Photo Gallery of Technologies at ASTRO 2021

MRI-Guided radiation therapy is the beginning of the future of with real-time adaptive radiation delivery, said Carri Glide-Hurst, Ph.D., University of Wisconsin. She said the technology offered by two FDA cleared MRI-LINAC systems allows treatment plans to be changed quickly. This includes turning the beam off during treatments as the target tumor moves out of the radiation field due to involuntary body movements, such as respiratory motion and bowl gas movement. #ASTRO #ASTRO21

The ASTRO President's forum at the 2021 annual meeting was much lighter on attendance than in previous years due to COVID. This session was often packed with attendees prior to COVID. Most attendees social distanced themselves from other attendees in sessions like this. The meeting was one of the first large healthcare meetings to be held since the pandemic began, but attendance at these meeting has been much lower than in pre-pandemic times. 

The New Elekta Harmony radiation therapy system at ASTRO 2021. It gained FDA clearance in the summer of 2021. It offers faster treatment times and a large round patient Information screen screen on the machine so their information is immediately available table side. It uses facial recognition to verify the correct patient is in the room for treatment. The speed increased, so the time a patient spends in the treatment room for lung SBRT from 30 Minutes down to under 2 minutes. SBRT prostate down from 5 minu

A radiotherapy treatment plan for Accuray’s Tomotherapy system to kill white blood cells prior to a liver cancer patient undergoing a transplant. Plan is aimed at the bone marrow and spares dose to most of the organs to reduce side effects. This was created on the new Volvo Ultra treatment planning system. It allows planning for more than 100 cm of anatomy and allows users to drag target dose values of the main graph and the system will recalculate all the doses in real time. Other efficiencies in this soft

CIRS tissue equivalent head phantom for proton and photon therapy treatment plan verification and QA.

The Zeiss Intrabeam 600 inter-operative photon radiotherapy system display on the expo floor of ASTRO 2021 today in Chicago. It used multiple probes that can treat different areas of the body, including breast (rounded balls), skin (flat), and spine (catheter shaped). The system originally gain FDA in 1999. #ASTRO #ASTRO21

DoseOptic gained FDA clearance in 2020 for its Cherenkov radiation imaging system for use during radiation therapy treatment so the irradiated field can be visualized. The system can show areas where there is misalignment of the beam, or needless irradiation of healthy tissue. They showed examples at ASTRO 2021 of whole breast radiotherapy, where the edge of beam hit the patient's chin and arm. One video showed how a patient moved and they placed their arm in the treatment field. #ASTRO21 #ASTRO

This is the Varian Identify surface guided radiation therapy patient positioning system demonstrated at ASTRO 2021 last week. It uses light projected from three different angles to triangulate the exact position of the surface of the patient using cameras. This is matched with treatment plan CT scans to register the patient exactly on the table. It also offers real-time color coded identification of areas that are not in the correct position on an overhead screen so adjustments can be made. #ASTRO21

The New Elekta Harmony radiation therapy system has a large round patient information screen screen on the machine so their information is immediately available table side. It uses facial recognition to verify the correct patient is in the room for treatment. Read more - www.itnonline.com/content/elekta-harmony-radiation-therapy-system-recei…

The Zeiss Intrabeam 600 inter-operative photon radiotherapy system showing placement of its breast probe in a model of a patient. The system can irradiate post-lumpectomy surgical cavities to kill any remaining cancer cells that may have been left behind.  The system originally gain FDA in 1999. #ASTRO #ASTRO21

The Varian Ethos artificial intelligence (AI) adaptive radiation therapy system at ASTRO 2021. The system, released in 2019, uses the onboard imaging system to scan the patient during each treatment session and can create a new treatment plan in a couple minutes to adapt to any changes in the body or tumor size. The radiation oncologist can choose to accept, reject or modify the plan. This adaptive therapy is designed to make radiotherapy more targeted, spare more healthly tissue and enable faster therapy.

A model of Toshiba’s ion beam radiation therapy system at the ASTRO 2021. There are currently 3 systems installed at hospitals in Japan and two more are planned to be online by 2024. Similar to proton therapy, ion beam systems also require a large accelerator and beam lines directed by electromagnets to separate treatment rooms.

