James A. Haley Veterans’ Hospital - Tampa, Florida
What is the TrueBeam Novalis STx system?
TrueBeam Novalis STx is an advanced radiosurgery system from Varian Medical Systems of Palo Alto, California USA and BrainLab AG, Germany. It was engineered to perform noninvasive, image-guided radiosurgery procedures with pinpoint accuracy and precision. It combines highly sophisticated imaging, and treatment delivery technologies making it possible to deliver radiation treatments more quickly and accurately. This opens the door to new possibilities for the treatment of challenging cancers throughout the body including those in the brain, spine, lung, liver, pancreas and prostate.
What is radiosurgery and how does it work?
Radiosurgery is an effective treatment for many different types of cancers that uses a very specialized sophisticated machine to deliver very precise and accurate higher doses of radiation to a tumor while minimizing exposure to nearby healthy tissue. There are two main types of radiosurgery—stereotactic radiosurgery (called SRS), which is for cancers in the brain and spinal region, and stereotactic body radiotherapy (also called SBRT), for cancers in other parts of the body. Both of these treatments are noninvasive—that is, the body isn’t operated on in the traditional sense. This type of high dose highly focused radiation therapy treatment is also called radiation surgery, stereotactic external beam radiation, or stereotactic radiation therapy
What is the difference between stereotactic radiosurgery and fractionated stereotactic radiotherapy?
Radiation treatment of a tumor can either be applied in a single session with a high dose of radiation, also known as stereotactic radiosurgery, or in a series of treatments over a period of time, known as fractionated stereotactic radiotherapy. Fractionated radiotherapy involves similar total doses of radiation as radiosurgery, but the radiation is delivered in smaller amounts.
Fractionated stereotactic radiotherapy allows the healthy tissue to recover from the impact of the radiation before the next treatment session. TruBeam, Novalis, STx offers both stereotactic radiosurgery and fractionated stereotactic radiotherapy treatments. Unlike some systems, TrueBeam Novalis STx can provide a very high number of fractions, which, studies have shown, are necessary for the best treatment of some tumors, protecting more healthy tissue. Your doctors will recommend the technique most appropriate for you, depending on the size and location of your tumor.
What is a TrueBeam Novalis STx treatment like?
TrueBeam Novalis STx is fast, with most treatments taking just a few minutes a day. A doctor may prescribe treatment with TrueBeam Novalis STx for many reasons. This technology gives medical professionals the tools to treat many different types of cancers and other medical conditions. A TrueBeam Novalis STx system can deliver treatments 2.4 to 4 times faster with a dose delivery rate of up to 2,400 monitor units per minute—double the output of most other radiosurgery systems. A radiosurgery treatment that typically takes 30 to 60 minutes can be completed in just 5 to 20 minutes. The TrueBeam Novalis STx will offer frameless radiosurgery. What this means is that no fixation device (also known as a head frame) is screwed unto the patient' skull before treatment can be delivered. In addition to enabling for a more comfortable experience, as the patient spends less time on the treatment couch, faster treatments also allow for reduced chance of patient and tumor movement during treatment. What this means for patients is accuracy, speed and comfort. What it means for medical professionals is the ability to treat many different types of complex conditions. The precision of the TrueBeam Novalis STx system is measured in increments of less than a millimeter. This accuracy is made possible by the system’s sophisticated architecture, which choreographs imaging, patient positioning, beam shaping and dose delivery, performing quality checks every ten milliseconds throughout the entire treatment. TrueBeam imaging technology can produce the three-dimensional images used to fine-tune tumor targeting in 60% less time than previous Varian imaging technology. Additional functionality makes it possible to create images using less X-ray dose. In addition to its impressive technical specifications, TrueBeam Novalis STx has also been designed to address patient comfort. It operates quietly and has built-in music capabilities so the patient can listen to music during their treatment. The therapist who operates the system can be in constant two-way communication with the patient. Plus, the therapist can visually see the patient through three closed-circuit monitors.
What kind of radiation does TrueBeam Novalis STx produce?
The treatment beam is generated by a machine called a medical linear accelerator. This machine shapes beams of energy with varying intensities. The treatment beam can be aimed at a tumor from multiple angles to hit the target in a complete three-dimensional manner using intensity modulated radiation therapy (IMRT) and Volumetric Arc Therapy (VMAT) . The idea is to deliver the lowest dose possible to the surrounding healthy tissue, while still delivering the maximum dose to the tumor.
