Krishnan Suthanthiran,President, Best Medical

What is New in Radia.on Therapy?
Krishnan Suthanthiran,President, Best Medical Interna5onal
Tuesday, June 7, 2011
Tuesday, June 7, 2011
Don’t think of Gamma as this…
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But this…
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Cancer Therapy Solu.ons That Work…
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A Global Leader in the fight against cancer
• Best® Theratronics Limited is a world-­‐wide leader in
the global fight against cancer
– BTL has over 60 years of experience designing, manufacturing, servicing and suppor5ng gamma beam treatment units
– We supply over 90% of world’s gamma external beam teletherapy machines
– ~ 140 employees and 100,000 sq. N. of manufacturing space
– Exports technology worldwide
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Team Best
Facili.es
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Affordable Treatments with Gamma Therapy
•
Proven Reliability
– 45,000 treatments performed worldwide every day
– Some centers treat 100+ pa5ents/day
– ~ 2700 installa5ons worldwide
•
Cost Effec.ve
– Lower infrastructure demands
– Reduced QA demands
Tuesday, June 7, 2011
Conformal Image Guided Treatments
• Taking an ac.ve role in modernizing gamma teletherapy by adding tools that will allow
clinicians to precisely target tumors and reduce side effects:
– Mul&-­‐Leaf Collimators [MLC]
– Intensity Modulated Radia&on Therapy [IMRT].
– 3D Conformal Radia&on Therapy [CRT]
– Image Guided Radia&on Therapy [IGRT]. •Cost-­‐effec.ve treatments delivered at much lower ini.al and opera.ng costs than comparable technologies.
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Complexity: Linear Accelerator vs Gamma Teletherapy
Linear accelerator
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Gamma teletherapy
Penumbra: Mul.ple Beams
100.00
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0
Cobalt AP
4MV AP
0
1.0
2.0
3.0
4.0
5.0
100.00
100.00
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0
6.0
90.00
Cobalt 6 field
4MV 6 field
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0
0
1.0
2.0
3.0
4.0
5.0
6.0
BaRsta, J. & Van Dyk, J., Gamma Therapy: Some myths, misconcep.on and mispercep.ons, Co-­‐Efficient 2(1): 1-­‐4, 2000.
Tuesday, June 7, 2011
360 Arc Cobalt
360 Arc 4MV
80.00
0
2
4
6
8
10
Cobalt 60 vs 6 mV: Which is the Cobalt Plan?
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Cobalt 60 vs 6 mV: Which is the Cobalt Plan?
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Dose Volume Histograms
Linac
Prostate
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Gamma
Prostate Coronal View
Linac
Cobalt
Prostate
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Prostate Sagi`al View
Linac
Cobalt
Prostate
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Prostate Results
• The two plans are essentially equivalent
• Gamma is actually more conformal than the other
plan (less non target tissue above target dose)
• In general, the Gamma plans tend to have less volume
of sensitive structure at high dose but more volume at
lower dose (subtle difference), consistent with shape
of depth-dose curve
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“Everyone deserves the best
healthcare. Education is the
most effective way to eliminate
poverty and promote global
understanding and peace.”
— Krishnan Suthanthiran
Tuesday, June 7, 2011
Dose Volume Histograms
Linac
Thorax
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Gamma
Thorax Coronal View
Linac
Cobalt
Thorax
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Thorax Sagi`al View
Linac
Cobalt
Thorax
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Thorax Results
• The Gamma plan is arguably better than
Linac plan (more conformal).
• The DVHs are otherwise extremely similar.
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Dose Volume Histograms
Gamma
Linac
Head & Neck
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Head & Neck
Coronal View
Linac
Cobalt
Head & Neck
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Head & Neck
Sagi`al View
Linac
Cobalt
Head & Neck
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Head & Neck Results
• The DVHs are comparable for all examples and all are
clinically quite good.
• Note that the Gamma plan is more conformal than the
Linac plan (less non-target tissue over target dose).
