This document discusses innovations in radiation oncology at Leeds Cancer Centre in the UK. It provides details on:
1) The implementation of Volumetric Modulated Arc Therapy (VMAT) using the Elekta Versa HD system, which reduced treatment time and improved efficiency compared to IMRT.
2) Clinical trials using the Agility multileaf collimator on the Versa HD, which enabled faster stereotactic body radiation therapy (SBRT) for lung cancer.
3) Research collaborations between Leeds Cancer Centre and Elekta to develop and evaluate flattening filter-free high dose rate mode delivery, which further reduced SBRT treatment times.
This document provides an overview of news and articles from Elekta's quarterly publication Wavelength. The main articles discuss the global adoption of Elekta's new Agility radiation therapy device, 25 years of Gamma Knife radiosurgery at UPMC, brachytherapy treatments for gynecological cancers, and the future of cancer care. It also includes letters from Elekta's CEO and profiles of various cancer centers that have adopted new Elekta technologies.
The Pursuit of Excellence in Image QualityCarestream
The accuracy of a medical diagnosis can only be as solid as the quality of the X-ray images. In this special report, we look at several ways that imaging facilities can improve their ability to capture pristine radiographs.
Nicholas Timmins: Canterbury, New Zealand's quest for integrated careThe King's Fund
1) Canterbury, New Zealand faced an unsustainable future healthcare demand that required a hospital twice the size, 20% more GPs, and 40% more aged care beds.
2) Leaders developed a vision of integrated care called Vision 2020 and implemented tools like lean process improvement and population health management to rethink care delivery.
3) By reducing waste like wait times and focusing funding on high-value services, Canterbury improved outcomes, shifted care to the community, and flattened healthcare demand curves, saving the need for billions in new facilities.
Digital x ray eclipses conventional radiography as a dental diagnosis toolMolly_Evensen
X-rays are vital for diagnosing dental problems that are hard to see during a visual check-up. The downside is they emit electromagnetic radiation. Although the American Dental Association (ADA) says the radiation from traditional dental x-rays is low, to begin with, many are still wary about dental x-rays.
The University of Colorado Hospital implemented the Cisco Nurse Connect solution to improve patient care and boost nurse productivity. The previous wireless nurse call system had shortcomings like short battery life and inconsistent sound quality. Cisco Nurse Connect allows nurses to respond to patient requests faster without physically visiting each room. It has led to faster response times, a quieter environment for patients, and more efficient use of nursing staff time. Nurses can spend less time waiting for doctor callbacks and more time on direct patient care activities.
A publication dedicated to bringing articles and advice, specific to the anesthesia and pain management community, that are practical and tangible.
This edition covers the following topics:
• Using Big Data for Big Research: MPOG, NACOR and other Anesthesia Registries
• Another Year of Changes Lies Ahead for Anesthesiologists
• Disruptive Change, Anesthesiologists, and ASCs
• Performing High Acuity Cases in ASCs: The Anesthesiologist’s Role
• Endoscopy: Revisited
• Reporting Postoperative Pain Management in 2014
• 2014 CPT Coding and Key Reimbursement Changes
The document discusses disruptive technology, convergence, and the purpose of hospitals. It notes that disruptive technology introduces new technologies that are simpler and cheaper than existing ones but eventually disrupt the market. Technology convergence involves different technologies performing similar tasks. The document questions what disruptive technologies may benefit healthcare and examines how convergence could improve areas like nurse call systems and tracking. It explores whether the purpose of hospitals is to serve communities or provide services efficiently, and how reducing waste and barriers could help address issues like overcrowding.
This document provides an overview of news and articles from Elekta's quarterly publication Wavelength. The main articles discuss the global adoption of Elekta's new Agility radiation therapy device, 25 years of Gamma Knife radiosurgery at UPMC, brachytherapy treatments for gynecological cancers, and the future of cancer care. It also includes letters from Elekta's CEO and profiles of various cancer centers that have adopted new Elekta technologies.
The Pursuit of Excellence in Image QualityCarestream
The accuracy of a medical diagnosis can only be as solid as the quality of the X-ray images. In this special report, we look at several ways that imaging facilities can improve their ability to capture pristine radiographs.
Nicholas Timmins: Canterbury, New Zealand's quest for integrated careThe King's Fund
1) Canterbury, New Zealand faced an unsustainable future healthcare demand that required a hospital twice the size, 20% more GPs, and 40% more aged care beds.
2) Leaders developed a vision of integrated care called Vision 2020 and implemented tools like lean process improvement and population health management to rethink care delivery.
3) By reducing waste like wait times and focusing funding on high-value services, Canterbury improved outcomes, shifted care to the community, and flattened healthcare demand curves, saving the need for billions in new facilities.
Digital x ray eclipses conventional radiography as a dental diagnosis toolMolly_Evensen
X-rays are vital for diagnosing dental problems that are hard to see during a visual check-up. The downside is they emit electromagnetic radiation. Although the American Dental Association (ADA) says the radiation from traditional dental x-rays is low, to begin with, many are still wary about dental x-rays.
The University of Colorado Hospital implemented the Cisco Nurse Connect solution to improve patient care and boost nurse productivity. The previous wireless nurse call system had shortcomings like short battery life and inconsistent sound quality. Cisco Nurse Connect allows nurses to respond to patient requests faster without physically visiting each room. It has led to faster response times, a quieter environment for patients, and more efficient use of nursing staff time. Nurses can spend less time waiting for doctor callbacks and more time on direct patient care activities.
A publication dedicated to bringing articles and advice, specific to the anesthesia and pain management community, that are practical and tangible.
This edition covers the following topics:
• Using Big Data for Big Research: MPOG, NACOR and other Anesthesia Registries
• Another Year of Changes Lies Ahead for Anesthesiologists
• Disruptive Change, Anesthesiologists, and ASCs
• Performing High Acuity Cases in ASCs: The Anesthesiologist’s Role
• Endoscopy: Revisited
• Reporting Postoperative Pain Management in 2014
• 2014 CPT Coding and Key Reimbursement Changes
The document discusses disruptive technology, convergence, and the purpose of hospitals. It notes that disruptive technology introduces new technologies that are simpler and cheaper than existing ones but eventually disrupt the market. Technology convergence involves different technologies performing similar tasks. The document questions what disruptive technologies may benefit healthcare and examines how convergence could improve areas like nurse call systems and tracking. It explores whether the purpose of hospitals is to serve communities or provide services efficiently, and how reducing waste and barriers could help address issues like overcrowding.
Carestream is committed to providing X-ray solutions that meet the unique needs of pediatric patients and governmental guidelines for pediatric imaging. Our products keep the needs of children in mind throughout the imaging chain. See how Carestream can help you meet your goals for X-rays for children.
For more information on Carestream solutions for Pediatrics visit: http://www.carestream.com/pediatrics
Digital Picture Archiving and Communication Systems (PACS) have led to significant efficiencies and cost savings for Canadian hospitals by eliminating film-based radiology systems. PACS have reduced costs by over $1 billion annually through eliminating expenses associated with film and film processing. PACS have also improved productivity equivalent to adding 500 radiologists by allowing fast access to medical images anywhere, reducing duplicate exams, and speeding diagnosis and treatment. However, rising demand for medical imaging poses ongoing challenges for cost containment despite these savings. Efforts are underway to connect local and regional PACS to create a pan-Canadian diagnostic imaging system and establish common standards.
eBook - Top Six Ways an Integrated EDR Improves Your Health CenterNextGen Healthcare
If you have doubts about whether you need an electronic dental record (EDR), look no further. This eBook packs the punch you need to see how the right EDR can really revolutionize your practice.
Dell Medical School at The University of Texas at Austin
began planning for the launch of its specialty clinics. The school’s Design Institute for Health was asked to design the service model & the physical layout of the clinic.
Dental informatics is the application of computer and information science to improve dental practice, research, education, and management. It draws upon fields like cognitive science, computer science, information science, and telecommunications. Dental informatics can improve the effectiveness, efficiency, quality of care, patient experience, and office management through applications like electronic oral health records, digital radiography, 3D imaging and modeling, teledentistry, and dental education simulations. Challenges include ensuring quality information, provision of care, licensure, reimbursement, and defining emerging roles for professionals with new technologies.
This PPT explains about how Singapore is using IT in healthcare, Integrated Health Information Systems, Singapore's Shifting Demographics and 2020 Master Plan. For more information visit: http://www.transformhealth-it.org/
The document provides an overview of telemedicine case studies, including both successful and unsuccessful implementations. A successful Alaskan telemedicine program collaborated between multiple organizations to provide remote breast cancer counseling using video conferencing. Patients reported high satisfaction rates. However, a proposed telemedicine program in remote Beaver Island, Michigan failed due to a lack of technical infrastructure, administrative support, and long-term funding. The document emphasizes the importance of a co-creation model to define needs through collaboration between patients, providers, and organizations.
The Story of the Imaginary Dental Group : Region 8Dave Edmiston
The document discusses implementing an antioxidant scanner in a dental practice. It describes how the scanner works, the benefits it provides to patients and the practice, and how to incorporate it into office workflow. It would generate revenue from scan fees and commissions from recommended supplements. The dental assistants and receptionists would be trained to perform scans and schedule follow-ups. They would receive bonuses based on the number of scans and patients starting supplements. The practice owners believed the scanner would establish them as leaders in preventative care and generate substantial income over time.
John Ribchester: Community integrated health careNuffield Trust
Whitstable Medical Practice has developed a model of community integrated healthcare to address the growing health needs of its aging population. The practice has expanded services to include diagnostics, outpatient clinics, therapies, screening, and minor procedures delivered on site or through partnerships. This has resulted in cost savings up to 63% compared to traditional referrals, shorter wait times, and improved patient experience. The practice has also strengthened partnerships to coordinate long-term condition management, urgent care, and rehabilitation services. While this model has benefits, expanding it would require overcoming obstacles such as practice consolidation, facility upgrades, and gaining support from clinical commissioning groups and other stakeholders.
Virtual reality in health care by Rabeendra Basnetरविन्द्र बस्नेत
Virtual Reality in Healthcare in terms of preventive, curative and restorative and rehabilitative purpose in the physical, virtual, Ambient and Augmented Reality through computer generation enviroments.
The University of Washington Medical Center in Seattle has successfully increased radiology department productivity through strategic deployment of technology and process improvements. They now complete 15-20% more exams annually with 10 fewer full time employees. This is due in large part to their strong technology partnership with GE Healthcare and use of Centricity RIS/PACS solutions, which have doubled or quadrupled functionality over recent years. The medical center serves as a model for maximizing efficiency through data-driven decisions and optimized workflows enabled by integrated imaging technologies.
Orthopedics Northwest implemented Dragon Medical Practice Edition speech recognition software along with their NextGen EHR to improve documentation workflows. This reduced annual transcription costs by $75,000 and increased revenue from more thorough notes. Physicians could generate notes 1% faster which improved cash flow. Administrative overhead was reduced from 46% to 43%. Referring physicians also responded positively to the more comprehensive notes created with Dragon Medical.
Digital radiography (DR) has transformed pediatric radiology by reducing radiation dose, imaging costs, and patient turnaround times compared to film-screen radiography and computed radiography. DR allows images to be acquired digitally and viewed immediately, improving workflow efficiency. Studies have shown average turnaround times for skeletal exams decreased from 12 minutes with film-screen radiography to 3 minutes with DR. Faster turnaround times with DR have improved relations between radiology and clinical services by keeping pace with busy clinics. Phoenix Children's Hospital transitioned exclusively to DR and saw these benefits firsthand with the installation of multiple DR units, including one with a dual-detector configuration.
A Tale of Two Hospitals—How Dynamic Healthcare Economics in Belgium Hastens N...Dana Gardner
Transcript of a discussion on how two Belgian hospitals are adjusting to dynamic healthcare economics by leveraging the multilevel benefits of composable infrastructure and pay-as-you-go buying options for data centers.
This document provides an overview and agenda for the iHT2 2013 Health IT Summit opening keynote. The keynote covers the impact of meaningful use on health IT and driving better healthcare, better health, and reduced costs. It also discusses innovation and transformation in health IT, including increasing venture capital funding and the growing size of the health IT industry. The keynote then focuses on the Sharp health system's journey in developing population health strategies and using technologies like their patient portal and health information exchange. It closes by emphasizing that health reform has catalyzed the need for care models that demand health IT and technology.
The radiology department at
Baton Rouge General Medical
Center takes pride in using
advanced technologies to offer
top-notch care to patients and
unparalleled service to referring
physicians.
Singapore’s National EHR - Adaptive Architecture for Transformation and Innov...Peter Tan
The document discusses Singapore's national electronic health record system. It provides context on Singapore's healthcare ecosystem, including demographics and existing initiatives. It outlines Singapore's vision for an integrated healthcare system, with the goal of establishing a pyramid model anchored by regional hospitals that provides step-down care and links acute hospitals to community hospitals and services.
