Customer Visits Presentationmedikalfizik.org/uploads/files/14_MDF_Kongre/1_gun... · • CBCT...

1 | VARİAN ONCOLOGY SYSTEMS

VARIANONCOLOGYSYSTEMS

TrueBeam™Machine Performance Check - Automatic Quality Assurance Tools TrueBeamTM 2.0 ImprovementsRapidPlanTM

Luis Carvalho

Product ManagerDelivery Systems

Nov 21, 2013Antalya


Disclaimer

• Employed by Varian Medical Systems


TrueBeam™ - Radically Different


TrueBeam™ - Radically Different

Field Size: 40*40 cm2

Center leafs (20 cm): 5 mmOuter leafs: 10 mm

Field Size: 40*22 cm2

Center leafs (8 cm): 2.5 mmOuter leafs: 5 mm

TrueBeam™ TrueBeam™ STx


TrueBeam - Worldwide Clinical Operation

ClinicalUse

>600 installations >850 orders

Registrations / Clearances: US FDA, CE Mark/ MDD, Russia Gost, Saudi Arabia SFDA, China SFDA, Japan Shonin, Australia & New Zealand, Thailand, Korea, India, …


CustomerFavorites

Ease of UseConfidence for SRS/SBRTand Gating• Accuracy• ImagingSpeed• Reduction in Tx time in SBRT

cases by 2.5 to 3X• High Intensity Mode• Automation

TrueBeam in Clinical Use


TrueBeam™

Heart of TrueBeam—The Maestro™ Control System


Accelerator/Accelerator Solenoid

Bend Magnet

Carousel

Collimator & MLC

Shielding

Energy Switch

Target

Stand / Gantry


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, RapidArcor small field SRS

Available in clinical mode for 6 MV 1400 MU/min10 MV 2400 MU/min


TrueBeam™

Treatment Console


Console Pendant Couch

Common User Interface


Safety

• Touch guards• Capacitive collision detection• Machine motion model• Zone rules• Live view• Standardized user interface• Pre-treatment dry-run• LaserGuard II

TrueBeam Highlights


ISOCal Goal – Align ISOcenters

Source: University Hospital Zürich, Hrbacek, Lang


ISOCal Phantom

• Aligning kV imaging ISOC toMV treatment ISOC


ISOCal Results

Source: University Hospital Zürich, Hrbacek, Lang


TrueBeam™

Innovative Treatment Techniques

GatedRapidArc

• Next evolutionary step• Compensates for tumor

motion• Expands application of

RapidArc treatments tomoving tumors

• Enables faster treatmentsof tumors that move with respiration


TrueBeam™

Intelligent

SmartConnect


TrueBeam™

Intelligent

RemoteMachineDiagnosis

• Service can proactively and remotely analyze machine status

• Quick access to experts• Faster diagnosis and resolution


TrueBeam™

Innovative

DeveloperMode

• New method of collaboration• Partnership for developing new

innovations• Protected non-clinical

environment


TrueBeam™

Exotic Trajectories

Red Journal - paper from MSKCC New York in Press

Dynamic trajectory-based algorithm integrates optimized couch and collimator trajectories into RapidArc/VMAT


TrueBeam™

Exotic Trajectories


TrueBeam 2.0


EnhancedIGRT

• New 2D / 3D algorithm(6DoF)

• Ad-hoc imaging(DRR on the fly)

• Additional triggers forintra-fraction imaging

• 4D CBCT

• CBCT Stitching

Selected features


On-Demand Imaging

• Deploy kV imaging system any time during treatment

• Instant DRR creation

• Match and Shift

TrueBeam 2.0 – New Features


Several mechanisms to trigger kV image acquisition:

Time“every 10 seconds”

Gantry angle “every 10 degrees”

Monitor Units“every 50 MU”

200 201

Respiration“every breath”

