Convention Spotlight

When the American Society for Therapeutic Radiology and Oncology meets this month in Atlanta (Oct. 3rd-7th), meeting-goers will have a feast of new products and enhancements to graze on. As you'll see, the products range from new radiation therapy treatment platforms and 4D treatment devices to CR for radiation therapy and IGRT training. We've included booth numbers, too, so you can get a look for yourself if you're walking the floor.

Varian Medical Systems (booth #825) is unveiling the Clinac iX linear accelerator, a new customizable platform for treatment delivery that features a high-performance, multifunctional foundation. Richard Stark, director of Delivery Systems Product Marketing, explains the flexibility of this new platform will enable customers to order a base unit with standard features, and then add high-end capabilities at a later date. With a commitment to "Dynamic Targeting" image-guided radiation therapy (IGRT), this platform incorporates a new 4D integrated treatment console for improved workflow efficiency.

"We've done a number of things that are very different on this machine," says Stark. "For example, the control area of the machine is designed with a single keyboard rather than multiple keyboards, and the software is designed to be integrated into a workflow that allows sophisticated techniques to be used more easily."

This design eliminates the proliferation of devices that control various components of the delivery system and improves ergonomic design and functionality. The 4D Integrated Treatment Console streamlines operations by combining controls for the linac, the Millennium multileaf collimator, the PortalVision megavoltage electronic portal imager and the On-Board Imager kV electronic imager. Additionally, this console is integrated with Varian's VARiS Vision patient information database.

Every Clinac iX system can be customized, configured and upgraded to facilitate purchase of a basic system to meet the current needs of a radiation therapy facility, yet enable future advances easily and affordably.

Varian's VARiS Vision radiation oncology information management system will unveil two new products at ASTRO. Clinical Assessment and Dynamic Documents are new plug-in modules for Patient Manager, the electronic medical record tied to radiation therapy systems.

The Clinical Assessment product allows the physician to capture the patient's original diagnosis and determine the stage of cancer based on size and extent of the tumor's spread. Because different scales are employed for staging various forms of cancer, this system is designed to lead the clinician through a series of questions to assist in determining staging and direct further treatment options.

Other features of Clinical Assessment enable the clinician to completely document any encounter with the patient, including laboratory results, vital signs, patient and family history, nursing notes and social background, including smoking or drug use. Employing a series of "checked" boxes, the system generates complete English sentences to facilitate reporting to referring physicians.

Dynamic Documents is capable of managing free-form text such as notes generated from outside the treatment center and faxes, through Microsoft Word functionality. Once a document is created and filed with the patient's chart, it can be tracked and fully utilized during patient treatment.

"This is a big productivity gain, and it's also about making a complete medical record, because when it comes to HIPAA, it's important that everything about a patient is captured and documented," says Keith LaPlain, business unit manager for information systems. After the encounter is documented, it is locked so that it cannot be modified after the event.

The last Varian information management enhancement being unveiled at ASTRO is a system for medical oncology integration. With many patients receiving simultaneous chemotherapy and radiation therapy treatment, this system is designed to fully merge information about both forms of treatment to facilitate care.

For radiation treatment planning activities, Varian will introduce a new version of its Eclipse 3D radiotherapy treatment planning software with two new dose calculation algorithms and stereotactic coordinate generation features.

Triple A (which stands for anisotropic analytical algorithm) is designed to improve dose calculation in heterogeneous media. In other words, when treatment beams must penetrate bone, soft tissue and lung, each with a different density, the dose definition must be adjusted to enhance treatment effectiveness. Triple A is designed to perform those dose calculations for photon treatment. The Electron Monte Carlo (eMC) algorithm is designed to facilitate treatment of structures that are less deep within the body, such as node beds.

A hybrid of the Zmed FastPlan plus Eclipse enables stereotactic radiosurgery techniques. Originally designed for cranial lesions, the Gamma Knife resided within the realm of the neurosurgeon. Given new capabilities enabled by the hybrid application introduced at this meeting, Jefferson Z. Amaker, III, business unit manager for treatment planning systems, anticipates movement of stereotactic techniques into treatment of other tumor sites.

Siemens Medical Solutions (booth #1624) is showcasing several new capabilities at ASTRO. They will introduce new solutions in Adaptive Radiation Therapy (ART) that use diagnostic quality images to adapt treatment delivery based on the actual state of what is happening at and around the tumor site. Traditionally, radiation treatments were delivered based on images that were obtained two or three weeks earlier. ART is a concept that is accomplished on the Siemens Primatom, a combination of linear accelerator and CT scanner on rails.

Siemens also will showcase "proven outcomes" throughout the oncology diagnosis and treatment process. Siemens defines proven outcomes as tangible, measurable results, including important standards such as increased throughput, increased efficiency, greater physician and patient satisfaction, optimized cycle time and the elimination of errors.

Agfa Healthcare (booth #1711) is demonstrating a new series of products designed to augment its existing line of computed radiography systems to meet specific needs of radiation therapy applications.

Showcasing as works-in-progress will be the new Agfa CR 25.0 and CR 75.0 that include a specially designed radiation therapy package. These new offerings are intended to increase image quality, including radiation therapy components and software. They are designed to afford easy integration and expand imaging capabilities for most PACS-enabled institutions.

Cardinal Health (booth #1415) is introducing a quality assurance program comprised of a phantom and software, called IMRTLog. This offering permits rapid measurements for intensity modulated radiation treatment (IMRT) plans with display of the integrated dose contribution from each segment as well as the total integral dose.

"IMRTLog is ideal for IMRT and other complex radiation measurements in external radiotherapy like 3D conformal therapy," says Ken Freeman, oncology product line manager for Cardinal Health.

