Orfit Products. Contribute Significantly to an Excellent Therapy Outcome

Transcription

1 Orfit Products Contribute Significantly to an Excellent Therapy Outcome

2 > Proud to State that we are a Complete Solution Provider 4 > Effective Patient Immobilization for Radiation Therapy 6 HEAD, NECK AND SHOULDERS 8 > Raycast High Precision Hardware 12 > High Precision Head Supports, Block and Wedges 16 > High Precision Masks for Head, Neck and Shoulders 21 > High Precision Hybrid Masks for Head, Neck and Shoulders 26 > High Precision Open Face Hybrid Masks for Head, Neck and Shoulders 28 > Push-Pin Masks for Head, Neck and Shoulders 32 > Immobilization for Treatment of Neck and Thorax 37 > Hardware for Push-Pin Masks 38 > High Precision Paediatric Hardware 42 > High Precision Paediatric Head Supports 43 > High Precision Paediatric Masks for Head, Neck and Shoulders 44 > Orfit MRI-S Solution for Brain, Head and Neck 48 > Orfit MRI-P and Orfit MRI-G Solution for Brain, Head and Neck 50 > UON and DUON Masks for Head, Neck and Shoulders 52 > Head Support Adapter Plates 55 THE AIO SOLUTION 56 > AIO Storage Cabinet 61 > AIO Head and Neck Applications 62 > High Precision Base Plate in CFL or HPL 64 > AIO Breast- and Lungboard Solution 66 > AIO Prone Breastboard Solution 68 > AIO Belly- and Pelvicboard Solution 70 > AIO Knee and Leg Positioning Set 72 > The AIO Solution - Accessories 74 PELVICAST 76 > Pelvicast Hardware 80 > Pelvicast Thermoplastic Masks 82 MAMMORX BREASTBOARD 84 SAGITTILT PRONE BREAST SOLUTION 96 THE SBRT SOLUTION 106 EXTREMITIES SOLUTION 118 VACUUM BAGS 124 ACCESSORIES 130 > Cyberknife Full Body Cushion for Cyberknife Couch Top 132 > Unique Comfort Cushions 133 > Water Bath 135 > Storage Solutions 135 > Bolus Material 136 > Fixation Devices 137 > Dosimetric Chart drivenbycare 3

3 Proud to State that we are a Complete Solution Provider For more than twenty years, Orfit Industries has been providing solutions for immobilizing patients in radiation oncology. In recent years, both our products and our production technology have thoroughly evolved by using the most innovative materials and production techniques. Based on an in-depth knowledge of the worldwide market, our team of engineers and product designers has developed optimal solutions that correspond with the requirements of ever increasing precision in radiation therapy. Our products and our market support are destined to offer you an important added value in your daily clinical practice where assuring a comfortable, reproducible and highly precise position of the patient is of utmost importance. The Raycast High Precision Product Group for Head and Neck, the AIO Solution for extra-cranial procedures and our Efficast and UON/DUON thermoplastic pre-cuts for all available hardware systems form a complete range of high quality immobilization and positioning products for all conventional radiation therapy procedures as well as for IMRT, IGRT, Hypo-Fractionated RT, SRT, SRS and proton, and other high energy therapy systems. Today, no other company in this highly specialized market masters the full cycle of requirements that lead to innovative and highly functional products. At Orfit Industries, we achieve this because we control the entire process of Research & Development, Manufacturing, Quality Assurance, Marketing & Sales and Customer Education. Thanks to this process, we offer optimal solutions for patient positioning and immobilization, everywhere in the world. Our R&D and manufacturing activities result in a product offering for radiation oncology that consists of especially formulated thermoplastic materials for patient immobilization, and high precision hardware for accurate and comfortable positioning on treatment couches and diagnostic machines. We bring innovation into the market, with a clear understanding of the needs of Radiation Therapy Specialists, the patient s comfort and the requirements of the authorities. 4 drivenbycare 5

4 Effective Patient Immobilization for Radiation Therapy Today s imaging and target localization possibilities allow you to see how your treatment plan corresponds with the location of the tumour. Corrections for better sparing of healthy tissue can be made. These innovative techniques can only be efficient if you are sure that your patient does not move during the delivery of the fraction. The Patient Immobilization Systems from Orfit Industries are an active component in achieving a high quality radiation therapy. Our thermoplastic masks immobilize a patient effectively to a point where movement of less than 1.5 Orfit Industries engineers developed a (patented) method to measure the relationship between mask contraction and fixation force. > Precision, Stabillity and Comfort of Patient Immobilization in Radiation Therapy Dr. Bogdan Bogdanov The Orfit range of products allows for a perfect balance between patient comfort and restriction of movement. UON and DUON give a comfortable immobilization where poor patient conditions form a restriction. The unique features of our thermoplastic materials, in combination with our head rests with cranial stop and our L-profiles that fix the masks in the High Precision Hardware give you the possibility of choosing the most suitable mask for your patient and for the type of treatment that you have planned. A number of clinical studies have proven the effectiveness of Efficast in combination with Raycast High Precision Hardware. > Repositioning accuracy of a commercially available thermoplastic mask system millimetre is possible. Martin Fuss, Radiotherapy and Oncology (2004), The Efficast thermoplastic material allows you to Efficast High Precision masks restrict movement to the 71 (3), remould a mask when the patient s volume has golden standard of less than 2 millimetre. increased or decreased. > Six dimensional analysis with daily stereoscopic x-ray Efficast Hybrid masks bring the movement restriction imaging of intrafraction patient motion in head and down to less than 1.5 millimetre. neck treatments using five points fixation masks Nadine Linthout, Med. Phys. (2006), 33 (2), > The evolution of quality assurance for intensitymodulated radiation therapy (IMRT): sequential tomotherapy Woo SY, Int J Radiat Oncol Biol Phys. (2003), 56 (1), > Migration from a full head mask to open-face mask for immobilization of patients with head and neck cancer Li, JACMP (2013), 14 (5), Stability of different immobilization masks from Orfit Industries 6 drivenbycare 7

5 Head, Neck and Shoulders > High Precision > Push-Pin > Paediatric product line > MRI-compatible products > UON + DUON 8 drivenbycare 9

6 High Precision Head, Neck and Shoulders Immobilization System The Orfit High Precision (HP) Mask System for Head, Neck and Shoulders consists of a unique combination of three carefully designed and engineered components. When integrated they result in the utmost accurate, reproducible and comfortable patient positioning and immobilization system. > Efficast thermoplastic masks with easy to fix and remove L-shaped profiles as interface between mask and base plate. > Raycast HP carbon fibre low density base plates and extensions for treatment machines. > Head rests with cranial stop and with positioning blocks and wedges. Orfit Industries unique masking technology increases the effect of patient immobilization on RT outcome by offering a (sub)millimetre precision needed with today s technology to perform IMRT, IGRT, SRS, SRT, Robotic RT and high energy RT. Thanks to a unique combination of advanced materials and innovative production methods, the Orfit system has achieved three critical goals for improving the quality of radiation therapy treatment. 1. PRECISION/ACCURACY Limit patient movement > Overall mask stability limits patient displacement to less than 2 mm within the mask. > Low-stretch draping method provides greater contouring and rigidity. > L-Profile technology secures more of the mask to the base plate. 2. REPRODUCIBILITY Reduce daily shifts > 3D Head Supports with cranial back stop that cradles the patient s head. > Well defined and indexable thermoplastic masks insure consistent daily position. > Openings at cranial end of mask provide space for patients with long hair. 3. PATIENT COMFORT Increase acceptance > Antibacterial non-stick coating with soft surface feel. > Comfortable foam head supports. > Thermoplastic with engineered limited shrinkage. > Cooler activation temperature of C. In addition to these fundamental advantages, the Orfit High Precision Head/Neck thermoplastics have other unique characteristics not found with any other manufacturer. 1. Thermoplastics with superior moulding properties that result in a high but comfortable degree of patient immobilization. 2. Very stable mask preventing chin-drop and shoulder rotation. 3. Memory Effect which allows the user to remould a finished mask as needed. This provides significant flexibility for modification during a patient treatment or simply to save on waste. 4. Thinner masks resulting in less absorption and increased skin sparing. 5. Positioning blocks and wedges that effectively support different neck shapes and allow for flexion and extension positioning of the head. 6. Quick Release system allows for fast and safe removal of the mask from the patient. 10 drivenbycare 11

7 Raycast High Precision Hardware Orfit s lightweight, professionally designed and precisely engineered hardware ensures outstanding patient immobilization results. The Orfit base plate design consists of a sandwich construction, with a foam core and ultra thin carbon fibre layers. This results in very low density with the highest possible radiation transmission during treatment. The use of your existing 2-pin lock bar, Orfit Loxon clamps or a similar device ensures that the Orfit High Precision base plate is securely mounted to the table top. High Precision Low Density Base Plates and Table Top Extensions High precision base plate in CFL Head, neck and shoulders High Precision Hardware for Head and Neck Positioning indicators on the base plate help to reduce patient set-up time and ensure precise positioning and immobilization during each fraction. An extensive range of Orfit High Precision base plates and Extensions are available and compatible for use with all treatment machines, CT and Simulator table tops. INT-1 Integra Couch Extension for Varian Exact Couch HP Efficast masks only Head, neck and shoulders High Precision Low Density Base Plates and Table Top Extensions High precision small base plate in CFL Head and neck High precision long base plate in CFL for IMRT/IGRT Head, neck and shoulders Treatments in overhang Tiltable head base plate in CFL Head and neck 12 drivenbycare 13

8 Raycast High Precision Hardware High Precision High Density Base Plates High precision extension for TRILOGY in polycarbonate Head and neck High Precision Hardware for Head and Neck 35751N High precision base plate in HPL Head, neck and shoulders High Precision High Density Base Plates 35754/6N High precision base plate in HPL Head and neck High precision base plate in polycarbonate Head and neck Cyberknife compatible High precision base plate in polycarbonate Head, neck and shoulders Cyberknife compatible 14 drivenbycare 15

