DETAILED ACTION
This office action is in response to the communication received on 07/10/2025 concerning application no. 17/735,586 filed on 05/03/2022.
Claims 1-4, 6-11, 13-18, and 20-23 are pending.
Notice of Pre-AIA or AIA Status
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Continued Examination Under 37 CFR 1.114
A request for continued examination under 37 CFR 1.114, including the fee set forth in 37 CFR 1.17(e), was filed in this application after final rejection. Since this application is eligible for continued examination under 37 CFR 1.114, and the fee set forth in 37 CFR 1.17(e) has been timely paid, the finality of the previous Office action has been withdrawn pursuant to 37 CFR 1.114. Applicant's submission filed on 07/10/2025 has been entered.
Claims 1-4, 6-11, 13-18, and 20-23 are pending.
Response to Arguments
Applicant's arguments filed 07/10/2025 have been fully considered but they are not persuasive.
Regarding the 103 rejection, Applicant argues “In contrast, the system as described in Bal lacks functionalities to image and treat a subject while the subject remains in a single position, as recited in claim 1. In Bal, the system 10 receives second images acquired by a second imaging system 60, moves the subject, and then delivers radiation by radiation delivery system 52. In particular, the subject support 50 moves the subject from the field of view of the second imaging system 60 to place the subject in the field of view of the radiation delivery system 52. Bal, [0024].” Applicant further argues “Further, a person having ordinary skill in the art would not have been motivated to arrive at the present claims from Prince. Prince expressly teaches a singular radiation apparatus operable to generate a radiation beam in a non- coplanar manner. Prince, Abstract. Simply, one of ordinary skill in the art would have been simply motivated to replace the radiation delivery system of Bal with the radiation apparatus of Prince. Therefore, the combined system of Bal and Prince would fail to teach a system capable of imaging a subject while the subject remains in a single position.”
Examiner disagrees. MPEP 2145 establishes “If a prima facie case of obviousness is established, the burden shifts to the applicant to come forward with arguments and/or evidence to rebut the prima facie case. See, e.g., In re Dillon, 919 F.2d 688, 692, 16 USPQ2d 1897, 1901 (Fed. Cir. 1990) (en banc). Rebuttal evidence and arguments can be presented in the specification, In re Soni, 54 F.3d 746, 750, 34 USPQ2d 1684, 1687 (Fed. Cir. 1995), by counsel, In re Chu, 66 F.3d 292, 299, 36 USPQ2d 1089, 1094-95 (Fed. Cir. 1995), or by way of an affidavit or declaration under 37 CFR 1.132, e.g., Soni, 54 F.3d at 750, 34 USPQ2d at 1687; In re Piasecki, 745 F.2d 1468, 1474, 223 USPQ 785, 789-90 (Fed. Cir. 1984). However, arguments of counsel cannot take the place of factually supported objective evidence. See, e.g., In re Huang, 100 F.3d 135, 139-40, 40 USPQ2d 1685, 1689 (Fed. Cir. 1996); In re De Blauwe, 736 F.2d 699, 705, 222 USPQ 191, 196 (Fed. Cir. 1984).” Applicant’s allegation that x-ray imaging and radiation treatment is not done with the subject remaining stationary is without support and contrary to the very basis of the x-ray based treatment and diagnosis of the art. It is well established that x-ray imaging requires the patient to remain still for a period of time during the imaging1. It is well established that LINAC requires the patient to remain still for a period of time during the treatment2. Applicant provides no evidence that stationary treatment and imaging is not the norm in the art. It is so common and fundamental that patients are informed to stay still while undergoing irradiation3. It is so common that the medical professional explicitly informs the patient to remain still4. Bal in paragraphs 0018- 0029 teaches that high resolution planning images are acquired using the CT scanner of a person and the use of LINAC. Prince further in Col. 5, lines 40-67 disclose that it is the radiation source that is moving with respect to the subject rather than the subject itself. Col. 6, lines 7-32 teach the rotation about the patient. Figs. 10-11 show the subject in a single position as the radiation source changes. Assuming, arguendo, Bal and Prince were silent, the idea of using x-ray imaging and treatment on a subject in a single position is not novel. It is well-known in the art as evidenced by at least Yan et al. (PGPUB No. US 20120020449), Kaiser et al. (PGPUB No. US 20080219407), Urano et al. (PGPUB No. US 20070211856) Maurer, Jr. et al. (PGPUB No. US 2012/0106704), Kusch et al. (PGPUB No. US 20050281389), and Faulhaber et al. (US Patent No. 11,759,157). Furthermore, Applicant’s remarks about the interview omit the fact that Examiner had informed Applicant the purpose of keeping patients stationary is so fundamental because “If the patient moves, it results in motion artifacts and undermines the procedure.” Examiner had also provided a citation5. See interview, filed 07/02/2025.
In response to applicant's arguments against the references individually, one cannot show nonobviousness by attacking references individually where the rejections are based on combinations of references. See In re Keller, 642 F.2d 413, 208 USPQ 871 (CCPA 1981); In re Merck & Co., 800 F.2d 1091, 231 USPQ 375 (Fed. Cir. 1986). In response to applicant's argument that Bal and Prince cannot operate together, the test for obviousness is not whether the features of a secondary reference may be bodily incorporated into the structure of the primary reference; nor is it that the claimed invention must be expressly suggested in any one or all of the references. Rather, the test is what the combined teachings of the references would have suggested to those of ordinary skill in the art. See In re Keller, 642 F.2d 413, 208 USPQ 871 (CCPA 1981). In response to applicant’s argument that there is no teaching, suggestion, or motivation to combine the references, the examiner recognizes that obviousness may be established by combining or modifying the teachings of the prior art to produce the claimed invention where there is some teaching, suggestion, or motivation to do so found either in the references themselves or in the knowledge generally available to one of ordinary skill in the art. See In re Fine, 837 F.2d 1071, 5 USPQ2d 1596 (Fed. Cir. 1988), In re Jones, 958 F.2d 347, 21 USPQ2d 1941 (Fed. Cir. 1992), and KSR International Co. v. Teleflex, Inc., 550 U.S. 398, 82 USPQ2d 1385 (2007). In this case, the modification would allow the user to can cover most clinical treatments as well as or better than conventional MLCs but by using fewer leaves for less cost and higher reliability (Col. 1, lines 60-62 of Prince). Furthermore, the modification can have better tolerance control, less cost, less weight, and can fit within a smaller cover or similar structures (Col. 7, lines 59-60 of Prince). Additionally, operation of diagnosis and treatment in one system improves the patient experience in a medical setting and would require less upkeep of multiple systems as they can be in a consolidated system as disclosed by Prince.
Examiner maintains the rejection.
Drawings
The drawings were received on 07/10/2025. These drawings are accepted.
The drawings are objected to under 37 CFR 1.83(a). The drawings must show every feature of the invention specified in the claims. Therefore, “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner” (Claims 21) and “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom” (Claims 22-23)must be shown or the feature(s) canceled from the claim(s). No new matter should be entered.
Corrected drawing sheets in compliance with 37 CFR 1.121(d) are required in reply to the Office action to avoid abandonment of the application. Any amended replacement drawing sheet should include all of the figures appearing on the immediate prior version of the sheet, even if only one figure is being amended. The figure or figure number of an amended drawing should not be labeled as “amended.” If a drawing figure is to be canceled, the appropriate figure must be removed from the replacement sheet, and where necessary, the remaining figures must be renumbered and appropriate changes made to the brief description of the several views of the drawings for consistency. Additional replacement sheets may be necessary to show the renumbering of the remaining figures. Each drawing sheet submitted after the filing date of an application must be labeled in the top margin as either “Replacement Sheet” or “New Sheet” pursuant to 37 CFR 1.121(d). If the changes are not accepted by the examiner, the applicant will be notified and informed of any required corrective action in the next Office action. The objection to the drawings will not be held in abeyance.
Claim Rejections - 35 USC § 112
The following is a quotation of the first paragraph of 35 U.S.C. 112(a):
(a) IN GENERAL.—The specification shall contain a written description of the invention, and of the manner and process of making and using it, in such full, clear, concise, and exact terms as to enable any person skilled in the art to which it pertains, or with which it is most nearly connected, to make and use the same, and shall set forth the best mode contemplated by the inventor or joint inventor of carrying out the invention.
The following is a quotation of the first paragraph of pre-AIA 35 U.S.C. 112:
The specification shall contain a written description of the invention, and of the manner and process of making and using it, in such full, clear, concise, and exact terms as to enable any person skilled in the art to which it pertains, or with which it is most nearly connected, to make and use the same, and shall set forth the best mode contemplated by the inventor of carrying out his invention.
