Linac new product
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My argument was that we do quite a bit for costing less than a single drug. Afaik keytruda monotherapy isn't curative for much outside of some skin cancers I've seen
Any thoughts on this?
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For those of us not at ASTRO, what's the summary of new features?
Someone sent me this: Accela | Siemens Healthineers | Cancer Care
Accela has three main improvements
1. Faster gantry movement
2. Faster MU delivery like 4000/min
3. Faster MLCs with DMAT (dynamic mediated arc therapy) - brand name “NeoArc”
The idea is to allow very rapid treatment. They report average left breast DIBH can be delivered in 20-30 sec range making it feasible to do so in one breath hold. Also can perform Reflexion like treatments with DMAT - like treat 9 extracranial mets simultaneously within 90 seconds.
1. Faster gantry movement
2. Faster MU delivery like 4000/min
3. Faster MLCs with DMAT (dynamic mediated arc therapy) - brand name “NeoArc”
The idea is to allow very rapid treatment. They report average left breast DIBH can be delivered in 20-30 sec range making it feasible to do so in one breath hold. Also can perform Reflexion like treatments with DMAT - like treat 9 extracranial mets simultaneously within 90 seconds.
I was there for the unveiling. I couldn't see much with the 100+ people gathered around. There was music, smoke, and Sasha Mutic's marketing speech.
Like Gfunk said: It's a faster CBCT linac. I have it summarized in my head as a faster Truebeam. I can't think of anything new I can do or anything I can do differently with this machine other than shorten some treatment times, but please let me know if I'm wrong.
Add two more (Arguable whether they are "main improvements", but alas):
4. A larger kV CBCT detector
5. Doubly focused MLCs
My concerns are:
1. How good are the MLCs? It has doubly focused MLCs, but I'm unclear if they will be as good as an Edge or a Truebeam or somewhere in between.
2. What is the rate limiting step for the arcs? The MLCs still need to move to beam shape the target, for example. When I use high dose rates (1200-1600 MU/min) on my current linacs for SBRT cases it's not as if it's cranking the maximum dose rate through the entire arc due to modulation. The arc doesn't move at full speed through a full arc in most cases. I'm sure Varian or one of their fanboys can generate me plans that do, but I'm still curious the real-world benefit for high-quality treatments. Then again my practice is SBRT/SRS dominated, so my view may be skewed compared to simple whole breast treatments.
3. How many arcs will plans actually need? Varian likes to sell single arc plans that have not been great on their existing products.
4. What additional benefit is the large EPID? It may allow for imaging large fields without having to image a superior and inferior field separately. It doesn't seem to come up that often to me. Varian likes to sell their CBCTs as being diagnostic CT quality which is not true.
Overall it seems like a fine Truebeam replacement. I don't see any clear drawbacks to it. It's kind of an obvious progression for Varian producing another workhorse linac.
Like Gfunk said: It's a faster CBCT linac. I have it summarized in my head as a faster Truebeam. I can't think of anything new I can do or anything I can do differently with this machine other than shorten some treatment times, but please let me know if I'm wrong.
Add two more (Arguable whether they are "main improvements", but alas):
4. A larger kV CBCT detector
5. Doubly focused MLCs
My concerns are:
1. How good are the MLCs? It has doubly focused MLCs, but I'm unclear if they will be as good as an Edge or a Truebeam or somewhere in between.
2. What is the rate limiting step for the arcs? The MLCs still need to move to beam shape the target, for example. When I use high dose rates (1200-1600 MU/min) on my current linacs for SBRT cases it's not as if it's cranking the maximum dose rate through the entire arc due to modulation. The arc doesn't move at full speed through a full arc in most cases. I'm sure Varian or one of their fanboys can generate me plans that do, but I'm still curious the real-world benefit for high-quality treatments. Then again my practice is SBRT/SRS dominated, so my view may be skewed compared to simple whole breast treatments.
3. How many arcs will plans actually need? Varian likes to sell single arc plans that have not been great on their existing products.
4. What additional benefit is the large EPID? It may allow for imaging large fields without having to image a superior and inferior field separately. It doesn't seem to come up that often to me. Varian likes to sell their CBCTs as being diagnostic CT quality which is not true.
