Linear Accelerato1

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Linear Accelerator (LINAC)

The Oncology department is situated Lucky for one young cancer patient in 1956 that Henry

Kaplan, MD, had already come to Stanford with an unusual goal: to turn a device used by the

physicists on campusthe linear acceleratorinto a tool for fighting cancer.

That patient, a 2-year-old boy suffering from a tumor in his eye, was the first to undergo X-ray

treatment from a medical linear accelerator that Kaplan developed with campus physicists. The

treatment saved the child's sight and he lived the rest of his life with his vision intact.

Fifty years and 40 million patients later, medical linear accelerators have become the backbone of

radiation therapy for cancer worldwide. Roughly half of all cancer patients receive radiation

therapy, primarily from the rays generated by a linear accelerator.

The device also has a number of other medical uses. Its radiation can quell the rejection of an

organ transplant, suppress the immune systems of patients undergoing blood and marrow

transplantation, and correct certain neurological and cardiovascular disorders.

The medical linear accelerator is a dramatic example of what can be achieved when researchers

from different academic disciplines converge to solve a problem. This 50-year-old achievement

was a precursor to the multidisciplinary approach now called translational medicine.

History of the medical linear accelerator:

1952: Henry Kaplan and Edward Ginzton begin building a medical linear accelerator.

1956: The first medical linear accelerator in the Western Hemisphere is installed at Stanford

Hospital in San Francisco.

1959: Stanford medical school and hospital move to the Palo Alto campus, bringing the medical

linear accelerator.

1962: Kaplan and Saul Rosenberg begin trials using the linear accelerator with chemotherapy to

treat Hodgkin's disease, an approach that dramatically improves patient survival.

1994: First use of the CyberKnife, invented at Stanford, which uses sophisticated computerized

imaging to aim a narrow X-ray beam precisely.

1997: Stanford pioneers the use of intensity-modulated radiation therapy, which combines precise

imaging with linear accelerators that deliver hundreds of thin beams of radiation from any angle.

2004: Implementation of four-dimensional radiotherapy, which accounts for the motion of

breathing during imaging and radiation delivery.

2006: 50th anniversary of the Stanford medical linear accelerator.


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Overview

Targeted treatments making cancer a manageable diseaseThe right dose. The right place. The right time.

Varian delivery systems enable clinicians to pick the best treatment option with a widerange of practical therapy choices. To enhance the effectiveness of these treatments, Varian

also offers unparalleled real-time position management and exacting dose output - vital

tools for achieving personalized cancer care and making cancer a manageable disease.

The Right Dose for Fewer MUs The Varian Clinac delivers the exact prescribed dose to the patient in the lowest number of

monitor units (MUs) possible - without sacrificing efficacy - every time.

Reliable dose - Varian's real-time beam steering and dual sealed ion chamber helps ensurethat optimal beam symmetry, flatness, and dosimetry are delivered throughout all gantry

angles.

Fast treatment times - a unique energy switch to deliver the highest possible dose rates forall energies.

Precise treatment - accurate beam control results in improved conformity to the tumor andsharp images

Waveguide - produces a very stable, sharp beam spot. Gridded gun - fast beam-on, beam-off control. Energy switch - enables delivering high doses quickly. Bending magnet - maintains the small, sharp beam focal spot.

The Right Place for the Highest Conformity Delivering the dose to the right place is a function of industry leading products working in

concert. These innovations include the highest resolution multileaf collimator (MLC), the

most capable dynamic control software, the best treatment plan for driving delivery, and the

most precise beam control.

Varian machines enable clinicians to use all three major IMRT methods - sliding window,step and shoot, and dynamic conformal arc - either separately or in the same treatment.


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Treatment planning software - the intuitive interactive design of Eclipse enables cliniciansto reach plan goals quickly and minimize critical structure doses while achieving the desired

conformity.

Multileaf collimator - treat even the smallest lesions. IMRT - quickly treat IMRT fields up to 34 x 40cm, thanks to fast leaf speed, high precision,

and interdigitation capabilities.

Stereotactic treatments - Trilogy provides high dose and precise resolution for intracranialand extracranial stereotactic radiosurgery and radiotherapy.

The Right Time for Precision Personalization Clinicians around the world depend on Varian systems to deliver treatment at the right time

- the instant the tumor is on target. Whether it's day-to day repositioning of the patient or

managing motion during treatment, Varian has developed the necessary Dynamic Targeting

Image-Guided Radiotherapy (IGRT) process tools: cone-beam CT, radiographic, fluoroscopic,

ultrasound, optical, and gating.

With Varian systems, clinicians can personalize each patient's care based on their needs andyour individual clinical protocol.

Breast: Respiratory gating enables improved dose targeting. Head and Neck: Cone-beam CT provides quick positioning, verifying, and monitoring.

Prostate: All the right tools for treatment include ultrasound-based guidance.


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Clinac 21EX/23EX and PlatinumLinear Accelerator

High performance, Maximum efficiency.

