Welcome to the March 2010 e-Lectron e-news edition.
This month’s feature is “The Linear Accelerator of the future” with articles from the major Linear Accelerator manufacturers.
There is also a section on how other equipment in Radiotherapy will have to keep up with new treatment delivery systems.

Index of this month’s edition, just click on the link to go there

 What’s new on RadPro…What the papers say!
 Featured Website… www.CompareRad.com
 Main feature…The Linear Accelerator of the future
Elekta article: Transforming radiation oncology’s new vision
Accuray article: CyberKnife® Robotic Radiosurgery System
Varian article: Varian's UNIQUE(tm) radiotherapy system
YouRad: surveys on IMRT and IGRT.
How other equipment keeps up with new delivery systems…
Imaging Equipment Ltd: QA systems
Radiotherapy Company Hot news…
Elekta VMAT radiation therapy rapidly gaining users worldwide as technique evolves
City of Hope testing new communication link between Mosaiq and Tomotherapy
Others;
International Radiotherapy Jobs
Radiology Update
Upcoming e-Lectron features


What’s new on RadPro...

What the papers say!…This is a brand new section where RadPro collects and features all of the news from the previous months international newspaper articles on Radiotherapy. This month we feature the major newspaper articles from February 2010. Please click on the link of any story that is of interest to you.  

Ban on Robotic cancer treatment may be lifted…
The NHS may lift its ban on cancer patients being treated by a £3m robotic radiosurgery machine, after an unexpected move by the chief medical officer. Sir Liam Donaldson has asked the National Institute of Health and Clinical Excellence (NICE) to examine the potential benefit of Cyberknife technology as soon as possible. Cyberknife machines deliver beams of radiation that can help destroy tumours in patients suffering from a range of cancers that would otherwise be inoperable. But the only two in use in Britain are in private clinics in London’s Harley Street where treatment costs £22,000.
To read more on this story click here
http://www.guardian.co.uk/society/2010/jan/24/robot-cancer-surgeon





New blood test detects whether a cancerous tumour is responding to therapy…
A blood DNA test that can detect whether a tumour has returned or is responding to therapy has been developed by American scientists, in an advance that could revolutionise cancer care.
The achievement promises to transform management of cancer by allowing doctors to monitor the progress of patients with any type of tumour and to adjust their treatment accordingly. The test, which should be widely available within five years, should spare some patients chemotherapy and radiotherapy that they do not need, while ensuring that others get potentially life-saving extra treatment when the initial course does not kill all the cancer.It should be capable of detecting even microscopic residual tumours that are missed by imaging methods such as computed tomography (CT) scans.
To read more on this story click here
http://www.timesonline.co.uk/tol/news/uk/article7032490.ece




Fewer, larger doses of radiotherapy better for breast cancer patients: research says… Women with breast cancer should be treated with fewer, larger doses of radiotherapy, researchers have found, as study shows the approach improves quality of life.
To read more on this story click here
http://www.telegraph.co.uk/health/healthnews/7165864/Fewer-larger-doses-of-radiotherapy-better-for-breast-cancer-patients-research.html 

Mother diagnoses daughter's brain tumour from Internet research… A mother successfully diagnosed her daughter’s brain tumour after accusing doctors of dismissing the child’s illness as “attention seeking”
To read more on this story click here
http://www.telegraph.co.uk/health/children_shealth/7189661/Mother-diagnoses-daughters-brain-tumour-from-Internet-research.html




Saved by the £2m CyberKnife and it's coming to the NHS…
It's the latest, very expensive and most advanced form of radiotherapy and its name is suitably impressive: the CyberKnife Robotic Radiosurgery System.
When actor Patrick Swayze was trying to treat his incurable pancreatic cancer, he turned to the CyberKnife. And while the treatment did not cure the star of smash-hit movies Dirty Dancing and Ghost - who died last year - it is thought to have prolonged his life.
To read more on this story click here
http://www.dailymail.co.uk/health/article-1249016/Saved-2m-CyberKnife--coming-NHS.html



Featured website…



www.CompareRad.com, the first ever product comparison website for Radiotherapy and Radiology equipment
Just fill in a simple template, submit and receive a product-based reply within 24 hours, simple!




e-Lectron Feature Article
The Linear Accelerator of the Future!