This video describes Intellimessage, a system for generating tailored medical messages to patients through the creation of individualized health profiles. The system matches patient data and preferences with clinical records to create personalized messages that improve health outcomes. It aims to reduce preventable hospital readmissions through evidence-based, tailored post-care messaging. The company was founded by a multidisciplinary team from the University of Kentucky, including a principal investigator, research assistants, an engineering student, and a successful entrepreneur.
The Story of the Imaginary Dental GroupDave Edmiston
How a small dental group in Texas made a tremendous difference by helping its patients prevent periodontal disease and its 53 associated medical problems.
This document provides an overview of methane hydrates and their potential as an energy source. Methane hydrates contain vast quantities of natural gas trapped in ice-like structures on the ocean floor and in Arctic permafrost. While challenging to extract economically, methane hydrates may hold more energy than all other fossil fuel reserves combined. Companies are working to develop technologies to locate and extract methane from hydrates. Sensors to detect dissolved methane are helping map hydrate deposits and advance extraction methods. Developing methane hydrates could reshape the global energy landscape.
Alena Touchet is seeking an opportunity that utilizes her skills and provides room for advancement. She has over 10 years of work experience in various roles including cashier, cleaner, caregiver, and seamstress. Her skills include proficiency with Word, Excel, and PowerPoint as well as money management. She is diligent, works well with others, and is prompt, honest, and dependable.
Carestream is committed to providing X-ray solutions that meet the unique needs of pediatric patients and governmental guidelines for pediatric imaging. Our products keep the needs of children in mind throughout the imaging chain. See how Carestream can help you meet your goals for X-rays for children.
For more information on Carestream solutions for Pediatrics visit: http://www.carestream.com/pediatrics
Digital Picture Archiving and Communication Systems (PACS) have led to significant efficiencies and cost savings for Canadian hospitals by eliminating film-based radiology systems. PACS have reduced costs by over $1 billion annually through eliminating expenses associated with film and film processing. PACS have also improved productivity equivalent to adding 500 radiologists by allowing fast access to medical images anywhere, reducing duplicate exams, and speeding diagnosis and treatment. However, rising demand for medical imaging poses ongoing challenges for cost containment despite these savings. Efforts are underway to connect local and regional PACS to create a pan-Canadian diagnostic imaging system and establish common standards.
eBook - Top Six Ways an Integrated EDR Improves Your Health CenterNextGen Healthcare
If you have doubts about whether you need an electronic dental record (EDR), look no further. This eBook packs the punch you need to see how the right EDR can really revolutionize your practice.
Dell Medical School at The University of Texas at Austin
began planning for the launch of its specialty clinics. The school’s Design Institute for Health was asked to design the service model & the physical layout of the clinic.
Dental informatics is the application of computer and information science to improve dental practice, research, education, and management. It draws upon fields like cognitive science, computer science, information science, and telecommunications. Dental informatics can improve the effectiveness, efficiency, quality of care, patient experience, and office management through applications like electronic oral health records, digital radiography, 3D imaging and modeling, teledentistry, and dental education simulations. Challenges include ensuring quality information, provision of care, licensure, reimbursement, and defining emerging roles for professionals with new technologies.
This PPT explains about how Singapore is using IT in healthcare, Integrated Health Information Systems, Singapore's Shifting Demographics and 2020 Master Plan. For more information visit: http://www.transformhealth-it.org/
The document provides an overview of telemedicine case studies, including both successful and unsuccessful implementations. A successful Alaskan telemedicine program collaborated between multiple organizations to provide remote breast cancer counseling using video conferencing. Patients reported high satisfaction rates. However, a proposed telemedicine program in remote Beaver Island, Michigan failed due to a lack of technical infrastructure, administrative support, and long-term funding. The document emphasizes the importance of a co-creation model to define needs through collaboration between patients, providers, and organizations.
The Story of the Imaginary Dental Group : Region 8Dave Edmiston
The document discusses implementing an antioxidant scanner in a dental practice. It describes how the scanner works, the benefits it provides to patients and the practice, and how to incorporate it into office workflow. It would generate revenue from scan fees and commissions from recommended supplements. The dental assistants and receptionists would be trained to perform scans and schedule follow-ups. They would receive bonuses based on the number of scans and patients starting supplements. The practice owners believed the scanner would establish them as leaders in preventative care and generate substantial income over time.
John Ribchester: Community integrated health careNuffield Trust
Whitstable Medical Practice has developed a model of community integrated healthcare to address the growing health needs of its aging population. The practice has expanded services to include diagnostics, outpatient clinics, therapies, screening, and minor procedures delivered on site or through partnerships. This has resulted in cost savings up to 63% compared to traditional referrals, shorter wait times, and improved patient experience. The practice has also strengthened partnerships to coordinate long-term condition management, urgent care, and rehabilitation services. While this model has benefits, expanding it would require overcoming obstacles such as practice consolidation, facility upgrades, and gaining support from clinical commissioning groups and other stakeholders.
Virtual reality in health care by Rabeendra Basnetरविन्द्र बस्नेत
Virtual Reality in Healthcare in terms of preventive, curative and restorative and rehabilitative purpose in the physical, virtual, Ambient and Augmented Reality through computer generation enviroments.
The University of Washington Medical Center in Seattle has successfully increased radiology department productivity through strategic deployment of technology and process improvements. They now complete 15-20% more exams annually with 10 fewer full time employees. This is due in large part to their strong technology partnership with GE Healthcare and use of Centricity RIS/PACS solutions, which have doubled or quadrupled functionality over recent years. The medical center serves as a model for maximizing efficiency through data-driven decisions and optimized workflows enabled by integrated imaging technologies.
Orthopedics Northwest implemented Dragon Medical Practice Edition speech recognition software along with their NextGen EHR to improve documentation workflows. This reduced annual transcription costs by $75,000 and increased revenue from more thorough notes. Physicians could generate notes 1% faster which improved cash flow. Administrative overhead was reduced from 46% to 43%. Referring physicians also responded positively to the more comprehensive notes created with Dragon Medical.
Digital radiography (DR) has transformed pediatric radiology by reducing radiation dose, imaging costs, and patient turnaround times compared to film-screen radiography and computed radiography. DR allows images to be acquired digitally and viewed immediately, improving workflow efficiency. Studies have shown average turnaround times for skeletal exams decreased from 12 minutes with film-screen radiography to 3 minutes with DR. Faster turnaround times with DR have improved relations between radiology and clinical services by keeping pace with busy clinics. Phoenix Children's Hospital transitioned exclusively to DR and saw these benefits firsthand with the installation of multiple DR units, including one with a dual-detector configuration.
A Tale of Two Hospitals—How Dynamic Healthcare Economics in Belgium Hastens N...Dana Gardner
Transcript of a discussion on how two Belgian hospitals are adjusting to dynamic healthcare economics by leveraging the multilevel benefits of composable infrastructure and pay-as-you-go buying options for data centers.
This document provides an overview and agenda for the iHT2 2013 Health IT Summit opening keynote. The keynote covers the impact of meaningful use on health IT and driving better healthcare, better health, and reduced costs. It also discusses innovation and transformation in health IT, including increasing venture capital funding and the growing size of the health IT industry. The keynote then focuses on the Sharp health system's journey in developing population health strategies and using technologies like their patient portal and health information exchange. It closes by emphasizing that health reform has catalyzed the need for care models that demand health IT and technology.
The radiology department at
Baton Rouge General Medical
Center takes pride in using
advanced technologies to offer
top-notch care to patients and
unparalleled service to referring
physicians.
Singapore’s National EHR - Adaptive Architecture for Transformation and Innov...Peter Tan
The document discusses Singapore's national electronic health record system. It provides context on Singapore's healthcare ecosystem, including demographics and existing initiatives. It outlines Singapore's vision for an integrated healthcare system, with the goal of establishing a pyramid model anchored by regional hospitals that provides step-down care and links acute hospitals to community hospitals and services.
This video describes Intellimessage, a system for generating tailored medical messages to patients through the creation of individualized health profiles. The system matches patient data and preferences with clinical records to create personalized messages that improve health outcomes. It aims to reduce preventable hospital readmissions through evidence-based, tailored post-care messaging. The company was founded by a multidisciplinary team from the University of Kentucky, including a principal investigator, research assistants, an engineering student, and a successful entrepreneur.
The Story of the Imaginary Dental GroupDave Edmiston
How a small dental group in Texas made a tremendous difference by helping its patients prevent periodontal disease and its 53 associated medical problems.
This document provides an overview of methane hydrates and their potential as an energy source. Methane hydrates contain vast quantities of natural gas trapped in ice-like structures on the ocean floor and in Arctic permafrost. While challenging to extract economically, methane hydrates may hold more energy than all other fossil fuel reserves combined. Companies are working to develop technologies to locate and extract methane from hydrates. Sensors to detect dissolved methane are helping map hydrate deposits and advance extraction methods. Developing methane hydrates could reshape the global energy landscape.
Alena Touchet is seeking an opportunity that utilizes her skills and provides room for advancement. She has over 10 years of work experience in various roles including cashier, cleaner, caregiver, and seamstress. Her skills include proficiency with Word, Excel, and PowerPoint as well as money management. She is diligent, works well with others, and is prompt, honest, and dependable.
Laurinda Abbie has over 15 years of experience as both a Licensed Vocational Nurse and Registered Nurse, with additional training as a Medical Aesthetician. She has worked in a variety of medical settings including schools, long-term care facilities, hospitals, clinics, and psychiatric units. Laurinda also has experience teaching nursing students and instructing CPR/AED and nursing assistant courses. She holds a Bachelor's degree in Nursing from Texas Tech University and licenses in both nursing and medical aesthetics.
This document is a resume for Jacob Jean P.A. It provides his personal details like date of birth, address, languages known, education qualifications and skills. It lists his work experience as a freelance trainer and faculty member. It also describes several web development projects he worked on as a team member at Astoria Software Exports Pvt. Ltd., building dealership websites using ASP.Net, SQL Server and VB.Net.
Joseph Popowich is a highly motivated casino industry leader with over 40 years of experience, including positions as a Pit Supervisor, Table Games Director, and General Manager. He has a strong track record of leadership, communication, budgeting, and developing staff. Most recently he has worked as a swing shift Pit Supervisor at Pechanga Resort and Casino since 2015, where he previously spent 14 years as a Pit Supervisor at Pala Resort and Casino, helping to open that casino in 2001.
The document provides details on the components needed to build a custom PC, including a mid-tower case, motherboard, power supply, CPU, DVD ROM, hard drive, and RAM. It lists the specifications and price for each component, such as an ASUS AM3+ motherboard for $78.24, AMD FX-6300 six-core CPU for $109.99, Rosewill 600W power supply for $54.99, and 8GB of G.SKILL DDR3 RAM for $74.99. The total cost of all components comes to $493.18.
The document provides instructions for projecting plane figures by:
1. Describing the plane figure and its position relative to the horizontal and vertical planes.
2. Projecting the figure in three steps: initial position, surface inclination, and side/edge inclination.
3. Key assumptions are made for the initial position depending on whether the surface is parallel to the horizontal or vertical plane.
4. Worked examples are provided to demonstrate projecting figures with different combinations of surface and side/edge inclinations.
Wavelength September 2014 Volume 18 No 2Jerry Duncan
The McLaren Health Care system and Barbara Ann Karmanos Cancer Institute have joined forces to create an integrated statewide cancer care network in Michigan. They have selected Elekta's oncology information system, MOSAIQ, to connect their facilities and provide patient-centered, coordinated care across the network. Implementing a common information system with clinical decision support tools and real-time data analytics will help the network standardize care, reduce variability, and monitor and improve quality of care. The goal is to efficiently deliver comprehensive, high-quality cancer treatment throughout the state.
Wavelength February 2012 Volume 16 No. 1Jerry Duncan
1) Elekta recently acquired Nucletron, the world leader in brachytherapy, consolidating its position as a complete provider of radiation oncology.
2) Brachytherapy involves placing a radiation source inside or next to the tumor, allowing high doses to be delivered over a short period while minimizing side effects.
3) Brachytherapy is often used in combination with other therapies like surgery and external beam radiation for cancers of the prostate, breast, gynecological organs, and is being studied for use in additional cancers and treatment combinations.
Wavelength February 2011 Volume 14 No.1Jerry Duncan
The document is a newsletter from Elekta that discusses:
1) Elekta's vision to provide the best technology and service in the industry with a commitment to open systems.
2) Elekta plans to consolidate trusted brands it has acquired under a single Elekta brand to provide a cohesive identity for customers.
3) The newsletter highlights two case studies of cancer centers that have implemented comprehensive Elekta solutions, including the Instituto do Cancer do Estado de Sao Paulo in Brazil and The Roy and Patricia Disney Family Cancer Center in the US.
Elekta's Versa HD linear accelerators provide Odense University Hospital the speed needed to routinely perform stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) for multiple patients per week. Versa HD's high dose rate mode and fast-moving leaves reduce treatment times by 60%, allowing lung SBRT to be delivered in about 3 minutes and brain SRS in 20 minutes. This efficiency has led OUH to treat over 250 patients with SBRT/SRS annually since acquiring Versa HD in 2013.