Overall it seems like a fine Truebeam replacement. I don't see any clear drawbacks to it. It's kind of an obvious progression for Varian producing another workhorse linac.
You can do a lot with 4000MU/min, and 3x faster gantry rotation during CBCT.
Like what? Ethos has a very quick cbct and the images aren’t great, nor up to ct quality.
“Doubly focused MLC”… is that an MLC bank that has leaves in one orientation and another set of leaves perpendicular to that? I’m too lazy to look it up.
Can’t you get that effect by turning the collomator? The leave edge something like the 50% Isidore line so it doesn’t have as much an effect on dose distribution as you’d expedt
Please elaborate.
Yes I believe that’s correct. Skip the primary jaws and replace it with another perpendicular mlc bank. These are initial impressions so I’m open to updated info.
I can speculate that it might help you get good plans without a second arc with a rotated collimator, but I don’t know if that’s true.
For a busy department that has longer than ideal treatment hours - A TrueBeam is SO much slower than a Halcyon/Ethos for CBCT timing. Anything that will speed up CBCT is good. Anything that will speed up treatment delivery for high dose/SBRT and/or DIBH treatments is good. More patients able to be treated in a shorter period of time. Less DIBH cycles necessary to treat a thing.
I worry about double bank MLCs instead of jaws in terms of maximum field size. Ethos has field size limitations because of this that TB does NOT have. Also, MLC leakage is going to be more than what we would expect with primary jaws.
It's a Linac. Short of adaptive capabilities and a diagnostic quality CBCT, what else is a photon linac going to do that a TB can't?
The more visual slickness the better imho, I'm a fan. I wanted to develop/invent/patent an idea to use "simple" projection tech to project the OARs and tumor volumes on to the patient prior to and during beam on giving you a real clinical picture of what and where the linac is aiming at (think: how they can project images on to whatever building shape these days). The projection would come out of the linac head as it rotates and/or from a fixed point in the room above the patient. I think it could have some utility for breast (cavity), stage one glottic... who knows. It would be trivial to implement.
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I just had a patient opt against coming to see me and my TrueBeam. She chose to not get radiation. Instead, she'll be getting Cyberknifed. Varian needs to do a better job naming their equipment in a way that would make a good verb.
Good idea. ChatGPT-6 Astra Medium came up with:
- OncoYeet: “I’m not getting radiation. I’m getting OncoYeeted.”
- TumorGhost: “I’m having my tumor ghosted.”
- CellOut: “My tumor’s getting CellOuted.” Finally, a treatment that bills itself.
- MassEvict: “I’m getting MassEvicted.” No surgery, just an extremely firm notice to vacate.
- LesionLaunder: “I’m getting LesionLaundered.” Twenty-eight cycles, gentle on normal tissue.
- ZapDaddy: “I’m getting ZapDaddied.” Varian’s legal department has concerns.
- TumorTerminator: “I’m getting terminated.” Probably needs another focus group.
I'm adding the BAH-ZAP just so you can have that tumor BAH-ZAPPED. BAH stands for: "Beam-Aimed Ablation Hardware" of course.
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If we could call it ZapDaddy, I think I can start seeing my consults with a tumbler with rye whiskey and giant spherical ice cube in it. That's my vote.
CK name still having cachet decades later.... Amazing. People were getting sexy robot arms in their departments two decades ago for that exact reason during peak CK in places like Florida
Something cheap abt the name Accela. Reminds me of acela /Amtrak and the north east corridor- not a great experience.
What are people’s thoughts on CK these days. Is there any point in getting one instead of an Edge or well equipped Truebeam?
I wouldn't, personally, over those but haven't used one in a decade at least
@Gfunk6 ?
I’ve been using CK since 2018, now with an S7, and have had a very good experience. In an established practice with sufficient SRS/SBRT volume, I think it can be an excellent investment, but I would not buy one to replace a conventional linac. If I had one vault and needed to treat a general radiation oncology population, I would choose a conventional linac without much hesitation. CK makes the most sense as a complement: we use it when its tracking, motion management, and delivery capabilities are valuable, while conventional machines handle cases for which they are more efficient or better suited.
