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Latest Radiation Equipment

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Prostate Cancer
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Pratoman
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Joined : Nov 2012
Posts : 9382
Posted 7/2/2018 11:13 AM (GMT -8)
As referred to in another thread, i contacted the local "outpost" treatment center of MSKCC on Long Island and asked them about the equipment they use. Curious if anyone can offer input/info (calling Tall Allen)

They have 2 machines. one is a Varian True Beam. The second is a Varian EX-1. The woman i spoke with told me that she believes that the EX-1 is what they use for Prostate Cancer specifically, most of the time. It was installed about 3 years ago. The True Beam was installed a bit longer than 3 years ago, but she said its not an old machine, wasn't ages ago.

Anybody have any knowledge about whether these are good machines that will offer lowest chance of permanent side effects in SRT?

I was also told that if i decided to do the treatments out on Long Island, i could have everything done up to and including the simulation, in Manhattan, with Dr Zelefsky, then when i am ready to start treatment, i would get transferred out to the island. The RO there has a primary focus on Prostate Cancer, almost exclusively. So that gives me some more confidence.
Anyway, if anyone has knowledge about the machines, much appreciated.
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Busted1
Regular Member
Joined : Apr 2018
Posts : 34
Posted 7/2/2018 11:19 AM (GMT -8)
Hospital near me uses a True Beam, just had it installed last November. Don't think they have a second option. Curious to hear other responses.
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Chipmaker
Regular Member
Joined : Aug 2016
Posts : 87
Posted 7/2/2018 11:47 AM (GMT -8)
I finished my SBRT in Nov, 16 at UAB in Birmingham Al. on the Varain Edge. I don't know how this machine compares to the ones you mentioned but the Edge was quick and appears at this time to be very accurate. It is my understanding by reading the info on UAB's web site that these are very good machines to do this kind of treatment. My experience so far has been without any major issues.
Perry
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InTheShop
Elite Member
Joined : Jan 2012
Posts : 11468
Posted 7/2/2018 11:52 AM (GMT -8)
as with most tools in my shop - it's the craftsman, not the tool that matters.

A good craftsman uses good tools.

It's a poor workman who blames his tools.

Varain is the leader in radiation delivery tools. I know this because once a year they try to recruit me for their software team and only the best companies want to hire me, because I'm the best.

Hope that was helpful.

Andrew
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Fairwind
Veteran Member
Joined : Jul 2010
Posts : 4107
Posted 7/2/2018 11:59 AM (GMT -8)
The Varien True Beam is pretty much state of the art stuff. It can be set up to administer all types of beam radiation...I think the True Beam is newer and more advanced than the Rapid Arc which was state of the art just a few years ago..You can visit Varians web-site and get all the details.
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garyi
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Joined : Jun 2017
Posts : 2244
Posted 7/2/2018 12:04 PM (GMT -8)
LOL.....

Can imagine how closely Prato checks out those discount airline old planes he flies between FL and NY, or the inexperienced pilots who fly them.

MSK will have equipment that won't fry your other vital organs, for sure. It's just simple SRT. rolleyes

Rapid Arc Linear accelerators, 3D, IMRT, integrated with LINAC.

https://www.oncologysystems.com/radiation-therapy/linear-accelerators/varian-high-energy-linear-accelerator-comparison-chart.php

https://www.oncologysystems.com/radiation-therapy/linear-accelerators/comparison-charts.php

The deal MSK is making you is outstanding. Jump on it before you wear them, and us, out. Just do it. turn
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Pratoman
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Posts : 9382
Posted 7/2/2018 12:12 PM (GMT -8)
Thanks for the responses.
I know True Beam is about as advanced as it gets. I think same for Edge. But i cant find info on EX-1. I wonder if she was mistaken and the TB is what they use for PC. I will need to ask Zelefsky's office.

Gary, once i got past your wise @ss comment, thanks for the other comments. But its not that simple. The suburban MSKCC facility that i am looking at, is scheduled to close in 2019, moving to a new facility that is under construction. So i dont expect that they have had a recent upgrade. Thats why its important that i know what kind of machine I'm going to get my nuts toasted on. smile
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Crazyick
Regular Member
Joined : Apr 2012
Posts : 205
Posted 7/2/2018 12:31 PM (GMT -8)

Pratoman said...
The suburban MSKCC facility that i am looking at, is scheduled to close in 2019, moving to a new facility that is under construction.

Prato,

is the suburban location that’s closing the Commack location in Suffolk county? And as to equipment, I got nuked on the varian edge at stony brook and they called it their Ferrari. They use it for SBRT in addition to SRT and lord knows what else.

