Siemens_160_MLC

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160 MLC Multileaf Collimator

The best-in-class collimator available.Fighting cancer – fast and focused.

http://www.77cn.com.cn/healthcare

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The philosophy behind

We are convinced that successful radiation therapy calls for the optimal resultant of speed and precision. Because speed alone at the cost of precision means to unacceptably increase the chance of affecting healthy surrounding tissue. And precision alone at the cost of speed means to lose short treatment times, high patient throughput, and a convenient patient experienceout of sight.

That’s why our radiation therapy solutions aim to incorporate the optimum of both, an intelligent balance of speed and precision – to help you fight cancer fast and focused.

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You require high speed

without compromising quality?

With the fastest collimator available.

The 160 MLCTM Multileaf Collimator, one of the core components of our ARTISTETM Solution and as well optionally available for our ONCORTM, helps you fight cancer fast and focused. The 160 MLC combines fast leaf movement of up to 4 cm per second and excellent resolu-tion with very low leakage. These features make it possible to treat patients with surgeon-like precision, spare healthy surrounding tissue regardless of the tumor shape, and provide more convenient therapy due to a shorter length of the treatment session. The 160 MLC is best-in-class and as such the center point of our overall solution for fast IMRT, IM-ConfidentTM Plan. From patient setup and imaging to quality control, IM-Confident together with the 160 MLC permits fast and precise radiation therapy – as effective and as efficient as possible.

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Content

Fighting cancer – fast and focusedTreating cancer faster

Treating cancer more focused

Experiencing excellence in all aspects

568

Clinical cases

Adenoid cystic carcinoma, male, 29 years 10Head & Neck, male 56 years 11Product speci cationsMechanical speci cations 12Dosimetrical speci cations 13System speci cations 14Automation and work ow 14160 MLC dimensions and ranges 15Positioning and calibration,

Service and maintenance features,Additional space requirements 16 Clinical case / Quality assurance

Head & Neck, male 56 years 18

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Treating cancer faster

Higher speed translates for the radiation therapy department into a smoother workflow, and for patients into shorter and less stressful therapy sessions. The 160 MLC turns our ARTISTE into one of the fastest and most precise medical radiation delivery devices on the market.

What makes our 160 MLC so fast?

A higher level of patient care …

The 160 MLC has numerous features that speed up One major benefit of speed is that your patients have radiation therapy. The collimator enables interdigi-to spend less time on the treatment table. This again tation, which makes therapy planning easier and results in many more advantages: First, patients will quicker. When opening or closing the collimator, appreciate shorter treatment times. Second, you gain opposite leaves can smoothly pass one another. This extra time you can spend caring for your patients. And means higher flexibility, enabling you to generate third, less treatment time also leads to less patient several segments within one field at the same time.movement, which in turn increases treatment precision. And, of course, the impressive leaf speed of up to As you see, a good balance of speed and precision 4 cm / second enables quick and efficient treatment leads to the maximum effect.

delivery.

… and workflow efficiency

Fast IMRT therapy that’s also focused at the max – in less than 5 minutes

The fully integrated 160 MLC and IM-Confident op-timize and speed up your workflow. You have all It’s simple maths: ARTISTE plus 160 MLC plus

important data when you need them and where you intelligent treatment planning software for further need them. The unique control system of the 160 optimization of the treatment time equals quick MLC is designed for seamless system handling. Thanks and precise IMRT therapy. In short: IM-Confident – to fully automated procedures, it takes only a click to a simple and efficient Intensity-Modulated Radiation align the leaves to the tumor shape. The two monitors Therapy (IMRT) solution designed to deliver fast, at the syngo RT Therapist provide a transparent display high-quality IMRT treatments. Combining the 160 MLC of treatment set-up and system control, showing the with Direct Aperture Optimization (DAO*) or Direct needed information in a clear and concise manner. Machine Parameter Optimization (DMPO**), it pro-This saves unnecessary workflow steps – so your vides not only better tumor conformity. IM-Confident staff can work as efficiently as they always wanted.

can also reduce the IMRT treatment time to less than five minutes as it fully utilizes the MLC technology. First of all, you have as few MLC segments as pos-sible per gantry setting. Moreover, the setting of the MLC sequences happens in one direction only so the leaves don’t have to move forward and backward again and again. IM-Confident means for you faster treatment delivery and improved treatment plan quality. At the same time, quality assurance remains fast, simple, and safe.