Its greatest strength for me is intrafraction motion management. We create highly conformal plans with steep gradients near critical structures, so knowing where the target is during treatment matters, particularly when delivering large doses per fraction. I especially value fiducial-based tracking for prostate SBRT, where the prostate may move after initial setup, and Synchrony for selected respiratory targets, including patients who cannot reliably perform breath hold. However, prospective buyers should understand the tracking workflow and its limitations; not every lung lesion is suitable for fiducial-less tracking.
The robotic geometry is also useful for complex spine, intracranial, and other stereotactic cases, although CK does not win every planning comparison. The MLC is important as well. Larger or irregular targets can be cumbersome with small circular fields, whereas an MLC plan may provide practical treatment times and good dosimetry. Collimator selection should be based on the intended case mix, delivery time, dosimetry, and patient-specific QA. Treatment time remains a legitimate criticism: compared with straightforward VMAT, CK will often take longer, so total room time—including setup, imaging, and interruptions—should be evaluated rather than relying on advertised minimum times. A dedicated stereotactic machine can nevertheless improve operations by keeping complex SBRT cases from disrupting a busy general-purpose linac schedule.
The financial case requires careful analysis. It depends on existing stereotactic volume, referral patterns, staffing, collections, service costs, and capital expenses. You must distinguish genuinely additional patients from cases simply transferred from another machine. The argument is stronger if you already have substantial volume, are referring appropriate patients elsewhere, or have a credible plan to grow the program, but installing CK alone will not create referrals. A committed team is also essential; planning, physics, therapist experience, fiducial placement, and imaging access all matter. I would visit a busy center with a similar patient population and speak with its therapists and physicists, not only its physicians.
I would not justify the purchase by claiming that CK produces superior outcomes to every well-equipped conventional linac. I value its specific capabilities and the flexibility of having a dedicated stereotactic platform, provided the volume supports the expense. For us, it has been an excellent addition, and I would consider buying it again in a practice with similar needs and resources. If the question is whether an S7 should replace an aging general-purpose linac, my answer is no; if you already have good conventional capacity and want to support a substantial SRS/SBRT program, it is well worth considering.
Its greatest strength for me is intrafraction motion management. We create highly conformal plans with steep gradients near critical structures, so knowing where the target is during treatment matters, particularly when delivering large doses per fraction. I especially value fiducial-based tracking for prostate SBRT, where the prostate may move after initial setup, and Synchrony for selected respiratory targets, including patients who cannot reliably perform breath hold. However, prospective buyers should understand the tracking workflow and its limitations; not every lung lesion is suitable for fiducial-less tracking.
The robotic geometry is also useful for complex spine, intracranial, and other stereotactic cases, although CK does not win every planning comparison. The MLC is important as well. Larger or irregular targets can be cumbersome with small circular fields, whereas an MLC plan may provide practical treatment times and good dosimetry. Collimator selection should be based on the intended case mix, delivery time, dosimetry, and patient-specific QA. Treatment time remains a legitimate criticism: compared with straightforward VMAT, CK will often take longer, so total room time—including setup, imaging, and interruptions—should be evaluated rather than relying on advertised minimum times. A dedicated stereotactic machine can nevertheless improve operations by keeping complex SBRT cases from disrupting a busy general-purpose linac schedule.
The financial case requires careful analysis. It depends on existing stereotactic volume, referral patterns, staffing, collections, service costs, and capital expenses. You must distinguish genuinely additional patients from cases simply transferred from another machine. The argument is stronger if you already have substantial volume, are referring appropriate patients elsewhere, or have a credible plan to grow the program, but installing CK alone will not create referrals. A committed team is also essential; planning, physics, therapist experience, fiducial placement, and imaging access all matter. I would visit a busy center with a similar patient population and speak with its therapists and physicists, not only its physicians.
I would not justify the purchase by claiming that CK produces superior outcomes to every well-equipped conventional linac. I value its specific capabilities and the flexibility of having a dedicated stereotactic platform, provided the volume supports the expense. For us, it has been an excellent addition, and I would consider buying it again in a practice with similar needs and resources. If the question is whether an S7 should replace an aging general-purpose linac, my answer is no; if you already have good conventional capacity and want to support a substantial SRS/SBRT program, it is well worth considering.
