IL305649B2

IL305649B2 - Irradiation treatment planning for collision avoidance in treatment room

Info

Publication number: IL305649B2
Application number: IL305649A
Authority: IL
Inventors: WINOGRAD Shimshon; Marash Michael
Original assignee: P Cure Ltd; WINOGRAD Shimshon; Marash Michael
Priority date: 2023-09-03
Filing date: 2023-09-03
Publication date: 2025-09-01
Also published as: IL305649A; WO2025046583A1; IL305649B1

Description

IL305649/ IRRADIATION TREATMENT PLANNING FOR COLLISION AVOIDANCE IN TREATMENT ROOM FIELD OF THE INVENTIONThe present invention generally relates to the fields of irradiation 5treatment and particularly to planning an irradiation treatment in a treatment room.

BACKGROUND OF THE INVENTIONTeletherapy is defined as a treatment methodology in which an irradiation source is at a distance from a body to be treated. X-rays and electron 10beams have long been used in teletherapy to treat various cancers. Unfortunately, X-rays exhibit a linear energy transfer approaching an exponential attenuation function and are therefore of minimal safe use for deeply embedded growths. The use of heavy particles, particularly hadrons and more particularly protons, in teletherapy, has found increasing acceptance, due to the ability of heavy particles 15to penetrate to a specific depth without appreciably harming intervening tissue. In particular, the linear energy transfer of hadrons exhibits an inversed depth profile with a marked Bragg peak defined as the point at which the hadrons deposit most of their energy and occurs at the end of the hadrons path. For electrons, the Bragg peak is not observable due to high scattering. For protons with energies below 20approximately 70 MeV, scattering considerably supresses the Bragg peak. As a result of this effect, increased energy can be directed at an embedded growth as compared to X-rays and electron beams, which particularly harm intervening tissues. While the term hadrons include a wide range of particles, practically, protons and various ions are most widely used in therapy. For clarity, this 25document will describe treatment as being accomplished with protons, however this is not meant to be limiting in any way. The protons or ions can be focused to a target volume of variable penetration depth. In this way the dose profile can be matched closely to the target volume with a high precision. In particular, a proton beam can conform to the 30shape and depth of a target growth, such as a tumor, so as to avoid irradiating healthy body tissue while delivering a lower total body irradiation dose. As a result, IL305649/ proton therapy can allow for escalated dosages as compared to conventional external beam therapies, which may be particularly beneficial for certain treatments, for example, ocular tumors or skull base and paraspinal tumors. Proton therapy may also enable high precision treatment plans with reduced side effects, such as for pediatric treatments or prostate cancer treatments. In order to 5ensure complete irradiation of a target growth, a plurality of beams arriving at the embedded growth from several different directions is usually applied. The point at which the plurality of beams intersects, whether they are beamed sequentially or simultaneously, is termed the "isocenter". To maximize biological effectiveness, the isocenter must be precisely collocated with the target growth. 10Irradiation treatment is performed on a target tissue in a well-defined process. In a first stage, the target tissue is imaged and a treatment plan is established. The treatment plan includes a series of treatment fields, each field defining at least a dosage, a target tissue position and orientation, and irradiation angles, for each irradiation dose. Placement or fiducial markers are defined 15respective of the patient, for guiding patient positioning for the treatment. In a subsequent stage, irradiation is performed responsive to the developed treatment plan, at a plurality of treatment sessions over a period of time. In each treatment session, care must be taken to ensure proper patient positioning responsive to the fiducial markers, so as to ensure that the applied irradiation doses are properly 20targeted and to avoid harming organs in vicinity of the target tissue. Positioning of the patient responsive to the markers may be performed based on visualization of the patient in relation to the defined markers. Particularly, prior to the treatment session the patient is brought into an initial setup position by positioning a platform supporting the patient such that the 25fiducial markers converge with an isocenter of the treatment room. A treatment plan is then executed in relation to this setup position, resulting in the target tissue localized at the treatment room isocenter. The patient is repositioned relative to the setup position in accordance with the treatment plan requirements. Specifically, the target tissue is sequentially repositioned with respect to the beam 30nozzle of the irradiation beam delivery device, which may have a fixed position or be capable of limited movement, such as by means of a gantry. The treatment room isocenter may be designated by a visual indication, such as a plurality of IL305649/ laser beams. The setup positioning of the patient may be verified using image guided radiation therapy (IGRT) techniques. Stabilization mechanisms may be applied to ensure patient positioning is maintained relative to the isocenter during the treatment, such as a mask or shield to affix the face or a body part of the patient. 5Irradiation treatments are typically administered while the patient is in a lying or recumbent position, where the patient body is aligned substantially horizontal to the ground and supported by an underlying platform surface. For example, a recumbent positioned patient may be in a supine posture, with their back resting against the underlying surface and their face positioned upwards, or 10in a prone posture, with their chest against the underlying surface and their face pointed downwards. However, certain treatments may be difficult to perform on a recumbent patient, such as due to the location of the target tissue in the body, and such treatments may require or be facilitated by an upright or seated (i.e., non-horizontal) positioning. Accordingly, the patient may be situated on a reclining 15chair that may be repositioned and reoriented along multiple axes in three-dimensional space. An upright or seated positioning may provide greater patient comfort relative to a recumbent positioning, such as for patients suffering from breathing complications. Upright positioning may also be associated with cost benefits and greater compatibility with existing equipment. Furthermore, upright 20positioning may affect changes in the volume, location, and/or motion of body organs, such as the lungs and heart, compared to recumbent positioning, which could have beneficial impacts in certain clinical situations. Accordingly, the treatment planning needs to ensure that proper treatment can be provided, in view of various constraints involved. For example, 25when the patient is brought into the setup position in the treatment room, there may be physical interference from foreign bodies and intervening elements present in the treatment room. In particular, the reclining chair (or other patient supporting platform), or body parts of the patient, particularly extremities such as the arms or legs, may collide or be obstructed by the treatment equipment or other 30objects in the room, such as a patient positioning device (e.g., x-ray detectors), the irradiation beam nozzle, a gantry, imaging equipment, processing equipment, and the like. The presence and location of such objects may not be known in IL305649/ advance and may be subject to change dynamically. These obstructions and potential collisions can significantly hinder the process of moving the patient into the setup position, which precise positioning is of utmost importance and required before the treatment can move forward. Such obstructions and collisions may also impede movement of the patient during application of the treatment, particularly 5(but not only) for patients treated in an upright or seated manner where frequent repositioning may be required. Potentially colliding objects may be difficult to account for when planning movements of the patient in the room and possible treatment angles, particularly objects that are not or cannot be imaged in conventional treatment planning systems. Collisions within the treatment room 10may significantly impede the execution of the treatment plan and may render the plan unfeasible.

