3. Elekta has always been a
pioneering company. In
recent months, we have
taken further steps that
promise to carry this
spirit forward. One of
these is the acquisition
of Nucletron, the world
leader in brachytherapy.
Nucletron’s product mix, values and management style
fit extremely well with those of Elekta, consolidating our
position as a complete provider of radiation oncology.
Together we have more than 6,000 customers serving
close to one million patients every year.
In this issue of Wavelength, you will see how our
welcoming of Nucletron into the Elekta family is in complete
harmony with our strategy to expand our radiotherapy
frontiers for our customers. The article, starting on the
next page, explores brachytherapy’s place in the modern,
versatile cancer clinic.
In addition to our brachytherapy news, this issue has
an abundance of company news and reports from clinical
customers, who – just like us – are animated by the
pioneering spirit and concern for the welfare of patients.
Good reading!
Tomas Puusepp
President and CEO of Elekta AB
3
Dear friends,Contents
Brachytherapy – Elekta’s 4
new “inside view”
Identify™ – simplifying 9
complex workflow
Clarity® – a gentler 10
perspective on soft tissues
Lung cancer foundation 12
seeks greater Gamma
Knife® surgery visibility
A new era in Russia 14
Elekta around the world 16
The practicality of neutrality 18
MOSAIQ® Evaluate 20
streamlines plan review
Satellite clinics are lifelines 22
for cancer patients
First MOSAIQ® in Japan 23
ClinicalView 24
What makes 26
your center unique?
Collaborations & Events 30
4. 4
Brachytherapy, or “brachy” for short, is used
extensively to treat gynecological, prostate and
breast cancers, in addition to several others. The
therapy also boasts lower maintenance and installa-
tion costs, shorter treatment times and potentially
reduced treatment costs for select indications.
Elekta’s acquisition positions the integrated
company to bring better service to patients, health
care providers and health care systems globally.
And, as modern cancer care increasingly depends
on combinations of different modalities, the joint
forces of two key players in external beam and
brachytherapy will result in a highly complementary
product and technology portfolio.
By joining forces with Elekta, Nucletron becomes
part of a world-leading provider of radiation therapy
for many types of cancers.
The promise of brachytherapy
Jos Lamers, Executive Vice President of Elekta
Brachytherapy Solutions, discusses the promise
and potential of brachytherapy in the modern
radiation therapy department.
“Now more than ever, brachytherapy is becoming
a critically important modality in cancer manage-
ment. In brachytherapy, the tumor is irradiated
from the ‘inside-out.’ Over the past few decades,
cancer has changed from what was often a fatal
disease into a treatable and survivable condition.
As a result, today it’s more often a matter of the
patient’s quality of life after treatment, versus a
matter of life or death,” says Lamers.
Several factors have contributed to this important
development, including improvements in screening,
which have enabled cancer detection at a stage at
which it can still be treated effectively. Today’s
imaging techniques also provide much more accurate
images of the cancer and the surrounding tissue,
which results in better treatment plans. There has
also been tremendous progress in cancer treatment
itself. Today, a combination of radiation, surgery and
chemotherapy – depending on the cancer being
treated – is often used, and the results have been
highly successful. Patients make these extremely
important choices along with their doctors.
Effective multidisciplinary treatment
Brachytherapy involves a high radiation dose
administered in a short period of time. While this
results in a lower total dose, the radiation still kills
or reduces the size of the tumor just as effectively.
Therapy then only takes a day or a few days.
For some prostate cancers, a patient treated with
external radiation visits the radiotherapy department
five days a week for seven weeks. Brachytherapy
takes only one or two days.
“It’s important to note,” says Lamers, “that
brachytherapy isn’t always an alternative to external
beam radiation. Although as a monotherapy,
brachytherapy is suitable for simple, smaller tumors,
for more complex tumors, it’s often combined with
external beam radiotherapy, as well as chemotherapy
and/or surgery.”
There are numerous other examples in which
brachytherapy reflects the increasingly multi
disciplinary nature of cancer management.
With uterine cancer, for example, several treat
ment methods are used today. First, a hysterectomy,
Elekta’s new “inside view”
Elekta reported in September 2011 the completed acquisition of Nucletron, the
world leader in brachytherapy. Now, in addition to providing proven solutions
employing external beam radiation therapy – from the “outside-in” – Elekta
also offers a modality that treats cancer from the “inside-out.”
ELEKTA BRACHYTHERAPY SOLUTIONS
Jos Lamers Executive
Vice President, Elekta
Brachytherapy Solutions
(previously Nucletron’s
President and CEO)
’’
Technological
and scientific
developments
in recent years
have enabled
us to treat more
advanced
tumors with
brachytherapy.”
Regulatory approval differs between markets, please contact the local Elekta representative regarding status for your country.
5. 5
Brachytherapy basics
Brachytherapy is a form of radiation therapy in which a radiation source
is placed inside or next to the area requiring treatment. It is commonly
used as an effective treatment for gynecological cancers, as well as for
cancers of the prostate, breast, head and neck, and in other clinical
situations in which soft tissue is involved.
Because the radiation is almost entirely confined to the tumor area,
a key advantage of brachy is that side effects can be minimized after
treatment. Another advantage is it can be used alone or in combination
with other therapies such as surgery, chemotherapy and external beam
radiotherapy (ebrt).
The two primary methods of brachytherapy are high-dose rate (hdr)
and low-dose rate (ldr) brachytherapy. With hdr, the physician places
applicators in or near the tumor. These applicators, or catheters, are
connected by transfer tubes to an afterloader, which delivers the
radiation source. By contrast, ldr involves permanent placement of
seeds that are implanted, most commonly in the prostate.
Brachytherapy treatment results have demonstrated that cure
rates are either comparable to surgery and ebrt, or are improved when
used in combination with these techniques. In addition, brachytherapy
is associated with a reduced risk of serious adverse events. l
and then when necessary, radiotherapy to prevent
recurrence, either external beam or brachytherapy.
A combination of external radiation, brachytherapy
and chemotherapy often is used in cervical cancer.
At an early stage, prostate cancer can be treated
with brachytherapy alone. At a later stage, when
the tumor has progressed to outside the prostate
wall, a certain dose of external radiation is often
administered, together with a brachytherapy boost.
And, technological and scientific developments
in recent years have enabled treatment of more
advanced tumors with brachytherapy.
New studies and research
The development of brachytherapy continues, with
extensive research underway and several studies
starting. For instance, Canadian research on
brachytherapy for rectal cancer indicates that there
is far less risk of cancer recurrence after radiation
prior to surgery. Research also is being performed
to better understand brachytherapy’s role before
surgical intervention; internal radiation reduces the
size of a tumor. It is then easier for the surgeon to
remove, which means less damage to the sphincter
and leaving smaller wounds to heal.
Another study examines the combination of
brachytherapy with external radiation in treating
cervical cancer at a more advanced stage. The
embrace1
study focuses on mri guided brachy
therapy in locally advanced cervical cancer. Today,
point-based two-dimensional brachytherapy is most
often used for definitive radiotherapy in cervical
cancer. However, mri guided 3d brachytherapy is
increasingly in use at several centers, and the results
so far are very promising. The aim of the embrace
protocol is to introduce mri based brachytherapy in
a multicenter setting within the frame of a prospec
tive observational study.
The portec-22
study (a randomized study
comparing external beam to brachytherapy in
the treatment of endometrial cancer) in The
Netherlands has been discussed worldwide and
has been used to formulate guidelines. The well-
being of patients is the primary benefit of brachy
therapy, even when the cancer is incurable.
“A patient with terminal lung cancer who has
obstruction in the bronchi finds it increasingly
difficult to breathe,” explains Lamers. “Brachy-
therapy can alleviate this condition and allows
the patient to breathe more easily. As you can see,
brachytherapy is very widely applicable.” l
facts
Four high-dose rate (HDR) components
F Applicators: Hollow, non-radioactive applicators are inserted into
the body.
F Imaging: Used to get a precise picture of the tumor and to verify
correct applicator position.
F Treatment planning: Software used to plan which dose of radiation
is needed and exactly where the radiation sources should be placed in
or next to the tumor.
F Afterloader: The radioactive sources are stored in the vault of the
remote afterloader. The afterloader guides the radiation source to the
tumor via the applicators for a specified length of time at specific positions.References:
1) EMBRACE http://clinicaltrials.gov/ct2/show/NCT00920920 2) PORTEC-2
http://www.lancet.com/journals/lancet/article/PIIS0140-6736 (09)62163-2/abstract
6. ELEKTA BRACHYTHERAPY SOLUTIONS
6
Elekta interviewed clinicians at three clinical
sites – which perform both ebrt and brachytherapy
– on the value of brachytherapy in the multidisci-
plinary radiation oncology department.
How do you define “modern brachytherapy?”
Marijnen: Modern brachytherapy is image guided,
preferably mri-based. This enables exact target
volume definition and minimizes toxicity.
Herman: The use of a high dose rate, which enables
a shorter course of radiation therapy with potentially
better results than conventional low dose rate
brachytherapy. We can use brachytherapy as a single
treatment – in intraoperative cases for example – or
in a couple of fractions. Endorectal brachytherapy
can take four treatments
Pötter: A greater use of image guidance combined with
advanced delivery technology that harnesses sophisti-
cated computer technology and treatment planning
algorithms. It also uses many methods to assess the
dose to the target and organs-at-risk. Increasingly,
brachytherapy looks at the balance between target
coverage and oar dose volume constraints.
What is the role of a brachytherapy installa-
tion in the radiation therapy department?
Marijnen: Given that brachytherapy requires
special skills and a certain volume, brachytherapy
is preferably centralized in expert centers,
depending on the size of the country or region.
In this way, these centers can offer the whole range
of radiotherapy, with state-of-the art external beam
treatment and brachytherapy.
