Introducing Versa HD™ BMX bike rider`s Gamma Knife® experience

PIONEERING SIGNIFICANT INNOVATIONS IN CLINICAL SOLUTIONS
FOR TREATING CANCER AND BRAIN DISORDERS
Vol. 17 | No. 1 | March 2013
Introducing
Versa HD™
PAGE 4
BMX bike rider’s
Gamma Knife®
experience
PAGE 6
Brachytherapy for
bladder cancer
PAGE 10
Pioneer and partner in cancer care.
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.
Contents
Dear friends,
Unmatched versatility
with Versa HD™
4
Clarity® 4D Monitoring
9
Agility™ users in Germany
10
From BMX to
Gamma Knife® radiosurgery
12
Elekta around the world
14
Consider lung cancer
for first SBRT target
16
Laparoscopic brachytherapy
for bladder cancer
18
eLearning labs
21
What makes your
center unique?
24
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 Puusepp
President and CEO of Elekta
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: michelle.joiner@elekta.com
Vol. 17 | No. 1 | March 2013
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.
Published by Elekta | www.elekta.com
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.
3
4
Unmatched versatility
The convergence of conventional radiotherapy
with advanced stereotactic precision
5
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.
“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.”
>>
6
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
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.”
7
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 & Spine
Versa 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 & Neck
To 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.
Lung
A 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.
Breast
Versa HD provides ground-breaking solutions to image and define the lumpectomy
cavity, in addition to products that enable accurate patient positioning and
respiratory management.
8
Prostate
Versa 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
Keeping track of the prostate
Elekta receives FDA 510(k) clearance for Clarity® 4D Monitoring
Clarity® 4D Monitoring software provides a new
ONLINE
elekta.com/clarity
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
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
9
Germany™ leads pack
of Agility clinical users
10
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.
* Wavelength, Vol. 16, No. 2
Prof. Frank Lohr,
Vice Chairman, University
Medical Centre Mannheim
“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
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
LOCATIONS
German centers clinical
with Agility
F University Medical Centre, Mannheim
F Ludwig-Maximilians-University, Munich
F Diagnostic Therapeutic Center Frankfurter Tor
...it creates
a package
that makes
treatments very
fast and also
treatment planning
extremely easy.”
(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
11
Josh Perry
12
ONLINE
Watch Josh Perry
F https://vimeo.com/54405951
F https://vimeo.com/44123283
F http://vimeo.com/35662875
PHOTOGRAPHY BY CODY YORK, CODYYORKPHOTOGRAPHY.COM
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!)
From BMX to Gamma Knife® surgery
and back – Josh Perry’s story
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.
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?
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
*American sports news
I was
riding within
a week after
treatment and
didn’t have any
effects from the
radiosurgery,
which was
a relief.”
13
Elekta around the world
uw ATL ANTA, 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, TEX AS, USA
Elekta gains MD Anderson Cancer Center as collaborator
in research consortium
14
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 SUNNY VALE, 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.”
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 CURITIBA, BR AZIL
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 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 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 MANDAL AY 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 VEENENDA AL, THE NETHERL ANDS
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 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 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 WOLLONGONG, NEW SOUTH WALES, AUSTR ALIA
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.”
15
Breathing life into
an SBRT program
The first target – lung cancer
16
Fully equipped for SBRT
WFBMC 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)
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.”
Wake Forest Baptist Medical Center
Starting out simple
Part 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
17
ONLINE
https://wakeforestsrt.com/
18
Bladder brachy renaissance
Dr. Elzbieta van der
Steen-Banasik assists in
robot-assisted laparoscopic
placement of brachytherapy
catheters
Dutch team and Nucletron collaborate
on minimally invasive laparoscopic
brachytherapy for bladder cancer.
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.
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.”
Dr. Geert Smits,
Rijnstate Hospital, Arnhem,
The Netherlands
Need novel needles
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
In 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
>>
19
Luneray™ catheters are
integrated sterile units of
high strength catheters and
curved needles
It’s important
to us to get
the word out
and let other
centers know
what is possible.”
20
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 assistance
By 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.
Getting ahead while
standing still
Customers embrace Elekta’s eLearning as training initiatives set to grow
eLearning is
starting in 2013
the best way
to transfer valuable Elekta’s Education and Training Department
describes the “Consumption Gap” as the difference
knowledge to our
between the customer’s ability to consume (i.e., use)
customers any
product features and the rate at which Elekta product
features are growing in number and increasing in
time, any place,
sophistication. Graphically, the customer curve is
anywhere via
rising steadily over time, while the product feature/
Internet-ready
complexity curve is shooting up logarithmically. To
make the best use of Elekta solutions, customers will
devices.”
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, webaccessible 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
>>
21
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 Winstanley
Specialist Radiotherapy Engineer
The Christie NHS Foundation Trust
22
Elekta 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.
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.”
23
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 checking
elekta.com and
Wavelength for future
developments!
What makes your center unique?
Saudi Arabia center advances radiotherapy technology
with nation’s first Elekta IGRT treatment system
In part to address the 12,000 new cancer
cases annually in Saudi Arabia – many of them
We have found
that delivery of
IMRT is faster on
Synergy versus our
other systems.”
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 radiotherapy 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 userfriendly 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.”
24
King Abdulaziz University
Hospital’s Elekta Synergy
boosts treatment speed for
patient comfort, integrates
imaging for patient safety
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
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
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
>>
From left to right: Young Kim,
MD; Michael Wesson, MD;
Chad DeYoung, MD and
Anthony D’Ambrosio, MD
25
John Marrinan and Susan
Lombardo, RN, Nurse
Navigator
What makes your center unique?
Hong Kong’s Tuen Mun Hospital focuses on cancer care
for the entire patient
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
26
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.”
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
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
4513 371 1124 01:13
One Solution.
Unlimited Possibilities.
The convergence of conventional radiotherapy
with advanced stereotactic precision.
www.VersaHD.com
Versa HD is not available for sale or distribution in all markets. Please contact your Elekta representative for details.
Human Care Makes
the Future Possible
www.elekta.com
Corporate Head Office:
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