The Oxford Cancer Centre will provide purpose built radiotherapy and radiodiagnostic facilities, together with wards, out-patient facilities and additional operating theatres. The building will also provide new accommodation for Medical Physics and Clinical Engineering staff based at the Churchill Hospital. It is due for completion in 2008. It is located at the Churchill Hospital site in Headington, just 2 miles from Oxford city centre. Oxford is located 60 miles North West of London.

http://www.oxfordradcliffe.nhs.uk/home.aspx

The centre have now joined RadPro and anyone interested in more information or to work in Oxford and for details of Radiotherapy radiographer vacancies at this new centre please contact Elisabeth Turner, Head of Radiotherapy, Churchill Hospital, Oxford on Lis.Turner@orh.nhs.uk

Amsterdam, Netherlands, October 14th 2008 – Doctors in the Netherlands have used RapidArc technology from Varian Medical Systems (NYSE:VAR) to treat four early stage lung cancer patients in what are believed to be among the world’s first treatments of their kind. Clinicians at VU University Medical Center in Amsterdam now plan to replace conventional stereotactic radiotherapy treatments with RapidArc for all such patients.

A 57-year-old male, diagnosed with a 1.2cm diameter non-small cell lung tumor in the right upper lobe and deemed unfit for surgery as a result of severe emphysema, was the first patient to receive the pioneering radiotherapy treatment at the hospital in early September.

“We normally use ultra-precise stereotactic radiotherapy in these cases and we have now treated more than 400 such patients in this way,” said Dr. Ben Slotman, chairman of the hospital’s department of radiation oncology. “But RapidArc offers some real time-savings over stereotactic radiotherapy and its use in this case is a real breakthrough for us and our patients.”

The pioneering treatment was delivered in less than 15 minutes versus the 30 to 45 minutes normally needed by the team at VU University Medical Center to treat lungs with image-guided intensity-modulated radiotherapy (IMRT). The treatment was delivered using six arcs – or rotations – of the treatment machine around the patient. RapidArc delivers a volumetric radiotherapy treatment in a single or multiple arcs of the treatment machine around the patient.

“We were very pleased with how the treatment went,” added Dr. Suresh Sunan, professor of clinical experimental radiotherapy. “The online patient setup using cone beam CT scans allowed direct visualization of the tumor just prior to fast treatment delivery using RapidArc, all of which greatly increased the confidence of the treatment team in the precision of delivery. The high dose radiation area was restricted to the tumor and the surrounding healthy tissue and critical organs received very low doses.”

“Due to the high precision and the speed of treatment delivery, and the associated increase in patient comfort, RapidArc will eventually replace all ‘conventional’ stereotactic treatments for early stage lung cancer at our hospital.”

RapidArc was introduced by Varian earlier this year and to date more than 30 hospitals around the world are using this new technology for advanced, precise and fast treatments. Non-small cell lung cancer treatments require extremely precise radiotherapy delivery to avoid affecting surrounding critical organs. Worldwide, lung cancer is the leading cause of cancer death in men and the second leading cause of cancer death in women.       

Neil Madle
Corporate Communications & Investor Relations Director, Europe
Varian Medical Systems +44 7786 526068

Mumbai, India, October 28th 2008 – One of India’s leading cancer hospitals will expand its program of advanced whole-body radiosurgery with the acquisition of a Varian/BrainLAB Novalis Tx™ radiosurgery platform. Tata Memorial Hospital in Mumbai is currently constructing a new facility to house the new device and plans to begin treatments in March next year.

The hospital, which currently delivers radiotherapy using three Varian Clinac® linear accelerators and four telecobalt devices, has been carrying out stereotactic radiotherapy on Clinac accelerators since 2000, mainly for brain tumor patients. The acquisition of the new Novalis Tx platform, which was ordered in March, will enable clinicians at Tata to expand this program by routinely delivering state-of-the-art stereotactic radiosurgery to combat both cranial and extra-cranial tumors. 

“The new machine will enable us to offer the most modern and advanced radiotherapy and radiosurgery treatments to fight cancer,” says Professor S.K.Shrivastava, head of Tata Memorial’s Department of Radiation Oncology. “It means our patients will receive very advanced treatments and we can carry out both straightforward and complex cases on the same device, which improves access and efficiency.”