* Panther DAO IMRT – a product of Prowess Inc.** p3IMRT – a product of Philips Medical Systems

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Treating cancer more focused

In radiation therapy, it’s most important to deliver highly precise dose. To irradiate the tumor in a targeted way. And to save as much healthy surrounding tissue as possible. The 160 MLC turns our ARTISTE into one of the most accurate systems on the market.

What makes our 160 MLC so precise?

The 160 MLC comes with a unique design concept: it provides 160 leaves – 80 on each side. With a leaf thickness of 5 mm over the full field, the leaves provide incredibly accurate conformity to the actual tumor shape for homogeneous dose coverage. The improved leaf positioning accuracy of 0.5 mm is even comparable to the gold standard of dedicated ste-reotactic systems. Our 160 MLC also offers exact leaf positioning reproducibility. This is particularly advan-tageous when treating small targets or volumes close to organs-at-risk where a precise placement of the leaves is especially required.

Moreover, the 160 MLC provides full 40 x 40 cm field coverage with a maximum circular field diameter of 40 cm at the isocenter. This is an important factor when rotating the collimator or during whole-body irradiation. Last but not least: The leaves are made of Tungsten, which also adds to precision thanks to the extraordinary radiopacity of the material.

Precision for conventional and advanced treatment techniques

The MLC shape downloads quickly to the linear

accelerator and adjusts all leaves to their prescribed positions, increasing accuracy and improving tumor conformity. Thanks to the small penumbra of the 160 MLC, you and your patients will benefit from maximized dose to the target tissue and minimized dose to the healthy surrounding tissue.

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As we use a new design principle of slightly tilted leaves instead of the common tongue-and-groove design, leakage is remarkably low. The small leaf res-olution of 5 mm at the isocenter over the whole field enables you to perform complicated cases such as head and neck, spinal cord, lungs or pediatric cases as well with highest possible precision. And besides conventional radiation therapy, you can also treat complex IMRT cases. So whatever the challenge, the 160 MLC helps you provide best possible treatment quality for your patients.

160 MLC Multileaf Collimator

Measured

Specified

(160 MLC data sheet)

Inter-leakage averageInter-leakage maximumInter-leakage leaf tip

Penumbra (mm)

0.37%< 0.75%

0.63%< 1.5%

13.5%< 15%

4.1 ± 0.5 mm*19%

< 7 – 8.5

(energy dependence)

Precision that even exceeds our specificationsAn independent study with our 160 MLC was conducted at the Department of Medical Physics in Radiation On-cology, German Cancer Research Center, in Heidelberg, Germany, by Prof. Uwe Oelfke and Dr. Martin B. Tacke with their colleagues. Their article was published in the Medical Physics magazine and presents the first detailed experimental investigation of the 160 MLC. The assessment included typical MLC characteristics such as leakage, tongue-and-groove effect, penum-bra, leaf speed, and leaf positioning accuracy with a 6 MV treatment beam. Martin B. Tacke and his colleagues performed several typical intensity-modulated radiation therapy treatments. And the results even exceed our specifications.

Tongue-and-groove effectLeaf resolution at isocenter (mm)Maximum field size

Not specified

5 mm5 mm

400 x 400 mm400 x 400 mm

Evidence of 160 MLC precision proven by Tacke et al., Medical Physics, Volume 35 No. 5, May 2008

* Longitudinal penumbra for central field section, ranging from -10cm to +10cm at depth dmax of 15mm

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Experiencing excellence in all aspects

Whether treatment quality, clinical use or economic aspects – the 160 MLC holds a great number of benefits you and your patients will appreciate.