Claims 1-4, 6-11, 13-18, and 20-23 are rejected under 35 U.S.C. 112(a) or 35 U.S.C. 112 (pre-AIA ), first paragraph, as failing to comply with the written description requirement. The claim(s) contains subject matter which was not described in the specification in such a way as to reasonably convey to one skilled in the relevant art that the inventor or a joint inventor, or for applications subject to pre-AIA 35 U.S.C. 112, the inventor(s), at the time the application was filed, had possession of the claimed invention.
Claim 1 recites “wherein the level of optimization is associated with prior knowledge”. The specification fails to disclose what the association of the level of optimization is with respect to the prior knowledge. The specification fails to disclose what degree of association is required or what form that association is in. The specification, with respect to prior knowledge and optimization, recites in paragraph 0039 “The levels of optimizations may include whether to include prior knowledge or not, the amount of prior knowledge to include, and the number of repetitions in optimization”. The specification does not disclose when the prior knowledge is included or when it is not included or what amount of the prior knowledge is includes and the repetitions for optimization. The specification fails to provide considerations or disclosure on what is determinative for the determination, assessment of the amount, and repetitions required for the optimizations. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 1 recites “prior knowledge”. While paragraph 0039 states “Prior knowledge is a set of relationships between radiation delivered and outcome of the malignant tissue. Prior knowledge may be a set of mathematical functions of the geometrical properties of radiation and the treatment plan”, the specification fails to elaborate what these relationships or mathematical functions are. Even broadly, the specification fails to disclose the relationships or mathematical functions and how they are incorporated or used in the prior knowledge for optimization purposes. Even more broadly, this paragraph is the only discussion regarding geometric properties of the radiation and the specification provides no disclosure of what these geometric properties of radiation are. Similarly, this paragraph is the only discussion of a relationship between radiation delivered and outcome of the malignant tissue and the specification provides no disclosure of what these relationships are. The specification state that there are a set of relationships and mathematical functions. However, the specification fails to provide even one relationship between radiation delivered and outcome of malignant tissue or mathematical function in the context of any geometric property of radiation (which is also not adequately disclosed). So, the specification fails to disclose what the prior knowledge is and how it is incorporated in the adaptive treatment planning such that it provides optimization based on the undisclosed prior knowledge. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 1 recites “the treatment plan including the delivery of radiation in the non-coplanar manner”. The specification fails to disclose the treatment planning establishing the delivery of radiation in the non-coplanar manner. The only recitations regarding co-planar or non-coplanar are in paragraphs 0027 and 0032 and it does not disclose the operation of the present invention. Rather, the specification discloses the state of the prior art that, according to Applicant’s specification, is not capable of operating in a non-coplanar manner when using a ring-type gantry (Paragraph 0027) and that it operates in coplanar manner (Paragraph 0032). The specification does not elaborate on the treatment planning such that it includes “the delivery of radiation in the non-coplanar manner.” The specification fails to disclose what are the considerations, parameters, adjustments, or planned variables that are optimized or used in resulting in the delivery such that it is non-coplanar. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 8 recites “wherein the level of optimization is associated with prior knowledge”. The specification fails to disclose what the association of the level of optimization is with respect to the prior knowledge. The specification fails to disclose what degree of association is required or what form that association is in. The specification, with respect to prior knowledge and optimization, recites in paragraph 0039 “The levels of optimizations may include whether to include prior knowledge or not, the amount of prior knowledge to include, and the number of repetitions in optimization”. The specification does not disclose when the prior knowledge is included or when it is not included or what amount of the prior knowledge is includes and the repetitions for optimization. The specification fails to provide considerations or disclosure on what is determinative for the determination, assessment of the amount, and repetitions required for the optimizations. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 8 recites “prior knowledge”. While paragraph 0039 states “Prior knowledge is a set of relationships between radiation delivered and outcome of the malignant tissue. Prior knowledge may be a set of mathematical functions of the geometrical properties of radiation and the treatment plan”, the specification fails to elaborate what these relationships or mathematical functions are. Even broadly, the specification fails to disclose the relationships or mathematical functions and how they are incorporated or used in the prior knowledge for optimization purposes. Even more broadly, this paragraph is the only discussion regarding geometric properties of the radiation and the specification provides no disclosure of what these geometric properties of radiation are. Similarly, this paragraph is the only discussion of a relationship between radiation delivered and outcome of the malignant tissue and the specification provides no disclosure of what these relationships are. The specification state that there are a set of relationships and mathematical functions. However, the specification fails to provide even one relationship between radiation delivered and outcome of malignant tissue or mathematical function in the context of any geometric property of radiation (which is also not adequately disclosed). So, the specification fails to disclose what the prior knowledge is and how it is incorporated in the adaptive treatment planning such that it provides optimization based on the undisclosed prior knowledge. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 8 recites “the treatment plan including the delivery of radiation in a non-coplanar manner”. The specification fails to disclose the treatment planning establishing the delivery of radiation in the non-coplanar manner. The only recitations regarding co-planar or non-coplanar are in paragraphs 0027 and 0032 and it does not disclose the operation of the present invention. Rather, the specification discloses the state of the prior art that, according to Applicant’s specification, is not capable of operating in a non-coplanar manner when using a ring-type gantry (Paragraph 0027) and that it operates in coplanar manner (Paragraph 0032). The specification does not elaborate on the treatment planning such that it includes “the delivery of radiation in the non-coplanar manner.” The specification fails to disclose what are the considerations, parameters, adjustments, or planned variables that are optimized or used in resulting in the delivery such that it is non-coplanar. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 15 recites “wherein the level of optimization is associated with prior knowledge”. The specification fails to disclose what the association of the level of optimization is with respect to the prior knowledge. The specification fails to disclose what degree of association is required or what form that association is in. The specification, with respect to prior knowledge and optimization, recites in paragraph 0039 “The levels of optimizations may include whether to include prior knowledge or not, the amount of prior knowledge to include, and the number of repetitions in optimization”. The specification does not disclose when the prior knowledge is included or when it is not included or what amount of the prior knowledge is includes and the repetitions for optimization. The specification fails to provide considerations or disclosure on what is determinative for the determination, assessment of the amount, and repetitions required for the optimizations. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 15 recites “prior knowledge”. While paragraph 0039 states “Prior knowledge is a set of relationships between radiation delivered and outcome of the malignant tissue. Prior knowledge may be a set of mathematical functions of the geometrical properties of radiation and the treatment plan”, the specification fails to elaborate what these relationships or mathematical functions are. Even broadly, the specification fails to disclose the relationships or mathematical functions and how they are incorporated or used in the prior knowledge for optimization purposes. Even more broadly, this paragraph is the only discussion regarding geometric properties of the radiation and the specification provides no disclosure of what these geometric properties of radiation are. Similarly, this paragraph is the only discussion of a relationship between radiation delivered and outcome of the malignant tissue and the specification provides no disclosure of what these relationships are. The specification state that there are a set of relationships and mathematical functions. However, the specification fails to provide even one relationship between radiation delivered and outcome of malignant tissue or mathematical function in the context of any geometric property of radiation (which is also not adequately disclosed). So, the specification fails to disclose what the prior knowledge is and how it is incorporated in the adaptive treatment planning such that it provides optimization based on the undisclosed prior knowledge. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 15 recites “the treatment plan including the delivery of radiation in a non-coplanar manner”. The specification fails to disclose the treatment planning establishing the delivery of radiation in the non-coplanar manner. The only recitations regarding co-planar or non-coplanar are in paragraphs 0027 and 0032 and it does not disclose the operation of the present invention. Rather, the specification discloses the state of the prior art that, according to Applicant’s specification, is not capable of operating in a non-coplanar manner when using a ring-type gantry (Paragraph 0027) and that it operates in coplanar manner (Paragraph 0032). The specification does not elaborate on the treatment planning such that it includes “the delivery of radiation in the non-coplanar manner.” The specification fails to disclose what are the considerations, parameters, adjustments, or planned variables that are optimized or used in resulting in the delivery such that it is non-coplanar. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 21 recites “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner”. The specification fails to disclose the rotation or the movement of the couch in the multiple degrees of freedom for the facilitation of radiation delivery in non-coplanar manner. The only recitations regarding co-planar or non-coplanar are in paragraphs 0027 and 0032 and it does not disclose the operation of the present invention. Rather, the specification discloses the state of the prior art that, according to Applicant’s specification, is not capable of operating in a non-coplanar manner when using a ring-type gantry (Paragraph 0027) and that it operates in coplanar manner (Paragraph 0032). The specification does not elaborate on the movement or rotation of couch for “facilitating delivery of radiation in the non-coplanar manner.” The specification fails to disclose what are the rotational configuration parameters, inputs, or variables that are resulting in the delivery such that it is non-coplanar. