Radiation Oncology Team
Back row, from left: Robert E. Krisch, MD, PhD, Radiation Oncologist; Kathleen Devlin, RT(T), Radiation Therapist; Eileen McDevitt , RT(T), CMD, Dosimetrist; Amy Ferris, RT(R)(T), Supervisor; Ramah Williams, RT(R), Student therapist; Andre Kalend, PhD, Physicist. Front, from left: Ann Marie Siegal, MD, Radiation Oncologist; Monica Sekela, RN, BSN; Lynne Davis, RT(R)(T), Radiation Therapist; Susan Nichols, Unit Secretary; and Marcella Kubovsak, RN.

Published: Synapse 2013, Vol. 1

The scene looks futuristic, like something born in the imagination of a science-fiction writer. A cancer patient lies still on a radiation treatment couch, as what looks like space-age machinery starts circling around them to deliver precise radiation treatment with a remarkable level of control and synchronization. The couch also moves to reposition the patient as needed. Called TrueBeam™, this advanced cancer treatment technology represents a quantum leap forward in the speed, accuracy and safety of radiation therapy.

The TrueBeam system makes it possible to aggressively, accurately and safely attack tumors in the lung, breast, prostate, reproductive organs, head, neck, brain and elsewhere with greater precision and in far less time than earlier generations of radiation delivery systems. Previous and many current models rely much more on human intervention and manual control, whereas the TrueBeam has built-in capabilities that enable it to automatically and specifically target and destroy tumors with maximum doses of radiation while protecting surrounding healthy tissue.

The Chester County Hospital and Health System recently purchased a new TrueBeam linear accelerator for its Radiation Oncology program, bringing the highest level of cancer care to the community. The TrueBeam can deliver various forms of radiation therapy; including image-guided radiotherapy (IGRT), intensity-modulated radiotherapy (IMRT) and Volumetric Modulated-beam Therapy (VMAT) like RapidArc® radiotherapy. The TrueBeam at Chester County will additionally feature a fast Gated RapidArc® - allowing it to deliver sophisticated and complex treatments accounting for patient respiratory movements.

According to Medical Physicist Andre Kalend, PhD, the TrueBeam far surpasses its predecessors with its onboard digital ability to synchronize all the different components involved in radiation therapy - including imaging, treatment delivery as well as patient positioning, and breathing and motion detection.

"TrueBeam is much more than cutting-edge technology; it is the leading edge of radiation therapy. It goes beyond what is considered state-of-the-art today. Having the TrueBeam means we have secured the state-of-the-art radiotherapy technology of the future," said Dr. Kalend. "Radiation Oncology is complex technology-driven medicine. With this purchase, The Chester County Hospital is poised to stay ahead of the innovation curve of radiation oncology in the region."

Indeed, the level of precision with which the TrueBeam delivers radiation treatment is unprecedented. The system is able to target cancers with sub-millimeter exactness as it continually monitors more than 100,000 points of patient live images and data. Another key to the system's pinpoint accuracy is that it includes sophisticated user-friendly imaging tools that physicians and therapists can use to generate various anatomical views 60% faster than previous accelerators. These advances also reduce overall imaging radiation exposure by 25% and offer greater patient comfort by shortening their treatment duration on the delivery couch. Typical irradiation duration that took 10 to 15 minutes takes a mere 1 to 2 minutes on TrueBeam.

According to Radiation Oncologist Ann Marie Siegal, MD, the increased precision of the TrueBeam has significantly fine-tuned an often-challenging treatment delivery process. Many tumors are located in places that are affected by the body's slightest movement. With the TrueBeam, radiation fields can be tailored tightly, directly targeting the cancer or area at risk.

"When we are treating some of the more challenging cancers - where tumors are in areas exposed to lots of organs and healthy tissues - we have to be very careful. Movement is inherent to the human body and can't be avoided, so precision is absolutely paramount when targeting a tumor. The slightest shift in the patient's position or movement in the body, even the lungs as they expand during breathing, can throw off radiation targeting," explains Dr. Siegal, who is also a Clinical Assistant Professor at the University of Pennsylvania Health System.

