Clinical Precision for Best Cancer Care Dee Mathieson Senior Vice President Oncology Business Line Management
Optimizing clinical results Key drivers in modern Radiation Therapy Clinical precision Continuous clinical innovation Close collaboration with clinical partners Cost containment and efficiency Comprehensive Services and Software solutions
Breast Prostate Lung Brain H&N Spine Other Radiation Treatment planning Radiation Information Systems Medical Oncology Information Systems Laboratory Information Systems Cancer Registry Surgical Planning Synergy Axesse LGK Perfexion MEG Oncology Research Neuroscience research Oncology Marketing, Neuroscience Marketing Pathology Marketing Linac sales, OIS sales, Pathology sales, Registry sales, GK/Perfexion sales, MEG sales RO customers MO customers, Neuro customers, Pathology customers, Registry customers
Cancer incidence in women 260 240 220 200 180 160 140 Breast 120 100 80 60 Colon & rectum Lund & bronchus CA Cancer J Clin 2006; 56:106-130 40 Uterine corpus 20 Ovary Non-hodgkin lymphoma 0-75 -80-85 -90-95 -00 Year of diagnosis
Breast clinical challenge Delicate underlying anatomy Lung Heart for left sided breast Patient breathing Target moves Accurate and repeatable set up Tissues very moveable Side effects Skin reddening and soreness Images courtesy of William Beaumont Hospital, Detroit
Current issues in Cancer Management Cancer death 100 Lung and bronchus 90 Rate of 100,000 population 80 70 60 50 40 30 Stomach Colon and rectum Prostate 20 Pancreas 10 0 Leukemia Liver -30-35 -40-45 -50-55 -60-65 -70-75 -80-85 -90-95 -00 Year of death CA Cancer J Clin 2006; 56:106-130
The challenge of Lung Cancer Respiratory Motion Lung tumors are moving targets and are subject to baseline shift
Integrity 6 th generation integrated digital control system Collimator position Leaf alignment Gantry position Gantry speed Monitor units
Continuously Variable Dose Rate From Discrete dose rate delivery To Continuous dose rate delivery Finer dose rate control Faster delivery times More accurate treatments
Customer experience of Integrity VMAT plans are significantly accelerated and the treatment delivery is a lot smoother than with the current control system. On average, it has reduced treatment times by 20-30% Prof. Frank Lohr, Vice Chairman of the Department of Radiation Oncology University Medical Center Mannheim, Germany
High dose rate Flattened beams Unflattened beams Data courtesy of research from Birmingham Hospital More homogenous distribution Hotspots moved from beam edge Faster treatment
3 tiers of safety Accurate & safe MOSAIQ/R& V Guardian Integrity Results Tier 1 in Tier 2 Tier 3 - Checks parameters of prescription - Ensures correct set-up Enhanced patient safety Continuously Smoother verifies patient parameters flow & checks correct position during delivery Improved patient throughput Confidence - Supervises with and all check delivery all techniques systems - Automatic safety stop
Agility Intelligent Conformance from a next generation beam-shaping solution This feature is in research and is not for sale or distribution.
Seamless field delivery 160 x 5mm Leaves across 40cm x 40cm field Capable of Interdigitation & Island Shapes Maximum effective leaf speed up to 6.5 cm/s 1mm dynamic tolerance No need to split the field More flexible planning Faster delivery Dynamic delivery Faster treatment planning This feature is in research and is not for sale or distribution.
Intelligent leaf positioning and design Low transmission < 0.5% for 6MV Small penumbra Sculpted dynamic diaphragms Dynamically assists with OAR protection, beam shaping & dose modulation Flexible shapes Reduced integral dose Protects organs at risk Improved plan quality Easy upgrade This feature is in research and is not for sale or distribution.
Rubicon Optical Technology Direct readout of leaf positions Fluorescing Ruby locators Distinct wavelengths Independent field light Reduced QA time Accurate Reliable Reproducible Inherent safety
ASTRO 2009 Combined leaf guide and leaf speed is 65mm/s Measurements obtained under the most unfavorable conditions St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, UK
ESTRO 2010 To establish the accuracy of Monte Carlo calculations compared with measured characteristics Concludes that minimal changes would be expected to be made in dosimetric models of the new head in radiotherapy treatment planning systems. St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, UK
Monaco New paradigm in treatment planning Biological Modeling Constrained Optimization Single and Multi Arc VMAT Sensitivity Analysis Monte Carlo Dose Algorithm Multicriterial Goals Voxel-based Structure Control Smart Sequencing
Biological modelling Takes into account the underlying biological effects of radiation on cells Optimizes based on the nature of the structure Parallel [Lung] Serial [Spinal Cord]
Smart Sequencing Fluence smoothing Weight optimization Minimum MU/segment Minimum segment area (cm 2 ) Shape optimization
MOSAIQ Diagnostic Imaging Image Fusion (CT, MRI, PET, US,...) Segmentation and contouring Deformable registration Powered by MOSAIQ Dose Accumulation MOSAIQ EMR Optimization Dose calculation and display Treatment Imaging Trial plan comparison, selection, review and approval
Progressive innovations in Image Guidance Ease of use Single button Push CBCT Advanced 3D image registration tools Simultaneous image reconstruction Low dose Accuracy Electronic alignment of image to radiation isocenter for sub-mm resolution Large field of view 4D imaging Symmetry
Odense University Hospital, Denmark Increased confidence treating lung tumors All lung patients now imaged with Symmetry Access to advanced 4D imaging, both at the CT scanner and on Elekta Synergy, has enabled new clinical protocols with individualized treatment margins. This has allowed margins to be reduced and the surrounding tissue protected Carsten Brink, Head of Research and Development
Cancer incidence in men Rate per 100,000 population 260 240 220 200 180 160 140 120 100 Prostate Lung & bronchus 80 Colon & rectum 60 Urinary bladder 40 Non-hodgkin lymphoma 20 Melanoma of the skin 0-75 -80-85 -90-95 -00 Year of diagnosis CA Cancer J Clin 2006; 56:106-130
MLC Tracking research Research is on existing MLC Agility high speed dynamic leaf guide and leaves optimized for tracking This feature is in research and is not for sale or distribution. Data courtesy Royal Marsden, London, UK
Couch Tracking research This feature is in research and is not for sale or distribution. Data courtesy Coventry, UK
Breast Prostate Lung Brain H&N Spine Other Radiation Treatment planning Radiation Information Systems Medical Oncology Information Systems Laboratory Information Systems Cancer Registry Surgical Planning Synergy Axesse LGK Perfexion MEG Oncology Research Neuroscience research Oncology Marketing, Neuroscience Marketing Pathology Marketing Linac sales, OIS sales, Pathology sales, Registry sales, GK/Perfexion sales, MEG sales RO customers MO customers, Neuro customers, Pathology customers, Registry customers