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ERICE APRIL 2009
Varian Particle Therapy – Why Varian?
Volker Schirrmeister
Partnering with Varian
� Founded in 1959 & dedicated to Oncology
� Varian Medical Systems created by Varian Associates in April, 1999
� Varian Medical Systems� Varian Oncology
� Varian X-ray Tubes
� Varian Security Inspection Products� Varian Biosynergy� Ginzton Research Center
Varian History
History of the Proton Program at Varian
� Proton program started in 1992
� Eclipse Proton treatment planning, VARiS and ARIA information management systems
� First Chinese proton center at Zibo uses Eclipse and VARiS
� MD Anderson, University of Florida; NCC Korea are on line
� Varian acquires ACCEL Instruments GmbH, 1/07
Clinac 600C/D
DBX, 6EXClinac DHX, DMX, 2100 C/D, 21EX
Clinac 2300C/D, 23EX, Silhoutte, iX, Trilogy
Single Photon Energy
4 or 6 MV
Dual Photon Energies
4 to 20 MV (25 MV)
5 or 6 Electron Energies4 to 22 MeV
Easy to operate
� Identical Collimator Head
� Identical Accessories
� Identical Treatment Couch
� Identical Operation
Identical Options
� Dynamic Wedge
� Asymmetric Jaws
� Multileaf Collimator
� PortalVision
� 4D Treatment Console
� Auto Field Sequencing
� ARIA Oncology Info System
Low Energy High Energy
Varian Clinac Family
Varian Oncology Products Overview
� Clinac®: Family of Linear accelerator treatment unit designed to provide quality radiation cancer therapy
� kV On-Board Imager®: Accelerator based kV radiographic, fluoroscopic and Cone-beam CT imaging capabilities for IGRT
� Millenium™ Multileaf Collimator (MLC):High-resolution beam shaping device used with Clinac to customize treatment dose
� PortalVision™: High-resolution, digital flat-panel megavoltage imaging device with robotic position capability
Varian Oncology Products Overview
� Trilogy™: Varian’s top-of-the-line, image-guided delivery system optimized for 3D-CRT, IMRT and Stereotactic Applications
� Novalis Tx®: The Power of Two. A dedicated solution for Neuro- and Radiosurgical procedures and applications, featuring gantry and room based imaging tools
� HD120™ MLC: Highest resolution beam shaping to achieve new levels if precision and accuracy(central region with 2.5 mm leaves)
Varian Oncology Products Overview
� Acuity: a comprehensive medical imaging system that integrates planning, simulation, and verification software for treating cancer with radiation therapy
� Eclipse, Helios & SomaVision: Computer systems for planning, calculating and visualizing dose distribution
� ARIA: the only fully integrated Oncology Information System (OIS) to manage all aspects of comprehensive cancer care, including radiation oncology, medical oncology and surgery.
� GammaMed / VariSource: HDR & PDR after-loading system that provides removable, implantable radiation for certain malignancies
Why Varian?
� Highest Uptime Logbook 2004
King Faisal Hospital, Riyadh, Saudi Arabia
Developmental Stages and Trends
in Radiation Therapy
Computerization of accelerators, development of MLCs and 3D planning
1980s
Why Varian?
The Technical Vision
Exploration of highenergies & electrons
1970sBasic Medical Accelerator designs developed & proved
1960s
Dynamic conformal techniquesStart Proton Therapy Program
1990s
IMRT, Integration and
process enhancement
1995
IGRT, full system integration and Dynamic Adaptive Radio Therapy
2000s
Biological Imaging & Targeting-Tumor Positioning
201x
RapidArc™ – Single Arc IMRT, Proton Therapy System ACCEL
Enhanced SBRT & Neurosurgical applications
2007
Strategic Acquisitions of Varian
in Oncology
TEM LtdSimulation
1984
Acquisitions
� The Strategic Vision
Basic Medical AcceleratorTeletherapy
1960s
ABBPortal Imaging & Data Management
1990
DosetekTreatment Planning
1993
OpTxMedOncology Software
2004
ACCEL Particle Therapy
2007
OmnitronBrachytherapy
1995
GammaMedBrachytherapy
2003
Sigma MicroOncology Information System
2005
RPTC Munich
AcceleratorTreatment Rooms with Gantry
Eye Treatment
Beam Transfer Line
First European Commercial Clinical PT Center
Superconducting Proton Cyclotron
ERICE APRIL 2009
Proton Beamline for guiding the beam to thetreatment rooms
The RPTC Gantries
Constructed by Schär Engineering
Mechanical precisionrequirements as verified in production:
Beam axis within 0,5 mm radius volume aroundIsocenter
Gantry and Patient Positioner
Gantry Treatment Room
ERICE APRIL 2009
Unique Proton BeamScanning Nozzle
���� PRECISE BEAM
���� LOWEST NEUTRON DOSE
Why Varian ?