IL305649/ SUMMARY OF THE INVENTIONIn accordance with one aspect of the present invention, there is thus provided a method for generating and verifying a treatment plan for an irradiation treatment. The method includes the steps of imaging a patient on a support platform to obtain a first set of target tissue images, and determining treatment 5plan fields including proposed treatment angles, based on the first set of images, the treatment angles including at least one platform positioning parameter of the support platform for positioning the patient such that the target tissue is localized at an isocenter of the treatment room. The method further includes the step of applying at least one first collision detection simulation to determine a feasibility 10of the proposed treatment angles, using a first group of simulation fields including: a three-dimensional room model of a treatment room for the irradiation treatment; platform settings of a support platform for supporting the patient during the irradiation treatment; and treatment plan fields including proposed treatment angles. The method further includes the step of generating a treatment plan for 15the irradiation treatment based on the first collision detection simulation, such that there is no collision for each treatment angle of the generated treatment plan. The method further includes the step of applying at least one second collision detection simulation to verify no collisions in movement paths between treatment angles of consecutive treatment plan fields, using a second group of simulation fields 20including: the three-dimensional room model; the target tissue volume; the platform settings; and treatment plan fields of the generated treatment plan. The method further includes the steps of, for each of at least one collision detected in the second collision detection simulation, updating treatment plan fields of the treatment plan to avoid collisions in movement paths between treatment angles, 25and applying at least one updated second collision detection simulation using an updated second group of simulations fields comprising the updated treatment plan fields; and approving the treatment plan when no collision is detected in the second collision detection simulation. The method may further include the steps of imaging the patient on the support platform to obtain a second set of target 30tissue images, and adaptively updating and validating the first treatment plan based on the second set of target tissue images. The step of imaging a patient on a support platform to obtain a first set of target tissue images may be performed IL305649/ in an imaging room different from the treatment room. The second group of simulation fields may further include at least one transition between treatment angles. The treatment angles may include at least one platform positioning parameter of: a platform surface yaw angle; a platform surface pitch angle; a platform surface roll angle; and a platform surface translational displacement. A 5platform positioning parameter of the support platform may be adjustable using a platform adjuster, configured to rotate at least one platform surface of the platform about at least one rotational axis, or to displace at least one platform surface of the platform along at least one displacement axis. The support platform may be aligned such that a patient anterior or a patient posterior is directed toward an 10irradiation beam delivery nozzle. The collision may include a collision between a first object and a second object in the treatment room. At least one of the first object and the second object may be: a body part of the patient; a component of an irradiation treatment system; the support platform; the imager; an irradiation beam delivery device; a gantry; an irradiation beam generator; a covering or 15accessory of a component of the treatment system; a chair; a table; and/or a wall of the treatment room. The patient support platform may include a chair, and the patient may be in a seated position. The irradiation treatment may include a proton irradiation treatment. At least one of the first collision detection simulation and the second collision detection simulation may be performed in a room different than 20the treatment room. In accordance with another aspect of the present invention, there is thus provided an irradiation treatment plan generation and verification system. The system includes a processor, configured to receive a first set of target tissue images of the patient; and to determine treatment plan fields including proposed 25treatment angles, based on the first set of images, the treatment angles including at least one platform positioning parameter of the support platform for positioning the patient such that the target tissue is localized at an isocenter of the treatment room. The system further includes a collision detection simulator, configured to apply at least one first collision detection simulation to determine a feasibility of 30the proposed treatment angles, using a first group of simulation fields including: a three-dimensional room model of a treatment room for the irradiation treatment; platform settings of a support platform for supporting the patient during the IL305649/ irradiation treatment; and the treatment plan fields including proposed treatment angles. The processor is further configured to generate a treatment plan for the irradiation treatment based on the first collision detection simulation, such that there is no collision for each treatment angle of the generated treatment plan. The collision detection simulator is further configured to apply at least one second 5collision detection simulation to verify no collisions in movement paths between treatment angles of consecutive treatment plan fields, using a second group of simulation fields including: the three-dimensional room model; the platform settings; and treatment plan fields of the generated treatment plan. The processor is further configured, for each of at least one collision detected in the second 10collision detection simulation, to update treatment plan fields of the treatment plan to avoid collisions in movement paths between treatment angles, and to direct the simulator to apply at least one updated second collision detection simulation using an updated second group of simulations fields including the updated treatment plan fields, and to approve the treatment plan when no collision is detected in the 15second collision detection simulation. The processor may be further configured to receive a second set of target tissue images of the patient imaged on the support platform, and to adaptively update and validate the first treatment plan based on the second set of target tissue images. An imaging of the patient to obtain a first set of target tissue images may be performed in an imaging room different from 20the treatment room. The second group of simulation fields may further include at least one transition between treatment angles. The treatment angles may include at least one platform positioning parameter of: a platform surface yaw angle; a platform surface pitch angle; a platform surface roll angle; and a platform surface translational displacement. A platform positioning parameter of the support 25platform may be adjustable using a platform adjuster, configured to rotate at least one platform surface of the platform about at least one rotational axis, or to displace at least one platform surface of the platform along at least one displacement axis. The support platform may be aligned such that a patient anterior or a patient posterior is directed toward an irradiation beam delivery 30nozzle. The collision may include a collision between a first object and a second object in the treatment room. At least one of the first object and the second object may be: a body part of the patient; a component of an irradiation treatment system; IL305649/ the support platform; the imager; an irradiation beam delivery device; a gantry; an irradiation beam generator; a covering or accessory of a component of the treatment system; a chair; a table; and/or a wall of the treatment room. The patient support platform may include a chair, and the patient may be in a seated position. The irradiation treatment may include a proton irradiation treatment. At least one 5of the first collision detection simulation and the second collision detection simulation may be performed in a room different than the treatment room.