Clinac EX linear accelerators are high-performance systems with:

An instant beam-on with dynamic treatment control The greatest number of energy options to treat the widest range of patients The most precise focal spot size for optimum portal imaging The highest dose rates across the energy spectrum for greater throughput

These capabilities, combined with optional integrated Varian multileaf collimation and electronic portal

imaging systems, enable clinicians to perform the most advanced computer-driven intensity-modulated

radiation therapy (IMRT) treatments, as well as conventional therapy techniques.

Features and Capabilities

Standard Features:

Two selectable photon beam energies Selectable dose rate up to 600MU/min Choice of electron energies to meet clinical needs, with electron applicators included Tight isocenter alignment of the gantry, couch, collimator, and imagers Reproducible, stable, and accurate machine positioning Exact couch for accurate reproducible patient positioning Modes for special clinical procedures, e.g. high dose total skin electron mode and total body X-ray mode Enhanced dynamic wedge saves time and the need to reenter the treatment room Auto field sequencing Dynamic procedure modes for photon arcs SmartConnect remote access technology provides access to Varian customer support expert

assistance and online remote analysis

Optional Features:

MLC - the widest range of multileaf collimator (MLC) resolution choices on the market Real-time Position Management (RPM) system for respiratory gating system PortalVision - megavoltage imaging with optional Portal Dosimetry On-Board Imager kV imaging system (OBI) - high-quality, low dose imaging for verification and

repositioning of patient prior to treatment
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Clinac iX Linear accelerator An innovative platform for today. A solid foundation for the future. The Clinac iX is a streamlined, high-performance and reliable platform that incorporates a

broad range of imaging and treatment options, including dynamic motion management.

Every Clinac linear accelerator is built on the new, high-performance iX platform, and every

system can be custom configured. That means every facility always starts with the best and

builds forward.

This combination of quality and customization allows clinicians to meet the specific needs ofeach site, and to ensure that future treatment advances are always within reach.

Features and Capabilities Standard Features: Up to three photon beams Range of electron energy choices High dose rate stereotactic radiosurgery Low dose rate therapy Respiration-synchronized image acquisition Tight isocenter alignment of the gantry, couch, collimator, and imagers Reproducible, stable, and accurate positioning Automated image acquisition Reproducible online image matching Remote control of imager position Exact couch, remote control of patient position, and improved positional accuracy Compact stand Efficient command center, ergonomically designed for therapists' comfort, and designed to

follow clinical workflow, with fewer controls to manage

Optional Features:


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Standard Features:

Two selectable photon beam energies Selectable dose rate up to 600MU/min Choice of electron energies to meet clinical needs, with electron applicators included Tight isocenter alignment of the gantry, couch, collimator, and imagers Reproducible, stable, and accurate machine positioning Exact couch for accurate reproducible patient positioning Modes for special clinical procedures, e.g. high dose total skin electron mode and total body X-ray mode Enhanced dynamic wedge saves time and the need to reenter the treatment room SmartConnect remote access technology provides access to Varian customer support expert

assistance and online remote analysis

Optional Features:

MLC - the widest range of multileaf collimator (MLC) resolution choices on the market Auto field sequencing - automate field delivery for maximum efficiency Advanced dynamic procedures - used with the MLC option to create true 3D doses with intensity

modulated techniques

Low dose rate option - 580mu/min dose rate selection Laser guard collision detection system


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Clinac 6EX Linear Accelerator

Cost efficient, full function

The Clinac 6EX linear accelerator enables clinicians to augment their multienergy machines with a

single-energy configuration optimized for small rooms where space and shielding are a design issue.

From conventional to stereotactic techniques, and fully dynamic intensity-modulated radiation therapy

(IMRT) support, the Clinac 6EX linear accelerator is a cost effective choice for the busy oncology

department.

Configured for the latest treatment techniques, the Clinac 6EX has the tightest mechanical and

dosimetric specification of any single-energy machine.


Standard Features:

Industry leading beam output, stability, and dynamic dose delivery Compact design for easy site preparation

Selection of 4MV or 6MV photon energy configuration Dose rates up to 600MU/min Tight treatment isocenter for stereotactic applications Exact couch SmartBeam IMRT capability, featuring dynamic dose-sculpting software Autofield sequencing

Optional Features:

High resolution multileaf collimator ( 80 leaf or 120 leaf) High speed beam gating for respiration motion management Low dose, high resolution PortalVision megavoltage imaging system with automated imager

positioning Stereotactic components
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Varian Medical Systems IntroducesRevolutionary New TrueBeam System

for High-Precision Image-Guided

Radiotherapy and RadiosurgeryNew technology enables a radical new approach that expands radiotherapy treatment options for

even the most challenging cases

New York, NY - April 14, 2010 - Varian Medical Systems (NYSE:VAR) today is announcing the

introduction of a new line of "super" accelerators designed to advance the treatment of lung,

breast, prostate, head and neck, and other types of cancer. The TrueBeam platform for image-

guided radiotherapy and radiosurgery is the first fully-integrated system designed from the ground

up to treat a moving target with unprecedented speed and accuracy. Varian unveiled the new line

last night at a special event conducted here for members of the cancer treatment community.

