Posts Tagged ‘VMAT’
• Life with Lars Leksell on page 8, written from the perspective of his son, Dan Leksell, Executive Vice President and Senior Advisor at Elekta, provides insight into the history of the company and the man who built it.
• See how a 17-year-old cancer survivor becomes an advocate for teens across the globe – her heartfelt story on page 24.
• On page 34, learn more about the benefits three centers have experienced using MOSAIQ® – Elekta’s EMR solution that’s set the bar by which all other radiation and medical oncology information systems are measured.
• On page 40, we go behind the scene for a glimpse of the development of Elekta’s new Monaco® treatment planning system with VMAT as well as the group behind its development.
Enjoy this issue of Wavelength!
Wavelength
The rapid adoption of volumetric modulated arc therapy is generating a flurry of new treatment planning solutions.
By: Cristen C. Bolan
Since volumetric modulated arc therapy (VMAT) became available in the U.S., it has taken off in radiation oncology. The promise of VMAT delivery is to drastically cut treatment times compared to traditional IMRT. The shorter treatment times result in less patient movement, and thus increased accuracy and the potential to spare healthy surrounding tissue.
The adoption of VMAT is driving an influx of new VMAT-enabled tools to market, and leading the trend are new treatment planning solutions with arc-enabled modules.
From IMRT to VMAT
Taking IMRT to a new level, Elekta and Varian Medical Systems developed the first commercially available solutions providing volumetric-arc therapy. Elekta grabbed the acronym — VMAT — to brand its treatment solution, while Varian introduced its arc therapy solution RapidArc.
Treatment planning for Elekta’s system follows a similar approach to planning for conventional IMRT, but Elekta’s VMAT can be delivered using a single arc, multiple arcs, partial arcs, or a combination, depending on what the physician considers best for the patient. New VMAT tools enable users to create arc-based treatment plans using the same features available in Elekta’s Monaco solution. With reduced planning time and increased clinical throughput, Monaco with VMAT optimizes single or multiple non-coplanar arcs simultaneously.
“It’s fair to say there is a lot of interest around volumetric arc therapy. It likely will be widely adopted,” said Vivek Mehta, M.D., radiation oncologist, Swedish Cancer Institute, Seattle, Wash. “There are two drivers. One is it’s a much more efficient way of treating patients, because it shortens the time the patient has to spend on the table, and it reduces the dose to normal tissue. That’s what’s going to drive uptake.”
Redesigning Treatment Plans
The rapid uptake of VMAT is the force behind the development of new treatment-planning solutions programmed to include algorithms for volumetric arc therapy planning.
This year Philips launched SmartArc, an independent treatment planning solution for volumetric-modulated arc therapy (VMAT). Bundled as a module in Philips’ Pinnacle3 version 9 radiation treatment planning (RTP) software, the new planning option can be used with any VMAT-capable delivery system on the market. The system provides for constant-dose rate delivery designed to allow clinicians to explore the benefits of VMAT delivery without the expense and downtime associated with an upgrade to their linear accelerator.
Dr. Mehta uses IMRT or VMAT to treat patients with brain, head and neck, intra-abdominal tumors, such as pancreas, gastric, for prostate cancers and to treat patients that have been previously irradiated. SmartArc allows single or multiple user-definable arcs and supports both constant- and variable- dose rate delivery. The advantage of both constant- and variable-dose rate delivery is it “allows for improved planning and dose delivery, particularly for patients with complicated target volumes,” explained Dr. Mehta.
Read the entire article here: http://www.itnonline.net/node/34633//
The second day of the 2009 AAPM drew thousands of Physicists to the Anaheim Convention Center. Elekta’s Booth 423, the largest and most prominent at the show, attracted hundreds of people for non-stop demonstrations of its new Monaco treatment planning system optimized for VMAT, its MOSAIQ EMR system and its Infinity and Synergy linear accelerators.
Elekta hosted an Impac Users Meeting Luncheon and drew record crowds, with over 200 people in attendance to hear a talk on Beyond Rapid: Elekta VMAT Innovations. Todd Powell, Sr. VP Product Creation described our MOSAIQ 2.0 EMR and Dee Mathieson, Sr. VP Business Line Management, spoke about our Monaco treatment planning system with VMAT and how it works with the Elekta
linear accelerators.