IL305649/ BRIEF DESCRIPTION OF THE DRAWINGSThe present invention will be understood and appreciated more fully from the following detailed description taken in conjunction with the drawings in which: Figure 1 is a schematic illustration of an irradiation treatment system, 5constructed and operative in accordance with an embodiment of the present invention; Figure 2 is a schematic illustration of an irradiation treatment plan generation and verification system, constructed and operative in accordance with an embodiment of the present invention; 10Figure 3 is an illustration of an exemplary set of simulation fields for a treatment plan simulation, operative in accordance with an embodiment of the present invention; Figure 4 is a perspective view visual representation of a first exemplary treatment plan simulation applied for a treatment plan in a treatment room, 15operative in accordance with an embodiment of the present invention; Figure 5 is a perspective view visual representation of a second exemplary treatment plan simulation applied for a treatment plan in a treatment room, operative in accordance with an embodiment of the present invention; Figure 6 is a visual representation of an irradiation beam directed to a 20target tissue imaging volume of a patient in the exemplary treatment plan simulation of Figure 5, operative in accordance with an embodiment of the present invention; Figure 7 is a perspective view visual representation of a third exemplary treatment plan simulation applied for a treatment plan in a treatment 25room, operative in accordance with an embodiment of the present invention; Figure 8 is a perspective view visual representation of a fourth exemplary treatment plan simulation applied for a treatment plan in a treatment room, operative in accordance with an embodiment of the present invention; Figure 9 is a perspective view illustration of a patient support platform 30colliding with a component of an irradiation treatment system, operative in accordance with an embodiment of the present invention; and IL305649/ Figure 10 is a flow diagram of a method for generating and verifying a treatment plan for an irradiation treatment, operative in accordance with an embodiment of the present invention. 5 IL305649/ DETAILED DESCRIPTION OF THE EMBODIMENTSThe present invention overcomes the disadvantages of the prior art by providing a novel method and system for verifying an irradiation treatment plan to avoid potential collisions or interference from objects in the treatment room, such as when positioning the patient for treatment, and without requiring a customized 5verification process for different treatment rooms, for different patient support platforms, and/or for different patients. Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. It will be further understood 10that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the specification and claims and should not be interpreted in an idealized or overly formal sense unless expressly so defined herein. Well-known functions or constructions may not be described in detail for brevity and/or clarity. 15It will be understood that, although the terms first, second, etc., may be used herein to describe various elements, components, regions, layers and/or sections, these elements, components, regions, layers and/or sections should not be limited by these terms. Rather, these terms are only used to distinguish one element, component, region, layer and/or section, from another element, 20component, region, layer and/or section. It will be understood that when an element is referred to as being "on", "attached" to, "operatively coupled" to, "operatively linked" to, "operatively engaged" with, "connected" to, "coupled" with, "contacting", "added to", etc., another element, it can be directly on, attached to, connected to, operatively 25coupled to, operatively engaged with, coupled with, added to, and/or contacting the other element or intervening elements can also be present. In contrast, when an element is referred to as being "directly contacting" another element or "directly added" to another element, there are no intervening elements and/or steps present. 30Whenever the terms "about" or "approximately" is used, it is meant to refer to a measurable value such as an amount, a temporal duration, and the like, IL305649/ and is meant to encompass variations from the specified value, as such variations are appropriate to perform the disclosed methods. Certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, 5described in the context of a single embodiment, may also be provided separately or in any suitable sub-combination or as suitable in any other described embodiment of the invention. Certain features described in the context of various embodiments are not to be considered essential features of those embodiments, unless the embodiment is inoperative without those elements. 10Whenever terms "plurality" and "a plurality" are used it is meant to include, for example, "multiple" or "two or more". The terms "plurality" or "a plurality" may be used throughout the specification to describe two or more components, devices, elements, units, parameters, or the like. The term set when used herein may include one or more items. Unless explicitly stated, the method 15embodiments described herein are not constrained to a particular order or sequence. Additionally, some of the described method embodiments or elements thereof can occur or be performed simultaneously, at the same point in time, or concurrently. Throughout, this disclosure mentions "disclosed embodiments", 20"disclosed systems" and "disclosed methods", which refer to examples of inventive ideas, concepts, and/or manifestations described herein. The fact that some disclosed embodiments are described as exhibiting a feature or characteristic does not mean that other disclosed embodiments necessarily share that feature or characteristic. 25This disclosure employs open-ended permissive language, indicating for example, that some embodiments "may" employ, involve, or include specific features. The use of the term "may" and other open-ended terminology is intended to indicate that although not every embodiment may employ the specific disclosed feature, at least one embodiment employs the specific disclosed feature. 30The term "operator" is used herein to refer to any individual person or group of persons operating a method or system according to a disclosed embodiment, such as a medical practitioner involved in performing and/or IL305649/ planning an irradiation treatment procedure (e.g., a radiation oncologist, a radiation therapy nurse, a medical radiation physicist, a radiation therapist, a dosimetrist, and the like). The terms "subject" and "patient" are used interchangeably herein to refer to an individual upon which a method or system according to a disclosed 5embodiment is performed, such as a person undergoing a proton therapy procedure. The subject may be any living entity, such as a person, human or animal, characterized with body tissue subject to irradiation treatment. The terms "proton therapy" and "proton treatment" are used interchangeably herein to broadly encompass all forms of particle therapy or 10hadron therapy that applies beams of energized ionizing particles for radiotherapy purposes, including but not limited to protons, neutrons and other types of ions (all of which are considered encompassed herein by the term "protons"). The terms "irradiation therapy" and "irradiation treatment" as used herein encompasses proton therapy and other treatments involving applied radiation. 15The present invention will be apparent from the following detailed description, which proceeds with reference to the accompanying drawings, wherein the same references relate to the same elements. For a better understanding of certain embodiments and to show how the same may be carried into effect, reference will now be made, purely by way of example, to the 20accompanying drawings in which like numerals designate corresponding elements or sections throughout. Reference is now made to Figure 1, which is a schematic illustration of an irradiation treatment system, generally referenced 110, constructed and operative in accordance with an embodiment of the present invention. Treatment 25system 110 includes an irradiation beam generator 112, an irradiation beam delivery device 114, an imager 116, a positioning verifier 117, a controller 118, a database 119, a patient support platform 122, and a platform adjuster 124. Controller 118 is communicatively coupled with beam generator 112, with beam delivery device 114, with imager 116, with positioning verifier 117, with database 30119, and with platform adjuster 124. Treatment system 110 is configured to be deployed for treating a patient 120 in a treatment room 100, which is generally characterized with shielding properties to limit radiation from penetrating beyond IL305649/ the treatment area. Some of the components of treatment system 110 may reside outside room 100. Patient support platform 122 is configured for supporting a patient 1during a treatment session or planning stage. In one embodiment, patient support platform 122 includes a reclining chair, such that patient 120 may be in a sitting 5position and supported by a pelvis support member 121, such as a seat, and a back support member 123, such as a back rest (as illustrated in Fig.1). Patient support platform 122 may also include or be converted into a bed, such that patient 120 may be in a lying or recumbent position (i.e., horizontal to the ground) supported by the bed. Patient support platform 122 is mounted on an adjustable 10platform base 126, coupled to platform adjuster 124. Pelvis support member 1may be tilted relative to platform base 126, such as defining an inclination angle (e.g., 10° inclination) relative to a vertical axis. Back support member 123 may be tilted relative to platform base 126, such as defining an inclination angle (e.g., 20° inclination) relative to a horizontal axis. 15Platform adjuster 124 is configured to adjust a position and/or orientation of platform 122, so as to correspondingly alter a position and/or orientation of patient 120 along six degrees of freedom (6DOF). Platform adjuster 124 may include a rotational adjustment mechanism, configured to adjust at least one rotational angle of platform 122 (e.g., pitch, yaw, roll rotations), and/or a 20translational adjustment mechanism, configured to translationally displace platform 122 along at least one axis. For example, platform adjuster 124 may include a first mechanism for adjusting a height of platform base 126, and a second mechanism for rotating platform 122 (e.g., by manipulating an orientation of platform base 126) about pitch, yaw, and roll axes, respectively (e.g., causing 25patient 120 to lay back, tip sideways, or swivel, respectively). For example, a rotational adjustment mechanism may rotate platform 122 (or platform base 126) about three orthogonal axes 125R, 127R, 129R, where a first axis 125R is parallel to a floor 102 of the treatment room 100, a second axis 127R is parallel to floor 102 and orthogonal to first axis 125R, and a third axis 129R is orthogonal to floor 30102. The rotation of patient support platform 122 causes a rotation of patient 1about three orthogonal axes 125P, 127P, 129P, where a first axis 125P is parallel to a longitudinal axis of platform base 126, a second axis 127P is parallel to a IL305649/ longitudinal axis of platform base 126 and orthogonal to first axis 125P, and a third axis 129P is orthogonal to a longitudinal axis of platform base 126. In one embodiment, axes 125P, 127P and 129P correspond to axes 125R, 127R and 129R, respectively. Irradiation beam generator 112 includes components and techniques 5for generating an irradiation therapy proton beam, such as a particle accelerator. For example, generator 112 may include a cyclotron or a synchrotron particle accelerator. Irradiation beam delivery device 114 includes components and techniques for delivering at least one irradiation dose 115 to patient 120 from a 10generated proton beam. For example, beam delivery device 114 may operate using a pencil beam scanning (PBS) mechanism. Delivery device 114 may optionally be coupled with a rotatable gantry (not shown), configured for positioning and orienting the beam nozzle about multiple axes in 3D space, for directing a delivered irradiation dose 115 to a selected position and orientation 15(i.e., a selected isocenter). Alternatively, treatment system 110 may operate without a rotatable gantry, which may provide increased treatment flexibility for different anatomical sites and may facilitate upright positioning of patient 120. Imager 116 is configured for imaging patient 120, such as during a treatment planning stage and/or a treatment session. For example, imager 116 20may be a medical imaging device used in a medical treatment setting, including but not limited to: a computed tomography (CT) scanner, a four-dimensional computed tomography (4DCT) scanner, an X-ray computed tomography (X-ray CT) scanner, an optical coherence tomography (OCT) scanner, a magnetic resonance imaging (MRI) scanner, and an ultrasound imager. In general, imager 25116 may include any type of imaging sensor capable of acquiring and storing an image representation of an object or scene. Accordingly, the term "image" as used herein refers to any form of output from such an imager, including any optical or digital representation of a scene acquired at any wavelength or spectral region, and encompasses both a single image frame and a sequence of image frames 30(i.e., a "video image"). An image rotation mechanism (not shown) may be configured to rotate imager 116 about at least one axis, to enable imaging from selected directions or viewing angles.

