Radiotherapy Competitive Comparison

1omo1herapy
(PlArL or 1omoPu)
Var|an w|th VMA1
(e.g. 1rllogy, 1rue8eam)
L|ekta w|th VMA1
(e.g. lnflnlLy)

S|emens
(e.g. ArLlsLe)
1omo1herapy key Advantages vs. Compet|t|on
C||n|ca| app||cat|ons Ceneral radloLherapy
(lM81/3uC81),
sLereoLacLlc radlosurgery (S8S),
sLereoLacLlc body radloLherapy
(S881)

Ceneral radloLherapy
(lM81/3uC81),
sLereoLacLlc radlosurgery (S8S),
sLereoLacLlc body radloLherapy
(S881)
Ceneral radloLherapy
(lM81/3uC81),
sLereoLacLlc radlosurgery (S8S),
sLereoLacLlc body radloLherapy
(S881)
Ceneral radloLherapy
(lM81/3uC81),
sLereoLacLlc radlosurgery (S8S),
sLereoLacLlc body radloLherapy
(S881)
All LreaLmenL Lypes are carrled ouL uslng Lhe same hardware
and fully lnLegraLed plannlng and dellvery processes.
Speclallzed add on equlpmenL and sofLware ls noL requlred.
Gantry sty|e C1-sLyle (rlng) ganLry allows
conLlnuous beam roLaLlons and
flxed beam angles.

C-Arm ganLry allows less Lhan
360 beam roLaLlons and flxed-
beam angles.
C-Arm ganLry allows less Lhan
360 beam roLaLlons and flxed-
beam angles.
C-Arm ganLry allows less Lhan
360 beam roLaLlons and flxed-
beam angles.
C1-sLyle ganLry ls exLremely sLable because all componenLs
are mounLed on a rlgld rlng. 1hls glves lsocenLer accuracy
durlng roLaLlon of wlLhln 0.3mm. no regular physlcs quallLy
assurance ls requlred Lo accounL for flexlon beLween
dellvery sysLem and add-on lmaglng sysLems (as requlred for
C-arm ganLry deslgns).

kotat|ona| IMk1
capab|||ty

1omoPellcal-Lyplcally 20-30
compleLe ganLry roLaLlons.
ModulaLlon vla blnary MLC.

vMA1 -1yplcally 1-3 arcs.
ModulaLlon vla convenLlonal
MLC, dose raLe and ganLry
speed varlaLlon.
vMA1 -1yplcally 1-3 arcs.
ModulaLlon vla convenLlonal
MLC, dose raLe and ganLry
speed varlaLlon.
none A much greaLer number of ganLry roLaLlons, ln con[uncLlon
wlLh Lhe blnary MLC, produce a more hlghly modulaLed
beam dellvery Lhan vMA1. uurlng each roLaLlon, a unlque
blnary MLC dellvery sequence ls used. uose dlsLrlbuLlons for
larger and more complex Lumor volumes are able Lo be
creaLed.

Mu|t|-|eaf co|||mator
des|gn

8lnary MLC wlLh 64 leaves.
Lach leaf can open or close aL
approx. 20 mllllseconds. Max
fan beam fleld wldLh: 40 cm.

ConvenLlonal MLC wlLh 120
leaves. Maxlmum fleld slze:
40 x 40 cm.
(40 x 22 cm for 1rue8eam S1x).
ConvenLlonal MLC wlLh 80
leaves. Maxlmum fleld slze: 40
x 40 cm.
ConvenLlonal MLC wlLh 160
leaves. Maxlmum fleld slze: 40
x 40 cm.
8lnary MLC ls deslgned speclflcally for lM81 dellvery. Lach
leaf opens and closes Lo leL Lhrough a preclse amounL of
radlaLlon accordlng Lo Lhe opLlmlzed LreaLmenL plan. Lach
open leaf creaLes a beamleL" LhaL ls 6mm wlde. 1here are
Lyplcally several Lhousands of beamleLs maklng up a
compleLe beam dellvery. ConvenLlonal MLCs creaLe a
maxlmum of a few hundred beam aperLures LhaL are each
much larger Lhan a 1omo1herapy beamleL. 1herefore, more
preclse and deLalled dose dlsLrlbuLlons are able Lo be
creaLed uslng 1omo1herapy.

hoton energ|es Low energy
(hlgh energy noL requlred for
roLaLlonal dellvery)

Low and hlgh energy Low and hlgh energy Low and hlgh energy use of only one energy reduces commlsslonlng and quallLy
assurance work. 8eam daLa for only one energy needs Lo be
collecLed. Low energy beams creaLe a sharper dose falloff
ouLslde Lhe LargeL volume. Low energles are all LhaL ls
requlred even for deep Lumors when roLaLlonal lM81 ls
used. uose calculaLlon accuracy ls Lyplcally beLLer for low
energles, especlally ln reglons such as lung, malnLalnlng
conslsLenLly hlgh LreaLmenL plan accuracy.

