wavelength march 2013 volume 17 no. 1
TRANSCRIPT
Vol. 17 | No. 1 | March 2013
PIONEERING SIGNIFICANT INNOVATIONS IN CLINICAL SOLUTIONS FOR TREATING CANCER AND BRAIN DISORDERS
Introducing Versa HD™
PAGE 4
BMX bike rider’s Gamma Knife® experiencePAGE 6
Brachytherapy for bladder cancerPAGE 10
In Wavelength Volume 16 No. 2, p. 14, we mentioned Peter C. Gerszten, MD, MPH as Associate Professor, Neurological Surgery and Radiation Oncology at University of Pittsburgh Medical Center. Dr. Gerszten is Professor, Neurological Surgery and Radiation Oncology. We regret the error.
Pioneer and partner in cancer care.
The world’s cancer management challenges demand bold solutions. As a global leader in the design and manufacture of cancer treatment technology, Elekta for decades has assumed the mantle of responsibility to help introduce systems and software to defeat this terrible disease. As this issue of Wavelength publishes (March 1, 2013), we will have demonstrated our leadership in this arena once again with the unveiling of Versa HD™, our new flagship linear accelerator designed to deliver higher-quality radiation therapy for more patients and more cancer types.
In Versa HD we endeavored to integrate technologies that would provide an immediate impact to patient health and quality of life — in a system that gives clinicians the flexibility to deliver conventional therapies to treat a full range of tumors throughout the body, while also enabling treatment of highly complex cancers that require ultra-precise targeting.
We hope you enjoy reading the article about Versa HD in this issue, starting on page 4.
In addition to Versa HD, Elekta is making inroads on a wide front in radiation therapy, for which we present articles on advances in brachytherapy, stereotactic radiosurgery with Leksell Gamma Knife®, stereotactic body radiation therapy, Elekta eLearning and inspirational stories from our customers around the world.
Good reading!
Tomas PuuseppPresident and CEO of Elekta
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Dear friends,Contents
Unmatched versatility 4 with Versa HD™
Clarity® 4D Monitoring 9
Agility™ users in Germany 10
From BMX to 12 Gamma Knife® radiosurgery
Elekta around the world 14
Consider lung cancer 16 for first SBRT target
Laparoscopic brachytherapy 18 for bladder cancer
eLearning labs 21
What makes your 24 center unique?
Vol. 17 | No. 1 | March 2013
Published by Elekta | www.elekta.com
All letters, comments or suggestions for future articles, requests for reprints and permissions are welcome.
Contact Wavelength: Michelle Joiner, Director, Global PR and Brand Management Tel: +1-770-670-2447 (time zone: Eastern Standard) | Email: [email protected]
The products and product clinical indications for use described within this magazine may not have clearance or registration in certain countries. Please consult Elekta in your country for questions concerning a product or clinical use subject.
Art. No. 1503506 © Elekta AB (publ). All mentioned trademarks and registered trademarks are the property of the Elekta Group. All rights reserved. No part of this document may be reproduced in any form without written permission from the copyright holder.
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Unmatched versatilityThe convergence of conventional radiotherapy with advanced stereotactic precision
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“The well-being of increasing numbers of cancer sufferers worldwide inspired us to create Versa HD,” says Elekta CEO Tomas Puusepp. “We strived to incorporate technologies that would provide an immediate and meaningful impact for the patient’s health and quality of life. As the pioneers of
stereotactic radiosurgery (SRS), stereotactic radiotherapy (SRT) and image guided radiation therapy (IGRT), Versa HD represents yet another market-leading innovation from Elekta. This system truly reflects the best thinking of Elekta’s technical experts and our clinical partners.”
On March 1, 2013, Elekta unveiled the new Versa HD™, an advanced linear
accelerator that provides the flexibility to safely and efficiently deliver the full
spectrum of conventional techniques, while also offering the versatility to enable
sophisticated linear accelerator based stereotactic treatments – all within a
single radiotherapy platform. With ground-breaking radiation beam shaping
and tumor targeting capabilities, Versa HD also debuts new technologies that
facilitate cutting-edge therapies without compromising treatment times.
>>
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Designed with patient safety in mind F Reduced collision risks with touch-activated patient protection and
the market’s largest isocenter clearance
F Decreased non-therapeutic doses with the lowest radiation transmission of any commercially available MLC
F Visualize broad regions-of-interest with the industry’s largest IGRT cone-beam CT field-of-view
F Audit and safely orchestrate multiple linac functions with Elekta’s 7th generation digital control system
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Advanced technology for demanding cases
Integrated with Elekta’s recently launched Agility™ 160-leaf multi-leaf collimator, Versa HD provides highly conformal beam shaping across the 40 cm X 40 cm field and can deliver high definition (HD) beams to a wide spectrum of complex targets, both small and large. Agility also features exceptionally low radiation transmission.
With new flattening filter-free (FFF) beam technology, Versa HD can deliver radiation doses three times faster than previous generation Elekta linear accelerators. In addition, harnessing the ultra-fast leaf speeds of Agility MLC, clinicians can now – for the first time – fully exploit higher dose rate delivery, potentially enabling even greater dose sculpting capabilities for advanced therapies such as SRS, SRT and and IMRT.
Versatility to deliver better treatments to more patients
Versa HD gives clinicians the flexibility to deliver conventional therapies to treat a wide range of tumors throughout the body, while also enabling treatment of highly complex cancers that require extreme targeting precision. As an integrated system, it offers the versatility to address today’s growing cancer management challenges in a single system platform.
“New radiotherapy techniques are continually introduced into the clinical environment, often resulting in the necessity to acquire dedicated systems,” Puusepp observes. “To acquire one system for conventional radiotherapy and another for SRT is impractical for the majority of cancer centers. Versa HD directly addresses this challenge by providing clinics with the very latest innovations in radiotherapy, and also the necessary versatility to deliver the widest spectrum of therapies – from conventional radiotherapy to advanced stereotaxy.”
Gentle for patients and the environment
Versa HD also debuts with modern ergonomics, including a patient-friendly, soft and sleek exterior, new hand held user controls, plus ambient lighting effects to create a confident, relaxed atmosphere for the patient.
In addition, the system was specifically designed to address energy consumption and environmental impact. With the ability to continuously operate on lower power levels, Versa HD runs at a significantly lower temperature to reduce cooling costs and decrease overall power consumption. Requiring up to 30 percent less energy than other delivery systems, Versa HD conserves resources to minimize cost of ownership and helps to preserve environmental resources. >>
The well-being of increasing
numbers of cancer sufferers worldwide inspired us to create Versa HD.”