"We took everything clinicians told us they wanted to enable next-generation treatments, and we

challenged ourselves to engineer a completely new treatment platform," said Tim Guertin,

president and CEO of Varian Medical Systems. "TrueBeam is the culmination of those efforts."

A TrueBeam system uses a completely re-engineered control system and a multitude of technical

innovations to dynamically synchronize imaging, patient positioning, motion management, and

treatment delivery. "It opens the door to the development of new and improved approaches for

treating cancer and other medical conditions commonly treated with image-guided radiotherapy

and radiosurgery," Guertin said. "We've also given TrueBeam a patient-friendly look with a

beautiful sleek design, but it's what's under the covers that makes this system so special. It's

intuitive, intelligent, and we think it is a game changer."

Designed to be a versatile platform, a TrueBeam system can be used for all forms of advancedexternal-beam radiotherapy including image-guided radiotherapy and radiosurgery (IGRT and

IGRS), intensity-modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT) and

RapidArc radiotherapy. The product line includes TrueBeam STx, specially configured for

advanced radiosurgery.

Faster, More Precise SystemsA TrueBeam system can deliver treatments up to 50 percent faster with a dose delivery rate of up

to 2400 monitor units per minute, double the maximum output of earlier, industry-leading Varian

systems. This makes it possible to offer greater patient comfort by shortening treatments, and to

improve precision by leaving less time for tumor motion during dose delivery.

"Intelligent" automation further speeds treatments with an up to five-fold reduction in the number

of steps needed for imaging, positioning and treating patients. A standard intensity-modulated

treatment that would typically take ten minutes can be completed in less than two minutes.

Complex radiosurgery that typically takes 40 minutes to an hour, can be completed in just 5 to 20

minutes. "When we introduced RapidArc radiotherapy, we were thrilled to see treatments done

in about 2 minutes," said Guertin. "With TrueBeam, RapidArc treatments can now be completed in

about a minute."

The precision of a TrueBeam system is measured in increments of less than a millimeter. This

accuracy is made possible by the system's sophisticated architecture, which establishes a new

level of synchronization between imaging, patient positioning, motion management, beam

shaping, and dose delivery technologies, performing accuracy checks every ten milliseconds

throughout an entire treatment. Over 100,000 data points are monitored continually as a


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at manufacturing sites in North America, Europe, and China and approximately 79 sales and

support offices around the world. For more information, visit http://www.varian.com.

Trilogy Power. Precision. Versatility.

The new Trilogy system adds more powerful advanced motion management capabilities.

Complete with Gated RapidArc and a new open motion management interface, these tools expand the

options for treating moving tumors.

Gated RapidArc utilizes the RPM system to monitor and adjust for tumor motion during a RapidArc

treatment.

The open interface can also be used with third party companies to connect their devices to Varian

accelerators for the purpose of monitoring motion. This interface further demonstrates the open

architecture design of the Trilogy system and provides support to third party companies to monitor

tumor motion in real time.

The power of Trilogy yields treatment times that are shorter, making the experience more comfortable

for the patient.

The precision of Trilogy allows you to spare healthy tissues to an extent that was unimaginable only a

few years ago.

The versatility of Trilogy enables treatment of a wide variety of patients using a single machine.

All In One. Best In One.

Varian offers the complete package in Trilogy:

Choose from a broad range of external beam therapies, including 3D CRT, IMRT, IGRT or DART using theTrilogy system.

Multiple dose rate options up to 1000mu/min for efficient SRS delivery. 2D and 3D KV image guidance for higher quality imaging at lower doses.
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Full 360 range of treatment delivery angles with positional couch angles. Stereotactic frame or frameless immobilization for patient positioning - treat any area of the body. Real-time Position Management (RPM) system - for gating perfectly timed beam delivery with minimal

margins.

Gated RapidArc with advanced motion management and open third-party interface. Portal Dosimetry IMRT treatment delivery verification. Dynamic high resolution MLC for exquisite beam sculpting. Delivery verification and quality assurance in Argus Linac and Argus IMRT quality assurance software.

Clinical benefits:

Highest dose rate for shorter sessions. Faster treatment times. Tight isocenter alignments on all three axes. Targets the smallest lesions. Rapid on-board imaging. Reposition patients quickly and accurately. Cone-Beam CT, fine tune patient set ups with ultra-precise CT scans.

Varian is not trying to make you follow our process, we provide you with the number one products that

will support your processes.

The Trilogy system is the first in a new generation of cancer care systems. A versatile system optimized

for multiple forms of treatment, from radiation therapy to radiosurgery.

The versatile Trilogy system delivers 3D conformal radiotherapy, IMRT, stereotactic radiosurgery,

fractionated stereotactic radiation therapy, and intensity-modulated radiosurgery for cancer and

neurosurgical treatment.

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