Transforming radiation oncology’s new vision


As the pioneer in image guided radiation therapy (IGRT), it was logical for Elekta to point the way to IGRT’s next dimension: incorporating more intelligence and automation into what IGRT-equipped systems “see” to further refine targeting accuracy. As in the development of Elekta Synergy, Elekta’s first IGRT treatment system, the company once again leveraged our collaborative relationships with customer partners to gain insight in research and product development. Through these efforts, Elekta is addressing the needs of healthcare systems and patients by reducing hospitalization costs and providing better treatment options. 

The technology on which these recent IGRT advancements is based is Elekta Synergy®, the first linear accelerator to bring 3D image guidance into the treatment  process—enabling soft tissue imaging with the patient in the treatment position at the time of treatment. This critical technological advance has enabled clinicians, on a daily basis, to correct patient setup errors and increase treatment accuracy.

Elekta Synergy is the only treatment system with a fully integrated imaging workflow.  Providing key imaging tools, Elekta Synergy addresses one of the most significant treatment challenges: organ motion. These imaging tools include 3D volumetric cone-beam imaging for soft tissue visualization; 2D real-time, fluoroscopic-like imaging for targets that move frequently; and 2D kV imaging for standard and orthogonal planar imaging.


Pic. Elekta Synergy System

New XVI tools critical in breathing motion management and better targeting
Elekta refers to its soft tissue visualization capability and associated tools as X-Ray Volume Imaging or XVI. The latest iteration of XVI, version 4.5, includes two key feature sets known as Symmetry™ and Intuity™, both CE-marked for commercial distribution in Europe. Both Symmetry and Intuity do more than merely improve visualization—they exploit the very capability of integrated imaging to automate the process of tumor targeting, thereby improving workflow. They also enhance clinical judgment by giving physicians more insight into the motion and position of targets and healthy tissues.

Symmetry—managing respiratory motion
Building on the foundation of Elekta Synergy, Symmetry is the next generation of image guidance, providing a simple and intuitive way to increase efficiency, reduce margins and maximize the probability of symmetrical dose distributions. The results are new approaches to the treatment of thoracic cancers that instill greater physician confidence to treat moving targets aggressively without compromising the safety of adjacent critical structures. Designed to help manage respiratory motion, Symmetry includes 4D acquisition (i.e, time is the fourth dimension), in-line reconstruction and automated 4D registration. These tools assist in determining a time-weighted average position of the tumor for each treatment. This solution is unique to Elekta and differs from other systems on the market, which use external surrogates, such as a belt or reflective markers.

A problem with surrogates is that they don’t necessarily have a stable relationship with the internal anatomy1. In addition, many lung cancer patients exhibit significant baseline shifts2 in tumor position during their course of treatment. Symmetry characterizes the extent of tumor motion and provides correction vectors to reposition the target to the original planned position. Removal of baseline shifts supports the delivery of conventional treatments with only small margins required for breathing motion3.

In a recent study, investigators led by S.S. Korreman found that the impact of 4D daily image guidance in the context of patient respiratory management was considerably more important than beam gating in margin reduction. They concluded that gated beam delivery is “neglible compared to the effects of 4D-CT and respiratory correlated image guidance for most patients.” The potential reductions in field margins ranged from 17-40 percent.4

Symmetry workflow is straightforward. The patient has a planning CT scan followed by the Symmetry acquisition and reconstruction. Symmetry registration occurs automatically, after which clinicians can perform patient shifts and subsequently deliver the treatment.  Once again, it should be acknowledged that evidence collected by leading clinical partners using Elekta Synergy has contributed to the improved understanding of respiratory motion and the development of Symmetry.

To read more please click here

For more information contact Jenny.Thornton@Elekta.com and mention RadPro




CyberKnife® Robotic Radiosurgery System

Many tumors have proven to shift during treatment delivery despite the use of patient immobilization. Using robotic mobility and continual image guidance, the CyberKnife® Robotic Radiosurgery System has the unique ability to not only detect, but also to automatically correct for intra-fraction target motion, intelligently delivering expert level treatments.
Free of the constraints imposed by a gantry architecture, the CyberKnife System’s combination of a robotic manipulator with six-degrees of freedom and a compact, lightweight linear accelerator enables the delivery of thousands of non-coplanar beam angles. This results in treatments that can ensure excellent tumor coverage, steep dose gradients and tight dose conformality regardless of the shape of the target.

