptive Quality Assurance through the three above mentioned workflows.

A smarter, patient-centric QA standard

Together, these tools will be designed to help clinics move from fixed tolerances to a personalized, dosimetrically grounded approach, with no MR-linac required. With RadCalc, QA becomes dynamic, data-driven, and built around the patient, not the plan. 

What our customers say

  • “The real game-changer is how your solution bridges SGRT with RadCalc’s dose calculation algorithms—that’s the icing on the cake.”
    Radiation Physicist
  • “I think the value is that you provide a more individual tolerance… It simplifies the workflow.”
    Radiation Physicist
  • "What you guys are doing {in displaying 3D projected dose} is evaluating it upfront instead of after the fact."
    Radiation Therapist (when discussing simplifying a challenging Breast setup process)

Making precision effortless

Smarter decisions with LUNA 3D and RadCalc
Smarter decisions with LUNA 3D and RadCalc
Discover our Surface Guided Radiation Therapy system to support reproducible patient positioning and monitor patient surface motion at the LINAC and CT.
Learn more
Precision where it matters with Fast Monte Carlo
Precision where it matters with Fast Monte Carlo
Simplify and accelerate radiation therapy quality assurance with our fast Monte Carlo algorithm. With calculation times 6x faster than BEAMnrc, we are able to bring the same level of precision to clinicians directly at the point of care.
Learn more

More about dose-aware Surface Guided Radiation Therapy

What is the new more in SGRT?

LAP is developing a next-generation dose evaluation module within RadCalc that uses SGRT surface data to provide clinicians with dosimetric insights that consider the daily variation in patient positioning. It will empowers clinicians with the opportunity to uncover undesirable dose deliveries before they deliver them.

How does the new more in SGRT add value to my clinical workflow?

Conventional setup verification (e.g., SGRT or CBCT alone) confirms surface and anatomical alignment but offers no insight into the dose being delivered to today’s patient setup. The new more in SGRT addresses this critical blind spot by showing how variations in patient setup, weight, or anatomy affect dose delivery — before and after treatment. 

What treatment machines will the new more in SGRT work with

RadCalc’s new module will support workflows for pretreatment dose evaluation for all standard C-arm linac configurations. 

How fast are the dose recalculations with RadCalc’s fMC?

The new more in SGRT will recalculate your clinical plans using RadCalc’s new fast Monte Carlo dose engine in typically 30 seconds. Find out more here.

Is it customizable to our clinical protocols?

Yes, you can define: unique clinical protocols, what structures are monitored, which metrics are flagged and thresholds for pass/warning/failures 

  

Are there special hardware requirements for the new more in SGRT?

Yes. Dedicated calculation hardware will be required for the fast Monte Carlo dose calculations. 

Will therapists be making dosimetric decisions on their own?

No. As part of LAP’s initial setup for RadCalc’s newest module, physicists will be determining guiderails for the treatment team. These guiderails are intended to lay a foundation for what is acceptable during the daily treatment sessions. If conditions develop which are outside of the acceptable guiderails, physicists will have the ability to remotely access the same information the therapists are seeing at the treatment console to assist with decision making.  

What does our clinical team do in the event of an undesirable dose evaluation?

RadCalc’s new TrueDose module will include a full record of the previously treated fractions for physics to review during the decision-making process 

German Patent Application No. 10 2023 115 102.9, PCT Patent Application No.  EP2024/065566, US Patent Application No.19/144,366

The information provided contains forward-looking concepts and is intended for illustrative purposes only. All referenced design elements, functionalities, and specifications are preliminary and subject to change without notice.

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