Varian Particle Therapy Why Varian?

Volker Schirrmeister

ERICE APRIL 2009

 Partnering with Varian

Varian History

Founded in 1959 & dedicated
to Oncology

Varian Medical Systems
created by Varian Associates
in April, 1999

Varian Medical Systems

Varian Oncology

Varian X-ray Tubes

Varian Security Inspection Products

Varian Biosynergy

Ginzton Research Center
History of the Proton Program at Varian

Proton program started in 1992

Eclipse Proton treatment planning, VARiS and ARIA
information management systems

First Chinese proton center at Zibo uses Eclipse and
VARiS

MD Anderson, University of Florida; NCC Korea are
on line

Varian acquires ACCEL Instruments GmbH, 1/07
Varian Clinac Family

Low Energy High Energy

Clinac 600C/D Clinac DHX, DMX, 2100 C/D, 21EX

DBX, 6EX Clinac 2300C/D, 23EX, Silhoutte, iX, Trilogy
Easy to operate
 Identical Collimator Head
 Identical Accessories
 Identical Treatment Couch
 Identical Operation

Identical Options
 Dynamic Wedge
Single Photon Energy  Asymmetric Jaws Dual Photon Energies
4 or 6 MV  Multileaf Collimator 4 to 20 MV (25 MV)
 PortalVision 5 or 6 Electron Energies
 4D Treatment Console 4 to 22 MeV
 Auto Field Sequencing
 ARIA Oncology Info System
Varian Oncology Products Overview

Clinac: Family of Linear accelerator treatment unit

designed to provide quality radiation cancer therapy

kV On-Board Imager: Accelerator based kV

radiographic, fluoroscopic and Cone-beam CT imaging
capabilities for IGRT

Millenium Multileaf Collimator (MLC):

High-resolution beam shaping device used with Clinac
to customize treatment dose

PortalVision: High-resolution, digital flat-panel

megavoltage imaging device with robotic position
capability
Varian Oncology Products Overview

Trilogy: Varians top-of-the-line, image-guided

delivery system optimized for 3D-CRT, IMRT and
Stereotactic Applications

Novalis Tx: The Power of Two.

A dedicated solution for Neuro- and Radiosurgical
procedures and applications, featuring gantry and room
based imaging tools

HD120 MLC: Highest resolution beam shaping to
achieve new levels if precision and accuracy
(central region with 2.5 mm leaves)
Varian Oncology Products Overview

Acuity: a comprehensive medical imaging system that

integrates planning, simulation, and verification software
for treating cancer with radiation therapy

Eclipse, Helios & SomaVision: Computer systems for

planning, calculating and visualizing dose distribution

ARIA: the only fully integrated Oncology Information

System (OIS) to manage all aspects of comprehensive
cancer care, including radiation oncology, medical
oncology and surgery.

GammaMed / VariSource: HDR & PDR after-loading
system that provides removable, implantable radiation
for certain malignancies
Why Varian?

Highest
Uptime Logbook 2004
King Faisal Hospital, Riyadh, Saudi Arabia
Why Varian?

Biological Imaging &

Targeting-Tumor Positioning
201x
The Technical Vision RapidArc Single Arc IMRT, Proton Therapy System ACCEL
Enhanced SBRT & Neurosurgical applications
2007
IGRT, full system integration and
Dynamic Adaptive Radio Therapy
2000s
IMRT, Integration and
process enhancement
1995
Dynamic conformal techniques
Start Proton Therapy Program
1990s
Computerization of accelerators,
development of MLCs and 3D planning
1980s
Exploration of high
energies & electrons
1970s
Basic Medical Accelerator Developmental Stages and Trends
designs developed & proved in Radiation Therapy
1960s
Acquisitions

ACCEL
Particle Therapy

The Strategic Vision Sigma Micro

2007
Oncology Information System
2005
OpTx
MedOncology Software
2004
GammaMed
Brachytherapy
2003
Omnitron
Brachytherapy
1995
Dosetek
Treatment Planning
1993
ABB
Portal Imaging & Data Management

TEM Ltd 1990

Simulation

Basic Medical Accelerator 1984 Strategic Acquisitions of Varian

Teletherapy in Oncology
1960s
RPTC Munich

Accelerator
Treatment Rooms with Gantry

Eye Treatment

Beam Transfer Line

First European Commercial Clinical PT Center

Superconducting Proton Cyclotron
 Proton Beamline for guiding the beam to the
treatment rooms

ERICE APRIL 2009

The RPTC Gantries

Constructed by Schr Engineering

Gantry and Patient
Positioner

Mechanical precision
requirements as verified in
production:
Beam axis within 0,5 mm
radius volume around
Isocenter
Gantry Treatment Room
 Unique Proton Beam
Scanning Nozzle

 PRECISE BEAM
 LOWEST NEUTRON DOSE

ERICE APRIL 2009

Why Varian ?

