TRUEBEAM - ADVANCED

TECHNOLOGY UPDATE
Varian Medical Systems International AG
Bangkok August 24, 2012

Rolf B Staehelin
VARIAN
ONCOLOGY
Director International Marketing
SYSTEMS
1 | VARIAN ONCOLOGY SYSTEMS

August 24, 2012

The Varian Oncology Solution Advantage

TrueBeam

Novalis Tx

Treatment Procedures with

Exceptional Ease, Speed
and Accuracy

Neurosurgical &
Radiosurgical
Applications

Trilogy
All in One
Treatment
System

ProBeam

Clinac

Fully-integrated
Proton Therapy
System

Innovative
Treatment
Platform

UNIQUE
Cost-Effective
Oncology
Solution

Varian BrachyTherapy
Eclipse
Treatment
Planning
System

2 | VARIAN ONCOLOGY SYSTEMS

ARIA
Oncology
Information
System

Product Suite for

Planning &
Delivery

Tailored Solutions for all Clinical Requirements

Complete Product Portfolio

TrueBeam

Clinical Capabilities

Complete
Product Portfolio

Novalis Tx
Trilogy

IMRT / RapidArc
Neuro- & Radiosurgery
Advanced IGRT
IMRT / RapidArc
SRS/SRT
kV & MV IGRT

Clinac iX/DHX
UNIQUE
Power

IMRT / RapidArc
kV & MV IGRT

UNIQUE
Performance

3D-CRT
MLC. MV imaging
Basic 2D RT
no MLC, no imaging
Investment

3 | VARIAN ONCOLOGY SYSTEMS

Clinical Challenges
Clinical Versatility

New Treatment Capabilities

combined with
3D-CRT, IMRT & RapidArc
SRS/SRT, IGRT & DART

Precision

Mechanics
Electronics (control)
Imaging System

Decision

Imaging Applications

Speed

Ergonomics of Software & Hardware

Integration & Safety Features

4 | VARIAN ONCOLOGY SYSTEMS

5 | VARIAN ONCOLOGY SYSTEMS

TrueBeam - Radically Different

6 | VARIAN ONCOLOGY SYSTEMS

TrueBeam - Radically Different

TrueBeam

TrueBeam STx

Field Size: 40*40 cm2

Center leafs (20 cm): 5 mm
Outer leafs: 10 mm

Field Size: 40*22 cm2

Center leafs (8 cm): 2.5 mm
Outer leafs: 5 mm

7 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Radically Different

Innovative
Intelligent
Intuitive

8 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Innovative

New
Architecture

9 | VARIAN ONCOLOGY SYSTEMS

The TrueBeam system has

been designed from the
ground up to optimize
radiotherapy and radiosurgery
Real time control system
provides a seamless integration
of treatment, imaging and
motion management

TrueBeam
Innovative

Beam
Generation

10 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
New Beam Generation System

Today in Clinics
Multi-Energy: 13 Carousel Positions available
5 Flattened Photon Energies: 4, 6, 8, 10, 15, 18 & 20 MV

< 5 up to 600 MU/min

plus 2 High Intensity Mode Energies

6X FFF, 10X FFF (Flattening Filter Free)

8 electron energies: many foils, 22e (max)

Future

low photon energy (2.5 MV) for MV imaging

4 MeV electron

11 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
High Intensity - Flattening Filter Free (FFF) Mode

Higher dose rates, lower scatter

and out of field leakage are
possible by removing the
flattening filter
Gains for IMRT, RapidArc
or small field SRS
Available in clinical mode for
6 MV 1400 MU/min
10 MV 2400 MU/min

12 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
High Intensity - FFF Mode - Literature

Red Journal - paper from

University Zurich in Press
FFF on TrueBeam

13 | VARIAN ONCOLOGY SYSTEMS

Non-flatness increases with energy

TrueBeam
High Intensity - FFF Mode - Profiles
X6

X10

X6FFF

X10FFF

TrueBeam data courtesy Hrbacek & Lang, University Hospital Zrich

14 | VARIAN ONCOLOGY SYSTEMS

Up to 3x3 cm2, difference in the profile for

flattened and FFF is neglectable

Leading the Way in Cancer Therapy

Prostate
Liver
Lung
Breast

SRS

15 | VARIAN ONCOLOGY SYSTEMS

FFF - Hypo-Fractionation (Hypo-fx)

Standard-fx e.g. 40 x 2Gy = 80 Gy

t
Hypo-fx e.g. 4 x 9.5 Gy = 38 Gy

Hypo-fx is not a matter of technology but clinical

feasibility & decision
Hypo-fx is not suitable for all indications
Studies focused on lung, liver, brain & prostate cancers
Safety, precision and time are crucial for hypo-fx
TrueBeam delivers hypo-fx in the shortest possible time
Hypo-fx treatments can be performed on all Varian linacs

t
16 | VARIAN ONCOLOGY SYSTEMS

TrueBeam - Clinical Benefit of High Intensity Mode

Brain SRS

Data courtesy
Neolife Cancer Center
Istanbul, Turkey

17 | VARIAN ONCOLOGY SYSTEMS

TrueBeam - Clinical Benefit of High Intensity Mode

Prostate SABR (Stereotactic Ablative Radiotherapy)