- AAPM
The first day of AAPM opened Sunday at 1 PM. Elekta, Impac Software and CMS Software are located in the largest booth at the show, which is near the Hall’s front entrance. [ Click here for AAPM Floorplan ]
AAPM is expecting over 2500 people at the show this year slightly less than last year, although physicistsare still registering. The Elekta booth was very busy during the first day with special interest in CMS Software’s treatment planning system, Monaco with VMAT which was just cleared by the FDA on July 17th. The workstations were packed all day with back-to-back demos.
The theme of this year’s show is, “Beyond rapid there is Elekta VMAT” and it is depicted through engaging graphics of young children in red capes, a subtle nod to VMAT as the hero of conformal therapy procedures with its multiple arc capability and high dose conformance, not to mention that the time and total monitor units needed to deliver these treatments can be reduced drastically from standard IMRT protocols.
There has been a lot of buzz about VMAT throughout the technical sessions, which positions Elekta very well in this space.
Three copies of this year’s AAPM summer school physics book, “Clinical Dosimetry Measurements in Radiotherapy” will be raffled off and shipped to AAPM attendees on August 3rd.
- Elekta Booth at AAPM 2009
Click To view more image from AAPM 2009
At the 2009 American Association of Physicists in Medicine (AAPM) annual meeting, July 26-30 in Anaheim, California, We will demonstrate how our company’s comprehensive VMAT solution can help health care providers deliver superior cancer care with precision and ease.
Discover the new paradigm in VMAT planning
An advanced, clinically relevant IMRT planning system, Monaco® brings innovative concepts to the clinic that help make the planning process easier, more straightforward and clinically reliable.
New VMAT tools enable users to create arc-based treatment plans using all of the features already available in Monaco. With reduced planning time and increased clinical throughput, Monaco with VMAT optimizes single or multiple non-coplanar arcs simultaneously, providing the flexibility and control needed for complex treatment plans.
“The receipt of 510(k) clearance from the FDA for Monaco with VMAT is a significant event on the way to final release of the planning software,” said Joseph K. Jachinowski, President and CEO of Elekta North America. “The VMAT capabilities within Monaco will help clinicians choose the best treatment options available and improve quality of care.”
Optimize treatment with the market-leading oncology EMR
Built upon 15 years of development, application and innovation, MOSAIQ® 2.0 increases productivity, elevates efficiency and facilitates high-quality patient care. Complete with new connectivity, new functions and database enhancements, while preserving the user interface MOSAIQ supports the entire cancer team by uniting diverse systems and devices.
“Simple and intuitive, yet incredibly powerful, MOSAIQ 2.0 is the next major milestone in the development of oncology information systems,” said Jay Hoey, Executive Vice President of Product Creation for Elekta and CEO of Elekta Impac Software. “We’ve invested thousands of man-months of R&D and seriously advanced technology to deliver the most elegant, most comprehensive, most stable, and highest performing information product available for radiation and medical oncology.”
Distinguish yourself with the definitive VMAT delivery system
Elekta Infinity integrates the most advanced capabilities available with unmatched ease of use. The only fully integrated treatment system that allows personalization of imaging and treatment workflows, Infinity can dramatically reduce IMRT treatment sessions with the flexibility of multiple arcs to improve conformance.
“Elekta has always focused on providing highly refined tools, like Infinity, that support specific clinical objectives, yet share a common foundation in terms of imaging, planning and information management,” continues Jachinowski. “The result is a comprehensive treatment solution that frees clinicians to focus on patients, instead of the technology.”
Elekta also plans to host several education seminars and events in conjunction with the annual meeting. For additional information and registration, visit elekta.com/aapmevents .
Treatment of small cell lung tumor using Elekta VMAT
Treatment of small cell lung tumor using Elekta VMAT
Physicists James Bedford, Jim Warrington
Radiographers Helen McNair, Alexandra Aitken
Radiation oncologists: Juliet Brock, Michael Brada
With the support of the Radiotherapy team, Royal Marsden NHS Foundation Trust, UK.