Scanner-Magnet 1 (y)

Vacuum chamber
Monitor chambers
Scanner-Magnet 2 (x)
 Scanning Nozzle

Scanning Magnets

Vacuum Chamber

Diagnostic Flat Panels

(Position Verification)

Dose and Position Monitors

Nozzle 3D-View
Patient Specific Devices
(Range Shifter, Ripple
Filter, Collimator, etc.)

Test of Scanning System at HMI, Berlin

Scanning Method

y-View
30cm

30 cm
y-Scanner x-Scanner

x-View
40 cm
40cm
SADSC1 SADSC2

lSC1 d lSC2

Irradiation of 1-l-Tumor with 2 Gy/min:

Spot scanning with continuous transition in row

Beam diameter (FWHM): 10 mm

Voxel spacing: 5 mm (20 20 20 voxels)

5 ms per spot (max. ~ 20 ms, min. ~ 3 ms)

Beam switching on/off: 50 s

1-10 s irradiation period per layer

Layer switching time: 1 s
Effective Proton Source

20 cm behind 50 cm before
isocenter isocenter

X: 195 cm (mech. 200 cm)

Y: 252 cm (mech. 256 cm)
Leakage and neutron doses (Hall, 2006)
 Scanning: Key Specifications & Measurements

Range: Up to 37.6 g/cm

Field size: Up to 30 40 cm

Dose Compliance: better than 2.5%

Beam spot size (FWHM): 4 to 7 mm

Repainting

Dose Distributions
measured at HMI, Berlin End-to-end test, RPTC Gantry-1
Test Cases Dose Results

1,000 1,007
0,030
1,010 1,007
0,000 doses [Gy]
- measured
- calculated
0,750
0,698
1,008
1,004
Deviations in
homogeneous
regions 1% !!!

Measured vs. calculated doses [Gy] depth

0.008 / 0 0.379 / 0.779 / 0.882 / 0.952 / 6 cm

0.376 0.748 0.919 0.927
0.030 / 0 0.750 / 1.035 / 1.025 / 1.007 / 14.5 cm
0.698 1.033 1.024 1.007
0.002 / 0 0.007 / 0.046/ 0.845 / 1.008 / 19.5 cm
0.002 0.040 0.881 1.010
System Performance Test (END TO END)

according to the DIN 6875-1, Special radiotherapy equipments - Part 1: Percutaneous stereotactic
radiotherapy, basic performance characteristics and essential test methods

Demonstration of the overall system performance

specification of dose and dose distributions in a target volume, simulated in a phantom, for a simple
and sophisticated geometry

Focus on agreement between planned and measured doses

Test steps:

CT imaging

Therapy Planning System:

contouring of target volume

definition of irradiation fields

dose calculations

positioning of the phantoms at Gantry 1 using the X-ray based position verification system

Beam application

dose measurements

comparison between measured and calculated dose distributions.

(published at PTCOG 44, Zurich, June 2006)

Test Cases

Field 1

Field 2

RPTC :
Field 1: 30, table rotation 90
11 layers, 1000 spots
Field 2: 90, with 57 mm w.e. range shifter
10 layers, 800 spots
QA plan generated for homogeneous PMMA phantom
Test Case Results

Field 1
Measured vs. calculated doses [Gy]

0.910 / 1.057 / 0.975 / 1.148 / 0.529 / Beam 1

0.851 1.060 0.995 1.161 0.547
Test Case - Results

Field 2

Measured vs. calculated doses [Gy]

0.674 / 0.838 / 0.893 / 0.832 / 0.286 / Beam 2

0.575 0.888 0.944 0.890 0.323
Scan Modes of new Gantry-2 at PSI Aiming
for Continuous Scanning
Spot scanning: step & shoot Cont. scanning TV mode

Integrating dose delivery kHz-Intensity modulation

per spot

intensity
Courtesy of M. Schippers,PSI

TargetRepainting, e.g. 17 scans / 2 min. 0 time (ms) 10

7 s for a 1 liter volume/scan
The faster the more important is a stable and continuous beam
Position Verification System

Features

Field-of-view 20 28 cm

30 40 cm amorphous silicon
panels

Semi-automated image
matching and position
correction procedure

Only 2 X-ray axes needed

Position correction possible for
any treatment position

Total accuracy: 0.5 mm
 User Interface Position Verification System

ERICE APRIL 2009

Why Varian?

