Can the compact economical Nano-X linear accelerator system be a solution for improving access to radiotherapy globally?

Transcription

1 Can the compact economical Nano-X linear accelerator system be a solution for improving access to globally? Poster No.: R-0142 Congress: Type: Authors: 2014 CSM Scientific Exhibit P. Lazarakis, E. Eslick, I. Feain, P. Keall; CAMPERDOWN/AU Keywords: Oncology, Radiation physics, Cone beam CT, Radiation therapy / Oncology, Radiation oncology in Developing Nations, Cancer DOI: /ranzcr2014/R-0142 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply RANZCR/AIR/ACPSEM's endorsement, sponsorship or recommendation of the third party, information, product or service. RANZCR/AIR/ ACPSEM is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold RANZCR/AIR/ACPSEM harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies,.ppt slideshows,.doc documents and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Aim 650,000 lives are lost every year due to the global shortage of 10,000 systems [1]. The situation is dire in the developing world, where 70% of the systems in use still rely on Cobalt therapy [2] and a further estimated 7000 systems are needed [2]. To address the global cancer shortage, we have invented the Nano-X, which utilizes patient (not gantry) rotation to deliver a compact, economical linear accelerator. We have previously published [3] cost comparisons between NanoX and conventional linear accelerators, which is a valid comparison for the developed world where linear accelerators makeup 85% of machines. In this paper, we present a straightforward cost comparison between NanoX and Cobalt therapy systems, the latter that comprises 70% of machines in the developing world. Table 1. The Australian and world shortage of systems Cancer patients treated with Number of cancer systems Cancer patients who should have received and didn't Lives lost due to lack of Australia 44,000 i , ,954 iii 50 7 Number of cancer systems needed World 1.5M 4 10, M ii 662,400 iv 10,000 1 (i) extrapolated from 6 (ii) estimated using method from 5 (iii) scaled from NSW population data (iv) estimated using method of 8 Images for this section: Page 2 of 8

3 Fig. 1: Global disparities in the number of people served by each centre by country (adapted from Page 3 of 8

4 Methods and materials We compare machine and bunker costs for a Cobalt system to NanoX using the published cost of a Cobalt machine[2]. Bunker costs for Cobalt are calculated assuming similar shielding requirements to a conventional 4MV linac system[3]. The NanoX bunker has been costed by [3]. The company building the NanoX prototype (Fig. 2 on page 4 has provided us with an estimated cost to build a production version NanoX. The NanoX prototype will include a fixed linear accelerator (as opposed to conventional rotatinggantry Linacs), a patient rotatino system, on-board kv and MV imaging systems as well as a Dynamic Multi-Leaf Collimator (DMLC). Images for this section: Fig. 2: NanoX system design including fixed linac and patient rotation system Page 4 of 8

5 Results The NanoX linear accelerator (linac) and bunker is estimated to cost approximately half that of a Cobalt system. In 2014 dollars, the approximate cost of a Cobalt machine and bunker ($830k + $500k) is about double that estimated for a mass produced NanoX ($500k + $150k). Table 2. Comparison of shielding requirements for the Nano-X device and a conventional cancer device. The bunker cost estimate assumes $8000 per m2. X-ray system NanoX patient rotation with Cobalt system 70 m 2 Treatment room footprint Concrete volume Bunker estimate cost Radiotherapy system + bunker 17 m 2 35 m 3 $150,000 $650, m 3 $500,000 $1.3M Although both Cobalt and Linac systems are clinically acceptable there are definite advantages and disadvantages to each system. The superior skin-sparing and higher throughput capabilities of Linac systems makes them more clinically desirable, however the higher capital costs can be a significant and limiting drawback. Cobalt systems greatest advantage in recent times has been the lower cost and infrastructure requirements. The NanoX system will maintain all of the advantages of conventional Linacs including onboard kv and MV imaging systems and a Dynamic Multi-Leaf Collimator. The reduced cost of the NanoX will provide an option for a system with the advantages of a conventional Linac at a cost lower than that of a Cobalt system. Table 3. Practical factors when considering Cobalt vs Linac systems Cobalt Conventional Linac NanoX Cost $1.3M $3-5M $650,000 Maintenance Replacing the source every 5 years is costly Frequent QA and servicing is required Simplified QA and reduced servicing requirements Page 5 of 8

6 Safety Radioactive source means transport and disposal issues Labour-intensive QA vs Cobalt Labour-intensive QA vs Cobalt Staffing Easier QA and operation More staff and infrastructure More staff and infrastructure Images for this section: Fig. 3: Bunker size needed for the Nano-X cancer device (left) compared to a conventional system (right). Page 6 of 8

7 Conclusion There is an urgent need for more cancer systems. The NanoX is a compact, economical cancer system to address global inequities in access to treatment. NanoX retains all the sophisticated imaging and tracking modalities of conventional and modern linear accelerators. We have shown that its expected cost (machine and bunker) will be approximately half that of a Cobalt therapy system. Personal information For more information please contact Peter Lazarakis at peter.lazarakis@sydney.edu.au or refer to the NanoX website available at References [1] Varian Medical Systems, Year End Review 2011 [2] WHO World Cancer Report 2003 [3] Eslick, E., Keall, P.J The Nano-X linear accelerator: A compact and economical cancer system incorporating patient rotation. Technol Cancer Res Treat, in press [4] Datta, N.R. and Rajasekar, D Improvement of facilities in developing countries: a three-tier system with a tele network. Lancet Oncology 5(11) [5] Estimated using method of:, Baume, P. 2002, A Vision for Radiotherapy: A report of the radiation oncology inquiry, Department of Health and Ageing Canberra,. [6] Milross, C., Page, J., Geoghegan, S. 2012, Planning for the Best: Tripartite National Strategic Plan for Radiation Oncology , version 1, Radiation Oncology Tripartite Committee,. [7] Morgan, G. 2009, Improving Radiotherapy: Where to from here?, Cancer Council NSW. Page 7 of 8

8 [8] Morgan, G., Barton, M., Crossing, S. et al A 'Catch Up' Plan for in New South Wales to Journal of Medical Imaging and Radiation Oncology 53(4) Page 8 of 8