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Dose Volume Histograms
Linac
Gamma
Meninigioma
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Meningioma
Coronal View
Linac
Cobalt
Meningioma
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Meningioma
Sagi`al View
Linac
Cobalt
Meningioma
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Meningioma Results
• DVH for the two techniques are essentially
the same.
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Conclusion
•
IMRT treatments of equivalent quality to those from 6/10MV linacs are theore5cally achievable with Gamma units on the sites studied
•
Gamma plans are at least as conformal as a Linac plan
•
Gamma plans tend to be more homogeneous than the Linac plans
•
Gamma has high uniformity of dose within the target (variability in hot/cold spots)
•
With rare excep5ons IMRT plans planned with Gamma from a Co-­‐60 Tx unit are excellent
•
They are more than appropriate for clinical delivery in a treatment slot of 15 minutes or less (including setup)
•
The vast majority of cases -­‐ prostate, lung, head/neck brain & breast – can be treated without concern for plan quality as compared to a Linac-­‐based IMRT delivery
Tuesday, June 7, 2011
Test Phantoms
CT vs MVCT
3 cm cylinders in water: CT
(computer simula5on: 0.25 cm2 pixels)
Schriener et al. (con5nuing studies)
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3 cm cylinders in water: MVCT
Future of Cobalt: CT imaging with Cobalt 60
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Best Gamma
Teletherapy System
• Best Theratronics (BT) will install a new Gamma Teletherapy System with IMRT and IGRT capability and associated soNware
Tuesday, June 7, 2011
Best Gamma
Teletherapy System
• The only revenue that BT will receive is a por.on of the technical component reimbursement. BT would like to receive 60 percent and your center will keep 40 percent
Tuesday, June 7, 2011
Best Gamma
Teletherapy System
• There will be no cost for the system to your center
Tuesday, June 7, 2011
Best Gamma
Teletherapy System
• BT will maintain at its own cost, service (parts and labor)
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Best Gamma
Teletherapy System
• BT will also incur all costs for replacement sources when they are needed
Tuesday, June 7, 2011
Best Gamma
Teletherapy System
• BT will be responsible for all costs associated with shipping, installa<on and training
Tuesday, June 7, 2011
“CURE Foundation is a non-profit,
non-governmental, private organization
committed to reducing the cost of
healthcare and education.”
– Krishnan Suthanthiran
Founder/President
Tuesday, June 7, 2011
“The CURE Foundation plans to set up
more than 1000 cancer centers worldwide
during the next ten years, starting in 2010,
to significantly reduce the cost of cancer
diagnosis and treatment. We will be
partnering with existing hospitals,
international agencies, public and private
institutions and government.”
— Krishnan Suthanthiran
Tuesday, June 7, 2011
®
™
Best Total Solu.ons
Integrated Solu5ons for Prostate Cancer Management
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Best NOMOS Facility
Pi`sburgh, PA
Sonalis Manufacturing Tuesday, June 7, 2011
Best Total Solutions
Imagine having the ability to…
• Precisely locate cancerous lesions within the body
• Plan ultra-­‐conformal treatments using “dose sculp5ng” technologies
• Accurately guide treatments to these lesion sites in real-­‐5me
• Have an integrated system of products that exchange data seamlessly and 5es all elements of diagnosis, planning and treatment in One Total Solu5on
Tuesday, June 7, 2011
™
Treatment Delivery
BATCAM
Best® Sonalis™ Imaging System
Thank you for choosing the very best for your pa.ents! Tuesday, June 7, 2011
Sonalis Keyboard
Sonalis Keyboard Update
Old tradi5onal style keyboard design
Tuesday, June 7, 2011
New an5microbial sealed keyboard with SensoFoil ™ technology
Integrated Imaging/
Targeting Systems
Integrated Imaging Solu.ons
Integrated Pathology Data Displays
Sample ID: 21: D-­‐3-­‐A
Gleason: 6
Integrated Dosimetry Displays
Superior Imaging
Simultaneous Bi-­‐Plane Viewing Sample ID 21: D-­‐3-­‐A