Intelligent Robotics Enabling Flexible Treatment Options

1000 MU/min Linear Accelerator
The compact and lightweight 6MV, X-band linear accelerator operated at a dose rate of 1000 MU/min, enabling treatments to be delivered in less time. Radiation beams are precisely collimated with either the Iris™ Variable Aperture Collimator or with fixed collimators.


Pic: Cyberknife Linac

 


Iris™ Variable Aperture Collimator

Intricate dose sculpting often requires the use of multiple collimators. With the Iris Variable Aperture Collimator, multiple collimator treatments with the CyberKnife System have been streamlined for routine use in daily clinical practice. Developed to optimize clinical workflow, the Iris Collimator consistently supports the sub-millimeter accuracy requirements of full body radiosurgery and high precision radiation therapy while significantly reducing treatment times and total monitor units delivered. Capitalizing on the robotic mobility and non-iscocentric beam delivery capabilities unique to the CyberKnife System, the Iris Collimator efficiently delivers beams with larger apertures to the center of the target, while using beams with smaller apertures to intricately sculpt dose to the target’s periphery.

Using tungsten segments to rapidly manipulate beam geometry, the Iris Collimator can deliver up to 12 different aperture sizes from each linac position. With beam characteristics virtually identical to that of fixed circular collimators, the Iris Collimator enables superior dose conformality while providing excellent preservation of healthy tissue.
The Iris Collimator consolidates multiple-path sets and multiple collimators into a single path set to significantly reduce treatment times. In addition to shortening treatment time, the Iris Collimator enables treatments that have proven to reduce the total dose delivered to the patient by up to 60%.

Learn more about the benefits and clinical results of Robotic Radiosurgery.
Register for the 3rd European Workshop on Stereotactiv Radiation Therapy and Whole Body Radiosurgery at www.radiosurgery2010.com/brusselsworkshop

The 3rd European Workshop on Stereotactic Radiation Therapy and Whole Body Radiosurgery will take place in Brussels on May 28 & 29. It brings together leading experts from Europe and the United States to share their knowledge and experience and to lead discussions on future perspectives. This exciting meeting drives the uptake of SBRT and Robotic Radiosurgery, providing a greater understanding of one of the most significant innovations in high-precision radiotherapy of this last decade.

This meeting provides great opportunities for learning more about the leading edge treatment options and for networking. The Scientific Committee chaired by Prof. Peter Levendag (Erasmus MC- Daniel den Hoed Cancer Centre, Rotterdam), Prof. Vincent Grégoire (Université Catholique de Louvain, Brussels) and Prof. Eric Lartigau (Centre Oscar Lambret, Lille) has put together a programme mixing plenary lectures focusing on the state-of-the-art treatments on spine, prostate, lung, liver and head and neck tumours, case studies presentations by experts in their fields and interactive discussion with the speakers. The aims of this year workshop are to provide a comprehensive overview on the following principles:
Beyond frame-based systems for C
SBRT for Organs Moving with Respiration
Management of Oligometastatic Patients
Evolution of Fractionation Schemes and Perspectives

For more information contact snakarat@accuray.com and mention RadPro

UNIQUE!


Varian Medical Systems is introducing the world's first low-energy linear accelerator-based radiotherapy system with image-guidance and RapidArc treatment capabilities for international cancer clinics.

Varian's UNIQUE(tm) radiotherapy system is expected to make advanced care more affordable and more widely available to cancer patients around the world. "This package is truly a unique offering for international markets," says Dow Wilson, president of Varian's Oncology Systems business.  "We have added high-tech image-guidance and arc therapy tools to a low energy platform together with our treatment planning and information management software so that technology for fast, state-of-the-art cancer treatments can be made available to treatment centers at a cost under $2 million.  It's in keeping with our mission to save more lives by making proven advanced radiotherapy technology available to people who currently do not have access to it."  

The UNIQUE Performance Edition incorporates all the tools needed to easily establish or enhance a clinically effective radiotherapy treatment operation. The UNIQUE* platform's low energy medical linear accelerator incorporates Varian's proven technologies for reliable and consistent dose control, delivery, and beam shaping, into an elegant machine with patient friendly design that is small enough to fit into almost all existing treatment bunkers. The system is ideally equipped for treating cancers of the head and neck, breast, cervix and prostate, which make up the majority of cases in most areas of the world. "It's a comprehensive, cost-effective offering that will provide cancer patients with standard treatments as well as advanced techniques, including intensity modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), and RapidArc(r) treatments," said Rolf Staehelin, Varian's European marketing director".  

