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Community Cancer Center Upgrades to Varian IGRT

Kalispell Regional Medical Center, Kalispell, Montana

When the Radiation Oncology Cancer Center at Kalispell Regional Medical Center added a Varian Medical Systems On-Board Imager® kV imaging system (OBI) to its linear accelerator, the timing was right. The Northwest Montana hospital had purchased its Clinac® 23EX in 2003 knowing that an upgrade to image-guided radiation therapy (IGRT) could be completed as technology matured.

The center agreed that patients would receive vastly improved care with the OBI, which integrates medical imaging with the treatment machine. Radiographic, cone-beam CT, and fluoroscopic imaging tools would reside in the treatment room to improve tumor tracking and targeting for radiation therapy. Using IGRT, less healthy tissue would be irradiated, resulting in fewer side-effects, improved outcomes, and better overall care.

"We could see that the future of radiation therapy was moving toward image guidance," said Mark Skwarchuk, Ph.D., a medical physicist. "We wanted to open up that level of precision to our patients."

The challenge for this single-linac community cancer center was how to add the IGRT capability with minimal downtime. After two years of internal planning, the upgrade installation occurred over just 7 1/2 clinical days. Two long weekends of preliminary work, including assessment of the Clinac system's performance, upgrade of the oncology information system and Clinac software, and mechanical preparation of the Clinac for OBI, preceded the actual installation.

"We liked the Varian technology, and when they came up with a shorter installation alternative, that sealed the deal," said Betty Munoz, a medical dosimetrist and radiation therapist. "We were pleased that we had the flexibility to just upgrade what we had."

"Varian exceeded our expectations in terms of the installation time, professionalism, and the quality of its product," Skwarchuk said. "Everything worked."

Munoz added, "And thanks to Varian's outstanding training, we were treating patients using OBI functionality the day after installation."

"We worked diligently with folks at Varian and IMPAC Medical Systems, Inc. (the oncology information system vendor) to ensure that we'd be able to send our images, plans, contours—everything that the Varian OBI would need for us to treat patients," Skwarchuk said. "The two have performed together very well on a daily basis."

He credited cooperation between Varian and IMPAC with facilitating that success. Discussions between both companies are continuing in order to ensure that the products interact optimally.

The new IGRT opportunity is exciting. "I am totally amazed at the shifts that are being done based upon the OBI and the kV beam," Munoz said. "They're amazingly accurate, and I am thrilled at what this technology has allowed me to do." Clearly, the kV images are superior to the MV images that the center once used.

During May, the first month following installation, 303 IGRT procedures were logged—roughly 85% of all patients. Most patients, including pelvic for ob/gyn, abdominal, head and neck, brain, and those being treated for bone metastases, have utilized the radiographic modality. Treatment of prostate cancer utilizing implanted fiducial markers has also been implemented. The center has found cone-beam CT useful for certain lung studies, and other applications may be forthcoming. The fluoroscopic capability has not been used, although the staff hopes to begin respiratory gating in late 2007 utilizing Varian's Real-time Position Management™ (RPM) system.

"This technology is going one step further," said Munoz. "It's changing the job description of therapists. The clinical skills that therapists need are evolving and the level of responsibility is increasing. We have to be much more analytical."

Indeed, Varian's OBI is changing the way that Kalispell Regional Medical Center's Radiation Oncology Cancer Center is able to treat patients. It's a win-win situation.

"We didn't add the On-Board Imager lightly, and we've certainly been pleased with the outcome," Skwarchuk said. "The On-Board Imager has enabled us to treat patients much more effectively, and that has made us a better cancer center overall. If we can provide better care and improve along the way, then we're serving those who are putting their trust in us the best way possible."

 

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