9 High Precision Head Supports, Blocks and Wedges An extremely important part of the Orfit High Precision Frameless Mask System is the innovative 3D Head Support with cranial stop. The shape helps to comfortably cradle the patient s head while the cranial stop allows a correct and reproducible position within the head support. You can now be sure that the patient is in the exact same position within the head support each and every time. The base of the head support indexes precisely Low Density Head Supports (set) Set of low density head supports (all sizes) High Precision Hardware for Head and Neck into the Orfit High Precision Base Plates. Several sets with differently shaped and sized supine and prone head supports are available to meet virtually every patient and treatment need ZF ZF Regular Density Head Supports MD (set) Set of regular density head supports (all sizes) MD 35758ZF-MD MD 35713ZF-MD MD 35714ZF-MD Regular Density Head Supports - Extra Soft (set) Set of regular density head supports - Extra soft (all sizes) MD Head support (regular density) with lateral neck flaps for patients with a curved spine Prone head support adjustable in size, movable chin cushion Prone head support adjustable in size, movable forehead cushion 16 drivenbycare 17

10 High Precision Head Supports, Blocks and Wedges mm Carbon fibre block Positioning Blocks and Wedges High Precision Hardware for Head and Neck (set) Low density (CFL) mm 40 mm (set) Low density (CFL) Orfit Blocks and Wedges are used in conjunction with our 40 mm Carbon fibre block Head Supports to increase high precision positioning. This combination provides mm mm ,5 you with unmatched flexibility and versatility in being able to quickly and easily achieve the specific patient position you require for treatment. You are able to comfortably position the patient in extreme flexion and extension Carbon fibre wedge 35754/8 (set) High density (rigid PE) 35754/ / / /4 Orfit Raycast High Precision 3D Head Supports with cranial 20 mm 40 mm 9 18 stop, Blocks and Wedges are totally compatible for use with all High Precision hardware. All components index to each other for increased stability, reproducibility and precision of the immobilization. 18 Carbon fibre wedge 18 drivenbycare 19

11 Head, Neck and Shoulder Accessories Arm strap High Precision Masks for Head, Neck and Shoulders Efficast masks offer a unique combination of high precision immobilization, ease of moulding, safety and comfort for the patient. Our engineering and production capabilities with proprietary thermoplastic formulations result in the best mask materials available. Stretch and shrinkage properties are always the same and assure a reliable mask moulding technique, resulting in a perfect fit around the patient s anatomy and a high degree of patient comfort. Antibacterial coating Efficast masks are treated with a unique water-based non-stick coating that has antibacterial properties and that prevents sticking of the mask to skin, hair and hardware Shoulder positioning system Base plate extension 32317/4 Knee Support indexed on 2-pin bar 32317/5 Feet Support Indexed on 2-pin bar 20 drivenbycare 21

12 Efficast High Precision Antibacterial Masks for Head, Neck and Shoulders For High Precision Immobilization The antibacterial effect of the coating was determined using the ISO 22196:2011 test method. The results show 33776/2MA 35763/2MA/EM a reduction of > 99.99% of the following bacteria: > Meticilline-resistent Staphylococcus aureus (MRSA) > Staphylococcus aureus > Escherichia colli An extensive range of Orfit Efficast HP masks are available to meet specific patient requirements and your immobilization preferences. > Chin only 2-points chin mask 3-points head mask with nose, eyes and mouth hole* > Head only MRSA, the so-called hospital bacteria, is the most common nosocomial infection in Europe. It is estimated that over MRSA infections in Europe result in 5000 deceases every year. The department of Health and Human Services in the USA estimated invasive MRSA infections in 2008, associated with deaths each year. > Head and Neck (with and without neck flap) > Head, Neck and Shoulders > Head, Neck and Shoulders with Cranial Flap > Hybrid Masks of all types for significantly increased Precision of the immobilization and for use with large patients > Open Face Hybrid mask 35763/2MA 3-points head mask with nose hole* 35763/2MA/G35 3-points head mask with nose hole 35mm up > Paediatric masks - All configurations for head, neck The WHO considers the Escherichia colli as a super bacteria because it is increasingly resistant to antibiotics. and shoulders. All Orfit Efficast HP masks are available with various Hand hygiene helps to prevent infections but it is not combinations of prepunched cutouts for ease of use. sufficient. Therefore a thorough hygienic care of the patient and of medical devices is of prime importance to prevent contamination. The antibacterial coating > Nose only > Nose and mouth > Nose, eye, mouth 35763/2MA/NH 35760/EFF2MA on all Orfit masks helps to reduce cross-contamination within a radiotherapy department. All Orfit masks have an antibacterial coating. 3-points head mask* 3-points head mask with nose hole extra cranial flaps* /2MA/M 35760/EFF2MA/M head 3-points head, neck and shoulders 4-points head, neck and shoulders 5-points (with cranial flap) 3-points head mask with nose and mouth hole* 3-points head mask with nose and mouth hole extra cranial flaps* 22 drivenbycare 23

13 Efficast High Precision Antibacterial Masks for Head, Neck and Shoulders Efficast High Precision Antibacterial Masks for Head, Neck and Shoulders For High Precision Immobilization For High Precision Immobilization 35760/EFF2MA/EM 35764/2MA 33700/2MA 33700/2MA/M 3-points head mask with nose, eyes and mouth hole extra cranial flaps* 4-points head, neck and shoulder mask with nose hole* 5-points head, neck and shoulder mask with nose hole* 5-points head, neck and shoulder mask with nose and mouth hole* 35779/2MA 35764/2MA/NH 33700/2MA/NH 33700/2MA/EM 3-points head mask with nose hole neck flap* 4-points head, neck and shoulder mask 5-points head, neck and shoulder mask 5-points head, neck and shoulder mask with nose, eyes and mouth hole* 35779/2MA/M 3-points head mask with nose and mouth hole neck flap* 35764/2MA/M 4-points head, neck and shoulder mask with nose and mouth hole* 33730/4 5-points head, neck and shoulder mask with nose hole large size 35779/2MA/EM 35764/2MA/EM These masks are available in 2 mm thickness with maxi perforation ( with extension /2MA) 3-points head mask with nose, eyes and mouth hole neck flap* 4-points head, neck and shoulder mask with nose, eyes and mouth hole* * Additional available thicknesses and perforation types: 1.6 mm micro perforation ( with extension/16mi) 24 drivenbycare 25

14 High Precision Hybrid Masks for Head, Neck and Shoulders Precision has always been, and will always be, the main driving force in Radiation Oncology for improving existing treatment techniques and for adopting changes in the existing treatment routines. The search for improvement of the overall precision of cancer treatment has led to the introduction of techniques like IGRT, Adaptive RT, real time robotic techniques, etc. It has also led to a better understanding of the importance of an accurate and sustainable patient positioning system. Very often, standard immobilization devices will not deliver the precision and reproducibility needed for these treatments as they leave too much room for the patients to move. Extra High Precision Immobilization - Nanor Reinforcement Efficast High Precision Antibacterial Hybrid Masks for Head, Neck and Shoulders 33740/2MA/12MI+N/NH 3-points hybrid head mask 33730/2MA/ 12MI+N/NH 5-points hybrid head, neck and shoulder mask Therefore Orfit Industries has created an innovative and patented range of hybrid thermoplastic immobilization masks that clearly overcome the above-mentioned positioning and immobilization problems. These reinforced thermoplastic masks offer the ease of use of a regular thermoplastic mask with an unparalleled horizontal stability and fixation force. In combination with the unique Orfit high precision head supports, one is able to really achieve a good immobilization and positioning of the patient /2MA/12MI+N 3-points hybrid head mask with nose hole 33730/2MA/ 12MI+N 5-points hybrid head, neck and shoulder mask with nose hole Even the largest and big-shouldered patients will be immobilized properly with these masks thanks to the reinforcement rim around the mask and the chin strap offering excellent control over the position of the patient s head. The range of hybrid pre-cuts consists of a 3-points head and neck pre-cut and 5-points head, neck and shoulders pre-cut, both for regular and paediatric patients /2MA/ 12MI+N/NH/G17 5-points hybrid head, neck and shoulder mask with trachea hole 33730/2MA/ 12MI+N/G17 5-points hybrid head, neck and shoulder mask with nose and trachea hole 26 drivenbycare 27

15 High Precision Open Face Hybrid Masks for Head, Neck and Shoulders The innovative Open Face Hybrid Mask leaves eyes, nose and mouth exposed, and is the ideal immobilization solution for brain, head and neck patients who suffer from claustrophobia and for treatments with a long duration, as on the Cyberknife. Like all thermoplastic materials made by Orfit, this high precision mask is easy to mould and it can be shaped very closely to the patient s anatomy. It provides excellent reproducibility of the patient s position. It warrants increased patient comfort and provides the same high precision immobilization as the standard single layer Efficast head and neck masks. The Open Face Hybrid Mask is reinforced with Nanor, an entirely new thermoplastic material, based on high end nano-technology, that allows to make a mask that is thinner, lighter, and yet stable. The new Open Face Mask is compatible with modern motion management systems, enabling radiation oncology clinicians to keep the target in the path of the radiation beam at all times. For High Precision Immobilization 33759/16MI/12MI+N 3-points open face head mask 33733/16MI/12MI+N 5-points open face head, neck and shoulder mask 28 drivenbycare 29

16 Push-Pin Masks and Hardware Superior Patient Immobilization with Efficast Thermoplastic Masks At Orfit Industries we are dedicated to provide the best possible solutions for patient positioning and immobilization in radiation oncology. The most important component of patient immobilization is the thermoplastic mask. The superior properties of Efficast thermoplastic pre-cuts assure an easy, comfortable and precise maskmaking process. Our thermoplastic masks with push-pin type profiles fit seamlessly on existing hardware that you may have in your department. 30 drivenbycare 31