IL305649/ Positioning verifier 117 is configured for verifying that patient 120 is properly positioned in a designated setup position for treatment. Positioning verifier 117 may be embodied, for example, by an X-ray imaging device including a set of complementary X-ray emitter and detector pairings located around the treatment isocenter, where the respective pairings are in perpendicular alignment 5to one another (i.e., to enable three-dimensional localization). Alternative approaches for position verification may include surface guided radiation therapy (SGRT) 3D imaging techniques, and cone beam computed tomography (CBCT) imaging techniques. Controller 118 is configured to selectively control the operation of 10components of system 110 and may dynamically adjust operational parameters thereof. Controller 118 is further configured to receive and provide instructions and data from/to components of system 110 and to perform required data processing. Database 119 stores relevant information to be retrieved and 15processed by processor 114, such as captured images. Database 119 may be embodied by one or more local servers or by remote and/or distributed servers, such as in a cloud storage platform. Reference is made to Figure 2, which is a schematic illustration of an irradiation treatment plan generation and verification system, generally referenced 20130, constructed and operative in accordance with an embodiment of the present invention. Treatment plan generation and verification system 130 includes a processor 132 and a collision detection simulator 135. Processor 132 is coupled with simulator 135 and is configured to receive instructions or data from one or more external components via a communication channel 138. System 130 may 25reside at least partially at a dedicated location 131. Information may be conveyed between the components of treatment system 110 or treatment plan generation and verification system 130 over any suitable data communication channel or network, using any type of channel or network model and any data transmission protocol (e.g., wired, wireless, radio, 30WiFi, Bluetooth, and the like). The components and devices of treatment system 110 or treatment plan generation and verification system 130 may be based in hardware, software, or combinations thereof. It is appreciated that the functionality IL305649/ associated with each of the devices or components of treatment system 110 or treatment plan generation and verification system 130 may be distributed among multiple devices or components, which may reside at a single location or at multiple locations. For example, the functionality associated with controller 1may be distributed between separate components, such as at least one control 5unit and at least one processing unit (e.g., which may be part of a server or a remote computer system accessible over a communications network, such as a cloud computing platform). Controller 118 may also be at least partially integrated with other components of system 110 (such as incorporated within a dedicated local control unit). 10Systems 110, 130 may optionally include and/or be associated with additional components not shown in the Figures, for enabling the implementation of the disclosed subject matter. For example, treatment plan generation and verification system 130 may include a user interface (not shown) for allowing a user to provide instructions or control various parameters or settings associated 15with system 130, and/or a display device (not shown) for visually displaying information relating to the operation of system 130. An exemplary workflow of an irradiation treatment will now be described in general terms. During an initial session, patient 120 is imaged on support platform 122. In particular, patient 120 is mounted and positioned on a 20selected support platform 122, representing a platform on which the irradiation treatment will be performed (i.e., the same platform or a similar type of platform). The selected platform 122 for treatment may be selected from multiple support platforms, each of which may have adjustable moving parts and accessories. In one embodiment, platform 122 is a reclining chair and patient 120 is supported in 25an upright or seated position. Parameters or configuration settings of the selected platform 122 are obtained when mounting patient 120 onto platform 122. Platform settings may include a platform type (e.g., type of bed or chair), features (e.g., reclining, non-reclining, maximum reclining angle), dimensions, accessories, default position/orientation, and the like. The platform settings may include how to 30mount the patient on the platform and which platform accessories should be employed during treatment. For example, certain patients, such as those of a diminutive stature, may be situated on one or more booster seats in order to raise IL305649/ their position upon the platform. Accordingly, the platform settings may include: whether a booster seat is applied; type of booster seats; amount and order of booster seats; and the like. Another form of platform accessory may be an armrest, in which case the platform settings may include: whether an arm rest is utilized; angle at which armrest is aligned; height at which armrest is attached to 5the platform; and the like. The obtained platform settings are stored, to be applied for the respective patient 120 during the treatment, and for performing the treatment plan simulation as will be described hereinbelow. Patient 120 is then positioned with respect to imager 116 (e.g., a CT scanner) to allow for imaging of the target tissue via imager 116. Patient 120 is brought into an imaging position, 10such as by moving platform 122 into a field of view of imager 116, and/or adjusting the positioning of patient 120 on platform 122. Imager 116 then images a target tissue of patient 120 to be treated, such as capturing a plurality of images from multiple imaging angles. The imaging may take place in treatment room 1where the patient treatment will take place, or in a different location, such as an 15imaging room, which may contain similar system elements as treatment room 100. For example, the imaging room may contain at least one similar support platform registered to the actual support platform to be used for the patient treatment. The patient imaging may be performed by a first operator, such as a CT imaging technician. 20In a subsequent stage, a treatment plan is established. The treatment planning may be performed by a second operator or treatment planner, such as a medical physicist. The treatment planning may be performed in the absence of patient 120, at a subsequent date following the patient imaging. The treatment planner receives treatment prescriptions for an irradiation treatment of patient 25120. The treatment prescriptions may include details relating to the target tissue (e.g., type, shape, size, location in body), and recommended doses (e.g., recommended minimum and/or maximum doses) to be applied to the target tissue. The treatment planner generates a treatment plan in accordance with the received treatment prescriptions and the imaging of the target tissue (during the 30previous imaging session). The treatment plan may include a series of irradiation parameters or "treatment fields" for at least one treatment session, each treatment field defined at least by a dosage, a position and orientation of the target tissue IL305649/ (e.g., relative to an isocenter), and an irradiation angle, for each irradiation dose. The treatment plan may define a series of treatment angles for directing a respective irradiation dose to the target tissue coordinates according to an irradiation angle. These treatment angles may include a sequence of three-dimensional rotations and translations for repositioning the support platform 5122 in a 3D coordinate system, such as rotations respective of pitch, yaw and roll axes of platform base 126, and at least one translation of a displacement axis of platform base 126. The treatment plan preparation may utilize a three-dimensional model of the target tissue generated from captured images. For example, the target tissue model may be a computed tomography (CT) imaging volume. The 10target tissue imaging volume may be constructed using auxiliary imaging devices, such as stereoscopic imaging. Placement markers may be positioned on or around patient 120 or patient support platform 122 to ensure proper targeting for each irradiation dose and to avoid harming non-treatment organs or tissue (in the vicinity of the target tissue) during the irradiation treatment. 15In a subsequent stage, the generated treatment plan is verified and updated if necessary. System 130 receives a 3D room model of the treatment room 100. The room model includes representations of objects and system components that will be present in room 100 during the treatment. The room model may be generated during the treatment planning or during a previous stage 20(prior to treatment planning), using 3D modeling techniques known in the art. The room model may be previously uploaded to system 130 or obtained from an external source. System 130 extracts relevant simulation fields for applying a simulation of a 3D collision in treatment room 100. The simulation fields include platform 25settings of support platform 122, which may be obtained when mounting patient 120 onto platform 122 during the patient imaging session. The platform settings may include 3D coordinates of platform 122 in room 100 during the treatment sessions. The platform settings may further include additional parameters relating to support platform 122, such as platform type, features, dimensions, accessories, 30and the like. The simulation fields further include 3D coordinates of the target tissue (e.g., a tumor), such as in relation to an imaging coordinate system respective of imager 116. The target tissue coordinates may be extracted from IL305649/ the generated treatment plan and/or from captured images (e.g., from a CT imaging volume). The simulation fields further include treatment angles of patient 120 for directing irradiation doses during a treatment session, which may be extracted from the generated treatment plan. The treatment angles may include a set of 5inclination angles at which a platform surface 121, 123 of platform 122 (i.e., pelvis support member 121 and/or back support member 123) is rotated in a 3D angular coordinate system, such as respective of pitch, yaw and roll angular rotations. For example, the treatment angles may include a "platform yaw angle", also referred to as a "patient support angle", defining an angle at which a platform surface 121, 10123 is aligned with respect to an axis orthogonal to the floor, such as by a side-to-side swiveling rotation (i.e., a yaw rotation). The treatment angles may further include a "platform pitch angle", also referred to as a "table top pitch angle", defining an angle at which a platform surface 121, 123 is aligned with respect to a transverse axis thereof, such as by a forward or backward tilting rotation (i.e., a 15pitch rotation). The treatment angles may further include a "platform roll angle", also referred to as a "table top roll angle", defining an angle at which a platform surface 121, 123 is aligned with respect to a longitudinal axis thereof, such as by a side to side pivoting rotation (i.e., a roll rotation). The treatment angles may further include at least one translational displacement along which platform 122 20(or a platform surface 121, 123) is displaced, such as a height displacement of platform base 126. The treatment angles effectively define a direction vector at which an irradiation beam 115 is directed toward the target tissue coordinates over the course of the treatment session. The target tissue coordinates may be defined in a field of the treatment plan as a point in the imager coordinate system 25where the target tissue is located. The simulation fields may further include at least one direction or alignment of at least one portion of platform adjuster 124 or platform base 126, under limitations or constraints of treatment room 100. For example, platform adjuster 124 may include at least one robotic arm (not shown) which may be 30selectively positioned in a particular orientation, such as a right side orientation or a left side orientation, which may be referred to as a "robotic elbow direction".