Increased patient convenience

Thanks to the intelligent design of our ARTISTE, the 160 MLC is placed close to the radiation source. Even if the accessory holder is mounted, you still have a high patient clearance of 430 mm. The benefit: free patient access at any time and patients won’t feel crowded when lying on the table. This in combina-tion with the shorter treatment time ensures that your patients feel as comfortable as possible during radia-tion therapy.

Higher efficiency all along the line

With the 160 MLC, you will experience efficiency in more than one aspect. Thanks to a more streamlined workflow and shorter treatment times, you will benefit from time savings. This again can increase both your patient throughput as well as the level of patient care.

Designed for easy serviceability

Moreover, you benefit from investment protection over the entire life cycle. Our calibration concept im-proves leaf accuracy and reduces service time: All set data can be electronically saved and called up again whenever needed. And an automatic diagnostic check helps assure system reliability, as leaf positions can be stored in databases and evaluated at any time.

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“

Our Radiation Oncologists are finding the ability to accurately shield around sensitive organs extremely advantageous, while our planners are finding it much easier to meet critical organ dose constants using the flexibility associated with the 0.5mm leaves.

Michael Davis

Chief Radiation Therapist,

St. Vincent’s Hospital, Sydney, New South Wales, Australia

”

Covering a broad clinical application spectrum …Our 160 MLC can be used for all radiation therapy cases. As it conforms to any tumor shape, it enables best possible treatment techniques and personalized medical care. Increasing the chance to cure cancer patients.

… from IMRT cases such as …Chest treatment Head & Neck Brain treatment ASN treatment Prostate cancer Pancreas cancer

… to non-IMRT cases such as …

Mamma with IMC (internal mammary chain)

Head & Neck with super clavicle Sarcoma (full muscle) Hodgkin’s disease (mantel fields) Stereotactic treatment

Pleuramesothelioma – Courtesy: Dept. for Radiooncology and Radiation Therapy, University Heidelberg, Germany

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Clinical case –

Adenoid cystic carcinoma

Gender: MaleAge:

29 years

Tumor type: Adenoid cystic carcinomaStage:

T4 N0 M1

Diagnosis

Adenoid cystic carcinoma of right lacrimal gland extending to skull base, maxillary sinus, nasal cavity, and soft tissue of right cheek. Tumor metastasized to C7 spine and clivus. Diagnosis made with PET CT and MRI.

Challenge

Best local tumor control and sparing of right frontal lobe brain parenchyma, right vision, brain stem, spinal cord, and oral mucosa. Because of the treatment plan described below, the gross tumor area may be considered to be a very risky area for late complica-tions and the acute treatment morbidity is expected to be high as well.

Solution

IMRT treatment with simultaneous integrated accel-erated fractionation schedule.

Dose prescription:

72 Gy over 33 fractions to gross target volume, 66 Gy over 3 fractions to high risk CTV area, and 56 Gy over 33 fractions to low risk CTV area.CTVisionTM System is used for daily tumor volume control and target localization verification.System: ARTISTE with 160 MLC and CTVision System with SOMATOM® Sensation Open 24Treatment course and success

Even though he lost 10 kg of weight during the entire IMRT procedure, the patient completed the planned radiation therapy. After 50 Gy of RT, his right eye ball protrusion got better. Due to the sub-stantial change of weight of patient, target volume, and organs-at-risk (OAR) – such as right optic nerve or optic chiasm – IGRT with CTVision was a must and could effectively support this process.

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Clinical case –Head & Neck

Gender: MaleAge:

39 years

Tumor type: G

lottic carcinoma of the larynx (recurrence)Stage: p

T4 pN0 (0 / 29) M0Diagnosis

Head & Neck cancer. ED glottic carcinoma of the larynx in 2006 and R2 resection (transoral laser-surgery) upon recurrence (June 2009). Result: decision for laryngectomy.

Challenge

Radiation protection of the spinal cord and the back of the cervical with complete dose coverage of the PTV.

Solution

IMRT treatment using ARTISTE with 160 MLC and DAO IMRT optimization.

Treatment technique:

6 MV photon 7 gantry angles, 2 or 3 segments per beam

Fractions: 25 Total MU: 313

Total number of segments: 16Treatment time: 4:16 minutes

This case shows a significant reduction in treatment time to 4:16 minutes.