Professor Shrivastava added, “We decided to acquire the Novalis Tx because this equipment is a technological marvel and an excellent combination of two leading suppliers of stereotactic radiosurgery technology. We have a history of introducing advanced radiotherapy treatments such as 3D-CRT and intensity-modulated radiotherapy and this move is another step in ensuring our patients receive highly accurate and effective treatments.”

Varian and BrainLAB joined forces late last year to introduce the Novalis Tx and Tata Memorial is the first hospital in India to order this advanced solution.  Tata Memorial treats over 16,000 new cancer patients each year, with head & neck, breast and cervical cancers the most common. More than 60 percent of the hospital’s patients require radiotherapy during their course of treatment.  India has a population of over a billion people and there are an estimated one million new cases of cancer diagnosed in India each year.

Novalis Tx offers radiosurgery for malignant and benign lesions throughout the body, arteriovascular malformations, and functional lesions. It features very high dose delivery rates, which means that treatments can be delivered very rapidly. Novalis Tx also offers dynamic ultra-fine beam shaping and frameless patient positioning for more rapid and comfortable treatments. The platform also includes an On-Board Imager® device for pinpointing the tumor and positioning the patient with sub-millimeter precision.

Novalis Tx allows multiple beam energies of up to 18 million volts for treating deep-seated tumors. “The speed coupled with the precise beam shaping and advanced imaging capabilities make advanced radiosurgical treatments with the Novalis Tx more affordable for hospitals and their patients,” adds Dow Wilson, head of Varian’s Oncology Systems business.

Varian editorial contact: Neil Madle +44 7786 526068

BrainLAB editorial contact: Eva Schuster +49 89 991568 312

White paper: “Defining the Future of Radiation Medicine: Where Technology Meets Cancer Care”

This White Paper, which is written by four of the top thought leaders in the field of neurology and radiation oncology, provides an overview of the key advances in radiation medicine with a particular focus on the tremendous innovation that has taken place over the last 5-6 years and what this means for clinical practice and patient care.

This document is supported by Elekta. If you wish to view the White Paper in full, or wish to interview one of the authors, please let us know. It was published 23 September 2008, at the American Society for Therapeutic Radiology and Oncology (ASTRO) congress.

www.elekta.com

Defining the Future of Radiation Medicine:
"Where Technology Meets Cancer Care"

Executive Summary

Despite improvements in overall cancer survival rates in recent years, the World Health Organization estimates cancer incidence will increase by 50 percent by the year 2020. To ensure survival rates continue to improve, cancer treatment strategies will need to combine surgical techniques, chemotherapy, targeted drug therapies and radiation medicine in conjunction with earlier screening and diagnosis.

Radiation medicine (the use of high-energy photons to precisely target and eliminate tumors), high-resolution imaging for tumor detection, and radiation treatment planning are powerful tools in the diagnosis and treatment of cancer. Radiation therapy is an extremely precise and cost effective method of delivering radiation directly to tumors, minimizing the amount of radiation that can be absorbed by surrounding healthy tissue.

In the 1950s, the linear accelerator (linac) was developed. At that time, the treatment method required multiple sessions of therapy and had poor precision, in part because exact location of the tumor could not be detected. The advent of computed tomography (CT) in the 1970s helped tackle this problem by providing clinicians with diagnostic information about the exact placement and shape of a tumor inside a patient’s body.

Further advances in CT, along with the use of magnetic resonance imaging (MRI) and positron emission tomography (PET), have refined the ability to ‘map’ both the tumor and surrounding tissue in three dimensions. Accuracy in locating, measuring and targeting tumors has allowed clinicians to deliver higher doses of radiation to eliminate the cancerous growths, while minimizing the risk of damaging the healthy tissue surrounding the tumor.

These improved technologies have incorporated:

• Imaging devices included on digital linacs to accurately map tumors at the time of treatment
• More accurate targeting of the radiation dose to the tumor, enabling higher doses to be delivered in single or multiple treatment sessions • A reduction in unnecessary, potentially harmful, radiation to surrounding healthy tissues
• Optimized radiation dose distributions, reducing the treatment time and enabling the number of treatment sessions to be cut

Technological advancement has continuously evolved the field of radiation oncology, and nearly half of all people with cancer are treated with radiation therapy at some stage of the disease. The most advanced radiation therapy systems today include volumetric modulated arc therapy (VMAT), a technique which rapidly delivers radiation in arcs, enabling the dose intensity, shaping and angle of the radiation beam to be continuously adjusted without switching the beam off. This system, which allows visualization of the tumor and dose delivery, means the total treatment session can be completed in less than 90 seconds.