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 22 recites “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom”. The specification fails to disclose the rotation or the movement of the couch in the multiple degrees of freedom for the facilitation of radiation delivery in non-coplanar manner. The only recitations regarding co-planar or non-coplanar are in paragraphs 0027 and 0032 and it does not disclose the operation of the present invention. Rather, the specification discloses the state of the prior art that, according to Applicant’s specification, is not capable of operating in a non-coplanar manner when using a ring-type gantry (Paragraph 0027) and that it operates in coplanar manner (Paragraph 0032). The specification does not elaborate on the movement or rotation of couch for “thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom.” The specification fails to disclose what are the rotational configuration parameters, inputs, or variables that are resulting in the delivery such that it is non-coplanar. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 22 recites “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom”. Paragraph 0031 of the specification establishes “Couch 104 may be rotational with one degree of freedom for treatment, rotating 90° to 270° through 0° (or 360°), and with three degrees of freedom of a limited range for subject setup”. While the specification provides support for one rotational degree of freedom, the specification fails to provide support that the movement with three degrees of freedom of a limited range facilitates the delivery in a manner in a degree of rotational freedom. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 23 recites “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom”. The specification fails to disclose the rotation or the movement of the couch in the multiple degrees of freedom for the facilitation of radiation delivery in non-coplanar manner. The only recitations regarding co-planar or non-coplanar are in paragraphs 0027 and 0032 and it does not disclose the operation of the present invention. Rather, the specification discloses the state of the prior art that, according to Applicant’s specification, is not capable of operating in a non-coplanar manner when using a ring-type gantry (Paragraph 0027) and that it operates in coplanar manner (Paragraph 0032). The specification does not elaborate on the movement or rotation of couch for “facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom.” The specification fails to disclose what are the rotational configuration parameters, inputs, or variables that are resulting in the delivery such that it is non-coplanar. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claim 23 recites “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom”. Paragraph 0031 of the specification establishes “Couch 104 may be rotational with one degree of freedom for treatment, rotating 90° to 270° through 0° (or 360°), and with three degrees of freedom of a limited range for subject setup”. While the specification provides support for one rotational degree of freedom, the specification fails to provide support that the movement with three degrees of freedom of a limited range facilitates the delivery in a manner in a degree of rotational freedom. Therefore, the claim contains subject matter which is not described in the specification in such a way as to reasonably convey to one with ordinary skill in the art that the inventor had possession of the claim invention at the time of filing.
Claims that are not discussed above but are cited to be rejected under 35 U.S.C. 112(a) are also rejected because they inherit the deficiencies of the claims they respectively depend upon.
The following is a quotation of 35 U.S.C. 112(b):
(b) CONCLUSION.—The specification shall conclude with one or more claims particularly pointing out and distinctly claiming the subject matter which the inventor or a joint inventor regards as the invention.
The following is a quotation of 35 U.S.C. 112 (pre-AIA ), second paragraph:
The specification shall conclude with one or more claims particularly pointing out and distinctly claiming the subject matter which the applicant regards as his invention.
Claims 1-4, 6-11, 13-18, and 20-23 are rejected under 35 U.S.C. 112(b) or 35 U.S.C. 112 (pre-AIA ), second paragraph, as being indefinite for failing to particularly point out and distinctly claim the subject matter which the inventor or a joint inventor (or for applications subject to pre-AIA 35 U.S.C. 112, the applicant), regards as the invention.
Claim 1 is indefinite for the following reasons:
Recites “non-coplanar manner”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what the delivery is in a non-coplanar manner with respect to. One interpretation is a reference plane. Another interpretation is with respect to a coordinate system. Another interpretation is with respect to the subject.
Applicant is encouraged to provide consistent and clear language.
Recites “wherein the treatment plan was designed based on the first images”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art if the treatment plan is being designed based on the first images as the claims are unclear as to whether they are positively recited or an intended use limitation.
Applicant is encouraged to provide consistent and clear language.
Recites “wherein the level of optimization is associated with prior knowledge”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art in what manner the association of the level optimization is with respect to the prior knowledge. The depth and breadth of the claim is unclear as it fails to establish what is excluded in this association or what is included in this association. It would be unclear to one with ordinary skill in the art what the association is with respect to. One interpretation is association to a treatment fraction. Another interpretation is association to an initial planning of the treatment fraction.
Applicant is encouraged to provide consistent and clear language.
Recites “prior knowledge”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what is the prior knowledge that is in association with the level of optimization. One interpretation is that it is the user knowledge. Another interpretation is that it is a preset. Another interpretation is that it is prior data.
Applicant is encouraged to provide consistent and clear language.
Recites “non-coplanar manner”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what the delivery is in a non-coplanar manner with respect to. One interpretation is a reference plane. Another interpretation is with respect to a coordinate system. Another interpretation is with respect to the subject.
Applicant is encouraged to provide consistent and clear language.
Claim 8 is indefinite for the following reasons:
Recites “wherein the treatment plan was designed based on the first images”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art if the treatment plan is being designed based on the first images as the claims are unclear as to whether they are positively recited or an intended use limitation.
Applicant is encouraged to provide consistent and clear language.
Recites “wherein the level of optimization is associated with prior knowledge”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art in what manner the association of the level optimization is with respect to the prior knowledge. The depth and breadth of the claim is unclear as it fails to establish what is excluded in this association or what is included in this association. It would be unclear to one with ordinary skill in the art what the association is with respect to. One interpretation is association to a treatment fraction. Another interpretation is association to an initial planning of the treatment fraction.
Applicant is encouraged to provide consistent and clear language.
Recites “prior knowledge”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what is the prior knowledge that is in association with the level of optimization. One interpretation is that it is the user knowledge. Another interpretation is that it is a preset. Another interpretation is that it is prior data.
Applicant is encouraged to provide consistent and clear language.
Recites “non-coplanar manner”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what the delivery is in a non-coplanar manner with respect to. One interpretation is a reference plane. Another interpretation is with respect to a coordinate system. Another interpretation is with respect to the subject.
Applicant is encouraged to provide consistent and clear language.
Recites “non-coplanar manner”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what the delivery is in a non-coplanar manner with respect to. One interpretation is a reference plane. Another interpretation is with respect to a coordinate system. Another interpretation is with respect to the subject.
Applicant is encouraged to provide consistent and clear language.
Claim 15 is indefinite for the following reasons:
Recites “wherein the treatment plan was designed based on the first images”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art if the treatment plan is being designed based on the first images as the claims are unclear as to whether they are positively recited or an intended use limitation.
Applicant is encouraged to provide consistent and clear language.
Recites “wherein the level of optimization is associated with prior knowledge”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art in what manner the association of the level optimization is with respect to the prior knowledge. The depth and breadth of the claim is unclear as it fails to establish what is excluded in this association or what is included in this association. It would be unclear to one with ordinary skill in the art what the association is with respect to. One interpretation is association to a treatment fraction. Another interpretation is association to an initial planning of the treatment fraction.
Applicant is encouraged to provide consistent and clear language.
Recites “prior knowledge”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what is the prior knowledge that is in association with the level of optimization. One interpretation is that it is the user knowledge. Another interpretation is that it is a preset. Another interpretation is that it is prior data.
Applicant is encouraged to provide consistent and clear language.
Recites “non-coplanar manner”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what the delivery is in a non-coplanar manner with respect to. One interpretation is a reference plane. Another interpretation is with respect to a coordinate system. Another interpretation is with respect to the subject.
Applicant is encouraged to provide consistent and clear language.
Recites “non-coplanar manner”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what the delivery is in a non-coplanar manner with respect to. One interpretation is a reference plane. Another interpretation is with respect to a coordinate system. Another interpretation is with respect to the subject.
Applicant is encouraged to provide consistent and clear language.
Claim 21 is indefinite for the following reasons:
Recites “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner”. This claim element is indefinite. The independent claim 1 establishes that the “subject remains in a single position”. The present element conflicts with the language of the independent claim language. It would be unclear top one with ordinary skill in the art if the subject is in a single position or if they are moved or rotated based on the couch movement.