Does radiosurgery expose people to radioactive substances?
Many people, when they hear the word “radiation,” think immediately of radioactive substances. However, no radioactive substances are involved in the creation of the beam by a medical linear accelerator. When a linear accelerator is switched “on,” radiation is produced and aimed directly at cancer cells. Then, like a flashlight, when the system is switched off, radiation is no longer emitted by the system.
What happens when a person is treated with radiosurgery?
All Radiosurgery treatments like TrueBeam Novalis STx treatment, involves three basic steps: visualization of the tumor, the planning of the individual treatment and the delivery of the treatment. After their diagnosis, the medical physicists and radiation therapists generate three-dimensional diagnostic images (usually CT or MRI) of the tumor and the area around it. The Radiation Oncologist then uses these images to specify high doses of radiation in 1 to 5 fractions needed to treat the tumor. A Radiation Oncologist will work with a physicist to plan an individualized treatment. After this, individualized TrueBeam Novalis STx treatments can be delivered according to a schedule specific to the treatment plan. During a TrueBeam Novalis STx treatment, the linear accelerator can rotate around the patient to deliver the radiation. The radiation is shaped and reshaped as it is delivered from many different angles. Most stereotactic treatments usually take only a few minutes a day.
X-rays and/or CT scans may be taken in preparation for planning the treatment. Following these scans, the treatment planning process can take several days. When the treatment plan is complete, TrueBeam Novalis STx radiosurgery treatments can begin. Most cases require a treatment preparation session. Specially molded devices that help the patient maintain the same position every day are sometimes developed at this point. The patient’s radiation oncologist may request to have the treatment area marked on their skin to assist in aligning the equipment with the target area.
The first TrueBeam Novalis STx treatment session may sometimes be longer than subsequent ones so that additional images can be acquired to check the positioning of the tumor on the day of the treatment. This is at the discretion of the treatment team. In the treatment room, the medical team uses the marks on the patient’s skin to locate the treatment area. Then the patient is positioned on a treatment table. Sometimes, specially molded devices are used to help the patient stay still and provide correct positioning. The radiation therapist can also use the machine’s imaging technology to position the patient for a treatment that is accurate to less than a millimeter. This involves the use of high-resolution X-rays of the targeted area to verify positioning of the tumor before administering the treatment. The radiation therapist then leaves the treatment room before the machine is turned on. The machine rotates around the patient to deliver the radiation beams, which are shaped by a special attachment called a high-definition multileaf collimator (HD MLC). This HD MLC device has 120 computer-controlled mechanical “leaves” or “fingers” that can move to create apertures of different shapes and sizes.
Who are the professionals a patient may typically encounter?
1) The radiation oncologist is a doctor who has had special training in using radiation to treat diseases and prescribes the type and amount of treatment. The radiation oncologist may work closely with other doctors and the rest of the healthcare team. 2) A medical physicist participates in the planning process and ensures that the machines deliver the right dose of radiation. 3) A dosimetrist plans the treatment with the oncologist and the physicist. High dose treatment plans are often generated by a physicist 4) A radiation therapy nurse provides nursing care and may help the patient learn about treatment or how to manage any side effects. The nurse will also help coordinate the patients imaging studies, consultations, and follow up visits 5) A radiation therapist positions the patient for treatment and operates the equipment that delivers the radiation. They monitor the patients at all times and report to the radiation oncologists.
How long is a course of treatment on a TrueBeam Novalis STx system?
The delivery of a patient’s treatments varies depending on the diagnosis, so ask the medical professional for information about their specific diagnosis. Generally, radiosurgery is completed in just one to five treatment sessions over a week or two.
Will there be any side effects?
The procedure itself is not painful. Side effects that you might experience immediately following treatment include headache and dizziness. Your doctor will discuss with you specific side effects that may occur depending on your overall treatment plan. Side effects of radiosurgery most often are related to the area that is being treated. A patient should consult with their medical professional to discuss the specific diagnosis, prognosis and possible side effects* from treatment
Does a person become radioactive after treatment?
External radiosurgery does not cause anyone’s body to become radioactive. A patient need not avoid being with other people because of treatment. Even hugging, kissing, or having sexual relations with others poses no risk to them of radiation exposure.
*The TrueBeam Novalis STx system may not be appropriate for all cancers. Serious side effects can occur, including fatigue and skin irritation. Treatment times may vary. Patients should ask their doctor if TrueBeam Novalis STx is right for their particular case.
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