This document summarizes the experience of Odette Cancer Centre in evaluating and implementing Elekta VMAT for prostate cancer patients. Key points:
1) Planning studies showed VMAT could significantly reduce treatment delivery times for prostate cases compared to IMRT and tomotherapy, without compromising dosimetry.
2) After extensive commissioning and quality assurance testing, Odette began treating their first prostate cancer patients with VMAT in 2011.
3) Initial results confirmed VMAT decreases treatment time from around 6 minutes for IMRT to around 90 seconds for a single-arc VMAT plan.
4) Faster treatment times with VMAT are expected to allow Odette to treat more patients per
The document discusses the physician voice in adopting new technologies like electronic medical records (EMRs). It notes that the physician voice has both an external role advocating for patients and an inner role considering personal impacts. Successful adoption requires addressing physician concerns about privacy, workload, and local needs through collaboration between physicians and other stakeholders. It outlines models used in Vancouver Coastal Health to engage physicians through user groups and champions to provide feedback and guide implementation.
The document summarizes the introduction of a new linear accelerator called Versa HDTM by Elekta. Key points:
- Versa HD provides unmatched versatility by converging conventional radiotherapy with advanced stereotactic precision.
- It offers flexibility to deliver a wide range of conventional and complex cancer treatments using a single platform.
- New technologies like a flattening filter-free beam and ultra-fast leaf speeds enable faster dose delivery for advanced therapies like stereotactic radiosurgery and stereotactic body radiation therapy.
Healing Arts - 2014 Annual Cancer ReportCone Health
The document provides an annual report on cancer care from Cone Health Cancer Center in 2014. It summarizes the expansion of facilities at Alamance Regional Medical Center including additional exam rooms, treatment rooms, and chemotherapy areas. It describes new radiation equipment and a partnership with Randolph Hospital to provide cancer care. It discusses innovations using imaging technology to improve radiation treatment accuracy and safety. The report provides data on cancer cases and treatment outcomes, showing Cone Health exceeds quality benchmarks compared to other cancer programs.
Launching Exilis nonsurgical face lift on Monday 20th January 2014. No pain no downtime 50% OFF. For more details visit us http://www.ojasaesthetic.com/face-procedures-facelift.html
Discover the future of cancer care at Apollo Proton Cancer Centre. Leading the way in medical oncology with advanced treatments for a brighter tomorrow.
Nuclear medicine focuses on physiological processes within the body, such as chemical activities or metabolism rates. Physicians at health centers and medical clinics in Abu Dhabi prefer nuclear medicine as a tool for medical diagnosis and analysis.
For more details visit : www.aesmc.com
We welcomed Dr. Andrew Feifer for a presentation about Ned, an app designed specifically for prostate cancer patients, as well as a discussion about the incorporation of data driven smart technology in the survivorship of cancer patients.
The webinar was followed by an interactive question & answer session.
Ned was conceptualized and co-founded by our webinar presenter: Dr. Andrew Feifer, a Urologic Surgical Oncologist at Trillium Health Centre in Toronto. Dr. Feifer evisioned a tool that would empower prostate cancer survivors by putting their health into their own hands and giving them more options to manage their own care.
Vidyo helped REACH Health Effectively Handle Emergency CareVidyo, Inc.
REACH Health is at the forefront of delivering patient care with telemedicine platform, especially in acute and emergency scenarios. Bringing expert healthcare teams and remote patients together for better interactions and healthcare workflow was a challenge.
Vidyo’s software based video conferencing capabilities was integrated into REACH telehealth system which allows physicians to connect with patients in no time. REACH Health is equipped with time immediate physician assistance possibility in the area of telestroke using Vidyo’s video conferencing platform.
More about Vidyo’s telemedicine solutions: http://www.vidyo.com/solutions/healthcare/
Sharing about “A typical day in the life as Radiation Therapy Technologist (RTT)” includes their roles, responsibilities, duties, working protocols, management, working stress, daily challenges in this modern radiotherapy era. As well as a bit information about how to become a RTT in India.
Roots international magazine of endodontology vol 9 issue 4 2013RPCendo
This article discusses the importance of proper diagnosis for successful endodontic treatment. The root canal system is complex with multiple branches that must be cleaned and debrided. Making an accurate diagnosis requires a multifocal approach considering the patient's report, history, clinical signs and symptoms, diagnostic tests, radiographs, and restorability of the tooth. Repeated practice is needed to develop the skills and confidence for endodontic treatment. The key is to use common sense and fully understand the root canal anatomy to achieve an effective cleaning and sterilization of the root canal system.
Theralase Technologies Inc., founded in 1995, designs, develops, manufactures and markets patented, superpulsed laser technology utilized in biostimulation and biodestruction applications. Theralase technology is safe and effective in treating pain, inflammation and for tissue regeneration of neural muscular skeletal conditions and wound healing. As well, these applications extend to the care of animals by veterinarians. Theralase is currently developing patented Photo Dynamic Compounds (PDCs) that are able to target and destroy cancers, bacteria and viruses when light activated by Theralase’s proprietary laser technology.
The document describes the Elekta Infinity linear accelerator system. It highlights its flexibility to treat a wide range of anatomical sites, its high definition beam shaping capabilities, fast leaf speeds, and advanced image guidance tools. It emphasizes its ability to efficiently treat complex cases while reducing treatment times and non-therapeutic dose.
Technology has revolutionized the medical field. Where medicine was once basic, modern testing equipment like X-rays, MRIs, and CT scans now provide detailed diagnoses. Successful transplants were once rare but pills now cure many diseases and transplants have higher success rates. Digitization also connects medical records globally and gives doctors access to more diagnostic information. Emerging technologies like 3D bioprinting of organs and robotic exoskeletons promise further advances, showing how technology continuously transforms medicine.
First of its kind in South India GE IQ PET/CT at MIOT HospitalsMIOT Hospitals
MIOT Hospitals provides nuclear medicine services including PET/CT scanning and targeted radionuclide therapy for cancers such as thyroid cancer, neuroendocrine tumors, and liver cancers. The department is equipped with a radionuclide therapy ward and offers therapies including radioiodine for thyroid cancer, radioiodinated MIBG for rare tumors, peptide receptor radionuclide therapy for neuroendocrine tumors, and radioembolization for liver cancers. MIOT aims to offer complete cancer care from diagnosis to rehabilitation all in one facility.
Similar to Wavelength March 2014 Volume 18 No. 1 (20)
This article discusses how Dr. Russell Low at Sharp and Children's MRI Center in San Diego has added whole-body diffusion-weighted imaging (DWI) to their abdominal and pelvic MRI protocol. DWI helps highlight abdominal pathology that may be invisible on other sequences, such as enlarged lymph nodes. Technical challenges of DWI in the body like susceptibility artifacts and motion have been addressed through an optimized rapid DWI sequence with short breath holds. DWI helps radiologists more quickly detect tumors, inflammatory diseases, and lymphadenopathy. It provides a new way to visualize disease states and helps guard against false positives from other sequences.
1) Three clinical sites that use SmartExam report benefits in workflow efficiency and scan consistency. SmartExam allows fully automated planning, scanning and post-processing of brain exams.
2) Saint Barnabas in New Jersey has performed over 1,000 brain scans with SmartExam, finding reproducibility advantages for follow-up scans and between patients. Training technicians is also easier.
3) A study at Saint-Luc University Hospital in Belgium found SmartExam performed as well as manual planning for knee exams, with quick and reliable automatic planning.
4) A 400-patient study at Maggiore della Carità Hospital in Italy found SmartExam reduced neuro exam times by an average of 5.2 minutes, a 30
The document discusses the use of MultiTransmit and SmartExam Breast technologies on a Philips Achieva 3.0T TX scanner at Fletcher Allen Health Care for breast imaging. When Fletcher Allen originally upgraded to a 3.0T scanner, image quality was inconsistent due to field inhomogeneities in different patients. SmartExam Breast simplifies workflow by automatically planning scans and optimizing shimming, resulting in excellent and reproducible fat saturation. MultiTransmit further improves image uniformity in non-fat saturated images. Both technologies help address challenges of 3.0T breast imaging and improve workflow and image quality.
WBRT vs GK Surgery_Cooper Univ_1507167_WhitePaper1Jerry Duncan
This document summarizes a study comparing the dosimetric advantages of Gamma Knife stereotactic radiosurgery (SRS) versus whole brain radiation therapy (WBRT) for treating multiple brain metastases. Investigators at Cooper University Hospital analyzed treatment plans for two patients with 13 and 16 brain metastases, respectively. They found SRS delivered a much higher biological effective dose to the tumor targets compared to WBRT, while doses to critical brain structures were significantly lower with SRS. This dosimetric advantage suggests SRS may provide superior local tumor control with fewer radiation-induced toxicities compared to WBRT for patients with multiple brain metastases.
Wavelength September 2013 Volume 17 No.2Jerry Duncan
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help boost feelings of calmness, happiness and focus.
1) Fortis Memorial Research Institute in India upgraded their radiation therapy workflow by transitioning from a purely paper-based system to a completely digital system using MOSAIQ Oncology Information System.
2) This transition streamlined their workflow, improved patient safety and efficiency by eliminating errors from manual paper processing, and provided staff with easy access to patient information and the ability to track workflow from any computer.
3) It took some time and training for staff to adjust to the new digital system, but they now appreciate the value it provides in better coordinating care and improving communication across the department.
Wavelength October 2015 Volume 19 No. 2Jerry Duncan
This article discusses the first clinical uses of Elekta's new Leksell Gamma Knife Icon system at University Hospital La Timone in Marseilles, France. The Icon allows for frameless Gamma Knife radiosurgery using a mask for head fixation rather than the traditional rigid frame. The first patient was treated on August 10th for a brain metastasis using this frameless approach. Additional patients were also treated for metastases. On August 17th, the first patient began a multi-session, hypofractionated treatment for a meningioma using the frameless approach. The Icon's advanced motion management and imaging capabilities enable these frameless treatments by precisely reproducing the patient's position over multiple sessions.
The document summarizes the implementation of Elekta's cancer management solutions across McLaren Health Care's network of 18 cancer centers. Key points include:
- Over one year, teams deployed a single EMR across community sites, a cancer registry in Elekta's cloud, and nearly 400 care plans. Hardware like a new linear accelerator was also installed.
- Transitioning to the EMR required hundreds of staff to dedicate time to ensure standardization and quality of care across sites as patients move throughout the network.
- Implementation involved multiple phases from 2014-2015, including merging discrete tumor registry databases into a single cloud-based system in June 2014.
1. Vol. 18 | No. 1 | March 2014
Pioneering Significant Innovations in Clinical Solutions
for Treating Cancer and Brain Disorders
In this issue
First US patients
receive Esteya®
electronic
brachytherapy
Versa HD™
boosts
VMAT efficiency
Bothwell Regional
Health Center: ease
of conversion
MEG sharpens focus
on human vision
4. 4
First US patients receive Esteya®
electronic brachytherapy
On January 14, 67-year-old retired
telecommunications company executive
Thomas Roberts received his last Esteya®
electronic brachytherapy session to treat a
squamous cell carcinoma on his right hand.
Mr. Roberts was the first patient in the
United States to receive Esteya treatment, which
was delivered at a Los Gatos, California clinic
by Rakesh Patel, MD, Medical Director at The
Targeted Radiation Institutes (Bay Area, Calif.).
Since Mr. Roberts began treatment in late
December, Dr. Patel has added nine additional
patients to the Esteya schedule.
Esteya electronic brachytherapy is a form of high
dose rate (HDR) brachytherapy that brings an
electronic brachytherapy source in close proximity
to the cancerous site. Its direct delivery enables
Esteya to focus more therapeutic radiation on the
disease target and to minimize radiation to
surrounding tissues and organs. The therapy
typically is delivered over six to eight treatments,
twice per week.
Dr. Patel presented Mr. Roberts with a variety of
options to treat his hand lesion, chief among these were
Mohs surgery and Esteya electronic brachytherapy.
“The hand is traditionally a very difficult place
to treat because of healing potential issues,” he says.
“In Mr. Roberts’s case, I want to stress that cosmetic
issues were not the main concern – it was about
form and function. The skin on the hand is very
thin and there are nerves and tendons that we want
to avoid the risk of damage that surgery potentially
incurs. I recommended – and Mr. Roberts agreed
– that electronic brachytherapy was a good option.
It’s pain-free, non-invasive and takes just a few
minutes per fraction.”
Mr. Roberts was treated from late December 2013
to January 14, 2014.
“Each Esteya treatment was very quick and
efficient and I had no pain whatsoever,” he recalls.
“I wouldn’t hesitate to have this procedure again.”
A few weeks after his final Esteya session, Mr.
Roberts is surprised and pleased with the results.
“The healing process began very quickly,” he
says. “I’m looking at it now and the site where the
lesion was looks completely flat and the skin is
starting to come back to its normal color. It’s
moving along extremely well. As a retired person,
it hasn’t interfered with my golf or tennis game
at all.”