Pötter: Brachytherapy should be an integral part
in any modern, high volume radiotherapy program,
because it covers frequently seen indications,
particularly prostate cancer, which benefits from
highly efficient, focused radiation delivered to a
small volume. However, brachytherapy should not
be positioned as a competing modality. It depends
on the conditions you are given – the disease site and
patient preferences, among other factors. For instance,
brachy for breast cancer is not especially widespread
globally, but is increasingly used for partial breast
irradiation. In addition, image guided gynecological
applications are emerging, due to Level 1 evidence
that it seems to be superior to external beam.
Herman: To deliver
comprehensive, indi
vidualized care – which
will result in the best
outcome for patients –
brachytherapy options
should be available. For
example, a patient with
t4 rectal cancer should
get external beam rt
and intraoperative
brachytherapy to obtain
the best chance of local
control. If brachy isn’t
available at a particular
center, many t4 rectal
cancer patients will
Allies in healing
Increasing numbers of clinical sites are performing both external
beam radiation therapy (ebrt) and brachytherapy, realizing the
benefits that can be derived from a more diverse offering of radiation
treatment modalities. These advantages extend to patients in
improved quality of life and clinical effectiveness (brachytherapy
alone or in combination with ebrt), in addition to the ability
to receive treatments under one roof.
Prof. C.A.M. Marijnen, m.d.,
Chair, Department of
Radiation Oncology, Leiden
University Medical Center
(Leiden, The Netherlands)
Prof. Richard Pötter, m.d.,
Professor and Head,
Department of Radiotherapy,
Medical University of Vienna,
General Hospital of Vienna
(akh, Vienna, Austria)
Regulatory approval differs between markets, please contact the local Elekta representative regarding status for your country.
7. 7
receive external beam rt alone to 50-54 gy without
iort. This is likely to increase local recurrence rates.
Utilizing iort following neoadjuvant rt can reduce
local recurrence by approximately 50 percent.
What are the advantages of brachytherapy
for the clinician, the payer and the patient?
Marijnen: For the clinician, brachytherapy enables
dose delivery with limited additional margins,
enabling treatment with minimal toxicity. For the
payer – although brachy seems more labor intensive
– the reduced toxicity and the possibility to achieve
higher cure rates will be cost-effective in the long
run. For select patients, brachytherapy will finally
lead to less toxicity and improved long term quality
of life compared to external beam treatment. We
have already demonstrated this in the portec-2 trial,
which randomized ebrt versus vaginal brachyther-
apy for high intermediate risk endometrial cancer.
Herman: Again, to offer truly comprehensive care
for oncology patients, especially in locally advanced
disease, modern brachytherapy should be an option
– even if it’s used solely in intraoperative cases or as
an adjunct. It’s important to devise modern clinical
trials to integrate and/or evaluate modern brachy
therapy techniques to determine the true efficacy of
these modalities. Many trials evaluate external beam
radiation with various drugs. We need to evaluate
the efficacy of combining modern brachytherapy
with concurrent targeted and/or chemotherapies
as well as radiation protectors. So, while historically
it has been brachytherapy. While historically trials
have evaluated brachytherapy alone, we have the
opportunity to explore novel targeted agents that
could potentiate brachytherapy’s effects.
Payers have viewed brachy favorably and that is
reflected by good reimbursement rates. As long as
the modality is clinically indicated and likely to
improve patient outcome, it is justifiable and needs
to be conveyed as such with individual insurance
companies.
Brachytherapy is attractive for cancer patients
because it is delivered over a shorter course. By
treating the tumor and/or tumor bed, it delivers a
dose of radiation to the surface while limiting dose
to normal tissues. This may result in an improved
quality of life for some patients.
Pötter: Clinicians like brachytherapy because they
can escalate the dose in a small volume while limiting
the dose to normal, uninvolved tissues. And, after
gaining the expertise needed in handling the special
applicators, brachy is a rather straightforward
procedure, which makes it quite useful. For the payer,
the modality is extremely cost-effective because it
can yield a local control rate of 90 percent and higher.
That means for a single treatment, the probability
of having a recurrence is quite low, as are side effects.
Of course, there are wide differences in healthcare
systems worldwide that will impact on cost-effective-
ness. Patients often opt for brachytherapy due to the
considerably shorter treatment course – typically for
many indications it’s the difference between one or
two treatment sessions versus five days per week for
seven to eight weeks. Cervical cancer presents a more
Joseph M. Herman, m.d.,
Director, Intraoperative
Radiation Therapy,
Johns Hopkins University
(Baltimore, md, usa)
Prof. Christian Kirisits, ph.d.,
Associate Professor Medical
Physics, Brachytherapy,
Department of Radiotherapy
Medical University of Vienna,
General Hospital of Vienna
(akh, Vienna, Austria)
The radiation oncology
department can realize gains
in productivity, cost-effectiveness
and practice marketing.
8. 8
challenging problem, but even then brachy can be
more attractive for patients. The standard treatment
is five weeks of chemo/radiation therapy, while
brachytherapy can last just one to two weeks at a
similar total dose and with very few side effects.
Where does brachytherapy fit into the
radiation oncology “armamentarium?”
Pötter: In contemporary radiotherapy programs,
there should be the opportunity and means to
deliver a significant dose to a specific target volume.
Brachytherapy meets this need in a unique way
compared to traditional radiation therapy. If the
volume is small from the beginning, such as the
prostate, brachy can definitely be considered
frontline therapy. Conversely, if there is the likeli-
hood of target shrinkage over the therapy course –
cervical cancer being a classical example – it may be
used as a boost. The same factors apply for breast
cancer. There is growing use of brachy alone to
deliver partial breast irradiation, and the modality
is increasingly used for recurrence in the intact
breast and as a boost after ebrt. Other more niche,
but certainly valid, indications include interstitial
applications, such as in anal cancer and head and
neck cancer, in addition to treatment of sarcoma
and palliative therapy for esophageal cancer.
Herman: Generally, when brachy may be indicated
for patient care, patients should be evaluated in a
multidisciplinary setting to ensure they will obtain
the optimal combination of surgery, chemotherapy
and radiation, including brachytherapy. So it
should be considered as part of the whole approach.
Historically, the problem has been that brachy
has been sort of an afterthought or available only
in certain institutions that offer the treatment.
Brachytherapy should be part of the discussion in
multidisciplinary tumor boards in the context that it
should always be considered in specific patients and
earlier on in the treatment process. For intraopera-
tive brachy, there are good data that suggest improved
local control. So, any kind of recurrent tumor at this
institution is at least considered for brachytherapy.
Marijnen: I see a great opportunity for brachy
therapy in the area of organ preservation. Whether
brachytherapy should be combined with external
beam or not depends on tumor type and treatment
indication.
How do you see brachytherapy
evolving in the next five years?
Marijnen: The major improvements in brachytherapy
will be in image guidance. The possibility of mri
compatible applicators enables far better dose delivery,
leading to better tumor control and less morbidity.
Herman: The combination of brachy with novel
targeted therapies that exploit the radiobiological
properties that it may offer that may be different from
standard fractionated therapies. We’re learning that
the radiobiology of shorter high dose rates of radiation
therapy may be more beneficial in tumors that are
generally resistant to standard therapies. Some of the
same principles that we’re learning with stereotactic
radiation therapy can be adapted to high-dose rate
brachytherapy. The key benefit is you’re moving all
the tissues out of the way of the beam.
Kirisits: Technologically, it will continue its evolu-
tion toward an increasingly image guided, adaptive
approach. Various imaging techniques are available
– ct, magnetic resonance and ultrasound – but we
have to make them available in a very practical way,
so they can be integrated easily into daily clinical
practice. We also need tools for online, simple adap-
tations of treatment plans, similar to how ultrasound
is used to image the prostate. Clinicians are doing
real-time plans, in which they not only can see the
application itself, but also the isodoses while using
certain applicators. These technologies become really
image guided during insertion of the applicators and
possibly even during dose delivery in the future.
Pötter: Functional imaging techniques could allow
us to fine-tune the dose distribution within the
prostate, for example, to focus an even higher dose
to certain areas of the gland. We can already focus
the dose, but right now we don’t exactly know where
to put it, which is critical. These same advances
could apply to gynecological indications as well. l
ELEKTA BRACHYTHERAPY SOLUTIONS
Allies in healing
’’
Patients
often opt
for brachy
therapy due to
the considerably
shorter treatment
course – typically
for many indica
tions it’s the
difference between
one or two treat
ment sessions
versus five days
per week for seven
to eight weeks.”
9. 9
Identify is designed to enhance patient safety
in the clinic, raise staff confidence in the reliability
of patient identification and accessories, and
supports best practices of the radiation therapist.
Identify employs advanced rfid (radio-frequency
identification) technology to ensure the right patient is
being treated at the right location and with the correct
set up and equipment. Integrated with Elekta’s mosaiq
Oncology Information System, Identify enables patient
queuing, automatic opening of patient charts and
treatment tracking at the emr, optimizing workflow.
Through this automated process, independent
real-time verification of the patient, accessories and
their position is performed without impacting the
treatment workflow. l
Identify™ simplifies complex
treatment workflow
Highlighted at the 2011 European
Society for Therapeutic Radiology
and Oncology (estro) and
American Society for Radiation
Oncology (astro) meetings, Elekta’s
Identify manages the complexity
of the radiotherapy process.
Data exported
to MOSAIQ
6
Identify
records snapshot
of the patient
and the
positional
information of
the accessories
5
CT scan
performed
4
Patient and
accessories
positioned
for treatment
(including RFID
tags optical
markers)
3
Patient
selected
from MOSAIQ
schedule
2
Patient
enters CT
scanner
room
1
Treatment
complete
6
Treatment
delivery
54
Image
guidance
performed
3
Patient and
accessories
positioned for
treatment
2
Patient
enters the
treatment
room
Identify sends
a report to
MOSAIQ
Identify visually
assists the
therapist with the
correct positioning
of the accessories
and verifies the
patient setup
position is as
planned
Identify
recognizes the
patient and
verifies their
identity matches
that of the
selected patient
treatment
in MOSAIQ
1
Identify monitors patient position in real-time, and interupts
treatment if the patient moves outside a pre-defined tolerance
Remote table
correction
performed
Identify is a work in progress and is not for sale in some markets.