IL305649/ The simulation fields may optionally include additional parameters, such as imaging parameters relating to imager 116 (e.g., viewing angle, focal length, field of view, resolution, lighting conditions), or parameters relating to beam delivery device 114 (e.g., distance from isocenter, range shifter existence, different possible covers or accessories). The simulation fields generally includes 5information relating to all objects or elements present in room 100, where such elements are predefined and measured as part of the 3D room model. It is noted that each of the simulation fields may be dynamic and may include a plurality of respective fields, such as a sequence of treatment parameters to be executed over time during at least one treatment session. For 10example, the table top pitch and roll angles may be associated with a sequence of respective angles, in accordance with changing angles for directing a sequence of irradiation doses to the target tissue as defined by the treatment plan. Reference is made to Figure 3, which is an illustration of an exemplary set of simulation fields for a treatment plan simulation, operative in accordance 15with an embodiment of the present invention. The exemplary simulation fields, generally referenced 140, includes: a set of imaging coordinates (representing the location coordinates of platform adjuster 124 during the planning stage imaging); an imaging orientation of 0 degrees (relative to a reference orientation); target tissue coordinates; a patient support angle of 270°; a table top pitch angle of 20°; 20a table top roll angle of 0°; and a robot elbow direction of "right" side. Referring back to Figure 2, simulator 135 performs a collision simulation on the 3D room model of treatment room 100 in accordance with the extracted simulation fields. Simulator 135 may execute the simulation using at least one designated simulation program, configured to simulate an irradiation 25treatment of a patient within a treatment room according to treatment parameters defined by the simulation fields, based on the generated treatment plan. The executed simulation may provide an indication of a potential collision during the simulated treatment plan. For example, a collision may occur when repositioning platform 122 during the treatment, such as by modifying a table top pitch angle or 30roll angle, so as to direct a selected irradiation dose to a designated location respective of the target tissue coordinates, as defined by the generated treatment plan. This may result in a body part of the patient (e.g., an arm or a leg) colliding IL305649/ or impacting with an element of treatment system 110, such as beam delivery device 114, a gantry, equipment covers, positioning verifier 117, and/or another object in treatment room 100, such as a chair or table, or an inner wall. A collision may also occur by platform 122 itself, such as a platform surface 121, 1impacting a system component or another object in room 100, when being 5repositioned in accordance with the defined treatment angles. A collision may be defined in accordance with selected criteria, such as, for example, any impact between any two objects in treatment room 100, or only impacts involving one or more selected objects in room 100 (e.g., only involving patient 120 or platform 122), or only impacts that substantially hinder the continuation of the treatment. 10The treatment plan verification may be performed by the treatment planner. It is noted that the treatment plan verification and simulation may be implemented at any location and does not need to be performed at the treatment room 100. Simulator 135 may display a visual depiction of the simulation, which may be observed by the operator for determining feasibility of the simulated 15treatment plan. The operator may view a visual representation of the executed simulation portraying an imaging volume of the treated target tissue and changing positions and orientations of patient 120 and support platform 122 within treatment room 100, during the simulated treatment session. The operator may visually perceive a collision during the simulation, and/or may receive an alert from 20simulator 135 in the event of a collision, such as via a visual notification (e.g., text or graphical symbol) or audible notification. The alert may include further information relating to the detected collision, such as objects involved in the collision, and a projected severity level. Simulator 135 may provide possible modifications to one or more treatment parameters to avoid the collision (e.g., 25while still meeting treatment planning requirements). The operator may then modify one or more simulation fields so as to avoid a collision, and may perform an updated simulation with the modified simulation fields. Additional simulations may be performed iteratively with different simulation fields, in order to identify at least one set of treatment parameters that would avoid collisions during the 30treatment session. The operator may then determine an optimal set of treatment parameters that meets treatment plan requirements and additional optional conditions, and finalize a treatment plan accordingly. After the treatment plan has IL305649/ been finalized, the irradiation treatment may be performed during one or more future treatment sessions. Reference is made to Figure 4, which is a perspective view visual representation of a first exemplary treatment plan simulation applied for a treatment plan in a treatment room, operative in accordance with an embodiment 5of the present invention. The simulation is applied in accordance with the exemplary simulation fields (140) of Figure 3 (shown in the upper right-hand corner). The simulation is applied on a 3D room model of a treatment room 200. A support platform 222 for supporting a patient (not shown) is configured in accordance with selected platform settings and selected platform positioning 10parameters (i.e., platform surface pitch, yaw and roll angles). Support platform 222 is adjustable via a platform adjuster 224, including a first robotic arm 224A and a second robotic arm 224B, configured to rotate platform 222 along respective pitch and roll axes. A beam nozzle 213 of a beam delivery device 214 is depicted delivering an irradiation beam 215 toward a target tissue, represented as a CT 15scan imaging volume 230. A gantry is configured to maneuver beam delivery device and may act as a potential collision impediment. A positioning verifier 2is configured for verifying the positioning of the patient for treatment. An operator may observe a visual representation of the simulation to detect a collision and may receive an alert in the event of a collision, and may modify the simulation 20fields to avoid a collision. Figure 5 is a perspective view visual representation of a second exemplary treatment plan simulation applied for a treatment plan in a treatment room, operative in accordance with an embodiment of the present invention. The simulation of Figure 5 is applied in accordance with exemplary simulation fields 25150 (shown in the upper right-hand corner), which are similar to simulation fields 140 of Figure 3 but with different table top pitch and roll angles. The simulation is applied on a 3D room model of a treatment room 200, with a support platform 2configured in accordance with the designated platform positioning angles. A target tissue imaging volume 232 is shown in relation to the treatment system. 30An operator may observe an irradiation beam 215 directed to target tissue imaging volume 232 according to the treatment plan. Reference is made to Figure 6, which is a visual representation of an irradiation beam 215 directed to a IL305649/ target tissue imaging volume 232 of a patient 220 in the exemplary treatment plan simulation of Figure 5, operative in accordance with an embodiment of the present invention. An irradiation treatment may target different body parts of a patient from different directions or angles. Accordingly, the patient may be positioned on 5the support platform in different alignments or anatomical positions in relation to the directed irradiation. For example, a patient may be positioned with the anterior of the patient facing the beam nozzle of the beam delivery device (as shown in Figures 4 and 5), or with a posterior of the patient facing the beam nozzle. Reference is made to Figure 7, which is a visual representation of a third 10exemplary treatment plan simulation applied for a treatment plan in a treatment room, operative in accordance with an embodiment of the present invention. The simulation of Figure 7 is applied in accordance with exemplary simulation fields 160 (shown in the upper left-hand corner), which are similar to simulation fields 140 of Figure 3 but with different target tissue coordinates and different table top 15pitch and roll angles. The simulation is applied on a 3D room model of a treatment room 200, with support platform 222 configured in a posterior alignment (i.e., with the back of the patient facing a beam nozzle of beam delivery device 215), to enable a treatment directed to the back of patient. Support platform 222 is further configured for treating seated patients with legs extended and facing forward, as 20pelvis support member 221 of platform 222 is extended lengthwise to accommodate extended legs of a patient. Support platform 222 is configured in accordance with the designated table top pitch and roll angles, which are adjustable via robotic arms 224A, 224B. A target tissue imaging volume 234 is shown in relation to the support platform 222 and the beam nozzle. 25The irradiation treatment may be applied on various support platforms, each of which may include different accessories or extensions (defined as part of the simulation fields). Reference is made to Figure 8, which is a visual representation of a fourth exemplary treatment plan simulation applied for a treatment plan in a treatment room, operative in accordance with an embodiment 30of the present invention. The simulation of Figure 8 is applied in accordance with the exemplary simulation fields 140 of Figure 3. The simulation is applied on a 3D room model of a treatment room 200, with a support platform 222 configured in a IL305649/ selected alignment, for treating seated or standing patients with legs lowered, where pelvis support member 221 of platform 222 is bent downwards to accommodate bent legs of a patient. Support platform 222 is configured in accordance with the designated table top pitch and roll angles, which are adjustable via robotic arms 224A, 224B. No target tissue imaging volume is 5shown. In the event a collision is detected in a simulation, modified simulation fields may be determined so as to avoid the collision. The modified simulation fields may be selected in accordance with the type and nature of the detected collision, for example which objects were involved in the detected collision, and 10the position and orientation of the colliding objects during and prior to the detected collision. For example, the collision may involve a body extremity of the patient or a portion of the support platform. Reference is made to Figure 9, which is a perspective view illustration of a patient support platform colliding with a component of an irradiation treatment system, operative in accordance with an 15embodiment of the present invention. A pelvis support member 221 of platform 222 is portrayed in a collision with beam delivery device 214. A collision may generally involve any object or accessory in the treatment room, particularly those that were not fully imaged by imager. Examples may include: walls, equipment, covers, imager 116, an auxiliary imager, such as an X-ray detector of positioning 20verifier 117, a platform adjusting arm (224A, 224B), and the like. The operator may apply further simulations with modified simulation fields to verify that no collision will occur. The operator may then select a set of collision avoiding simulation fields for generating an updated treatment plan, based on which the irradiation treatment may later be implemented. After the 25treatment plan had been verified and finalized, a validation of the treatment plan may be performed on site, such as by an operator physically checking and validating the feasibility of treatment plan fields (e.g., doses, patient positioning, treatment angles) at treatment room 100. It will be appreciated that the disclosed embodiments may allow for the 30verification of a proposed treatment plan during a preliminary stage, without needing to manually implement the proposed plan or to physically experiment with aspects of the plan in the treatment room itself. In particular, potential collisions IL305649/ may be detected for a proposed treatment to be performed in a given treatment room without requiring a treatment planner to be inside the room itself. This may result in significant time savings, and also frees up the treatment room for actually performing irradiation treatments. A three-dimensional visualization of a treatment room may be provided, including the patient, elements of the treatment system, 5and additional objects that may not be covered by the imaging, for simulating a proposed treatment plan and detecting potential collisions during a treatment plan verification stage. The disclosed embodiments may provide an early indication for whether a proposed treatment plan is feasible and may facilitate the maneuvering and repositioning of the patient within the treatment room during the treatment 10sessions. Such treatment planning may be particularly beneficial for patients treated in a seated or upright position, as well as for patients treated in a recumbent or lying position. According to an embodiment of the present disclosure, the treatment planner applies a collision detection simulation prior to generating the initial 15treatment plan. An operator (e.g., treatment planner) may implement a preliminary collision detection simulation for checking whether possible treatment angles may result in a collision and then utilize the results for establishing a treatment plan with suitable treatment angles. In particular, the treatment planner determines an initial set of treatment plan fields with proposed treatment angles according to the 20target tissue images. The treatment planner executes an initial collision detection simulation via simulator 135 to check the feasibility of the proposed treatment angles in terms of whether the proposed angles may result in a collision during treatment. The simulation fields for the preliminary simulation may include: the treatment room model, platform settings of support platform 122, and a target 25tissue volume (e.g., CT volume) derived from the initial imaging of the target tissue. The preliminary simulation may be based on an approximation of the target tissue location, according to the target tissue imaging volume which is virtually allocated at the treatment room isocenter and position of the support platform. The simulation fields further include proposed treatment angles, such as a set of 30inclination angles (e.g., pitch, yaw and roll angular rotations) of platform surfaces 121, 123 of platform 122, defining a direction vector for directing an irradiation beam 115 to the target tissue positioned at the treatment room isocenter for each IL305649/ irradiation dose. The proposed treatment angles may be based on a default treatment plan or default values, which may be modified for the specific treatment in accordance with the target tissue images. The simulation fields may optionally include additional parameters (e.g., parameters of imager 116, parameters of beam device 114, accessories of support platform 122). 