Simple and refined
Dr. Patel, past president of the American
Brachytherapy Society, adds that in comparison to
Thomas Roberts, first patient in US to receive Esteya treatments by Rakesh Patel, MD, Medical
Director at The Targeted Radiation Institutes, Los Gatos, CA
It’s pain-free,
non-invasive
and takes just
a few minutes
per fraction.”
5. 5
other HDR brachytherapy systems, Esteya offers a
combination of simplicity and refinement.
“Esteya has significant advantages over current
brachytherapy technology,” he observes. “The quality
assurance process is robust and efficient, requiring
only a once-daily, two-minute QA. In other systems,
QA must be done not only for every source in every
machine, but also for every single patient every time
they come in, which decreases clinic efficiency.”
He adds that the durability of the Esteya source
throughout the day and throughout the patient’s
treatment course is a significant advantage in the
Esteya system. The Esteya source is expected to last
for 4,000 fractions (i.e., 12,000 minutes) which is
15 times greater than existing technology.
“We’re not used to disposable sources in radiation
oncology,” Dr. Patel notes. “In that respect, Esteya is
more akin to existing high dose rate technology in,
for instance, Elekta’s microSelectron® system. Esteya
has reintroduced the concept of durable radiation
output for electronic brachytherapy, and that removes
some of the variability day to day and patient to
patient.”
More importantly, from a patient welfare
perspective, electronic brachytherapy as a modality
can control the dose and minimize the exposure to
underlying critical structures relative to electron
beam radiation and superficial radiotherapy, he adds.
A typical course of electronic brachytherapy includes
six to eight short visits often twice a week, compared
to up to six weeks for other radiation modalities.
“Superficial radiotherapy employs a similar
energy range as electronic brachy, but the source to
skin distance in superficial, orthovoltage or electron
beam radiotherapy is greater, which translates into
higher doses at depth,” Dr. Patel observes. “The way
this technology is configured – if you’re trying to
treat a small, superficial skin lesion, like a skin cancer,
particularly in a cosmetically sensitive area such as
the face – you will potentially get unnecessary
collateral radiation exposure to deeper structures.
This is not the case in highly tailored electronic
brachytherapy.
“Electronic brachytherapy systems,” he continues,
“present a tremendous opportunity to extend the
reach of brachytherapy for patients with skin cancer
beyond cancer centers and radiation facilities.” l
FOR MORE INFORMATION
visit www.esteya.com
Case study details and patient photos for this patient provided by Dr. Rakesh Patel.
Post-treatment
6. Vivian Cosgrove, PhD, Head of Radiotherapy Physics
Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
Leeds Cancer Centre is among Europe’s largest cancer treatment centers, serving a catchment
population in Yorkshire of 2.8 million. Radiotherapy facilities include three CT-simulators with 4D CT
capability, 10 Elekta linear accelerators, a dedicated brachytherapy suite with theatres for high dose rate
(HDR) treatment and I125
seed implants, and an Xstrahl orthovoltage (kV) unit. Today, the centre delivers
over 7,500 new radiotherapy treatment courses annually.
A research suite also was established in the center, comprising two Elekta Synergy® linear accelerators.
This facility provides a platform for developing and evaluating novel radiotherapy equipment and delivery
techniques. One of these linear accelerators is used primarily for radiation physics research and equipment
development in partnership with Elekta. The second accelerator is used for translating these developments
into clinical research programs and ultimately into routine clinical practice. This was instrumental in
establishing a Stereotactic Body Radiation Therapy (SBRT) program in Leeds for the treatment of inoperable
non-small cell lung cancer1
. Leeds now has the largest clinical service for this treatment in the UK, with over
600 patients treated to date. The linear accelerator technology that has facilitated this new program – Agility™
MLC and flattening filter-free (FFF or High Dose Rate mode) – is part of Elekta’s new Versa HD system.
Technology in VersaHD™
boosts VMAT efficiency
THE LEEDS CANCER CENTRE EXPERIENCE
6
Technology in VersaHD™
boosts VMAT efficiency
Vivian Cosgrove, PhD, Head of Radiotherapy Physics
Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
Leeds Cancer Centre is among Europe’s largest cancer treatment centers, serving a catchment
population in Yorkshire of 2.8 million. Radiotherapy facilities include three CT-simulators with 4D CT
capability, 10 Elekta linear accelerators, a dedicated brachytherapy suite with theatres for high dose rate
(HDR) treatment and I125
seed implants, and an Xstrahl orthovoltage (kV) unit. Today, the centre delivers
over 7,500 new radiotherapy treatment courses annually.
A research suite also was established in the center, comprising two Elekta Synergy® linear accelerators.
This facility provides a platform for developing and evaluating novel radiotherapy equipment and delivery
techniques. One of these linear accelerators is used primarily for radiation physics research and equipment
development in partnership with Elekta. The second accelerator is used for translating these developments
into clinical research programs and ultimately into routine clinical practice. This was instrumental in
establishing a Stereotactic Body Radiation Therapy (SBRT) program in Leeds for the treatment of inoperable
non-small cell lung cancer1
. Leeds now has the largest clinical service for this treatment in the UK, with over
600 patients treated to date. The linear accelerator technology that has facilitated this new program – Agility™
MLC and flattening filter-free (FFF or High Dose Rate mode) – is part of Elekta’s new Versa HD system.
Technology in VersaHD™
boosts VMAT efficiency
THE LEEDS CANCER CENTRE EXPERIENCE
6
7. Volumetric Modulated Arc Therapy (VMAT)
An early focus of the research program was the development of VMAT, the fast, arc-based method for
delivering IMRT. It was recognized in 2010 that the UK’s adoption of IMRT was lagging behind much
of Europe, leading to several initiatives to increase the UK availability of the technique, so that at least
24 percent of all radical treatments were delivered using IMRT2
. In Leeds, calculations based on initial
experience using step-and-shoot IMRT indicated that delivering 24 percent IMRT would strain the service
due to the increased time required to deliver an IMRT fraction compared to standard CRT (Table 1).
However, the evaluations on the research accelerators demonstrated that VMAT would reduce the time
taken to deliver a treatment course, which is consistent with early adopters’ experience3
.
Technique
No.
Treatment
fractions
Set-up time
(min)
Imaging
(min)
Treatment
delivery
(min)
Room exit
(min)
Total time
per patient
(min)
Linac time
for 320
patients
(hours)
Time
demands
relative to
standard
CRT (Hrs)
3D CRT 37 4 4 4 1 369 1968 -
IMRT 37 4 4 8 1 517 2757 +789
VMAT 37 4 4 3 1 332 1771 -197
Table 1: Time taken to deliver radical radiotherapy for prostate carcinoma. Therefore, to increase patient access to IMRT in the
Leeds Cancer Centre, and achieve better equipment utilization, a program to upgrade linacs in the center to deliver VMAT was
implemented. This was completed in 2013, helped in part by the national Radiotherapy Innovations Fund4
.
Agility™ multi-leaf collimator
Another project carried out in Leeds in partnership with Elekta was the evaluation and clinical
implementation of the first Agility MLC5-6
. The unique features of Agility have improved IMRT delivery.
These features include field shaping over a maximum field size of 40 cm x 40 cm with 160 leaves that can
individually move by up to 6.5 cm per second. The final production head was installed in January 2012
and received CE marking in April 2012, when first clinical treatments started in Leeds.
A chief objective was to use Agility to deliver SBRT for inoperable non-small cell lung cancer (NSCLC) using
VMAT. SBRT enables high-doses of radiation to be precisely targeted to the tumor with a sharp dose fall-off
beyond the volume, thereby reducing the dose to normal, healthy tissue. Radiotherapy can then be delivered
in high-dose hypofractionated sessions. In terms of local control and survival, considerable non-randomized
evidence supports SBRT as superior to conventional radiotherapy for medically inoperable NSCLC7
. This is
achieved with fewer visits to the hospital (3-8) compared to a conventionally-fractionated approach (up to 30).
Initial work using Agility and VMAT demonstrated that lung SBRT could be delivered much faster than
standard SBRT with fixed conformal beams (Table 2). Standard SBRT might require seven fixed beams and eight
to nine minutes of beam-on time, whereas SBRT with Agility VMAT typically required around three minutes
of beam delivery time. The reduced delivery time was found to be more tolerable for patients, while minimizing
the risks of patient movement during treatment. Therefore the technique was seen to improve the overall patient
experience and reduce clinical risks.
3D CRT
(MLCi, XiO Planned)
Agility VMAT
Monaco v3.2 Planned
Agility VMAT with High
dose rate (FFF)
Monaco v3.3 Planned
Average measured
beam-on times per 11 Gy
fraction (seconds) ± 1SD
516 ± 109 183 ± 20 106 ± 9
Table 2: Comparison of beam-on times using different SBRT delivery techniques. A five patient average; initially planned and
treated with 3D CRT using an MLCi2, 6 MV on an Elekta Synergy accelerator. Plans were to treat inoperable lung cancer with
SBRT, 55 Gy in five fractions. All patients were re-planned with Agility VMAT and then Agility VMAT with high dose rate,
flattening filter-free or FFF. VMAT plans were delivered on the same Synergy accelerator using 6 MV and 6 MV FFF.
Dosimetrically, all plans met the dose-volume targets and constraints defined by the UK SBRT consortium8
.
Flattening filter-free High Dose Rate mode delivery
Another joint Leeds-Elekta project was the development of FFF delivery for clinical use. By removing
the flattening filter from the linear accelerator, dose rates of up to two to three times greater than those
of standard, flattened beams can be achieved9
. Advanced treatment planning technology can then be used
to modulate the non-flat, high dose rate treatment beams so that highly conformal, VMAT dose
distributions can be achieved but with a reduced delivery time.
7
Volumetric Modulated Arc Therapy (VMAT)
An early focus of the research program was the development of VMAT, the fast, arc-based method for
delivering IMRT. It was recognized in 2010 that the UK’s adoption of IMRT was lagging behind much
of Europe, leading to several initiatives to increase the UK availability of the technique, so that at least
24 percent of all radical treatments were delivered using IMRT2
. In Leeds, calculations based on initial
experience using step-and-shoot IMRT indicated that delivering 24 percent IMRT would strain the service
due to the increased time required to deliver an IMRT fraction compared to standard CRT (Table 1).
However, the evaluations on the research accelerators demonstrated that VMAT would reduce the time
taken to deliver a treatment course, which is consistent with early adopters’ experience3
.
Technique
No.
Treatment
fractions
Set-up time
(min)
Imaging
(min)
Treatment
delivery
(min)
Room exit
(min)
Total time
per patient
(min)
Linac time
for 320
patients
(hours)
Time
demands
relative to
standard
CRT (Hrs)
3D CRT 37 4 4 4 1 369 1968 -
IMRT 37 4 4 8 1 517 2757 +789
VMAT 37 4 4 3 1 332 1771 -197
Table 1: Time taken to deliver radical radiotherapy for prostate carcinoma. Therefore, to increase patient access to IMRT in the
Leeds Cancer Centre, and achieve better equipment utilization, a program to upgrade linacs in the center to deliver VMAT was
implemented. This was completed in 2013, helped in part by the national Radiotherapy Innovations Fund4
.
Agility™ multi-leaf collimator
Another project carried out in Leeds in partnership with Elekta was the evaluation and clinical
implementation of the first Agility MLC5-6
. The unique features of Agility have improved IMRT delivery.
These features include field shaping over a maximum field size of 40 cm x 40 cm with 160 leaves that can
individually move by up to 6.5 cm per second. The final production head was installed in January 2012
and received CE marking in April 2012, when first clinical treatments started in Leeds.
A chief objective was to use Agility to deliver SBRT for inoperable non-small cell lung cancer (NSCLC) using
VMAT. SBRT enables high-doses of radiation to be precisely targeted to the tumor with a sharp dose fall-off
beyond the volume, thereby reducing the dose to normal, healthy tissue. Radiotherapy can then be delivered
in high-dose hypofractionated sessions. In terms of local control and survival, considerable non-randomized
evidence supports SBRT as superior to conventional radiotherapy for medically inoperable NSCLC7
. This is
achieved with fewer visits to the hospital (3-8) compared to a conventionally-fractionated approach (up to 30).
Initial work using Agility and VMAT demonstrated that lung SBRT could be delivered much faster than
standard SBRT with fixed conformal beams (Table 2). Standard SBRT might require seven fixed beams and eight
to nine minutes of beam-on time, whereas SBRT with Agility VMAT typically required around three minutes
of beam delivery time. The reduced delivery time was found to be more tolerable for patients, while minimizing
the risks of patient movement during treatment. Therefore the technique was seen to improve the overall patient
experience and reduce clinical risks.