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Product specifications

The new Siemens 160 MLC offers a combination of industry-leading specifications with outstanding performance and a high degree of reliability. 160 MLC was designed specifically for Intensity-Modulated Radiation Therapy (IMRT) and Adaptive Radiation Therapy (ART), and to address the most challenging trends in radiotherapy while protecting immediate surrounding healthy tissues.

Mechanical specifications

Special care has been used in the development process to provide high overall positioning accuracy

independent of leaf, gantry, or carriage position.

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Dosimetrical specifications

The improved leaf positioning of 160 MLC provides homogeneous dose coverage, independent of tumor size. When used for IMRT, it helps maximize dose to target tissue while minimizing dose to normal tissue.

Penumbra

Penumbra for 10 cm x 10 cm field (mm)According to IEC 60976 and 60977

( Penumbra is the maximum distance along the major axes between the 80% and 20% points of the ABSORBED DOSE at the standard measurement depth; the 80% and 20% points refer to the absorbed dose on the radiation beam axis at 10 cm)

6 MV: ≤ 710 MV: ≤ 7.518 MV: ≤ 8.5

Transmission (% of unattenuated beam)Between leaves – inter-leafThrough leaves – intra-leafThrough jaws

Leakage (% of unattenuated beam) as per IEC 60601-2-1Average

(average of measurements at 24 specific locations in patient plane, outside area M)

< 1.5< 0.75< 0.5

< 0.1

Maximum

(maximum of measurements at 24 specific locations in patient plane, outside area M)

< 0.2

Transmission along in-plane profile of leaves (% of unattenuated beam)Closed leaves at the central beam axis*

* Can be influenced by treatment planning system

< 15

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System specifications

Advanced treatment techniques such as IGRT and ART enable more sophisticated approaches in treatment setup. Flexibility for non-coplanar patient setups is significantly improved with isocenter clearance. 160 MLC provides an enlarged patient clearance combined with open access to patient, helping ensure patient comfort. Siemens is committed to providing flexible, easy-to-use solutions for automation and workflow optimization of complex treatment applications. As a result, 160 MLC’s design provides an isocenter clearance that significantly improves non-coplanar patient setups and accommodates the more sophisticated approaches enabled by advanced treatment techniques such as IGRT and ART.

Isocenter and leaf orientation

Isocenter clearance without accessory holder (cm)Isocenter clearance with accessory holder (cm)Leaf orientation with collimator at 0° reference frame, as defined in IEC 1996

Light field to radiation field coincidenceNormal treatment distance

10 cm x 10 cm

Maximum (square or rectangular)1.5 times normal treatment distance 10 cm x 10 cm

Maximum (square or rectangular)

For multi-element radiation fields, the maximum distance between the centers of the radiation field and the light fieldNormal treatment distance

1.5 times the normal treatment distance

2 mm4 mm4 mm

6 mm or 2%2 mm

3 mm or 1%47.542.8Yes

Automation and workflow

The Automatic Field Sequencing (AFS) allows for fast download of all required fields and parameters. Virtual Wedges also represents a procedure for automatic delivery of dose distributions.

Treatment automation

Maximum number of MLC fields for an

Automatic Field Sequencing (AFS) treatment

Maximum number of MLC segments per gantry angle for an IMRTVirtual wedgeAngle values (º)Angle increments (º)Wedge orientation

15 – 601

Y-jaw directionUnlimitedUnlimited

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160 MLC dimensions and ranges

The graphic below illustrates how the 160 MLC is integrated within the whole design of ARTISTE or ONCOR, and the distances seen from the target. The distance between isocenter and target is 1,000 mm.

0 Target

106

Bottom Flattening FilterBottom Scattering Foil

222 Top Y-Jaws

222 Bottom Y-Jaws357 Top Level Upper Leaf365 Top Level Lower Leaf

452 Lower Level Upper Leaf460 Lower Level Lower Leaf525 Bottom MLC

560 Slot #3

572 Bottom Accessory Holder

1000

All Dimensions are in mm.