Gleason: 6
Tuesday, June 7, 2011
Real-­‐time Fluoro-­‐
US Image Fusion
Clinical Images
SimulView Image with Balloon in Bladder, Seminal Vesicles, Urethra and Bulb Clearly Visible
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Clinical Images
SimulView Image Resolving En.re Length of Implant Needle Tuesday, June 7, 2011
Clinical Images
SimulView Image Resolving Seed Train Tuesday, June 7, 2011
Clinical Images
SimulView Image without Catheter Resolving Venus Plexus, Urethra, Seminal Vesicles and Bulb
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Superior Sonalis Resolution
CT Image Resolving a Single Fiducial Marker
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Sonalis Image Resolving Two Fiducial Markers
MediBoard
The PC keyboard for medical environments
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MediBoard Models
MediBoard without Mousepad
• Integrated numeric keypad
• Keyboard with 105 keys
• An<microbial surface
• Viruses & bacteria don’t have a chance
• Plug & Play -­‐ no installa<on needed
• Can be fully disinfected without disconnec<ng
MediBoard with Mousepad
• Integrated numeric keypad
• Keyboard with 90 keys
• An<microbial surface
• Viruses & bacteria don’t have a chance
• Plug & Play -­‐ no installa<on needed
• Can be fully disinfected without disconnec<ng
Tuesday, June 7, 2011
Treatment Delivery
Fluoro-­‐US Imaging Integra.on •
Remanufactured OEC 9xxx series C-­‐Arms
•
Affordable imaging solu5ons for prostate brachytherapy
Future Direc5ons:
• R&D underway to develop US-­‐Fluoro fused OR Dosimetry solu5ons
– Stereo Images
– Limited angle CT reconstruc5on techniques
Tuesday, June 7, 2011
Best Treatment Planning Sohware (Best TPS)
• Laptop based TPS
– Concurrent 2D/3D Visualiza5on
– Easy to use GUI workflow
– Planning templates
• Future Direc5ons:
– Pathology mapping/ octant dosimetry
– Integrated data flows between pathology and treatment planning
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MOSFET Dosimeters
mobileMOSFET Wireless & Portable Dosimeter
Dose Verifica5on Systems
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Real-­‐Time In-­‐Vivo Dosimetry
• The first and only commercially available combina5on that allows for the real-­‐5me quality assurance of all brachytherapy procedures, without a significant investment in extra 5me
• The Linear Array is used for various HDR applica5ons such as prostate and gynecological Brachytherapy using model TN-­‐252LA5 • When placed on the surface of the breast, the array can also validate MammoSite™ treatments
Tuesday, June 7, 2011
Pa.ent Posi.oning &
Other Accessories
• We also manufacture a complete line of other products required for the brachytherapy procedure including well-­‐chambers, chairs, stepper/stabilizers, shielding blocks
• We also manufacture a broad line of loose and stranded fiducial markers
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An Integrated Approach to Prostate Cancer Management
Best’s Prostate Brachytherapy product poriolio includes not only radioac.ve sources but also a complete line of Pa.ent Posi.oning, Treatment Planning, Guidance, Delivery and Verifica.on products. This breadth of product poriolio is unmatched in the industry.
Tuesday, June 7, 2011
Why Medical Physicists, Radia.on Oncologists and Urologists Prefer Best®
Thank you for choosing the very best for your pa.ents! Tuesday, June 7, 2011
Conclusion
• Total Solu5ons™ is a collec5on of “best-­‐in-­‐class” products manufactured by members of the TeamBest family of companies
– This breadth of product porqolio is unmatched in the industry
• The Total Solu5ons™ includes several curng edge products such as the Sonalis ultrasound which are being upgraded to support advanced capabili5es required for delivering focal therapies
• Best also has Total Solu5ons™ for external beam based treatments for prostate as well as other cancers
Tuesday, June 7, 2011
Thank you
Acknowledgements and special thanks to:
• Jake Van Dyk • Jerry Barsta • John Schreiner • Paul Ravindran
Tuesday, June 7, 2011
Visit us at:
www.cure.lu
www.teambest.com
www.theratronics.ca
www.gammatherapy.com
www.mosfet.ca
www.nomos.com
Tuesday, June 7, 2011