Precision and accuracy is critically important for radiosurgery, a radiation medicine technique that combines several hundred super-high precision beams together to surgically ‘cut’ a brain tumor. The procedure can provide greater accuracy and less damage than traditional surgical instruments in one, short treatment session. In 1986 the Leksell Gamma Knife®—the first radiosurgical tool to do this—was made available to neurosurgeons. The Gamma Knife has offered neurosurgeons an unprecedented, non-invasive treatment option to treat brain tumors and other brain disorders.

Milestones in radiation medicine

Glossary Image guided radiation therapy (IGRT):

Employs two or three-dimensional imaging during a course of radiation treatment to accurately plan and deliver radiation therapy. IGRT has the advantage of validating the target tumor volume by directly comparing the pre-treatment image to the diagnosis image and automatically correcting for changes in tumor size or position. • Two-dimensional computed tomography (2D CT): A series of two-dimensional (planar) X-ray images, captured with fluroscopy or CT, are reconstructed into a 3D image to aid planning of radiation treatment. • Three-dimensional computed tomography (3D CT): Three-dimensional images are digitally captured using MRI or PET which allows more accurate visualization and dose delivery to irregularly-shaped tumors.

Intensity modulated radiation therapy (IMRT): Uses a combination of linacs and computer-guided imaging to deliver discrete radiation doses to a tumor or specific areas within the tumor. The intensity of the radiation beam is controlled to focus a higher radiation dose to the tumor while minimizing radiation exposure to surrounding normal tissues. IMRT can be planned and delivered as a series of many radiation beams during one treatment session.

Volumetric modulated arc therapy (VMAT): A form of IMRT in which a single source of radiation rotates up to 360 degrees around the patient. Treatment is delivered efficiently and accurately in single or multiple dynamically modulated arcs. This enables radiation dose intensity and the shape and angle of the radiation beam to be continuously adjusted without switching the beam on and off. The advantage is a single treatment session can last a matter of a few minutes where traditionally it might take 20-25 minutes.

Four-dimensional image-guided radiotherapy (4D-IGRT): Building on three-dimensional IGRT, this technique accounts for the change in tumor volume and shape, along with the position and weight gain/loss a patient may experience, as a function of time. This has a particular advantage for lung cancers where patient’s breathing can mean the tumor changes position during treatment.

A recent study undertaken by the Radiotherapy physics department of the Royal Berks Hospital in Reading found that a Linac based constancy device delivered consistent results within the required tolerances when used on their superficial treatment machine. The Sun Nuclear Checkmate device was used and good correlation was found between this device and the monthly Farmer chamber measurements.

The data shows that at equivalent energies and depths the range of difference was <1.5% proving the instruments repeatability, this data was complied over a number of weeks. Monitor unit linearity was another test conducted to determine dose limits for the device. A series of checks at 50,100 and 200 MU were carried out over differing energies and the resultant agreement was very good returning maximum variations of 0.2% at 50MU, 0.1% at 100 MU and 0.6% at 200 MU. In this case 100 MU was selected as the standard. The study found the daily clinical output measurements were with +-2.5% of the set monitor units putting the device well with the limits of IPEM 81². The Checkmate device is primarily designed as a Linear accelerator constancy device, utilising a vented chamber of Farmer volume it has the provision for 15 stored energies which are read via the treatment room camera system.

Checkmate is distributed in the UK and Ireland by Imaging Equipment Ltd.

Acknowledgements : V.Orlendorf et al, Medical Physics Deparment, Royal Berkshire Hospital

For more information contact Phil@Imagingequipment.co.uk

London, United Kingdom – September 30, 2008 – The Royal Marsden NHS Foundation Trust announced today that patients with cancers from a number of different subsites such as prostate, bladder, lung, gastrointestinal tract and gynaecological areas will be treated with image-guided radiotherapy (IGRT) using the new ExacTrac® system from BrainLAB. This image-guidance and positioning technology allows for more accurate treatments of benign or malignant tumours. Prostate cancer patients are now being treated using this system and clinical protocols/studies are being developed for other cancer subsites.

