15_ Staehelin, Varian Technology Update - TrueBeam

8/16/2019 15_ Staehelin, Varian Technology Update - TrueBeam

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1 | VARIAN ONCOLOGY SYSTEMS

VARIAN

ONCOLOGY

SYSTEMS

TRUEBEAM™ - ADVANCEDTECHNOLOGY UPDATE

Varian Medical Systems International AG

Bangkok – August 24, 2012

Rolf B Staehelin

Director International Marketing

August 24, 2012


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ARIA™

Oncology

Information

System

Eclipse™

Treatment

Planning

System

Clinac®

Innovative

Treatment

Platform

UNIQUE™

Cost-Effective

Oncology

Solution

ProBeam™

Fully-integrated

Proton TherapySystem

Varian BrachyTherapy

Product Suite for

Planning &

Delivery

TrueBeam™

Treatment Procedures with

Exceptional Ease, Speed

and Accuracy

Novalis Tx®

Neurosurgical &

Radiosurgical Applications

Trilogy™

All in One

Treatment

System

The Varian Oncology Solution Advantage

http://localhost/var/www/apps/conversion/tmp/scratch_1/03%20-%20SRS%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/04%20-%20BT%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/05%20-%20PTB%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/02%20-%20RT%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/14%20-%20Trilogy%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/15%20-%20Novalis%20Tx%20short.ppthttp://localhost/var/www/apps/conversion/tmp/scratch_1/16%20-%20TrueBeam%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/17%20-%20VBT%20Products%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/18%20-%20VPT%20Products%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/12%20-%20UNIQUE%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/13%20-%20Clinac%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/11%20-%20Eclipse%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/10%20-%20ARIA%20short.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_1/01%20-%20Cancer%20Tx%20short.pptx


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3D-CRT

MLC. MV imaging

IMRT / RapidArc

kV & MV IGRT

Basic 2D RT

no MLC, no imaging

IMRT / RapidArc

SRS/SRT

kV & MV IGRT

IMRT / RapidArc

Neuro- & Radiosurgery

Advanced IGRT

UNIQUE

Power

UNIQUE

Performance

Clinac

iX/DHX

Trilogy

Novalis Tx

Complete

Product Portfolio

TrueBeam

Investment

C l i n i c a l C a p a b i l i t i e s

Tailored Solutions for all Clinical Requirements

Complete Product Portfolio


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Clinical Challenges

• Clinical Versatility

• Precision

• Decision

• Speed

New Treatment Capabilitiescombined with

3D-CRT, IMRT & RapidArc

SRS/SRT, IGRT & DART

Mechanics

Electronics (control)

Imaging System

Imaging Applications

Ergonomics of Software & HardwareIntegration & Safety Features


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http://localhost/var/www/apps/conversion/tmp/scratch_1/2011-11-16%20TrueBeam,%20Kobe.pptx


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TrueBeam™ - Radically Different


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TrueBeam™ - Radically Different

Field Size: 40*40 cm2

Center leafs (20 cm): 5 mm

Outer leafs: 10 mm

Field Size: 40*22 cm2

Center leafs (8 cm): 2.5 mm

Outer leafs: 5 mm

TrueBeam™ TrueBeam™ STx


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Radically Different

TrueBeam™

Innovative

IntelligentIntuitive


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TrueBeam™

Innovative

New Architecture

• The TrueBeam system has

been designed from the

ground up to optimize

radiotherapy and radiosurgery

• Real time control system

provides a seamless integration

of treatment, imaging and

motion management


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TrueBeam™

Innovative

BeamGeneration


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• Today in Clinics• Multi-Energy: 13 Carousel Positions available

• 5 Flattened Photon Energies: 4, 6, 8, 10, 15, 18 & 20 MV

• < 5 up to 600 MU/min

• plus 2 High Intensity Mode Energies

6X FFF, 10X FFF (Flattening Filter Free)

• 8 electron energies: many foils, 22e (max)

• Future

• low photon energy (2.5 MV) for MV imaging

• 4 MeV electron

TrueBeam™

New Beam Generation System


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TrueBeam™

High Intensity - Flattening Filter Free (FFF) Mode

Higher dose rates, lower scatter

and out of field leakage are

possible by removing the

flattening filter

Gains for IMRT, RapidArc

or small field SRS

Available in clinical mode for

6 MV 1400 MU/min

10 MV 2400 MU/min


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TrueBeam™

Red Journal - paper from

University Zurich in Press

FFF on TrueBeam

High Intensity - FFF Mode - Literature


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Non-flatness increases with energy

Up to 3x3 cm2, difference in the profile for

flattened and FFF is neglectable

X6 X10

X10FFFX6FFF

TrueBeam™ data courtesy Hrbacek & Lang, University Hospital Zürich

TrueBeam™

High Intensity - FFF Mode - Profiles


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Leading the Way in Cancer Therapy

• Prostate

• Liver

• Lung

• Breast

• SRS


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FFF - Hypo-Fractionation (Hypo-fx)

• Hypo-fx is not a matter of technology but clinical

feasibility & decision

• Hypo-fx is not suitable for all indications

Studies focused on lung, liver, brain & prostate cancers

• Safety, precision and time are crucial for hypo-fx• TrueBeam delivers hypo-fx in the shortest possible time