The IMRTLog phantom consists of a 2D array of 506 radiation-hardened solid-state detectors placed in a plate with inherent backscatter material. The detectors are connected to a mobile cart where all electronics are stored, including electrometers. In this way, all of the radiation sensitive components are kept out of the therapy beam. Each detector has its own electrometer to remove errors and delay in measurement that can arise with multiplexing.

IMRTLog software includes tools for comparison of the therapy plan against measurement using dose difference, distance to agreement, or gamma.

Elekta (booth #2124) is rolling out Elekta Synergy, a new radiation treatment platform with an integrated imaging system. This technology enables physicians to obtain images of patients at the point of treatment, which permits visualization of tumors at the time of treatment to more precisely target tumors while minimizing damage to surrounding tissue.

In addition, Elekta is showing off changes to the Leksell Gamma Knife 4C used to perform intracranial stereotactic radiosurgery, that are designed to improve workflow, increase accuracy and provide enhanced imaging capabilities. These features offer the capability of integrating images from multiple sources to produce accurate treatment parameters. Images may be exported on a CD-ROM, to provide pre-op or post-op images for reference and follow-up.

Philips Medical Systems (booth #1324) is showcasing its Gemini PET/CT hybrid scanner as well as new software offerings designed to benefit radiation therapy applications.

Philips is introducing a works-in-progress, auto-segmentation software that contains a library of organ models built into the package designed to speed contouring activities used in IMRT. Complex head and neck contouring activities can require up to two hours of planning time. Auto-segmentation is designed to cut that time requirement in half. For example, if the clinician plans to contour a prostate, he or she moves the mouse cursor and clicks on the area of interest, and it automatically presents a shape of a typical prostate.

"The really neat thing about the software is that it is self-learning," explains Robert Fenwick, global marketing director for Philips PROS. If you have a certain specialty of patients that you see routinely, you can build your own library of organs of interest based on your patient population. This lends geographic accuracy to the product.

Shared PET Imaging LLC (booth #655) is showcasing three software offerings in its first trip to ASTRO.

ClarityRead allows physicians to view PET images in a Microsoft Windows-based program on a Dell Desktop. It's FDA 510K approved, and permits visualization of all views of the image.

ClarityLite is used in marketing. A viewer that is loaded onto a CD enables images to be transported and read on any personal computer where they can view images. In other words, it provides a CD copy that can accompany the written report in the place of a stack of films. It also can be given to patients. There is no need for special software to read the images because ClarityLite is embedded. ClarityFusion is a works-in-progress and is designed to fuse CT or MR images with PET images.

Nucletron (booth #2325) will be highlighting Oncentra Optimizer, its new IMRT solution designed to provide fast and accurate results. They're previewing the latest advancements in digital simulation using the Simulix Evolution simulator and Oncentra Cone Beam CT technology as a works-in-progress.

In addition, Nucletron will introduce OncoSelect HDR-3, a new three-channel after-loader for use in brachytherapy as well as a variety of applicators for more than 200 body-site specific solutions such as Comfort Catheters for the Inergy Breast brachytherapy system.

Radionics (booth #2951) is debuting a new product called HDRT, High Definition Radiation Therapy, that provides image-guided precision targeting. It uses a combination of Radionics products including hardware components that provide patient immobilization to permit calibration of the CT images. The image fusion component enables the clinician to fuse daily CTs with a reference CT to position the patient for optimization of the plan.

"It's a combination using stereotactic localization and immobilization to get precise patient positioning from fraction to fraction, and then using our high resolution IMRT for delivering highly conformal dose plans to targets," says Chuck Vecoli, director of marketing. Activities where this system may prove valuable are extra cranial applications such as use in spine metastases to enable dose escalation while sparing critical structures such as the spinal cord.

Codonics (booth #1701) is announcing a new 5-year warranty for the Horizon Multi-Media Dry Imager. This 66-pound, 14-inch by 17-inch imager can produce multi-format, multi-size, multi-media film and color output and requires less than two feet of desk space as its footprint. Its capability to print grayscale and color in one imager makes it attractive for advanced imaging applications that require large format film, color for CT perfusion, functional and 3D rendering, plus grayscale paper for diagnostic review, referral and patient copies.

The new five-year warranty coupled with Codonics 24-hour replacement service helps to assure the system's availability.

Eastman Kodak Company (booth #1315) is rolling out enhancements to the KODAK 2000RT Plus CR System for Oncology, designed to improve productivity and augment the user interface. Current customers with service agreements will receive the new software at no change, which will be included with all new systems shipped by November 1st.

In addition, Kodak will exhibit the KODAK DIRECTVIEW Web Distribution System which offers referring physicians fast and convenient access to imaging studies and reports using a standard web browser.

GAMMEX rmi (booth #2145) is presenting several products, including phantoms to verify dosimetry and a laser tracking system.

The Gammex 467 Tissue Characterization Phantom provides users with a rapid, reliable source designed to assist in identifying tissue inhomogeneities for treatment planning purposes. The Solid Water base phantom contains a wide range of tissue and water simulating rods, physical densities and electron density relative to water. The phantom includes a pattern of small air holes with known spacing for checking the CT scanner's distance measurement accuracy. The Gammex 473 Planar IMRT phantom provides a method to verify complex IMRT treatment plans.

Finally, the Gammex CT Sim Robotic Laser Tracking System offers laser alignment technology that can be integrated with the facility's treatment planning system. This Windows-based software allows a site to customize runs. Lasers can be obtained either in red or green diode versions.

D3 Radiation Planning Services (booth #2816) will introduce its 2005 initiative to enhance training programs, protocols and remote planning in order to leverage IGRT technology, which requires dramatic adjustments in workflow and protocols. The company's focus will involve providing training for these work processes as well as education about specialized protocols.