3D CRT
(MLCi, XiO Planned)
Agility VMAT
Monaco v3.2 Planned
Agility VMAT with High
dose rate (FFF)
Monaco v3.3 Planned
Average measured
beam-on times per 11 Gy
fraction (seconds) ± 1SD
516 ± 109 183 ± 20 106 ± 9
Table 2: Comparison of beam-on times using different SBRT delivery techniques. A five patient average; initially planned and
treated with 3D CRT using an MLCi2, 6 MV on an Elekta Synergy accelerator. Plans were to treat inoperable lung cancer with
SBRT, 55 Gy in five fractions. All patients were re-planned with Agility VMAT and then Agility VMAT with high dose rate,
flattening filter-free or FFF. VMAT plans were delivered on the same Synergy accelerator using 6 MV and 6 MV FFF.
Dosimetrically, all plans met the dose-volume targets and constraints defined by the UK SBRT consortium8
.
Flattening filter-free High Dose Rate mode delivery
Another joint Leeds-Elekta project was the development of FFF delivery for clinical use. By removing
the flattening filter from the linear accelerator, dose rates of up to two to three times greater than those
of standard, flattened beams can be achieved9
. Advanced treatment planning technology can then be used
to modulate the non-flat, high dose rate treatment beams so that highly conformal, VMAT dose
distributions can be achieved but with a reduced delivery time.
7
8. Again, SBRT VMAT treatments were prioritized for the high dose rate, FFF treatment deliveries. The
high doses per fraction (up to 16 Gy) were considered ideally suited to benefit from the higher dose rates now
attainable. Initial experience demonstrated a reduction in treatment beam-on times down to less than two
minutes for an 11 Gy irradiation (Table 2). Leeds began high dose rate, VMAT SBRT clinical treatments in
February 2013. One of the first patient treatments was featured in an Al Jazeera documentary program10
.
Versa HD in action
In March 2013, Elekta unveiled Versa HD, a system that unites Agility, High Dose Rate mode (FFF)
and improved image guidance capabilities in a single platform. Soon after the unveiling, negotiations
commenced between Leeds Teaching Hospitals NHS Trust, Elekta and Medipass Healthcare Ltd., the
Managed Equipment Service provider to Leeds Trust. This provided an opportunity to advance the
schedule of the PFI equipment replacement program, leading to the installation of two Versa HD
systems in Leeds. The first entered clinical service in July 2013, and the second in November 2013.
Already, the first Versa HD has had a significant impact on clinical workflow. Up to 60 patients per day
are scheduled for treatment on the new machine. Treatment slots are booked at 10 minute intervals, so that as
many as six patients can be treated per hour. Initially, patients undergoing radical prostate radiotherapy have
been prioritized for treatment, all with High Dose Rate mode VMAT. In addition, the process to move all lung
SBRT treatments to High Dose Rate mode VMAT has begun. Patients have their SBRT treatment scheduled
to a 20-minute time slot on the Versa HD.
Conclusion
In September 2013, over 25 percent of all radical treatments were delivered in the Leeds Cancer Centre
using IMRT and VMAT. This equates to around 90 new patients starting advanced radiotherapy treatment
every month. In addition, 20-25 new patients also start an SBRT course each month. This volume growth
has been greatly enhanced by opportunities to develop the techniques, delivery equipment and workflow on
the research accelerators, side-by-side with the clinical service.
The ambition for the Leeds Cancer Centre has been to make advanced radiotherapy available for more of our
patients. The release of Versa HD and the early adoption of the new accelerators at Leeds have supported further
improvements in the technical delivery of radiotherapy while also increasing productivity and efficiency. This
will help to both increase patient access to radiotherapy and to improve clinical outcomes following treatment. l
References
[1] http://www.oncologynews.biz/pdf/mar_apr_11/13-16_ONMA11_lung.pdf
[2] Williams MV, Cooper T, Mackay R, Staffurth J, Routsis D, Burnet N The implementation of intensity-modulated radiotherapy in the UK.
Clin Oncol (R Coll Radiol). 2010 22(8):623-8.
[3] Matuszak MM, Yan D, Grills I, Martinez A. Clinical applications of volumetric modulated arc therapy. Int J Radiat Oncol Biol Phys. 2010 77(2):608-16..
[4] http://www.cancerresearchuk.org/prod_consump/groups/cr_common/@nre/@pol/documents/generalcontent/rifevalreport.pdf
[5] Cosgrove VP, Thomas MDR, Weston SJ, et al. Physical characterization of a new concept design of an Elekta radiation head with integrated 160-leaf
multi-leaf collimator. Int J Radiat Oncol Biol Phys. 2009; 75(3 Suppl):S722–S723.
[6] Bedford JL, Thomas MD, Smyth G. Beam modeling and VMAT performance with the Agility 160 leaf multileaf collimator. J Appl Clin Med Phys.
2013 14(2):4136.
[7] Soldà F, Lodge M, Ashley S, Whitington A, Goldstraw P, Brada M. Stereotactic radiotherapy (SABR) for the treatment of primary non-small cell
lung cancer; Systematic review and comparison with a surgical cohort. Radiother Oncol. 2013 Oct 12. doi:pii: S0167-8140(13)00464-7.
[8] Jain P, Baker A, Distefano G, Scott AJ, Webster GJ, Hatton MQ. Stereotactic ablative radiotherapy in the UK: current status and developments.
Br J Radiol. 2013 86(1029):20130331.
[9] Georg D, Knöös T, McClean B. Current status and future perspective of flattening filter free photon beams. Med Phys. 2011 38(3):1280-93.
[10] http://www.aljazeera.com/programmes/thecure/2013/05/2013520135849935701.html
8
Members of the Leeds Cancer Centre SBRT team received
an award from the Quality in Care (QiC) Programme
in 2013. Leeds members pictured are: Dr. Kevin Franks
(second from left), followed by Dr. Vivian Cosgrove,
radiographers Helen Summers and Alan Needham,
physicist John Lilley and dosimetrist Stuart Wilson.
9. 9
My last PET
scan around
the middle of
October 2013
indicated that the
lung tumors were
80 percent gone.”
Sally Owens on vacation
Versa HD
is critical tool
in patient’s
miraculous
recovery
Elekta’s Versa HD partnered with
aggressive chemotherapy and Sally Owens’s
own indestructible positive attitude and faith
to beat back her cancer. In May 2013, the
71-year-old Dayton (Ohio, USA) resident and
retired registered nurse was diagnosed with stage
four colon cancer that had metastasized to her
liver. When a chest X-ray also revealed lung
cancer, Sally nearly gave up.
“To be told you have two primary cancers is
devastating,” she recalls. “I was to the point of
giving away possessions.”
Doctors told Sally that surgery for the lung
tumors wasn’t an option due to their location.
Kettering Medical Center Chairman of Radiation
Oncology, Douglas Einstein, MD, PhD, however,
reassured her that stereotactic radiosurgery offered
her a fighting chance.
“Chemotherapy was having a positive effect
on Sally’s colon cancer, but we needed a different
strategy to address her lung tumors, as surgery
would be too risky,” Dr. Einstein says. “Versa HD
would give us the ability to administer the
radiation very accurately and rapidly to these
tumors.”
Sally became the first in the United States
to receive radiosurgery on Kettering’s Versa HD
system.
She received five treatments to one tumor
and three treatments to the second tumor – each
under just 4.5 minutes of total beam-on time –
between September 4 and September 23, 2013.
“My last PET scan around the middle of
October 2013 indicated that the lung tumors were
80 percent gone,” she says.
In addition to the benefits of revolutionary
technology like Versa HD and advanced
chemotherapy techniques, Sally attributes her
recovery to the power of prayer and a positive
attitude.
“It’s so important to be positive and grateful
every day,” she says. “I’m a living example
of that!” l
FIRST PERSON
10. 10
Conversion creates
seamless radiotherapy
workflow
With its Siemens PRIMUS system having
operated past its lifecycle, Sedalia, Missouri’s
Bothwell Regional Health Center (BRHC), in 2010,
began the process of re-equipping the radiation
oncology department. Vendor evaluations narrowed
the field to Elekta and Varian, but in the end it was
Elekta’s open systems philosophy that gave the
company the edge. BRHC’s selection of Elekta as its
provider proved a wise choice, yielding spectacular
clinical, workflow, care quality and financial
benefits.
Time for a change
Although patient satisfaction surveys consistently
gave BRHC’s radiation therapy service high marks,
change was inevitable as the center’s Siemens
PRIMUS eclipsed its service life.
“Before the Elekta conversion, we were limited to
3D conformal radiation therapy and compensator-
based IMRT,” according to BRHC’s Director,
Oncology Service Line, Sandra M. Hewlett, MS, RN,
AOCN, FACHE. “We needed to expand our
radiation therapy capabilities and bring needed and
different treatment modalities to our community.”
In addition to a new linac, a rejuvenated
department would optimally include CT simulation,
cancer registry, electronic medical records (EMR),
treatment planning, patient support, immobilization,
motion management, and quality assurance (see list
page 13). In such a multi-system workflow,
integrating the components to operate together
would be crucial.
“I wanted to create a comprehensive workflow
that was seamless, interoperable, and integrated,”
Hewlett says. “Elekta enabled us to incorporate
virtually any product and have it operate smoothly
through direct integration or minimal interfaces.
“I wanted to avoid a ‘piecemeal’ approach to
Sandra M. Hewlett, MS, RN, AOCN, FACHE,
BRHC’s Director, Oncology Service Line
Bothwell Regional Health Center, Sedalia, Missouri
11. 11
building a complete radiation therapy solution,” she
continues. “Conversely, we also wanted to avoid the
risk of choosing a vendor that would compel us to
acquire only their solutions to avoid compatibility
issues.”
On April 29, 2010, BRHC officials signed the
purchase order with Elekta, initiating the radiation
oncology department overhaul. This project
proceeded concurrently with a $25 million
renovation and construction of the Susan O’Brien
Fischer Cancer Center and the new, contiguous
Canon Cancer and Cardiovascular Center.
Elekta’s Consulting Services assists in
rapid implementation
In October 2010, BRHC began modifying the
linac vault to accommodate installation of an
Elekta Synergy® linear accelerator. Delivery of
the system occurred in mid-December and
installation was complete in January 2011. From
mid-January to February 2011, Elekta and BRHC
staff performed commissioning, acceptance testing
and beam modeling.
In the meantime, Dr. Decker and BRHC staff
treated their radiation therapy patients at a hospital
located approximately 30 miles away.
To help them manage the new workflow, Hewlett
and BRHC staff called on Elekta’s Consulting
Services team during the pre-go-live stage.
“They evaluated our existing radiation oncology
clinical, operational, administrative and financial
procedures, and then process mapped every
department area,” Hewlett says. “That helped me
build our assessments and many aspects of
customizing our new MOSAIQ® oncology
information system (OIS), while the rest of the
radiation team was at the temporary location.”
On February 15, 2011, BRHC went live with its
comprehensive Elekta solution, its dual centerpieces
Elekta Synergy and MOSAIQ, the latter enabling
BRHC to manage a paperless department on the
first day.
Elekta
enabled us
to incorporate
virtually any
product and
have it operate
smoothly through
direct integration or
minimal interfaces.”
12. 12
Everyone benefits – patients, physicians, hospital
Since go-live, BRHC has seen major improvements
in clinical capabilities and workflow, in addition to
realizing financial rewards.
Once limited to traditional techniques, BRHC
now offers VMAT, stereotactic radiotherapy and
radiosurgery (SBRT, SRS), IMRT, respiratory gating,
and electron treatments. The greater precision that
Elekta Synergy® affords also has reduced treatment-
related toxicity in patients.
“In the last 19 months, I have not had to report
any Grade III or IV toxicities, which we occasionally
incurred and reported before the Elekta conversion,”
she says.
Treatments are also quicker. Patient set-up,
CBCT and beam delivery now take just 12 minutes,
a reduction of about seven minutes. Faster treatments
also have improved BRHC’s process efficiencies and
bottom line. BRHC was averaging 2-4 percent in
overtime costs each fiscal year. In the first year with
Elekta (2011), overtime dropped from the previous
year’s 2.1 percent to 0.5 percent. In 2012, overtime
decreased to 0.3 percent and from June 1, 2013 to
November 2013, it was 0.1 percent. .
The added speed and capabilities of Elekta
Synergy have created openings in the treatment
schedule, increasing revenues and improving access
to treatment, she adds. BRHC’s patient volume has
increased over 10 percent year-on-year, with
concomitant increases in revenues.
Harmony through integration
The most dramatic result has been a much
improved technological interconnectedness within
the department.
“Other radiotherapy sites have heard about
our seamless operation and have requested visits to
observe our system,” Hewlett says. “This project was
more than replacing a linac – it was also about how
the technology would work together now and in the
future. Keeping people on treatment and ensuring
fully functional intra- and interdepartmental work
flow processes are mission-critical.”
At BRHC, establishing and maintaining
effective work flow processes starts the moment
the patient enters the cancer center. Barcode
technology in MOSAIQ® facilitates patient check-
in and tracking, increasing safety and improving
the patient’s experience. New patients receive a card
with a unique barcode label. Instead of standing in
line to check in, patients check themselves into the
queue with their card. The radiation nurse is
prompted upon patient arrival, and can see the
patient’s face on her desktop screen.
