Varian introduces Halcyon system

[Gfunk6]

Halcyon™ System | Varian Medical Systems

Is this basically Tomotherapy? Doesn't sound like you can use the machine to do 3D/2D treatment . . .

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[medgator]

Sounds like it. I remember tomo introduced something awhile back that allowed the gantry to be stopped to treat static fields. I imagine something like that might be able to be done here.

Bigger question is what do places do for electrons if they only have this one machine....

 

[Phantom1]

Have to say, demo looks pretty cool... seems like could have pretty high throughput..

 

[BobbyHeenan]

I think it's all about throughput here.

It's not going to be a good machine as a single-linac type of situation (no electrons, only 6X energy). But if you have a busy department and need between 2-3 machines, then this one might be good to treat a bunch of patients quickly and have only two linacs where without that speed you may need three machines.

 

[Brim]

"Halcyon" doesn't quite roll of the tongue the way "Tomo" does.

Nobody's going to say: "We're going to Halcyon that guy's tumor." "He got 35 fractions of Halcyon." "I Halcyoned that bitch and now he's NED!"

 

[evilbooyaa]

I mean getting a CBCT in 15 seconds instead of like 5 minutes would be a big time saver by itself.

But yes, appears to be Varian's answer to Tomo.

 

[Palex80]

Does anyone know how "big" the maximal field size on that MLC of the Halkyon is? In the broschure it says something about a double layer MLC, but I don't really get it. What's the maximum field size you can treat with it?
It seems like an impressive machine and its fast CBCT will be helpful for treating for example brain tumors or a prostate, but will it also work for larger volumes?

The way I see it, it's not a Tomo-clone but rather a a clone of the Brainlab VERO system, which is (as far as I know) not that popular:

 

[nkmiami]

vero can do non coplanar beams, I am not sure if tomo can or halkyon could?

 

[Palex80]

Sounds like it. I remember tomo introduced something awhile back that allowed the gantry to be stopped to treat static fields. I imagine something like that might be able to be done here.

Bigger question is what do places do for electrons if they only have this one machine....

That's the Tomo Direct feature.

Electrons can be helpful in a few cases but nowadays I see less and less electron patients in our clinic.
Breast boosts after BCS are treated with 3-4 photon fields and the classic mixed electron-photon techniques (like electrons for inguinal nodes in anal/vulvar cancer) are being replaced by IMRT/VMAT.

 

[evilbooyaa]

That's the Tomo Direct feature.

Electrons can be helpful in a few cases but nowadays I see less and less electron patients in our clinic.
Breast boosts after BCS are treated with 3-4 photon fields and the classic mixed electron-photon techniques (like electrons for inguinal nodes in anal/vulvar cancer) are being replaced by IMRT/VMAT.

Tangent boost after BCS is possible, but a rarity in my experience. 3 to 4 photon fields for the boost? What sort of angles does it come at?

Otherwise do agree that stuff that used photon/electron matching is now easier to do with IMRT.

 

[medgator]

That's the Tomo Direct feature.

Electrons can be helpful in a few cases but nowadays I see less and less electron patients in our clinic.
Breast boosts after BCS are treated with 3-4 photon fields and the classic mixed electron-photon techniques (like electrons for inguinal nodes in anal/vulvar cancer) are being replaced by IMRT/VMAT.

And skin ca with HDR brachy? We see a lot of skin and still use electrons for all of them

 

[Palex80]

Tangent boost after BCS is possible, but a rarity in my experience. 3 to 4 photon fields for the boost? What sort of angles does it come at?

Otherwise do agree that stuff that used photon/electron matching is now easier to do with IMRT.

For a right sided breast let's say 260°, 300°, 340° for example. It's basically dependent on where it is, so there is no "standard" field setup.

 

[Palex80]

And skin ca with HDR brachy? We see a lot of skin and still use electrons for all of them

We still have one of these fancy orthovolt machines with up to 100kV and can use that for superficial lesions. It saves Linac slots and you only need one technician to operate it.

 

[scarbrtj]

Halcyon.

Weird branding. It means peaceful, happy days *in the past*. Also, "Halcion" (pronounced the same) is brand name for a benzodiazepene drug, typically used for insomnia.

 

[evilbooyaa]

And the brand name for Erbulin is Halaven.

Something something Halaven and Halcyon

 

[fiji128]

One of our physics guy was talking about this machine's "Patented dual-layer MLC for fast beam modulation." Not sure what advantages there would be with that but it sure sounds cool.

 

[PruritisAni]

Essentially treats fast VMAT. Something like gantry can do 4RPM. Rather than slice-by-slice like Tomo, treats a large field size (like 20-30 cm) and does some rapid arcs. Urorads gonna love this. Single-digit minute treatment slots!

 

[medgator]

Essentially treats fast VMAT. Something like gantry can do 4RPM. Rather than slice-by-slice like Tomo, treats a large field size (like 20-30 cm) and does some rapid arcs. Urorads gonna love this. Single-digit minute treatment slots!

Until astro finally convinces cms to split out prostate into a "simple" imrt code

 

[PruritisAni]

Until astro finally convinces cms to split out prostate into a "simple" imrt code

Y would they ever do this? It's self-defeating. Hey CMS, please give our departments (let's face it, it's an academic body) less money. On the other hand, ASTRO just might be dumb enough.

 

[medgator]

Y would they ever do this? It's self-defeating. Hey CMS, please give our departments (let's face it, it's an academic body) less money. On the other hand, ASTRO just might be dumb enough.

They tried once already and it failed.

2015 CPT Coding Update for Radiation Therapy

Astro is pretty much pro academic/hospital based rad onc at this point

 

[Gfunk6]

Bundled payments can't come fast enough . . .


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[radiaterMike]

They tried once already and it failed.

2015 CPT Coding Update for Radiation Therapy

Astro is pretty much pro academic/hospital based rad onc at this point

Is this still in effect ? I thought breast and prostate were billed lower.


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[medgator]

Is this still in effect ? I thought breast and prostate were billed lower.


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It got canned at the last minute. It never went into effect. Imrt is all billed the same, regardless of disease site