17 Push-Pin Masks for Head, Neck and Shoulders Orfit Industries unique masking technology increases the effect of patient immobilization on RT outcome by offering the millimetre precision needed with today s technology. Thanks to a unique combination of advanced materials and innovative production methods, the Orfit system has achieved three critical goals for improving the quality of radiation therapy treatment. For High Precision Immobilization 35772/2MA Efficast Push-Pin Antibacterial Masks for Head, Neck and Shoulders 35774/2MA PRECISION/ACCURACY Limit patient movement > Overall mask stability limits patient displacement to 2-points head mask with nose hole* 4-points head, neck and shoulders mask with nose hole* less than 2 mm within the mask. > Equal and controlled stretch draping method provides greater contouring and rigidity. REPRODUCIBILITY Reduce daily shifts > 3D head supports with cranial back stop that cradles the patient s head. > Well-defined thermoplastic masks insure consistent daily position /2MA 3-points head mask with nose hole*/** 33770/2MA 5-points head, neck and shoulders mask with nose hole - regular size** PATIENT COMFORT Increase acceptance > Antibacterial non-stick coating with soft surface feel. > Comfortable foam head supports. > Thermoplastic with engineered limited shrinkage. > Cooler activation temperature of 65 C-70 C /2MA 35791/2MA In addition to these fundamental advantages, the Orfit high precision head/neck thermoplastics have other unique characteristics not found with any other 3-points head mask with nose hole*/** 5-points head, neck and shoulders mask with nose hole - large size** manufacturer: > Thermoplastic with superior moulding properties that result in a high but comfortable degree of patient immobilization. > Very stable mask preventing chin-drop and shoulder rotation. > Memory effect which allows the user to remould a finished mask as needed. This provides significant flexibility for modification during a patient treatment or simply to save on waste. > Thinner masks resulting in less absorption and increased skin sparing /2MA 3-points head mask with nose hole These masks are available in 2 mm thickness with maxi perforation ( with extension/2ma) Additional available thicknesses and perforation types: * 1.6 mm micro perforation ( with extension /16MI) ** 2.0 mm micro perforation ( with extension /2MI) 32 drivenbycare 33

18 Efficast Push-Pin Antibacterial Hybrid Masks for Head, Neck and Shoulders Hybrid Masks for Extra High Precision Immobilization - Nanor Reinforcement For High Precision Immobilization Efficast Push-Pin Antibacterial Open Face Hybrid Masks for Head, Neck and Shoulders 33747/ 2MA/12MI+N/NH 33747/ 2MA/12MI+N MI/12MI+N 33781/ 16MI/12MI+N 3-points hybrid head mask 3-points hybrid head mask with nose hole 3-points open face head mask 5-points open face head, neck and shoulder mask 33739/ 2MA/12MI+N/NH 33739/ 2MA/12MI+N 5-points hybrid head, neck and shoulder mask 5-points hybrid head, neck and shoulder mask with nose hole 33755/ 2MA/12MI+N/NH 33755/ 2MA/12MI+N 5-points hybrid head, neck and shoulder mask - large 5-points hybrid head, neck and shoulder mask - large with nose hole 34 drivenbycare 35

19 Efficast Push-Pin Antibacterial Masks for Head, Neck and Shoulders - without profiles For High Precision Immobilization 35772/2MA/NP 2-points head mask with nose hole* 35774/2MA/NP 4-points head, neck and shoulder mask with nose hole* Immobilization for Treatment of Neck and Thorax Precision in lung treatment is highly increased by immobilizing the chin and thorax of the patient. Orfit Industries has designed a hybrid 4-points mask that assures a correct repositioning of the chin, the arms and the chest. The reinforced part of the mask over the armpit and over the lower ribs prevents rotation of the thorax. In addition, long fiducial markers can be attached on the mask for additional control of the patient s position /2MA/NP 3-points head mask with nose hole*/** 33770/2MA/NP 5-points head, neck and shoulder mask - regular size with nose hole** 35768/2MA/NP 3-points head mask with nose hole*/** 35791/2MA/NP 35776/2MA/NP 5-points head, neck and shoulder mask - large size with nose hole*/** Lung Mask 3-points head mask with nose hole*/** 33761/16MI/NP 3-points head mask with nose hole and narrow neck flap Masks with with extension /2MA are available in 2 mm thickness with maxi perforation Additional available thicknesses and perforation types: * 1.6 mm micro perforation ( with extension /16MI) ** 2.0 mm micro perforation ( with extension /2MI) 33788/2MI/12MI+N 4-points hybrid lung mask for push-pin hardware 36 drivenbycare 37

20 Hardware for Push-Pin Masks An extremely important part of the Orfit High Precision Frameless Mask System is the innovative 3D Head Support with cranial stop. The shape helps to comfortably cradle the patient s head while the cranial stop allows a correct and reproducible position within the head support. You can now be sure that the patient is in the exact same position within the head support each and every Low Density Head Supports Hardware for Push-Pin Masks Set of 6 low density head supports (all sizes) time. The base of the head support indexes precisely into the Push-Pin Base Plates Several sets with differently shaped and sized supine and prone head supports are available to meet virtually every patient and treatment need Regular Density Head Supports MD (set) Set of 6 regular density head supports (all sizes) MD 32423ZF-MD MD 32421ZF-MD MD 35422ZF-MD Regular Density Head Supports - Extra Soft (set) Set of 6 regular density head supports - Extra soft (all sizes) drivenbycare 39

21 Hardware for Push-Pin Masks Hardware for Push-Pin Masks Regular Density Head Supports Low Density Base Plate MD Head support (regular density) With lateral neck flaps for patients with a curved spine Base plate in CFL for push-pin masks Head, neck and shoulders Prone head support rectangular interface Movable forehead cushion Adapters for HP Head Supports and Blocks and Wedges Regular density adapter Low density adapter Profiles in Carbon Fibre Small 35664/20 Push-pin (set of 20 pieces) Large 40 drivenbycare 41

22 High Precision Paediatric Hardware Orfit s lightweight and precisely engineered Paediatric hardware ensures outstanding immobilization results. The Orfit Paediatric base plate design consists of a sandwich construction, with a foam core and ultra thin carbon fibre layer. This results in very low density with the highest possible radiation transmission during treatment. The use of your existing 2-pin lock bar, Orfit Loxon High Precision Paediatric Head Supports Head Supports with Cranial Stop An extremely important part of the Orfit High Precision Frameless Mask System is the innovative 3D Head Support with cranial stop. The shape helps to comfortably cradle the patient s head while the cranial stop allows a correct and reproducible position within the head support. You can now be sure that the patient is in the exact clamps or a similar device ensures that the Orfit same position within the head support each and every Paediatric High Precision base plate is securely mounted time. The base of the head support indexes precisely to the table top. Positioning indicators on the base plate into the Orfit High Precision Base Plate. help to reduce patient set-up time and ensure precise Several sets with differently shaped and sized supine positioning and immobilization during each fraction. and prone head supports are available to meet virtually every patient and treatment need. High Precision Paediatric Low Density Base Plates Paediatric Head Supports HP paediatric base plate Head, neck and shoulders Paediatric head support with lateral neck flaps Age 6 to ZF Paediatric head support without lateral neck flaps Age 6 to Paediatric head support with lateral neck flaps - Extra-small size Age 0 to MD Paediatric head support with lateral neck flaps Age 6 to ZF-MD PED Paediatric head support without lateral neck flaps Age 6 to 12 HP long base plate for IMRT/IGRT Paediatric version Head, neck and shoulders Prone head support adjustable in size, Movable chin cushion Prone head support adjustable in size, Movable forehead cushion 42 drivenbycare 43

23 High Precision Paediatric Masks for Head, Neck and Shoulders For High Precision Immobilization 33710/2MA 3-points head mask with nose hole - small Efficast Paediatric High Precision Antibacterial Masks for Head, Neck and Shoulders 33710/2MA/NH 3-points head mask without nose hole - small 33688/2MA 3-points head mask with nose hole - medium 33705/2MA 5-points head, neck and shoulders mask with nose hole - small 44 drivenbycare 45

24 Efficast Paediatric High Precision Antibacterial Hybrid Masks for Head, Neck and Shoulders Efficast Paediatric Push-Pin Antibacterial Masks for Head, Neck and Shoulders For Extra High Precision Immobilization For High Precision Immobilization 33748/2MA/12MI+N/NH 3-points hybrid head mask paediatric - small 33690/2MA 3-points head mask with nose hole paediatric - small 33749/2MA/12MI+N/NH 3-points hybrid head mask paediatric - medium 33691/2MA 5-points head, neck and shoulder mask with nose hole paediatric - small 33750/2MA/12MI+N/NH 5-points hybrid head, neck and shoulder mask paediatric - small For High Precision Immobilization 33784/16MI/12MI+N 3-points open face head mask paediatric - small 33782/16MI/12MI+N 3-points open face head mask paediatric - small 33786/16MI/12MI+N 5-points open face head, neck and shoulder mask paediatric - small 33783/16MI/12MI+N 3-points open face head mask paediatric - medium For Extra High Precision Immobilization 33766/2MA/12MI+N/NH 33785/16MI/12MI+N 5-points open face head, neck and shoulder mask paediatric - small 3-points hybrid head mask paediatric - small 33787/16MI/12MI+N 5-points open face head, neck and shoulder mask paediatric - medium 33777/2MA/12MI+N/NH 5-points hybrid head, neck and shoulder mask paediatric - small 46 drivenbycare 47

25 Orfit MRI-S Solution for Brain, Head and Neck The Orfit MRI-S Solution for Brain, Head and Neck provides patient immobilization on the Siemens MAGNETOM family of MRI scanners. It allows for fusion of images with the patient in exactly the same position as in simulation and treatment. The Solution includes a High Precision (HP) Base Plate, a bi-lateral antenna holder, a set of six HP headrests, and a set of couch top fixations. Patients are immobilized with an Efficast thermoplastic 3-points or 5-points mask. All components and thermoplastic masks are MRIcompatible and meet the standards of Siemens AG Healthcare with respect to functioning on the following Magnetic Resonance Systems HP base plate The HP base plate comes with different sets of dedicated indexing fixations so that it can be mounted on top of the different couch tops of the Siemens MAGNETOM family MRI scanners. Slots are provided in the base plate to attach Orfit Efficast thermoplastic head and neck masks. All Orfit HP head supports, blocks and wedges can also be positioned on the base plate. This allows the patient to be immobilized in exactly the same position as for simulation and treatment. Bi-lateral antenna holder The antenna holder slides over the cranial end of the base plate. It can be opened for easy mounting of the antennas and for patient set-up with a mask. In a closed position the antennas are very close to the head of the patient for optimal image quality. The levers of the holder accept the large Flex coils of the Siemens MRI system. Tim System Tim 4G System 1.5 Tesla Avanto Espree Symphony a Tim System Aera 3 Tesla Verio Trio a Tim System Skyra Spectra 48 drivenbycare 49

26 Orfit MRI-P and Orfit MRI-G Solution for Brain, Head and Neck The Orfit MRI-P Solution is designed for Philips MRI Scanners and the Orfit MRI-G Solution for GE MRI Scanners. Both Solutions can be combined with the flexible coils of the respective MRI Scanners. The base plates allow the use of a thermoplastic mask, head supports, blocks and wedges in order to scan the patient in the treatment position /P 29111/G 50 drivenbycare 51

