Abstract: An intubation and supraglottic airway medical device. The device includes an air tube for ventilation, and a tube for guiding a fiber-optic-probe-scope to the distal end of the device. The distal end of the device is configured with a balloon around the tube system and between a bottom plate and the tube system such that when inflated the distal end of the air-tube is moved and thereby positioning the air-tube distal opening in front of a laryngeal inlet. Additionally, the balloon forms a seal with the surrounding tissue. The device includes a drainage loop and an esophageal blocker preventing aspiration. The air tube distal end can include a lifting plate configured to lift an epiglottis when the balloon is inflated.

Abstract: A method and apparatus can be used in the selection of correctly sized respiratory interfaces. The method includes the use of light beams to project sizing markers onto a patient's face, which enables the size of the patient's facial features to be measured relative to a set of interface sizes. A sizing apparatus can include a light source and beam splitters that will refract and project the light source into a series of beams that can be aligned on a patient's face in order to measure the features of the patient.

Abstract: An active exhalation valve for use with a ventilator to control flow of patient exhaled gases. The valve includes a patient circuit connection port, a patient connection port, an exhaled gas port, a pilot pressure port, and a valve seat. The valve further has a movable poppet with inner and outer bellows members and a bellows poppet face. An activation pressure applied to the pilot pressure port extends the bellows members to move the poppet face into engagement with the valve seat and restrict flow of patient exhaled gases to the exhaled gas port, and the reduction of the activation pressure allows the bellows members to move the poppet face away from the valve seat and out of engagement with the valve seat to permit flow of patient exhaled gases to the exhaled gas port, thereby controlling the flow of patient exhaled gases from the valve.

Abstract: A ventilator, or a breathing assistance apparatus, is provided to ventilate patients who may have breathing difficulties, said device comprising a inspiratory pressure control duct; a positive end-expiratory pressure control duct; at least one valve connected to the peak inspiratory pressure control duct and to the positive end-expiratory pressure control duct, and at least one controller communicably connected to the valve to control rate of cycling of the valve, thereby controlling number of breaths per minute, and to control the duration of peak inspiratory pressure also known as inspiratory time.

Abstract: An intravenous catheter may include a distal end, a proximal end, a lumen extending between the distal end and the proximal end, and an inner surface forming the lumen. At least a portion of the inner surface may include a non-circular and non-oval cross-section, which may prevent occlusion of the intravenous catheter when a kink in the intravenous catheter occurs. The non-circular and non-oval cross-section may include a variety of shapes. For example, the non-circular and non-oval cross-section may be polygonal and/or include one or more ribs.

Abstract: A flushable catheter device has an outer tube with a first distal end opening to be introduced into a blood vessel and defining a first lumen. An inner tube is disposed in the first lumen with a second distal end opening proximally spaced from the first distal end opening and defining a second lumen. A space axially disposed between the end openings defines an outflow/inflow inhibiting portion which inhibits a flow of fluid out from the first lumen into the into the vessel as a result of a perfusion of a flushing fluid being supplied through the first lumen and into the second lumen.

Abstract: Removable catheter cap, and applications thereof, for delivering medical tubes in bodily passages. Removable catheter cap covers flexible medical tube (e.g., catheter) distal tip during delivery in a body lumen. Catheter cap includes: cap body removably connectable to, for capping, catheter distal tip, and transformable into a predefined constituent part freely passable through catheter lumen; and cap releasing member extending through catheter proximal end when catheter cap is connected to the catheter, and manipulatable for transforming cap body into constituent part or/and for withdrawing constituent part from catheter distal tip through catheter lumen.

Abstract: An introducer assembly for introducing a catheter into a patient, includes a sheath having a distal end and a proximal end with a hollow lumen extending between the distal end and proximal end. The assembly also includes a coupler having a distal end operatively coupled to the proximal end of the sheath, the coupler having an internal passage in fluid communication with the hollow lumen. The assembly further includes a connector having a distal end operatively coupled to the coupler proximate the distal end of the coupler.

Abstract: A medical system tracks the position of a medical instrument within a body of a patient. The medical instrument includes an elongated flexible printed circuit and an electromagnet structure having a conductive coil wound around a core. A control circuit applies an excitation signal across the conductive coil. Electrical current running through the conductive coil (wound around the core) generates a magnetic field. A plurality of sensors sense parameters of the magnetic field and output sensor signals. The control circuit calculates the position of the medical instrument based on the sensor signals.