Patient history and diagnosis
A 71-year-old lady presented with a cough, haemoptysis, chest pain and shortness of breath on exertion although she remained of performance status 1. She was a non-smoker with a past medical history of a heart murmur, hypercholesterolaemia and a melanoma of the right leg treated surgically in 1984.Imaging showed a large subcarinal mass measuring 7 x 5cm and a small nodule in the apical segment of the left lower lobe (Figure 1). Histology showed small cell carcinoma of the lung. The disease was staged as limited stage and chemoradiotherapy was prescribed. Chemotherapy consisted of six cycles of Carboplatin and Etoposide. Radiation therapy consisted of 50gy in 25 fractions, concomitant with cycles 5 and 6 of chemotherapy.
Read the full Treatment of small cell lung tumor using Elekta VMAT case study here
Very few areas of medicine are changing faster than cancer care and Seattle physicians and researchers are leading the way.
A patient with pancreatic cancer at the Swedish Cancer Institute (SCI) recently became the first person in the United States to be treated with a new technology known as Volumetric intensity Modulated Arc Therapy (VMAT). VMAT cuts radiation treatment times by one-half to two-thirds through delivering a higher and more targeted dose to cancerous tumors, without compromising patient safety. To date, more than 10 patients have been treated with VMAT at the Swedish Cancer Institute. They have included patients with tumors of the brain, abdomen and pelvis.
“VMAT allows the delivery of higher radiation doses with greater precision. We will kill more cancer and patients will have fewer side effects,” said Vivek Mehta, M.D., director of SCI’s Center for Advanced Targeted Radiation Therapies.
Faster treatment times often mean improved comfort for patients, making it easier for them to remain still during the process. For the first VMAT patient, total treatment time was less than 10 minutes. More important, Dr. Mehta’s team was able to greatly reduce the radiation exposure to surrounding sensitive areas – including the spinal cord, left and right kidneys and the liver.
Dr. Mehta is the principal investigator on a VMAT clinical study that will last approximately six months and involve at least 20 separate patients. Part of the study’s purpose is to prove definitively that VMAT is both faster and safer than the existing treatment approach.
With VMAT, Swedish clinicians are able to treat more patients with complex cancers than they could in the past. That includes those who have had radiation therapy previously with limited success and patients with tumors adjacent to critical structures in the body. Also, the technology should benefit patients who find it difficult to lie completely still for the typical 30 or more minutes of treatment time.
Dr. Mehta estimates that 10 percent to 15 percent of people now treated at the Swedish Cancer Institute will be good candidates for VMAT.
Swedish clinicians are working closely with VMAT developer Elekta. “I believe we were chosen as the first North American site because Swedish has a proven track record of innovation in cancer care,” Dr. Mehta said. “Medical manufacturers often come to SCI’s Center for Advanced Targeted Radiotherapy with novel ideas and we select the technologies that have the greatest potential to improve treatment and save lives.”
What’s on the horizon?
Dr. Mehta believes the next innovation will be some form of adaptive radiotherapy. By borrowing software from other disciplines, clinicians may be able to see the results of the radiation therapy within 30 to 60 seconds and adapt their treatment plans instantly. Instead of viewing an image of the tumor in week one of treatment and not again for the typical six weeks, physicians could make near real-time corrections to both radiation targeting and dosage.
“We can cure about half of the patients we see, many of whom have very serious cancers. That is far better than a generation ago, but we need to keep improving outcomes for the other 50 percent,” said Dr. Mehta. “As the largest and most comprehensive cancer treatment program in the Pacific Northwest, that is our sole mission.”
follow Swedish Cancer Institute on Twitter: http://twitter.com/Swedish
follow Elekta on Twitter: http://twitter.com/ElektaAB
Potential of volumetric modulated arc therapy (VMAT) for anal cancer –
Anal cancer is primarily treated with radio chemotherapy and represents a complex treatment situation due to the size, shape and position of the pelvic planning treatment volume (PTV). Pelvic radiation therapy may cause significant acute and late toxicity, therefore advanced 3D treatment planning strategies as well as intensity modulated radiotherapy (IMRT) are used to reduce exposure to organs at risk (OAR). Volumetric modulated arc therapy (VMAT) may provide excellent dose distributions with very short treatment times. This case-based planning study explores this potential.
read more about VMAT for Anal Cancer
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