27 UON and DUON Masks for Head, Neck and Shoulders For superior performance, patient comfort and reproducibility UON U-Shaped Head masks and DUON S-Shaped Head-Neck-Shoulder masks combine the unique features of U-Plast thermoplastic material with a U- and S-Shaped frame that is compatible for use with virtually all base plate hardware. UON and DUON masks will provide superior performance and patient immobilization. They will eliminate virtually all of the problems/ difficulties associated with the existing first generation masks that are currently used in other U-Shaped and S-Shaped products. UON and DUON Immobilization Masks UON Head & Neck DUON Head & Neck mm hybrid perforation mm hybrid perforation UON and DUON are easier to use and much more comfortable for patients thanks to an innovative non-stick coating and significantly reduced shrinkage. UON and DUON masks will not stick to the patient s hair, skin or hardware. There is no need to use silicone spray to prevent sticking of the mask to the patient or hardware as is common with other thermoplastic materials. UON and DUON masks eliminate the difficulties associated with uncontrolled shrinkage that is commonplace with other masks. 2.4 mm micro plus perforation mm micro plus perforation with neck flap 2.4 mm micro plus perforation mm micro plus perforation with neck flap In addition, UON and DUON masks become moldable at 65 C-70 C. This is 4 C-8 C lower than the first generation masks on the market. Therapists no longer have to worry about burning their hands in a hot water bath or burning the patient. UON and DUON can be placed immediately on the patient after it is towel dried, increasing patient throughput. It totally eliminates the need to use special cold sprays or cooling mitts before placing the masks on the patient. The low molding temperature of UON and DUON masks also significantly increases patient comfort mm maxi perforation mm maxi perforation mm maxi perforation mm maxi perforation UON and DUON masks are compatible for use with virtually all base plates on the market that are currently used with U-Shaped and S-Shaped masks. Orfit also offers a full range of carbon fibre laminate and high density base plates and couch extension for use with UON and DUON mm maxi perforation with neck flap mm maxi perforation with neck flap 52 drivenbycare 53

28 UON and DUON Immobilization Masks DUON Head, Neck and Shoulders mm micro plus perforation Head Support Adapter plates Head Supports with Cranial Stop An extremely important part of the UON and DUON Mask System is the innovative 3D shaped Head Support with cranial stop. The shape helps to comfortably cradle the patient s head while the cranial stop allows correct and reproducible positioning within the head support. You can now be sure that the patient is in the exact same position within the head support each and every time. The base of the head support indexes precisely into the UON and DUON Base Plate. UON and DUON base plate mm maxi perforation Base plate for head and neck - Acrylic UON and DUON head supports for use with your base plate Now you can quickly and easily use UON and DUON low density head supports with your existing U-Shaped or S-Shaped base plate. Orfit head support adapter plates for U-Shaped base plates and and CFL for S-Shaped base plates enable you to quickly convert your base plate so it s compatible for use with all Orfit head supports. DUON-HP EXTENSION INT-1D Integra Table Top Extension for a Varian Exact couch HP and DUON masks DUON-HP Base Plates UON and DUON Head Support Adapter Plates INT-3 Integra head, neck and shoulders board - CFL For use with U-Shaped base plates - Acrylic CFL For use with S-Shaped base plates - CFL For use with S-Shaped base plates - Acrylic 54 drivenbycare 55

29 The AIO Solution > Allows precise and reproducible immobilization of all the body regions > High level of patient comfort > Reduction of patient set-up time > Ease of use > Good dosimetric properties 56 drivenbycare 57

30 The AIO Solution All-in-One patient positioning system created by Dr. Kati Hideghéty The reproducibility and stability of patient positioning is extremely important for a precise radiation therapy treatment. The position of the tumour in space is a dynamic element that is difficult to keep under control during the actual treatment delivery. Therefore, potential changes in the position of the patient should be limited to a minimum. The AIO Solution makes this possible by immobilizing patients in a precise, reproducible and yet comfortable way. The AIO Solution facilitates and refines treatments. With one base plate and different sets of cushions and thermoplastic masks, all parts of the body are positioned and immobilized in a comfortable, exact and reproducible way. These refined immobilization techniques allow IMRT and IGRT procedures in almost any anatomical location, Meeting the highest demands in radiation oncology... > Exact reproducibility of the patient s position in imaging and therapy. > Highest degree of patient comfort for IMRT and IGRT procedures. > Precise immobilization of all body regions. > Increased certainty of location of external and internal anatomical structures. > Reduced inter- and intra-fraction variations. > Reduced daily positioning uncertainties. > Reduced patient set-up time. > Increased ease of use.... The AIO Solution fulfils all these requirements. The AIO Solution contains a cushion set for each AIO head and neck applications including breast and lung. anatomical region > Brain, head and neck > Thorax and abdomen in supine position > Prone breast position > Belly and pelvis in supine and in prone position AIO breast- and lungboard AIO prone breastboard AIO belly- and pelvicboard 58 drivenbycare 59

31 All cushions are easily positioned on the base plate in an indexed way. The cushions have a colour code for easy recognition and fast setup of the system: head supports and knee & leg cushions are in grey, thorax/abdomen cushions for supine are in blue, breast in prone position cushions are in yellow and belly/pelvis cushions are in green colour. The extra-cranial cushions can be adapted in width to accommodate all patient sizes. The prone breast cushions can be adapted in height. Each patient position is reproduced and immobilized by means of an Efficast thermoplastic mask that limits movement of the anatomical area of concern. AIO Storage Cabinet The AIO Storage Cabinet has 5 vertical sliding panels, and can store a complete AIO cushion set, as well as all fixation devices and an AIO board. The panels slide out completely, allowing easy access to the cushions. The cabinet is designed to efficiently store the AIO Solution components in the simulation or treatment room while taking up limited space (width x depth x height = 1600 x 690 x 1980 mm). The cushions are made of a low density foam with The AIO Solution is truly an All-In-One system with excellent dosimetric properties. They are coated to a head and neck immobilization system, lungboard, Every AIO part has its own dedicated place so that it can assure patient comfort and hygiene. breastboard, abdominal system and belly- and easily be found. This reduces patient set-up time and makes pelvicboard in one single product. inventory control easy in the event of misplaced parts. The cabinet is made of laminated pressed wood boards, which are easy to clean. It is easy to assemble, but at the same time sturdy to make it long-lasting. The cushions are stored in such a way that they remain well protected from possible damage. AIO Head & Neck AIO Breast- & Lungboard AIO Prone Breastboard AIO Belly- & Pelvicboard drivenbycare 61

32 AIO Head and Neck Applications The main goal in the positioning of patients with head and neck tumours is a very precise and reproducible positioning and immobilization of the head and upper torso of the patient. To achieve this, a combination of the AIO hardware and Efficast thermoplastic masks provides an ideal solution. > The AIO base plate allows for a reproducible and comfortable positioning of the patient, reducing Head Supports (set) AIO Head and Neck Applications stress and anxiety. > Efficast 3-points masks assure a precise immobilization of the head and 5-points masks of the head, neck and shoulders MD (set) MD Positioning Blocks and Wedges (set) Low density CFL Low density CFL (13,5 C) 35754/8 (set) High density PE 62 drivenbycare 63

33 High Precision Base Plate in CFL or HPL > Long board base plate for a reproducible positioning of all body regions. > Made of a low density carbon fibre laminate sandwich structure with excellent dosimetric properties. > This base plate remains on the treatment couch throughout the day, irrespective of the type of radiation treatment. > It can be extended over the edge of the couch when using IMRT techniques for a 360 free gantry rotation space around the head and neck area. > The plate is colour marked for easy and fast setup of the different cushion sets. > Indexing bars can be fitted for indexing vacuum cushions and alpha cradles. > The mask fixation slots (for Efficast masks) are identical as in all other Raycast High Precision Base Plates, assuring complete compatibility between all Orfit products. High Precision Base Plate in CFL and HPL AIO base plate Carbon fibre laminate AIO ID P-LD AIO base plate in carbon fibre laminate PED PED 32301/NOLS P-HD P-LD P-HD AIO base plate in high pressure laminate AIO paediatric base plate in carbon fibre laminate AIO paediatric base plate in high pressure laminate AIO base plate in carbon fibre laminate - no leg separator AIO base plate High pressure laminate PED AIO paediatric base plate in high pressure laminate PED AIO paediatric base plate in carbon fibre laminate 32301/NOLS AIO base plate in carbon fibre laminate No leg separator 64 drivenbycare 65

34 AIO Breast- and Lungboard Solution This cushion set is designed to achieve a comfortable and reproducible supine position of the patient. This position is primarily used for the treatment of malignancies in the thorax and the abdomen. The set consists of wedges, with different angles to increase patient comfort, and arm rests to allow for a comfortable, but reproducible positioning of the arms above the head and out of the treatment fields. Hand grips and head supports will further help in increasing the precision and in finding the correct patient position. > 5, 10 and 15 angled wedges lift the upper body of the patients and thereby facilitate breathing. > The coating of the cushions prevents the patient from sliding down > The armrests (20 and 30 angle) have a flat top to support the total upper arm. This increases the patient s comfort > Lateral insert in the cushions allow the positioning of large patients > Specially developed Efficast masks are used in combination with this set to increase the precision of the treatment. Cushions They effectively immobilize the patient in the treated areas by reducing translational and AIO ID rotational movements TA-WE-5 Wedge 5 > The indexed head supports position the head in a TA-LS-5 Lateral support - 5 (left) reproducible way and function as an outstanding TA-LS-5 Lateral support - 5 (right) reference point for the exact position of the rest of the body TA-WE-10 TA-LS-10 Wedge 10 Lateral support - 10 (left) TA-LS-10 Lateral support - 10 (right) TA-WE-15 Wedge TA-LS-15 Lateral support - 15 (left) TA-LS-15 Lateral support - 15 (right) TA-AR-L Arm rest - low TA-AR-H Arm rest - high TA-WE-0 Wedge TA-LS-0 Lateral support - 0 Accessories AIO ID P-SE-LD Secondary base plate in CFL 32015/9 AC-GP Grip pole system MD Set head supports (3) regular density - without lateral neck flaps 66 drivenbycare 67