Abstract: A needle steering system and apparatus provides active, semi-autonomous control of needle insertion paths while still enabling a clinician ultimate control over needle insertion. The present teaching describes a method and system for controlling needle path as the needle is inserted by precisely controlling the rotation of the needle as it continuously rotates during insertion. This enables underactuated 2 degree-of-freedom (DOF) control of the direction and the curvature of the needle from a single rotary actuator. Control of the rotary motion is therefore decoupled from the needle insertion. The rotary motion controls steering effort and direction, while the insertion controls needle depth or insertion speed. In one implementation, the proposed method does not require constant velocity insertion, interleaved insertion and rotation, or known insertion position or speed. The insertion may be provided by a robot or other automated method, may be a manual insertion, or may be a teleoperated insertion.

Abstract: Disclosed are devices, systems, and methods for providing access to a patient. The patient access device comprises a proximal end, a distal end and a lumen therethrough. The patient access device further comprises a hollow shaft, an input port and a liquid supply port. At least a portion of the lumen passes through the shaft. The input port is coupled to the lumen, and the lumen and the input port are constructed and arranged to receive an elongate probe. The liquid supply port is in fluid communication with the lumen. The patient access is constructed and arranged to reduce gas from exiting the distal end while a portion of the elongate probe is positioned in the patient access device.

Abstract: Guidewires useful for cooperating with catheters may be actively steered and/or provide adjustable stiffness. Angle or curvature of a guidewire, and/or flexural modulus of a guidewire, may be adjusted at one or more locations between ends thereof. Variable stiffness segments may include electrically operated compressible and/or extensible materials. Multiple tensile elements may terminate at different body elements to adjust angle or curvature at multiple locations. Multiple circumferentially and/or radially contractible fiber regions may be provided and distributed over a length of a guidewire. Adjustable flexure elements arranged in or along a guidewire may be electrically operated. A flexible core member may be centrally arranged in a tubular body. A flexible guide wire or track may cooperate with electrically operable motor units.

Abstract: The present invention relates to a method of delivering drugs having e.g., anti-proliferative activity in the vascular, preferably, the cardiovascular, system locally or systematically using an at least partially drug-coated guidewire. The drug-coated guidewire, particularly an expansion member or portion thereof, is brought into contact with the target tissue or in circulation and the drugs are quickly released into the area surrounding the device in a short time after the contact step. Once the therapeutic drugs are released, they are quickly and effectively absorbed by the surrounding cells or circulation.

Abstract: Embodiments of the invention provide apparatus, methods and systems for delivering treatments and for medications to the site of an aneurysm (SOA). One embodiment of a method comprises delivering a neural growth stimulating factor (NGSF) to the site of the aneurysm to grow new nerve cells and/or stimulate the regeneration of damaged nerve cells. The NGSF may be delivered in a carrier such as a gel which can be selected to allow for long term delivery of the NGSF to the SOA. In many embodiments, the NGSF may be delivered to the SOA using a microcatheter based system which includes a microcatheter that can be advanced in the cerebral vasculature. The microcatheter may also be used to delivery occlusive element to the SOA such as occlusive coils or balloon which promote clotting and reduce bleeding at the SOA and together with the carrier allow for long term release of NGSF.

Abstract: Systems, instruments, and methods for minimally invasive procedures including one or more of fractional resection, fractional lipectomy, fractional skin grafting, fractional scar revision, and/or fractional tattoo removal are described. Embodiments include instrumentation comprising a scalpet assembly coupled to a carrier, and the scalpet assembly includes a scalpet array. The scalpet array includes one or more scalpets configured for fractional resection, fractional lipectomy, fractional skin grafting, fractional scar revision, and/or fractional tattoo removal. The system includes a vacuum component coupled to the scalpet assembly and configured to evacuate tissue from the a site. The carrier is configured to control application of a rotational force and/or a vacuum force to the scalpet assembly.

Abstract: Systems, instruments, and methods for minimally invasive procedures including one or more of fractional resection, fractional lipectomy, fractional skin grafting, fractional scar revision, and/or fractional tattoo removal are described. Embodiments include instrumentation comprising a scalpet assembly coupled to a carrier, and the scalpet assembly includes a scalpet array. The scalpet array includes one or more scalpets configured for fractional resection, fractional lipectomy, fractional skin grafting, fractional scar revision, and/or fractional tattoo removal. The system includes a vacuum component coupled to the scalpet assembly and configured to evacuate tissue from the a site. The carrier is configured to control application of a rotational force and/or a vacuum force to the scalpet assembly.