“Even if it’s a new consult, the nurse can
recognize the patient’s face in reception and greet
her personally,” she explains. “It’s a personal
experience that Elekta technology enables us to
offer patients.”
The most significant workflow change at BRHC
was the paperless environment that MOSAIQ
created, Hewlett emphasizes.
“We’re not hand-carrying or searching for
charts,” she says. “The medical record is available
for all authorized users to see in real time. MOSAIQ
has decreased most of the time-consuming face-to-
face communication that was required in the
paper-based system.”
Either through interface or direct integration,
BRHC worked to make most key applications
This project was
more than
replacing a linac –
it was also about
how the technology
would work
together now and
in the future.
Keeping people
on treatment
and ensuring
fully functional
intra- and
interdepartmental
work flow
processes are
mission-critical.”
Dr. William Decker,
radiation oncologist at BRHC
13. 13
The Susan O’Brien Fischer
Cancer Center oncology team
Location
• Sedalia, Missouri, USA
Staff
• 1 radiation oncologist;
6 PRN radiation oncologists
• 3 radiation therapists
• 1 dosimetrist
• 1 physicist
• 2 nurses
• 1 secretary-biller
• Oncology service line director
Elekta Solutions
• Elekta Synergy®
• MOSAIQ®
• METRIQ® cancer registry
• 2 HexaPOD™ evo RT System
• Monaco® treatment planning system
• XiO® treatment planning system
• Focal™, Focal 4D® TPS
• Atlas-Based Auto-segmentation™
• Respiratory Gating
• BodyFIX®
• Bar code
instantly accessible through MOSAIQ, including
billing, ADT, charge entry, check-in, e-Prescribe and
computerized physician order entry.
“My physician is meeting the required HITECH
Act meaningful use criteria,” she says. “Currently,
we’re implementing the final interface: labs. The
interface will facilitate dual functions: allowing
MOSAIQ orders to flow into the hospital’s
MEDITECH EMR and enabling MEDITECH-based
lab results to auto-import into MOSAIQ.”
Another workflow enhancement is the
department’s Philips Brilliance Oncology Big Bore
CT. Patients at the hospital no longer need to be
transported to the radiology department for their
CT scans.
High tech, high touch satisfaction
Since go-live, BRHC is achieving almost perfect
scores in patient surveys.
“We now consistently score 99 percent. for
‘likelihood to recommend’,” she notes. “Patients
perceive that the radiation oncology department
can compete with anything in Missouri. That is a
testament to the complementary blend of my staff’s
high touch and Elekta’s high tech solutions.”
Hewlett also is “likely to recommend” when
it comes to advising other radiation oncology
programs.
“I would tell them that BRHC defined and met
its goals to create a radiation oncology workflow that
is interoperable, integrated, seamless and paperless.
This approach ensured high safety, clinical
performance and care quality – in addition to a
greater range of treatment techniques,” she says.
“If a radiation oncology program desires these
qualities, Elekta is the clear choice.” l
ABOUT SUSAN O’BRIEN FISCHER CANCER CENTER,
AFFILIATE OF BOTHWELL REGIONAL HEALTH CENTER (BRHC)
14. 14
Elekta around the world
uw ALGIERS, ALGERIA
Elekta collaborates with Algeria to bring new hope to cancer patients
Algeria’s Ministry of Health, Population and Hospital Reform launched a plan in 2013 to equip
or build 13 new cancer centers over the next five years. In January, the Ministry announced
that this plan includes the purchase of hardware and software solutions from Elekta, including
training. “The MoHPHR has reported the number of new cancer cases at 44,000 annually,
making cancer the second leading cause of death in Algeria,” says Ian Alexander, Executive
Vice President Region Europe and AFLAME. “We are proud that Elekta has been chosen to
help close the gap between treatment needs and treatment capacity.”
uw ATLANTA, GEORGIA, USA
Elekta raises $67,000 to support pediatric brain tumor disease
Elekta activities at the 55th ASTRO annual meeting raised a total of $67,000 for the Brain
Tumor Foundation for Children, the first nonprofit organization in the United States to focus
on pediatric brain tumor disease. “Organizations such as the Brain Tumor Foundation for
Children are part of an absolutely vital support network for families who are touched by this
disease,” says Jay Hoey, Executive Vice President, Elekta. “We are proud to use the occasion
of our annual charitable event to ensure BTFC and its sister institutions carry on their
important activities.”
uw CRAWLEY, ENGLAND, UK
Elekta wins “Made in the South East” award
In October, Elekta won the Technology Award at the
inaugural Made in the South East Awards 2013, sponsored
by Insider Media and held in Guildford. “We’re a global
company, but we’re very proud of our home here in the
South East,” says Bill Yaeger, Executive Vice President, Elekta
Oncology. “We were delighted to stand shoulder to shoulder
with other manufacturing businesses and celebrate the
region’s outstanding contribution to the UK economy and
honored to receive an award that offers further recognition
of all our efforts here in Crawley.”
uw GELSENKIRCHEN, GERMANY
Versa HD system boosts speed and precision at
German clinic
On October 28, clinicians at Evangelische Kliniken
Gelsenkirchen launched a new era of radiation therapy
speed and accuracy with their first Versa HD™ case. “This
was a seven-field, 56-segment IMRT treatment, and what
we found was that – in comparison with our other system
– Versa HD afforded better dose conformance to the target
and enhanced avoidance of critical structures, such as the
small bowel, kidneys, rectum and bladder,” says Razvan
Galalae, MD, PhD, Chief Physician at Evangelische Kliniken.
“We think Versa HD is a really wonderful linac, and we’re
happy we made this decision over the other systems
we evaluated.”
uw BANGALORE, INDIA
First Elekta Synergy with Agility MLC sited in India
On December 18, 2013, the first patient in India was treated at HCG MSR Centre of Oncology in
Bangalore with Elekta’s Agility™ multileaf collimator. “This is truly a fantastic achievement
when one considers that HCG itself was founded in 1990 with five oncologists opening a
private cancer hospital to ensure people in Bangalore have top-flight cancer treatment at the
Bangalore Cancer Hospital,” says Dr. G.
Kilara, Director of HCG MSR Centre of
Oncology. “We are very happy to be the
first site in India to have the Agility MLC on
our Synergy, and we see this as a long-term
partnership with Elekta to improve cancer
treatments to people in Bangalore.”
uw BEIJING, CHINA
State-of-the-art Elekta education and training center
opens in Beijing
In November, Chinese government officials, key Elekta
radiotherapy customers and members of Elekta’s senior
management inaugurated Elekta’s Learning and Innovation
Center (LINC) in Beijing. The three-story, 1,800 sq m (19,375
sq ft) facility is equipped with Elekta systems and classrooms
to educate professionals as well as employees on the use of
radiotherapy solutions and workflows. “Elekta is committed
to customer education and training, a priority of all of our
users worldwide,” says Gilbert Wai, Executive Vice President,
Elekta Asia Pacific. “A center such as the Beijing LINC is
urgently needed in Asia-Pacific as the region rapidly grows
its radiation
therapy
capacity.”
15. 15
uw MELBOURNE, AUSTRALIA
More than 200 users gather for Australasian User Meeting
In August 2013, more than 200 customers, prospective customers and Elekta staff gathered
at the Sofitel on Collins in Melbourne for Elekta’s Australasian User Meeting. “Compared to
the 2012 meeting, the number of attendees increased by 30 percent,” says Andrew Wilson
Managing Director, Elekta Pty, Ltd. “And, for the first time, we held a Monaco® User Forum,
which almost 50 percent of people present at the user meeting attended. We are looking
forward to this year’s meeting in Queenstown, New Zealand.”
uw MOSCOW, RUSSIA
Eastern European User Meeting convenes in Moscow
The 2nd Eastern Europe Elekta User Meeting was held October 2013 in Moscow. Doubling
the number of attendees since the last meeting held in 2011, more than 200 customers from
centers in Russia, Ukraine, Belarus, Kazakhstan, Bulgaria and other countries of the region
participated in the gathering, which featured presentations and interactive discussions on a
wide variety of technological and cancer management topics. In addition to user
presentations, Elekta representatives gave presentations on treatment techniques, such as
VMAT and SRS, used with Elekta linear accelerators. “Elekta is committed to ensuring our
Eastern European
customers are trained in
the proper use of their
equipment and that they
receive ongoing clinical
support,” says Irina Sandin,
Elekta Business Director
for Eastern Europe.
uw SÃO PAULO, BRAZIL
Hospital do Coração to site São Paulo’s first Gamma Knife
In January, HCor inaugurated a new building as part of their ongoing expansion plan.
Designed to house the new, oncology and neuroscience centers, the building will serve as
home for Elekta’s latest generation Leksell Gamma Knife® Perfexion™ radiosurgery system,
the first in São Paulo. Neurosurgeons leading the project are Dr. Antonio De Salles and Dr.
Alessandra Gorgulho, both of whom bring vast experience in intracranial radiosurgery, spine
radiosurgery and open surgery in the magnetic resonance environment. “HCor Neuro is the
first in Brazil to integrate these technologies and recruit the medical expertise required to
successfully implement stereotactic radiosurgery,” says Dr. De Salles. “In addition, at HCor
Neuro/Onco, radiosurgery is extended to the spine and other body sites with Elekta Axesse™
technology,” adds Dr. Gorgulho. “This system contributes to our full range of radiosurgery
capabilities.”
uw VEJLE, DENMARK
Radiotherapy symposium at Vejle Hospital addresses
challenges
In November, an interdisciplinary symposium titled “Advanced
Radiotherapy of Anal and Rectal Cancer” was held at Vejle
Hospital. The scope of the program, which was attended by
more than 70 healthcare professionals, was to share knowledge
about the radiotherapy-related challenges these two patient
groups face. Martin Berg, MSc, Head of Medical Physics at Vejle
Hospital, and his colleagues, organized the symposium, the
second such meeting in two years. The first symposium focused
on radiotherapy for breast cancer. “The symposia were
very highly
appreciated by
the attendees
and a great
success for
the clinic
and Elekta.”
uw STOCKHOLM, SWEDEN
Elekta wins Swedish Export Award
On Wednesday, December 4, Tomas Puusepp, Elekta’s
President and CEO, accepted the 2013 Swedish Export
Credit Corporation’s (SEK) Export Award, on behalf of the
company. In addition to being on hand to receive the award,
Puusepp also was among the invited speakers at the event.
“This distinction from SEK means a lot,” says Puusepp. “It’s
also an acknowledgement of the job we’re doing and the
pride we feel at Elekta, and this award will inspire us to be
even better.”
uw NEW YORK, NEW YORK USA
New York hospital first in the U.S. to install Esteya
In December, the first Esteya® electronic brachytherapy system in the United States was
installed at Memorial Sloan-Kettering Cancer Center. “With support from Elekta, Memorial
Sloan-Kettering will lead a multicenter clinical study with the goal to further improve skin
cancer treatment,” says John Lapré, Executive Vice President, Elekta Brachytherapy. “With
its leading role at the forefront of brachytherapy research, the hospital will help further
improve the quality of patient care and add to the evidence base that caregivers need for
their clinical decisions.”
uw VIENNA, AUSTRIA
Elekt-aRT Band delights customers around the globe
In 2011, the love of music brought together about a dozen
men and women, Elekta employees and customers to form
the ever-popular Elekt-aRT band. Bringing smiles to the faces
of those attending conventions, Elekta user meetings and
internal trainings, the band has played together across the
globe, in locations such as: Warnemünde, Germany;
Barcelona, Spain; and Rhodes, Greece. “We just love to play,”
says Roberto Pellegrini, Director Clinical Solutions for Elekta
and a saxophone player. “Life is full of music and there are
some really talented musicians in the group coming from
inside Elekta and different clinical centers.” If you enjoy
dancing, RB, Blues Brothers style and rock and jazz, be
sure to check out the Elekt-aRT band as they headline the
Elekta User Meeting at ESTRO in Vienna. More information
and photos can be found here: https://www.facebook.com/
elekt.art?ref=tsfref=ts and here: https://www.facebook.
com/pages/Elekt-aRT-Band/401504256546736?fref=ts.
Enjoy!
16. While magnetoencephalography (MEG) progresses clinically in such areas
aslocalizationofepilepsyandpre-surgicalfunctionalmappingbeforeatumor
resection,basicMEGresearchisunderwayinsuchareassuchasthediagnosis
oftraumaticbraininjuryandtoexplorehowthebraininteractswiththesenses
to impart meaning about the world.
16
MEG sharpens focus
on human vision
Investigators at the Massachusetts Institute
of Technology’s (MIT) MEG lab are unraveling
the elemental mechanics of the human visual
system, the “what” and “when” of vision once visual
information passes from the retina to the brain.
Human vision, MIT researchers are finding, is a
highly complex process involving low- and high-
level neural computations, yet it’s also incredibly
fast – much faster than a typical 300 ms eye-blink
– and one that requires no conscious effort.