Simulation
Treatment
PRODUCT HIGHLIGHT
These workflow diagrams show how Identify seamlessly integrates with both simulation
and treatment processes, enabling accurate and efficient reproduction of patient set-up.
Watch a demonstration of
Identify at elekta.com/astro
10. 10
Non-ionizing, patient-friendly ultrasound
via Elekta’s Clarity system is enhancing the patient
experience at Fletcher Allen Health Care (Burlington,
vt, usa), and has proven indispensable in its ability to
visualize soft tissues in patients undergoing treatment
for breast or prostate cancer. Fletcher Allen radiation
oncologists Ruth Heimann, m.d., ph.d. and James
Wallace, m.d. have been using Clarity for several years
to better characterize the lumpectomy cavity and
prostate before and during radiation therapy.
Clarity helps visualize lumpectomy cavity
Since 2007, Dr. Heimann has been using fused
Clarity/ct images to depict the dimensions and
location of the lumpectomy cavity prior to electron
boost treatments. Clarity has helped Dr. Heimann
and her colleagues evolve beyond having to infer
the lumpectomy cavity’s proportions and position
using conventional techniques.
“We had been using superficial skin guidance,”
she says. “We would estimate the location of the
cavity by palpating the scar site, and use ultrasound
not for localization, but to ascertain the depth of the
cavity from the skin surface. We would then set the
patient up daily based on surface skin markers over
the scar. Subsequently, we learned that the cavity
volume and location can change over time.”
The integration of cone beam ct imaging
technology in linear accelerators addresses cavity
localization issues to a degree, but at the cost of a
small dose of ionizing radiation.
“Clarity ultrasound was appealing to us not only
because this modality easily visualizes the lumpec-
tomy cavity, but also because there is no daily ionizing
radiation dose given,” Dr. Heimann notes. “Many
of our patients are younger women and with Clarity
we can avoid giving a dose to normal tissues in the
affected breast and exposure to the contralateral
non-cancerous breast.”
Fused CT and Clarity images are superior
At Fletcher Allen – for hundreds of patients over the
last four years – the only ionizing imaging dose given
during the entire treatment course is the single ct
simulation scan, which precedes the initial Clarity
scan. The ct and Clarity images are fused, providing
an image with more anatomical information than
what could be provided by the individual modalities.
“The fused ct/Clarity image is truly superior,”
she says. “It gives you a good combination of soft
tissue visualization and bony landmarks.”
Precise localization of the lumpectomy cavity
and determination of its exact 3d volume are
critical for planning e-boost treatments.
Ruth Heimann, m.d., ph.d.
James Wallace, m.d.
Below: Lumpectomy
cavities are typically con-
toured using only ct only,
left, where it can sometimes
be hard to distinguish cav-
ity (blue contour) from
normal breast tissue. These
fluid-filled cavities are well
visualized using Clarity.
By fusing this information
with ct, right, physicians
are able to more confi-
dently contour the desired
target (yellow contour).
Above: The importance of planning the boost closer
to the beginning of treatment. Cavities shrink over the
whole breast therapy. The different colored contours
from Clarity images acquired at different intervals
during whole breast therapy show this change.
Clarity can be used to track size and position of the
target over treatment.
A gentler perspective on soft
Fletcher Allen Health Care physicians rely on Clarity® ultrasound
for patients with breast and prostate cancers.
CUSTOMER PERSPECTIVE
11. 11
“We can obtain more accurate coverage of the
lumpectomy cavity and ensure that less normal
tissue is exposed,” Dr. Heimann adds.
The Clarity scan also is useful for daily position-
ing of the patient, to make certain the patient is in
the exact position as she was during simulation.
In addition, electronic documentation of e-boost
treatments are facilitated for the first time by placing
the Clarity images in the mosaiq emr.
“Clarity is well integrated here at Fletcher
Allen,” she says. “While ultrasound is a modality
most therapists don’t usually encounter, they were
easily trained. They really like it.”
Clearer view of the prostate
Clarity soft tissue visualization software is a
well-integrated component of Fletcher Allen’s
prostate radiation therapy workflow. The service
treats 10 to 15 patients daily and 60 to 70 new patients
annually receive radiation therapy for prostate
cancer at Fletcher Allen.
Ultrasound/ct fusion with Clarity provides
significantly superior prostate visualization than
does ct alone, and is a more practical solution than
ct/mri fusion, Dr. Wallace says.
“ct overestimates prostate margins by 20 percent,
which makes it difficult to differentiate the prostate
from surrounding tissues,” he notes. “Conversely, if
you can get a good acoustic window, ultrasound
imaging provides beautiful prostate images, which
– when fused with the planning ct images – give you
a comprehensive view of the anatomy.”
About 20 percent of Fletcher Allen’s patients with
prostate cancer have had recurrence following prosta-
tectomy. Clarity has also proved valuable in these cases.
“We use the base of the bladder as our surrogate
for the prostate bed and perform a daily Clarity scan,
and a weekly cbct scan to ensure we’re not seeing
any systematic error,” Dr. Wallace says. “The
correlation has been outstanding.”
Fletcher Allen is also one of a few sites that is
evaluating a new Clarity Autoscan functionality,
which may enable remote real-time scanning while
the treatment beam is on. l
Clarity positioning for prostatectomy cases using the bladder neck. Green is the reference
from Clarity images taken at simulation and red is the current image from treatment.
The blue contours are the CT bladder and rectum. fahc clinicians align the inferior
bladder wall to achieve daily positioning.
Above, upper: ct alone can overestimate the prostate volume. Lower: Fused Clarity and ct helps
physicians contour by showing soft tissue detail for target and surrounding anatomy .
tissues
’’
Clarity ultrasound was
appealing to us not only because
this modality easily visualizes
the lumpectomy cavity, but also
because there is no daily ionizing
radiation dose given.”
12. 12
Like most patient advocacy groups,
bjalcf values – above everything else – the patient’s
quality of life throughout their treatment journey
and beyond (see sidebar). Lung cancer, especially,
presents a major challenge to an individual’s
prospective quality of life, as four out of 10 people
diagnosed with the disease also will develop one or
more brain metastases. Whole brain radiation
therapy (wbrt) is a common treatment for brain
mets, but it is not without its risks. Evidence is
mounting that demonstrates that individuals who
receive wbrt can suffer from a variety of symptoms,
including balance problems, short term memory
loss, fatigue and general neurocognitive decline.1-3
Awareness campaign launch in June
Accordingly, the Foundation will launch in June 2012
a major awareness campaign directed to patients and
providers that includes Gamma Knife® radiosurgery
as a viable alternative to wbrt when radiotherapy is
prescribed. The precision and gentleness of Gamma
Knife radiosurgery may represent an attractive
option to lung cancer patients who want to avoid the
potential side effects of wbrt. The problem has been
an apparent lack of communication of radiosurgery
as an alternative.
“In the lung cancer forums of online patient commu-
nities, many patients report that Gamma Knife
surgery wasn’t offered as an option for treatment for
metastases,” says Nicolle Foland, bjalcf’s Director
of Community Relations. Danielle Hicks, the
Foundation’s Director of Patient Advocacy, confirms
Foland’s experience in her daily contact with lung
cancer patients who have been newly diagnosed with
metastases.
“Most of the individuals I’m dealing with weren’t
offered Gamma Knife,” she says. “Some of them
were, but as far as I’m concerned that doesn’t equate
to nearly enough.”
To raise awareness about all treatment options
for lung cancer patients with metastases, bjalcf has
formulated its Patient 360 program. They hope
Patient 360 will usher in a dramatic new paradigm, a
novel clinical pathway, for patients with lung cancer.
A new pathway
The Patient 360 paradigm shift will greatly influence
patient outcomes by redesigning lung cancer services
around a new standard of care, according to Hicks.
“This growing, integrated network takes
available clinical resources, partners and people and
restructures services along patient-centric lines,”
Bonnie J. Addario Lung Cancer Foundation (bjalcf) is on a mission to ensure
all treatment options are on the table for individuals with brain metastases.
Advocating for a better future
Bonnie J. Addario,
founder of bjalcf.
PATIENT ADVOCACY
13. 13
she says. “Under Patient 360, patients will receive
greater and unique access to specialized lung cancer
teams that will strive to collaborate through multi-
institutional and multi-disciplinary, comprehensive
lung cancer treatment paths. This model is designed
to improve patient wait times by months with an
unprecedented coordination of care.”
The lung cancer program at an institution that
adopts bjalcf’s Patient 360 model would include
seeing patients within a week of their lung cancer
diagnosis, and offering or referring patients to all
molecular/proteomic testing, tumor board, patient
support services (e.g., bjalcf), targeted radiation
therapy options – including Gamma Knife radio
surgery – and the comprehensive array of tests
and procedures that can be brought to bear on the
patient’s case.
On centers that participate in the Patient 360 initiative,
the Foundation will bestow its “Seal of Excellence,”
reflecting the institution’s dedication to an improved
standard of care for individuals with lung cancer.
Handbook for patients
To better arm patients with the information they
need to weigh treatment options, bjalcf also is
developing a patient education handbook.
“There is no comprehensive patient education
handbook out there for lung cancer patients,” Foland
says. “This publication would inform patients about
what’s available in the healthcare system to address
their case. We hope to get it into as many patients’
hands as possible.”
In the meantime, the Foundation will continue
to reach out to and respond to patients who are
facing a decision between wbrt and Gamma Knife
radiosurgery.
“A patient once told me ‘If you have to drive six
hours to get Gamma Knife radiosurgery, then get in
your car and go!’”, recalls bjalcf’s Executive Director
Communications, Sheila Von Driska. “We need to
raise the profile of Gamma Knife radiosurgery as
a serious alternative – not just for lung cancer
patients, but for anyone with brain mets.” l
’’
We need to raise the profile of
Gamma Knife radiosurgery as
a serious alternative – not just
for lung cancer patients, but for
anyone with brain mets.”
1. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, Arbuckle RB, Swint JM,
Shui AS, Maor MH, Meyers CA. Neurocognition in patients with brain metastases treated with
radiosurgery or radiosurgery plus whole-brain irradiation: a randomized controlled trial.
The Lancet Oncology 2009; 10: 1037-1044.
2. Tsao M, Xu W, Sahgal A. A Meta-analysis evaluating stereotactic radiosurgery, whole-brain
radiotherapy, or both for patients presenting with a limited number of brain mestastases.
Cancer. 2011 Sep 1. doi: 10.1002/cncr.26515. [Epub ahead of print]
3. Aoyama H, Tago M, et al. Neurocognitive function of patients with brain metastasis who
received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone.
Int J Radiat Oncol Biol Phys 68[5]: 1388-1395 2007.
The Bonnie J. Addario
Lung Cancer Foundation
When Bonnie J. Addario was
diagnosed with lung cancer in 2004
her prognosis was grim. Following a
14-hour surgery, a battery of nurses
and doctors, an army of radiation
and chemotherapy treatments,
blood clots, procedures and tubes
that invaded her formerly predictable
life, Bonnie became a Lung Cancer
survivor.
In a unique position to become
the voice for the other 1.5 million
people personally affected by the No. 1 cancer killer, she began
to think of ways to help others facing the crisis of this highly
stigmatized disease. “What about the 450 other patients who
die a day of Lung Cancer in the U.S. alone, and their families?”
Bonnie asked. “Where’s the outrage?”
On March 6, 2006, the news broke that Dana Reeve lost her battle
with Lung Cancer. Bonnie decided: “Enough was enough!” BJALCF was
born and became the first international collaborative entity of its
kind, raising more than USD 6 million for lung cancer research.
For more information, visit www.lungcancerfoundation.org.
14. 14
In just two years, Russia’s National Oncology
Program (rnop) has transformed the country’s
radiation therapy and oncology capacity, resulting
in modernization of existing radiotherapy facilities
and establishment of several new treatment centers,
and the introduction of modern radiotherapy
technology and support facilities with extended
training programs for clinical staff. With its Russian
distributor “msm-medimpex”, Elekta has installed
21 linear accelerators and 23 treatment planning
systems at several Russian centers. rnop activities
continue in 2012, with the selection of Elekta to
supply modern equipment to eight more centers,
for a total of 29 new linacs in only three years.
In addition to radiotherapy center moderniza-
tion under rnop, regional programs also support
oncology institutions such as Russian Research
Centre of Radiology and Surgical Technologies
(rrcrst) in St-Petersburg, Stereotactic Center
at Meshalkin Institute in Novosibirsk and the
Regional Oncology hospital in Khanty-Mansiysk.
Prime Minister of Russia,
Vladimir Putin, presiding
over opening of FRCC on
June 1, 2011.
A new era
in Russia
Launched in 2009, National Oncology Program supercharges country’s
radiotherapy infrastructure, Elekta solutions flow into Russia.
New federal children’s cancer center established
On June 1, 2011, Russian Prime Minister Vladimir
Putin opened the Federal Research and Clinical
Center (frcc) of Children’s Hematology, Oncology
and Immunology in Moscow.
frcc includes a comprehensive scientific and
clinical complex with an intensive care department,
research and outpatient clinics and laboratory. In
addition, the center has its own blood service and a
guest house-hotel for children and their parents.
The center is among Eastern Europe’s largest,
with a capacity for up to 400 children. frcc clini-
cians will employ advanced technologies never
before used in Russia, including genetic testing of
residual tumor and molecular therapy. For its
radiotherapy department, frcc acquired a compre-
hensive package for stereotactic radiation therapy,
including an Elekta Synergy system and Elekta
Synergy platform, in addition to Elekta treatment
planning systems and oncology information system.
15. 15
Elekta’s largest center in Eastern Europe
In Saint-Petersburg, the rrcrst is among the world’s
first to conduct research on the use of radiation for
cancer treatment. The rrcrst/Elekta collaboration
began about 50 years ago with the installation of
Russia’s first linac in this center.
Currently, the institute is undergoing a large
scale modernization of radiotherapy facilities and
services that includes installation of five linear
accelerators (three Elekta Synergy® platforms and
two Elekta Axesse™ systems), a Leksell Gamma
Knife® Perfexion™ and Elekta planning and ois
systems. When the project is complete, the rrcrst
will be Russia’s largest radiotherapy center and a key
Elekta reference center in Eastern Europe.
Stereotactic treatment with VMAT in Siberia
In September 2010, the new center for stereotactic
radiotherapy at the Meshalkin State Research
Institute in Novosibirsk became clinically opera-
tional. The center is equipped with two Elekta
Axesse systems for high precision image guided
stereotactic treatments. A team of specialists,
doctors, physicists and radiographers was prepared
to quickly implement this advanced technology
under the leadership of Dr. Olga Anikeeva. In the
last 15 months, over 1,300 patients have been treated,
most with 3d image guidance and vmat delivery.
Elekta’s Eastern European users
convened for first conference
To further develop the professional preparation and
collaboration between Elekta users in Eastern
European countries, the first Eastern European
Users Meeting was organized in Moscow June 24-25,
2011. More than 80 users from over 40 centers in
Russia, Belarus and the Ukraine participated in
presentations and interactive discussions on a range
of cancer management topics.
“Once a region reaches a ‘critical mass’ in
acquiring our cancer management solutions, it
becomes vital to build a stronger support network
around centers,” says Irina Sandin, Elekta Business
Director for Eastern Europe. “That encompasses
not only this important first Users Meeting, but
also commitments to ensure our Eastern European
customers are trained in the proper use of their
equipment and that they receive ongoing clinical
support. It also includes clinical collaborations,
the establishment of help desks and reinforcement
of our parts and service organizations.”
“Highly qualified specialists are essential to
operate and maintain advanced radiotherapy
equipment,” says Prof. Chernyaev, Vice Rector of
Moscow State University. “Sharing experiences and
knowledge between local radiotherapists, medical
physicists, engineers, doctors and scientists is more
critical than ever.”
An important outcome of the meeting was the
decision to establish specialized training courses for
Russian medical physicists in leading European
clinics. At the Users Meeting, a proposed Training
Center for Medical Physicists was announced at the
msu with the support of Elekta, “msm-medimpex”
and Hertzen Moscow Oncology Research Institute.
“Education of current and future clinical
end-users, Users Meetings, clinical collaboration,
innovative spare parts management, improving
response times, and an Elekta office in Moscow – in
addition to working with an excellent local partner
– are some examples of Elekta’s long-term commit-
ment to emerging markets, especially Russia,” says
Nabil Elias Romanos, Vice President, Eastern Europe
Middle East. “We are conscious of these needs and
are investing significantly in these countries.”
Elekta’s diligence in serving the Russian market
is paying dividends in customer perceptions of
Elekta, Romanos adds. Elekta’s worldwide Customer
Satisfaction Survey showed that Russian customers
ranked among the most satisfied in 2011.
New spare parts warehouse to keep
Elekta systems up and running
A major challenge for maintaining advanced
technology in Russia is the supply of spare parts.
Importing spare parts has been logistically difficult.
After analyzing statistics on equipment issues
and user input, Elekta is establishing a local spare
parts warehouse for the all radiation therapy
equipment it sells in the Russian market.
“This warehouse will significantly reduce the
time required to deliver spare parts for scheduled and
unscheduled maintenance, and it will ensure faster
and more efficient service, significantly improving
equipment uptime,” says Jason Rear, Service Director,
eeme. l
’’
Education of
clinical end-
users, clinical
collaborations and
an Elekta office in
Moscow are some
of many examples
of Elekta’s long-
term commitment
to the Eastern
European market.”
16. 16
Elekta around the world
uw SUNNYVALE, CALIFORNIA, USA
MOSAIQ ranked 2011’s Best in KLAS for
Oncology Information Systems
l The 2011 Best in KLAS Awards: Software
Services report recently ranked Elekta’s
MOSAIQ® oncology information system as
number one among software oncology products.
“We are enormously gratified that our customer
respondents in the KLAS survey recognized the
value of MOSAIQ for managing their patients’ care,”
says Todd Powell, Executive Vice President, Software.
“More than 1,400 U.S. cancer treatment centers trust MOSAIQ
to manage their patient information and provide unmatched
connectivity to enterprise systems.”
uw BEIJING, CHINA
Gilbert Wai appointed Executive Vice President
Region Asia Pacific
l Elekta appointed Gilbert Wai as Executive Vice President
of Elekta’s Asia Pacific region and member of the Executive
Committee. “Elekta has been established in China since 1982,
and today we are the country’s market leader,” says Wai.
“Seven of the ten leading clinics have Elekta equipment.
We are committed to supplying our cancer care solutions in
the build out of health care in the Asia Pacific region.”
uw BRATISLAVA, SLOVAKIA
Bratislava hosts Nucletron’s Central European Users Meeting
l Approximately 200 Nucletron customers from Central Europe
gathered in Bratislava in October for a users meeting. The theme
was Modern Brachytherapy: Role in Multidisciplinary Cancer
Treatment. “We are proud to partner with customers, and set
up a solid program in a great location,” says Arjen van‘t Hooft,
Director of Europe Emerging Markets for Business Area
Brachytherapy Solutions. “The meeting, held every two years, has
become a very successful tradition, and we are looking forward
to continuing to organize it, together with our customers.”
uw PERTH, WESTERN AUSTRALIA
Australian hospital first in Asia Pacific
to acquire Clarity system
l One of Australia’s leading teaching tertiary hospitals, Sir
Charles Gairdner Hospital, has acquired Elekta’s Clarity® soft
tissue visualization system. The hospital, which is the first in the
Asia Pacific to acquire the system, will offer a novel approach to
imaging soft tissue anatomy for cancer treatment, including the
treatment of breast. “Modern radiation therapy requires
increasingly precise means of identifying and targeting cancer,”
says Rui Lopes, Director of Business Development, Soft Tissue
Visualization. “With Clarity, SCGH may achieve these goals in a
non-invasive and completely non-ionizing way.”
uw RIVNE, UKRAINE
Ukraine addresses shortage of
modern cancer treatment technology
l The Rinat Akhmetov Foundation took bold strides in 2011
to advance patient care by acquiring a range of Elekta’s cancer
management solutions to equip the radiotherapy department
at Rivne Regional Oncologic Dispensary. “President Viktor
Yanukovych took part in the opening ceremony, noting that
center’s equipment provides patient treatment at the highest
level,” says Nabil Elias Romanos, Vice President, Eastern Europe
and Middle East. “President Yanukovych also toured the center,
cut a symbolic ribbon and presented certificates to the hospital.”