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Supported by a series of anatomical packages specifically designed to work together, Versa HD simplifies the development of a system that fulfills the requirements of both clinicians and patients. Packages are available for a range of disease sites – brain & spine, head & neck, breast, lung and prostate.
Brain & SpineVersa HD provides a suite of solutions specifically designed to maximize field shaping accuracy and optimize the ability to place high SRS doses on brain and spine targets while avoiding nearby normal tissues.
Head & NeckTo achieve optimal targeting of selected head and neck tumors, while sparing adjacent normal structures, Versa HD offers a package of solutions designed to provide high resolution beam-shaping, and products for secure, patient-friendly head fixation.
LungA unique portfolio of solutions supports Versa HD lung radiotherapy, which prioritizes highly accurate dose placement to lung targets while minimizing radiation exposure to surrounding organs-at-risk.
BreastVersa HD provides ground-breaking solutions to image and define the lumpectomy cavity, in addition to products that enable accurate patient positioning and respiratory management.
ProstateVersa HD capabilities are reinforced by a key set of solutions specifically designed to visualize and isolate the prostate and surrounding critical structures, and to enable secure, reproducible patient positioning.
For more information, visit www.VersaHD.com l
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with Clarity will not only be more cost-efficient, but patient acceptance will also be higher. Telling patients that we have a new way to track their prostate without sticking a needle through the rectum will make them pretty happy. This is unbelievably great technology.”
The capability to image anatomy during treatment could provide other advantages as well, according to Di Yan, DSc, chief physicist at William Beaumont Hospital (Royal Oak, Michigan).
“We have been interested in developing methods for adaptive therapy for a while now,” he says. “The missing link has been the anatomical information from a continuous imaging source. Clarity 4D Monitoring with an Autoscan probe has great potential to provide that missing link.”
Continuous target visualization
4D monitoring of the prostate with Clarity during treatment offers continuous tracking of the target and imaging of the surrounding anatomy, including the bladder, rectum and penile bulb, the latter thought to be responsible for erectile function. Clearly visualizing these structures during treatment could enable clinicians to create plans with tighter margins around intended targets, thereby minimizing radiation exposure to healthy tissue.
Clarity 4D Monitoring uses Autoscan acquisition technology, which robotically acquires live transperineal ultrasound images of soft tissue anatomy from the linear accelerator control area. This is a comfortable, non-invasive imaging procedure that does not involve any extra radiation dose and does not require the use of implanted markers. l
Clarity® 4D Monitoring software provides a new way to reduce the uncertainty caused by prostate motion during radiation treatment. Physicians will be able to monitor the motion and precise location of the prostate and surrounding tissues and organs – in real time and with sub-millimeter accuracy – during radiation therapy. This capability can be especially valuable for clinicians pursuing advanced prostate protocols, such as reduced margin hypofractionated therapy or advanced stereotactic ablative body radiotherapy (SABR).
“What makes 4D monitoring with Clarity a possible ‘game-changer’ is that it’s simple, inexpensive, and will enable real time continuous monitoring of the prostate – increasingly critical as we consider techniques such as hypofractionation, which entails treating patients in shorter therapy courses, but with longer individual treatments,” says James Wallace, MD, radiation oncologist at Fletcher Allen Health Care (Burlington, Vermont). “We know that the prostate moves during these prolonged treatments and we are going to have to account for it in some way. The capability to observe the prostate from the beginning of the fraction to the end will be incredibly powerful. We will integrate 4D monitoring with Clarity into our clinical practice as soon as we can.” Dr. Wallace notes that the image quality of Clarity ultrasound is exceptional.
“It’s remarkably clear compared to other ultrasound technology and in our experience comparable to MRI in terms of our ability to identify structures in the lower pelvis,” he says. “In comparison to other systems, 4D monitoring
Keeping track of the prostateElekta receives FDA 510(k) clearance for Clarity® 4D Monitoring
ONLINE
elekta.com/clarity
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Elekta’s Agility™ 160-leaf MLC continues to sweep the globe* – shipping to clinics in more than 20 countries in the last half of 2012. At 14 sites, Germany is by far the most prolific in the number of centers that have begun using the beam shaping solution clinically.
“Agility is particularly popular in Germany for a variety of reasons,” says Volker Bingemann, Elekta Director of Sales, Germany. “The high treatment efficiencies that Volumetric Modulated Arc Therapy [VMAT] brings to the clinic already have resulted in the ability to make superior treatment techniques available to more patients. When you combine VMAT with Agility – and the much faster leaf speeds this MLC offers – clinics can realize even faster treatments, resulting in more patient comfort, less risk for patient motion and an overall more efficient workflow.
“Of course, rapid beam delivery also creates the need to safeguard normal tissues,” he continues, “which Agility ensures with its high conformance leaves and extremely low transmission. This has been a key consideration at German centers. Third, over the years, Elekta has strived to create many strong relationships with customers and prospective customers in this country, and clearly this is paying off.”
One such Agility user is University Medical Centre (UMC) Mannheim, which has been using Agility for several months on two of its four Elekta Synergy® systems.
“With the 5 mm leaves of Agility, conformality is improved and the accelerated leaf speed has significantly shortened beam delivery times for the same plan quality,” says UMC Vice Chairman, Prof. Frank Lohr. “The ability to interdigitate MLC leaves per se provides about a five to 10 percent reduction in treatment time, but when you add interdigitation to faster leaf speed and narrower leaves – and other * Wavelength, Vol. 16, No. 2
Germany leads pack of Agility™ clinical users
Prof. Frank Lohr, Vice Chairman, University Medical Centre Mannheim
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existing Elekta features, such as continuously variable dose rate [CVDR] – it creates a package that makes treatments very fast and also treatment planning extremely easy.
Capability to develop better plans
“In most standard paradigms, the first plan that you ‘shoot off’ is the one you take,” he continues. “You don’t do a lot of planning alterations because you have your templates. However, the Agility features combined with other capabilities enables you to get very good plans, very short treatment planning hands-on time and very good treatment delivery times.”
The low transmission of Agility (< 0.5 percent) also contributes to the development of better plans, Prof. Lohr adds. “It gives you better plans because transmission dose is dose that is not controlled by the treatment planning system,” he says. “When transmission is low, the treatment planning system has more dose at its disposal to put it where it wants it. And, most likely, it will produce plans with less dose outside the target volume than would an MLC that has a high amount of transmission.”
