Radiation Oncology & Radiation Therapy
RSNA President David H. Hussey, MD, discussed the need for more collaboration between diagnostic radiologists and radiation oncologists during his opening address - and some exhibitors were already heeding that call. Hussey said that greater collaboration would lead to an end result of strengthening both fields and improving patient care, and radiation oncology vendors were ready to show how their products can improve diagnosis and treatment. Here are a variety of technology solutions from the exhibit show floor.

GE Healthcare's
Evolution for Bone is a new suite of reconstruction tools for GE's Infinia with Xeleris functional imaging workstation for SPECT/CT bone imaging. Bone scintigraphy is one of the most frequently performed procedures in nuclear medicine to detect bone lesions. The importance of SPECT bone scintigraphy in improving lesion detection and specificity is well-established.

GE also showcased at RSNA its revolutionary Advantage 4D and Advantage SIM technology, fusing the capability of 4D imaging and planning to deliver the highest levels of precision and speed for radiotherapy. AdvantageSIM MD is the latest generation of industry-leading simulation and localization technology that takes motion management to the next level by seamlessly integrating 4D data into the planning process, and providing multi-modality/multi-phase simulation for the optimal use of state-of the art treatment methods, like IMRT and IGRT. The exclusive AdvantageSim MD multi-dimensional display presents a real-time view of the anatomy in motion giving radiation oncologists the ability to see the true shape of the tumor and critical structures, evaluate its full dynamic range of motion, and select a segment of the respiratory cycle for treatment that will offer the optimal benefit to the patient. Radiation oncologists can then export the selected phase to the treatment planning system.

By using multi-modality/multi-phase contouring tools, the AdvantageSim MD allows for simultaneous contouring of multiple data sets, including MR and PET, increasing the precision and speed of contour localization by eliminating the need for multiple contouring sessions. In addition, contours can be imported and superimposed over cine images in multiple planes-simultaneously, making it easier to confirm tumor motion and deformation relative to the Planning Target Volume. The auto-segmentation function automatically delineates critical organs and structures in 3D, improving the speed and accuracy of organ segmentation, for conventional treatment methods as well as newer 4D techniques.

Siemens Medical Solutions at RSNA displayed its PRIMATOM System, a multifunctional configuration consisting of a Siemens PRIMUS Linear Accelerator and a SOMATOM CT Scanner with Sliding Gantry. This technology brings image guidance to radiation treatment delivery, providing accurate, near real-time target localization within the treatment room. Access to a CT scanner within the therapy delivery room offers the oncologist the ability to obtain current information on the size, shape and location of the target volume and nearby critical organs. Since the patient is in a ready-for-treatment position during CT acquisition, the information can be applied immediately for improved treatment accuracy. The system allows for fast, 3D tumor localization prior to any treatment fraction, providing an opportunity to escalate dose, reduce complications, and evaluate therapeutic effectiveness of treatment, the company says. CT functionality in the treatment room provides diagnostic quality images with the patient in the actual treatment position, ensuring routine visualization of the tumor in order to check for anatomical movement. Having the CT scanner under the control of the therapy department can help to manage the scheduling and acquisition of patients' CT image data for simulation, planning and treatment purposes.

The BEAMVIEW TI Electronic Portal Imaging Device (BEAMVIEW TI EPID) is used to improve the quality of patient treatments by assuring accurate placement of the radiation beam, field alignment on the patient and any beam shaping devices. Digital images of the treatment port are captured and displayed throughout each fraction. Patient positioning errors made evident by the BEAMVIEW TI System may be corrected before continuing the treatment. BEAMVIEW TI adds Image Guided Radiation Therapy (IGRT) workflow benefits such as the ability to check accuracy of field placement prior to daily treatment, providing real-time anatomical verification, automatic patient set-up and referenced image display option for increased productivity, and a large detector size that helps to observe treatment targets and surrounding anatomical structures.

The BEAMVIEW TI system includes a fully retractable and collapsible gantry-mounted detector assembly with collision detection, which can be easily used at any gantry angle. Based on Target Integration technology, the BEAMVIEW TI is capable of acquiring high-quality portal images with a very low number of Monitor Units, thus ensuring that the images are acquired with very little dose to the patient.