Partnership in R & D

Varian Medical Systems has about 200 technical,

research, and process partnerships with the
Radiotherapy community throughout the world!
US Top 50 Cancer Centers 2007
(Varian=78% )
1. University of Texas, M. D. Anderson Cancer Center
2. Memorial Sloan - Kettering Cancer Center
3. Johns Hopkins Hospital, Baltimore
4. Mayo Clinic, Rochester, Minn.
5. Dana - Farber Cancer Institute, Boston
6. University of Washington Medical Center, Seattle
7. University of Chicago Hospitals
8. UCLA Medical Center, Los Angeles
9. Duke University Medical Center, Durham, N.C.
10. Massachusetts General Hospital, Boston
11. Fox Chase Cancer Center, Philadelphia
12. University of Pittsburgh Medical Center
13. Stanford Hospital and Clinics, Stanford, Calif.
14. University of California, San Francisco Medical
Center
15. Ohio State University James Cancer Hospital
16. H. Lee Moffitt Cancer Center and Research Inst
17. Cleveland Clinic
18. University of Alabama Hospital at Birmingham
19. Barnes - Jewish Hospital/Washington University
20. University of Wisconsin Hospital and Clinics
21. University of Michigan Medical Center, Ann Arbor
22. Vanderbilt University Medical Center, Nashville
23. Yale - New Haven Hospital, New Haven, Conn.
24. University of Minnesota Medical Center
25. University Hospitals Case Medical Center
Cleveland
Source: US News and World Report 2007
26. Beth Israel Deaconess Medical Center, Boston
27. University of Virginia Medical Center
28. Brigham and Women's Hospital, Boston
29. Hospital of the University of Pennsylvania
30. City of Hope, Duarte, CA
31. University Medical Center, Tucson, Ariz.
32. University of Utah Hospitals and Clinics
33. Rush University Medical Center, Chicago
34. Mayo Clinic Hospital Phoenix
35. University of Colorado Hospital, Denver
36. Dartmouth - Hitchcock Medical Center
37. Oregon Health and Science University Hosp.
38. William Beaumont Hospital, Royal Oak, Mich.
39. University of California, San Diego Medical Center
40. University of North Carolina Hospitals, Chapel Hill
41. New York - Presbyterian Univ. Hosp. of Columbia
and Cornell
42. Evanston, Northwestern Healthcare
43. Abbott Northwestern Hospital, Minneapolis, MN
44. Loyola University Medical Center, Maywood, IL
45. Sarasota Memorial Hospital, Fla.
46. University of Kentucky Chandler Hospital
47. Methodist Hospital, Houston, TX
48. Lehigh Valley Hospital, Allentown, PA
49. Lancaster General Hospital, Lancaster, PA
50. Inova, Fairfax Hospital, Falls Church, VA
The unique Varian Oncology Solution

Cancer Treatment
IMRT & RapidArc

IGRT & DART

Proton Therapy

Radiosurgery

BrachyTherapy
 Ground Floor RPTC Munich
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Technical Level Diagnostic Level

PT Treatment Level Office Level
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ARIA
Oncology Information System
featuring a single unified Data Base
What Matters Most?

Technology?

Innovation?

.
What Matters Most? Save 100,000 more
people.
 Our Vision

Make Cancer a manageable, chronic disease

that can be treated by our products better and
more cost-effectively

Make advanced therapy affordable for

many around the world, not few

ERICE APRIL 2009

The Integrated Oncology Service

PTS
LIS HIS Proton Therapy
Lab Information Hospital Information Control System
System System
PVS
HL7 Position
Verification
System Protons
EMR Scheduler Machine
Electronic
Medical Record Control
ARIA
Oncology Cone Beam
Information CT & Portal
System Imaging
Linac
Charge
RT-PACS Machine
Capture Control

Cone Beam
CT & Simulator
Imaging
DICOM 3.0
Simulator
DICOM-RT
ECLIPSE
VSIM VSIM
Treatment
Virtual Virtual
Planning System Simulation Simulation

CT MR
PET-CT
 Varian at a Glance

Thank you very much for your interest

and attention

ERICE APRIL 2009