Advanced Radiation Therapy showed a new breast lumpectomy surgical cavity marker called AccuSyte. The device from partner Accusite uses bioresorbable a bioresorbable structure with embedded fiducial markers. The markers help identify where the surgical site was for monitoring during future imaging exams. #ASTRO #ASTRO2021 #ASTRO21

Advanced Radiation Therapy showed a new breast lumpectomy surgical cavity marker called AccuSyte. The device from partner Accusite uses bioresorbable a bioresorbable structure with embedded fiducial markers. The markers help identify where the surgical site was for monitoring during future imaging exams.

A breast cancer radiation therapy treatment plan from the AccuBoost noninvasive brachytherapy approach specifically for the treatment of breast cancer. The AccuBoost Technique is offered for the boost phase of whole breast irradiation (WBI) or alternatively for an accelerated, 5 or 10-day course of, partial breast irradiation (APBI). #ASTRO

The GE Healthcare Revolution CT system on display at ASTRO 2021 in a radiation oncology configuration. The system offers spectral CT capability, comes in 256 or 500 slice configurations, offers 80 cm of anatomical coverage per rotation and can be used for treatment planning or CT-guided biopsies. CT systems used for RT use a flat coach top rather than concave table top used for general radiology. The flat tops match those on the radiotherapy systems so the anatomy is in the same position. #ASTRO

Vendor Simulated Inanimate Models at ASTRO 2021 demonstrated a virtual reality surgical training system.

This is Reflexion’s X1 LINAC radiotherapy system on display at ASTRO 2021. It recently gained FDA clearance for standard SBRT, IMRT and SRS. However, the real value of the system is that it was designed for biologically guided radiotherapy, where PET radiotracer detectors can image metastases and the system can target each one with real time adaptive radiotherapy. That technology is currently involved in a FDA IDE trial. If it gains FDA clearances, the technology promises to reduce treatment times. #ASTRO21

DoseOptic gained FDA clearance in 2020 for its Cherenkov radiation imaging system for use during radiation therapy treatment so the irradiated field can be visualized. The system can show areas where there is misalignment of the beam, or needless irradiation of healthy tissue. They showed examples at ASTRO 2021 of whole breast radiotherapy, where the edge of beam hit the patient's chin and arm. One video showed how a patient moved and they placed their arm in the treatment field. #ASTRO #Radiotherapy

The set up of the DoseOptic Cherenkov radiation imaging system in a treatment room. The system gained FDA clearance in 2020for use during radiation therapy treatment so the irradiated field can be visualized. The system can show areas where there is misalignment of the beam, or needless irradiation of healthy tissue.  #ASTRO21 #ASTRO2021

Shielding Construction Solutions Vault Builders showed examples of its specialized bricks made from high density concrete mixed with iron ore, and/or steel pellets. The image shows a comparison of bricks side-by-side including one of the vendor’s that weights 20 pounds and it has the shielding equivalent to three lower density standard bricks. These vault brick systems also come in interlocking curved edge blocks to add stability and prevent gaps where radiation beams could penetrate the walls.

Shielding Construction Solutions Vault Builders showed examples of its specialized bricks made from high density concrete mixed with iron ore, and/or steel pellets. This provides shielding in the vault walls of therapy system rooms to prevent  radiation beams from penetrating the walls.

The new CIRS Zeus MRI-LINAC Phantom for treatment planning verification. Since MRI-LINACS allow for real time tumor tracking and visualization, this phantom was developed to simulate patient respiration with a moving diaphragm and organs in a gel filled tank that can move with the motion of the diaphragm.

The new CIRS Zeus MRI-LINAC Phantom for treatment planning verification. Since MRI-LINACS allow for real time tumor tracking and visualization, this phantom was developed to simulate patient respiration with a moving diaphragm and organs in a gel filled tank that can move with the motion of the diaphragm.

A CIRS QA phantom for volumetric modulated arc therapy (VMAT) intensity modulated radiation therapy (IMRT).