Abstract: Systems, instruments, and methods for minimally invasive procedures including one or more of fractional resection, fractional lipectomy, fractional skin grafting, fractional scar revision, and/or fractional tattoo removal are described. Embodiments include instrumentation comprising a scalpet assembly coupled to a carrier, and the scalpet assembly includes a scalpet array. The scalpet array includes one or more scalpets configured for fractional resection, fractional lipectomy, fractional skin grafting, fractional scar revision, and/or fractional tattoo removal. The system includes a vacuum component coupled to the scalpet assembly and configured to evacuate tissue from the a site. The carrier is configured to control application of a rotational force and/or a vacuum force to the scalpet assembly.

Abstract: Systems, instruments, and methods for minimally invasive procedures including one or more of fractional resection, fractional lipectomy, fractional skin grafting, fractional scar revision, and/or fractional tattoo removal are described. Embodiments include instrumentation comprising a scalpet assembly coupled to a carrier, and the scalpet assembly includes a scalpet array. The scalpet array includes one or more scalpets configured for fractional resection, fractional lipectomy, fractional skin grafting, fractional scar revision, and/or fractional tattoo removal. The system includes a vacuum component coupled to the scalpet assembly and configured to evacuate tissue from the a site. The carrier is configured to control application of a rotational force and/or a vacuum force to the scalpet assembly.

Abstract: An implantable access port for use in transferring a fluid transdermally between an external fluid storage or dispensing device and a site within a patient's body is disclosed. The access port includes a base, a bowl-shaped reservoir defined within the base by a smooth surfaced wall, and a septum secured to the base and enclosing the reservoir within the base. The access port also has an outlet passageway defined within the base and extending in communication with a reservoir outlet defined within the reservoir and an external opening defined in the exterior of the base.

Abstract: A medical device accessory comprising an interface configured to connect the medical device accessory with a medical device for administration of a medical treatment using the medical device and the medical device accessory, a plurality of electrical contacts proximate the interface, the electrical contacts comprising a lead electrical contact adapted to receive an voltage from a power source associated with the medical device and one or more identifying electrical contacts, and at least one conductor providing an electrical connection between the lead electrical contact and the one or more identifying electrical contacts. An arrangement of the one or more identifying electrical contacts connected to the lead electrical contact identifies a characteristic of the medical device accessory.

Abstract: A process, apparatus and a catheter and a flexi needle for medical applications formed by the process of selecting a tubular flexible member and a metal/ceramic cap member to be securely joined to the tubular member, placing the cap member in engaging relation with a holding member of a material joining device, securing the tubular member on a positioning member of the material joining device, positioning a distal end of the tubular member in engaging relation with an end of the cap member positioned in the holding member, and rotating the holding member and maintaining the tubular member in frictionally engaging relation with the cap member to melt or soften a predetermined portion of the distal end of the tubular member engaged with the cap member to integrally join a predetermined portion of the distal end of the tubular member within the cap member forming a joined composite member.

Abstract: A dental valve device has a valve body having a tip receiving end having a flexible tubing extending outwardly from the tip receiving end with the flexible tubing having a flexible tubing opening, a hose receiving end, a lumen formed between the flexible tubing opening and the hose receiving end, and a partial opening formed in the valve body, and a rotatable valve sealing body adapted to be inserted into the partial opening, the rotatable valve sealing body having a bore for alignment with the lumen formed between the flexible tubing opening and the hose receiving end, the bore having a tip receiving opening and a hose receiving opening.

Abstract: Various fixation techniques for implantable medical device (IMDs) are described. In one example, an assembly comprises an IMD; and a set of active fixation tines attached to the IMD. The active fixation tines in the set are deployable from a spring-loaded position in which distal ends of the active fixation tines point away from the IMD to a hooked position in which the active fixation tines bend back towards the IMD. The active fixation tines are configured to secure the IMD to a patient tissue when deployed while the distal ends of the active fixation tines are positioned adjacent to the patient tissue.