L|ectron energ|es Pellcal lM81 can emulaLe
elecLron LreaLmenL.

MulLlple MulLlple MulLlple MulLlple LangenLlal modulaLed phoLon beams can creaLe a
sharply deflned dose dlsLrlbuLlon near Lhe surface.
1herefore, almosL all cllnlcal slLuaLlons requlrlng elecLrons on
convenLlonal sysLems can be managed uslng hellcal
1omo1herapy.
Comm|ss|on|ng ln facLory

Cn slLe Cn slLe Cn slLe All beam measuremenLs are carrled ouL before shlpmenL Lo
Lhe cusLomer. Also, all beams are maLched Lo a gold
sLandard." AfLer dellvery, cllnlcal physlclsLs work wlLh
Accuray physlclsLs Lo verlfy Lhls daLa. 1lme beLween dellvery
and flrsL paLlenL LreaLmenLs ls Lyplcally only abouL 30 days.
SysLems from oLher vendors musL be compleLely
commlssloned ln Lhe cllnlc, Lyplcally addlng several weeks
before paLlenLs can be LreaLed.

koom sh|e|d|ng ApproxlmaLely 1 meLer of
concreLe all around

Approx. 1 -2 meLers of
concreLe all around (Lhlcker ln
beam plane)
Approx. 1 -2 meLers of
concreLe all around (Lhlcker ln
beam plane)
Approx. 1 -2 meLers of
concreLe all around (Lhlcker ln
beam plane)
uue Lo Lhe 1omo1herapy sysLem's hlgh degree of radlaLlon
shleldlng, a very low level of radlaLlon ls emlLLed from Lhe
sysLem. ln parLlcular, a 13cm Lhlck lead beam sLopper
absorbs almosL all prlmary radlaLlon LransmlLLed Lhrough Lhe
paLlenL. uue Lo Lhe lack of prlmary radlaLlon, Lhlck walls are
noL requlred ln Lhe beam plane. CLher sysLems do noL use a
beam sLopper and Lherefore, requlre exLra shleldlng ln Lhe
beam plane. CfLen 1omo1herapy sysLems are lnsLalled ln
bunkers (rooms) orlglnally deslgned for low energy CobalL-60
sysLems.

|an data
management
All plan daLa sLored on a
cenLral daLa server. no Lransfer
of daLa beLween plannlng and
dellvery sysLems.
All plan daLa Lransferred
beLween plannlng sysLem and
dellvery sysLem daLabases vla
oncology lnformaLlon sysLem
(ClS).
All plan daLa Lransferred
beLween plannlng sysLem and
dellvery sysLem daLabases vla
oncology lnformaLlon sysLem
(ClS).
All plan daLa Lransferred
beLween plannlng sysLem and
dellvery sysLem daLabases vla
oncology lnformaLlon sysLem
(ClS).
A cenLral daLabase connecLed Lo boLh Lhe plannlng and
dellvery sysLems sLores all paLlenL, machlne, and plan daLa.
uurlng LreaLmenL dellvery plan daLa ls reLrleved from Lhe
cenLral daLabase. no Lransfer of daLa occurs beLween Lhe
plannlng and dellvery sysLems. 1hls reduces Lhe chance of
daLa corrupLlon and poLenLlally harmful errors ln LreaLmenL
dellvery. WlLh oLher sysLems, accldenLs have occurred due
Lo Lhe complexlLy of correcLly Lransferrlng daLa beLween
plannlng and dellvery sysLems.

Imag|ng (IGk1)
modes
3u mega-volLage fan beam C1
(as ln dlagnosLlc C1 scanner),
!"#$ &'( $)*+, -. */)0#102*$#$
3)4*#54 3'"*4*'5*50

3u kllo-volLage cone beam C1.
2u x-ray. 6,3*7)+ 2"# *" $)*+,
8.19)"#$ 3)4*#54 3'"*4*'5*50
)5$ :##;+, 7'5#19#)/ <6=
3u kllo-volLage cone beam C1.
2u x-ray. 6,3*7)+ 2"# *" $)*+,
8.19)"#$ 3)4*#54 3'"*4*'5*50
)5$ :##;+, 7'5#19#)/ <6=
3u mega-volLage cone beam
C1. 2u mega-volLage lmaglng.
6,3*7)+ 2"# *" $)*+, 8.19)"#$
3)4*#54 3'"*4*'5*50 )5$ :##;+,
7'5#19#)/ <6=

A fan beam lmaglng geomeLry as used by dlagnosLlc C1
scanners ls ldeal for hlgh quallLy 3u C1 lmaglng. 1he use of
fan beam lmaglng ls enabled by 1omo1herapy's C1 -sLyle
ganLry. no oLher lmaglng modes are requlred because C1
lmaglng ls efflclenLly deployed for every LreaLmenL fracLlon.
A very low dose (Lyplcally 1-2 cCy) ls dellvered Lo Lhe paLlenL
per lmage, maklng dally 3u lmage guldance safe and
pracLlcal. CLher sysLems Lyplcally use 2u lmaglng on mosL
LreaLmenL days, whlch may compromlse seLup accuracy and
reduce ablllLy Lo use small LreaLmenL marglns.