Monitor chambersVacuum chamber
Scanner-Magnet 1 (y)
Scanner-Magnet 2 (x)
Test of Scanning System at HMI, Berlin
Nozzle 3D-View
Scanning Magnets
Dose and Position Monitors
Vacuum Chamber
Diagnostic Flat Panels(Position Verification)
Patient Specific Devices(Range Shifter, RippleFilter, Collimator, etc.)
Scanning Nozzle
Scanning Method
Irradiation of 1-l-Tumor with 2 Gy/min:� Spot scanning with continuous transition in row
� Beam diameter (FWHM): 10 mm
� Voxel spacing: 5 mm (20 ×××× 20 ×××× 20 voxels)
� 5 ms per spot (max. ~ 20 ms, min. ~ 3 ms)
� Beam switching on/off: 50 µs
� 1-10 s irradiation period per layer
� Layer switching time: 1 s
30 cm
40 cm
y-View
x-View
30cm
40cm
lSC1 d lSC2
SADSC1SADSC2
y-Scanner x-Scanner
X: 195 cm (mech. 200 cm)Y: 252 cm (mech. 256 cm)
50 cm beforeisocenter
20 cm behindisocenter
Effective Proton Source
Leakage and neutron doses (Hall, 2006)
Scanning: Key Specifications & Measurements
� Range: Up to 37.6 g/cm²
� Field size: Up to 30 × 40 cm²
� Dose Compliance: better than ± 2.5%
� Beam spot size (FWHM): 4 to 7 mm
� Repainting
Dose Distributions measured at HMI, Berlin End-to-end test, RPTC Gantry-1
Test Cases Dose Results
doses [Gy]
- measured
- calculated
Deviations in homogeneousregions ≈≈≈≈1% !!!
1,0071,007
1,0001,010
1,0081,004
0,7500,698
0,0300,000
14.5 cm1.007 / 1.007
1.025 / 1.024
1.035 / 1.033
0.750 / 0.698
0.030 / 0
depthMeasured vs. calculated doses [Gy]
1.008 / 1.010
0.952 / 0.927
19.5 cm
6 cm
0.845 / 0.881
0.046/ 0.040
0.007 / 0.002
0.002 / 0
0.882 / 0.919
0.779 / 0.748
0.379 / 0.376
0.008 / 0
System Performance Test („END TO END“)
� according to the DIN 6875-1, “Special radiotherapy equipments - Part 1: Percutaneous stereotacticradiotherapy, basic performance characteristics and essential test methods”
� Demonstration of the overall system performance
� specification of dose and dose distributions in a t arget volume, simulated in a phantom, for a simple and sophisticated geometry
� Focus on agreement between planned and measured dos es
Test steps:
� CT imaging
� Therapy Planning System:
� contouring of target volume
� definition of irradiation fields
� dose calculations
� positioning of the phantoms at Gantry 1 using the X -ray based position verification system
� Beam application
� dose measurements
� comparison between measured and calculated dose dis tributions.