She adds, "The TrueBeam can detect the smallest movements during a treatment session. It has the ability to automatically adjust where the delivery beam is directed; allowing radiation to hit its intended target, protecting healthy organs and tissues."

As the patient breathes and the lungs inflate and deflate, tumors are pushed in different directions, becoming both moving and shape-changing targets. TrueBeam contains a respiratory-motion management feature that is specifically designed to track movement of tumors as the patient breathes. The system ensures that radiation is only delivered when the tumor is within the beam's line of sight. It even recognizes unplanned disruptions in the patient's breathing cycle, such as coughing or sneezing.

The added safety of the TrueBeam does not end with precision when targeting the tumor. The TrueBeam also has an internal collision protection and avoidance component that protects the entire patient while the linear accelerator's gantry (the head of the machine) moves around their body, which means safeguarding patient positioning does not solely rest on the professionals operating the equipment. The system itself continually monitors where the patient is located throughout treatment, using special sensors to detect where the patient couch is in proximity to the machinery circling around the patient.

"As treatments become more complex, it is essential that we have accelerator systems in place that monitor patient safety," said Dr. Kalend. "TrueBeam has its own GPS-like capabilities that check itself to make sure the gantry never encroaches into the patient's space. If there is ever an issue, the machine will immediately stop, move the patient out of the gantry path and then bring the patient back again to the treatment position. Prior to the True- Beam, machines were 'blind' to the location of the patient and the couch when the beam was on. Only the operator was aware of the patient's location."

The advances in the TrueBeam system have significantly shortened the duration a patient has to spend on the couch undergoing treatment, even for those requiring high doses of radiation. The length of time needed for radiation sessions is always determined by the type of cancer a patient has, what dose of radiation is needed, and the individualized treatment plan. However, in many cases, delivery time will now be reduced by 50% or more with the TrueBeam. For example, treatments for patients with prostate cancer or some of the more difficult head and neck cancers that may take up to a half hour or longer with conventional linear accelerators can now be delivered in just 2 to 7 minutes with the TrueBeam.

"Faster treatments make the whole experience much easier for our patients," said Dr. Siegal. "And the TrueBeam has a two-way communication system so therapists are in constant contact with patients and vice versa. That is very reassuring to patients."

The purchase of the TrueBeam linear accelerator is a significant milestone for The Chester County Hospital, expanding the services provided by its Radiation Oncology Department and opening the door to new possibilities for treating cancers that are more complicated closer to home. A new vault for the TrueBeam was incorporated into plans for the Hospital's Tower Project, a $45.2 million expansion slated to open this summer. The Hospital will begin scheduling patients on the TrueBeam this coming July.

The Radiation Oncology Department is a key component of the Hospital's comprehensive Cancer Program, which has been part of the Penn Cancer Network since 1995. Because of the Hospital's existing and growing connection to Penn Medicine, radiation oncology and medical oncology patients seeking treatment in Chester County will benefit from direct and immediate access to the resources of the university health system - including the latest oncology clinical trials.

As The Chester County Hospital moves forward with its new TrueBeam system, its team of experts will not only be training with Varian - the vendor that manufactures the TrueBeam - but will also draw from the clinical expertise from Penn Medicine staff that has hands-on experience with the equipment. Patients can feel confident they are being treated by experts from one of the top academic institutions in the country, while being cared for close to home at The Chester County Hospital.

Bringing the TrueBeam to The Chester County Hospital will dramatically expand its clinical treatment capabilities, and it demonstrates the Health System's firm commitment to expanding services and adding the future of technology to treat a broader spectrum of cancer patients with the most sophisticated program between Philadelphia and Lancaster.

By Beth Eburn
Team Photo by Rick Davis

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