17. 17
uw STOCKHOLM, SWEDEN
Elekta leading in emerging markets
l At Capital Markets Day in December, Elekta’s President and
CEO, Tomas Puusepp, described to analysts, investors and other
stakeholders how Elekta plans to build on its leading position in
emerging markets. “We will continue to see a tremendous need
for cancer care in emerging markets for years to come,” Puusepp
says. “By approaching them with a long-term commitment and
by serving an increasing number of hospitals with advanced
solutions within oncology and neurosurgery, including education
and training, Elekta can contribute to making the most
advanced cancer care available to more patients.”
uw SÃO PAULO, BRAZIL
Elekta Latin America relocates to new office
l In recent years, Elekta has strengthened its presence in Latin
America, particularly in Brazil. “To support the region’s growing
cancer management requirements, Elekta relocated its Latin
America office to a new location, where we can support the
team growth, as well as welcome our guests, customers and
suppliers in a better way,” says Antonio Ponce, Vice President,
Elekta Latin America. The address is: Rua Carneiro da Cunha,
303 - 1º and. cj. 11, São Paulo - SP - Brazil - 04144-000.
uw SINGAPORE
Elekta sponsors gala to benefit cancer research
l Elekta Singapore served as a proud sponsor of The National
Cancer Centre Singapore Charity Gala in December to benefit
cancer research. More than 800 guests, including businessmen,
corporate and individual donors, clinicians and cancer survivors
attended the gala, where Prime Minister Lee Hsien Loong served
as the guest of honor. “All proceeds went toward providing
crucial grants for clinicians and scientists to pursue research in
the fields of oncology, to better understand, diagnose and treat
cancer,” says SF Chan, Managing Director, Far East.
uw SEVILLE, SPAIN
Elekta brightens waiting room for children with cancer
l Two years ago, the Virgen del Rocio University Hospital
installed Elekta Synergy®. “One of the first Spanish centers to
implement advanced cancer treatment technologies, the Seville
team is one of the most experienced in using IGRT and VMAT
technology to treat children,” says Jorge Lopez, Sales Manager for
Elekta Spain. “Upon visiting the hospital, we noticed that there
were no toys, and not much for the kids being treated to play
with. So, to the delight of the younger patients – we purchased
toys for them and arranged for a cartoon character to visit.”
uw ZHANGJIAJIE, HUNAN, CHINA
Trans-Asian Nasopharyngeal Cancer Research Group
gains momentum
l Participants from six Asian centers gathered at the Jin Jiang
International Hotel for the Nasopharyngeal Cancer Research
Group’s second conference in September. “Elekta’s clinical
consortia program is a venue for fostering collaboration with
key opinion leaders in cancer care to improve patient outcomes
and advance technology,” says Joel W. Goldwein, M.D., Sr. Vice
President of Medical Affairs. “With this group of thought
leaders, we hope to help refine and propagate advanced
treatment methods using Elekta technology for treatment of
NPC throughout Asia.”
18. 18
What sort of workflow advantages do you
realize by having the same treatment plan-
ning system (TPS) across all therapy systems?
Kinsey: We support many different treatment
modalities in this clinic, in addition to five different
planning systems plus ct simulation. This puts a
tremendous burden on the planners who have to
know how to generate high quality plans for the
different systems and for those responsible for
treatment planning qa for all of these systems.
Being a long time XiO user allowed us to change
from a single vendor user (i.e., Varian) to a multiple
vendor user (i.e., Varian and Elekta) for our external
beam treatments. The vendor neutral philosophy of
XiO allowed the transition to be implemented
seamlessly from a treatment planning perspective.
Harmon: There are several advantages: efficiency
of commissioning, qa, staff training, staff cross
coverage and standardization of planning protocols.
Lopez: We use XiO for contouring before we send
plans to our TomoTherapy system. We also transfer
plans from another treatment planning system to
XiO and add to it, for example, a boost or a previous
plan or two different courses for the same patient.
What criteria were set for selection
of the TPS in your clinic?
Kinsey: We required strong support for all treatment
techniques, including 3d, imrt and sbrt. We also
needed a non-steep learning curve for all modalities
and excellent customer support.
Crist: We chose the Elekta tps solutions because
we wanted the option to more easily expand our
existing system, and because we predicted that,
over the long term, operational costs would be
lower. The expectation of good customer service
was also a factor.
The practicality of neutrality
FACTS
The benefits of vendor neutrality
F Customers can maintain their current technology while updating
their techniques and tools in treatment planning
F Vendor neutral software allows the customer to consider adoption
of new technologies as they emerge
F Customer’s existing software, workflow and training are minimally
affected
Elekta interviewed four customers about the key principle of vendor neutrality
as it applies to their use of XiO® and/or Monaco® treatment planning.
Each of the centers operates at least one non-Elekta linear accelerator.
19. 19
How has the vendor neutral TPS positively
impacted patient care at your clinic?
Crist: They provide the ability to optimize the use
of our existing linac hardware to provide state-of-
the-art treatments, in terms of delivery techniques
and advanced imaging options.
Lopez: We can treat anything – any part of the body
with any kind of plan, whether it’s imrt or 3d, x-rays
or electrons. XiO is a system we can count on. If our
non-Elekta tps goes down, we still have seven XiO
workstations that can do the job.
Kinsey: The efficiency inherent in a vendor neutral
tps platform enables more time to be allocated to
the development of a high quality plan independent
of the treatment platform. Also, a vendor neutral
tps by its very nature will have more robust beam
modeling tools. This allows the estimate of how we
are going to treat the patient to more closely reflect
how we will actually treat the patient.
How has the vendor neutral TPS contributed
to your consideration, or integration,
of new emerging technologies?
Kinsey: Our clinical introduction of sbrt is a
good example. We could use our current tps mix
to introduce this new modality without having to
“reinvent the wheel.” All of our contouring tools,
beam selection tools and patient-specific qa tools
stayed in place. The learning curve consisted of
developing a family of valid (both in dose distribu-
tion treatability) beam arrangements and how
the plan is presented (normalize to isocenter while
prescription dose to lower percent isoline vs.
normalizing to prescription dose line).
Crist: They have afforded us the opportunity to
select a linac based on key delivery and imaging
features without worrying about limitations on use
of those features due to the tps or tps interface
constraints. l
Elekta customers share their views
UPDATE
The latest on Elekta TPS
F Monaco now also supports the inclusion of existing dose in optimization
(Bias Dose), multiple VMAT arcs for Elekta linacs along with optimization,
tabletop inclusion toolset and dose calculation performance enhancements.
F The new XiO features contribute to an approximate 30 percent reduction in
segments and an approximate 20 percent reduction in IMRT monitor units
(MU)*, which translates into lower integral dose and faster treatment times.
F Recent XiO enhancements include an improved IMRT segmentation
algorithm, fluence map smoothing, creation of a structure from an isodose
line, PDF improvements and MOSAIQ integration.
F Focal now provides improved tools for contouring, enabling clinicians to
contour anatomy faster and more easily.
*Data collected by Elekta on Smart Sequencing™ compared to step-and-shoot XiO plans.
Francisco Lopez, ph.d.,
Medical Physicist,
Froedtert The Medical
College of Wisconsin
(Milwaukee, wi)
Charles W. Kinsey, msph,
dabr, Chief Physicist,
Presbyterian Hospital
(Charlotte, nc)
Teresa Crist, rtt, cmd,
Director Radiation Oncology,
Bon Secours Cancer Institute
(Midlothian, va)
J. Fred Harmon, ph.d.,
Chief Physicist,
Bon Secours Cancer
Institute (Midlothian, va)
’’
Among Elekta’s most
important guiding
principles is its support
of vendor neutrality – particularly
as treatment planning system
(TPS) solutions are concerned.”
20. 20
With the introduction of mosaiq Evaluate,
Elekta has initiated the process of unifying the
electronic medical record (emr) and the treatment
planning system. mosaiq Evaluate, the first package
of a suite of tools in mosaiq rtp, integrates plan
and dose review capabilities into the workflow
with mosaiq Oncology Information System.
mosaiq Evaluate is designed to simplify the plan
review tasks of the radiation oncologist, physicist and
dosimetrist, thereby streamlining overall department
workflow. Equally important, mosaiq Evaluate
represents a migration of our technology to support
evidence-based medicine activities, which ultimately
will be fully realized in the complete mosaiq rtp.
mosaiq Evaluate is based on the premise that the
path to better clinical decisions starts with a single
source for review of treatment and patient data.
A key aspect of the new software is its worklist-
driven architecture, which ensures staff are notified
for timely plan review and approval.
An exceptional workflow tool, particularly for
the radiation oncologist, mosaiq Evaluate also
replaces the existing 3d viewer with an improved
solution, and enables plan review from a variety of
treatment planning systems and comparison of plans
from multiple treatment modalities.
On the following page are key descriptions of the
benefits for the three principle staff involved in plan
review – the radiation oncologist, the physicist and
the dosimetrist. l
First toolset of mosaiq® Radiation Treatment Planning (rtp) launches integration
of classic treatment planning features into the oncology information system.
By Jennifer Markham,
Manager for Product
Management TPS
Treatment planning, patient data workflows unite in MOSAIQ RTP
The worlds of the radiation oncologist,
physicist and dosimetrist will meet in the
electronic medical record in MOSAIQ RTP.