5It will be appreciated that such a preliminary collision detection simulation may establish general limitations or tolerances for generating the initial treatment plan fields in a manner that minimizes potential collisions during the treatment. For example, a treatment plan based on such a preliminary collision detection simulation may eliminate a majority (e.g., about 80%) of potential 10collision issues during the treatment, such that the substantially few remaining collision issues can be overcome more quickly and efficiently based on further simulations applied during a subsequent verification process. It is noted that the treatment plan generation may be an arduous and time-consuming process (e.g., may take place over several weeks), such that optimizing the generated plan may 15enhance overall efficiency of the pre-treatment process. According to an aspect of the disclosed embodiments, a secondary collision detection simulation for verifying the generated treatment plan may take into account movement paths or transitions between treatment angles, rather than merely the treatment angles themselves. In particular, an operator (e.g., treatment 20plan verifier) may execute a secondary collision detection simulation via simulator 135 to verify the generated treatment plan fields in terms of whether transitions between consecutive treatment angles in the generated treatment plan may result in a collision during treatment. The simulation fields for the secondary simulation may include: the treatment room model, platform settings of support platform 122, 25and the derived target tissue volume, as well as treatment plan fields of the generated treatment plan. Transitions between consecutive treatment angles may be provided as a simulation field or a further input to the simulation. The secondary simulation may detect collisions resulting from a transition or movement path between one set of treatment angles to another, and the treatment plan verifier 30may update treatment plan fields accordingly. Further simulations may be performed to ensure the suitability of the updated treatment plan fields. The IL305649/ treatment plan may be approved or finalized when no further movement path collisions are detected in a simulation. Following the generation and verification of the treatment plan, the plan may optionally be validated based on an updated set of patient images, such as to account for possible changes in the target tissue ahead of the treatment. For 5example, an operator (i.e., a treatment plan validator) may examine the verified treatment plan in view of a second target tissue volume (e.g., CT volume) derived from a second set of images captured by imager 116. The operator may examine the feasibility of treatment fields of the treatment plan (e.g., doses, patient positioning, treatment angles) in view of the second target tissue volume, and 10update treatment fields, if necessary, before the actual treatment takes place. Reference is made to Figure 10, which is a flow diagram of a method for generating and verifying a treatment plan for an irradiation treatment, operative in accordance with an embodiment of the present invention. In a step 272, a patient is imaged on a patient support platform to obtain a first set of target tissue 15images. Referring to Figure 1, patient 120 is mounted on a support platform 122, representing a same or similar platform on which patient will be treated, and imager 116 images a target tissue of patient 120 supported on support platform 122. For example, imager 116 captures a plurality of images of a target tissue from multiple imaging angles, from which a target tissue imaging volume may be 20generated, such as a CT imaging volume obtained from CT imaging. The imaging may take place in an imaging room, which may be different from but contain similar system elements as treatment room 100. In a step 274, treatment plan fields including proposed treatment angles are determined based on the first set of target tissue images. Referring to 25Figures 1 and 2, an operator (e.g., a treatment planner) processes the target tissue images and determines an initial set of treatment plan fields for a treatment plan, including possible treatment angles. In a step 276, at least one first collision detection simulation is applied to determine a feasibility of the proposed treatment angles, using a first group of 30simulation fields including: a treatment room model; platform settings; and the determined treatment plan fields with proposed treatment angles. Referring to Figures 1 and 2, simulator 135 executes a first collision detection simulation using IL305649/ a first group of simulation fields, for enabling the operator to determine a feasibility of the proposed treatment angles in the determined treatment plan fields. The simulation fields include a 3D room model of treatment room 100, which includes representations of all objects and components of treatment system 110 that will be present in treatment room 100 during the planned treatment. The simulation 5fields further include platform settings of support platform 122, such as information pertaining to: a platform type, platform features, a default position and orientation, platform dimensions, platform accessories, and how to mount the patient on platform 122. The simulation fields may further include a target tissue volume derived from the first set of target tissue images. The target tissue volume may 10include coordinates of the target tissue in relation to a coordinate system of imager 116. The simulation fields further include proposed treatment angles (i.e., determined in step 274), such as a set of inclination angles (e.g., pitch, yaw and roll angular rotations) of platform surfaces 121, 123 of platform 122, defining a direction vector for directing an irradiation beam 115 to the target tissue positioned 15at the treatment room isocenter for each irradiation dose. Simulator 135 may provide a visual representation of the executed simulation, such as shown in Figure 4, portraying a target tissue imaging volume 230 and changing positions and orientations of a support platform 222 within treatment room 100. The simulation may be executed at any location and does not require use of treatment 20room 100. In a step 278, a treatment plan is generated based on the first simulation, such that there is no collision for each treatment angle of the generated treatment plan. In particular, an operator (i.e., a treatment planner) generates a treatment plan, based on the first collision detection simulation. The treatment 25plan may include a series of treatment plan fields for at least one treatment session, each treatment plan field defined at least by a dosage, target tissue coordinates, and an irradiation angle, for each irradiation dose. The treatment plan may define a series of treatment angles for directing a respective irradiation dose to the target tissue according to an irradiation angle. The treatment planner 30generates the treatment plan based on the results of the first collision simulation, such that the treatment angles of the treatment plan will not result in a collision during the treatment. The treatment plan may be based on received treatment IL305649/ prescriptions (e.g., target tissue characteristics, recommended doses), and the target tissue volume derived from the first set of target tissue images. The treatment plan may be generated in the absence of the patient, such as during a later date subsequent to the patient imaging and/or the first simulation. Steps 272, 274, 276, 278 may be implemented during a first group of 5sessions over a first time period, such as a period of several weeks. In a step 280, at least one second collision detection simulation is applied to verify no collisions in movement paths between treatment angles of consecutive treatment plan fields, using a second group of simulation fields including: a treatment room model; a target tissue volume; platform settings; and 10treatment plan fields of the generated treatment plan. Referring to Figures 1 and 2, simulator 135 executes a second collision detection simulation using a second group of simulation fields, for enabling an operator (i.e., a treatment plan verifier) to verify that there are no collisions resulting from the movement paths between treatment angles of consecutive treatment fields of the generated treatment plan. 15The simulation include a 3D room model of treatment room 100, which includes representations of all objects and components of treatment system 110 that will be present in treatment room 100 during the planned treatment. The simulation fields further include platform settings of support platform 122, such as information pertaining to: a platform type, platform features, a default position and orientation, 20platform dimensions, platform accessories, and how to mount the patient on platform 122. The simulation fields may further include a target tissue volume, which may be derived from the first set of target tissue images. The target tissue volume may include coordinates of the target tissue in relation to a coordinate system of imager 116. The simulation fields further include treatment angles of 25the generated treatment plan, such as pitch, yaw and roll angles of platform surfaces 121, 123 of platform 122, defining a direction vector for directing irradiation beam 115 to the target tissue (positioned at the treatment room isocenter), for each respective irradiation dose, according to the generated first treatment plan. For example, the treatment angle may include a patient support 30angle, corresponding to a side-to-side swiveling rotation (yaw rotation); a table top pitch angle, corresponding to a forward or backward tilting rotation (or pitch rotation); and a table top roll angle, corresponding to a side to side pivoting IL305649/ rotation (or roll rotation). The simulation fields may further include information relating to transitions between consecutive treatment angles or consecutive treatment fields. Simulator 135 may provide a visual representation of the executed simulation, such as shown in Figure 4, portraying a target tissue imaging volume 230 and changing positions and orientations of a support platform 222 5within treatment room 100. The operator may receive an alert in the event of a collision during the simulation. The simulation may be executed at any location and does not require use of treatment room 100. If at least one collision is detected in the second simulation, then in a step 282, the treatment plan is updated to avoid the collision. When the operator 10(i.e., treatment plan verifier) detects a collision in the second collision detection simulation, such as a collision between the legs 244 of patient 220 and beam delivery device 214 (Figure 9) resulting from a transition between consecutive treatment angles, the operator determines updated treatment plan fields with updated treatment angles for avoiding the detected collision. The updated 15treatment plan fields for avoiding the collision may be determined in accordance with characteristics of the detected collision, such as which objects were involved, the position and orientation of the colliding objects during and prior to the collision, and the like. An updated second group of simulation fields may be determined using the updated treatment fields (e.g., with updated treatment angle transitions), 20and at least one further collision detection simulation may be executed using the updated second group of simulation fields, to verify that there are no collisions resulting from the updated treatment plan fields (e.g., due to movements between consecutive treatment angles). If a collision is still detected, further updated treatment plan fields may be determined, and further simulations applied using 25the further updated treatment plan fields, until no further collisions occur. If no collision is detected in a second simulation, then in a step 284, the treatment plan is approved. When the operator (e.g., treatment plan verifier) no longer detects a collision in a second collision detection simulation, including in at least one updated second simulation executed using updated treatment plan 30fields, the generated treatment plan is verified and approved. The approved treatment plan may include treatment plan fields for which there are no simulated IL305649/ collisions, including collisions resulting from the treatment angles or movement paths between consecutive treatment angles. Steps 280, 282, 284 may be implemented in a second time period, which may be subsequent to the first time period of the plan generation stage (i.e., steps 272, 274, 276, 278), such as several days, weeks, or months thereafter. 5In a step 286, the patient is imaged on a patient support platform to obtain a second set of target tissue images. Referring to Figure 1, patient 120 is mounted on a support platform 122, representing a same or similar platform on which patient will be treated, and imager 116 captures a second set of images of the target tissue of patient 120 on support platform 122. For example, imager 116 10captures a plurality of images of the target tissue from multiple imaging angles, from which a target tissue imaging volume may be generated, such as a CT imaging volume obtained from CT imaging. The content of the second set of images may be slightly different from the first set of images (captured at an earlier imaging session) due to minor changes in the patient who is dynamic. When 15remounting patient 120 to platform 122 for the second imaging or for the actual treatment, there may be deviations from the previous mounting of patient 120 for the first imaging, and such deviations may be identified and compensated for. The imaging may take place in an imaging room, which may be different from but contain similar system elements as treatment room 100. 20In a step 288, the treatment plan is adaptively updated and/or validated based on the second set of images. An operator (i.e., a treatment plan validator) examines the verified treatment plan in view of a second target tissue volume derived from the second set of images. The operator may examine the feasibility of treatment fields of the second treatment plan (e.g., doses, patient positioning, 25treatment angles) in view of the second target tissue volume and possible minor changes of the patient or target tissue, and update treatment plan fields if necessary, before validating the treatment plan. The treatment plan may optionally undergo a further validation process with the patient physically present in the treatment room 100 before the actual 30treatment takes place.