Abstract: Retention devices for use with an implantable medical device (IMD) are disclosed. An illustrative retention device may comprise an elongate body including a bore configured to receive and substantially surround an implantable lead of the IMD and an outer surface configured to receive a suture. The retention device may also include a securing mechanism configured to push against tissue of the patient.

Abstract: Tools adapted to allow a fixation device to be applied near the distal end of an implantable lead, and methods for using such tools. Preparing the lead for implantation may be performed by placing a tool over a distal tip of the lead, moving a fixation device from the tool to the lead, and placing the fixation device the lead.

Abstract: A method of laparoscopically implanting an electrically stimulating lead proximate the lower esophageal sphincter (LES) of a patient includes delivering the lead through a port of a laparoscope inserted into the abdominal cavity of the patient through an incision in the abdominal wall. The stimulating electrode is implanted in or proximate the muscularis layer of the lower esophageal wall to treat esophageal reflux disease (GERD). The lead includes a needle and suture at its distal end for pulling the electrode into the muscular wall of the LES. Clips are applied to the suture attached to the distal end of the lead to prevent retrograde movement of the electrode. The lead also includes an anchoring member for anchoring the portion of the lead proximal to the electrode. The method and lead used with the method allow the surgeon to work within the confined anatomy present at the gastroesophageal junction and prevents backwards movement and dislodgment of the electrode.

Abstract: An anchoring device for anchoring an implantable medical device to tissue of a patient, wherein the anchoring device comprises at least one marker that is visible when using an imaging technique such as x-ray imaging.

Abstract: A neural probe system having a single guide tube that is inserted into neural tissue and from which a number of neural probes can be deployed is described. Each probe is deployable into tissue along a desired trajectory. This is done by supporting the electrode array on a spring tape-type carrier that maintains axial stiffness once the neural probe has deployed out a channel in the guide tube. That way, a target neural tissue is bounded by an increased number of neural probes while minimizing trauma to surrounding body tissue.

Abstract: Provided herein are methods of generating a biologically effective unipolar nanosecond electric pulse by superposing two biologically ineffective bipolar nanosecond electric pulses and related aspects, such as electroporation and/or therapeutic applications of these methods to non-invasively target electrostimulation (ES) selectively to deep tissues and organs.

Abstract: The present disclosure relates to a modular system for deep brain stimulation (DBS) and electrocorticography (ECoG). The system may have an implantable neuromodulator for generating electrical stimulation signals adapted to be applied to a desired region of a brain via an attached electrode array. An aggregator module may be used for collecting and aggregating electrical signals and transmitting the electrical signals to the neuromodulator. A control module may be used which is in communication with the aggregator module for controlling generation of the electrical signals and transmitting the electrical signals to the aggregator.

Abstract: This disclosure provides an apparatus or system for the modulation of neural activity in the cervical sympathetic chain (CSC) or superior cervical ganglion (SCG) or SCG post-ganglionic branch(es) and for the treatment of sleep apnoea, as well as methods for their use.

Abstract: An implantable medical device system is configured to detect a tachyarrhythmia from a cardiac electrical signal and start an ATP therapy delay period. The implantable medical device determines whether the cardiac electrical signal received during the ATP therapy delay period satisfies ATP delivery criteria. A therapy delivery module is controlled to cancel the delayed ATP therapy if the ATP delivery criteria are not met and deliver the delayed ATP therapy if the ATP delivery criteria are met.

Abstract: A method for providing electrical stimulation to a user as a user performs a set of tasks during a time window, the method comprising: providing an electrical stimulation treatment, characterized by a stimulation parameter and a set of portions, to a brain region of the user in association with the time window; for each task of the set of tasks: receiving a signal stream characterizing a neurological state of the user; from the signal stream, identifying a neurological signature characterizing the neurological state associated with the task; and modulating the electrical stimulation treatment provided to the brain region of the user based upon the neurological signature, wherein modulating comprises delivering a portion of the set of portions of the electrical stimulation treatment to the brain region of the user, while maintaining an aggregate amount of the stimulation parameter of the treatment provided during the time window below a maximum limit.