In a process that begins with MOSAIQ Evaluate,
Elekta will steadily integrate advanced toolsets
inside MOSAIQ, ultimately creating an advanced
comprehensive treating planning system in
the EMR. Bringing together treatment planning
and oncology information workflows will
streamline radiation oncology department
activities and enhance the coordination of
planning and delivery in a way that has been
unattainable with traditional isolated workflows.
MOSAIQ RTP will give the planning system
access to all clinical treatment data, empowering
the clinician and planning staff to adapt the plan
to fraction-to-fraction changes in the treatment
course, based on the wealth of therapy data
entered into the EMR. In this way, MOSAIQ RTP
supports efforts to implement adaptive therapy
and evidence-based medicine.
In a single application, MOSAIQ RTP
provides a suite of tools:
• MOSAIQ Evaluate: multiple plan
evaluation/approval/promotion
• MOSAIQ Locate: stereo frame and
angiographic localization
• MOSAIQ Delineate: automatic/manual
segmentation, registration and 4D
• MOSAIQ Simulate: simulation, beam placement
• MOSAIQ Calculate: dose calculation,
optimization
MOSAIQ Evaluate streamlines
ELEKTA SOFTWARE UPDATE
MOSAIQ RTP including Evaluate, Locate, Delineate, Simulate and Calculate is a works in progress.
21. 21
Benefits for the Radiation Oncologist
Radiation oncologists have wanted the ability to
see and approve treatment plans inside mosaiq.
Although within mosaiq the radiation oncologist has
been able to create and approve prescriptions, and
enter notes about the patient’s treatment, reviewing
and approving the plan always has involved a trip to
the dosimetrist’s office. In addition to the time it
takes the clinician to go to and from the dosimetry
office, further time can be lost if the plan is not ready
for review or if the dosimetrist is unavailable.
mosaiq Evaluate eliminates these delays by
supporting distributed plan review at the radiation
oncologist’s mosaiq workstation (figure 1). A consoli-
dated plan and pdf worklist allows the clinician to
view a “to-do” list of plans needing review, launch the
review of one or more plans and approve a plan and
associated prescription. The radiation oncologist
reviews a true rt plan, not simply a pdf.
With MOSAIQ Evaluate, the clinician can:
• View a volumetric plan
• Interact with DVHs (figure 2)
• Quickly determine if a plan has met the pre-defined
goals for targets and organs-at-risk
• View a dose overlay on CBCT to make
informed decisions regarding treatment
Benefits for the Physicist
Distributed review is also available to physicists,
enabling them to review plans at any mosaiq
workstation at their convenience, reducing the
backlog in dosimetry.
MOSAIQ Evaluate also simplifies physicist QA checks:
• Use the Plan Worklist to view plan information
side-by-side with all treatment fields
• Approve treatment fields directly from the Plan Worklist
• View imported DRR’s alongside the treatment plan
Benefits for the Dosimetrist
• Use the Plan Worklist to identify approved plans,
triggering the next step in the workflow
• Promote plan for treatment field creation
from the Plan Worklist
• Simplify chart rounds preparation
– use MOSAIQ to review the treatment plan
• Apply DVH templates and use to quickly
review treatment plan quality
Figure 2: Interactive DVHs for review of pre-defined goals.
Figure 1: Plan and dose review within mosaiq.
plan review
22. 22
Before Manchester’s The Christie nhs
Foundation Trust opened its satellite radiotherapy
clinic in Oldham in 2010, patients in north
Manchester and further north faced a daily driving
odyssey. The roundtrip journey could easily take
three hours to get to Withington, a suburb south of
Manchester. By establishing a satellite center in
Oldham, however, The Christie has dramatically
improved access to radiation therapy services and
commute times for patients in the expansive region
of Greater Manchester.
“We probably are the first center in the United
Kingdom to be a ‘true’ satellite, in that we are
networked completely with the main site in
Manchester, with information passing to and from
the two centers,” says Julie Davies, lead radiographer
at The Christie at Oldham. “Patients come here for a
planning scan, and the patient goes home. We then
instantly send their electronic patient record and
planning scan down the network to the Manchester
site where the main planning hub is. Manchester
develops the plan and sends it back, then the patient
returns and we perform the treatment.”
Paperless from day one
The Christie at Oldham has used advanced tech-
niques, such as Intensity Modulated Radiation
Therapy (imrt) and Image Guided Radiation
Therapy (igrt) since March 16, 2010. In total, more
than 1,600 patients have been treated, averaging 37
patients per day on each of its two Elekta Synergy®
treatment systems. Elekta’s mosaiq® Oncology
Information System connects the Oldham center
with The Christie in Manchester, enabling bi-direc-
tional transmission of patient records and treatment
plans.
Because of mosaiq ois, The Christie at Oldham
has been an entirely paperless environment since
the first day, one of only a few centers in the country
that can make that claim, according to Davies.
In addition, with the electronic linkage between the
main and satellite clinics, The Christie at Oldham
has avoided considerable treatment delays.
“If the 1,600 patients we’ve treated were waiting
for paper documents and plans to arrive in transit
that’s a delay of one to two days,” she says. “That’s as
many as 3,200 days of time already saved just looking
at that one aspect.”
The two clinics ensure maximum uptime by
employing two high-speed t1 communication lines
in parallel. “It is imperative that we provide a system
that is totally reliable and maintains our service at
all times, she says.
A truly independent center
While advanced technology has made access to
world class healthcare possible at an outpost of a
much larger main center, it is the personnel at The
Christie at Oldham that help the clinic provide its
services professionally and efficiently, Davies
stresses.
“The staff here are absolutely brilliant,” she says.
“They have embraced the paperless environment
and the challenges of satellite working. Because we’re
a satellite we don’t have abundant facilities and
support that you would find at a big host site in a
large hospital. Therefore, the staff have taken on
additional training to meet our needs, such as
radiographers becoming proficient in the use of
cannulas and in phlebotomy. In addition, experi-
enced radiographers also are trained to dispense
certain drugs. We can save one week every month
in waiting times by dispensing drugs at the linac.
Truly, the dedication and hard work of a great
many people, both here and at the main center, have
made The Christie at Oldham a huge success.” l
The Christie at the Royal Oldham Hospital use mosaiq® ois to increases cancer
therapy access and convenience for patients north of bustling Manchester hub.
Satellite clinics are lifelines
for cancer patients
CUSTOMER HIGHLIGHT
’’
Because of
MOSAIQ IOS,
The Christie
at Oldham has
been an entirely
paperless environ
ment since the
first day.”
23. 23
mosaiq ois in Japanese
– an important first in Japan.
Elekta’s work to develop a Japanese language
version* of mosaiq Oncology Information System
has resulted in Japan’s first installation of a compre-
hensive, dedicated ois at the Institute of Biomedical
Research and Innovation (ibri) in July 2010. A year
later, ibri and Kobe City Medical Center collabo-
rated to implement mosaiq in the Japanese language
to unify the centers’ radiation oncology services,
creating the country’s first multi-department
operation.
Before ibri began using mosaiq there were
no ois’s operating in Japan – not even an English
language system. ibri, Kobe City Medical Center used
– and other Japanese sites currently employ – one
system to control treatment schedules and manage
activity codes for payment, and another system for
record-and-verify. mosaiq presented the opportunity
to combine these functions, but the barrier had been
the lack of a Japanese language version.
“Not having an ois in Japanese isn’t that critical to
most physicians in Japan, but for therapists, nurses,
receptionists and other staff, it simply had to be in
the Japanese language,” says Masaki Kokubo, m.d.,
Director, Division of Radiation Oncology at ibri.
“The hospitals would not have accepted even mosaiq
if a Japanese language version wasn’t offered.”
Two centers, one workflow
Since the summer of 2011, mosaiq has been coordinat-
ing a single workflow between the two centers, which
have, through a dedicated network line, integrated
four treatment systems – Kobe City’s two Varian linacs
and ibri’s Varian and mhi Vero linacs – in addition to
Kobe City’s nec his and ibri’s Fujitsu his. All patient
information is centralized in one database, the mosaiq
server at Kobe City Medical Center.
“Our single workflow is more efficient, and it
allows us to use both centers’ treatment machines
more effectively, by allocating patients to linacs based
on treatment technique or treatment indication,”
Dr. Kokubo notes. “This results in less time for one
treatment, as similar treatments are concentrated on
a given linac. In addition, because mosaiq integrates
with different treatment systems, the staff doesn’t
have to remember different operations for each linac
as they did under the previous information system.”
The centralized patient database also enables
staff at both sites to check on their respective
activities without time-consuming travel to the
other department.
“Everyone in both hospitals is happy,” he says.
“The unified workflow between ibri and Kobe City
Medical Center has boosted efficiency in both human
resource and treatment system use. The fact that
mosaiq also employs standard protocols, such as hl7
and dicom, makes integration of new technology and
implementation of upgrades much simpler.” l
MOSAIQ®
– Japan’s first OIS
Availability of mosaiq Oncology Information System (ois) in the Japanese Language
unites radiation oncology services of two major Japanese medical centers.
* Elekta also offers MOSAIQ in the Chinese Language.
’’
Not having
an OIS in
Japanese isn’t
that critical to
most physicians
in Japan, but for
therapists, nurses,
receptionists and
other staff, it
simply had to be
in the Japanese
language.”
24. 24
A number of themes seemed woven through
some of the literature I perused these past
months, but some really grabbed my attention.
A paper on post-operative radiation therapy
for breast cancer took top billing.
Joel W. Goldwein, m.d.,
Senior Vice President,
Global Medical Affairs
ClinicalViewScanning the trends of our field
Value of post-op radiation therapy
The Lancet, October 20 issue, published a paper
from the Early Breast Cancer Trialists’ Collabora
tive Group (EBCTCG). Investigators performed a
meta-analysis of 17 breast cancer studies that
included nearly 11,000 patients, looking at the
long term effect of post-lumpectomy radiation1
.