The high leaf speed and 5 mm leaf width of Agility are even more potent when available across a full 40 x 40 cm field size, he adds. “This removes the limitations in beam shaping across very large fields,” Prof. Lohr says. “To date, with high resolution MLCs with a limited maximum aperture, very often for the lung, head and neck you would need two isocenters. Using an MLC with narrow leaves on only part of the system would double your treatment time. The nice thing with Agility is that you still have the 40 cm x 40 cm field, which makes the entire linac extremely versatile.” l
...it creates a package that makes
treatments very fast and also treatment planning extremely easy.”
LOCATIONS
German centers clinical with Agility F University Medical Centre, Mannheim
F Ludwig-Maximilians-University, Munich
F Diagnostic Therapeutic Center Frankfurter Tor (DTZ), Berlin
F St. Vincenz-Hospital, Limburg
F University Hospital, Würzburg
F IBA International Competence Centre (ICC) Schwarzenbruck (training only)
F Heidelberg University Hospital, Heidelberg
F J.W. Goethe University Hospital, Frankfurt am Main
F University Hospital, Freiburg
F Private Hospital Dr. Hancken, Stade
F Pius-Hospital, Oldenburg
F University Hospital, Aachen
F Imland Hospital, Rendsburg
F Asklepios Hospital St. Georg, Hamburg
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Josh Perry
ONLINE
Watch Josh Perry Josh can be found at BMX parks and impromptu venues doing some really amazing things with his bike: tech moves like footjam variations and 360° whip drop-ins with mega-bangers, such as the barspin-to-barspin to late tailwhip 360°! Check out these videos of Josh – astonishing! (better to watch then to try – Josh is a professional!)
F https://vimeo.com/54405951
F https://vimeo.com/44123283
F http://vimeo.com/35662875
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Elekta: What did doctors tell you about your case before your initial surgery in April 2009?
Josh Perry: They said that if I didn’t get treated the first thing that would happen is that I would be close to blind or completely blind. That was because the meningioma was pressing on my optic nerve, and when I was diagnosed, my vision was getting to the point where I couldn’t see much anyway. They also said if I weren’t treated I would eventually die. I don’t really clearly remember what they said. I guess I don’t remember much of anything from around those months. (laughs)
So after the surgery, you were fine, but what happened in November 2012?
JP: When my MRI scan from a normal yearly check up came back, there were two small tumors. I didn’t have any symptoms.
Had you ever heard about Gamma Knife radiosurgery before 2012?
JP: No, I hadn’t heard anything about it until 2012. My girlfriend helped me research radiation therapies and she found out about Gamma Knife and it seemed like that would be the best treatment. I was psyched when we found it and all that we learned about it. Obviously, I was a bit nervous about having radiation in general, but when we learned facts about radiosurgery, it calmed me down a bit.
Your physician, Dr. Allan H. Friedman at Duke University, also agreed that radiosurgery would be the best treatment. How did he explain it to you?
JP: He said that another surgery wasn’t a good option because no one will be able to get that kind of wide margin around the surgical resection. By that he meant – and the Gamma Knife doctor agreed – that because it was located on or near a main artery that it was very unlikely, due to the risk, that we could get all of the tumor out with traditional surgery.
Can you describe the experience of preparing for radiosurgery?
Last November, professional BMX bike rider Josh Perry had to take a break from defying the laws of gravity and physics and take care of a health problem he thought he had dealt with back in April 2009. It was then that Josh, then 21-years-old, had surgery on a meningioma threatening not only his eyesight, but also his life. After the operation, everything seemed to be fine until November 2012, when a follow-up examination revealed two new tumors. Josh’s physicians recommended Gamma Knife® radiosurgery to treat these lesions. Elekta spoke to Josh about his experience.
JP: When I found out back in 2010 that I would have to have surgery, I looked up all kinds of brain surgeries and got scared. (laughs). This time I didn’t know what to expect and just went with the flow and that kept me calm. When they sat me down and explained what they were going to do to prep me for treatment – putting the head frame on – I thought to myself: Oh, wow. They are really about to do that to me? (laughs). It wasn’t bad and I didn’t feel a thing. I just got a little nauseous as they were screwing it in because I could hear it happening and I knew what was going on. I was fine once it was done and waiting for the treatment.
What was Gamma Knife radiosurgery like?
JP: It was like getting an MRI done, but shorter. I went in and out of the tunnel [collimator helmet] three times for different lengths of time. It wasn’t bad at all. It was a bit weird when they had to clip my frame on my head into the part I laid on, but that’s all. It was also painless and quick.
How did you feel right after the procedure?
JP: I felt the same, but I was relieved it was done and I felt fine.
An ESPN* article quoted you as saying your goal was to be riding within a week after radiosurgery. Did this happen and were there any residual effects from the procedure?
JP: I was riding within a week after treatment and didn’t have any effects from the radiosurgery, which was a relief.
What have you been doing since then?
JP: I have been doing my normal day to day things that include riding, training and enjoying my life. I’d like to thank all my doctors that have helped me, my family and friends for their support and love, my sponsors – Eastern Bikes and Bern Helmets for supporting me as well – and you for this interview and your interest in my story. I also want to thank whoever invented Gamma Knife to help treat people in my situation. l
I was riding within
a week after treatment and didn’t have any effects from the radiosurgery, which was a relief.”
*American sports news
From BMX to Gamma Knife® surgeryand back – Josh Perry’s story
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Elekta around the world
uw CURITIBA, BRAZIL
World’s 500th Leksell Gamma Knife begins patient treatments
The 500th Leksell Gamma Knife® system manufactured since 1986 was recently installed at Instituto de Neurologia de Curitiba (INC). The site – which acquired Elekta’s Leksell Gamma Knife® Perfexion™ – began clinical treatments in October 2012, delivering radiosurgery to a patient with a skull base meningioma. “It’s very important to offer our people the best treatment in brain radiosurgery,” says INC neurosurgeon, Daniel Benzecry Almeida, MD. “Being the first center in Brazil with a Perfexion system makes us very proud, yet also places upon us a commitment to help patients who could benefit from radiosurgery.”
