Clinicians at Icon Group’s radiation oncology centre in Toowoomba, Queensland, Australia, chose the Halcyon™ system because they knew it would provide fast, high-quality service for the local community and the surrounding Darling Downs Region, eliminating the need for patients to travel great distances for treatment. Australia’s largest dedicated provider of cancer care, Icon Group became the first site in Australia to offer treatment on their newly-installed Halcyon system in late 2017.
“We were the seventh site in the world to install the Halcyon system, and we were able to get the system to “beam on” within two days of its arrival,” said Trent Aland, Icon’s National Director of physics. “Commissioning took three and a half weeks, which is significantly less than the six to eight weeks it has taken us to commission other systems. Now that we’ve learned from the process, future commissions should be completed in 12 days, including installation.”
Aland indicated that one big benefit of the Halcyon system’s efficiency is, of course, increased capacity. “The system is very helpful for departments that need to increase their throughput. We typically use volumetric modulated arc therapy (VMAT), delivering up to four arcs per treatment. Most often, only two or three arcs are required and because of the faster gantry speed, these deliveries take less time than their two-arc counterparts on other systems. Using the Halcyon system, for example, our treatment times for the prostate are 54 seconds faster than other systems and 90 seconds faster for head & neck cases. These efficiencies are compounded by the streamlined workflow,” Aland said.
The clinical team, left to right: Talia Jarema, Anthony Walsh, Trent Aland, Rebecca Murry.
Automated Treatment Workflow
Talia Jarema, medical physicist at Icon, said that she and her colleagues appreciate the simplicity of the nine, machine-guided, push-button steps that constitute the Halcyon workflow. But it’s not just treatment delivery that is simpler, she pointed out. Treatment planning is easier too. “Compared to other systems, treatment planning for Halcyon is a lot quicker. It incorporates more automation and eliminates some manual steps — such as setting a field for VMAT. The simplified workflows make even complex radiotherapy treatments easy to plan and deliver.”
Image Guidance Options
For image guidance, the Icon team has utilized both the MV and kV imaging available since Halcyon 2.0 was introduced.
“We first installed the Halcyon 1.0 treatment system with MV imaging, so we used MV-CBCT for most disease sites. We didn’t have to be concerned about the dose being added, as it was accounted for in the treatment plan optimization,” said Jarema. “Since upgrading to version 2.0, we’ve been using kV-CBCT for most anatomical sites for the soft tissue matching capabilities it provides. Compared to our other systems, Halcyon 2.0 with kV-CBCT imaging is fast at acquiring and reconstructing images and offers outstanding CT-like image quality. Treatment and imaging, including reconstruction, are 109 seconds faster for the average prostate case, and 96 seconds faster for head & neck cases.”
Icon oncology professionals also use the Iterative CBCT capability, a kV image reconstruction technique that smooths the dataset, removes “noise” from the image, and often makes it easier to differentiate between soft tissue structures. “We have found that patients who have an artifact, like a metal hip or fillings in the head & neck area derive the greatest benefit from Iterative CBCT compared to our other imaging options,” Jarema noted.
Simplified Quality Assurance
Physics QA requirements are reduced with the Halcyon system as compared to other technologies. According to the AAPM Task Group 142 Report, Quality Assurance of Medical Accelerators, the QA tasks suggested for Halcyon machines are about 40% less compared to a standard C-arm linear accelerator (linac).1
“Because of the simplicity of the Halcyon system, there’s less QA to do on a routine basis,” said Jarema. “One of the main time savers is the single-energy nature of the machine compared to other systems, where you’re required to check every component of beam dosimetry — whether it be symmetry, output, energy etc. — across six to nine energies.”
Operational Reliability
Because Icon in Toowoomba is a regional center (i.e. not in an urban center), practitioners appreciate having Varian’s SmartConnect® remote servicing at their disposal—even if they don’t anticipate using it often. “If there is ever an issue, a service engineer can start a diagnostic process from wherever they are to get us up and running again,” said Jarema. “This saves everyone time as our closest service engineer is two hours away, which is a long time to wait if there’s an issue that can be fixed remotely. Even if an issue can’t be fixed remotely, SmartConnect can help give our engineers an idea of what the issue is before starting their journey, which can help if the required parts aren’t onsite.”
Icon Group CEO, Mark Middleton, said the company remains focused on bringing cancer care to where people live, especially across regional areas.
“In Australia, we’re continuing to deliver comprehensive cancer care services that were once only available in cities and bringing them to people in regional and rural areas. As a Queensland-founded company with strong roots in Toowoomba, we’re proud to bring the latest technology like Halcyon to local communities and make a lasting difference to cancer patients now and into the future,” Middleton said. “By investing in the latest technologies and techniques, Icon is able to provide the best care possible, to more people, closer to their homes. Our global partnership with Varian is an integral part of our success and ability to deliver world-leading care to our patients.” *Installation times vary in different geographic areas; check with your Varian representative.
1Klein E E, Hanley J, Bayouth J, et al. Task Group 142 report: Quality assurance of medical accelerators. Med. Phys. 36(9), September 2009.
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The information captured herein represents the genuine experience of the attributed individuals and may not necessarily represent the views of Varian or the above referenced institution. Individuals were not compensated for their participation. Radiation treatment may not be appropriate for all cancers. Individual results may vary.