Applicant is encouraged to provide consistent and clear language.
Recites “non-coplanar manner”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what the delivery is in a non-coplanar manner with respect to. One interpretation is a reference plane. Another interpretation is with respect to a coordinate system. Another interpretation is with respect to the subject.
Applicant is encouraged to provide consistent and clear language.
Claim 22 is indefinite for the following reasons:
Recites “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom”. This claim element is indefinite. The independent claim 1 establishes that the “subject remains in a single position”. The present element conflicts with the language of the independent claim language. It would be unclear top one with ordinary skill in the art if the subject is in a single position or if they are moved or rotated based on the couch movement.
Applicant is encouraged to provide consistent and clear language.
Recites “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art in what manner translational movement provides the facilitation in a degree of rotational freedom.
Applicant is encouraged to provide consistent and clear language.
Recites “non-coplanar manner”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what the delivery is in a non-coplanar manner with respect to. One interpretation is a reference plane. Another interpretation is with respect to a coordinate system. Another interpretation is with respect to the subject.
Applicant is encouraged to provide consistent and clear language.
Claim 23 is indefinite for the following reasons:
Recites “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom”. This claim element is indefinite. The independent claim 1 establishes that the “subject remains in a single position”. The present element conflicts with the language of the independent claim language. It would be unclear top one with ordinary skill in the art if the subject is in a single position or if they are moved or rotated based on the couch movement.
Applicant is encouraged to provide consistent and clear language.
Recites “a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art in what manner translational movement provides the facilitation in a degree of rotational freedom.
Applicant is encouraged to provide consistent and clear language.
Recites “non-coplanar manner”. This claim element is indefinite. It would be unclear to one with ordinary skill in the art what the delivery is in a non-coplanar manner with respect to. One interpretation is a reference plane. Another interpretation is with respect to a coordinate system. Another interpretation is with respect to the subject.
Applicant is encouraged to provide consistent and clear language.
Claims that are not discussed above but are cited to be rejected under 35 U.S.C. 112(b) are also rejected because they inherit the indefiniteness of the claims they respectively depend upon.
Claim Rejections - 35 USC § 103
In the event the determination of the status of the application as subject to AIA 35 U.S.C. 102 and 103 (or as subject to pre-AIA 35 U.S.C. 102 and 103) is incorrect, any correction of the statutory basis for the rejection will not be considered a new ground of rejection if the prior art relied upon, and the rationale supporting the rejection, would be the same under either status.
The following is a quotation of 35 U.S.C. 103 which forms the basis for all obviousness rejections set forth in this Office action:
A patent for a claimed invention may not be obtained, notwithstanding that the claimed invention is not identically disclosed as set forth in section 102, if the differences between the claimed invention and the prior art are such that the claimed invention as a whole would have been obvious before the effective filing date of the claimed invention to a person having ordinary skill in the art to which the claimed invention pertains. Patentability shall not be negated by the manner in which the invention was made.
Claims 1-4, 6, 8-11, 13, 15-18, and 20 are rejected under 35 U.S.C. 103 as being unpatentable over Bal et al. (PGPUB No. US 2011/0103551) in view of Prince et al. (US Patent No. 10,071,263).
Regarding claim 1, Bal teaches a linear particle accelerator (LINAC) radiotherapy system of treating a subject (Title teaches it is associated to radiotherapeutic treatment plan adaptation), comprising:
a gantry (Fig. 1 shows the gantry), comprising:
a radiation delivery assembly including LINACs and configured to generate radiation (Paragraph 0023 teaches that the tomographic system includes a LINAC and the delivery of radiation. Paragraph 0038 teaches that the treatment system can employ any imaging modality of combination needed); and
an X-ray imaging assembly configured to image the subject (Paragraph 0023 teaches that the radiation delivery system is a tomographic system with a radiation delivery system. Paragraphs 0024-25 teach that the second system can be a CT scanner),
an adaptive radiotherapy computing device, the adaptive radiotherapy computing device comprising at least one processor in communication with at least one memory device (Paragraphs 0018-20 teach the use of a processor and memory. It is inherent that a computational system will utilize a processor and memory for the performance of its computational functions), and the at least one processor programmed to:
receive first images of the subject acquired by an imaging system (Paragraph 0029 teaches that high resolution planning images are acquired using the CT scanner. The images can be of the cancerous tissue, organs, and regions of interest. Paragraph 0018 teaches imaging of a person),
receive second images of the subject acquired during a treatment fraction by the X-ray imaging assembly; wherein the first images have higher resolutions than the second images (Paragraph 0031 teaches that the workflow for each radiation therapy session is performed and it includes the acquisition of the one or more treatment images using the second imaging system. Paragraph 0035 teaches that the treatment images are of a lower resolution than the images from the planning scanner);
adapt a treatment plan using the second images, wherein the treatment plan was designed based on the first images, and a level of optimization in adapting the treatment plan is adjustable based on changes in anatomical features of a tumor in the subject compared to the anatomical features before the treatment fraction, wherein the level of optimization is associated with prior knowledge, the treatment plan including the delivery of radiation in the non-coplanar manner (Paragraph 0031 teaches the registration of the treatment images and the planning images. Paragraph 0037 teaches that the images are registered in the treatment process and can be functional or biological treatment images and used in updating the contour to produce updated contours in the updating optimization. Paragraph 0033 teaches that the treatment plan parameters can be optimized according to the updated contours. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ. Paragraph 0019 teaches that the contouring processor is able to use pattern recognition to refine and adjust contours and the contours are stored in the memory. Other anatomical data derived from the one or more planning images is also stored in the memory. Paragraph 0020 teaches that the anatomical information that is stored is used in the radiation treatment plan and the optimization of the radiation parameters such as: multileaved collimator settings that define the aperture shape; global beam intensity or weight; beam direction; wedge angle; fractionation schedule. The optimized treatment plan parameters are stored in the treatment plan parameters memory. This optimization criteria includes the production of substantial irradiation of the malignant tissue and the limitation of the irradiation of the OAR. Fig. 2 shows this contouring and optimization occurs prior to their performance of the treatment. Additionally, it shows that the treatment parameters are updated based on the updated contours. Paragraph 0003 teaches that the treatment plan includes the selection of beam locations, beam divergence angles, and multileaved collimator settings. Paragraph 0030 teaches consideration of global parameters such as overall beam intensity or weight, beam direction, wedge angle, fractionation schedule. Paragraph 0021 teaches 3D imaging. Paragraph 0023 teaches application of LINAC on the subject over a range of angular views at a full 360 degrees);
output the adapted treatment plan (Paragraph 0019 teaches that the computed results can be displayed. Paragraph 0033 teaches that the parameter values determined by the optimization parameter are stored in the memory and used in the process operation where the therapy is performed. Abstract teaches that the radiation of the patient is performed using the optimized parameters),
wherein the radiation delivery assembly is configured to treat the subject according to the adapted treatment plan (Paragraph 0033 teaches that the parameter values determined by the optimization parameter are stored in the memory and used in the process operation where the therapy is performed. Abstract teaches that the radiation of the patient is performed using the optimized parameters. Fig. 2 shows the optimization to be conducted within the workflow for each radiation therapy session. Paragraph 0031 teaches this and that the patient is within the support for irradiation); and
wherein the X-ray imaging assembly and the radiation delivery assembly are configured to image and treat the subject while the subject remains in a single position (Paragraph 0029 teaches that high resolution planning images are acquired using the CT scanner. The images can be of the cancerous tissue, organs, and regions of interest. Paragraph 0018 teaches imaging of a person. Paragraph 0023 teaches LINAC. It is well established that x-ray imaging requires the patient to remain still for a period of time during the imaging6. It is well established that LINAC requires the patient to remain still for a period of time during the treatment7).
However, Bal is silent regarding a system, comprising:
wherein the radiation delivery assembly and the X-ray imaging assembly form into a C-arm and is configured to rotate with three degrees of freedom as one single unit, thereby facilitating delivery of radiation in a non-coplanar manner.