uw BOSTON, MASSACHUSETTS, USA
Elekta raises $52,200 to support individuals with cancer
Elekta activities at ASTRO raised a total of $52,200 for Facing Cancer Together, a greater-Boston area nonprofit organization that guides and empowers individuals through the challenges of cancer. “As a key ally in the fight against cancer, Facing Cancer Together has demonstrated an intense dedication to providing resources and services to people with all types of cancer at all stages of the disease,” says Jay Hoey, Executive Vice President, Elekta. “As this organization’s devotion to individuals with cancer aligns with Elekta’s ‘We Care for Life’ mission, it is a fitting recipient of this year’s charitable funds.”
uw ATLANTA, GEORGIA, USA
Elekta’s North America headquarters moves to a new location in Atlanta
In January, Elekta announced the move of our North America headquarters. This was the culmination of a multi-year project inspired by the ongoing support of our customers. The new address is: 400 Perimeter Center Terrace, Suite 50, Atlanta, Georgia 30346. “We are very proud of our move to these premises as it reflects the progress we’ve made over the last four decades,” says Jay Hoey, Executive Vice President, Region North America. “We hope you will have an opportunity to visit us in our new location in 2013. We would be delighted to host you in our spectacular new home!”
uw HOUSTON, TEXAS, USA
Elekta gains MD Anderson Cancer Center as collaborator in research consortium
The University of Texas MD Anderson Cancer Center recently signed an agreement to join a research group to advance the development of an innovative image guided treatment technology for cancer care. The technology merges radiation therapy and MRI technology in a single system. “My colleagues at Elekta, Philips and University Medical Center Utrecht are thrilled to welcome MD Anderson to the research consortium, which will profit immensely from this center’s high-caliber medical, technological and patient care expertise,” says Jay Hoey, Executive Vice President, Elekta North America.
uw SUNNYVALE, CALIFORNIA, USA
MOSAIQ ranked No. 1 oncology software solution for second consecutive year
The 2012 Best in KLAS Awards: Software & Services report recently ranked Elekta’s MOSAIQ® oncology information system as number one among software oncology products. The report showed that MOSAIQ scored 80.1 out of 100 and 87 percent of customers indicated they would buy again. “We are honored that KLAS survey respondents recognized MOSAIQ as the top oncology information system for the second year in a row,” says Todd Powell, Executive Vice President, Elekta Software. “MOSAIQ is the preferred OIS for thousands of oncology practices for a reason.”
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uw MOSCOW, RUSSIA
Elekta and MSM-MEDIMPEX enter agreement to increase radiotherapy production
In October, Elekta and MSM-MEDIMPEX announced their intention to set up production of radiotherapy equipment in Russia, with the intent to improve access to radiotherapy treatments to Russian citizens with cancer. “In line with the Russian government’s efforts to modernize and improve the oncology field, and within Elekta’s human care mission, Elekta is elated to bring its clinical solutions even closer to Russian patients,” says Elekta President and CEO, Tomas Puusepp. “Ultimately, this developing infrastructure will provide similar added value and high-tech processes as those in Elekta’s main supply center in the United Kingdom.”
uw VEENENDAAL, THE NETHERLANDS
Elekta introduces MOSAIQ® connectivity for its microSelectron® Digital brachytherapy afterloader
At the 54th Annual Meeting of the American Society for Radiation Oncology, Elekta announced that MOSAIQ® v 2.50 now includes connectivity with Nucletron’s microSelectron® Digital afterloader. “This added connectivity allows the treatment record and chart information, in addition to dose and structure sets, to be part of the complete patient record – saving time, simplifying workflow and creating a paperless flow of brachytherapy practice information,” says John Lapré, Executive Vice President, Elekta Brachytherapy.
uw SHANGHAI, PEOPLE’S REPUBLIC OF CHINA
China center marks 25,000th patient treated with Leksell Gamma Knife®
In 2012, a 60-year-old male resident of Shanghai’s Baoshan District became Shanghai Gamma Hospital’s 25,000th patient to receive Gamma Knife® radiosurgery. The target was a mulberry-shaped benign blood vessel abnormality in his brain, the treatment of which benefits by the extreme precision that Gamma Knife provides. Shanghai Gamma Hospital installed its first Leksell Gamma Knife in 1993, upgrading to the next generation system in 2002.
uw MANDALAY AND NAYPYIDAW, MYANMAR
Elekta closes first major deal in South Asian nation of Myanmar
In 2012, Elekta announced its first major deal in Myanmar – a contract to deliver Precise Treatment System™ linacs and related software to two government-run hospitals. The country, also known as Burma, has only a handful of cobalt units and linear accelerators in operation and many are outdated and in poor working condition. “Elekta will deliver the first Precise unit to Mandalay Hospital, with the second going to Naypyidaw Hospital,” says Jimmy Lam, Regional Sales Director, Elekta Far East. “Once fully operational, each unit will be capable of treating over 300 patients a year.”
uw STOCKHOLM, SWEDEN
Elekta participates in Swedish-Iraqi business conference
In October, Elekta took part in the Swedish-Iraqi Business and Investment Conference in Stockholm. Representatives of Iraq’s government and business sectors and more than 100 Swedish companies, including Elekta, attended. “Breaking new ground, Elekta has supported Iraq clinics’ and Ministry of Health efforts to increase accessibility to cancer management technology,” says Nabil Elias Romanos, Elekta’s Vice President, Eastern Europe and Middle East. “We particularly are pleased that the prestigious Medical City in Baghdad chose Elekta as its main partner in providing cancer care to the Iraqi people.”
uw TAIPEI, TAIWAN
Asian Leksell Gamma Knife Society convenes in Taiwan
In November, 150 participants across Asia gathered at The Grand Hotel for the third Asian Leksell Gamma Knife Society Meeting. A dominant subject among the 80 presentations in the scientific program was Gamma Knife radiosurgery of metastatic brain tumors; however the meeting covered all aspects of innovation in Gamma Knife® radiosurgery for brain disorders. “The meeting provided a great platform for users to share their clinical experience,” says David Hung-Chi Pan, MD, President of the 3rd Asian Leksell Gamma Knife Society Meeting and Neurosurgeon at Veterans General Hospital, Taipei, Taiwan.
uw WOLLONGONG, NEW SOUTH WALES, AUSTRALIA
MOSAIQ helps Illawarra Cancer Care Centre win award for cancer care
In 2012, Illawarra Cancer Care Centre was awarded the Cancer Institute NSW’s Award for ‘Improving Cancer Care in the Community’ at the 2012 NSW Health Awards. The Centre recently launched a new system, including MOSAIQ®, whereby the processes involved in prescribing, administering and scheduling medications are now standardized, electronic and paperless. This resulted in a 63 percent reduction in reported medication incidents. “MOSAIQ has a record of being best in breed,” says Ty Hundley, Medical Oncology Product Specialist. “Now, it has helped Illawarra to win an award for quality in cancer care.”