By making UNIQUE available with advanced capabilities developed for our high-energy platforms, we hope to help more clinicians around the world to offer higher standards of care for all of their patients." Varian will also offer a UNIQUE Power Edition without RapidArc technology or image-guidance software, for centers that prefer to begin with a more basic yet upgradeable platform. Either package is ideal for treatment centers looking to transition from older cobalt units to modern radiotherapy technology.  The small footprint of the UNIQUE accelerator allows it to fit into most small, existing treatment vaults. UNIQUE, which is being manufactured in China, is expected to start shipping in May and will not be for sale in the U.S., Canada, or Japan.  

For more information contact Neil.Madle@Varian.com and mention RadPro.


Pic: Varian Unique Linac




The current YouRad survey is “The purchase and commissioning of an IGRT system”, click here to participate in the survey and win a prize of a trip to ASTRO 2010. The first online poll is called “How useful is IMRT? and is still active.




How will other equipment keep up with the advances in treatment delivery systems?



Dealing with the challenges in QA with new modalities


The provision of radiation based therapeutic radiology is growing due to better accuracy, this is driven by better understanding of radiobiology, better diagnostic acquisition and subsequent treatment planning and of course more advanced delivery methods.

More advanced delivery methods offer challenges to dosimetry and QA and the strive to meet these challenges is being met by investment in physics and R & D in companies such as Sun Nuclear.

Because Sun Nuclear is a physics driven organisation with great links and synergy with the treatment machine manufacturers they are able to meet the demands of better accuracy, repeatability and yet still maintain independence thus providing safe and dependable QA systems.

Machine QA should be performed with three primary goals in mind.  The first is to foresee an issue before it occurs, the second is to identify an issue as soon as it is measureable, and the third is to apply prior understanding to improve the machine output and stability of the overall QA programme. Many of these goals are reflected in international QA guidelines, and many are easily and accurately accomplished using the Sun Nuclear line of Machine QA tools. 
Two success stories for Sun Nuclear related to new modality delivery machines are Tomodose ™ and SRS Profiler ™.  Tomodose is a two dimensional detector array for quality assurance.
Features include;
Capturing full beam characteristics not possible using other measurement systems
 •  TomoDose presents users with fast and accurate beam data acquisition
 •  Labour intensive water tanks and electrometers are not required
 •  Self contained, set up by a single person in a few minutes
 •  User calibrated every 1-2 years using a patented calibration method
 •  Utilises 223 Sun Nuclear Diodes that measure only 0.8mm x 0.8mm
 •  The small detector size allows for very precise measurement in areas of steep dose gradient
 •  Detectors are spaced every 5mm along the x-axis and 4mm or 8mm along the nine y-axes
 •  Data is collected electronically and is available to the user immediately after measurement
 •  Beam pulse detection, beam time and detector temperature measurement capability
 •  PC computer software included

SRS profiler is a sophicated beam QA for use in stereotactic radiosurgery fields measuring output, flatness, symmetry and field size with a single exposure.  This is the first device to be designed for cone based SRS.
Quick to set up and easy to use
 •  Measures at any angle
 •  Streamlines acceptance testing, commissioning and routine QA test
 •  High sensitivity (32.OnC/Gy) and smallest size (0.64mm2)
 •  50ms update interval
 •  Designed to be accommodated by manufacturers ‘Bird cage’

It has four axis measurements with central-axis detector, X,Y and Diagonal axes, 4mm spacing with 2mm offset for effective 2mm radial detector spacing.

Sun Nuclear is committed to meeting and exceeding the goals of Machine QA and exceeding the goals of Machine QA regardless of the challenge of delivery modality.  These products are distributed by Imaging Equipment in the UK.

Contact phil@imagingequipment.co.uk or jessica@imagingequipment.co.uk and mention RadPro.