“We produced a first-of-its-kind movie that
illustrates how information travels in the human
visual cortex in a resolution of milliseconds and
millimeters,” says Dimitrios Pantazis, PhD, Director
of the MEG Lab at MIT’s McGovern Institute for
Brain Research. “Such fidelity opens up tremendous
possibilities. For example, even the most advanced
machine vision algorithms are hopeless compared
to the human visual system. The human brain can
teach us how to radically redesign machine vision
by replicating human brain function. Additionally,
our efforts to understand brain disorders – with our
current emphasis on autism spectrum disorders (ASD)
– can characterize the nature of hypersensitivities
to stimuli, and lead to improved interventions at
younger ages.”
With their Elekta Neuromag® TRIUX™ MEG
system, MIT researchers are exploring various
aspects of the human visual system. MEG can detect
the very weak magnetic fields arising from electrical
activity in the brain, enabling investigators to
monitor the timing of brain activity with millisecond
precision. Imaging modalities such as fMRI
complement MEG by adding spatial data.
Invariant object recognition
For many computer algorithms for vision, when
does a cup cease to be a cup? Answer: when the
perspective is shifted to above the cup, radically
transforming its appearance. Object
transformations frustrate computer algorithms,
while human vision solves these “puzzles”
effortlessly and unconsciously.
MIT Prof. Tomaso Poggio and doctoral student
Leyla Isik are using MEG to study this phenomenon,
Dimitrios Pantazis, PhD, Director of the MEG Lab at
MIT’s McGovern Institute for Brain Research
Machine
Learning
Algorithm
Predicted
Image
Label
Figure 1. MEG decoding work flow: A subject views images during a MEG scan and their MEG signals are recorded. Their MEG
activity is then fed into a machine learning algorithm to get a predicted label for what image the subject was looking at. The
accuracy of this prediction tells researchers what visual information is present in the MEG signals.
17. 17
known as invariant object recognition. Invariance is
a measure of how well the human visual system or
computer algorithm recognizes objects despite
transformations in their appearance (e.g., size,
viewing angle).
To test invariant object recognition in human
subjects, Isik presents different objects (e.g., faces,
inanimate objects, letters, scenes) while the subject
receives a MEG scan. Vision happens automatically,
so subjects view the objects without being asked to
perform a task. To analyze the MEG data, Isik uses a
machine learning algorithm that associates a pattern
of MEG activity with the image the subject was
shown.
“We found we could very accurately determine
which image a subject was viewing just based on the
MEG data,” she observes. “In addition, because
MEG provides very high temporal resolution, I can
see how the neural signals evolve in response to the
images.” (Figure 1)
Object recognition in space and time
Investigators Aude Oliva, PhD, Radek Cichy, PhD
and Dr. Pantazis, are using MEG and fMRI to study
how the visual processing of objects in the human
brain evolves in time and space within the first few
hundred milliseconds of neural processing.
“We still lack fundamental knowledge on the
‘where’ and ‘when’ of these processes,” Dr. Cichy
says. “We’re looking for analogies for how this
processing works from a mechanistic viewpoint.”
Subjects are presented with 92 different object
images at 1.5- to 2-second intervals while receiving
MEG and fMRI scans. The images represent six
categories: human and non-human faces and bodies,
and natural and artificial objects.
A machine learning algorithm is employed to
determine when individual objects are decoded (i.e.,
“recognized”) based on MEG signals in the brain’s
ventral visual pathway. The timing of assignment of
objects to their membership in a category (e.g.,
human v. non-human) also is examined. To obtain
spatial information, the MEG results are compared
to fMRI responses to the objects.
“Individual images are decoded as early as 60 ms
in the primary visual area, whereas the object’s
membership in a category is decoded later – ranging
from 120 to 170 ms – with further processing in the
inferior temporal cortex,” explains Dr. Cichy. “These
studies provide an integrated space- and time-
resolved view of human object categorization during
the first stages of vision. Importantly, this research
provides a quantitative link between human visual
dynamics and results from studies of the visual
system of primate models.” (Figure 2)
Neural basis of attention
Attention to certain visual characteristics of an
object is actually guided by widely distributed
neural networks in the brain. These networks
receive information from early visual areas and
relay signals back to improve the integration of this
visual information into a concept of the object or its
characteristics. Research by Prof. Robert Desimone
and Daniel Baldauf, PhD, is helping identify the
higher order brain networks responsible for
attention and the mechanisms by which they
coordinate the refinement of object recognition.
“We produced
a first-of-its-kind
movie that
illustrates how
information travels
in the human
visual cortex in
a resolution of
milliseconds and
millimeters.”
Figure 2. a) Observers saw 92 different images of everyday objects while their brain activity was measured with MEG and fMRI.
b) Combining MEG and fMRI data with representational similarity analysis, MIT researchers showed which part of the brain is
active shortly after an image appeared. At about 60ms, only the early visual cortex in the back of the brain was active, a brain
region known for early visual analysis. Subsequently, activity spread to brain regions involved in later visual processing, until the
inferior temporal cortex was activated, a brain region that represents complex shapes and categories of objects.
18. 18
An example of how this bottom-up and top-
down communication system works might be a
scenario in which one is looking for a friend at the
airport who is wearing a red sweater.
“Knowing your friend is wearing red allows you
to selectively concentrate on that color,” Dr. Baldauf
explains. “A brain network called the inferior frontal
junction [IFJ] would encode the target color red and
then selectively engage the areas in the visual cortex
that process red. Accordingly, this boosts that visual
information over, for instance, green or blue items.”
The use of MEG, fMRI and diffusion tensor
imaging (DTI) have helped Dr. Baldauf better
understand this process. Experimental subjects are
presented with short movies containing images of
either houses or faces and – importantly – shown in
a specific rhythm to enable frequency tagging and
reveal if certain brain areas are coupled.
“If we present something in a 2 Hz rhythm on
the screen, we will find some neural networks that
also oscillate at 2 Hz,” he says. “We found evidence
that the IFJ guides the attentional process. If you
attend to a face stimulus, the IFJ becomes
functionally coupled with the fusiform face area,
and if you attend to a house stimulus, the IFJ
connects stronger to an inferior temporal area, the
parahippocampal place area, which is more attuned
to houses.”
Visual habituation in autism
MEG’s ability to measure the brain’s response
to repeated stimuli is helping researchers
understand Autism Spectrum Disorders (ASD).
Profs. Pawan Sinha and Margaret Kjelgaard, and
MEG Lab Director Dr. Pantazis, recently completed
a study exploring ASD subjects’ and control
subjects’ habituation to auditory stimuli. This study
showed that ASD subjects demonstrate increasing
MEG signal strengthening to periodic auditory
stimuli, consistent with a lack of habituation that
contrasts with the diminishing MEG signals in the
brains of normal control subjects.
“The hypothesis is that kids with ASD cannot
properly habituate to stimuli – everything seems
new to them and so they tend to avoid stimuli and
withdraw into their own world,” researchers
Kleovoulos Tsourides and Tapan Gandhi conducting
the study, explain. “We’re now moving from testing
auditory stimuli to testing visual stimuli to
corroborate this sensory hypersensitivity.”
In the visual modality, several experiments are
underway. So far, the results have correlated well for
the control subjects. “We don’t have results yet for
the ASD subjects, but we predict similar behavior as
observed with the auditory stimuli,” Dr. Pantazis
says. “This would confirm our hypothesis that
autistic individuals lack habituation across domains.
Such findings could lead to habituation as a
biomarker for diagnosing ASD very early in child
development.”
On the horizon
Dr. Pantazis believes there is a great deal yet to learn
in their explorations of the human visual system
with MEG.
“We have only scratched the surface,” he says.
“I am thrilled with the progress we have made
during the three years of our MEG Lab operation.
These projects are unique, yet at the same time they
complement each other toward a comprehensive
understanding of vision. I promise more will come
in the near future.” l
MEG’s ability
to measure the
brain’s response to
repeated stimuli is
helping researchers
understand Autism
Spectrum Disorders
(ASD).”
MEG technology is very quiet and comfortable, offering an
ideal environment to study the visual system of children
participating in visual experiments at MIT’
19. 19
HIPO (Hybrid Inverse Planning Optimization) is an optimization tool for brachytherapy treatment planning. As
part of Oncentra Brachy, HIPO supports quick and accurate optimization of treatment plans within predefined
dose constraints.
Oncentra Brachy and HIPO will help you create optimal treatment plans that fulfill your constraints both for
target conformity and homogeneity, and sparing of organs-at-risk.
HIPO advantages include:
• Automated tool that guides you through the optimization process
• Make complex dose optimization accessible at significantly reduced time investment
• Full control over high and low dwell time peaks, to avoid hot and cold spots
• Option to lock your standard loading or the “good
part” of a plan and optimize only the remainder
using Catheter Locking
A HIPO white paper is available to you, explaining the
algorithm, its operation and outcomes, as well as the unique
capability of Catheter Locking.
Access the HIPO white paper by sending an email
to info@nucletron.com and enter “HIPO White Paper”
in the subject field.
NEW!
White paper on HIPO in Oncentra®
brachy
Wavelength is a great place to show your fellow cancer care professionals what you did to make your clinic
stand out, and to give them some inspiration about what they can do to make their clinic a special place for
patients – the people who are the focus of everything we do. Tell us what makes your center unique. Write a
brief description of what you did to improve your facilities or services. Photographs (high-resolution jpegs)
are welcomed and encouraged. Include your name, clinic or hospital name and email address and
email to: media@elekta.com.
Here are some examples to get you thinking:
· Unique patient or survivorship story
· Recent renovations or use of technology such as solar-powered linacs
· Artwork, décor or architecture
· Patient parties, cancer survivor or celebrity-hosted events
· Support groups or classes such as art, music or yoga therapies, etc.
Tell us why we should feature your clinic in the
September 2014 Wavelength
20. 20
First Monaco®
5
users assess benefits
Clinicians at a few of the first centers worldwide who recently began using
Monaco®
5providedtheiropinionsaboutthelatestversionofthisadvanced
treatmentplanningsystem.Monaco5,introducedlastfall,consolidatesthebest
ofElekta’streatmentplanningsolutionsintoasinglesystemandfeaturesanew
system architecture and graphical user interface.
Question answer participants:
University Medical Center Mannheim (Mannheim, Germany)
Lennart Jahnke, PhD, physicist
Frank Schneider, PhD, physicist
Jens Fleckenstein, PhD, physicist
Tulsa Cancer Institute (Tulsa [Oklahoma] USA)
Matthew West, PhD, chief medical physicist
Amrita Institute of Medical Sciences (Cochin [Kerala] India)
Raghavendra Holla, MSc, DRP, assistant professor
The Mannheim physics team: (l-r) Dr. Florian Stieler, Dr. Jens Fleckenstein, Dr. Frank Schneider and Dr. Lennart Jahnke
21. 21
What are your impressions about the Monaco 5
graphical user interface?
Dr. Jahnke: It is a tremendous change. The ribbon-
based format of the user interface is significantly
cleaner than previous versions. You don’t hide
behind small icons anymore and it seems less
crowded, without as many toolbars lying around
on the screen. Everything is now in a single window
on the lower side of the screen, the beams, the
prescription and the IMRT constraints.
Dr. West: Overall, it’s much easier to use than that
of the previous version – it’s more streamlined,
better organized and more intuitive. The
dosimetrists seem to like it better as well.
Mr. Holla: The new user interface improves
workflow substantially. The look and feel of it are
dramatically different. It is organized in a very
systematic manner. It is aimed at an easy flow of the
planning process from simulation to treatment plan
export. When I go for a new beam, I know that the
beam modifiers, the treatment aid, beam weight and
dose prescription all come in one window.
Monaco 5 now supports all of the most clinically
useful delivery techniques in a single system.
How important is this to you?
Dr. West: Having everything in one “box” has been
a huge psychological boost among the dosimetrists
here. It has really increased their comfort level
working with Monaco.
Mr. Holla: This is very important to me, because
with our previous version – Monaco 3.3 – I had two
databases. With 3D, I used to do it in XiO®, then for
VMAT, I export that into Monaco. That was a
difficult thing to handle. With all the delivery
techniques in a single system, it is easy for us to
migrate the entire database into Monaco and make
sure that only Monaco takes the complete database.
In addition, we didn’t have electron Monte Carlo
treatments in XiO. To have Monte Carlo electron
treatments available in Monaco 5 is a big change for
us, because we use quite a lot of electrons, especially
for most of the breast cancers and even head-and-
neck. It’s very important for us to have an accurate
dose calculation for electrons.
What are your thoughts about how the new
system architecture based on CPU and GPU-based
technology is benefiting your center?
Mr. Holla: I have found that by employing the GPU
for the collapsed cone algorithm, Monaco 5 boosts
the speed and performance of 3D dose calculations
over the previous version.
What else about Monaco 5 impressed you?
Dr. Schneider: Frankly, it was a pleasant surprise
that we could merely switch off Monaco 3 on one
day and switch on Monaco 5 without any issues.