Mike
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Gear
Regular Member
Joined : Oct 2016
Posts : 356
Posted 7/2/2018 12:44 PM (GMT -8)
I think I was on the Varian machine, but since the software kept bugging out and the system hardware had to be rebooted every couple of times.... I was not sure the darn thing was even working. One day I came in and the whole room was ripped up for a carpet change... maybe they were looking for the plug?
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garyi
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Joined : Jun 2017
Posts : 2244
Posted 7/2/2018 12:46 PM (GMT -8)
Yeah Mike, I got toasted on the Varian Edge also, and I was most impressed.

Prato getting his nuts zapped is no BIG deal. redface
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garyi
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Joined : Jun 2017
Posts : 2244
Posted 7/2/2018 1:20 PM (GMT -8)
Basically any machine that delivers IMRT/IGRT or SBRT are going to be equally safe. The Varian class machines use a method where they continuously deliver the radiation while the gantry is moving around the body. Other machines do a start and stop method. The Varian is not safer, per se, it is just faster. The actual zapping/IMRT from a Varian machine takes about six minutes. The only real advantage seems to be time, and the much reduced chance of you, and your organs moving around while being zapped. The advantage to the radiation center is that they can treat more people in the same amount of time and thus make more money. Technology development isn't just oriented for client effectiveness, it also generate additional revenue.

As to choosing the center, they will all have to follow the same accepted protocols for safety. MSK is very well regarded and does a lot of PCa work. The convenience to you will be valuable. As already said, it's is the people, not the brand of machine that's the most important factor.

Near the end of the treatment, they sometimes narrow the beam and zero in on likely troublesome areas. In my case, they referred to this as a 3.6 Gy "boost"..

Picture this...The older LINACS, the x-ray machines that deliver the radiation, usually moved into position and stopped, became stationary, while the dose was administered. It would then move on to a new position and fire again..Typically, it would repeat this 7 times during a treatment session. This reduced the exposure to healthy tissue to one seventh of what the target received..With the newer LINACS, the gantry is in motion (Rapid-Arc/Edge) when the beam is activated so healthy tissue receives much less exposure..The RO, with help, writes a treatment plan, a dose volume histogram, so these moving arcs seldom if ever overlap as the gantry can accommodate a wide range of motion, but the target, the focal point, receives the full intended dose..Also, the new machines have a built-in CAT scanner that checks organ position just before the beam is activated...If anything has moved out of position for any reason the beam is aborted until the situation is corrected, and the control room that the techs are in while you're being zapped is most impressive, with an array of PC's and displays.

The company that developed this new technology is Varian and the first generation of these LINACS were called Rapid-Arcs. They were introduced about ten years ago. It's the minimum you should be looking for. Today, the newest models are even more advanced....Most up to date treatment centers, especially ones like MSK, even satellites being phased out, use this new equipment. Just as important is the skill of the techs and RO's that operate it.

Since you worry about everything....have you checked out the bathrooms yet, Prato? They come in very handy when relieving yourself of the preparation water. Just do it, already!

Post Edited (garyi) : 7/2/2018 3:26:04 PM (GMT-6)

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bluebird123
Regular Member
Joined : Aug 2012
Posts : 482
Posted 7/2/2018 1:37 PM (GMT -8)
When my husband had SRT Dr. Zelefsky told him that the only way he could do the planning for his SRT and be in charge of it was if he got the treatments at MSK in NYC. Dr. Zelefsy said that if my husband used a suburban facility near our house, the local doctor would do the planning and be in charge. Perhaps the protocol has changed since then.
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Pratoman
Forum Moderator
Joined : Nov 2012
Posts : 9382
Posted 7/2/2018 1:38 PM (GMT -8)

Crazyick said...

Pratoman said...
The suburban MSKCC facility that i am looking at, is scheduled to close in 2019, moving to a new facility that is under construction.

Prato,

is the suburban location that’s closing the Commack location in Suffolk county? And as to equipment, I got nuked on the varian edge at stony brook and they called it their Ferrari. They use it for SBRT in addition to SRT and lord knows what else.

Mike

Mike, no I’m talking about the Rockville Center location. Could be the Commack location too, not sure. This is because of the new facility being built in Uniondale.
Stony brook is way too far for me. Even Commack is a trip. I live in northeast Queens, work in garden city
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Pratoman
Forum Moderator
Joined : Nov 2012
Posts : 9382
Posted 7/2/2018 1:47 PM (GMT -8)

bluebird123 said...
When my husband had SRT Dr. Zelefsky told him that the only way he could do the planning for his SRT and be in charge of it was if he got the treatments at MSK in NYC. Dr. Zelefsy said that if my husband used a suburban facility near our house, the local doctor would do the planning and be in charge. Perhaps the protocol has changed since then.