Abstract: An excitation unit is configured to induce action potentials by applying an excitatory current to a nerve. A blocking unit is configured to block the induced action potentials from propagating along the nerve by applying a blocking current to the nerve. A sensor unit is configured to detect the induced action potentials in the nerve, and to responsively provide a sensor signal that conveys information about the detected induced action potentials. Circuitry is configured (i) to drive the excitation unit to apply the excitatory current, (ii) to drive the blocking unit to apply the blocking current, (iii) while driving the blocking unit to apply the blocking current, to drive the sensor unit to detect the induced action potentials and provide the sensor signal, (iv) to receive the sensor signal, and (v) in response to the sensor signal, to alter a parameter of the blocking current.

Abstract: Devices, systems and methods are provided for targeted treatment of a variety of conditions, particularly conditions that are associated with or influenced by the nervous system, such as pain. Targeted treatment of such conditions is provided with minimal deleterious side effects, such as undesired motor responses or undesired stimulation of unaffected body regions. This is achieved by directly neuromodulating a target anatomy associated with the condition while minimizing or excluding undesired neuromodulation of other anatomies.

Abstract: Feedback regarding electrical stimulation is provided to a patient. Electrical stimulation is applied to the patient. The electrical stimulation is applied by varying an electrical stimulation parameter. A signal is communicated to the patient via an electronic device. The signal is correlated with the electrical stimulation parameter such that the signal varies in association with the varying of the electrical stimulation parameter. The communicating is performed while the electrical stimulation is applied. Feedback is received from the patient in response to the electrical stimulation. Based on the received feedback from the patient, the electrical stimulation is adjusted.

Abstract: Methods and tool kits for implanting a lead subcutaneously. Examples include tool kits and methods for establishing first and second subcutaneous tunnels at an angle relative to one another to facilitate introduction of a lead to the subcutaneous space. In an example, a tunneling tool and lead assembly are advanced simultaneously into the subcutaneous space. The tunneling tool may include a curved region configured to transition the tool from the first subcutaneous tunnel to the second subcutaneous tunnel with the use of a single incision.

Abstract: A lead assembly and associated process include a lead and an integrated feature that facilitates extraction of the lead from the associated body passage. The integrated feature in one embodiment is a sheath received between the associated body passage and received over the lead. The sheath has a first portion extending from adjacent the proximal end to adjacent the distal end of the lead, where the first portion has an inner surface facing with the lead outer surface and the first portion having an outer surface facing radially outward from the lead outer surface. A second portion of the sheath extends from adjacent the distal end to adjacent the proximal end of the lead. The second portion has an inner surface received over the outer surface of the first portion, and the second portion further having an outer surface abutting an inner surface of the associated body passage that receives the lead therein. The integrated feature is alternatively a wire, band, or spoke assembly.

Abstract: An implantable medical device (IMD) is configured with a pressure sensor. The IMD includes a housing and a diaphragm that is exposed to the environment outside of the housing. The diaphragm is configured to transmit a pressure from the environment outside of the housing to a piezoelectric membrane. In response, the piezoelectric membrane generates a voltage and/or a current, which is representative of a pressure change applied to the housing diaphragm. In some cases, only changes in pressure over time are used, not absolute or gauge pressures.

Abstract: Presented herein are techniques for initiating a night-time mode of operation in an implantable hearing prosthesis in response to detection of night-time recharging operations. More specifically, an implantable hearing prosthesis comprises a rechargeable battery that is configured to be recharged via an external night-time charging device, such as a pillow charger. The implantable hearing prosthesis is configured to detect inductive charging of the rechargeable battery by the external night-time charging device. In response, the implantable hearing prosthesis is switched to a night-time mode of operation.

Abstract: A system for programming electrical stimulation by a lead includes a processor coupled to a display. The processor presents an interface on the display with user-selectable controls to define stimulation fields and repeating stimulation patterns for delivering the stimulation fields temporally-coordinated with each other. The user-selectable controls include a field control to define the number of stimulation fields, a location control to define locations of the stimulation fields relative to the lead, a repetition control to define a repetition frequency of the stimulation patterns, and a temporal-adjustment control to define temporal adjustments of the stimulation fields.

Abstract: A system for managing care of a person receiving emergency cardiac assistance is disclosed that includes one or more capacitors for delivering a defibrillating shock to a patient; one or more electronic ports for receiving signals from sensors for obtaining indications of an electrocardiogram (ECG) for the patient; a patient treatment module executable on one or more computer processors to provide a determination of a likelihood of success from delivering a future defibrillating shock to the person with the one or more capacitors, using (a) information about a prior defibrillating shock, and (b) a value that is a function of current ECG signals from the patient.