Radiotherapy Company Hot News…

ELEKTA VMAT RADIATION THERAPY RAPIDLY GAINING USERS WORLDWIDE AS TECHNIQUE EVOLVES

Elekta calls next generation Elekta Volumetric Modulated Arc Therapy (VMAT) “the definitive arc-based technique.”
 ATLANTA, Feb. 12 /PRNewswire/ – Entering its third year of commercial availability, Elekta VMAT has garnered more than 200 orders, with many customers using the arc-based technique clinically since 2008. These clinical Elekta VMAT users have employed the method to treat hundreds of patients worldwide. With Elekta VMAT, single or multiple radiation beams sweep in uninterrupted arc(s) around the patient, reducing treatment times from the eight to 12 minutes required for standard radiation therapy to as few as two minutes.
To read more click here

CITY OF HOPE TESTING NEW COMMUNICATION LINK BETWEEN CANCER THERAPY SYSTEM AND ELEKTA ELECTRONIC MEDICAL RECORD SYSTEM
First-ever interface between TomoTherapy’s Hi-Art treatment system and Elekta’s MOSAIQ oncology information system designed to increase workflow efficiency and enhance patient safety.
ATLANTA, Feb. 17 /PRNewswire/ – City of Hope (Duarte, Calif.), a leading research and treatment center for cancer and other diseases, is the first medical center to implement an electronic interface that links its TomoTherapy® Hi-Art® treatment systems with the MOSAIQ® radiation oncology information management system. The connection enables communication between the MOSAIQ and the Hi-Art systems, facilitating access to vital information, such as the patient’s treatment verification and documentation, insurance company data, and data and records between clinicians, scientists and outside laboratories involved in the patient’s care.
To read more click here


Latest International Radiotherapy Jobs…



Aberdeen Royal Infirmary
Therapy Radiographer: Band 5 & 6

We want you to join our forward thinking, dynamic team here in the beautiful ‘granite city’ of North East Scotland. Our continual aim is to improve the quality of our patient care through technological innovation and the development of all our staff.
email nicola.redgwell@nhs.net and mention RadPro.
http://www.radpro.org.uk/employment.php

HSE Ireland
Opportunities in Radiation Therapy Planning in Ireland for Services Managers
The Health Service Executive (HSE) has ambitious plans for the future of radiation oncology in Ireland.  In line with the development of a National Cancer Control Programme a significant expansion of Radiation Oncology services is underway.  The first Phase involves the expansion of existing services to include eight linear accelerators network across two hospital sites in Dublin. All new equipment will have IMRT, IGRT and Arc therapy capability together with distributed treatment planning. The overall aim is to deliver optimal outcomes for patients by applying evidenced based standards and best practice in patient care and treatment. 
We are now seeking to expand our radiation oncology workforce to help deliver our vision. 
Applications are invited for the following positions in the HSE:
Radiation Therapy Services Managers
In these pivotal roles in the HSE you will participate in leading service developments in the context of both local and national developments. Short listing may apply and panels may be formed from which future vacancies will be filled.  Vacancies may be filled on a full or part time basis. 
For more information and to apply online, please log on to www.publicjobs.ie.
If you have any queries on the above positions please contact: Emma Adams, Public Appointments Service, 26-30 Abbey Street Upper, Dublin 1. Tel 00353 1 858 7494 or emma.adams@publicjobs.ie and mention RadPro.
Closing date for receipt of applications is 31st March 2010.
We are an equal opportunities employer. 

http://www.radpro.org.uk/employment.php


Radiology News Update…


www.CompareRad.com , the first product comparison website for radiology and radiotherapy is now online, just submit a template, simple!
For International Radiology Jobs, click here to enter the International Radiology Job Pages.


weblink: http://www.radpro.org.uk/jobs_radiology.html


Upcoming e-Lectron features…


April 2010 International Recruitment in Radiotherapy with a co-feature on student training in Radiotherapy
May 2010 Radiotherapy company international website review! We publish your website details and a web-link to some important “news or special feature items” on it and our readers simply click to be taken there…simple but very effective!
June 2010 Immobilisation in Radiotherapy, featuring advances in thermoplastics, frames, carbon fibre systems and other treatment accessories
July 2010 Radiation protection, shielding and QA in Radiotherapy feature
August 2010 ESTRO 29 Barcelona, 12th to 16th September 2010 manufacturers exhibition and congress preview
September 2010 Your choice of feature subject!
Please send you editorial, corporate or clinical, suggestions and any questions to admin@RadPro.eu
Duncan Hynd, March 2010

 

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