The study showed that radiation after surgery
not only significantly reduced the recurrence risk
and death rate compared to women who had
surgery alone, but they also related the reduction
in 15-year risk of breast cancer death to the
absolute reduction in 10-year recurrence risk.
Indeed, one breast cancer death was prevented
by year 15 for every four recurrences at year 10.
Furthermore, recurrence risk was reduced by
post-operative radiation more in some
subgroups than others. For example, patients
who were ER-positive appreciated nearly double
the benefit of those who were ER-negative.
The publication was picked up widely
across the lay media from outlets such as
CBS News2
and The New York Times, prompting
an ASTRO press release3
.
Thomas Buchholz, M.D., FACR, Division
Head of Radiation Oncology at MD Anderson
Cancer Center (MDACC) wrote an accompanying
editorial4
and made an excellent point. To
paraphrase, the reduction in 10-year overall
recurrence from RT exceeds that resulting from
chemotherapy alone or hormonal therapy
alone, and was roughly equivalent to the
benefits of Herceptin (trastuzumab) for patients
with HER2/neu-positive disease. That makes a
pretty compelling case.
No doubt, post-operative radiation therapy
is “standard of practice”. The NCCN Guidelines
specify its use, and indicate Category I – the
highest – as the level of evidence5
. The EBCTCG
analysis provides further proof of the utility of
post-operative radiotherapy, and reinforces its
necessity in an era in which some patients still,
unfortunately, do not receive the necessary
standard of care.
Gamma Knife® radiosurgery follow-up crucial
A colleague identified a very interesting article
that appeared in the latest issue of the
American Journal of Neuroradiology, a study
that came out of Yale University of over 100
patients with more than 500 brain metastases
treated with Gamma Knife® radiosurgery6
.
The article describes the increasing utilization
of Leksell Gamma Knife® in the treatment of
brain metastases due to its ease of use, the
potential avoidance of neurocognitive deficits
resulting from whole brain radiation therapy
and the ability to deliver treatment during
chemotherapy.
Because of this increasing utilization and
as patients are living increasingly longer, it is
imperative that we develop better management
routines during their survivorship.
In the study, the investigators sought to
identify factors that portended outcome in
patients who had serial MR images post-SRS,
especially among those who demonstrated
progressively increasing lesion size associated
with increasing surrounding MR FLAIR signal-
intensity abnormality.
There were a number of interesting find-
ings from the analysis. First, about one third
of all lesions increased in size, and more than
half of the patients had at least one lesion that
increased in size after treatment. However, most
lesional increases were transient and asymp-
tomatic (only 8% required salvage surgery), with
growth most likely to be seen at three to six
months post-SRS, and with some as long as 15
months after treatment. Second, male patients
and patients with mean voxel doses 37 Gy were
the most likely to have size increases. Finally, and
perhaps most interestingly, patients in whom
all lesions increased in size had the longest
median survival (18.4 months versus 9.5 months
in patients whose lesions did not change). This
finding suggested that these lesions increased
For general interest only. Elekta takes no responsibility for the clinical data presented in the mentioned papers below.
25. 25
in size due to inflammation and necrosis, and
not to tumor growth. In summary, the longer
the survival, the more likely an increase in
lesion size might be seen on follow-up MRI.
Guideline dissemination examined
In a seemingly unrelated publication in the
October 15th issue of Cancer, investigators from
MDACC examined the impact of evidence-based
clinical guidelines on treatment for patients who
should have received radiation post-mastectomy
(PMRT) for high-risk breast cancer7
. They found
that nearly half the patients who should have
received PMRT did not, despite clear level 1
evidence and the availability, albeit by passive
distribution, of major guidelines recommending
its use. Of note, a previous study demonstrated
significantly higher conformance rates in
National Comprehensive Cancer Network
(NCCN) members institutions, exemplifying the
discrepancy in guideline adoption and practice
in specialized cancer centers.
This analysis underscores the failure of
evidence-based guidelines “to satisfy their
intended goal of summarizing and disseminating
clinical evidence to everyday practice.” The
authors speculate that “reliance on passive
dissemination for raising awareness of
guidelines in treating and referring physicians”
might be at the root of the problem, citing
evidence that successful examples of guideline
implementation was promoted by combined
active distribution and accountability for
guideline adherence.
Elekta initiatives
So where does Elekta fit with respect to all
these findings? Certainly, we have the technol-
ogy to support the delivery of the necessary
therapy be it post-lumpectomy or post-mastec-
tomy radiation for breast cancer patients, or
Gamma Knife stereotactic radiosurgery for
treatment of brain metastases. The technology
per se hardly seems the challenge.
The fundamental problem seems to center
around the active distribution of evidence-based
guidelines, and the removal of barriers to their
adoption. These guidelines must be available to
help clinicians manage patients not just during
their initial evaluation and treatment, but
throughout follow-up and survivorship.
In response, Elekta has been working
diligently to address this issue. For some time
now, we have been collaborating with NCCN
representatives in an effort to incorporate direct
guideline access into our electronic medical
record system, MOSAIQ®. We are doing so in a
way that is context sensitive so that the appropri-
ate guideline is readily available at the touch of a
button depending on the tumor type and stage,
and in a way that provides a convenient reference
for the clinician. MOSAIQ connectivity to various
devices, including Leksell Gamma Knife, along
with the incorporation of work flow management
tools will help simplify the process. If guidelines
are unavailable, we can and will provide direction
from the published experience of experts, many
of whom are our customers who are at the
forefront of discovery.
“Care plan” automation
Over time, we will embed more and more capa-
bilities that will extend this paradigm to facilitate
treatment “care plan” automation in accordance
with the available scientific evidence. As new
evidence becomes available, the ability to readily
import and employ these workflows will be nec-
essary to remove the obstacles to wide adoption.
This will allow you, our users, to provide better
care for your patients and will help Elekta to fulfill
its vision of helping to provide not just technolog-
ical solutions to clinical problems, but ways
to facilitate adoption broadly across the cancer
care continuum. l
References
1. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). The Lancet. 2011;378(9804):1707-1716.
2. David W. Freeman; Breast cancer study shows radiation cuts recurrence, ups survival;
www.cbsnews.com; (http://www.cbsnews.com/8301-504763_162-20123079-10391704.html);
October 20, 2011.
3. Press Release: ASTRO: The Lancet study further confirms radiation benefits; cs.astro.org;
http://cs.astro.org/blogs/astronews/pages/press-release-astro-the-lancet-study-further-confirms-
radiation-benefits.aspx) October 25, 2001.
4. Thomas A. Buchholz. Radiotherapy and survival in breast cancer [editorial].
The Lancet. 2011:378(9804):1680-1682.
5. http://www.nccn.org/professionals/physician_ gls/pdf/breast.pdf
6. T.R. Patel, B.J. McHugh, W.L. Bi, et al. A Comprehensive Review of MR Imaging Changes Following
Radiosurgery to 500 Brain Metastases, 2011. Am J Neuroradiol. 32: 1885-1892.
7. Shirvani SM, Pan I-W, Buchholz TA, Shih T Y-C, et al. Impact of evidence-based clinical guidelines
on the adoption of postmastectomy radiation in older women. Cancer. 2011:117(20):4595-4605.
26. 26
What makes your center unique?
More attention and resources are flowing into cancer management clinics than ever
before – not only at clinics that are effectively harnessing Elekta technology to help
patients, but also ones that have invested time and creativity into transforming the
In addition to offering a calm, comfortable
environment with wood accents, artwork and soft
lighting, the staff at the Center for Cancer Care at
Griffin Hospital (Derby, Conn., usa), is always
looking for ways to enhance the patient experience.
Since the opening in 2008, several patient-focused
programs have been implemented, including: holiday
celebrations, a Guided Imagery program, custom
music during treatment, patient birthday celebra-
tions, art therapy, exercise programs and more.
“Something special is always cooking here,”
says Lori Murphy, rtt, Chief Radiation Therapist
at the Center. “On Valentine’s Day we make candy
bouquets for each patient; on St. Patrick’s Day,
patients are treated to green treats and green
carnations; there is a Hawaiian Luau on the first day
of summer; on Halloween, there is trick-or-treating
around the department; on Thanksgiving, each
patient is given an apple pie baked by staff and for
Christmas we bake homemade cookies and present
each patient a platter of their own.”
According to Murphy, the design of the depart-
ment focuses on privacy as well as comfort.
“Private lounges allow patients to wait for
treatment while relaxing by the fire and enjoying
the natural scenery of our healing garden,” she says.
“Many times, while patients are waiting, they are
treated to a hand or foot massage provided by our
soft touch volunteers, enjoying a freshly-baked
cookie or cinnamon roll prepared by one of our
volunteer bakers, or even visiting with one of our
friendly pet therapy dogs.”
In 2011, the Cancer Center was named
Department of the Year. “The staff had to compete
with three other departments and ultimately be
voted on by the hospital’s administrative staff to
receive the title,” says Murphy. “While only opera-
tional for three years, this award speaks volumes
to the level of commitment and dedication shown
by all the staff at the Center.” l
Kindness at Center for Cancer Care at Griffin Hospital
touches patients
ELEKTA CUSTOMERS IN FOCUS
’’
Something
special is
always
cooking here.”
27. 27
Thailand has been a magnet for tourists for
many decades, but in the last 10 years, visitors with
medical conditions have been able to combine a trip
with life-sustaining treatment. Individuals with
benign and malignant brain tumors, as well as a
variety of functional and vascular disorders have
traveled to Thailand for Gamma Knife® surgery on
the country’s only Leksell Gamma Knife. Bangkok’s
Wattanosoth Cancer Hospital acquired this stereo-
tactic radiosurgery system in 1996, and in just five
years became the object of “medical tourism,” a
growing practice of traveling across international
borders to obtain healthcare.
“Tourists who come to Thailand for Gamma
Knife surgery should know that the country has a
long, vaunted reputation for radiation therapy, per
se,” says Dr. Niwat, Director at Wattanosoth Cancer
Hospital. “The skills and professionalism of our
cancer management clinicians, and the facilities
themselves, have put Thailand and Singapore in the
top two in Association of Southeast Asian Nations
(asean) countries in radiotherapy.”