(published at PTCOG 44, Zurich, June 2006)
Test Cases
RPTC :
Field 1: 30°, table rotation 90°
11 layers, ≈≈≈≈1000 spots
Field 2: 90°, with 57 mm w.e. range shifter
10 layers, ≈≈≈≈ 800 spots
QA plan generated for homogeneous PMMA phantom
Field 1
Field 2
Test Case – Results
Measured vs. calculated doses [Gy]
0.529 / 0.547
Beam 11.148 / 1.161
0.975 / 0.995
1.057 / 1.060
0.910 / 0.851
Field 1
Test Case - Results
Field 2
Beam 2 0.286 / 0.323
0.832 / 0.890
0.893 / 0.944
0.838 / 0.888
0.674 / 0.575
Measured vs. calculated doses [Gy]
�Target Repainting, e.g. 17 scans / 2 min.
� 7 s for a 1 liter volume/scan�The faster the more important is a stable and continuous beam
Spot scanning: step & shoot
0 time (ms) 10in
tens
ity
Cont. scanning “TV” mode
kHz-Intensity modulation
Courtesy of M. Schippers,PSI
Integrating dose delivery per spot
Scan Modes of new Gantry-2 at PSI – Aimingfor Continuous Scanning
Position Verification System
Features
� Field-of-view 20 × 28 cm²
� 30 × 40 cm² amorphous silicon panels
� Semi-automated image matching and position correction procedure
� Only 2 X-ray axes needed
� Position correction possible for any treatment position
� Total accuracy: ± 0.5 mm
ERICE APRIL 2009
User Interface Position Verification System
Why Varian?
� Partnership in R & D
�Varian Medical Systems has about 200 technical, research, and process partnerships with the Radiotherapy community throughout the world!
US Top 50 Cancer Centers 2007 (Varian=78% )
1. University of Texas, M. D. Anderson Cancer Center2. Memorial Sloan - Kettering Cancer Center3. Johns Hopkins Hospital, Baltimore4. Mayo Clinic, Rochester, Minn.5. Dana - Farber Cancer Institute, Boston 6. University of Washington Medical Center, Seattle 7. University of Chicago Hospitals8. UCLA Medical Center, Los Angeles9. Duke University Medical Center, Durham, N.C.10. Massachusetts General Hospital, Boston11. Fox Chase Cancer Center, Philadelphia 12. University of Pittsburgh Medical Center 13. Stanford Hospital and Clinics, Stanford, Calif. 14. University of California, San Francisco Medical
Center 15. Ohio State University James Cancer Hospital 16. H. Lee Moffitt Cancer Center and Research Inst 17. Cleveland Clinic18. University of Alabama Hospital at Birmingham19. Barnes - Jewish Hospital/Washington University 20. University of Wisconsin Hospital and Clinics21. University of Michigan Medical Center, Ann Arbor22. Vanderbilt University Medical Center, Nashville23. Yale - New Haven Hospital, New Haven, Conn. 24. University of Minnesota Medical Center 25. University Hospitals Case Medical Center
Cleveland
26. Beth Israel Deaconess Medical Center, Boston27. University of Virginia Medical Center28. Brigham and Women's Hospital, Boston29. Hospital of the University of Pennsylvania30. City of Hope, Duarte, CA31. University Medical Center, Tucson, Ariz.32. University of Utah Hospitals and Clinics 33. Rush University Medical Center, Chicago34. Mayo Clinic Hospital Phoenix35. University of Colorado Hospital, Denver 36. Dartmouth - Hitchcock Medical Center 37. Oregon Health and Science University Hosp.38. William Beaumont Hospital, Royal Oak, Mich. 39. University of California, San Diego Medical Center 40. University of North Carolina Hospitals, Chapel Hill 41. New York - Presbyterian Univ. Hosp. of Columbia