35 AIO Prone Breastboard Solution The yellow cushion set is designed to obtain a comfortable and reproducible patient position for the prone breast treatment technique. This technique keeps the ipsi-lateral breast away from the chest wall and the underlying tissues and reduces the lung, heart and contra-lateral breast tissue volume that is trapped in the treatment fields. > The support wedge on the tunnel plate helps in limiting the volume of the sternum and contralateral breast tissue that will be caught in the radiation fields. > The use of the elevation cushion increases the total height of the set to 23 cm which allows the treatment of very large pendulous breasts > The slope in the head cushion allows the arms to drop and thereby reduce the tension in the shoulders during longer imaging and treatment sessions to increase the patient s comfort > The head can be positioned by means of two types of head supports: - A soft head support in the form of a ring that allows for a comfortable positioning of the head in prone position or sideways. - A support that fixes the head rigidly in prone position. This support can be adjusted to fit the anatomy of the patient s face and allows the use Cushions of Efficast masks for added precision. > Lateral inserts in the cushions are used for large patients. > Specially developed Efficast masks increase the precision of the treatment. They effectively immobilize the patient in the treated areas by reducing translational and rotational movements AIO ID BP-BW BP-SC BP-HC-B BP-CC-B BP-LS Comfort wedge for contralateral side Support cushion for contralateral breast Cranial cushion - standard 15 cm clearance Caudal cushion - standard 15 cm clearance Lateral support (left) BP-LS Lateral support (right) BP-HC-E Cranial cushion - elevation to 23 cm clearance BP-CC-E Caudal cushion - elevation to 23 cm clearance Accessories AIO ID HS-PR-A Prone head support HS-PR-M Comfort prone head support 35754/1 PE block 20 mm 35754/2 PE block 40 mm 68 drivenbycare 69

36 AIO Belly- and Pelvicboard Solution The purpose of the belly board is to keep the intestines of the patient out of the radiation fields for treating malignancies in the pelvis area. The opening in the cushion is meant to accommodate the belly of the patient and thereby effectively separate the small bowels from the area to be treated. > The opening in the belly board can be fitted with three sizes of belly inserts for different sized patients. These inserts are made of a soft foam to increase comfort in the rib cage area. > Lateral inserts in the cushions allow the positioning of large patients. > The head part of the cushion is designed to drop the shoulders of the patient and reduce stress. The hands of the patient are placed under the base plate on a special supporting device > The head can be positioned by means of two types of head supports: - A soft head support in the form of a ring that allows for a comfortable positioning of the head in prone position or sideways. - A support that fixes the head rigidly in prone position. This support can be adjusted to fit the anatomy of the patient s face and allows the use of Efficast masks for increased precision. > Pelvicast thermoplastic masks are used to reduce Cushions the cranial-caudal and rotational movements of the patients. A specially designed Leg Separator can be inserted after the patient has mounted the cushion, to fix a 6-points Pelvicast mask. This type of mask will further increase the reproducibility and precision of the treatment AIO ID BB-BI-2 BB-BI-3 BB-BI-1 BB-BC Insert - small Insert - large Insert - full Belly & pelvic cushion BB-LS Belly & pelvic lateral support (left) BB-LS Belly & pelvic lateral support (right) Accessories AIO ID 32015/8 AC-BG Hand grips AC-LS Leg separator HS-PR-M Comfort prone head support 35754/1 PE block 20 mm 35754/2 PE block 40 mm MD Set head supports (3) regular density without lateral neck flaps 70 drivenbycare 71

37 AIO Knee and Leg Positioning Set An exact and comfortable position of the patient s legs is obtained by using the indexable knee and leg positioning set. > An elevated position of the legs reduces stress in the patient s back during the daily treatment fractions. > Can be used as a knee support in supine and as an ankle support in prone treatment position. > These cushions are also used as a reference point for setting up the other AIO Solution cushion sets. > The position of the cushion is easily reproduced by means of the millimetre scale and letter combinations AIO ID LP-KS-B Basic low LP-KS-W Wedge LP-KS-E Elevation LP-EC Base plate extension 72 drivenbycare 73

38 The AIO Solution - Accessories The AIO Solution - Accessories Thorax High Precision Pre-Cuts for the AIO Solution Indexable Knee and Foot Solutions 33715/2MA 4-points thorax supine mask - small AIO indexable knee frame - short 33716/2MA 4-points thorax supine mask - medium /2MA AIO indexable knee and foot frame 4-points thorax supine mask - large 33775/2MI/12MI+N 4-points hybrid lung mask AIO indexable knee frame long 33723/32MA/L 5-points assymetric breast mask supine - left Positioning Plate 33723/32MA/R 5-points assymetric breast mask supine - right 33724/32MA 6-points thorax and abdomen supine mask Positioning plate for prone head support 74 drivenbycare 75

39 Pelvicast > Pelvicast masks decrease interfractional and intrafractional motion > Masks are available in different sizes > The leg separator is the ideal reference point and decreases skin folds > The L-profiles secure more of the mask to the base plate and are easy to release > Suitable for both the prone and supine position 76 drivenbycare 77

40 Pelvicast High Precision Pelvis and Abdomen Frameless Immobilization System The Pelvicast High Precision Frameless Mask System for Pelvis and Abdomen immobilization consists of a unique combination of three (3) carefully designed and engineered components. When integrated they result in the most accurate, reproducible and comfortable patient immobilization and positioning system. 1. Raycast carbon fibre low density hardware. 2. Pelvicast frameless thermoplastic masks. 3. Easy to insert and remove L -shaped profiles as interface between mask and base plate. Orfit Industries has developed a pelvis and abdomen frameless, multi-point masking system that offers the precision in patient immobilization needed with today s technology to perform IMRT, IGRT, SRS, and SRT. Thanks to a unique combination of advanced materials and innovative production methods, the Orfit system has achieved three critical goals for improving the quality of radiation therapy treatment. PRECISION/ACCURACY Limit patient movement > Overall mask stability limits patient displacement. > Low-stretch draping method provides greater contouring and rigidity. > L -Profile technology secures more of the mask to the base plate. REPRODUCIBILITY Reduce daily shifts > Well defined and indexable thermoplastic masks insure a consistent daily position. > Unique central wedge prevents patient from sliding, ensuring a precise and reproducible immobilization. It also acts as a reference point for positioning patient prior to immobilization. PATIENT COMFORT Increase acceptance > Antibacterial non-stick coating with soft surface feel. > Thermoplastic with engineered limited shrinkage. > Cooler activation temperature of C. > Silk feel mask coating with smooth perforations (or non perforated) results in a soft feeling on the In addition to these fundamental advantages, the Pelvicast High Precision thermoplastics have other unique characteristics: > Thermoplastic with engineered limited shrinkage that results in a high but comfortable degree of patient immobilization. > Very stable mask limits movement and patient rotation. > Memory Effect allows the user to re-mould a finished mask as needed. This provides significant flexibility for modification during a patient treatment or simply to save on waste. > Quick Release system allows fast and safe removal with high risk patients. > Innovative integrated L profiles enable you to quickly and easily secure the mask to the Pelvicast base plate for a precise immobilization. patient s skin. 78 drivenbycare 79

41 Pelvicast Hardware Orfit s lightweight, professionally designed and precisely engineered hardware ensures outstanding patient immobilization results. The Orfit base plate design consists of a sandwich construction, with a foam core and ultra thin carbon fibre layer. This results in very low density with the highest possible radiation transmission during treatment. Pelvicast Base Plates High precision carbon fibre base plate for non-indexed couches The use of your existing 2-pin lock bar, Orfit Loxon clamps or a similar device ensures that the Orfit High Precision base plate is securely mounted to the table top. Positioning indicators on the base plate help to reduce patient set-up time and ensure precise positioning and immobilization during each fraction. Orfit High Precision base plates are available and compatible for use with all treatment machines, CT and Simulator table tops High precision carbon fibre base plate for Exact* or ibeam* couches High precision HPL base plate for non-indexed couches with central panel for added patient comfort Leg Separators Leg separator Contains slots for 6-points Pelvicast masks Low leg separator for less voluminous patients Contains slots for 6-points Pelvicast masks. *Exact is a trademark of VARIAN Medical Systems Inc. / *ibeam is a trademark of Medical Intelligence 80 drivenbycare 81

42 Pelvicast Thermoplastic Masks Pelvicast thermoplastic masks reduce the cranial-caudal and rotational movements of the patients. A specially designed Leg Separator can be inserted into the base plate after the patient has mounted the cushion, to fix a 6-points Pelvicast mask. This type of mask will increase the reproducibility and precision of the immobilization. An extensive range of Pelvicast masks are available to meet specific patient requirements and your immobilization preferences. Thermoplastic Pelvic Masks 35784/32MA 4-points pelvic mask - large prone and supine 35710/32MA 6-points pelvic mask - small for use with leg separator prone and supine 35711/32MA 6-points pelvic mask - medium for use with leg separator prone and supine 35788/32MA 35712/32MA 4-points pelvic mask - small prone & supine 6-points pelvic mask - large for use with leg separator prone and supine 35787/32MA 35780/32MA 4-points pelvic mask - medium prone & supine 6-points pelvic mask - large for use with leg separator supine 82 drivenbycare 83

43 MammoRx Breastboard > Narrow carbon fibre board > Light weight board > Ease of use > Quick assembly > Highly adaptable for patient comfort > Optional items for head and neck treatment in tilted position 84 drivenbycare 85

44 MammoRx Patient Positioning Systems Accurately establish and reproduce patient positions in radiation therapy. MammoRx Carbon Fibre Breastboard For patients receiving multiple radiation therapy treatments, position reproducibility is critical. MammoRx patient positioning products help you to quickly set up the patient during simulation and to easily reproduce settings during subsequent treatments. CFB-1 MammoRx ci Carbon Fibre Breastboard Insert MammoRx carbon fibre breastboards provide solutions Carbon Fibre Board Benefits that meet and exceed the changing needs of radiation > Provide easy and effective reproduction of patient therapists. Orfit offers two carbon fibre products: set-up the standalone MammoRx breastboard, and the > Enhance patient comfort through next-generation MammoRx ci insert for Varian Exact Couch customers. design improvements > Thinner, stronger and lighter than acrylic systems Because both boards use the same tilt-board design, > Feature lower attenuation levels than acrylic systems set-up information is transferable between systems. This allows you to use the standalone MammoRx system in a broad range of treatment or simulation environments and the MammoRx ci insert in conjunction with Varian Exact Couch systems. Both systems deliver precise immobilization for IMRT, enhanced set-up reproducibility, and are compatible with Orfit thermoplastic masks. CFI-1 86 drivenbycare 87