CIRS displayed its newest anthropomorphic phantom at ASTRO 2021. It is made of materials that mimic the same electron densities as the human body, so the phantom appears the same as human body in CT imaging, treatment plans and had the same attenuation properties when irradiated by the therapy system.

An example of the Pymedix Autofuse artificial intelligence (AI) enabled deformable image registration software. It is designed to exactly co-register several CT and or treatment plan images. The AI identifies lines of plausible matches and makes sure the structures in the image make sense and then morphs the image using 16 parameters. The image shows the start of the process with the AI working through the details of the image using a color coded system of lines. The system can combine data from treatment p

An example of the Pymedix Autofuse artificial intelligence (AI) enabled deformable image registration software. It is designed to exactly co-register several CT and or treatment plan images. The AI identifies lines of plausible matches and makes sure the structures in the image make sense and then morphs the image using 16 parameters. The image shows an combined treatment plan with contours that carried over to a new co-registered CT scan. #ASTRO #Artificialintelligence #AI

Liver cancer with multiple lesions, as seen on a cinematic rendering of a CT scan. Imaging like this can help patients better understand their disease because it is easier to interpret, as opposed to CT MPR image slices, which are foreign and difficult to understand for non-clinicians.

Kristy Brock, Ph.D., MD Anderson Cancer Center, presents virtually during the ASTRO 2021 Presidential Symposium. She was among many who needed to present in a virtual video format at the in-person conference because MD Anderson and several other healthcare systems have travel bans in place for their employees due to the COVID pandemic. However, with COVID positivity rates dropping in most places in recent weeks, some hospitals lifted their travel bans so ASTRO reported numerous of last-minute registrations

COVID impacted attendance at the 2021 ASTRO meeting, so there was ample open space between attendees in most sessions, such as the opening presidential symposium.

One of the hot topics at ASTRO 2021 was the increasing use of adaptive radiotherapy systems, which several thought leaders pointed out in sessions as a possible way of the future. Two systems that there is a lot of excitement about are the Varian Ethos with AI-enabled adaptive planning capability, and the Reflexion system, which is now in a U.S. trial testing its ability to track PET tracers from several metastatic tumors at the same time to target and treat them while the patient is in the machine.  

Presentation in the main theater of ASTRO 2021.

Long time friends Niema Razavian, M.D., Wake Forest School of Medicine, and Anjali Saripalli, M.D.m Loyola University Medical Center, reunited in person for first time in a couple years due to COVID. They take a photo in front of the ASTRO logo at the in-person 2021 conference. They attended medical school together, but did not see each other for more than a year and were able to catchup with this year's meeting. ASTRO 2020 was virtual like most medical conferences in 2020 during the pandemic. 

Here is a bra specifically designed for use in radiation therapy in the Civco booth. It was designed by radiation oncologist to hold the breasts in place to prevent movement during radiotherapy. Find out more in the VIDEO: FDA-cleared Bra Helps Improve Breast Positioning During Radiation Therapy. #ASTRO21

View from inside a head and neck immobilization mask in the Civco booth.

The label on the side of this patient positioner is a radio frequency identification (RFID) tag used in combination with a ceiling mounted RFID detector to show the precise location of the positioner on the Elekta Harmony radiation therapy system, shown for the first time at ASTRO 2021. The RFID positioning system allows exact alignment with the treatment plan, based on the CT scans and position of the patient used in that scan. #ASTRO #ASTRO21 #ASTRO2021

View of the overhead screen for the Varian Identify surface guided radiation therapy patient positioning system. It uses light projected from three different angles to triangulate the exact position of the surface of the patient using cameras. This is matched with treatment plan CT scans to register the patient exactly on the table. It also offers real-time color coded identification of areas that are not in the correct position on the screen so adjustments can be made until the patient matches the plan. 