In an analogous imaging field of endeavor, regarding image-based radiotherapy and contour analysis, Prince teaches a system, comprising:
wherein the radiation delivery assembly and the X-ray imaging assembly form into a C-arm and is configured to rotate with three degrees of freedom as one single unit, thereby facilitating delivery of radiation in a non-coplanar manner (Col. 6, lines 40-47 teaches the C-arm pivoting in the x and y directions. Col. 12, lines 34-39 teaches the swivel about the axis. Col. 6, lines 7-32 teaches the radiation beams are for imaging and treatment. Col. 7, lines 4-46 teach the creation of 3D radiation dose distribution according to a treatment plan. See Fig. 1 and 10 that show the angular relationship with respect to the patient and the plane);
the treatment plan including the delivery of radiation in the non-coplanar manner (Col. 6, lines 40-47 teaches the C-arm pivoting in the x and y directions. Col. 12, lines 34-39 teaches the swivel about the axis. Col. 6, lines 7-32 teaches the radiation beams are for imaging and treatment. Col. 7, lines 4-46 teach the creation of 3D radiation dose distribution according to a treatment plan. See Fig. 1 and 10 that show the angular relationship with respect to the patient and the plane);
wherein the X-ray imaging assembly and the radiation delivery assembly are configured to image and treat the subject while the subject remains in a single position (Col. 5, lines 40-67 disclose that it is the radiation source that is moving with respect to the subject rather than the subject itself. Col. 6, lines 7-32 teach the rotation about the patient. Figs. 10-11 show the subject in a single position as the radiation source changes. It is well established that x-ray imaging requires the patient to remain still for a period of time during the imaging8. It is well established that LINAC requires the patient to remain still for a period of time during the treatment9).
It would have been obvious to a person of ordinary skill in the art, before the effective filing date of the claimed invention, to modify Bal with Prince’s teaching of C-arm with multiple degrees of freedom and non-coplanar treatment. This modified apparatus would allow the user to can cover most clinical treatments as well as or better than conventional MLCs but by using fewer leaves for less cost and higher reliability (Col. 1, lines 60-62 of Prince). Furthermore, the modification can have better tolerance control, less cost, less weight, and can fit within a smaller cover or similar structures (Col. 7, lines 59-60 of Prince).
Regarding claim 2, modified Bal teaches the system in claim 1, as discussed above.
Bal further teaches a system, wherein the at least one processor is further programmed to:
adapt contours of the anatomical features in the treatment plan by registering the first images with the second images (Paragraph 0031 teaches the registration of the treatment images and the planning images. Paragraph 0037 teaches that the images are registered in the treatment process and can be functional or biological treatment images and used in updating the contour to produce updated contours in the updating optimization. Paragraph 0033 teaches that the treatment plan parameters can be optimized according to the updated contours. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ).
Regarding claim 3, modified Bal teaches the system in claim 2, as discussed above.
Bal further teaches a system, wherein the at least one processor is further programmed to:
adapt the treatment plan based on the adapted contours (Paragraph 0031 teaches the registration of the treatment images and the planning images. Paragraph 0037 teaches that the images are registered in the treatment process and can be functional or biological treatment images and used in updating the contour to produce updated contours in the updating optimization. Paragraph 0033 teaches that the treatment plan parameters can be optimized according to the updated contours. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ).
Regarding claim 4, modified Bal teaches the system in claim 1, as discussed above.
Bal further teaches a system, wherein the at least one processor is further programmed to:
adapt the treatment plan using modules of the system that are separate from the adaptive radiotherapy computing device, the modules configured to generate the treatment plan before adaption by the adaptive radiotherapy computing device (Paragraph 0018 teaches that the planning CT scanner is used in making the planning images and storing the information in the memory. Fig. 1 shows the CT scanner to be different from the treatment system. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ. See Fig. 2 which shows the collection and contouring by the high-resolution system is prior to the workflow).
Regarding claim 6, modified Bal teaches the system in claim 1, as discussed above.
Bal further teaches a system, wherein the at least one processor is further programmed to:
adapt the treatment plan while the subject is positioned in the system (Fig. 2 shows the optimization to be conducted within the workflow for each radiation therapy session. Paragraph 0031 teaches this and that the patient is within the support for irradiation).
Regarding claim 8, Bal teaches an adaptive radiotherapy computing device of a linear particle accelerator (LINAC) radiotherapy system (Title teaches it is associated to radiotherapeutic treatment plan adaptation. Paragraph 0023 teaches that the tomographic system includes a LINAC and the delivery of radiation. Paragraph 0038 teaches that the treatment system can employ any imaging modality of combination needed. Paragraph 0023 teaches that the radiation delivery system is a tomographic system with a radiation delivery system. Paragraphs 0024-25 teach that the second system can be a CT scanner), the adaptive radiotherapy computing device comprising at least one processor in communication with at least one memory device (Paragraphs 0018-20 teach the use of a processor and memory. It is inherent that a computational system will utilize a processor and memory for the performance of its computational functions), and the at least one processor programmed to:
receive first images of a subject acquired by an imaging system, receive second images of the subject acquired during a treatment fraction by an X-ray imaging assembly, wherein the first images have higher resolutions than the second images (Paragraph 0029 teaches that high resolution planning images are acquired using the CT scanner. The images can be of the cancerous tissue, organs, and regions of interest. Paragraph 0018 teaches imaging of a person. Paragraph 0031 teaches that the workflow for each radiation therapy session is performed and it includes the acquisition of the one or more treatment images using the second imaging system. Paragraph 0035 teaches that the treatment images are of a lower resolution than the images from the planning scanner);
adapt a treatment plan using the second images, wherein the treatment plan was designed based on the first images, and a level of optimization in adapting the treatment plan is adjustable based on changes in anatomical features of a tumor in the subject compared to the anatomical features before the treatment fraction, wherein the level of optimization is associated with prior knowledge, the treatment plan including delivery of radiation in a non-coplanar manner (Paragraph 0031 teaches the registration of the treatment images and the planning images. Paragraph 0037 teaches that the images are registered in the treatment process and can be functional or biological treatment images and used in updating the contour to produce updated contours in the updating optimization. Paragraph 0033 teaches that the treatment plan parameters can be optimized according to the updated contours. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ. Paragraph 0019 teaches that the contouring processor is able to use pattern recognition to refine and adjust contours and the contours are stored in the memory. Other anatomical data derived from the one or more planning images is also stored in the memory. Paragraph 0020 teaches that the anatomical information that is stored is used in the radiation treatment plan and the optimization of the radiation parameters such as: multileaved collimator settings that define the aperture shape; global beam intensity or weight; beam direction; wedge angle; fractionation schedule. The optimized treatment plan parameters are stored in the treatment plan parameters memory. This optimization criteria includes the production of substantial irradiation of the malignant tissue and the limitation of the irradiation of the OAR. Fig. 2 shows this contouring and optimization occurs prior to their performance of the treatment. Additionally, it shows that the treatment parameters are updated based on the updated contours. Paragraph 0003 teaches that the treatment plan includes the selection of beam locations, beam divergence angles, and multileaved collimator settings. Paragraph 0030 teaches consideration of global parameters such as overall beam intensity or weight, beam direction, wedge angle, fractionation schedule. Paragraph 0021 teaches 3D imaging. Paragraph 0023 teaches application of LINAC on the subject over a range of angular views at a full 360 degrees);
output the adapted treatment plan (Paragraph 0019 teaches that the computed results can be displayed. Paragraph 0033 teaches that the parameter values determined by the optimization parameter are stored in the memory and used in the process operation where the therapy is performed. Abstract teaches that the radiation of the patient is performed using the optimized parameters),
wherein a radiation delivery assembly of the LINAC radiotherapy system is configured to treat the subject according to the adapted treatment plan in an on-table setting (Paragraph 0033 teaches that the parameter values determined by the optimization parameter are stored in the memory and used in the process operation where the therapy is performed. Abstract teaches that the radiation of the patient is performed using the optimized parameters. Fig. 2 shows the optimization to be conducted within the workflow for each radiation therapy session. Paragraph 0031 teaches this and that the patient is within the support for irradiation)
wherein the X-ray imaging assembly and the radiation delivery assembly are configured to image and treat the subject while the subject remains in a single position (Paragraph 0029 teaches that high resolution planning images are acquired using the CT scanner. The images can be of the cancerous tissue, organs, and regions of interest. Paragraph 0018 teaches imaging of a person. Paragraph 0023 teaches LINAC. It is well established that x-ray imaging requires the patient to remain still for a period of time during the imaging10. It is well established that LINAC requires the patient to remain still for a period of time during the treatment11).
However, Bal is silent regarding an adaptive radiotherapy computing device, comprising:
X-ray imaging assembly in a C-arm gantry of a LINAC radiotherapy system;
wherein the radiation delivery assembly and the X-ray imaging assembly form into the C-arm gantry and is configured to rotate with three degrees of freedom as one single unit, thereby facilitating the delivery of radiation in the non- coplanar manner.