The ExacTrac system uses high-resolution x-rays to pinpoint a patient’s position, detect small shifts or patient movement and ensures a millimetre precise set-up immediately prior to radiotherapy treatment. Potential damage to surrounding healthy tissue can be reduced. To increase accuracy during the radiotherapy sessions, the system is also designed to automatically correct patient set-up errors and identify any movement throughout the treatment procedure in real-time.

The Royal Marsden NHS Foundation Trust already has extensive expertise with IGRT treatments. “The IGRT technology allows us to administer advanced Stereotactic Body Radiotherapy (SBRT) protocols with high doses in fewer treatment sessions. Studies have shown that the prostate moves up to 15mm within one single session. ExacTrac allows us to pin-point the position of these moving targets and subsequently, to decide if the patient needs to be repositioned before the treatment continues to ensure high precision,” says Dr. Vincent Khoo, Consultant in Clinical Oncology at The Royal Marsden.

With the implementation of ExacTrac, more patients can now benefit from treatment options such as intensity-modulated radiotherapy (IMRT). The high accuracy provides consultants the possibility to precisely treat a wide range of indications, including head and neck, spine, prostate, bladder, lung and liver lesions.

The BrainLAB system also brings advantages for the clinical staff. Its intuitive workflow makes ExacTrac fast and easy to use, thereby allowing patients to benefit from IGRT accuracy without adding to the overall treatment time. Radiographers can be confident that their patients are accurately positioned for every day of their treatment.

ExacTrac systems are in clinical use in hundreds of hospitals worldwide. The Royal Marsden is the first cancer centre to adopt this technology in the UK. “We are very pleased that the ExacTrac technology has been introduced to the UK here in London as clinical experience at other international centres has shown that IGRT offers significant improvements for radiotherapy treatment of cancer,” comments David James, Area Sales Manager for BrainLAB in the UK.

Rotational therapy techniques have shifted paradigms in terms of treatment efficiency and precision.

Simultaneous modulation of gantry rotation speed, dose rate and MLC position at every gantry angle result in a highly accurate conformity of the dose delivery with greatly diminished treatment times.  With this significant improvements, plans can now be tailored to each clinical case.

With this increased dynamism, the need for fast and accurate dosimetric verification of planned vs. Delivered doses as well as dedicated Linac QA is evident.

The fastest and most accurate way to validate your RapidArc™, VMAT®, Hi-Art® or conventional IMRT treatment plan under exact treatment conditions and in real time.

• Easy set-up on the patient couch. No additional mounting required.
• MatriXXEvolution digital 2D Dosimetry: fastest sampling time, highest spatial resolution and lowest angular dependancy.
• Unique Plastic Water® phantom for quick set-up and registration.
• Only one phantom needed throughout the entire process.

Workflow driven efficiency in OmniPro-I‘mRT software

MatriXXEvolution is the optimized 2D digital verifi cation system for Rotational therapy techniques. It operates with the intuitive and user-friendly OmniPro-I‘mRT application software for complete plan verifi cation and QA of IMRT / IGRT / Rotational treatments:

• Air-vented pixel ionization chambers with lowest angular dependence.
• Parallel read-out of all ionization chambers without dead time. Down to 20 msec / sample.

Highest spatial resolution: 1020 ionization chambers in an active area of 24 x 24 cm2.

One MULTICube, multiple configurations

The MULTICube provides an efficient way to validate the dose under parameters mirroring those of the patient during treatment. The new MULTICube combined with MatriXXEvolution and OmniPro-I‘mRT software is the smart solution for all dynamic applications. The multiple configurations in 5 cm increments allow you to physically position the measurement plane of the MatriXXEvolution at a point in the phantom material that will resemble its position in the patient. The MULTICube enables you to position the MatriXXEvolution in different depths vertically by raising the measurement plane off the couch by up to 20 cm.

Removable film cassette with registration points for independent film verification at same measurement plane as the MatriXXEvolution.

QADOS will be attending the forthcoming IPEM meeting in Bath. Mike Sweeney, Suzanne Gibbins and Jan Antons will be on hand at the QADOS stand. We will be exhibiting a range of QA equipment including:
• IBA Dosimetry Matrixx 2D Array
• Faxitron X-Ray Cabinet
• Resonant Medical Clarity Ultrasound IGRT System
• Harshaw TLD Readers and Accessories
• IBA Dosmetry DPD-12 and In-Vidos Patient Dosimetry System
• Various Patient Fiaxation Devices and Accessories
We welcome you to visit us at stand number 8 and we invite you to enter our competition to win an Apple iPod. Please be sure to visit our stand for entry to this competition.