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Fully equipped for SBRTWFBMC uses a comprehensive array of Elekta solutions to perform SBRT, including:
F Elekta Axesse™ treatment system
F HexaPOD™ evo RT positioning system
F BodyFIX® immobilization
F MOSAIQ® Oncology Information System
F Monaco® treatment planning system (for VMAT delivery of spine SRS and multi-target lung/liver, Philips’ Pinnacle for day-to-day cases)
Breathing life into an SBRT program
The first target – lung cancer
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Sitting in the heart of Big Tobacco country – with lung
cancer the top cancer diagnosis – it would be easy to
conclude that the reason Dr. Jim Urbanic at Wake Forest
Baptist Medical Center (WFBMC), Winston-Salem,
North Carolina recommends centers launch a stereotactic
body radiation therapy (SBRT) program with lung cancer
cases first is due to the steady stream of lung cancer
sufferers in the medical center’s catchment area.
But the prevalence of lung cancer and clear patient need in
North Carolina are just part of it, according to Dr. Urbanic.
“‘For which cancer should we start an SBRT service?’ is one of the most common questions asked of me,” notes Dr. Urbanic, a radiation oncologist at WFBMC, designated an Elekta Stereotactic Center of Excellence in 2008. “My general response – if you’re starting anew with body radiosurgery or SBRT – would be to start with tumors in the lung, either primary medically inoperable Stage 1 lung cancer, lung metastases and isolated recurrences. It has to do with the relative simplicity of treating this target compared to other targets in the body, and with the expansive body of medical literature on radiotherapy of lung tumors.”
He cites the National Comprehensive Cancer Network (NCCN) guidelines that provide useful treatment algorithms for small-cell and non-small cell lung cancers, and information on patient selection and staging issues, in addition to current ongoing Radiation Therapy Oncology Group (RTOG) clinical trials that spell out in exhaustive detail the technical parameters for treating lung cancer.
“These data are going to give centers a foundation to stand on in terms of what doses to use and a sense of what normal tissue dose limits should be – so it will be harder, if you will, to get into ‘trouble’ or into gray areas with the lung,” he says. “The other thing is, although the risks are real in doing these treatments, the lung is perhaps a bit more forgiving than other organs in the body.”
Lung cancer also is amenable to a number of proven radiation therapy techniques, Dr. Urbanic adds.
“You can come at it from a variety of methods that have a real high likelihood of success,” he says. “Whether or not you’re using VMAT or static field IMRT, you can really harness these methodologies and get very satisfactory results. Lastly, the fact that lung cancer is going to be a high volume indication in most places means that centers will be treating a lot of tumors, and thereby developing their practice and expertise and confidence before they venture into targets that are a bit more risky and/or complicated to treat, such as the spine and liver.”
Breathing life into an SBRT program
Starting out simplePart of the reluctance by some clinicians to begin SBRT with lung cases may lie in an erroneous impression that they’ll need the most sophisticated technology for gating, imaging, immobilization and positioning, according to Dr. Urbanic. The HexaPOD™ table that is part of WFBMC’s Elekta Axesse™ system, for example, provides precise patient position correction in six axes. While this solution is useful for lung cases, it is of even more value in spine radiosurgery cases. In addition, before WFBMC began using Elekta Axesse and its integrated cone beam CT, Elekta’s Stereotactic Body Frame® was perfectly suitable as immobilization device for lung cases.
“As we transferred to cone beam imaging, we realized that Stereotactic Body Frame was very good therapy, because the shifts that we make when we set them up properly in the device was actually very minimal,” he recalls. “It was nice to see it was good technology, though we now use Elekta’s BodyFIX® immobilization solution. The point is centers don’t need to invest in the most advanced solutions when they launch their SBRT program – these can be added as the complexity of cases increases after centers gain experience.”
WFBMC’s experience in lung SBRT predates its acquisition of Elekta Axesse in 2009, but it was the introduction of the dedicated stereotactic system that caused its SBRT caseload to triple, with lung SBRT cases leading the way. Today at WFBMC, lung cases represent 85 percent of the 150 SBRT cases the medical center performs annually. The success of the program – measured in greatly increased referrals – helped WFBMC clinicians expand into spine and liver SBRT simultaneously. “We were able to rapidly gain the trust of referring physicians with our lung SBRT work,” Dr. Urbanic says. “Showing clinical efficacy in this area opened the door to more complex SBRT targets.” The center’s international expertise in SBRT for all targets is reflected in its stereotactic radiation therapy courses, which Dr. Urbanic and his colleagues have been offering since 2009. l
ONLINE
https://wakeforestsrt.com/
Wake Forest Baptist Medical Center
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Dutch team and Nucletron collaborate
on minimally invasive laparoscopic
brachytherapy for bladder cancer.
Bladder brachy renaissanceDr. Elzbieta van der Steen-Banasik assists in robot-assisted laparoscopic placement of brachytherapy catheters
Brachytherapy for select bladder cancer patients is undergoing a radical transformation in Arnhem, the Netherlands. Clinicians at Arnhem Radiotherapy Institute (ARTI) and Rijnstate Hospital (RS) are collaborating on perfecting what typically has required full surgical exposure of the bladder for implanting brachytherapy catheters. In 2009, ARTI-RS was first in the world to use a laparoscopic approach for implantation, then shifted in 2010 to even more refined robot-assisted (da Vinci® Surgical System, Intuitive Surgical, Inc.) laparoscopy.
At the heart of this bladder brachytherapy renaissance is a key partnership between ARTI-RS’s Dr. Elzbieta van der Steen-Banasik and Dr. Geert Smits, and Nucletron – an Elekta company.
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Nucletron brought ARTI-RS’s laparoscopy concept to life by providing needles and catheters specialized for the task.
For a subset of patients with muscle invasive bladder cancer – those with a solitary T1 lesion/Grade 3, or T2 tumors with a diameter of less than 5 cm – physicians can often avoid a full cystectomy, thereby preserving the bladder. The treatment for this patient group consists of a course of external beam radiation therapy (EBRT) followed by brachytherapy.