IL305649/ Steps 286, 288 may be implemented in a third time period, which may be subsequent to the second time period of the plan verification stage (i.e., steps 278, 280), such as several days, weeks, or months thereafter. After the treatment plan has been generated and verified, and optionally validated (based on a second imaging and/or based on the patient 5presence at the treatment room), the irradiation treatment may be performed according to the approved treatment plan during a subsequent treatment stage. In particular, an irradiation treatment is applied to patient 120, during at least one future treatment session, in accordance with the treatment fields of the approved (e.g., verified and validated) treatment plan. To perform the treatment, patient 120 10is mounted on platform 122 and brought into a setup position in treatment room 100, such that the target tissue is centered at the treatment room isocenter. The treatment plan is implemented with the patient sequentially repositioned relative to the setup position in accordance with the treatment plan requirements. Positioning verifier 117 may be used for verifying proper patient positioning. 15Auxiliary imaging may be utilized to ensure that the characteristics of the target tissue have not changed dramatically since the onset of treatment, in addition to verifying proper patient positioning. Stabilization mechanisms may be applied to ensure patient positioning is maintained relative to the isocenter during the treatment, such as a mask or shield to affix the face and/or other body parts of 20patient 120. While certain embodiments of the disclosed subject matter have been described, so as to enable one of skill in the art to practice the present invention, the preceding description is intended to be exemplary only. It should not be used to limit the scope of the disclosed subject matter, which should be determined by 25reference to the following claims.

