cobraleaf presentation 2013
TRANSCRIPT
25.11.2013 1 1
Stefan Ueltzhöffer
© 2013 Precisis AG
The all new mechanical Add-on MLC for Co-60 teletherapy
25.11.2013
CobraLeaf®
• Background
• Worldwide application Co-60
• Rationale for CobraLeaf
• Specifications
• CobraLeaf
• Development
• Dosimetry
• Workflow
• Safety
• Advantages
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Content
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Cobalt worldwide
© 2013 Precisis AG
• 2 types of treatment machines: Cobalt vs. Linac
• Cobalt: Power independent, low maintenance, lower cost
• Linac: High sophisticated electron gun, high cost + maintenance
• > 2.000 Co60 machines worldwide + > 30 new installations per yr
Distribution of RT machines by regions
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Dirac Database of IAEA
Cobalt worldwide
© 2013 Precisis AG
http://www-naweb.iaea.org/nahu/dirac/map.asp
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Region Region Number RT Centers Clinical Accel. Co60 TPS Med. Phys
Caribbean Subtotal 32 25 22 27 59
Central Africa Subtotal 7 8 7 10 22
East Africa Subtotal 8 4 8 9 18
East Asia Subtotal 1933 1147 592 2105 1472
Eastern Europe and Northern Asia Subtotal 397 439 464 560 999
Indian Ocean Islands Subtotal 2 1 3 3 5
Mexico and Central America Subtotal 107 87 75 106 74
Middle East Subtotal 187 282 102 215 499
North Africa Subtotal 69 76 46 81 166
North America Subtotal 2787 4085 158 326 2085
South Asia Subtotal 350 204 384 280 225
Southeast Asia Subtotal 124 149 83 107 215
Southern Africa Subtotal 41 63 15 43 54
Southern and Western Pacific Subtotal 66 164 2 119 239
Temperate South America Subtotal 117 129 53 89 124
Tropical South America Subtotal 359 405 145 238 402
West Africa Subtotal 14 10 8 15 28
Western Europe Subtotal 1035 2532 108 1581 2701
Gesamtergebnis 7635 9810 2275 5914 9387
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Problem
Rationale
© 2013 Precisis AG
Solution
• Re- / New development for specific task
• Cobalt only
• Close cooperation with
(Best Theratronics, Ottawa, Canada)
• No MLC for Cobalt available, despite demand
• Limitations of current techniques, modern techniques (e.g. IMRT) not available
• Linac MLC too expensive (~ 300.000 €)
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MLC:
• 3D conformal
• Single Focus + Rounded Leaf-Ends
• Leaf width 10 mm / Field size 20x30 cm2*
Mechanical:
• Independencies
• Robustness
• Inserted in Lower enclosure
• Combinable with standard wedges
Cobalt:
• Co-60: 1.17 MeV und 1.33 MeV
* at 80 cm SAD / Quelle: Wikipedia, Ali et al. 2012 PMB
Specifications
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Drive: Passive Pneumatics*
High power / low maintenance
Leaf material: Brass
Low cost
Innovative Leaf and Drive concept
Development
*patent pending
= 8.47 g/cm3
μCuZn39Pb3 = 0.4311 cm-1
HVL = 1.6079 cm
6*HVL = 9.65 cm ≙ 1.563 %
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Field preparation
• Import of DICOM or
any field outline file
• Fully automated
processing
• Adaptation if required
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Penumbra
Dosimetry
In plane: 1.29 cm
Cross plane: 1.25 cm
Field 10 x 10 cm
Depth 10 cm,
SAD 80 cm
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Leakage
Dosimetry
Leakage 1,92%
Interleaf: < 2,4%
Gap: 6%
0 50 100 150 200 2500.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1.1
1.2
Position (pixel values)
Rela
tive leakage n
orm
aliz
ed t
o a
vera
ge
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Concept
Safety
Implementation of various measures to
prevent errors and damages
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No setup errors possible
Safety
Planning PC
CNC Milling
Corner bars
CNC Index pin
Template blank & milled shape
Drill (Home position)
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Templates
Defined holes
Indexing pins
Prevents rotation or off-centre
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Interlock
Base coding (###)
Connector in
CobraLeaf
Tray + Wedge No. (###) Prevents wrong fields
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Advantages
• Increased safety
• Better conformity
• Combinable with wedges
• Modern 3D techniques
Treatment
• Power independent
• Instant installation
Usability
• Mechanical parts, no wearing
• Long intervals
Maintenance
• Quick return
Investment
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Testimonials of Key opinion leaders, Radiotherapy
Opinions
© 2013 Precisis AG
Prof. Dr. Wolfgang Schlegel, DKFZ, Germany
“So far, such radiation collimators were available only for linear accelerators,
with CobraLeaf, the shape of the leaves is adjusted manually. But this is a
great advancement over previously used rectangular radiation beams.”
Prof. Dr. Lokesh Viswanath M.D, Kidwai Memorial Institute of
Oncology in Bangalore (KMIO), India
“There is a real and urgent need to demonstrate to the world, that a cost-
effective 3D CRT, which is the basic minimum standard of care in Radiation
Therapy can be given on a Telecobalt Machine with a MLC. A simple low cost
accessory like this will benefit many patients throughout the world, especially
in many developing nations. Hence, we deeply appreciate the effort by
Precisis AG and DKFZ to bring this to the market.”
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Material & Methods
Dosimetry
Material
PTW IC
Theratron Elite80 (Ø1.5cm) &
Theratronics Equinox (Ø2.0cm)
GafChromic EBT Film
PTW Phantom/Virtual Water
Methods
80cm/85cm/100cm SSD
pdd & skin dose
Interleaf & End2End Leakage
Penumbra: 80% / 20%
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read more…
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Background & Partners
Entwicklungspartner
© 2013 Precisis AG
• Small (10 empl.) medical device developer / manufacturer
• Specialized in precision techniques in Neurosurgery + Radiotherapy
• Cooperation partner of DKFZ
• State funded, world renown Cancer Research institution
• 2500+ employees, 1000+ scientists
• Long history in MLC development (formerly with Siemens)
• 2011: Joint idea of using Know-how in MLC technology to develop new device
for large need in developing / emerging countries
(300+ employees), CA based market leader for Cobalt machines
supports (technical + marketing) as add-on to their machines
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Precisis
Kontakt
© 2013 Precisis AG
Resources
• IAEA, 2011: Inequity in Cancer Care: A Global Perspective
• IAEA, 2008: Setting up a radiotherapy progamme
• AMPICON, 2012: Baumann et al.: A manual Multileaf Collimator for use in Cobalt-60 Teletherapy.
Proceedings of 33rd Annual Conference of the Association of Medical Physicists of India, 2012 (O-02 12070902)
• Web: Cobraleaf / DKFZ / Best Theratronics / PR09/12 / Embassy Info / PR12/12
Stefan Ueltzhöffer Head of Innovation Management
Project Manager CobraLeaf
Precisis AG · Hauptstr. 73 · 69117 Heidelberg
Tel: +49 6221 6559300 / mobile: +49 177 7523924
E-Mail: [email protected] · www.cobraleaf.com · www.precisis.de