1reatment |ength up Lo 133 cm up Lo 40 cm

up Lo 40 cm up Lo 40 cm 1reaLmenL lengLh ls noL llmlLed by Lhe wldLh of Lhe
colllmaLor as lL ls wlLh oLher sysLems. A LreaLmenL volume
LhaL exLends almosL Lhe enLlre lengLh of Lhe body can be
creaLed uslng hellcal dellvery. 1he LreaLmenL couch
LranslaLes Lhe paLlenL Lhrough Lhe plane of beam roLaLlon
unLll Lhe whole LargeL has been lrradlaLed.

key operat|ona|
character|st|cs
ConslsLency and ease of use for
all case Lypes, easy
commlsslonlng and quallLy
assurance processes
SelecLlon of LreaLmenL modes
dependlng on case Lype. Lach
mode requlres separaLe
commlsslonlng and CA
procedures.
SelecLlon of LreaLmenL modes
dependlng on case Lype. Lach
mode requlres separaLe
commlsslonlng and CA
procedures.
SelecLlon of LreaLmenL modes
dependlng on case Lype. Lach
mode requlres separaLe
commlsslonlng and CA
procedures.

1omo1herapy can LreaL all case Lypes wlLh one slmple
process. 1here ls no need Lo choose a dlfferenL LreaLmenL
mode accordlng Lo case Lype. 1omo1herapy's
sLralghLforward sysLem operaLlon speeds adopLlon, reduces
Lralnlng needs, and mlnlmlzes chance of operaLor error.
lurLhermore, use of slngle beam energy reduces
commlsslonlng Llme and cosL, along wlLh requlred ongolng
quallLy assurance resources.

Natura| strengths 1reaLmenL of complex, large or
mulLlple LargeLs wlLh a slngle
seL-up and wlLhouL beam
[uncLlons. LfflclenL, dally 3u
lmage guldance. lnLegraLed
plannlng, LreaLmenL, and
lmaglng vla cenLral daLabase.

8apld LreaLmenL of slmple
LargeLs. Large user base wlLh
slmllar sysLems.
8apld LreaLmenL of slmple
LargeLs. Large user base wlLh
slmllar sysLems.
Slmple, lnLegraLed deslgn and
operaLlon. Large user base wlLh
slmllar sysLems.
Pellcal lM81 ls Lhe ldeal Lechnlque for LreaLlng large,
complex, or mulLlple LargeLs - anywhere ln Lhe body. 1he
sysLem ls noL consLralned by Lhe usual geomeLrlc llmlLaLlons
assoclaLed wlLh convenLlonal sysLems. ually lmage guldance
adds very hlgh accuracy Lo Lhe preclslon of Lhe dose
dlsLrlbuLlons creaLed by hellcal lM81 dellvery. uslng
1omo1herapy, a hlgh LhroughpuL of sophlsLlcaLed
LreaLmenLs ls enabled because of Lhe hlghly lnLegraLed
naLure of Lhe enLlre sysLem. CLher sysLems Lyplcally perform
a much smaller number of cllnlcally challenglng LreaLmenLs
because of Lhe complexlLy lnvolved ln Lhese cases.
1omo1herapy ls an ldeal soluLlon for a cllnlc wanLlng Lo
perform a large number of lM81 LreaLmenLs, wheLher slmple
or hlghly complex.

Adapt|ve p|ann|ng
capab|||ty
lanned adapLlve sofLware
appllcaLlon enables dose
guldance uslng dally MvC1.

none none none uurlng a course of radlaLlon Lherapy, paLlenL anaLomy ofLen
changes causlng dose Lo crlLlcal organs Lo be lncreased, and
coverage of Lhe LargeL Lo be reduced.

uslng 1omo1herapy's lanned AdapLlve sofLware, Lhese
changes can be monlLored ln order Lo declde wheLher Lhe
plan should be adapLed. A dally mega-volLage C1 lmage can
be used for Lhe adapLed plan lf deslred. 1he key advanLage
of 1omo1herapy ln adapLlve plannlng ls Lhe avallablllLy of
dally C1 lmages on whlch accuraLe dose can be calculaLed.
CLher sysLems uslng cone beam C1 Lechnology do noL
produce lmages sulLable for dose calculaLlon. no
compeLlLlve sysLem has Lhe ablllLy Lo monlLor doslmeLrlc
effecLs of anaLomlcal changes uslng Lhe onllne C1 lmages
and Lherefore, 1omo1herapy ls Lhe only sysLem wlLh
lnLegraLed adapLlve plannlng capablllLy.