Siemens also showcased KonRad inverse planning application for IMRT. The speed of the program reduces the workload and planning time for the physician and medical staff, the company says. Due to its accuracy and its advanced modeling of the MLC, KonRad is the prefered inverse planning solution for all Siemens linacs. The IMFAST patented software accounts for MLC characteristics to optimize beam fluence distribution and help minimize the time needed to deliver IMRT. SIMTEC IMRT and SIMTEC IM-MAXX, each provide the mechanism for fast, accurate and verifiable delivery of IMRT by totally automating IMRT delivery.

Lastly, the LANTIS Oncology Management System provides a full suite of information management tools designed specifically for the oncology care provider. LANTIS connects the therapy process by centralizing data, simplifying access and enhancing collaboration. Its modular design provides flexible, scalable solutions.

TeraMedica Healthcare Technology showcased its new Evercore Oncology Information Manager, which integrates and manages all radiation oncology and radiation therapy (RT) information objects, now includes the RT ION objects into a single cohesive infrastructure. The integrated clinical focus includes connectivity of data sets from traditional radiology modalities, including CT and MR, along with departmental PACS systems, linear accelerators, tomotherapy units, cone beam CTs, and proton beam generators. The aggregated device information is then seamlessly linked to treatment planning systems and oncology information systems.

Evercore uses the SmartStore Clinical Policy Engine, which allows the classification of radiation oncology objects dependent on the object's inherent departmental value, which may include classification due to clinical or research relativity. As a result, Evercore is a new type of clinically oriented information lifecycle manager. It supports physician acceptance while optimizing storage area networks and delivering consolidated information to the EMR or other HL7-based systems. Evercore Oncology Information Manager also uses open standards in managing and storing digital information and makes the radiation oncology data available at the point of patient care in multiple formats and at multiple service levels.

Thinking Systems introduced at RSNA a range of enhancements to its multimodality, web-based ThinkingPACS specific to nuclear medicine use. The company introduced support for co-registration and fusion of independently acquired images in a full range of modalities, including PET and SPECT. Clinicians often fuse studies of oncology patients with different modalities such as MR and PET, PET and PET, and CT and CT, and any other combination. In PET-CT, in particular, co-registration allows for quick comparison between studies to compare different phases of radiation therapy, for example. The system also offers maximum intensity projection 3D for a quick overview of a lesion's location.

Varian Medical Systems Inc. demonstrated for RSNA-goers elements of its DART solution for dynamic adaptive radiotherapy-an approach for using up-to-date image data to adapt a cancer patient's treatment based on constantly-evolving information about changes in tumor shape, size, and position. Over a six-week course of therapy, lots of tissue can change, so the treatment plan may have to change for best results. The company said that real-time position management has really taken off because a patient's respiratory phase and breathing pace changes also can affect treatment.
The company also showcased the new ARIA Oncology Information Management System, a comprehensive, real-time management system and database product for operating filmless and paperless cancer clinics that offer radiation therapy, chemotherapy, and/or surgery. The software product, which debuted in October, integrates rapid image processing and treatment machine controls for all types of radiotherapy, including advanced forms of image-guided radiotherapy (IGRT) and stereotactic radiosurgery (SRS). It can be utilized to manage comprehensive cancer treatment centers as well as stand-alone radiation oncology or medical oncology departments in hospitals and clinics. It incorporates a robust set of medical oncology tools for managing chemotherapy treatment regimens and is the first and only product of its kind that supports all forms of radiotherapy, including fully- automated IGRT and dynamic adaptive radiotherapy (DART)-an emerging approach for more personalized cancer care, Varian says.
Among system features are:  
  • Offline Review (pending FDA 510(k) clearance): A unique tool that enables clinicians to review and approve-offline, anywhere, any time, the images generated by an On-Board Imager device.
  • Chart QA: Enables physicists to review a patient's charts, check the treatment history and monitor the patient's continuing course of treatment.
  • Long-Term Archive: Automatically extracts "inactive" patient data from the database for storage. Stored information and images can be easily retrieved as needed.
  • Report Manager: Enables users to modify ready-made report templates and then embed those personalized reports into other ARIA applications.
  • Data Segmentation: Manages information at sites that have more than one physical department or location. Procedure codes, cost/charge details and other information can be customized to reflect local requirements.
  • Outlook Sync: Allows users to synchronize appointments and tasks with a Microsoft Outlook calendar and download the information to a personal digital assistant (PDA) device.
  • Trial Administrator: Manages the overall administrative needs of a clinical research office for trial activation, clinical monitoring and closure of research.