Until 2009 at ARTI-RS, brachytherapy (following EBRT) involved an open surgical procedure, in which the urologist made an incision in the abdomen – exposing the bladder – and then opened the bladder to enable implantation of Nucletron
brachytherapy needles and catheters. The catheters are placed through the tumorous area and the bladder and abdominal wall are closed, followed by a course of pulsed dose rate (PDR) brachytherapy. In some cases, this operation may include a partial cystectomy for removing the tumor. Although open brachytherapy permits bladder sparing, it’s not without its problems, according to Dr. van der Steen-Banasik, consultant radiation oncologist at ARTI.
“Irradiation after an open procedure is more complex,” she says. “There is the possibility of the catheters kinking, because the tissue is sutured in layers. In one case we had to stop the treatment because two of three catheters became obstructed as a result of kinking. Hospitalization is longer because the healing process for large post-operative wounds is more complicated – often involving wound infections, in addition to bladder infections due to longer catheterization.”
Dr. Smits, urologist at Rijnstate Hospital and specialized in robot-assisted laparoscopy and uro-oncology, and Dr. van der Steen-Banasik were convinced that a minimally invasive laparoscopic approach to brachytherapy implantation would be a more elegant solution. The procedure involves just four 0.8-1 cm incisions in the abdominal wall for the insertion of instruments and, in most cases, minimal manipulation of the bladder wall, resulting in significant reduction in tissue trauma.
“An MRI before the operation localizes the tumor, and we can see the tumor from the outside with a laparoscopic view,” Dr. Smits explains. “And, by using a cystoscope introduced through the urethra into the bladder, we obtain an endoscopic view of the location and extension of the tumor. The combined views determine our target volume, so we know exactly where to place the brachytherapy catheters.”
Need novel needlesIn June 2009, the ARTI-RS team attempted its first laparoscopic brachy implantation, accompanied by former Nucletron CEO Eric van’t Hooft. Dr. van der Steen-Banasik and Dr. Smits discovered readily, however, that using the same Nucletron needles and catheters employed for the open brachytherapy operation was an imperfect solution.
“The needle diameter is too wide, since they’re hollow to enable passage of the catheter,” Dr. Smits says. “We found from this very first try that manipulating hollow needles using laparoscopy instruments was too cumbersome. We explained to Mr. van’t Hooft that it doesn’t work – that it would be easier to have a solid needle attached in some way to the catheter, so that the catheter follows the needle through the abdominal wall, into and out of the bladder wall, and back out through the abdominal wall. We asked him to collaborate with Nucletron to invent more suitable needles and catheters.”
Based on this input, Nucletron set out to create an entirely new class of brachytherapy needles for
Dr. Geert Smits, Rijnstate Hospital, Arnhem, The Netherlands
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ARTI-RS to use laparoscopically. ARTI-RS used the first needles in September 2009 in bladder cancer patients with T1/G3 and T2 tumors (<5cm). The needles were solid and had a slight curve to them to enable them to reach further around the bladder.
Nucletron delivered the new needles and standard catheters to ARTI-RS as separate units that had to be joined pre-operatively – not ideal – however, implantations were successful in every case from the first to the thirty-first (June 2009-April 2012).
“They worked well,” Dr. van der Steen-Banasik said. “The first needles were simple, but as time went on, and with our input to Nucletron, subsequent versions became more developed, the curve improved and the needles became longer.”
The ARTI-RS team also consulted successfully with Nucletron on the needle-catheter connection and discussed improving the catheters, which are now made of a revolutionary new material that makes them strong, yet flexible and highly kink-resistant.
Nucletron reports that the new line of Luneray™ catheters (integrated needle-catheter units) will be available in 37mm, 47mm and 57mm needle lengths with a range of curvatures to reach different parts of the bladder, with a 50 cm high-strength catheter already attached. They are intended to be delivered to clinical sites ready-to-use, pre-assembled and sterile. Commercial introduction of the Luneray catheters should occur in the spring of 2013.*
Robotic assistanceBy September 2010, exclusively from case 9 onward, ARTI-RS had begun using the progenitors of the Luneray catheters in robot-assisted laparoscopy for bladder brachytherapy, further refining the procedure. “da Vinci makes the laparoscopic operation easier,” observes Dr. Smits, who operates the system. “I only perform robotic surgery now, because with the robot it is much easier to treat more difficult bladder tumor locations than it is
with conventional laparoscopy. I can also perform more precise maneuvers with the robot. The console enables you to look at the endoscopic cytoscopy view and laparoscopy view together, giving you a good 3D impression of where the tumor is.”
Once the one-hour implantation is complete (following a 40 Gy EBRT course), PDR brachytherapy is initiated, in which 10 fractions of 2.5 Gy (a low dose equivalent of 30 Gy) are given three times per day over four consecutive days.
Length of hospitalization using the laparoscopic procedure is dramatically shorter than for open brachytherapy – an average of just six days, versus 17 days on average for the open procedure. “The length of hospitalization for the laparoscopic patients is not due to the amount of time they need to recover from the operation, but due to the time required for the PDR treatment,” Dr. Smits notes. “Conceivably, if afterloading could be performed at home, they could leave the hospital the day of the procedure.” Accordingly, morbidity with laparoscopic brachytherapy also is significantly less than for open brachytherapy in ARTI-RS’s experience. Dr. Smits and Dr. van der Steen-Banasik have been invited by the editorial board of European Urology to submit a video and paper on their robot-assisted experience for bladder brachytherapy. “It’s important to us to get the word out and let other centers know what is possible,” he says. “They should be able to duplicate these procedures and make them available for more patients.” On the Nucletron-ARTI-RS collaboration that resulted in a new way to deliver brachytherapy to bladder cancer patients, the ARTI-RS team could not be more pleased. “It is a real example of cooperation and understanding,” says Dr. van der Steen-Banasik. “It was great to be a part of it.” l
*This product will not be available in all markets in the spring of 2013.
It’s important to us to get
the word out and let other centers know what is possible.”
Luneray™ catheters are integrated sterile units of high strength catheters and curved needles
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Getting ahead while standing still
Elekta’s Education and Training Department describes the “Consumption Gap” as the difference between the customer’s ability to consume (i.e., use) product features and the rate at which Elekta product features are growing in number and increasing in sophistication. Graphically, the customer curve is rising steadily over time, while the product feature/complexity curve is shooting up logarithmically. To make the best use of Elekta solutions, customers will need to learn a lot about their Elekta products and learn it fast. As part of a “blended learning” strategy, which includes online web-based eLearning plus traditional in-house instructor-led training, Elekta seeks to close the Consumption Gap.