In an analogous imaging field of endeavor, regarding image-based radiotherapy and contour analysis, Prince teaches an adaptive radiotherapy computing device, comprising:
X-ray imaging assembly in a C-arm gantry of a LINAC radiotherapy system (Col. 6, lines 40-47 teaches the C-arm pivoting in the x and y directions. Col. 12, lines 34-39 teaches the swivel about the axis. Col. 6, lines 7-32 teaches the radiation beams are for imaging and treatment See Fig. 1 and 10 that show the angular relationship with respect to the patient and the plane. Col. 2, lines 21-31 teaches facilitating IMRT);
wherein the radiation delivery assembly and the X-ray imaging assembly form into the C-arm gantry and is configured to rotate with three degrees of freedom as one single unit, thereby facilitating the delivery of radiation in the non- coplanar manner (Col. 6, lines 40-47 teaches the C-arm pivoting in the x and y directions. Col. 12, lines 34-39 teaches the swivel about the axis. Col. 6, lines 7-32 teaches the radiation beams are for imaging and treatment. Col. 7, lines 4-46 teach the creation of 3D radiation dose distribution according to a treatment plan. See Fig. 1 and 10 that show the angular relationship with respect to the patient and the plane);
the treatment plan including the delivery of radiation in the non-coplanar manner (Col. 6, lines 40-47 teaches the C-arm pivoting in the x and y directions. Col. 12, lines 34-39 teaches the swivel about the axis. Col. 6, lines 7-32 teaches the radiation beams are for imaging and treatment. Col. 7, lines 4-46 teach the creation of 3D radiation dose distribution according to a treatment plan. See Fig. 1 and 10 that show the angular relationship with respect to the patient and the plane);
wherein the X-ray imaging assembly and the radiation delivery assembly are configured to image and treat the subject while the subject remains in a single position (Col. 5, lines 40-67 disclose that it is the radiation source that is moving with respect to the subject rather than the subject itself. Col. 6, lines 7-32 teach the rotation about the patient. Figs. 10-11 show the subject in a single position as the radiation source changes. It is well established that x-ray imaging requires the patient to remain still for a period of time during the imaging12. It is well established that LINAC requires the patient to remain still for a period of time during the treatment13).
It would have been obvious to a person of ordinary skill in the art, before the effective filing date of the claimed invention, to modify Bal with Prince’s teaching of C-arm with multiple degrees of freedom and non-coplanar treatment. This modified apparatus would allow the user to can cover most clinical treatments as well as or better than conventional MLCs but by using fewer leaves for less cost and higher reliability (Col. 1, lines 60-62 of Prince). Furthermore, the modification can have better tolerance control, less cost, less weight, and can fit within a smaller cover or similar structures (Col. 7, lines 59-60 of Prince).
Regarding claim 9, modified Bal teaches the adaptive radiotherapy computing device in claim 8, as discussed above.
Bal further teaches an adaptive radiotherapy computing device, wherein the at least one processor is further programmed to:
adapt contours of the anatomical features in the treatment plan by registering the first images with the second images (Paragraph 0031 teaches the registration of the treatment images and the planning images. Paragraph 0037 teaches that the images are registered in the treatment process and can be functional or biological treatment images and used in updating the contour to produce updated contours in the updating optimization. Paragraph 0033 teaches that the treatment plan parameters can be optimized according to the updated contours. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ).
Regarding claim 10, modified Bal teaches the adaptive radiotherapy computing device in claim 9, as discussed above.
Bal further teaches an adaptive radiotherapy computing device, wherein the at least one processor is further programmed to:
adapt the treatment plan based on the adapted contours (Paragraph 0031 teaches the registration of the treatment images and the planning images. Paragraph 0037 teaches that the images are registered in the treatment process and can be functional or biological treatment images and used in updating the contour to produce updated contours in the updating optimization. Paragraph 0033 teaches that the treatment plan parameters can be optimized according to the updated contours. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ).
Regarding claim 11, modified Bal teaches the adaptive radiotherapy computing device in claim 8, as discussed above.
Bal further teaches an adaptive radiotherapy computing device, wherein the at least one processor is further programmed to:
adapt the treatment plan using modules of the LINAC radiotherapy system that are separate from the adaptive radiotherapy computing device, the modules configured to generate the treatment plan before adaption by the adaptive radiotherapy computing device (Paragraph 0018 teaches that the planning CT scanner is used in making the planning images and storing the information in the memory. Fig. 1 shows the CT scanner to be different from the treatment system. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ. See Fig. 2 which shows the collection and contouring by the high-resolution system is prior to the workflow).
Regarding claim 13, modified Bal teaches the adaptive radiotherapy computing device in claim 8, as discussed above.
Bal further teaches an adaptive radiotherapy computing device, wherein the at least one processor is further programmed to:
adapt the treatment plan while the subject is positioned in the system (Fig. 2 shows the optimization to be conducted within the workflow for each radiation therapy session. Paragraph 0031 teaches this and that the patient is within the support for irradiation).
Regarding claim 15, Bal teaches a method of adapting radiotherapy on a subject with a linear particle accelerator (LINAC) radiotherapy system (Title teaches it is associated to radiotherapeutic treatment plan adaptation. Paragraph 0023 teaches that the tomographic system includes a LINAC and the delivery of radiation. Paragraph 0038 teaches that the treatment system can employ any imaging modality of combination needed. Paragraphs 0018-20 teach the use of a processor and memory. It is inherent that a computational system will utilize a processor and memory for the performance of its computational functions), comprising:
receiving first images of the subject acquired by an imaging system (Paragraph 0029 teaches that high resolution planning images are acquired using the CT scanner. The images can be of the cancerous tissue, organs, and regions of interest. Paragraph 0018 teaches imaging of a person),
receiving second images of the subject acquired during a treatment fraction by an X-ray imaging assembly, wherein the first images have higher resolutions than the second images (Paragraph 0031 teaches that the workflow for each radiation therapy session is performed and it includes the acquisition of the one or more treatment images using the second imaging system. Paragraph 0035 teaches that the treatment images are of a lower resolution than the images from the planning scanner);
adapting a treatment plan using the second images, wherein the treatment plan was designed based on the first images, wherein adapting a treatment plan further comprises adjusting a level of optimization in adapting the treatment plan based on changes in anatomical features of a tumor of the subject compared to the anatomical features before the treatment fraction, wherein the level of optimization is associated with prior knowledge, the treatment plan including the delivery of radiation in the non-coplanar manner (Paragraph 0031 teaches the registration of the treatment images and the planning images. Paragraph 0037 teaches that the images are registered in the treatment process and can be functional or biological treatment images and used in updating the contour to produce updated contours in the updating optimization. Paragraph 0033 teaches that the treatment plan parameters can be optimized according to the updated contours. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ. Paragraph 0019 teaches that the contouring processor is able to use pattern recognition to refine and adjust contours and the contours are stored in the memory. Other anatomical data derived from the one or more planning images is also stored in the memory. Paragraph 0020 teaches that the anatomical information that is stored is used in the radiation treatment plan and the optimization of the radiation parameters such as: multileaved collimator settings that define the aperture shape; global beam intensity or weight; beam direction; wedge angle; fractionation schedule. The optimized treatment plan parameters are stored in the treatment plan parameters memory. This optimization criteria includes the production of substantial irradiation of the malignant tissue and the limitation of the irradiation of the OAR. Fig. 2 shows this contouring and optimization occurs prior to their performance of the treatment. Additionally, it shows that the treatment parameters are updated based on the updated contours. Paragraph 0003 teaches that the treatment plan includes the selection of beam locations, beam divergence angles, and multileaved collimator settings. Paragraph 0030 teaches consideration of global parameters such as overall beam intensity or weight, beam direction, wedge angle, fractionation schedule. Paragraph 0021 teaches 3D imaging. Paragraph 0023 teaches application of LINAC on the subject over a range of angular views at a full 360 degrees);
output the adapted treatment plan (Paragraph 0019 teaches that the computed results can be displayed. Paragraph 0033 teaches that the parameter values determined by the optimization parameter are stored in the memory and used in the process operation where the therapy is performed. Abstract teaches that the radiation of the patient is performed using the optimized parameters),
treating the subject according to the adapted treatment plan using a radiation delivery assembly of the LINAC radiotherapy system (Paragraph 0033 teaches that the parameter values determined by the optimization parameter are stored in the memory and used in the process operation where the therapy is performed. Abstract teaches that the radiation of the patient is performed using the optimized parameters. Fig. 2 shows the optimization to be conducted within the workflow for each radiation therapy session. Paragraph 0031 teaches this and that the patient is within the support for irradiation);
wherein the X-ray imaging assembly and the radiation delivery assembly are configured to image and treat the subject while the subject remains in a single position (Paragraph 0029 teaches that high resolution planning images are acquired using the CT scanner. The images can be of the cancerous tissue, organs, and regions of interest. Paragraph 0018 teaches imaging of a person. Paragraph 0023 teaches LINAC. It is well established that x-ray imaging requires the patient to remain still for a period of time during the imaging14. It is well established that LINAC requires the patient to remain still for a period of time during the treatment15).