Claims

IL305649/ -34- CLAIMS

1. A method for generating and verifying a treatment plan for an irradiation treatment, the method comprising the steps of: imaging a patient on a support platform to obtain a first set of target tissue images; 5determining treatment plan fields comprising proposed treatment angles, based on the first set of images, the treatment angles comprising at least one platform positioning parameter of the support platform for positioning the patient such that the target tissue is localized at an isocenter of the treatment room; 10applying at least one first collision detection simulation to determine a feasibility of the proposed treatment angles, using a first group of simulation fields comprising: a three-dimensional room model of a treatment room for the irradiation treatment; platform settings of a support platform for supporting the patient during the irradiation treatment; and the treatment 15plan fields comprising proposed treatment angles; generating a treatment plan for the irradiation treatment based on the first collision detection simulation, such that there is no collision for each treatment angle of the generated treatment plan; applying at least one second collision detection simulation to verify no 20collisions in movement paths between treatment angles of consecutive treatment plan fields, using a second group of simulation fields comprising: the three-dimensional room model; the target tissue volume; the platform settings; and treatment plan fields of the generated treatment plan; for each of at least one collision detected in the second collision 25detection simulation, updating treatment plan fields of the treatment plan to avoid collisions in movement paths between treatment angles, and applying at least one updated second collision detection simulation using an updated second group of simulations fields comprising the updated treatment plan fields; and 30approving the treatment plan when no collision is detected in the second collision detection simulation. IL305649/ -35-

2. The method of claim 1, further comprising the steps of: imaging the patient on the support platform to obtain a second set of target tissue images; and adaptively updating and validating the first treatment plan based on the 5second set of target tissue images.

3. The method of claim 1, wherein the step of imaging a patient on a support platform to obtain a first set of target tissue images is performed in an imaging room different from the treatment room. 10

4. The method of claim 1, wherein the second group of simulation fields further comprise at least one transition between treatment angles.

5. The method of claim 1, wherein the treatment angles comprises at least one 15platform positioning parameter selected from the group consisting of: a platform surface yaw angle; a platform surface pitch angle; a platform surface roll angle; and a platform surface translational displacement. 20

6. The method of claim 1, wherein a platform positioning parameter of the support platform is adjustable using a platform adjuster, configured to rotate at least one platform surface of the platform about at least one rotational axis, or to displace at least one platform surface of the platform along at least 25one displacement axis.

7. The method of claim 1, wherein the support platform is aligned such that a patient anterior or a patient posterior is directed toward an irradiation beam delivery nozzle. 30

8. The method of claim 1, wherein the collision comprises a collision between a first object and a second object in the treatment room. IL305649/ -36-

9. The method of claim 8, wherein at least one of the first object and the second object is selected from the group consisting of: a body part of the patient; a component of an irradiation treatment system; 5the support platform; the imager; an irradiation beam delivery device; a gantry; an irradiation beam generator; 10a covering or accessory of a component of the treatment system; a chair; a table; and a wall of the treatment room. 1510.

10. The method of claim 1, wherein the patient support platform comprises a chair, and wherein the patient is in a seated position.

11. The method of claim 1, wherein the irradiation treatment comprises a proton irradiation treatment. 20 12.

12. The method of claim 1, wherein at least one of the first collision detection simulation and the second collision detection simulation is performed in a room different than the treatment room. 2513.

13. An irradiation treatment plan generation and verification system, comprising: a processor, configured to receive a first set of target tissue images of the patient; and to determine treatment plan fields comprising proposed treatment angles, based on the first set of images, the treatment angles comprising at least one platform positioning parameter of the support 30platform for positioning the patient such that the target tissue is localized at an isocenter of the treatment room;, IL305649/ -37- a collision detection simulator, configured to apply at least one first collision detection simulation to determine a feasibility of the proposed treatment angles, using a first group of simulation fields comprising: a three-dimensional room model of a treatment room for the irradiation treatment; platform settings of a support platform for supporting the patient during the 5irradiation treatment; and the treatment plan fields comprising proposed treatment angles, wherein the processor is further configured to generate a treatment plan for the irradiation treatment based on the first collision detection simulation, such that there is no collision for each treatment angle of the 10generated treatment plan, wherein the collision detection simulator is further configured to apply at least one second collision detection simulation to verify no collisions in movement paths between treatment angles of consecutive treatment plan fields, using a second group of simulation fields comprising: the three- 15dimensional room model; the platform settings; and treatment plan fields of the generated treatment plan, and wherein the processor is further configured for each of at least one collision detected in the second collision detection simulation, to update treatment plan fields of the treatment plan to avoid collisions in movement 20paths between treatment angles, and to direct the simulator to apply at least one updated second collision detection simulation using an updated second group of simulations fields comprising the updated treatment plan fields, and to approve the treatment plan when no collision is detected in the second collision detection simulation. 25

14. The system of claim 13, wherein the processor is further configured to receive a second set of target tissue images of the patient imaged on the support platform, and to adaptively update and validate the first treatment plan based on the second set of target tissue images. 30 IL305649/ -38-

15. The system of claim 13, wherein an imaging of the patient to obtain the first set of target tissue images is performed in an imaging room different from the treatment room.

16. The system of claim 13, wherein the second group of simulation fields further 5comprise at least one transition between treatment angles.

17. The system of claim 13, wherein the treatment angles comprises at least one platform positioning parameter selected from the group consisting of: a platform surface yaw angle; 10a platform surface pitch angle; a platform surface roll angle; and a platform surface translational displacement.

18. The system of claim 13, wherein a platform positioning parameter of the 15support platform is adjustable using a platform adjuster, configured to configured to rotate at least one platform surface of the platform about at least one rotational axis, or to displace at least one platform surface of the platform along at least one displacement axis. 2019.

19. The system of claim 13, wherein the support platform is aligned such that a patient anterior or a patient posterior is directed toward an irradiation beam delivery nozzle.

20. The system of claim 13, wherein the collision comprises a collision between 25a first object and a second object in the treatment room.

21. The system of claim 20, wherein at least one of the first object and the second object is selected from the group consisting of: a body part of the patient; 30a component of an irradiation treatment system; the support platform; the imager; IL305649/ -39- an irradiation beam delivery device; a gantry; an irradiation beam generator; a covering or accessory of a component of the treatment system; a chair; 5a table; and a wall of the treatment room.

22. The system of claim 13, wherein the patient support platform is a chair, and wherein the patient is in a seated position. 10

23. The system of claim 13, wherein the irradiation treatment comprises a proton irradiation treatment.

24. The system of claim 13, wherein at least one of the first collision detection 15simulation and the second collision detection simulation is performed in a room different than the treatment room.