The Elekta installed base has grown so quickly recently that it was clear an alternative method – in addition to on-site training and Elekta’s existing online knowledge base – was needed to share product information, according to Trevor Sparkes, Elekta Global Information and Learning Services Manager.
“We’ve given our customers some very advanced technology, but in many cases they don’t fully understand how the technology works and can’t schedule the time to come to Elekta for training,”
says Trevor Sparkes, Technical Training Manager. “eLearning is the best way to transfer valuable knowledge to our customers any time, any place, anywhere via Internet-ready devices. It’s helping us close the Consumption Gap so customers get the most from the equipment and pass those benefits onto patients.”
Modular learning
eLearning Labs – an array of interactive, web-accessible modules – are available for software customers seeking education on new features for MOSAIQ® Oncology Information System (v 2.3 to 2.5), Monaco® and XiO® treatment planning systems, treatment planning tools (e.g., ABAS, Focal4D®), and MOSAIQ meaningful use, to name a few, says David Burns, Manager of Education and Training.
“In addition to ease of access, the real advantage of eLearning modules is that they enable students to control their learning at their own pace in a way that classroom learning doesn’t,” he observes. “There also is improved retention of information via the combination of multimedia and instructional design, which can produce a rich, repeatable learning
Customers embrace Elekta’s eLearning as training initiatives set to grow
starting in 2013
>>
eLearning is the best way
to transfer valuable knowledge to our customers any time, any place, anywhere via Internet-ready devices.”
22Elekta brand eLearning
A major differentiator between Elekta’s eLearning program and online educational programs offered by competitors is that Elekta eLearning was developed entirely in house.
“Some companies outsource to different vendors to develop distance learning programs, resulting in a lack of consistency between the navigation, assessment, format and/or look and feel,” Burns notes. “It can get very frustrating, because all of the tools, buttons, actions and simulations are all different. You have to learn a whole new interface every time you log on.”
Over the last 15 months, Elekta developers have created a set of eLearning standards and development tools (templates) that enables Elekta to standardize its eLearning activities to ensure they are accessible to all learners, including those with color perception and learning difficulties, such as dyslexia.
In addition to the suite of tools created for developers, Elekta hosts an online eLearning development forum that allows developers to spread best practice and information.
“By developing eLearning in house, we can more effectively manage our output by developing our own people to create content tailored to our customers’ needs,” Sparkes adds.
The pre-residential eLearning module was excellent. It was clear, informative and simple to use. The images, schematics, videos and
audio were all useful and insightful. The eLearning approach allowed us to absorb a lot of theoretical information prior to arrival at Crawley, which frees up more time for practical aspects. In my experience, most engineers prefer to do hands-on exercises when being trained.”
Ryan Young Radiotheraphy Engineer
The Christie NHS Foundation Trust
The presentation of the course material is well done, it’s not too intensive – like just throwing facts and figures as many do –
but the inclusion of video and interactive content helps keep the student’s attention and aids knowledge transfer. The ability to drop out of a module and re-enter at a later date is beneficial, especially when providing ‘breakdown cover’ at the clinic.”
Paul WinstanleySpecialist Radiotherapy Engineer
The Christie NHS Foundation Trust
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experience. eLearning modules also include interactive knowledge checks to ensure that knowledge has been transferred.”
For the oncology business, Elekta recently launched an Agility™ 160-leaf MLC eLearning module to an initial pilot group of 30 customers, comprising physicists and engineers. Several were from The Christie.
“It was a blended learning program in which the customers completed six eLearning modules before attending the residential course at the Crawley facility,” Sparkes says. “In that way, they had the requisite basic knowledge in advance, enabling them to spend just four days here instead of two weeks. It saved time away from the clinic, saved travel and money, and they had more availability on the system.”
The roll-out of Agility eLearning modules for all Elekta customers – in addition to quality assurance modules for physicists – is scheduled for the summer of 2013.
Most eLearning modules were originally intended to instruct Elekta employees on new product features; however, to address the Consumption Gap and to expand Elekta’s education and training frontiers, the line between employee training and customer training is dissolving. For example, materials designed to train Elekta field service engineers are increasingly being regarded as instructional tools for the customer’s oncology engineers. An example is a three-minute video – a “training short” – on the proper handling of retractile cables, which would often break if mishandled.
“We will provide our customers’ engineers with access to the retractile cable training short as well, because anyone who is a level II qualified oncology engineer will get access to it at some point,” Sparkes says. “We’re looking at many different ways to push knowledge out there, rather than the ‘traditional’ eLearning course.”
Creating a knowledge sharing community
The vision for eLearning going forward is not only to increase the volume of eLearning modules that customers can access, but also to create a sort of multi-directional feedback loop in which customers can share knowledge between each other and Elekta. “Conceivably, we could have some kind of Web 2.0 capability within the next two years,” Sparkes predicts. “In that way, we can build a community of knowledge – through social networking or a learning portal – that is much more rich and expansive, yielding considerable benefits for both customers and Elekta.” l
STAY TUNED
Keep checkingelekta.com and Wavelength for future developments!
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What makes your center unique?
With Elekta Synergy, King Abdulaziz University Hospital has, for the first time, used VMAT in select cases, resulting in dramatic decreases in beam delivery time compared to conventional techniques.
“The beam delivery time for VMAT is about five minutes, compared to nine minutes for dynamic Intensity Modulated Radiation Therapy [IMRT] and 20 minutes for step-and-shoot IMRT,” Prof. Bahadur notes. “In addition, we have found that delivery of IMRT is faster on Synergy versus our other systems. With Synergy, we can easily treat 20 patients daily using either VMAT or dynamic IMRT, with daily CBCT, during eight working hours, which we were unable to do before. Now we can treat more patients and this has shortened our waiting list.”
As the hospital launches its new stereotactic radiation therapy (SRT) service, Prof. Bahadur looks forward to the same level of Elekta support his team received in implementing advanced radiotherapy with Elekta Synergy.
“We have been impressed by the outstanding standard of training activities provided by Elekta to our staff,” he remarks. “The professionalism of the application specialists, in addition to their kindness and continuous support are highly appreciated by the entire team. After nearly one year of using Elekta Synergy, we are confident and satisfied with the system, and are very optimistic that with the launch of the SRT service, we will have another opportunity to strengthen our collaboration and partnership.” l
In part to address the 12,000 new cancer cases annually in Saudi Arabia – many of them diagnosed at an advanced stage – King Abdulaziz University Hospital (Jeddah, Saudi Arabia) is the first center nationally to acquire image guided treatment technology from Elekta. The 700-bed hospital launched a new era of advanced radio-therapy with the first clinical treatments on its Elekta Synergy® system in 2012, offering patients with difficult cases sophisticated IGRT and VMAT for added precision and speed.
