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Radiation oncology: MR and CT taking on bigger roles

by Lauren Dubinsky, Senior Reporter | September 16, 2016
From the September 2016 issue of HealthCare Business News magazine

Planning with CT
CT might not be the optimal choice for guiding treatment, but it is useful for treatment planning. A CT simulator helps the oncology team create patient models using the CT data and then calculates the radiation dose that should be administered. Philips Healthcare’s Brilliance CT Big Bore is one of the CT simulators on the market. It’s larger than a diagnostic CT because it needs to accommodate patient setup and it has a rigid tabletop to ensure there’s minimal deflection when the patient is on the table.

X-ray was the original imaging modality used for radiation therapy planning, but over the last four to five years CT has replaced it. CT is now considered the accepted standard of care for simulation treatment planning, says Jennifer Bryniarski, senior product manager of oncology and CT at Philips. MR is also being increasingly used for radiation therapy planning. It has advantages for certain body parts where soft tissue contrast is needed, but CT remains superior because of its iterative reconstruction algorithms.

What’s new this year?
In late June, Accuray received FDA clearance for its next-generation TomoTherapy System, the Radixact Treatment Delivery Platform, which includes the Accuray Precision Treatment Planning System and iDMS Data Management System. This new platform expands access of treatment to a wider range of cancer patients, including those who are being re-treated. Accuray told HealthCare Business News that while other systems offer image-guided intensity-modulated radiation therapy (IMRT), the TomoTherapy System is specifically designed for that purpose.

Using the system’s TomoHelical delivery mode, physicians can target the tumor continuously, administering the dose 360 degrees around the patient. This next-generation platform has a more powerful linear accelerator and offers low-dose fan beam megavoltage CT imaging and helical treatment delivery. It also features automated workflows and mid-course, decision-making tools, so the clinicians can modify treatment delivery based on changes in tumor size, shape and location.

Its ability to provide daily image guidance is what makes it unique. The system takes an image of the patient every day, as part of the setup, so that it knows exactly where the tumor is on that particular day. “As the [cancer patient goes] through the treatment process, anatomical changes may occur, such as the tumor shrinking or the patient losing weight,” says Kelly Londy, chief operating officer at Accuray. “Clinicians need to be able to quickly determine when these types of changes warrant modifying the treatment and efficiently creating new treatment plans.” Competitor systems are designed with a C-arm gantry. The TomoTherapy System is built on a ring gantry platform with a CT scanner.

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