However, Bal is silent regarding a method, comprising:
an X-ray imaging assembly in a C-arm gantry of a LINAC radiotherapy system;
wherein the radiation delivery assembly and the X-ray assembly form into the C-arm gantry and is configured to rotate with three degrees of freedom as one single unit, thereby facilitating delivery of radiation in the non-coplanar manner.
In an analogous imaging field of endeavor, regarding image-based radiotherapy and contour analysis, Prince teaches a method, comprising:
an X-ray imaging assembly in a C-arm gantry of a LINAC radiotherapy system (Col. 6, lines 40-47 teaches the C-arm pivoting in the x and y directions. Col. 12, lines 34-39 teaches the swivel about the axis. Col. 6, lines 7-32 teaches the radiation beams are for imaging and treatment See Fig. 1 and 10 that show the angular relationship with respect to the patient and the plane. Col. 2, lines 21-31 teaches facilitating IMRT);
wherein the radiation delivery assembly and the X-ray assembly form into the C-arm gantry and is configured to rotate with three degrees of freedom as one single unit, thereby facilitating delivery of radiation in the non-coplanar manner (Col. 6, lines 40-47 teaches the C-arm pivoting in the x and y directions. Col. 12, lines 34-39 teaches the swivel about the axis. Col. 6, lines 7-32 teaches the radiation beams are for imaging and treatment. Col. 7, lines 4-46 teach the creation of 3D radiation dose distribution according to a treatment plan. See Fig. 1 and 10 that show the angular relationship with respect to the patient and the plane);
the treatment plan including the delivery of radiation in the non-coplanar manner (Col. 6, lines 40-47 teaches the C-arm pivoting in the x and y directions. Col. 12, lines 34-39 teaches the swivel about the axis. Col. 6, lines 7-32 teaches the radiation beams are for imaging and treatment. Col. 7, lines 4-46 teach the creation of 3D radiation dose distribution according to a treatment plan. See Fig. 1 and 10 that show the angular relationship with respect to the patient and the plane);
wherein the X-ray imaging assembly and the radiation delivery assembly are configured to image and treat the subject while the subject remains in a single position (Col. 5, lines 40-67 disclose that it is the radiation source that is moving with respect to the subject rather than the subject itself. Col. 6, lines 7-32 teach the rotation about the patient. Figs. 10-11 show the subject in a single position as the radiation source changes. It is well established that x-ray imaging requires the patient to remain still for a period of time during the imaging16. It is well established that LINAC requires the patient to remain still for a period of time during the treatment17)..
It would have been obvious to a person of ordinary skill in the art, before the effective filing date of the claimed invention, to modify Bal with Prince’s teaching of C-arm with multiple degrees of freedom and non-coplanar treatment. This modified method would allow the user to can cover most clinical treatments as well as or better than conventional MLCs but by using fewer leaves for less cost and higher reliability (Col. 1, lines 60-62 of Prince). Furthermore, the modification can have better tolerance control, less cost, less weight, and can fit within a smaller cover or similar structures (Col. 7, lines 59-60 of Prince).
Regarding claim 16, modified Bal teaches the method in claim 15, as discussed above.
Bal further teaches a method, wherein adapting the treatment plan further comprises adapting contours of anatomical features in the treatment plan by registering the first images with the second images (Paragraph 0031 teaches the registration of the treatment images and the planning images. Paragraph 0037 teaches that the images are registered in the treatment process and can be functional or biological treatment images and used in updating the contour to produce updated contours in the updating optimization. Paragraph 0033 teaches that the treatment plan parameters can be optimized according to the updated contours. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ).
Regarding claim 17, modified Bal teaches the method in claim 16, as discussed above.
Bal further teaches a method, wherein adapting the treatment plan further comprises: adapting the treatment plan based on the adapted contours (Paragraph 0031 teaches the registration of the treatment images and the planning images. Paragraph 0037 teaches that the images are registered in the treatment process and can be functional or biological treatment images and used in updating the contour to produce updated contours in the updating optimization. Paragraph 0033 teaches that the treatment plan parameters can be optimized according to the updated contours. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ).
Regarding claim 18, modified Bal teaches the method in claim 15, as discussed above.
Bal further teaches a method, wherein adapting the treatment plan further comprises: adapting the treatment plan using modules of the LINAC radiotherapy system, the modules configured to generate the treatment plan before adaption by the adaptive radiotherapy computing device (Paragraph 0018 teaches that the planning CT scanner is used in making the planning images and storing the information in the memory. Fig. 1 shows the CT scanner to be different from the treatment system. Paragraph 0029 teaches that the high-resolution images are for planning and assessing the contours of the regions of interest. Paragraph 0028 teaches that the treatment images are assessing the contour deformation and account for changes in position, orientation, size, shape, and radiosensitivity of the tissue or organ. See Fig. 2 which shows the collection and contouring by the high-resolution system is prior to the workflow).
Regarding claim 20, modified Bal teaches the method in claim 15, as discussed above.
Bal further teaches a method, wherein adapting the treatment plan further comprises:
adapting the treatment plan while the subject is positioned in the system (Fig. 2 shows the optimization to be conducted within the workflow for each radiation therapy session. Paragraph 0031 teaches this and that the patient is within the support for irradiation).
Claims 7 and 14 are rejected under 35 U.S.C. 103 as being unpatentable over Bal et al. (PGPUB No. US 2011/0103551) in view of Prince et al. (US Patent No. 10,071,263) further in view of Younge et al. ("Predicting deliverability of volumetric-modulated arc therapy (VMAT) plans using aperture complexity analysis", 2016).
Regarding claim 7, modified Bal teaches the system in claim 1, as discussed above.
However, the combination of Bal and Prince is silent regarding a system, wherein the at least one processor is further programmed to: perform a quality assurance of the treatment plan on at least one of achievability or deliverability of the treatment plan.
In an analogous imaging field of endeavor, regarding radiation therapy, wherein the at least one processor is further programmed to: perform a quality assurance of the treatment plan on at least one of achievability or deliverability of the treatment plan (Abstract teaches that VMAT quality assurance can be used to validate the ability of the complexity metric to predict plan deliverability. Title teaches predicting deliverability of BMAT plans using aperture complexity analysis).
It would have been obvious to a person of ordinary skill in the art, before the effective filing date of the claimed invention, to modify the combination of Bal and Prince with Younge’s teaching of quality assurance for deliverability. This modified apparatus would allow the user to reduce the number of QA failures and improve the quality of VMAT plans used for treatment (Abstract of Younge). Furthermore, the modification may reduce plan complexity and thereby improve deliverability and reduce treatment time (Abstract of Younge).
Regarding claim 14, modified Bal teaches the adaptive radiotherapy computing device in claim 8, as discussed above.
However, the combination of Bal and Prince is silent regarding an adaptive radiotherapy computing device, wherein the at least one processor is further programmed to: perform a quality assurance of the treatment plan on at least one of achievability or deliverability of the treatment plan.
In an analogous imaging field of endeavor, regarding radiation therapy, Younge teaches an adaptive radiotherapy computing device, wherein the at least one processor is further programmed to: perform a quality assurance of the treatment plan on at least one of achievability or deliverability of the treatment plan (Abstract teaches that VMAT quality assurance can be used to validate the ability of the complexity metric to predict plan deliverability. Title teaches predicting deliverability of BMAT plans using aperture complexity analysis).
It would have been obvious to a person of ordinary skill in the art, before the effective filing date of the claimed invention, to modify the combination of Bal and Prince with Younge’s teaching of quality assurance for deliverability. This modified apparatus would allow the user to reduce the number of QA failures and improve the quality of VMAT plans used for treatment (Abstract of Younge). Furthermore, the modification may reduce plan complexity and thereby improve deliverability and reduce treatment time (Abstract of Younge).