Abstract: Systems and techniques for applying a pulsed electromagnetic field to body include: Self-contained portable pulsed electromagnetic field generating device which creates electromagnetic pulses given to feet and hands of the body. This device includes an electromagnetic field generator to provide power, device base to receive pulses from feet and device bulb to receive pulses from hand, thereby increasing energy of cells in the body.

Abstract: Provided herein are systems, devices and methods for the treatment of fungus. In particular, provided herein are systems, devices and methods employing energy to nail and tissue structures to treat fungal infection.

Abstract: The present invention provides a photo-therapy device and its use for treatment of skin conditions such as rashes or similar dermatological conditions that are exhibited by Grover's disease or other diseases which are associated or co-existent with Grover's disease. The treatment includes exposure of the subject's affected skin and preferably the entire body with blue LED light to improve skin status by stimulating body's immune system to reduce itching, blotchiness and skin discomfort.

Abstract: The present invention relates to a light therapy device article of manufacture, system and method for providing light is delivered to the skin by means of one or more optical fibers in therapeutic dosages from light source in wavelengths of 614-624 nm, 668-684 nm, 751-772 nm, and 813-846 nm. The light source may be comprised from one or more light emitting diodes LED disposed on a flexible printed circuit board (PCB) and ferrule adapter assembly configured to deliver light to the skin directly of the patient from the light source disposed on the PCB adjacent a scalp surface. A control circuit operably connected to the PCB is adapted to provide energy to one or more zones of LEDs to address hair loss treatment regimen including splotchy balding, receding hairline balding, crown balding and total scalp surface therapy.

Abstract: A method for noninvasive treatment of diabetic retinopathy helps prevent and reverses diabetic retinopathy and other vascular retinopathies, such as diabetic macular edema for a patient. The method comprises administering at least 80 percent pure oxygen to a patient in an oxygen chamber or nasal cannula. The oxygen chamber includes light emitting diodes that emit a light having a wavelength between 630-700 nm wavelengths on the patient. The method also includes administering an anti-inflammatory agent; an anti-oxidant; at least one of the following: an amino acid, arginine, and citrulline; and an omega-3 fatty acids to the patient. In extreme cases of diabetic retinopathy, a cold laser therapy is also administered to the patient with a wavelength between 570 nanometers and 1000 nanometers. The combination of all the aforementioned treatment modalities and compositions that work to synergistically to achieve unexpected clinical results for prevention and reversal of diabetic retinopathy.

Abstract: A process for treating highly localized carcinoma cells that provides precise positioning of a therapeutic source of highly ionizing but weakly penetrating radiation, which can be shaped so that it irradiates essentially only the volume of the tumor. The intensity and duration of the radiation produced by the source can be activated and deactivated by controlling the neutron flux generated by an array of electrically controlled neutron generators positioned outside the body being treated. The energy of the neutrons that interact with the source element can be adjusted to optimize the reaction rate of the ionized radiation production by utilizing neutron moderating material between the neutron generator array and the body. The source device may be left in place and reactivated as needed to ensure the tumor is eradicated without exposing the patient to any additional radiation between treatments. The source device may be removed once treatment is completed.

Abstract: The invention relates to a brachytherapy system for supporting application of radiation to a patient body. The system cooperates with an applicator (1) configured for fixating at least one radiation source in a body region and comprises an ultrasound device (3) configured for generating a three-dimensional image of the body region including the applicator (1). Further, an image generation unit (9) comprises a pre-stored three-dimensional model of the applicator (1) and is configured to obtain position information relating the applicator (1) on the basis of the three-dimensional image of the body region and to align the three-dimensional image of the body region and the pre-stored three-dimensional model of the applicator (1) on the basis of the position information.

Abstract: In planning of radiation therapy treatment of at least one structure in a region of a patient body, a first treatment plan is generated on the basis of a planning image of the body region and on the basis of dose objectives. A further image of the body region of the patient body is received, and a transformation is determined for generating an adapted treatment plan from the first treatment plan and/or for generating an adapted dose distribution from the dose distribution corresponding to the first treatment plan on the basis of the further image and determines an adapted treatment plan on the basis of the transformation and/or the adapted dose distribution. The transformation on the basis of the dose objectives. In adapting the dose distribution, an efficient iterative dosimetric patient setup optimization may be employed to reduce the dose computations.