45 MammoRx Carbon Fibre Breastboard Seamless Connection between MammoRx ci Insert and Varian Exact Couch The MammoRx carbon fibre breastboard is specifically Benefits Ongoing research and collaboration with radiation Benefits designed for narrow-bore CT SIM environments. As one of the most lightweight boards on the market, > Fits through most small-bore CT units > No metal components in CT scan areas therapists led to the creation of the MammoRx ci carbon fibre breastboard Insert. Designed for IMRT, this > Fits precisely in the Varian Exact Couch > Eliminates the need to move breastboard from the MammoRx breastboard is easy to lift and replace on > Enables single-side and bilateral patient innovative board is the first of its kind to fit seamlessly in counter to table the treatment table - a key benefit when you consider immobilization the Varian Exact Couch. You ll never again need to place > Provides two locations for inserting upper-arm how often therapists remove patient positioning boards > Single-handed trigger action enables quick and easy a standalone breastboard on a traditional treatment supports, improving flexibility in patient set-up each day. movement of the upper-arm support between six table. The MammoRx ci board features all the benefits of > Comfortably lift and replace lightweight insert standard settings, providing faster set-up times for our standard MammoRx systems - in a thinner, lighter > Easily adjusts to standard angles: 0, 5, 7.5, 10, 12.5, 15, patients package - and can be left in the Varian Exact Couch for 20 and 25 degrees > Y-handle wrist support enhances comfort by other treatment set-ups. > Can be combined with Orfit thermoplastic masks for allowing patients to grip the handle or rest their increased precision. wrists in the saddle > Unique slide-motion lock on both sides of the board prevents dislodging of the angle supports, eliminating risk of tilt-board collapse > Can be combined with Orfit thermoplastic masks for increased precision. CFB-3 Built-in supports allow you to quickly achieve standard treatment angles of 0, 5, 7.5, 10, 12.5 and 15 degrees. Optional upper angle support bracket provides 20- and 25-degree treatment angles. 88 drivenbycare 89

46 Additional Functionalities MammoRx Patient Positioning Systems The MammoRx breastboard allows for advanced patient immobilization with Efficast thermoplastic masks: > 4-points mask for thorax immobilization > 3-points head and neck masks for patients that have difficulties in breathing when lying flat. Benefits > Tilting of the breastboard facilitates the patient s breathing. > The mask increases the reproducibility and stability of the patient s position /2MA Small /2MA Medium /2MA Large 4-points thorax supine mask Breast High Precision Pre-Cuts /2MA 2-points breast mask - rectangular design 35727/32MA 2-points breast mask - medium 35728/32MA 2-points breast mask - large 90 drivenbycare 91

47 MammoRx Patient Positioning Systems MammoRx Patient Positioning Systems Standard Configuration Description Qty. MammoRx Carbon Fibre Breastboard - Solution Bundles Breastboard CFB-1 MammoRx carbon fibre breastboard 1 pc. Breastboard CFI-1 MammoRx ci carbon fibre breastboard 1 pc. CFB-3 - Bilateral Arm Configuration Breastboard CFB-1 MammoRx carbon fibre breastboard 1 pc. Head support CHB-1 Blue gel ring head holder 1 pc. CFB-3 Arm support CAS-2 Upper arm support: 17.5 degree 2 pcs. Wrist support CWS-1 Wrist support: Y handle 2 pcs. Bottom Stop CBS-1 MammoRx bottom stop 1 pc. CFB-4 - Bilateral Arm Support Configuration Breastboard CFB-1 MammoRx carbon fibre breastboard 1 pc. Head support CHB-1 Blue gel ring head holder 1 pc. CFB-4 Arm support CBA-1 Bilateral arm support board 1 pc. Wrist support CWS-1 Wrist support: Y handle 2 pcs. Bottom stop CBS-1 MammoRx bottom stop 1 pc. CFB-5 - Combination Breastboard CFB-1 MammoRx carbon fibre breastboard 1 pc. Head support CHB-1 Blue gel ring head holder 1 pc. CFB-5 Arm support CAS-2 Upper arm support: 17.5 degree 2 pcs. Arm support CBA-1 Bilateral arm support board 1 pc. Wrist support CWS-1 Wrist support: Y handle 2 pcs. Bottom stop CBS-1 MammoRx bottom stop 1 pc. 92 drivenbycare 93

48 MammoRx Patient Positioning Systems MammoRx Patient Positioning Systems Accessories Accessories Upper Arm Support Options - Swivel CAS-1 Single and Dual Wrist Support Options Unique design provides easy trigger action for adjusting upper arm positions. The support is constructed from carbon fibre and black glass-filled nylon to eliminate large amounts of metal components while providing a rigid support for the patient. Both 17.5 ( CAS-2) and 35-degree ( CAS-1) upper arm supports are available with a wrist support pad that can swivel. CAS-2 To maximize patient comfort, multiple wrist supports are available. Our unique Y-handle enables patients to either grip the device or rest their wrist in the saddle portion of the device. A single post and wrist pad are also available. CWS-1 CHP-1 CWP-1 CAS-3 CAS-4 Upper Arm Support Options - Stationary Unique design provides easy trigger action for adjusting upper arm positions. The support is constructed from carbon fibre and black glass-filled nylon to eliminate large amounts of metal components while providing a rigid support for the patient. Both 17.5 (CAS-3) and 35-degree (CAS-4) upper arm supports are available with a stationary wrist support pad. CBA-1 Bilateral Arm Support System (BASS Board) Constructed from resilient ABS material, the BASS Board provides strength and integrity in a lightweight package. Ideal for supporting the patient s arms during treatment and diagnostic procedures of the breast, thorax and upper abdomen, the BASS Board also provides indexing capabilities for our standard head support options. CHD-1 Upper Angle Support Head Support Interfaces Optional upper angle support provides 20- and 25-degree support for rare occasions when higher angles are required. CHA-1 A blue gel ring head support or a round head cup can be attached directly to the MammoRx. CHB-1 CBS-1 MammoRx Bottom Stop Used with the MammoRx breastboard, the bottom stop eliminates patient slippage during treatment. Four positions are available. Placement correlates to the MammoRx ci Bottom Stop Indexing Bar for transition between MammoRx ci and MammoRx systems. CHO-1 CHT-1 MammoRx ci Bottom Stop Indexing Bar Indexes to existing Varian Exact Couch notches to eliminate patient slippage during treatment. CBB-1 Head Support Interfaces Interfaces are available for the Orfit High Precision Head Support, Silverman and Timo Head Supports. CHS-1 94 drivenbycare 95

49 Sagittilt Prone Breast Solution > Tilting the patient increases beam access to the ipsi-lateral breast > The tilted position can relief pressure on the ribs and contra-lateral breast > All het positions of the supports are indexed > When tilting the patient she is secured to the system by a thermoplastic hip mask > Easy storage and transportation with the storage cart 96 drivenbycare 97

50 Sagittilt Prone Breast Solution Radiation therapy of breast cancer in prone position is an increasingly used treatment technique. Several publications, also recent ones, prove the dosimetrical advantage of this technique. When treating a patient in the prone position the heart and lung tissue and the contra-lateral breast will be less affected. > Mulliez, T. et al. (2013), Hypo-Fractionated whole breast therapeutic ratio of post-lumpectomy radiation by improving dose homogeneity and minimizing incidental is likely to result in unacceptable dose inhomogeneity or significant doses to normal tissue. irradiation for patients with large breasts: A randomized cardiac and lung dose. Developed in collaboration with the University trial comparing prone and supine positions, > Olson, K.N. (2014), Improving treatment outcomes of Hospital of Liège, Belgium (Prof. P. Coucke) Radiotherapy and Oncology, vol. 108, issue 2, p > De Wyngaert J.K et al. (2007), Accelerated Intensity- breast radiation therapy: the prone position, Radiation Supine Prone Sagittilt Patient Comfort Prone treatment resulted in: improved dose coverage, better homogeneity, less volumes of over-dosage, reduced acute skin desquamation, a 3-fold decrease of moist desquamation, lower incidence of dermatitis, edema, pruritus, and pain. 2- to 4-fold reduction of grades 2-3 Modulated Radiotherapy to Breast in Prone Position: Dosimetric Results, Int. J. Radiation Oncology Biol. Phys., Vol. 68, No. 4, p This technique for whole breast radiotherapy is feasible and enables an accelerated regimen in the prone position therapist, Vol. 23, No. 1, p The prone position has been shown to reduce skin reactions by eliminating skin folds. This position can reduce late toxicities by greatly reducing the amount of dose to critical organs. Dose homogeneity can be toxicity, lower ipsilateral lung and mean LAD dose. while sparing the lung and heart. improved up to 1.2%. The prone position also has shown reduced intrafractional motion while having > Stegman, L.D. et al. (2007), Long-Term Clinical > Merchant, T.E. et al. (1994), Prone position breast interfractional motion within tolerance. outcomes of whole-breast irradiation delivered in the irradiation, Int. J. Radiation Oncology Biol. Phys., Vol. 30, prone position, Int. J. Radiation Oncology Biol. Phys., No. 1, p Treatment of the breast with the patient in prone position Vol. 68, No 1, p Irradiation of the heart, lungs, chest wall and is perceived by many to be less comfortable and also less Dosimetrical advantages High Precision Prone position breast radiation results in similar long-term disease control with a favourable toxicity profile compared contralateral breast are minimized with this technique. Prone position breast irradiation appears to be a simple reproducible than the supine position. The Sagittilt Prone Breast Solution solves these issues. with standard supine tangents. The anatomic advantages and effective alternative to irradiation of the breast in the of prone positioning may contribute to improving the conventional supine position when the supine position When developing the Sagittilt we looked at those aspects that make the supine breast position comfortable and translated that into a prone immobilization device. 98 drivenbycare 99

51 Sagittilt Features and Benefits 1. Tilting of the Patient Sagittilt has a mechanism that allows to rotate a patient along the sagittal axis in a reproducible and safe way. This rotation makes the breast hang further away from heart and lung and at the same time it decreases pressure on the ribs and the contralateral breast to 2. High Reproducibility of Patient Position Sagittilt allows for an optimal reproducibility of the position of a patient by means of supports for the arms, hands, elbows, head and feet that are individually adjustable and indexed, which creates a comfortable, stable and reproducible position for the patient. Head improve the comfort. The patient s elbows are positioned in a cup shaped The advantage of tilting the entire length of the body along the sagittal axis is that it remains flat on the device. The patient can be tilted from 0 to 10 with increments of 1 degree. One person only can perform the tilt. support structure, similar to what is used in supine breastboards. Once the elbows are positioned on Sagittilt, the position of the shoulders will also be reproducible for each session and the upper body will remain still during treatment. Hands Arms Elbows Feet 100 drivenbycare 101

