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How to Implement An IGRT and SBRT with Siemens Linacs and the Brainlab ExacTrac System


D Mihailidis


D Mihailidis*, *Charleston Radiation Therapy Cons, Charleston, WV

TH-C-218-1 Thursday 10:30:00 AM - 12:30:00 PM Room: 218

Image guided stereotactic radiotherapy is a treatment modality that combines a variety of new technologies from imaging, to treatment planning and treatment delivery. It has been the primary method of treatment for several cranial and extra cranial tumors, where accurate patient immobilization and setup, tumor delineation, complex treatment planning and pre-treatment imaging, are necessary for accurate treatment delivery. Typically, the coverage of the topic has been for a single-technology, single-vendor system, for example, MVCBCT by Siemens was presented, against kVCBCT by Elekta and Varian or MVCT by Tomotherapy, all for IG and/or SBRT purposes. The clinical reality many times is far from single-vendor technology. Many medium and small size clinics upgrade their delivery systems (linacs) for IG and SBRT by add-ons coming from multiple vendors. As an example, a Siemens linac with Brainlab Exactrac IG system and third party treatment planning system, all put together to provide IG and SBRT programs within the clinical environment. Users find themselves up against issues that are not necessarily addressed by a course that describes a closed single-vendor IG/SBRT systems, like a Novalis TX with i-plan or Tomotherapy or Cyberknife or others. This presentation will outline the main issues and give a step-by-step method for clinical implementation of all the components in order to achieve the final goal. Points of caution for the user, limitations and financial considerations will be part of the presentation.

Learning objectives:
1) To gain insight into the issues that come up when technologies from various vendors are combined towards an integrated IG and/or SBRT program.
2) To understand the step-by-step method of integration of the involved technologies towards their clinical implementation.
3) To develop the understanding of the importance of benchmarking of IG and SBRT programs and usefulness of end-to-end testing.
4) To develop the ability to deal with the technical limitations of the technologies chosen to be implemented in the clinic.


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