Claims 21-23 are rejected under 35 U.S.C. 103 as being unpatentable over Bal et al. (PGPUB No. US 2011/0103551) in view of Prince et al. (US Patent No. 10,071,263) further in view of Ranganathan (PGPUB No. US 2020/0054895).
Regarding claim 21, modified Bal teaches the system in claim 1, as discussed above.
However, the combination of Bal and Prince is silent regarding a system, further comprising: a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner.
In an analogous imaging field of endeavor, regarding radiation therapy planning, Ranganathan teaches a system, further comprising: a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner (Paragraph 0036 teaches that the couch provides three degrees of translational freedom of movement and also three degrees of rotational freedom of movement with couch position parameters of the optimized radiation therapy plan setting the could translational and rotational position for each CP).
It would have been obvious to a person of ordinary skill in the art, before the effective filing date of the claimed invention, to modify the combination of Bal and Prince with Ranganathan’s teaching of patient couch that is rotatable movable for treatment. This modified apparatus would allow the user to treat the patient with the optimized radiation therapy plan (Paragraph 0036 of Ranganathan). Furthermore, the modification provides improved fidelity of continuous arc radiation therapy session plan to dose objectives and in combination with more computationally efficient continuous arc radiation therapy session planning (Paragraphs 0012-14 of Ranganathan).
Regarding claim 22, modified Bal teaches the 8 in claim 8, as discussed above.
However, the combination of Bal and Prince is silent regarding an adaptive radiotherapy computing device, wherein the LINAC radiotherapy system further comprises: a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom.
In an analogous imaging field of endeavor, regarding radiation therapy planning, Ranganathan teaches an adaptive radiotherapy computing device, wherein the LINAC radiotherapy system further comprises: a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom (Paragraph 0036 teaches that the couch provides three degrees of translational freedom of movement and also three degrees of rotational freedom of movement with couch position parameters of the optimized radiation therapy plan setting the could translational and rotational position for each CP).
It would have been obvious to a person of ordinary skill in the art, before the effective filing date of the claimed invention, to modify the combination of Bal and Prince with Ranganathan’s teaching of patient couch that is rotatable movable for treatment. This modified apparatus would allow the user to treat the patient with the optimized radiation therapy plan (Paragraph 0036 of Ranganathan). Furthermore, the modification provides improved fidelity of continuous arc radiation therapy session plan to dose objectives and in combination with more computationally efficient continuous arc radiation therapy session planning (Paragraphs 0012-14 of Ranganathan).
Regarding claim 23, modified Bal teaches the method in claim 15, as discussed above.
However, the combination of Bal and Prince is silent regarding a method, wherein the LINAC radiotherapy system further comprises: a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom.
In an analogous imaging field of endeavor, regarding radiation therapy planning, Ranganathan teaches a method, wherein the LINAC radiotherapy system further comprises: a couch on which the subject lies during a session of treatment, the couch configured to rotate and to move in one or more degrees of freedom, thereby facilitating delivery of radiation in the non-coplanar manner in a degree of rotational freedom (Paragraph 0036 teaches that the couch provides three degrees of translational freedom of movement and also three degrees of rotational freedom of movement with couch position parameters of the optimized radiation therapy plan setting the could translational and rotational position for each CP).
It would have been obvious to a person of ordinary skill in the art, before the effective filing date of the claimed invention, to modify the combination of Bal and Prince with Ranganathan’s teaching of patient couch that is rotatable movable for treatment. This modified method would allow the user to treat the patient with the optimized radiation therapy plan (Paragraph 0036 of Ranganathan). Furthermore, the modification provides improved fidelity of continuous arc radiation therapy session plan to dose objectives and in combination with more computationally efficient continuous arc radiation therapy session planning (Paragraphs 0012-14 of Ranganathan).
Conclusion
The prior art made of record and not relied upon is considered pertinent to applicant's disclosure:
Yan et al. (PGPUB No. US 20120020449): Teaches a c-arm for imaging and therapy with at least three degrees of freedom for non-coplanar irradiation while the patient is stationary.
Kaiser et al. (PGPUB No. US 20080219407): Teaches a c-arm for imaging and therapy with at least three degrees of freedom for non-coplanar irradiation while the patient is stationary.
Urano et al. (PGPUB No. US 20070211856): Teaches a c-arm for imaging and therapy with at least three degrees of freedom for non-coplanar irradiation while the patient is stationary. Teaches multiple imaging sets with varying resolution for treatment optimization.
Fu et al. (PGPUB No. US 20080130825): Teaches multiple imaging sets with varying resolution for treatment optimization.
Maurer, Jr. et al. (PGPUB No. US 2012/0106704): Teaches a c-arm for imaging and therapy with at least three degrees of freedom for non-coplanar irradiation while the patient is stationary.
Kusch et al. (PGPUB No. US 20050281389): Teaches a c-arm for imaging and therapy with at least three degrees of freedom for non-coplanar irradiation while the patient is stationary.
Faulhaber et al. (US Patent No. 11,759,157): Teaches a c-arm for imaging and therapy with at least three degrees of freedom for non-coplanar irradiation while the patient is stationary.
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/ADIL PARTAP S VIRK/Primary Examiner, Art Unit 3798
1 “Depending on the part of your body being examined, you may be asked to stand, sit, or lie down. You will need to stay still for a short time while the image is taken.” (Link: https://medlineplus.gov/xrays.html)
2 “The patient lies still on the couch while the machine delivers exact radiation doses to the tumour from carefully chosen angles.” (Link: https://www.medanta.org/patient-education-blog/linear-accelerator-uses-in-cancer-treatment)
3 “. It is important that you remain still as the picture is taken.” (https://healthcare.utah.edu/radiology/preparing-appointment/fluoroscopy)
4 “The radiologic technologist will ask you to hold still in a certain position for a few moments while the X-ray exposure is made” and “ Unless the technologist instructs you otherwise, it is extremely important to remain completely still while the exposure is made.” (Link: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/xrays-of-the-spine-neck-or-back)
5 https://www.med.unc.edu/radiology/patient-care/forpatients/ exam-prep-patient-education-resources/. Also, https://valencemedicalimaging.com/ what-happens-if-you-move-during-an-x-ray-understanding-motion-artifacts/
6 “Depending on the part of your body being examined, you may be asked to stand, sit, or lie down. You will need to stay still for a short time while the image is taken.” (Link: https://medlineplus.gov/xrays.html)
7 “The patient lies still on the couch while the machine delivers exact radiation doses to the tumour from carefully chosen angles.” (Link: https://www.medanta.org/patient-education-blog/linear-accelerator-uses-in-cancer-treatment)
8 “Depending on the part of your body being examined, you may be asked to stand, sit, or lie down. You will need to stay still for a short time while the image is taken.” (Link: https://medlineplus.gov/xrays.html)
9 “The patient lies still on the couch while the machine delivers exact radiation doses to the tumour from carefully chosen angles.” (Link: https://www.medanta.org/patient-education-blog/linear-accelerator-uses-in-cancer-treatment)
10 “Depending on the part of your body being examined, you may be asked to stand, sit, or lie down. You will need to stay still for a short time while the image is taken.” (Link: https://medlineplus.gov/xrays.html)
11 “The patient lies still on the couch while the machine delivers exact radiation doses to the tumour from carefully chosen angles.” (Link: https://www.medanta.org/patient-education-blog/linear-accelerator-uses-in-cancer-treatment)
12 “Depending on the part of your body being examined, you may be asked to stand, sit, or lie down. You will need to stay still for a short time while the image is taken.” (Link: https://medlineplus.gov/xrays.html)
13 “The patient lies still on the couch while the machine delivers exact radiation doses to the tumour from carefully chosen angles.” (Link: https://www.medanta.org/patient-education-blog/linear-accelerator-uses-in-cancer-treatment)
14 “Depending on the part of your body being examined, you may be asked to stand, sit, or lie down. You will need to stay still for a short time while the image is taken.” (Link: https://medlineplus.gov/xrays.html)
15 “The patient lies still on the couch while the machine delivers exact radiation doses to the tumour from carefully chosen angles.” (Link: https://www.medanta.org/patient-education-blog/linear-accelerator-uses-in-cancer-treatment)
16 “Depending on the part of your body being examined, you may be asked to stand, sit, or lie down. You will need to stay still for a short time while the image is taken.” (Link: https://medlineplus.gov/xrays.html)
17 “The patient lies still on the couch while the machine delivers exact radiation doses to the tumour from carefully chosen angles.” (Link: https://www.medanta.org/patient-education-blog/linear-accelerator-uses-in-cancer-treatment)
Prosecution Insights