The label is a small radio frequency identification (RFID) tag that can show the position of the table or positioners in relation to the original treatment plan. This example is part of the Varian Identify surface guided radiation therapy patient positioning system. ASTRO #ASTRO #ASTRO21 #ASTRO2021

View of the overhead screen for the Varian Identify surface guided radiation therapy patient positioning system. It uses light projected from three different angles to triangulate the exact position of the surface of the patient using cameras. This is matched with treatment plan CT scans to register the patient exactly on the table. It also offers real-time color coded identification of areas that are not in the correct position (red on this screen) and green when in alignment. #ASTRO #ASTRO21

A radiotherapy treatment plan for Accuray’s Tomotherapy system to kill white blood cells prior to a liver cancer patient undergoing a transplant. Plan is aimed at the bone marrow and spares dose to most of the organs to reduce side effects. This was created on the new Volvo Ultra treatment planning system. It allows planning for more than 100 cm of anatomy and allows users to drag target dose values of the main graph and the system will recalculate all the doses in real time. Other efficiencies in this soft

The Stryker Airo Mobile TruCT CT scanner on display at ASTRO 2021. It is a small footprint 32-slice computed tomography system designed for us in operating rooms for post surgical review scans and for brachytherapy procedures. It is small enough to fit through standard doorways when being moved from one room to another. It uses a wired tablet on the side of the scanner for patient set up and imaging. #ASTRO #ASTRO21

Prostate brachytherapy seeds in a vial (no-radioactive display) from Bard in a booth display at ASTRO. #ASTRO #ASTRO21

Prostate brachytherapy components from Bard in a booth display at ASTRO. Includes brachytherapy seen delivery catheters and the grid the catheters are inserted into to guide delivery.

A demonstration of the ViewRay treatment planning system at ASTRO 2021 on the expo floor.

A key slide shown in a couple sessions on FLASH radiotherapy where an large, single dose of radiation is given in one treatment session and avoids the need for fractionated doses over days or weeks. This cat study was among some of the animal studies performed using FLASH, which shows there is a healthy tissue sparing response even with these high doses. A single session also greatly simplified radiation therapy. This slide was shown in the FlashKnife electron beam system booth. #ASTRO21 #FLASHtherapy

A model of the FlashKnife electron beam radiation therapy (EBRT) system on display on the ASTRO expo floor.

This is a new type of hybrid bolus from the company Decimal called an electron beam density modulator or electron beam radiation therapy (EBRT) displayed at ASTRO 2021. The bolus incorporates tungsten pins of various sizes to dampen hot spots in areas being treated to better attenuate the dose delivered. The vendor said it is being used for research for very high dose FLASH radiation therapy delivery, where a conventional is not good enough to attenuate the high doses being delivered. #ASTRO #ASTRO21

Example of a 3D printed, customized face bolus to treat cancer with electron beam radiation therapy in the Decimal booth at ASTRO 2021. #EBRT #ASTRO #ASTRO21

An example of flexible bolus made from silicone on molds that were 3-D printed from patient CT scans. These are very flexible, so more comfortable fro the patient. These are used to attenuate electron beam radiation therapy doses in treating skin cancers. This a new product, FlexiBol, is from Decimal at ASTRO 2021.

Steven Chmura, M.D., Ph.D., University of Chicago, speaks at a press conference for the results of a phase 1 clinical trial testing the effects of stereotactic body radiotherapy for treating multiple metastases has determined that treatments used for single tumors can also be safely used for treating patients with multiple metastases.

A sign listing the COVID precautions at ASTRO 2021. ASTRO required all attendees to wear masks and to be vaccinated in order to attend the annual meeting. RSNA will follow these same requirements for its 2021 meeting, which will also be in Chicago.

An ASTRO 2021 press conference where the presenters are masked prior to giving their presentations. COVID guidelines for masking and requiring vaccinations were enforced at the annual meeting. Efforts were also made to socially distance chairs in sessions.

Siemens showing its MRI system optimized for radiation therapy at ASTRO 2021. MRI is the gold standard imaging modality for soft tissue, and is ideal for visualizing cancers. However, CT imaging is what is needed to create the treatment plans for radiotherapy systems. Siemens was among a few vendors this year showing new software to take MRI datasets and convert them into synthetic CT image datasets for use in the treatment planning process and eliminate the need for an extra scan.