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Positioning and calibration

A completely new MLC control system has been devised for 160 MLC in order to achieve the highest possible

accuracy and reliability. The absolute position of every single leaf is continuously monitored by two independent measuring devices, significantly improving MLC calibration time and frequency. Initialization is not required.

Absolute leaf and carriage positioning

Two independent position sensors per leaf and carriageCalibration procedure

Time for complete calibration procedure (min)Calibration data backup support

YesYes

Semi-automatic using calibration blocksApprox. 30Yes

Service and maintenance features

Siemens offers one of the most comprehensive remote medical systems service solutions in the industry.

Through a combination of advanced medical engineering with leading-edge information technology, services are available remotely via data transfer instead of traditional onsite visits – enabling proactive monitoring of customers’ systems.

Siemens Remote ServiceBoot-up check

Yes

Relays, contacts, voltages, and othersYes

Safety-relevant parameters like

potentiometer voltages, board connections, and others

Yes

Via syngo® RT Therapist, allows for motor currents, look-up of calibration values, calibration, and others

Continuous self-check

Remote service check

Additional space requirements

Besides the parameters below, please also refer to Product Planning Guide for ARTISTE or ONCOR for relevant roomreadiness requirements.

MLC controller dimensionsHeightWidthDepth

Additional requirements

Additional cable space required in conduitAdditional power requirementsAdditional electrical requirements

YesNoNo≤720 mm≤915 mm≤815 mm

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“

160 MLC provides faster leaf movement speed, smaller penumbra for most treatment fields, and the dose leakage rate from MLC leaves is extremely low. The quality assurance result gives very good accuracy and reproducibility. The dose distribution check shows that we can get better flatness for small field sizes compared to other MLC fields. We also benefit from treatment delivery time savings.

Dr. Yang Wang, PD

St. Vincent´s Hospital, Sydney, New South Wales, Australia

”

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Clinical case –Head & Neck

Gender: MaleAge:

56 yearsTumor type: Squamous cell carcinoma (SCC) supraglottic larynxStage:

T3 N1 M0

Diagnosis

Well differentiated squamous cell carcinoma of the left supraglottic larynx with left cervical node involvement. Ulcer on the supraglottic larynx, left anterior fold expanded.

Challenge

Total laryngectomy with adjuvant radiotherapy and chemotherapy.

Solution

Radical radiotherapy with concurrent chemotherapy.Treatment technique:

Intensity-Modulated Radiation Therapy (IMRT) with 8 beams (gantry positions), 16 segments per beam.

Treatment goals (dose constraints):

min./max. total dose to target volume 66 / 68 Gy, max. given dose at dmax = 72.98 GyDevice: ARTISTE with 160 MLC

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Quality assurance

for 160 MLC – in clinical environment

For evaluation and verification reasons of this clinical case, the dose map calculated by the RTP system CMS XiO was compared with the film measurements taken with the phantom under complete Intensity-Modulated Radiation Therapy (IMRT) fraction delivery using ARTISTE Solution with 160 MLC Multileaf Collimator. The results of the measurements show excellent conformity with the dose calculation. The following pictures illustrate the high precision and conformity of calculation and delivery.

Comparison of dose map calculated by RTP and fluence map delivered to IMRT phantom

The measurements were done using ARTISTE Solution with 160 MLC Multileaf Collimator with GafChromic film. Fig.1 and 2 already show very good conformity between data.

Isodose analysis

For an isodose curve analysis, the isodose curves in cross plane and in plane are compared, as shown in Fig.3.

Evaluation and verification results for head and neck case

According to gamma evaluation, with acceptable delta d = 2 mm and delta D = 3% for the 80% isodose curve, an area discrepancy of 0.24 cm2 over an area of about 52 cm2 and max. position discrepancyof 0.8 cm were detected (Fig.4). Fig 5 shows the gam-ma matrix, where no red color is visible (blue gamma value <1.0, red gamma value >1.0), which is a posi-tive sign.

This quality assurance corroborates the high precision that can be reached with the IMRT treatment delivered using ARTISTE Solution and 160 MLC Multileaf Collimator.

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