Treatment planning
The latest releases of XiO®, Focal and Monaco® treatment planning systems are now available from Elekta.
Request your TPS upgrade today at www.elekta.com/upgrade.
Customers rely on planning systems’ exceptional connectivity to department’s technology to improve QA, training and workflow
According to clinicians at many cancer centers, it is difficult to overestimate the value of Elekta’s vendor neutral planning solutions for the smooth operation of the radiation therapy department. By implementing a single treatment planning system (TPS) across the entire department, clinics are realizing greater efficiencies in workflow, quality assurance and training.
“We support many different treatment modalities in this clinic, in addition to five different planning systems plus CT simulation,” says Charles W. Kinsey, Chief Physicist, Presbyterian Hospital, (Charlotte, N.C.) “This puts a tremendous burden on the planners who have to know how to generate high quality plans for the different systems and for those responsible for treatment planning QA for all of these systems. Implementing Elekta’s XiO TPS for two of our treatment systems, a Varian and an Elekta, has been a huge improvement.”
“The efficiency inherent in a vendor neutral TPS platform gives us more time to develop a high quality plan independent of the treatment platform,” he continues. “Also, a vendor neutral TPS will have more robust beam modeling tools. This allows the estimate of how we are going to treat the patient to more closely reflect how we will actually treat the patient.”
Bon Secours Cancer Institute (Midlothian, Va.) operates three non-Elekta linear accelerators at three clinics, but chose an Elekta treatment planning system to develop plans at each site.
“We chose the Elekta TPS solution because we wanted the option to more easily expand our existing system, and we predicted that over the long term our operational costs would be lower,” says Teresa Crist, R.T.T., Director of Radiation Oncology at Bon Secours. “The fact that it is vendor neutral enables us to optimize the use of our existing linac hardware to deliver advanced techniques and imaging options.”
Read more about Elekta’s vendor neutral treatment planning solutions in the February 2012 issue of Wavelength customer magazine.
Biological-based planning maximizes critical organ sparing in fast VMAT for SBRT of prostate, lung and liver lesions. Med. Phys. 39, 237 (2012)
High-dose Stereotactic Body Radiation Therapy (SBRT) has emerged as a critical treatment option for patients with prostate, lung and liver cancer. The challenge has been delivering SBRT’s large doses as quickly as possible, for improved patient comfort and to reduce the chance the patient will move during treatment delivery. While Volumetric Modulated Arc Therapy (VMAT) promises much faster treatment delivery, clinicians have been reluctant to sacrifice plan quality to deliver therapy faster. The Editor Pick in the January 2012 issue of Medical Physics is an article by Quentin Diot, Brian Kavanagh, Robert Timmerman, and Moyed Miften that demonstrates that the use of Monaco biological-based planning meets the need for fast SBRT with high quality plans.
“We found that using biological-based optimization and VMAT we could deliver faster treatments with comparable or better plan quality for patients with prostate, lung and liver patients, compared to fixed gantry [i.e., step-and-shoot] IMRT,” says the University of Colorado School of Medicine’s Moyed Miften, Ph.D., a senior-author of the paper, Biological-based optimization and volumetric modulated arc therapy delivery for stereotactic body radiation therapy.*
The researchers found that biological-based planning achieves the goal of sparing organs-at-risk (OARs) – the physician’s main concern when delivering SBRT’s significantly larger radiation doses per treatment fraction. Subjects included 24 SBRT patients with prostate, liver or lung cancer.
Biological-based planning v. physical planning
Elekta’s Monaco® uses biological-based plan optimization, in contrast to planning systems that offer only physical planning.
The optimization process entails the twin goals of maximizing the dose to the target and minimizing the dose to OARs. Because targets and OARs are contiguous, these goals compete and the optimizer needs to make the appropriate trade-offs.
With physical-based optimization, the planner manually enters points (volume receiving a given dose or dose volume (DV)) to constrain the optimization based on available clinical data that demonstrate a correlation between tumor control and normal tissue complications and particular DV metrics.
“These metrics are only surrogates of the biological response and different plans that meet the same discrete constraints can have a very different biological outcome,” explains Quentin Diot, Ph.D., of the University of Colorado School of Medicine. “Conversely, biological-based optimization – such as that provided by Monaco – uses model functions directly related to biological outcomes to guide the optimization, and can distinguish between apparently equivalent physical plans.”
*Biological-based optimization and volumetric modulated arc therapy delivery for stereotactic body radiation therapy. Med. Phys. 39(1), January 2012.