The transition went very, very smoothly. We didn’t
have to redraw all of our templates like we had to do
with the last version change. With Monaco 5, all of
the existing templates worked.
Dr. Fleckenstein: Monaco 5 provides us with
Segment Shape Optimization for the dynamic MLC,
in addition to feet-first orientation of the CT scan,
which enables us to set up CT scans for patients who
have tumors in the lower abdomen or extremities.
We also will be able to develop 3D plans, and there
are some contouring features – such as a pearl tool
that allows you to draw freehand contours – that are
much better in Monaco 5.
Mr. Holla: The change in the beam model – which
used a single machine with all the photon and
electron models including VMAT models – really
impressed me. It is easy to change the beam energy
in the planning process. l
Matthew West, PhD, chief medical physicist,
Tulsa Cancer Institute, Tulsa, OK
Raghavendra Holla, MSc, DRP, assistant
professor, Amrita Institute of Medical
Sciences, Cochin, India
22. 22
Boosting workflow
efficiency with MOSAIQ®
IQ Scripts
Epic Care injects increased automation and
process improvement into its radiotherapy service
Epic Care’s three radiation therapy centers in the California communities of
Antioch, Dublin and Pleasant Hill have used MOSAIQ® since 2008. However,
the complexity of the radiotherapy workflow meant there were always areas
to improve and standardize. With MOSAIQ® IQ Scripts, Epic Care has
dramatically simplified its radiation therapy workflow, by enabling the
department to consolidate and eliminate many Quality Check Lists (QCL’s),
more fully exploit Assessments and automate the creation and completion of
documents via eScribe merge fields.
Jesse Kaestner, Chief Radiation Therapist
and Department Manager,
Epic Care
Since Epic Care
began using IQ
Scripts in May 2013,
our staff have
experienced a much
more fluid, orderly
and streamlined
radiotherapy
operation.”
23. 23
Before IQ Scripts, staff at each Epic Care
center coordinated the flow of radiation therapy
activities through MOSAIQ, generating a quick
order and QCL task sets for a particular patient’s
care. Once each workflow step was complete, the
next QCL task set would be sent to another staff
member to complete related to the patient’s
movement through the radiation therapy process.
The somewhat disjointed nature of task sets and
QCL’s, however, resulted in a sometimes less-than-
optimal workflow.
“The QCL’s in a task set didn’t have any
particular order of when to complete them, and any
given task set could contain as many as 10 QCL’s,”
says Jesse Kaestner, Epic Care’s Chief Radiation
Therapist and Department Manager. “We simply had
too many QCL’s.”
Scripting an ideal solution
Epic Care needed a way to reduce the number of
workflow steps (i.e., completion of QCL’s) and speed
up the workflow process in a coherent manner.
MOSAIQ IQ Scripts presented the ideal solution,
enabling Epic Care to automate and customize key
aspects of the radiotherapy workflow to match its
needs. IQ Scripts utilizes simple scripting via
preferences that link together tasks in a chain. They
automatically trigger the presentation of one or
more new QCL’s or an Assessment when a previous
QCL or Assessment is completed.
In its implementation of IQ Scripts, Epic Care
also exploited an improved Assessment design in
MOSAIQ 2.5 to consolidate many discrete QCL’s
into the automatic presentation of items in checkbox
Assessments. IQ Scripts automation also permitted
data in Assessments to be captured and merged into
eScribe documents, thereby eliminating the time-
consuming manual completion of MS Word
documents.
“With IQ Scripts, I was able to reduce the
number of QCL task sets from 68 to 0, and eliminate
approximately 35 QCLs, most of which were
inactivated and converted into line item checkboxes
within Assessments,” Kaestner says. l
Pre-IQ Scripts, Assessments for both Radiation Oncology and Medical Oncology
departments were combined, creating a long list from which to select the desired
Assessment. Kaestner developed a new tab on this screen (Radiation Oncology) and
grouped RO-only Assessments, making RO Assessment selection from the dropdown
menu a quick task.
The clinician checks boxes that specify parameters for the patient’s CT Simulation. Note
that checking the box “CT Sim Appt” serves as the trigger for an IQ Script to run after the
physician clicks “Generate.” The IQ Script (Engine) begins executing (note progress bar
above) – automatically generating QCL’s for the next step (Figure 3).
Automatically generated QCL’s arrive in staff members’ boxes ready for execution. Alerts
can also be set up to remind users to complete the QCL.
FOR ADDITIONAL EXAMPLES
of IQ Script workflows at Epic Care, visit
http://www.elekta.com/mosaiqscripts
24. 24
What makes your center unique?
surrounding critical organs. Agility contributed to
exceptionally low radiation leaf leakage, thereby
reducing the integral dose, while the fast leaf speed
and high precision leaf positioning provides better
plan quality and delivery.
Daily imaging before treatment utilized the
Symmetry 4D CBCT on the XVI system. This
enables the monitoring of respiratory motion and
correction of baseline shifts. Symmetry also provides
better avoidance of moving critical structures at the
time of treatment. For sub-millimeter positional
accuracy, setup corrections were remotely applied
using HexaPOD™ robotic patient positioning system,
which offers six degrees of positioning freedom.
Setup correction was followed by 3D XVI
verification scans before, halfway through and at the
end of the treatment.
The patient remarks that his SBRT treatment has
given him renewed hope in his fight against cancer,
but above all he values the exceptional effort,
kindness and care shown by ARO staff.
“My initial fears about the therapy melted away
each day as soon as the staff engaged with me and
made me feel valued and respected,” he says. “Their
concern for my well-being was very much
appreciated and it made a huge difference
throughout my treatment journey.”
“We continually do our utmost to provide the
best technology and care for our patients,” adds
Denise Redwood, Manager, Radiation Therapy
Services at ARO. “The introduction of SBRT has
helped us improve the accuracy and convenience of
treatment, and provides better survival benefits that
were previously unavailable for patients who are
candidates for this treatment.” l
Auckland Radiation Oncology (ARO) is the
first and only center in New Zealand to employ
Elekta’s Agility™ beam-shaping technology and
Symmetry™ software to deliver highly accurate
stereotactic body radiation therapy (SBRT), giving
patients hope for treatment of previously incurable
tumors.
In November 2013, a male patient diagnosed
with medically inoperable early stage non-small cell
lung cancer, was ARO’s first to benefit from SBRT.
The treatment was delivered on the Elekta Synergy®
linear accelerator equipped with Agility 160-leaf
multi-leaf collimator (MLC).
“PET staging confirmed an active lung tumor
and no nodal involvement. Based on the clinical
evidence and the patient’s condition, we determined
that surgery and other alternatives were unsuitable
for this patient, and that his best option for this
potentially curable cancer was SBRT,” explains Dr.
Louis Lao, ARO Radiation Oncologist. “Patients
tolerate SBRT well, and several studies show survival
and local control advantages as well as a very
acceptable side effect profile and treatment-related
morbidity.”
For highly accurate and reproducible positioning
for the planning scans, the patient was immobilized
with the BodyFIX® system, while the bellows
respiratory monitoring system was used to correlate
breathing motion to the tumor position. 4DCT
scans acquired for the different breathing phases
were used to determine the internal target volume
and planning target volume (PTV) for precision
treatment planning.
The treatment planning for delivering 60 Gy in
eight fractions was aimed at closely conforming to
the PTV while substantially minimizing dose to
New Zealand center debuts
advanced Elekta technology
for lung radiotherapy
We continually
do our utmost
to provide the best
technology and
care for our
patients.”
25. 25
With the assistance of foreign companies,
Iraq is working to rebuild and reinforce its
healthcare delivery capabilities. On November 6,
the Maysan Center for Tumor Treatment began
treating patients with its complement of new Elekta
radiation treatment systems and software. On
November 26, Iraqi Ministry of Health officials
inaugurated the new clinic, located in Mamouna,
Maysan Province, about 400km (250 miles)
southeast of Baghdad.
“Up to this point, Iraq had operated some very
old Siemens linear accelerators in the center of
Baghdad and a few cobalt teletherapy machines,”
says Dr. Emad Salman, director of El-Etimad,
Elekta’s Baghdad-based distributor partner. “Most
patients were traveling outside of Iraq to Iran, Jordan
and Turkey for treatment.”
Maysan Center for Tumor Treatment is equipped
with two Elekta Synergy® Platform systems, in
addition to XiO® treatment planning system,
MOSAIQ® Oncology Information System and patient
fixation solutions.
“The Maysan center chose Elekta because of its
sophisticated products, in addition to Elekta’s
willingness to support the clinic in a still-perilous
region,” Dr. Salman observes.
“We received assurances that when the center
needs support, Elekta would provide it,” says Dr.
Salman, whose distributorship is coordinating
medical and administrative staffing of the clinic for
the first six months. “The company demonstrated
this level of support initially by sending four Elekta
engineers to work with three El-Etimad engineers to
rapidly conduct the installation phases – it took just
three weeks. They were able to complete
commissioning in less than a month. I think this
reflects Elekta’s seriousness and commitment to
finishing this project in a very short time, and to
start treating the high number of Iraqis who need
advanced care.”
The Maysan clinic will treat 40 to 45 patients
per day.
Iraq’s radiotherapy capacity will grow further
in 2014, as El-Etimad and Elekta recently signed a
contract to install two new linear accelerators in the
Baghdad Oncology Center, currently under
construction.
“I hope other foreign companies learn from
Elekta about what it takes to be a good partner to
help this country,” Dr. Salman says. “With such
support, there will be many more success stories
in Iraq.” l
At Elekta, we share a passion with our customers to advance the frontiers of cancer care
and enjoy sharing news from clinics that are treating patients more effectively, precisely
and efficiently with the help of Elekta technology. We asked readers of Wavelength to tell us
what makes your center unique. Here are a few stories from across the globe.
Iraq’s first new cancer clinic
in more than a decade
treats first patients
I hope
other foreign
companies learn
from Elekta about
what it takes to be
a good partner to
help this country,”
26. 26
Russia center treats record number of
patients with Gamma Knife in 2013
I predict that
with Perfexion,
we will be able to
treat 2,000 patients
per year easily.”
What makes your center unique?
Although only 10 to 15 percent of patients
in Russia who would benefit from intracranial
radiosurgery actually receive the therapy, that
hasn’t stopped the St. Petersburg Diagnostic and
Treatment Center from beating its own “patients-
treated” record every year since the center began
using its Leksell Gamma Knife® 4C radiosurgery
system. The St. Petersburg clinic and Moscow’s N.N.
Burdenko Neurosurgical Institute are the only
centers operating a Gamma Knife system in this
country of about 144 million inhabitants.
“An estimated 30,000 patients per year in Russia
need some form of intracranial radiosurgery,” says
Arkadi Stolpner, MD, President of the Diagnostic
and Treatment Center. “Between our center and the
Burdenko Neurological Institute, we treat about
1,500 patients each per year using mainly Gamma
Knife, but also linac-based modalities.”
Gamma Knife radiosurgery has been available in
Russia only since 2006, when the Burdenko
Neurological Institute acquired its system. In
December 2008, the Diagnostic and Treatment
Center purchased its Leksell Gamma Knife 4C,
treating about 300 patients in 2009. It built on this
volume steadily, adding approximately 200 patients
each year through 2012, during which about 900
patients received Gamma Knife radiosurgery.
The St. Petersburg clinic uses its Gamma Knife
4C to treat a wide array of benign and malignant,
functional and vascular disorders, with
meningiomas, metastases and vestibular
schwannomas the top three indications.
2014 presented the Diagnostic and Treatment
Center with a decision to reload the cobalt-60
sources on its Gamma Knife 4C or to upgrade to
Leksell Gamma Knife® Perfexion™.
“The Gamma Knife 4C has been an extremely
reliable system over the last five years, but I have
heard from many centers that use Perfexion that this
model is also exceptionally reliable and promises
major workflow advantages, so we decided to
upgrade to Perfexion,” he says.
The existing Gamma Knife 4C will either be
refurbished and sited in a satellite clinic in
Novosibirsk or decommissioned and replaced with a
Perfexion system for that clinic. The St. Petersburg
Perfexion is expected to begin clinical treatments in
May 2014.
Depending on the level of government subsidies
for patients to receive Gamma Knife radiosurgery,
Dr. Stolpner is optimistic that 2014 will break
another world record for patients treated.
“I predict that with Perfexion, we will be able to
treat 2,000 patients per year easily,” he says. l
Arkadi Stolpner, MD,
President of the Diagnostic
and Treatment Center
27. One Solution. Unlimited Possibilities.
www.VersaHD.com
Sophisticated respiratory motion management
without compromised treatment times
As compared to previous generation Elekta digital linear accelerators. Stieler F, Steil V, Wenz F, Lohr F, Department
of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany.
Versa HD is not available for sale or distribution in all markets. Please contact your Elekta representative for details.
Deliver Lung SBRT
in 43% Less Time
4513371122911:13
28. Corporate Head Office:
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