52 3. Immobilization with a Thermoplastic Mask 4. Easy Storage A dedicated thermoplastic mask 33774/2MA/12MI+N for Sagittilt immobilizes the hips of the patient and keeps the patient in place in a secure way when tilting the system. Both the thermoplastic mask and the elbow support prevent the patient from sliding sideways when using the tilt function. There are 3 different positions for the thermoplastic mask. The mask is locked into the board by using 2 High Precision profiles, which is a patented technology by Orfit Industries. Middle Cranial A smartly designed storage cart comes with each Sagittilt so that the system can be moved around effortlessly and placed on the treatment couch without performing heavy lifting. 5. Couch Indexation The Sagittilt Prone Breast Solution is attached to the simulation and treatment couch by means of two dedicated 2-pin indexing bars, allowing to place it in a reproducible and safe way on most of the couch tops that are in use. Caudal 102 drivenbycare 103

53 6. High Tech Design Product Sagittilt is the result of an innovative development process and a high-tech production method involving carbon fibre techniques from the aviation industry. Special attention was given to the design of the product with the purpose of making it patient and user friendly while taking up a minimum amount of space in a treatment or simulation room. Sagittilt Accessories Sagittilt Accessories 33774/2MA/12MI+N 2-points hybrid hip mask Clinical Publications Sagittilt Prone Breast Solution > Cucchiaro, S. et al. (2014), Clinical Introduction of an all-in class solution for prone breast hyprofractionated SIB with multibeam IMRT, Radiotherapy & Oncology, Vol. 111, Supplement 1, p. 47 > Lakosi, F. et al. (2014), Hypo-Fractionated whole prone breast RT using Sagittilt system: patient comfort, setup accuracy and acute toxicity, Radiotherapy & Oncology, Vol. 111, Supplement 1, p. 477 > Lakosi, F. et al. (2013), Introduction of Sagittilt prone breastboard into daily practice: from pre-clinical to first clinical experience, Radiotherapy & Oncology, Vol. 106, Supplement 2, p /14 Sanitary cover 104 drivenbycare 105

54 The SBRT Solution > Both a short and a long version of the system are available > Both a mechanical and pneumatic abdominal pressure system are available > The abdominal pressure can be easily released in case of emergency by the safety mechanism that locks the screw > Two different types of arm immobilization can be used: AIO type and MammoRx type > The base plates can also be used for non-sbrt treatments > MRI compatible base plates 106 drivenbycare 107

55 The SBRT Solution Positioning of the Arms (MammoRx Arm Set-up) The MammoRx arm supports and hand grips are compatible with the SBRT Solution Positioning of the Arms (AIO Arm Set-up) The Arm Rest Cushion can be lifted with the use of an Elevation Cushion. There is a cranial and a caudal position for these cushions. Various indexed positions are available for the Hand Grips for optimal comfort and reproducibility The SBRT Solution is developed in collaboration with users worldwide via existing SBRT studies, products available on the market and on-site testing to provide a system which combines high technology, ease of use and precision to meet current and future demands. The SBRT Solution provides a precise, stable and easy to use set-up that allows to apply the most effective radiation treatment method for thoracic and abdominal tumors. Elevation cushion Various configurations of the product are available to adapt it to your needs. > Long vs short base plate > Arm set-up with cushions vs MammoRx arm supports > Mechanical vs pneumatic abdominal compression system drivenbycare 108 The MammoRx arm supports and hand grips are 109

56 Positioning of the Knee and Feet Abdominal Compression (Mechanical Pressure System) The mechanical pressure system consists of a bridge with a pressure plate and a screw. There is a low and a high version of the bridge. Longitudinal indexing of the knee support cushion. Longitudinal indexing of the foot support cushion. The Knee and Feet Support are indexed on top of the Long Base Plate. Abdominal Compression (Pneumatic Pressure Belt System) Abdominal compression can also be created with a pressure belt with inflatable air bladder. When using the Short Base Plate, the Knee and Feet Support are attached to the treatment couch with a 2-pin indexing bar. 110 drivenbycare 111

57 Vacuum Bag Thermoplastic Masks Various sizes of vacuum bags can be indexed both on the Long and the Short Base Plate. Thermoplastic Masks 33724/32MA 6-points thorax and abdomen supine mask Note: when using a vacuum bag, blocks will need to be placed underneath the head support to elevate the head of the patient. Thermoplastic Immobilization Masks Slots are provided over the entire length of the base plate to allow the use of different thermoplastic masks /32MA 4-points shoulder and thorax mask for SBRT 33724/32MA 35788/32MA 4-points pelvic mask - small 35784/32MA 35787/32MA 4-points pelvic mask - medium /32MA 4-points pelvic mask - large 112 drivenbycare 113

58 Package 1 SBRT Long Base Plate Package 3 SBRT Long Base Plate Description Description Mechanical Pressure System + AIO Arm Set-Up Mechanical Pressure System + MammoRx Arm Set-Up /1 Long SBRT Base Plate 32317/2 Pressure system bridge - low - variable height 32317/10 Pressure system bridge - high - variable height 32317/4 Knee support - indexed 32317/5 Feet support - indexed 32317/6 Arm rest support plate 32317/8 Arm rest cushion 32317/11 Arm rest elevation cushion 32015/9/2 Grip pole long - 2 pcs /9/3 Grip pole short - 2 pcs MD Head support in PU foam - model 1 - with lateral neck flaps 32317/ / / / / /15 CAS-2 CAS-2 CWS-1 CWS MD Long SBRT base plate Pressure system bridge - low - variable height Pressure system bridge - high - variable height Knee support - indexed Feet support - indexed Arm rest support plate for upper arm supports and wrist supports Upper arm support - 17,5 degrees Upper arm support - 17,5 degrees Wrist support: Y handle Wrist Support: Y Handle Head Support in PU Foam - Model 1 - with lateral neck flaps Package 2 SBRT Long Base Plate Package 4 SBRT Long Base Plate Description Description Pneumatic Pressure Belt System + AIO Arm Set-Up Pneumatic Pressure Belt System + MammoRx Arm Set-Up /1 Long SBRT base plate /1 Long SBRT base plate 32317/9 Pressure belt with manual pump 32317/9 Pressure belt with manual pump 32317/4 Knee support - indexed 32317/4 Knee support - indexed 32317/5 Feet support - indexed 32317/5 Feet support - indexed 32317/6 Arm rest support plate 32317/15 Arm rest support plate for upper arm supports and wrist supports 32317/8 Arm rest cushion CAS-2 Upper arm support - 17,5 degrees 32317/11 Arm rest elevation cushion CAS-2 Upper arm support - 17,5 degrees 32015/9/2 Grip pole long - 2 pcs. CWS-1 Wrist support: Y handle 32015/9/3 Grip pole short - 2 pcs. CWS-1 Wrist support: Y handle MD Head support in PU foam - model 1 - with lateral neck flaps MD Head Support in PU Foam - Model 1 - with lateral neck flaps 114 drivenbycare 115

59 Package 1 SBRT Short Base Plate Package 3 SBRT Short Base Plate Description Description Mechanical Pressure System + AIO Arm set-up Mechanical Pressure System + MammoRx Arm set-up /14 Short SBRT base plate 32317/14 Short SBRT base plate 32317/2 Pressure system bridge - low - variable height 32317/2 Pressure system bridge - low - variable height 32317/10 Pressure system bridge - high - variable height 32317/10 Pressure system bridge - high- variable height 32317/4 Knee support - indexed 32317/4 Knee support - indexed 32317/5 Feet support - indexed 32317/5 Feet support - indexed 32317/6 Arm rest support plate 32317/15 Arm rest support plate for upper arm supports and wrist supports 32317/8 Arm rest cushion CAS-2 Upper arm support - 17,5 degrees 32317/11 Arm rest elevation cushion CAS-2 Upper arm support - 17,5 degrees 32015/9/2 Grip pole long - 2pcs CWS-1 Wrist support: Y handle 32015/9/3 Grip pole short - 2pcs CWS-1 Wrist support: Y handle MD Head support in PU foam - model 1 - with lateral neck flaps MD Head support in PU foam - model 1 - with lateral neck flaps Package 2 SBRT Short Base Plate Package 4 SBRT Short Base Plate Description Description Pneumatic Pressure Belt System + AIO Arm set-up Pneumatic Pressure Belt System + MammoRx Arm Set-Up /14 Short SBRT base plate /14 Short SBRT base plate 32317/9 Pressure belt with manual pump 32317/9 Pressure belt with manual pump 32317/4 Knee support - indexed 32317/4 Knee support - indexed 32317/5 Feet support - indexed 32317/5 Feet support - indexed 32317/6 Arm rest support plate 32317/15 Arm rest support plate for upper arm supports and wrist supports 32317/8 Arm rest cushion CAS-2 Upper arm support - 17,5 degrees 32317/11 Arm rest elevation cushion CAS-2 Upper arm support - 17,5 degrees 32015/9/2 Grip pole long - 2pcs CWS-1 Wrist support: Y handle 32015/9/3 Grip pole short - 2pcs CWS-1 Wrist support: Y handle MD Head support in PU foam - model 1 - with lateral neck flaps MD Head support in PU foam - model 1 - with lateral neck flaps 116 drivenbycare 117

60 Extremities Solution > Standardized system for the immobilization of arms and legs > Compatible with push-pin masks that can be placed in various locations > Mask come as a pre-cut shape for the hand, elbow, foot and knee > Detachable elevation bridge to lift one leg so the other leg is not positioned in the treatment field > Comfort cushions that can give additional support for the hand, elbow, foot and knee > Possible to place the base plate out of center for arm positioning away from the abdomen 118 drivenbycare 119