“Managing the planning and treatment of late stage cancers is challenging,” says Prof. Yasir Bahadur, MD, Chairman of the Department of Radiology, under which the Department of Radiation Oncology operates. “We needed user-friendly technology that would allow us to accurately cover the target and protect normal tissues, while treating our patients in a comfortable and timely manner. We determined that Elekta Synergy met these needs from a technological standpoint.”
Saudi Arabia center advances radiotherapy technology with nation’s first Elekta IGRT treatment system
King Abdulaziz University Hospital’s Elekta Synergy boosts treatment speed for patient comfort, integrates imaging for patient safety
We have found that delivery of
IMRT is faster on Synergy versus our other systems.”
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71-year-old John Marrinan thought it was time to take his car into the shop for a re-alignment when it began drifting to the left as he steered. In reality, it was John himself whose driving was causing the car to veer. When a friend pointed this out, John sought emergency care for what he thought might be a mini-stroke because he also felt tingling sensations in his left arm and leg.
At The Valley Hospital’s Bolger Emergency Department, a CT scan revealed the culprit for his disorientation: a cancerous tumor in the right frontal lobe of his brain that was affecting movement on his left side. Further tests also disclosed a renal cell carcinoma, a cancerous tumor on his left kidney, and several tiny cancerous spots in his lungs. The brain tumor and lung condition were metastases of the kidney cancer.
His doctors, Medical Oncologist Amita Kalia, M.D., Radiation Oncologist Chad DeYoung, MD, and Neurosurgeon Anthony D’Ambrosio, MD, developed a plan that focused initially on destroying the brain tumor with Leksell Gamma Knife® Perfexion™ and then stopping the growth of the kidney tumor.
“We had to treat the most critical organ first, Mr. Marrinan’s brain,” notes Dr. DeYoung, Co-Medical Director of the Gamma Knife Center and Radiation Oncology Department at Valley’s Daniel & Gloria Blumenthal Cancer Center (Paramus, New Jersey, USA). “Because of the tumor’s dangerous location, surgery was not optimal. Instead, Gamma Knife would enable us to focus beams of concentrated radiation to the precise location of the tumor, without having to irradiate the whole brain, and thus safeguard surrounding healthy brain tissue.”
Just 15 days after his trip to the ED, John came to the Gamma Knife Center for treatment. While waiting for treatment to begin, John received a calming “M” technique massage of his hands and arms, a holistic therapy that is used throughout the Hospital by nurses/certified massage therapists to soothe patients. The “M” technique works on skin receptors that send relaxing signals to the brain. Sometimes, patients even fall asleep during treatment, which is exactly what happened to John, after he was positioned on the treatment couch and surrounded by relaxing music.
A semi-retired electronic maintenance specialist, John was fascinated by the technology of Gamma Knife, returning to work after surgery and to tinkering with his model trains. “I’m continuing all my regular activities and taking life one step at a time,” he says. l
At Elekta, we share a passion with our customers to advance the frontiers of cancer care and enjoy sharing news from clinics that are treating patients more effectively, precisely and efficiently with the help of Elekta technology. In the last issue of Wavelength, we asked readers to tell us what makes your center unique. Here are a few stories from across the globe.
Massage technique at Valley Hospital’s Gamma Knife Center puts patients at ease before treatment
From left to right: Young Kim, MD; Michael Wesson, MD; Chad DeYoung, MD and Anthony D’Ambrosio, MD
John Marrinan and Susan Lombardo, RN, Nurse Navigator
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Treating patients for 23 years, Tuen Mun Hospital (Tuen Mun, New Territories, Hong Kong) is an acute 1,915-bed hospital serving a population of over one million in the western part of the New Territories of Hong Kong. With a primary focus on treating not only a cancer, but also the psychosocial needs of patients, the Department of Clinical Oncology was the first center in Hong Kong to provide seamless oncological and palliative care
through a dedicated team of oncologists, nurses, radiation therapists, medical physicists, medical social workers, clinical psychologists, and other allied health professionals.
“Besides providing medical care, our center also pays special attention to the psychosocial needs of patients,” says Dr. Stewart Tung, Chief of Service, Department of Radiation Oncology at Tuen Mun Hospital. “The Cancer Patient Resources Centre in our Department, together with the Hong Kong Cancer Fund, as well as Maggie’s Centre, has supported patients for years. Through counseling, educational talks and support group activities such as yoga, art and music therapy, relaxation sessions and nutrition classes, we help patients and their families through the journey of cancer treatment, from diagnosis, treatment and convalescence. And, for patients whose disease is deemed incurable, we provide hospice care to increase their comfort during their remaining time, as well as bereavement service for their children and family members.
One particularly unique feature of the department is the vibrantly colored Elekta linear accelerators.
“Life is colorful,” says Dr. Tung. “We want to bring life to patients and believe that an environment that supports and nurtures them can have a healing effect. Automobiles are available in different colors, even for mobile phones and cameras nowadays there are more color choices available – so why not a linear accelerator?”
Tuen Mun Hospital is looking forward to the installation of Elekta’s Agility™ 160-leaf, multi-leaf collimator. “We believe a high-definition MLC is beneficial in treating irregular target volumes which constitutes a significant amount of the workload in our center,” Dr. Tung adds. “The new Agility MLC is 5 mm across the entire treatment field, and more importantly its high speed can lead to faster treatment time and may be useful in gating as well.”
Dr. Tung notes that Tuen Mun Hospital will be the first in Hong Kong to employ Agility MLC and that the first treatment should take place in April. l
Hong Kong’s Tuen Mun Hospital focuses on cancer care for the entire patient
Clockwise from top: Elekta Synergy Platform at Tuen Mun Hospital; The working team of radiation therapists at our Elekta Synergy Platform; The commissioning team for our Elekta Agility; Elekta Synergy at Tuen Mun Hospital
Life is colorful. We want
to bring life to patients and believe that an environment that supports and nurtures them can have a healing effect.”
What makes your center unique?
The convergence of conventional radiotherapywith advanced stereotactic precision.
www.VersaHD.com
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Versa HD is not available for sale or distribution in all markets. Please contact your Elekta representative for details.
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