Leeds Teaching Hospitals NHS Trust Accelerates Cancer Care with Monaco Planning Software from Elekta
Clinicians cut VMAT planning times, aim to increase access to rapid radiotherapy for more patients
Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) delivery techniques have dramatically reduced treatment times for thousands of patients. An obstacle to offering this technique to more patients is the time it takes to create a VMAT plan. Physicians at St. James’s University Hospital – the first in the United Kingdom to use Monaco® VMAT clinically – have been able to significantly reduce VMAT planning times, increasing the potential to offer this advanced therapy to greater numbers of patients.
“Our referral rate for radiation therapy is expanding by over seven percent annually,” says St. James’s head of radiotherapy physics Vivian Cosgrove, Ph.D. “We see VMAT as a key way to manage that growth. If we can plan complex radiotherapy quickly and deliver treatment more efficiently with VMAT, then we can treat more patients and derive more benefit from our existing fleet of treatment machines.”
Elekta VMAT is an advanced radiation therapy technique that delivers treatment in one or more continuous high-speed arcs around the patient, enabling the radiation dose to precisely conform to a tumor by modulating the radiation beam’s intensity in multiple small volumes.
The key to rapidly developing Elekta VMAT plans lies in understanding the principles of efficiently producing traditional IMRT plans with step-and-shoot (i.e., non-dynamic) delivery. Medical physics staff at St. James’s have used Monaco since January 2011 to plan head-and-neck IMRT cases.
“Monaco has transformed our IMRT service,” Dr. Cosgrove notes. “After contouring, we can complete a complex head-and-neck plan in two to three hours. This is two to three times quicker than other planning systems we have used. Since we introduced Monaco clinically, we have been able to significantly increase the number of patients receiving intensity modulated treatment: over 260 patients in 2011 and a target to increase this further in 2012.”
That number includes many patients who have received VMAT planned with Monaco, which St. James’s clinicians began performing in August 2011 on one of its 12 Elekta digital accelerators.
VMAT delivery of head-and-neck cases takes 6.5 minutes, half the time of a seven-field step-and-shoot delivery, he says. Read more at: http://www.elekta.com/press/389c2bcd-2287-4ba8-8cad-72f5d96b175c/leeds-teaching-hospitals-nhs-trust-accelerates-cancer-care-with-monaco-planning-software-from-elekta.html.
Register online at elekta.com/symposium
Elekta Software customers in North America are invited to attend our complimentary Treatment Planning Symposia held January 27 in Chicago and February 28 in Philadelphia. The conference is an opportunity for treatment planning users to share their experiences, while acquiring new techniques. Topics include:
- Quality assurance system for normal tissue contouring
- The utilization of advanced IMRT techniques for large fields
- Tips and tricks to optimize planning and workflow processes with XiO® and Monaco®
We also will discuss current and future release plans. To register and view an agenda, click here: Treatment Planning Symposia.
Friday, January 27, 2012 • Chicago, Illinois
Westin Lombard Yorktown Center
Tuesday, February 28, 2012 • Philadelphia, Pennsylvania
Doubletree Philadelphia Center City
*Program includes breakfast, light lunch, MDCB and CAMPEP CEUs through an educational grant by Elekta.
Institution: University of Colorado Cancer Center, Denver, Colorado, US
Patient: 72 year old male
Diagnosis: Localized small cell carcinoma of the distal thoracic esophagus
Plan: Stereotactic body radiation therapy (SBRT) using VMAT
Patient History and Diagnosis
This 72 year old male presented with a localized small cell carcinoma of the distal thoracic esophagus. He underwent a single cycle of cisplatin and esoposide followed by concurrent chemoradiation therapy, using 3D conformal radiotherapy to encompase the esophageal primary and regional lymph nodes. He received a total dose of 45 Gy in 25 fractions along with the second cycle of cisplatin and etoposide. He received 4 additional cycles of chemotherapy.
He remained well until restaging with PET-CT 8 months following completion of therapy showed a new FDG-avid hypodensity in the right lobe of the liver, segment 6. The lesion measured 2.0 x 1.7 cm and had a SUV of 6. A MRI of the brain was negative. The PET was negative in the region of the esophageal primary as were upper endoscopy and biopsy. The patient performance status was excellent and despite the usual aggressive course of extra-pulmonary small cell carcinoma, because his primary was controlled, we elected to be aggressive with this solitary liver metastasis.
Download the entire case study here: http://www.elekta.com/assets/new-proof/assets/Software/CS%20Stereotactic%20Body%20Radiation%20Therapy%20for%20Liver%20Cancer%20Using%20the%20Monaco%20Treatment%20Planning%20System%20and%20VMAT%20Delivery%20at%20University%20of%20Colorado%20Cancer%20Center%20Denver%20Colorado.pdf.
New Release of Monaco Treatment Planning System Prepares Software for Stereotactic Radiation Therapy
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