• Hypo-fx treatments can be performed on all Varian linacs

t

Standard-fx – e.g. 40 x 2Gy = 80 Gy

Hypo-fx – e.g. 4 x 9.5 Gy = 38 Gy

t


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TrueBeam - Clinical Benefit of High Intensity Mode

Brain SRS

Data courtesy

Neolife Cancer Center

Istanbul, Turkey


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Prostate SABR (Stereotactic Ablative Radiotherapy)

Data courtesy

Humanitas Institute

Rozzano-Milano, Italy


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Lung SABR (Stereotactic Ablative Radiotherapy)

Data courtesy

VU University Medical Center

Amsterdam, Netherlands


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Liver Mets SABR (Stereotactic Ablative Radiotherapy)

Data courtesy

Humanitas Institute

Rozzano-Milano, Italy


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TrueBeam™

Intelligent

Superior

ImageGuidance

Simplified, Automated

Imaging Modes

• CBCT (Single Button)

• kV/kV, MV/MV and MV/kV

radiographic pairs


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TrueBeam™

Intelligent

Superior

ImageGuidance

Image Acquisition duringTreatment—kV and MV

• Fluoroscopy—

with playback and review

• MV Cine

Respiration synchronized

kV and MV Imaging

• During setup

• During treatment


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TrueBeam™

Innovative

Intrafraction

MotionReview

• Acquire kV radiographs during

treatment

• Synchronized with respiration• Monitor tumor position

throughout treatment


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TrueBeam™ Imaging

kV Fluoroscopy during RapidArc Treatment


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TrueBeam™ Imaging

Intrafraction Motion Review - Fiducial Markers


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New

StandardsIn Accuracy

TrueBeam™

Intelligent

• Mechanical and Imaging

Isocenter Accuracy < 0.75 mm

• Gantry rotational:

< 0.3 degrees

• Collimator rotational:

< 0.5 degrees


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TrueBeam™

Intuitive

Simple,

AutomatedOperation


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TrueBeam™

Treatment Console


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TrueBeam™

Intuitive

• One button image acquisitionand full automation of beam

delivery make treatments 50%

faster*

• Changing imaging procedures

and protocols is simple and fast

• Position and treat in less time

than RapidArc benchmark50

Faster

%

* Comparisons, Data on file, Trilogy system,

Varian Medical Systems, 2010


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TrueBeam - Worldwide Clinical Operation

ClinicalUse

>270 installations

>550 orders

Registrations / Clearances: US FDA, CE Mark/ MDD, Russia Gost, Saudi Arabia SFDA, China SFDA, Japan Shonin,

Australia & New Zealand, Thailand, Korea, India, …


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TrueBeam™

Work-in-progress

ExoticTrajectories

* Work-in-progress. Not available for sale.


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TrueBeam™

Exotic Trajectories


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TrueBeam™

Exotic Trajectories


MSKCC New York in Press

Dynamic trajectory-basedalgorithm integrates

optimized couch and

collimator trajectories into

RapidArc/VMAT


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TrueBeam™

Exotic Trajectories


MSKCC New York in Press

Dynamic trajectory-based

algorithm integratesoptimized couch and

collimator trajectories into

RapidArc/VMAT


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CalypsoGPS for the Body®


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Calypso System Overview

• Real-time motion management for radiation therapytreatments

• Accurate, precise, real-time tracking of treatment targets

with electromagnetic technology

• Designed for body-wide use

• Prostate transponder FDA/CE cleared

• Surface transponder cleared for body-wide use

• Lung indication is a current work-in-progress


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Beacon® Transponder

Actual size: ~8.5 mm


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Calypso Platform Overview

4D Electromagnetic Array

Implanted Beacon ®

ElectromagneticTransponders

4D Console

4D Tracking Station

Optical System with

3 Infrared Cameras


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Works in Progress

Calypso

Tumor Tracking Technology


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Augmenix – SpaceOAR™ Hydrogel

™


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RapidArc

Radiosurgery

TrueBeam™

6 Degrees of Freedom (6DoF) Couch

Works in Progress – Not for Sale

™


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RapidArc

Radiosurgery

TrueBeam™

6 Degrees of Freedom (6DoF) Couch

Works in Progress – Not for Sale


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TrueBeam™

Clinical relevance

• Vertebrae

• High dose gradients around the

spinal cord• Pitch is important when the

tumor spreads over more than

one vertebra


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Image: VUMC Amsterdam

TrueBeam™

Clinical relevance

• Intracranial tumors

• Sparing optical structures

(optical chiasm, optical nerve)


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TrueBeam™

Clinical relevance

• Lungtop

• Very sensitive to arm position

• Sparing myelum and plexus

T B ™


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TrueBeam™

Summary

Radically

DifferentFuture

• Designed to optimize

radiotherapy and radiosurgery

• Integrates and choreographs

powerful imaging and treatment

systems

• Unparalleled accuracy

• Unlocks new treatment options


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Our Vision

Make Cancer a manageable, chronic disease

that can be treated by our products better and

more cost-effectively

Make advanced therapy affordable for

many around the world, not few


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Documents

15_ Staehelin, Varian Technology Update - TrueBeam