Among The World's First In Clinical Use
Imagine not only seeing a tumor in real time, but also using the same equipment to aim a cancer-killing beam at it—a beam shaped to the tumor, timed to the patient's breathing, and delivering high dose treatments in only a fraction of the time with extreme precision that protects surrounding tissue. Now, imagine doing it all digitally with a keyboard console that is as easy to operate as using a remote control to adjust the volume on your television. For good measure, the treatment couch is tied into the computer and can adjust the patient's position to less than a millimeter.
The UAB Radiation Oncology Department is putting their new TrueBeam™ system through its paces to do all that and more as one of the world's first facilities using the new technology in a clinical setting.
"The higher resolution beam shaping system allows a higher dose rate for faster treatment," said Richard Popple, PhD, Physicist and Professor of Radiation Oncology. "In accelerators, most of energy goes forward and less to the side. Other systems use a flattening filter on the beam to make the dosage more uniform, which slows the delivery of dosage. The TrueBeam system shapes the beam to the shape of the tumor without flattening it. It has a multileaf collinator, like fingers moving in and out, to adjust the shape so we don't have to pour a lead block."
Completely redesigned for efficacy of treatment and ease of operation, the TrueBeam system from Varian Medical Systems, Inc., seamlessly integrates imaging, beam delivery and motion management. The first TrueBeam system has just gone into operation in Europe. The technology has been tested in the United States, but with an equipment serial number of "3," the UAB TrueBeam STx is among the first in the world to be used in a clinical setting.
"The onboard imaging system allows us to directly see what the beam sees. The contrast also gives us a better image, and improvements on a 3-D view are in development," Popple said." "The open technology platform will also allow us to easily incorporate advances from multiple sources and continue to update as new capabilities become available.
"The high precision gives us confidence in placement when we're working adjacent to high critical structures such as near the spinal cord or base of the skull, and the fast delivery rate is particularly good for patients requiring high dose treatments."
Radiation oncologist John Fiveash, MD sees numerous benefits to patients in the image-guided radiotherapy and radiosurgery technology.
"Output is four times faster, so the TrueBeam system lets us do stereotactic high dose treatments much faster," Fiveash said. "A procedure that once took an hour can be done in 15 minutes, and a 20-minute procedure is finished in only a few minutes. Patients are more comfortable, less tired, and it's easier to maintain the right position to get the dose where it's needed."
"The precision of imaging and placement, together with the dynamic tracking and the beam shaping and speed of delivery help us get a more effective dose to the tumor while protecting surrounding tissue," he added.
"Another advantage that could make a real difference is that some treatments who previously required multiple sessions can be completed in only one, so patients who need chemotherapy can get started immediately instead of having to wait for more radiation treatments."
Ideal for treatment of head and neck, liver, prostate and breast cancers, the TrueBeam system offers particular advantages in attacking tumors in the chest.
"As patients breathe, the lungs continue to move. The TrueBeam has a control for breathing so it only delivers radiation in the part of the cycle when the patient exhales and it senses that the lungs and tumor have returned to the right position," Fiveash said.
"In addition to being able to do CT scans, x-rays and sych x-rays with breathing, the plug-in architecture will allow us to add an infrared camera to the system later," Fiveash said. "The system has been redesigned from the ground up with a platform that lets us add new tools in easier way and operate the with a control system that is much easier to use."
The new TrueBeam System is part of a major initiative to fight malignancies at the new UAB Cancer Center.
"We have six cancer biology labs working on new medications, and we're recruiting three new physician scientists to treat patients and work on new therapies that we can add to advances like the TrueBeam system to fight cancer more effectively," Fiveash said.
Will the new capabilities of True Beam technology translate to more lives saved and longer survival times?
"That's what we're hoping for," Fiveash said. "The extreme precision lets us get closer to tumors in difficult areas so we can deliver a more accurate and effective dose. By completing radiation faster, some patients will save days or weeks and be able to get started on other therapies earlier to enhance the potential for recovery."