Data courtesy
Humanitas Institute
Rozzano-Milano, Italy

18 | VARIAN ONCOLOGY SYSTEMS

TrueBeam - Clinical Benefit of High Intensity Mode

Lung SABR (Stereotactic Ablative Radiotherapy)

Data courtesy
VU University Medical Center
Amsterdam, Netherlands

19 | VARIAN ONCOLOGY SYSTEMS

TrueBeam - Clinical Benefit of High Intensity Mode

Liver Mets SABR (Stereotactic Ablative Radiotherapy)

Data courtesy
Humanitas Institute
Rozzano-Milano, Italy

20 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Intelligent

Superior
Image
Guidance

21 | VARIAN ONCOLOGY SYSTEMS

Simplified, Automated
Imaging Modes

CBCT (Single Button)

kV/kV, MV/MV and MV/kV
radiographic pairs

TrueBeam
Intelligent

Superior
Image
Guidance

Image Acquisition during

TreatmentkV and MV

Fluoroscopy
with playback and review
MV Cine
Respiration synchronized
kV and MV Imaging
During setup
During treatment

22 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Innovative

Intrafraction
Motion
Review

23 | VARIAN ONCOLOGY SYSTEMS

Acquire kV radiographs during

treatment

Synchronized with respiration

Monitor tumor position
throughout treatment

TrueBeam Imaging
kV Fluoroscopy during RapidArc Treatment

24 | VARIAN ONCOLOGY SYSTEMS

TrueBeam Imaging
Intrafraction Motion Review - Fiducial Markers

25 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Intelligent

New
Standards
In Accuracy

26 | VARIAN ONCOLOGY SYSTEMS

Mechanical and Imaging

Isocenter Accuracy < 0.75 mm

Gantry rotational:
< 0.3 degrees
Collimator rotational:
< 0.5 degrees

TrueBeam
Intuitive

Simple,
Automated
Operation

27 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Treatment Console

28 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Intuitive

50
Faster

One button image acquisition

and full automation of beam
delivery make treatments 50%
faster*
Changing imaging procedures
and protocols is simple and fast

Position and treat in less time

than RapidArc benchmark

* Comparisons, Data on file, Trilogy system,

Varian Medical Systems, 2010

29 | VARIAN ONCOLOGY SYSTEMS

TrueBeam - Worldwide Clinical Operation

Clinical
Use
Registrations / Clearances:

30 | VARIAN ONCOLOGY SYSTEMS

>270 installations
>550 orders

US FDA, CE Mark/ MDD, Russia Gost, Saudi Arabia SFDA, China SFDA, Japan Shonin,
Australia & New Zealand, Thailand, Korea, India,

TrueBeam
Work-in-progress

Exotic
Trajectories
* Work-in-progress. Not available for sale.

31 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Exotic Trajectories

32 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Exotic Trajectories

Red Journal - paper from

MSKCC New York in Press
Dynamic trajectory-based
algorithm integrates
optimized couch and
collimator trajectories into
RapidArc/VMAT

33 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Exotic Trajectories

Red Journal - paper from

MSKCC New York in Press
Dynamic trajectory-based
algorithm integrates
optimized couch and
collimator trajectories into
RapidArc/VMAT

34 | VARIAN ONCOLOGY SYSTEMS

Calypso
GPS for the Body

35 | VARIAN ONCOLOGY SYSTEMS

Calypso System Overview

Real-time motion management for radiation therapy

treatments

Accurate, precise, real-time tracking of treatment targets

with electromagnetic technology

Designed for body-wide use

Prostate transponder FDA/CE cleared
Surface transponder cleared for body-wide use
Lung indication is a current work-in-progress

36 | VARIAN ONCOLOGY SYSTEMS

Beacon Transponder

Actual size: ~8.5 mm

37 | VARIAN ONCOLOGY SYSTEMS

Calypso Platform Overview

Optical System with
3 Infrared Cameras

4D Electromagnetic Array

4D Tracking Station

Implanted Beacon
Electromagnetic
Transponders

38 | VARIAN ONCOLOGY SYSTEMS

4D Console

Calypso
Tumor Tracking Technology

Works in Progress
39 | VARIAN ONCOLOGY SYSTEMS

Augmenix SpaceOAR Hydrogel

40 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
6 Degrees of Freedom (6DoF) Couch

RapidArc
Radiosurgery

Works in Progress Not for Sale

41 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
6 Degrees of Freedom (6DoF) Couch

RapidArc
Radiosurgery

Works in Progress Not for Sale

42 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Clinical relevance

Vertebrae
High dose gradients around the
spinal cord
Pitch is important when the
tumor spreads over more than
one vertebra

43 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Clinical relevance

Intracranial tumors
Sparing optical structures
(optical chiasm, optical nerve)

44 | VARIAN ONCOLOGY SYSTEMS

Image: VUMC Amsterdam

TrueBeam
Clinical relevance

Lungtop

Very sensitive to arm position

Sparing myelum and plexus

45 | VARIAN ONCOLOGY SYSTEMS

TrueBeam
Summary

Radically
Different
Future

46 | VARIAN ONCOLOGY SYSTEMS

Designed to optimize
radiotherapy and radiosurgery
Integrates and choreographs
powerful imaging and treatment
systems

Unparalleled accuracy
Unlocks new treatment options

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

47 | VARIAN ONCOLOGY SYSTEMS

48 | VARIAN ONCOLOGY SYSTEMS