It’s very possible that the person I got it from had it wrong. He (Z) told me if I got treated on Long Island I wouldn’t be under his care. But when the person on Long Island told me this, I assumed, getting the simulation done might not be a big deal. But what you are saying, Bluebird, makes sense.
I think I’ve got reason to have a high degree of confidence in the RO on Long Island, from meeting him twice and reading his bio.

Gary, my friend who is head of Administration of the cancer center at a large hospital, told me different. He says that as far as minimizing side effects, it’s all about the technology. He makes the decisions on buying equipment, along with input from the clinicians I’m sure, and he’s pretty close with all the department Chairmen. So I have to believe he knows his stuff.

I’ve got the right questions to ask Zelefsky next time I see him.
As much of a PITA AS IT WILL BE TO GO INTO THE CITY EVERY DAY, ILL DO IT IF I CANT GET THE SAME level of care out by me. (Excuse the caps, too lazy to go back)
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Crazyick
Regular Member
Joined : Apr 2012
Posts : 205
Posted 7/2/2018 1:52 PM (GMT -8)
I hear ya Prato, the commack location is relatively new so I would have been surprised if that was the one closing. I grew up in queens (Astoria/ozone park) and worked for a few years out of an office the FAA had on Stewart ave in garden city.

Mike
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Sr Sailor
Veteran Member
Joined : Sep 2015
Posts : 1342
Posted 7/2/2018 4:23 PM (GMT -8)
I repeat what InTheShop has written,
it's the expertise of the people, not so much the equipment. SRT is not some newfangled, barely out of diapers, therapy. But you can ask the radiologist directly what data they have accumulated on side effects. I wouldn't trust their answer much though...
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garyi
Veteran Member
Joined : Jun 2017
Posts : 2244
Posted 7/2/2018 5:44 PM (GMT -8)

Pratoman said...


Gary, my friend who is head of Administration of the cancer center at a large hospital, told me different. He says that as far as minimizing side effects, it’s all about the technology. He makes the decisions on buying equipment.....

Either your friend is wrong, or you misunderstood him. Not that you’ve established what equipment MSK has. Even on the off chance they are really old models, you can be certain that MSK has updated them. The stuff you find to worry about. rolleyes

Just do it....
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island time
Veteran Member
Joined : Dec 2014
Posts : 2343
Posted 7/2/2018 10:20 PM (GMT -8)
my sister told me during my year of "investigative work" for my surgery.... "We were joking about you the other night bro. Everyone agreed....if you could operate on yourself...you would."

hang in there lol smile
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Skypilot56
Veteran Member
Joined : Mar 2017
Posts : 1452
Posted 7/3/2018 3:52 AM (GMT -8)
Prato.. the ADT will take care of the nuts!! LOL. The skill of the RO and his team of techs are much more critical than the the zapper as most of the good hospitals and cancer centers have good equipment as like Gary says the better machines do it faster and we all know it comes down to the mighty dollar and the more people you can run through in a day the more mula!!!

Larry
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Dogdays
Regular Member
Joined : Jan 2017
Posts : 309
Posted 7/3/2018 3:54 AM (GMT -8)
Maybe a little different scenario than yours Prato, but, Zelefsky controlled everything, simulation for SBRT, fiducial placement and did the brachy. I had my SBRT done in Middletown NJ at MSK. The RO told me he would be handling everything from that point on. So Zelefsky was done after the brachy.
That facility is fairly new also. And if I remember correctly, it was Varian True Beam.

Forward Prato......always forward
Dogdays
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Redwing57
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Joined : Apr 2013
Posts : 2817
Posted 7/3/2018 5:58 AM (GMT -8)
It probably depends on the facility, but at Vanderbilt they had a team of 3 physicists on staff to develop the radiation delivery plans. The RO gave the goal, the parameters, of the treatment, but didn't actually develop the dosing program.

For my primary IGRT , IIRC the guidelines were 50.4 Gy to lymph nodes, 79.2 Gy to prostate, with a 10 mm margin around lymph nodes, 6 mm around the prostate except for a 4 mm margin where it was next to the rectal wall. This was developed with a combination of the simulation CT scan (after the markers were implanted) and the 3T MRI for maximum accuracy. (Yes, I ask a lot of questions and appreciated an RO who would answer them.)

So another question to ask your RO is, "Who develops the dosing plan?".

For SRT I don't know how critical all of that is, though. I was very careful to have similar conditions (full bladder, empty rectum) at simulation and every single day's treatment. Today, 5 years later, I have no side effects from the radiation therapy and am quite happy with it.
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Pratoman
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Joined : Nov 2012
Posts : 9382
Posted 7/3/2018 7:04 AM (GMT -8)
Thanks all for the responses. Maybe my friend wasn’t completely correct. Still, I would feel better knowing I was on the latest machines.