Triggered Image acquisition


Triggered Imaging

• Project onto real-time triggered kV

• Outline of 3D structures from treatment planning

• Circular outline when treating with markers

Advanced IGRT and Motion Package


Advanced IGRT and Motion Package


New “Vivid” Display filter

CE Mark & Intl. Registrations Pending – Not for Sale in all Markets


43x43cm MV Detector

active area30X40cm2

active area43X43cm2


4D CBCT

Basic 4D Advanced 4D

Images courtesy of Free University of Amsterdam, W. Verbakel


Advanced IGRT & Motion PackageAdvanced Reconstructor - Multiscan CBCT


PerfectPitch™ Couch



• Increased treatment precision for challenging indications• Robotic beam alignment with 6 degrees of freedom • Smooth Isocentric rotation


• Increased treatment precision for challenging indications• Robotic beam alignment with 6 degrees of freedom • Smooth Isocentric rotation

• Fully integrated• Sub-millimeter Accuracy• Robust Design – supports up to 200 kg



Upcoming Options

TrackingCouch / MLC

• Non-Clinical(Developer mode)

• Couch or MLC compensation

• Periodic with model

• Non-periodic with Calypso(Real-Time Feedback)


TrueBeam™ 2.0Dynamic Couch Tracking - Reactive


Machine Performance Check


What is MPC?

An application to verify that geometry and beam performance of the TrueBeamTM

accelerator are operating within system specifications.

Automated checks which can be performed on a daily basis using kV and MV imaging systems as the primary measurement devices.


What is MPC?

IsoCal Phantom + Holder

kV / MV imaging systems

+MPC application running on treatment console

+


Beam Constancy Check(against reference MV image)

Beam output change

Beam uniformity change

Beam center shift

What does MPC test?Geometry Check Size of treatment isocenter

Coincidence of treatment and imaging isocenter

Positioning accuracy of MV and kV imaging systems

Accuracy of collimator and gantry rotation angle

Positioning accuracy of jaws and MLC leafs

Couch positioning accuracy (up to 6 DoF)


MPC Workflow


MPC Review Workspace

Available on treatment console and on separate workstation (MPC in offline mode)

Detailed analysis of recent and previous MPC results (including acquired images)

Simple trend analysis

Generation of test reports

Export of test results to CSV files


Future Steps

Automation of Quality Assurance Procedures Interface for automated QA scripting

Automated shoot & measure sequences

Enabling customized analysis using e.g. Matlab based on exported MPC data


RapidPlan™


Clinical Process

Contouring Treatment Planning

Plan Approval

Physics & QA

Treatment Delivery

• Each step in the treatment process has variability & inefficiencies associated with it

SmartSeg ? ? QA tools (MPC)

Delivery accuracy

(RapidArc)

• Varian provides technology to reduce variability at each step of the process



Reference case match

Auto contour

Auto planAuto Evaluation

Add to Knowledge

Base

New patient

Contours morphed from Expert Case

Local Knowledge Base

Evaluate against prior experience

IMRT Dose distribution derived from prior

experience

TargetCord

Parotid

Patient Case

Reference CaseShare cases with colleagues.

Improve quality of care globally.

Introducing RapidPlan™


Knowledge-Based Planning

-0,2

0

0,2

0,4

0,6

0,8

1

0 10 20 30 40 50 60

Measurements

Dev

iatio

n fro

m M

ean Implementation of a

knowledge based approach


Source: Washington University



New IMRT users

• Increase quality• Provide good

starting point• Confidence

Experienced IMRT users

• Reduce variability

• Normalize clinician skills & experience

Busy clinics

• Increase efficiency

Clinical trials

• Easier to participate

• Greater consistency




What RapidArc™ did for Treatment Delivery;

KBP will do for Treatment Planning

Start with your best plan

Quality Consistency Efficiency


Customer Visits Presentationmedikalfizik.org/uploads/files/14_MDF_Kongre/1_gun... · • CBCT...

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