QADOS (A division of Cross Technologies plc)
5 Lakeside Business Park, Swan Lane, Sandhurst, Berkshire, GU47 9DN
T: 01252 878 999
F: 01252 877 288
E: sales@qados.co.uk
W: www.qados.co.uk

The DAVID measurement chamber is a transparent, segmented, multiwire ionization chamber (MIC). Measurement wires are stretched parallel in the chamber. Each chamber wire measures the dose resulting from the opening of a leaf pair. The chamber is inserted into the accessory tray of the accelerator. A battery supplies power to the measurement system. The battery offers an operating time of at least 16 hours when used continuously. It is replaced without installation work daily and charged in a separate charging station. The measurement signals are transmitted using a Bluetooth radio link to a receiver installed in the radiotherapy room. The receiver is connected to a PC outside the radiotherapy room via serial cable link.

RadPro attended the recent Radiotherapy in Practice (RIP4) congress in Sheffield on the 11th and 12th October, the following presentations are a synopsis of the new products and services from some of the companies that were presented and exhibited there. Click on the respective logos to download the presentations .

	Oncology Imaging systems featured CR in Radiotherapy, a new Orthovoltage machine and carbon fibre couch tops. Contact phil@oncologyimaging.com for more information
	RadPro presented what’s new for 2009! Contact Duncan@dha.co.uk for more information
	Varian presented their new Linac features for 2009 and to receive a copy of this please presentation please email david.scott@varian.com
	Imaging Equipment's presentation covered their range of QA phantoms. Contact phil@imagingequipment.co.uk
	Siemens discussed Carbon Ion, heavy particle treatment systems. Contact Andrew.Jeffery@siemens.com for more information

PETNET Solutions reports a 98.8% success rate in reliability of production and delivery

PETNET Solutions, a division of Siemens plc, has reported a 98.8% success rate in the production and delivery of its radioactive isotopes. This exceptional uptime rate ensures the safe production and delivery of its biomarkers to UK PET Scanner centres

A reliable and efficient biomarker service is vital to ensure the smooth running of diagnostic PET scans. The success of production and delivery means that PET centres can provide cancer patients with highly accurate scans that pinpoint the exact nature of disease. This includes information on how patients are responding to treatment as well as metastases.  Without isotopes delivered in time, examinations have to be cancelled and patients may miss out on vital follow-up examinations.

The radioactive nature of PET biomarkers mean that PETNET Solutions must produce and deliver the vital pharmaceuticals before they decay. For example, the biomarker MetaTrace FDG has a half-life of 110 minutes during which time it must be manufactured, QC tested, transported and delivered ready for use in diagnostic imaging.  This means that the service has to operate at maximum efficiency to produce the products and ensure they are on the road in time to get to the relevant destinations.

We are very pleased that the results of this analysis indicate the reliability and efficiency of PETNET Solutions™ service, said Ian Brown, Business Development Manager for PETNET Solutions. We are always striving to deliver the optimum service by improving the reliability of FDG deliveries. By providing biomarkers within a reliable timeframe we have ensured the trust of our customers and will continue to deliver a high quality service. We are also constantly expanding our research and development capabilities to offer further services and develop new biomarkers. We think this is important given the rapid developments in Molecular Imaging technology and the ever increasing weight of clinical evidence in support of PET. Recent well-publicised global shortages in the availability of Technetium (Tc-99) have demonstrated the fragility of supply of certain isotopes. PETNET Solutions offers alternative technologies which can help to mitigate these shortages both now and in the future.

PETNET Solutions operates two PET Manufacturing and Distribution sites in the UK, one at Mount Vernon Hospital and the latest at Nottingham City Hospital. For more information visit www.siemens.co.uk/petnet

Further information can be found by visiting http://www.siemens.co.uk/healthcare.

Contact: mike.bell@siemens.com

For Radiology Jobs, click here to enter the International Radiology Job Pages.

Please send your editorial, corporate or clinical, suggestions and any questions to admin@RadPro.eu

Duncan Hynd

August 2008