This document is the report of a task group of the AAPM and has been prepared primarily to advise medical physicists involved in the external-beam radiation therapy of patients with thoracic, abdominal, and pelvic tumors affected by respiratory motion. This report describes the magnitude of respiratory motion, discusses radiotherapy specific problems caused by respiratory motion, explains techniques that explicitly manage respiratory motion during radiotherapy and gives recommendations in the application of these techniques for patient care, including quality assurance (QA) guidelines for these devices and their use with conformal and intensity modulated radiotherapy. The technologies covered by this report are motion-encompassing methods, respiratory gated techniques, breath-hold techniques, forced shallow-breathing methods, and respiration-synchronized techniques. The main outcome of this report is a clinical process guide for managing respiratory motion. Included in this guide is the recommendation that tumor motion should be measured (when possible) for each patient for whom respiratory motion is a concern. If target motion is greater than 5 mm, a method of respiratory motion management is available, and if the patient can tolerate the procedure, respiratory motion management technology is appropriate. Respiratory motion management is also appropriate when the procedure will increase normal tissue sparing. Respiratory motion management involves further resources, education and the development of and adherence to QA procedures.

/pdf/the-management-of-respiratory-motion-in-radiation-oncology-3m6tr6pexi.pdf

The management of respiratory motion in radiation oncology report of AAPM Task Group 76.

Task Group 101 of the AAPM has prepared this report for medical physicists, clinicians, and therapists in order to outline the best practice guidelines for the external-beam radiation therapy technique referred to as stereotactic body radiation therapy (SBRT). The task group report includes a review of the literature to identify reported clinical findings and expected outcomes for this treatment modality. Information is provided for establishing a SBRT program, including protocols, equipment, resources, and QA procedures. Additionally, suggestions for developing consistent documentation for prescribing, reporting, and recording SBRT treatment delivery is provided.

https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1118/1.3438081

Stereotactic body radiation therapy: The report of AAPM Task Group 101

A surgical instrument can comprise a channel configured to support a staple cartridge and, in addition, an anvil pivotable between open and closed positions relative to the channel. The surgical instrument can further comprise a cutting member configured to incise tissue positioned captured between the staple cartridge and the anvil and, in addition, means for stopping the cutting member prior to a distal end datum, wherein the distal end datum can be defined by the distal-most staple cavity in the staple cartridge. In such embodiments, the incision within the tissue may not extend beyond the portion of the tissue that has been stapled.

Surgical stapling instrument with an articulatable end effector

A surgical instrument including a handle assembly, a first endoscopic portion, a motor, and a first end effector is disclosed. The first endoscopic portion is selectively connectable to a distal portion of the handle assembly and defines a longitudinal axis. The first endoscopic portion includes a housing adjacent its proximal portion and includes an actuation member. The motor is disposed in mechanical cooperation with the housing of the first endoscopic portion and is operatively connected to the actuation member for moving the actuation member substantially along the longitudinal axis. The first end effector is selectively connectable to a distal portion of the first endoscopic portion and is configured to perform a first stapling function.

Powered surgical instrument

A surgical instrument, such as an endoscopic or laparoscopic instrument. The surgical instrument may comprise an end effector comprising at least one sensor. The surgical instrument may also comprise an electrically conductive shaft having a distal end connected to the end effector wherein the sensor is electrically insulated from the shaft. The surgical instrument may also comprise a handle connected to a proximate end of the shaft. The handle may comprise a control unit electrically coupled to the shaft such that the shaft radiates signals as an antenna from the control unit to the sensor and receives radiated signals from the sensor. Other components electrically coupled to the shaft may also radiate the signals.

Surgical instrument with wireless communication between control unit and remote sensor

A system for generating a magnetic field for excitation of a leadless marker assembly. The system of at least one embodiment includes a source generator that generates a plurality of alternating electrical signals each having an independently adjustable phase. A plurality of excitation coils are configured to simultaneously receive a respective one of the alternating electrical signals at a selected phase to generate a magnetic field. The phase of the alternating electrical signal for each excitation coil is independently adjustable relative to the phase of the alternating electrical signal for the other excitation coils so as to adjust the magnetic field from the respective coil. The magnetic fields from the excitation coils combine to form a spatially adjustable excitation field for excitation of the remote leadless marker assembly.

System for spatially adjustable excitation of leadless miniature marker

Electromagnetic transponders as markers are used to localize and guide orthopedic procedures including: knee replacement, hip replacement, shoulder replacement, damaged bone reconstruction, and spine surgery, and more particularly, to guide orthopedic surgical navigation and alignment techniques and instruments. For example, the marker could further be used in any number of guides or templates that attach to the bony anatomy, such as a surgical guide, cutting guide, cutting jig, resection block and/or resurfacing guide. Further, the marker could be incorporated into an existing intramedullary guide rod for a femur and an extramedullary guide rod for a tibia in a knee replacement surgery; or into an external surgical guide system, or the marker could eliminate the need for an external template altogether. According to yet another anticipated use of the tracking system, the marker could be used in conjunction with or replace an optical alignment system.

Apparatus and methods for using an electromagnetic transponder in orthopedic procedures

A receiver for determining the location of a marker that is excited with an exciting waveform. A sensing array having coils is used to sense magnetic flux from the resonating marker. The coils provide inputs to the receiver. The receiver includes a correlation processor for analyzing the inputs in a coherent manner. The receiver determines the phase component of each of the inputs and compensates for differences.

Receiver used in marker localization sensing system using coherent detection

Instruments and methods for tracking such instruments in a human patient. One embodiment of an instrument in accordance with the invention comprises an elongated body, such as an elongated flexible member, which has a distal section configured to be passed through a vessel or other passageway in a human. The instrument can further include a lumen through the distal section and a magnetic marker having a transponder at the distal section. The transponder includes a circuit configured to be energized by a wirelessly transmitted magnetic excitation energy and to wirelessly transmit a magnetic location signal in response to the excitation energy. The magnetic marker, for example, can be attached to or otherwise integral with the instrument.

Instruments with location markers and methods for tracking instruments through anatomical passageways

Systems and methods for treating a lung of a patient. One embodiment of a method comprises positioning a leadless marker in the lung of the patient relative to the target, and collecting position data of the marker. This method further comprises determining the location of the marker in an external reference frame outside of the patient based on the collected position data, and providing an objective output in the external reference frame that is responsive to movement of the marker. The objective output is provided at a frequency (i.e., periodicity) that results in a clinically acceptable tracking error. In addition, the objective output can also be provided at least substantially contemporaneously with collecting the position data used to determine the location of the marker.

Systems and methods for treating a lung of a patient using guided radiation therapy or surgery

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