61 The Extremities Solution Orfit offers a complete immobilization solution, specifically designed for fixation of extremities in a reproducible way. The system consists of a low density carbon fibre base plate with a leg support, two comfort cushions and five dedicated masks. The base plate can be indexed to any couch top on two-pin bars and has multiple holes to offer a maximum of possibilities for positioning and immobilizing both upper and lower extremities. The Extremities Solution Hardware Set When using the leg support, one leg can be lifted and placed out of the treatment field. Masks can be made on the leg support as well as on the base plate itself. Foam cushions are placed under the knee and heel to provide patient comfort. Upper extremities can be immobilized while the patient is lying on the couch, or sitting next to it. In both cases, masks are made over the elbow and hand to obtain an immobilization with excellent reproducibility. Comfort cushions are used under the elbow and the hand for patient comfort /1 Base plate 32103/3 Leg support 120 drivenbycare 121

62 The Extremities Solution Thermoplastic Masks 35792/32MA 3-points foot mask 35793/32MA 2-points knee mask 35794/2MI 2-points hand mask 35795/2MI 2-points elbow mask - straight 35796/2MI 4-points elbow mask - curved 122 drivenbycare 123

63 Vacuum Bags > Available in different sizes > Narrow sizes are easy to combine with a thermoplastic thorax or pelvic mask > The vacuum bags can be used on various Orfit base plates with the indexing bar > The vacuum bag will maintain its shape up to 6 weeks 124 drivenbycare 125

64 Orfit Vacuum Bag Cushion The combination of Orfit Vacuum Bag Cushions and Efficast High Precision Frameless masks enables you to achieve a highly customized immobilization of your patient with high precision, excellent reproducibility and great comfort for the patient. The Orfit vacuum bags are more narrow and longer than conventional vacuum bags. This ensures a much A moulded Orfit vacuum bag will maintain its integrity during the course of treatment (up to six weeks), which ensures precise and reproducible patient positioning from imaging through the entire treatment process. The Orfit vac bags are compatible for use with CT, MRI (when used with Orfit MRI compatible base plates), PET/ > Custom Paediatric CNS Immobilization/Positioning: The Paediatric full-body Orfit bag (art. no ) is designed specifically for CNS treatment. A broad range of accessories is available to increase the versatility of the Orfit VBC System: > Indexing Bar: (art. no ) more intimate contouring to the patient s anatomy. CT, SPECT and Ultrasound imaging modalities. You can easily index the vac bags directly to the The head and neck bags are designed for specific use in couch top using a two-pin bar. combination with the Orfit 3D shaped Head Supports The Orfit VBC System includes the following and the Orfit hybrid masks to offer an unsurpassed high immobilization/positioning applications: > Arm Rest Adapter Cushion: (art. no ) precision immobilization that limits patient movement Provides increased comfort and support by ensuring a to 1.5 mm and less. > Custom Individual Patient Head Support: smooth transition from thorax to shoulders and arms. The half body bags for adults and the paediatric bags The small size Orfit bag (art. no ) when used in have a narrow shape to easily fit on the All-in-One base combination with the Orfit 3D Head Support enables > Patient ID Labels: (art. no ) plate in combination with an Efficast thermoplastic mask. you to create a custom head support mould that The labels are easily attached to Orfit vac bags using a eliminates all gaps in the neck area while providing clip method. The Orfit vacuum bags are made from radio-translucent unmatched patient comfort. materials that will provide artefact free image clarity > Vacuum Pump: with minimal beam attenuation. A special coated nylon > Custom Thoracic Immobilization/Positioning: For quick and easy use with Orfit vac bags. bag material in combination with the thin fill helps to The half-body Orfit bag (art. no ) is perfect ensure intimate mould definition. The bags are easy when you need to create a customized thoracic to clean and are designed to withstand the rough immobilization. The half-body bag is compatible for handling conditions of a busy Radiation Oncology use with the Orfit All-in-One Base Plate and SBRT Base department. Plates. 126 drivenbycare 127

65 Vacuum Bags Vacuum Bag - Accessories Custom Types Hoses and Connectors Identification Hose connector for hose ID Patient ID tag for vacuum bag (Pack of 20 pieces) Transparent hose ID4 (2 meters) Clip for ID tag (pack of 5 pieces) Pumps Vacuum pump with hose, hose connector and cable High capacity vacuum pump with hose, hose connector and cable Individual head support (vacuum bag) 200 x 450 mm / 8 (w) x 18 (l) 0,9 liter Indexing Devices AIO arm rest adapter for use with vacuum bag Indexing bar AIO vacuum bag half body - adult 480 x 900 mm / 19 (w) x 35,5 (l) 16 liter Side Panels for moulding Side panels for individual cushions (4 pcs.) Additional Vacuum Bags (Not available in The Netherlands) AIO vacuum bag full body - paediatric 340 x 1240 mm / 13,5 (w) x 49 (l) 16 liter Vacuum bag 700 x 1825 mm / 50 liter Vacuum bag 1130 x 1375 mm / 51 liter - T-shape Vacuum bag 850 x 1825 mm / 75 liter Vacuum bag 900 x 2325 mm / 117 liter Vacuum bag 700 x 1625 mm / 45 liter Vacuum bag 750 x 1025 mm / 35 liter Vacuum bag 700 x 1625 mm / 58 liter Vacuum bag 850 x 1540 mm / 53 liter 128 drivenbycare 129

66 Accessories > Cyberknife Full Body Cushion > Unique Comfort Cushions > Water Bath > Storage Solutions > Bolus > Fixation Devices 130 drivenbycare 131

67 Cyberknife Full Body Cushion for Cyberknife Couch Top The full body cushion for Cyberknife Couch Top is designed for spinal and thorax treatment. The patient is positioned supinely on the cushion with the arms along the side of the body. Due to the narrow width of the cushion, the arms will be positioned next to the cushion on the treatment table, instead of on top of the cushion. This allows the use of lateral fields to radiate the spine and thorax without the arms being located in the treatment field. Unique Comfort Cushions drivenbycare 133

68 Unique Comfort Cushions Patient Support Cushions 32005/2-V /10-V3 Water Bath 35097/115/ /230/1400 The new Orfit Industries water bath is large enough to fit every mask. Features: > Extra-large to fit every size of mask (inner dimensions: 74cm x 54.5cm x 9.5cm) Trunkal cushion 800 x 400 x 20 mm Leg support 400 x 400 mm Not available in North America > A grill to lift the mask out of the water without putting your hands in the water > A built-in thermometer ( C and F) that indicates when the water has reached the target temperature > A built-in timer > Easy to empty with a tap on the side 32005/4-V /11-V3 > Available in 115V and 230V Small block 200 x 200 x 40 mm Foot support 400 x 150 x 200 mm 32005/5-V /14-V3 Medium block 200 x 200 x 60 mm Cylindrical knee support 544 x D200 mm 32005/6-V3 Large block 200 x 200 x 100 mm 32005/15-V3 Half cylindrical knee support 544 x R100/50 mm Storage Solutions 32005/8-V V Wide wedge 400 x 250 x 100 mm 19,8 Set of 10 comfort cushions Storage stand for base plates 32005/8A-V3 Small wedge 200 x 250 x 100 mm 19, Wall mount storage stand for base plates 134 drivenbycare 135

69 Bolus Material The thermoplastic bolus material, which is available in sheets and pellets, is a specially formulated, rigid thermoplastic with a low melting temperature. It is very easy to mould and can be placed on thermoplastic masks. After heating, it also sticks to itself, which makes it possible to make thicker bolus sheets if needed. Fixation Devices pin indexing bar for Exact* couches Sheets Beige Sheets White 8336.SO1/R/53 10 cm x 10 cm x 5 mm 8313N.SO1/R 22,5 cm x 20 cm x 2 mm pin indexing bar for Exact* couches MRI compatible 8336.SO1/R/ N.SO1/R 15 cm x 15 cm x 5 mm 45 cm x 60 cm x 2 mm pin indexing bar for ibeam* couches MRI compatible 8336.SO1/R/59 20 cm x 20 cm x 5 mm Pellets SO1/R/60 30 cm x 30 cm x 5 mm /1 Bag of 500g 2-pin indexing bar Prodigy couches - 53 cm MRI compatible SO1/R 2- pin bar for Pinpoint couches - 50 cm MRI compatible 45 cm x 60 cm x 2 mm Other fixation devices can be found on the Orfit website drivenbycare 137

70 Dosimetric Chart Notes Measured values Product reference Density (g/cm3) Absorption Factor (AF%) (± 0,15%) 6MV (%) 15MV (%) Skin build-up (mm H₂O equiv.) (± 0,1 mm) Thermoplastic Mask Materials Orfit Classic 2 mm maxi Efficast 1.6 mm micro Efficast 2 mm maxi Efficast 2 mm micro Efficast 2.4 mm maxi Efficast 3.2 mm maxi Nanor 1.2 mm micro Nanor 1.6 mm micro U-Plast 1.6 mm micro U-Plast 2 mm maxi U-Plast 2.4 mm maxi U-Plast 3.2 mm maxi Hybrid (Efficast 2MA, Orfilight 16MI) NA Hybrid (Efficast 16MI, Nanor 12MI+) NA Bolus (per mm of material) HP L-Shaped profiles (ABS) Positioning Hardware Base plates 12 mm thick in carbon fibre laminate , 32130, 32140, 32111, 32122, mm thick in high pressure laminate N, 35754/6N, 32112, mm thick in carbon fibre laminate , (also the NOLS and PED versions) 30 mm thick AIO in high pressure laminate mm thick in polycarbonate , 32117, 32097, 32098, NA NA Head supports Low density range (in %/cm foam) Regular density range (in %/cm foam) Blocks and wedges Blocks and wedges in carbon fibre laminate Blocks and wedges in polyethylene NA AIO Cushions Per cm of foam Vacuum Bags 10 mm thickness (deflated) 100 mm thickness (deflated) NA NA Note: Use these numbers as a guidance only. Perform the measurements again in your department to verify these results. 138 drivenbycare 139

71 Art. Nr E All rights reserved. No part of this publication may be produced, stored in a retrieval system or transmitted, in any way, form or by any means, electronic, mechanical, photocopying or otherwise, without prior written permission of Orfit Industries. D/2015/13.637/1 ORFIT Industries Vosveld 9A B-2110 Wijnegem Belgium Phone: (+32) (0) Fax: (+32) (0) welcome@orfit.com verantwoordelijke uitgever / éditeur responsable / verantwortlicher Redakteur : Steven Cuypers - Groene Wandeling 58, B-2970 s-gravenwezel scan.me/gnskjp drivenbycare