Thailand and Wattanosoth Cancer Hospital have
strived to make medical tourism for Gamma Knife
surgery as easy as possible. Referring points exist in
50 different countries and assistance with visas is
available. In addition, the referring network offers
tickets, concierge service to and from the airport to
the hotel, and assistance in booking accommodations.
Wattanosoth also provides:
• Facilities for religious services
• Prayer rooms for Muslims
• A variety of different cuisines
• Translators for 26 languages
• Customer service department that deals
with third-party liabilities
• No-cost TP Payer services that handle administration
of insurance issues and request regarding claims
Over the last 10 years of Wattanosoth’s medical tourism
program, Gamma Knife surgery has been provided
to patients from Vietnam, Burma, Laos, The United
Arab Emirates, Germany, South Korea, South Africa,
Switzerland, China, u.k., Russia, France and the u.s. l
“cancer ward” into an environment where optimism lives, a home away from home,
a place of hope. In the last issue of Wavelength, we asked readers to tell us what
makes your center unique. Here are a few stories from across the globe.
Wattanosoth Cancer Hospital in exotic Thailand
lures medical tourism patients for Gamma Knife surgery
’’
Tourists
who come
to Thailand
for Gamma Knife
surgery should
know that the
country has a
long, vaunted
reputation for
radiation
therapy.”
28. 28
What makes your center unique?
Does your clinic have a compelling patient story?
Did you receive press from a particular treatment at
your hospital or center? Do you have some special
procedure or details that would be interesting to share?
Your challenge: Tell us your story and we may feature
your clinic in the August 2012 issue of Wavelength.
Write a brief description of your story and send it, marked
“Unique Center”, to media@elekta.com. Include your name,
clinic or hospital name and email address. Send it by June 15, 2012.
Photographs (high-resolution jpgs) are welcome and encouraged if
they help tell the story. We will contact you for more details.
We look forward to hearing from you!
Show us what is happening where you are!
A video display on the door of Lake Constance
Radiation Oncology Centre (Singen, Germany)
includes the message “Let the Sun Shine,” exhorting
patients to think positively and have sunny thoughts
despite the reason for their visit to this Southern
Germany clinic. The message might as well also
signify a plea for cloudless skies, as the radiotherapy
center’s lights, treatment systems and other
machines and systems get a major percentage of their
power from the sun.
In August 2011, the Centre installed an array of
232 solar panel modules on its roof, creating a 400 m2
energy collector that converts sunlight into hundreds
of kilowatt-hours of electricity daily.
During the summer, the array’s output will be
more than the Centre needs to run its two Elekta
Synergy® systems, a large bore ct system and the
clinic’s IT technology, lighting and air-conditioning.
In the winter months, the clinic will need to
supplement its solar power generation with electric-
ity from the power grid, resulting in Lake Constance
Radiation Oncology Centre purchasing more
electricity than it will produce when averaged over
365 days. However, it is the concept of decentralized
power production that is critical, according to
Holger Wirtz, the clinic’s Technical Director/Chief
of Medical Physics, and brainchild of the solar
power project.
“This is a brand new idea. We are shifting the
paradigm from centralized to decentralized energy
production. We are the first in Germany to follow
this model in healthcare and the environment and
generate our own energy to drive our ‘industrial
processes,’” Mr. Wirtz pronounces. “This decreases
the financial investment and effort that utilities
expend in creating electricity at a central production
point – such as an atomic, coal or hydroelectric plant
– and distributing it to every energy consumer.
Imagine if every home produced energy from its
own solar array independent of the power grid; the
current needed to be carried on the grid would be
much lower.” l
Germany’s Lake Constance Radiation Oncology Centre
is world’s only solar-powered radiation therapy clinic
From the left: Holger Wirtz, Technical Director/Medical
Physicist, Mari Björnsgard, m.d., Site Management “Satellite
Friedrichshafen,” and Prof. Johannes Lutterbach, m.d , m.b.a.,
Medical Director
ELEKTA CUSTOMERS IN FOCUS
’’
We are
the first in
Germany to
follow this model
in healthcare and
the environment
and generate our
own energy to
drive our indus
trial processes.”
29. 29
The Farber Center has partnered with Donna
Karan’s Urban Zen to provide Integrative therapy to
all their patients on treatment for free. These
sessions include specific yoga therapies, reiki therapy,
and oil therapy that deal with different aspects of the
symptoms of all diseases. They are designed to assist
with the symptoms of pain, anxiety, nausea,
insomnia, constipation and exhaustion.
Once treatment is over, The Farber Center for
Radiation Oncology has joined forces with Urban
Zen’s integrative therapy program (uzit) and
developed ohe (optimal healing environment)
classes. The four-week integrative program is
targeted to empower the cancer patent to get the
best treatment of mind, body, and sprit. l
The first and only freestanding radiation
oncology facility of its kind in Manhattan, The
Farber Center for Radiation Oncology (New York
City) represents a warm alternative to a hospital
environment, without compromising quality of
medical care.
In fact, when you walk into The Farber Center,
the first question you’re asked is what you’d like to
drink – not what insurance you have. Amenities
include the ability to rest by the fireside in a cozy
chair before slipping into a plush robe in a private
dressing room and a warm, welcoming treatment
room. Their exam rooms have spa tables with real
fitted sheets instead of paper. You will encounter a
multilingual staff, aquariums, and state-of-the-art
Elekta equipment. They even accept most insurance.
“No matter what kind of treatment a cancer
patient receives, the fight against cancer is more than
a physical challenge. It impacts everything from
emotional well-being to financial stability,” says
Leonard Farber, m.d., radiation oncologist and
founder of The Farber Center for Radiation
Oncology. “We realize that people exist within a
matrix of family, friends, jobs, homes, neighbor-
hoods, geographical areas, and psychological and
cultural environments, all of which can influence
health and disease. Our mission is to develop a
treatment plan that is right for our patient and their
loved ones in an environment that supports and
nurtures them.”
The Farber Center for Radiation Oncology caters to
patients’ lives at the center and beyond
Leonard Farber, m.d.,
radiation oncologist and
founder of The Farber Center
for Radiation Oncology
’’
Our mission
is to develop
a treatment
plan that is right
for our patient
and their loved
ones in an envi
ronment that
supports and
nurtures them.”
30. Virtual community
encourages collaboration
30
Log on to Elekta’s new
Oncology Community
website and share informa-
tion, contribute to discussion
forums, and collaborate with
colleagues and Elekta.
This virtual community
encourages oncology custom-
ers to share their experiences
and challenges related to
modern radiation therapy
practices. A single site brings
together several discussion
forums, covering a range of
radiotherapy techniques.
In this user-driven
environment, Elekta customers
moderate discussion forums,
and visitors can provide
unbiased input and feedback.
You can discuss clinical
research or multi-center
trials and engage in cross-site
collaboration. The Oncology Community
lets you develop partnerships with Elekta
and other customers, and even offers
the ability to set up private chat rooms
for customer collaboration.
Visit:
www.onco-community.com
SAVE THE DATE – GLOBAL ELEKTA CUSTOMERS!
Elekta Oncology Users Meeting
Open to all Elekta customers including:
l Radiation Medical Oncology Information Systems
l Radiation Oncology Delivery Systems
l Treatment Planning Systems
l Neurosurgery
When? Saturday
October 27, 2012
Where? Boston, MA, USA
www.elekta.com/usersmeeting
Calendar
of Events
MARCH 20-23
1st International Congress
on Minimally Invasive
Neurosurgery
Florence, Italy
MARCH 25-29
The 16th International
Meeting of the Leksell
Gamma Knife Society
Sydney, Australia
MARCH 31 – APRIL 5
CLAN 2012
Rio De Janeiro, Brazil
APRIL 14-18
AANS
Miami, USA
MAY 9-13
ESTRO 31
Barcelona, Spain
MAY 10-12
World Congress of
Brachytherapy
Barcelona, Spain
MAY 14-19
51st PTCOG
Seoul, Korea
MAY 16-19
6th International Congress
of the World Federation
of Skull Base Societies
Brighton, UK
JUNE 3-6
ASSFN
San Francisco, USA
JUNE 7-10
DEGRO 2012
Wiesbaden, Germany
JUNE 10-14
18th Annual OHBM
Beijing, China
JULY 29 – AUGUST 2
AAPM 54th Annual Meeting
Charlotte, USA
AUGUST 26-30
18th International
Conference on Biomagnetism
Paris, France
SEPTEMBER 26-29
ESSFN
Caiscais, Lisbon, Portugal
OCTOBER 6-10
CNS 2012
Chicago, USA
OCTOBER 24-27
EANS Annual Meeting 2012
Bratislava, Slovakia
OCT 28 – NOV 1
ASTRO
Boston, USA
31. Combined Clarity®
and CT ImageCT Image
...clearly visualizing the
lumpectomy cavity
With Clarity®
, it’s reality
Capable of integrating with all linac platforms, Elekta’s
Clarity enhances contouring and setup to support PTV margin
reductions – all without added ionizing radiation or invasive
fiducial markers. With imaging that has proven sub-millimetric
spatial accuracy, Clarity takes visualization of soft tissue
to new, unsurpassed levels.
Experience the Elekta Difference
More at elekta.com/imagine
4513371096801:12
imagine
32. Corporate Head Office:
Elekta AB (publ)
Box 7593, SE-103 93 Stockholm, Sweden
Tel +46 8 587 254 00
Fax +46 8 587 255 00
info@elekta.com
Regional Sales, Marketing and Service:
North America
Tel +1 770 300 9725
Fax +1 770 448 6338
info.america@elekta.com
Europe, Latin America,
Africa, Middle East India
Tel +46 8 587 254 00
Fax +46 8 587 255 00
info.europe@elekta.com
Asia Pacific
Tel +852 2891 2208
Fax +852 2575 7133
info.asia@elekta.com
www.elekta.com