and Cornell42. Evanston, Northwestern Healthcare43. Abbott Northwestern Hospital, Minneapolis, MN44. Loyola University Medical Center, Maywood, IL45. Sarasota Memorial Hospital, Fla. 46. University of Kentucky Chandler Hospital47. Methodist Hospital, Houston, TX48. Lehigh Valley Hospital, Allentown, PA49. Lancaster General Hospital, Lancaster, PA50. Inova, Fairfax Hospital, Falls Church, VA
Source: US News and World Report 2007
The unique Varian Oncology Solution
Cancer Treatment
IMRT & RapidArc
IGRT & DART
BrachyTherapy
Radiosurgery
Proton Therapy
Ground Floor RPTC Munich
StairwaysShaftsPreparation Area
PT and Building SystemsTreatment
42.6
95.2
13.4 2.4 11.2 2.0 11.2 2.0 11.2 2.0 11.2 2.0 10.8 2.9 11.0 1.9
2.0
4.2
1.7
13.6
2.2
1.8
1.2
AA
A
A B
B
CyclotronPosition
Cross Section RPTC Munich
19.42
1.2
1.9
3.1
2.4
15.8
2.4
11.0
2.4
2.1
4.5
1.5
2.9
1.8
0.3
3.8
0.4
4.2
0.4
4.7
0.3
4.7
1.0
Technical LevelPT Treatment Level
Diagnostic LevelOffice Level
3 Gantry – 1 Fixed Beam
Iso-center
G
H
I
F
E
D
C
B
A
waiting areabed
recovery
surveillance
anaesthesia/immob. bed/add. pos.verification
el. sub-div./data
facilitymanagement
varian/accel
workshop maincontrol room
storageVarian
vacuumworkshop
technical delivery
entrance staff/general delivery
administration
waiting area
main entrance
entranceambulance
mob.
immob.
ct
contr.
techn.
exit_1 entrance_1
mob.
immob.
ct
contr.
techn.
exit_2 entrance_2
mob.
immob.
mrt
contr.
techn.
exit_3 entrance_3
reception
lavatory_w
lavatory_m
dosimetry/qs
control_1 control_2 control_3
treatment gantry_1 treatment gantry_2 treatment gantry_3
cyclotron/ess
fixed beam
control_4
changingfixed beam
medicalconsultation
varian/accel
secretary
headclinical service
administration
preparation
staff
el. sub-div./data
supply
disposal
changinganaesth.
reception areabedded patients
treatment corridor
immo.devices
immo.devices
rad.act.devices(deflectors)
labyrinthcyclotron
labyrinth_1 labyrinth_2 labyrinth_3
labyrinth_4
+ 0,00
+ 0,00
bed/ immo.elevator
freightelevator
entrance hall
installationaccess
platformelevator
patientselevator
Iso-center
Beam Transport System (BTS) / Strahlengang
Roof opening
Iso-center
Clinical area
Building Requirements
Clinical Workflow – Increasing Challenges
Cons
ulta
tion
Imag
ing f
or st
aging
Imag
ing f
or T
x Plan
ning
Post Plan.
Ver
ifica
tion
Patie
nt Se
tup Man
agem
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Tx D
eliver
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QA
QA
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ARIAOncology Information System
featuring a single unified Data Base
Clinical Workflow – Increasing Challenges
Patie
nt M
anag
er
SomaV
ision
SomaV
ision
Acuity
Cone
Bea
m C
T
Clinac
, MLC
, Pro
ton Th
erap
y
On-Bo
ard Im
ager
Exac
t Cou
ch, R
PM G
ating,
Optical Tra
cking
Eclip
se H
elios
ARIA A
pplic
ations
PortalVisio
n &
Portal D
osim
etry
Argu
s
What Matters Most?
� Technology?
� Innovation?
� ….
What Matters Most? Save 100,000 more people.
ERICE APRIL 2009
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
DICOM 3.0 DICOM-RT
HL7
LISLab Information
System
HISHospital Information
SystemPVS
Position Verification
System
PTSProton Therapy Control System
Cone Beam CT & Portal
Imaging
Machine Control
Cone Beam CT & Simulator
Imaging
Machine Control
Protons
Linac
Simulator
CT MRPET-CT
VSIMVirtual
Simulation
RT-PACS
EMRElectronic
Medical Record
Charge Capture
VSIMVirtual
Simulation
ARIAOncology
Information System
Scheduler
ECLIPSE Treatment
Planning System
The Integrated Oncology Service
ERICE APRIL 2009
Varian at a Glance
Thank you very much for your interest and attention