Dogdays, what you say makes sense, Zelefsky’s got a big focus on Brachytherapy, and in fact is Vice Chair of the Brachytherapy service.

Jerry, thanks I appreciate the info. As you know, I too, am “blessed” (or cursed, depending on perspective) with a need for details. I should have been an Engineer, like you LOL.

IT, the way things turned out, maybe we both SHOULD HAVE operated on ourselves.
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Hardlyrob
Regular Member
Joined : Sep 2017
Posts : 142
Posted 7/3/2018 7:55 AM (GMT -8)
I had my SRT on a Varian True-Beam - it is the current state of the art technology, and about three years old.

My process was the RO set targets, and the physicist, RO and lead technicians all developed / agreed on the dosing plan. I agree with In the Shop - the RO and Techs are as important, if not more important than the technology. True Beam is fast - two revolutions around you and it's done - about 5 or 6 minutes from the last "shove" as they finalize position after the CT's for alignment.

Good luck

Rob
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Fauntleroy
Veteran Member
Joined : Dec 2012
Posts : 542
Posted 7/3/2018 8:09 AM (GMT -8)
Here's what you need

Dynamic Adaptive Radio Therapy

DART stands for Dynamic Adaptive Radio Therapy, and has been developed at the ****Cancer Center as the most sophisticated form of radiation therapy currently available. DART encompasses a unique combination of leading-edge 4D image-guided technologies, for example; “Exact Couch/Table”, 3rd generation on-board imaging, 3rd and 4th dimensional bone-to-bone and soft tissue matching, Portal Vision (MV), Portal Imaging (using amorphous silicone diode technologies), 3rd generation SonArray, 3rd generation Cone Beam Tomography, 2nd generation Respiratory Gating and AlignRT, all of which allow for the most precise and highly focused dynamically controlled radiation treatment available anywhere in the world.

The integration of these technologies makes DART possible. DART is the technique that allows our physicians to maximize the radiation dose to the tumor while minimizing the dose to surrounding normal tissue (thereby minimizing side effects). This is accomplished by targeting thousands of predetermined voxels (cubic millimeters) with thousands of microbeams. This high-precision approach to curing cancer has been the dream of radiation therapy dating back more than four decades. The equipment is continually updated from first generation models to more refined succeeding generation enhanced by further innovations.

For treating prostate cancer, the accuracy of DART is superior to Intensity Modulated Radiotherapy Therapy (IMRT), Image-Guided Radiation Therapy (IGRT), Rapid-Arc®, Cyberknife, Truebeam™ and Proton therapy. DART incorporates every 4 dimensional image-guided device, taking radiation to new level of precision and control. This increased level of precision allows us to shoot microbeams of radiation to targets the size of tiny dots, referred to as “voxels.” Each voxel is the size of a cubic millimeter. This degree of control and focus enables us to greatly reduce the risk of damage to the bowel and bladder, while preserving erectile function.

The On-Board Imaging Device (OBI) with the 3rd generation Cone Beam Helical Tomography add an additional layer of accuracy checks that ensures a level of precision not dreamed of just five years ago.

In order to make sure that each microbeam reaches the designated target, the 4th dimension of motion must be taken into account. All the components of DART enable us to deliver the right dose to the right target at precisely the right time – each time and every time. Based on physiological and anatomical changes that occur between and during treatment. Our physicians, physicists, dosimetrists, therapists and combination of technical equipment can modulate or alter the original plan to account for these daily changes. This highly integrated approach is the key to DART – intra and interfractional changes, allowing for the most precise targeting of tumor(-s) imaginable.

Respiratory Gating is another way that we can identify patient motion, with advanced video tracking technology which allows for real-time monitoring and correction of physiologic motion of the Chest, Abdomen and pelvis (prostate)which as a result of patient breathing. It should be noted the DART is not possible without Respiratory Gating, and most centers do not offer this technology as it is prohibitively expensive.

It should be noted that with DART, not only is the prostate tracked, but also specific areas within the prostate are tracked as are all of the critical surrounding tissues. Moreover, during the tracking, minibeams are dynamically adjusted to reach their designated target (like “smart missiles”).
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Pratoman
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Joined : Nov 2012
Posts : 9382
Posted 7/3/2018 8:51 AM (GMT -8)
Fauntleroy, thanks. I saw that text on the Dattoli website.
It looks like DART has been around since 2005. Makes me wonder why if its better than all the others, like True Beam, its not in use by the Majors like MSKCC.

In reading about the technology, it sounds very similar to True Beam and other treatments that use real time imaging while giving the treatment.
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