This is the Neurologica BodyTom Elite mobileCT scanner being shown at ASTRO 2021 for its application for brachytherapy. It is also used for emergency stroke detection in some hospital ERs and has been mounted in mobile stroke unit ambulances to lower neuro interventions or TPA delivery. The 32-slice CT uses standard wall plugs.

Digital pathology is rapidly growing, enabling images and reports to be called up on PACS or oncology reporting systems. This example was shown by Philips Healthcare at ASTRO as part of its Oncology Navigator  Genomics Workspace. This brings genomic data alongside disease histology and patient phenotype for a comprehensive biomarker-informed diagnostic and therapeutic picture. #ASTRO21 #Pathology

A view of Philips' new Oncology Tumor Board Navigator software dashboard view. It allows all members of tumor boards to be on the same page and able to access all the related images and reports to make the best recommendations for patients. #ASTRO #ASTRO21 #TumorBoard

Lung cancer nodules with measurements called up as one of the options in Philips Oncology Navigator software demonstrated at ASTRO 2021.

Philip's Oncology Navigator Software demonstrated at ASTRO 2021 consolidates all patient data into one location and helps automate guideline-based recommendations to make it easier and faster for physicians manage and treat oncology patients.

A big trend on the ASTRO 2021 expo floor was the introduction of software that can now convert MRI datasets into them into synthetic CT image datasets for use in the treatment planning process. This eliminates the need for a CT scan and can speed care and reduce costs. Philips Healthcare showed this example of the original brain MRI on the left, and the synthetic CT image on the right.

Siemens Healthineers Go Open.Pro CT system optimized for use in radiation therapy. Shown with patient positioning system mounted to the coach.

A slide from a recent study using TAE Life Sciences' boron neutron capture therapy (BNCT) radiation therapy system. A patient is first infused with a non-toxic boron-10 compound, which selectively accumulates in tumor tissue. A neutron beam is then focused on the tumor and the neutrons are captured by the boron and causes emission of alpha radiation particles within the tumor. Alpha particles have a a very short range, so this helps spare surrounding healthy tissue from radiation damage.

The Elekta’s Laksell Gamma Knife Icon cobalt-60 system at ASTRO. The shield doors on the system are closed when not in use because the cobalt “beam” is always on. The system uses 192 cobalt sources mounted on movable paddles. These move over holes of a fixed collimator to attenuate the dose the patient receives. It also has an attached 4D cone beam CT imaging system that folds out of the way.

ITN Editor Dave Fornell with Anthony Zietman, M.D., interim chief, radiation oncology, Mass General Cancer Center, and former president of the American Society for Radiation Oncology (ASTRO). They met for a video interview on key radiation oncology technology trends to watch. Zietman said the key technologies he sees are proton therapy, FLASH and hypofractionated therapy, image guided radiotherapy such as MRI-LINACs, and PET guided radiotherapy, including PSMA-PET for prostate cancer and PET-guided RT.

A display at the Accuray booth for the multileaf collimator for the TomoTherapy radiation therapy system. The leaves open and close to collimate and shape the dose of the photon beam to spare the healthy tissue outside of the tumor treatment area.

The Accuray multileaf collimator (MLC) for the RadXact radiotherapy system.

A patient jaw immobilization device for head and neck radiotherapy displayed by Civco.

This is a new tattoo marker that can be used to mark skin targets on radiation therapy patients. These marks are used throughout treatment to align the CT and the radiotherapy system with the tumor and treatment plans during each treatment and follow up scans. The Civco Precision Medicine system uses disposable Ink and needle heads in sterile packaging and offers extreme ease of use, in case the user is not an experienced tattoo artist. This is a new product shown by Civco at ASTRO 2021. #ASTRO

This is a new tattoo marker that can be used to mark skin targets on radiation therapy patients. These marks are used throughout treatment to align the CT and the radiotherapy system with the tumor and treatment plans during each treatment and follow up scans. The Civco Precision Medicine system uses disposable Ink and needle heads in sterile packaging and offers extreme ease of use, in case the user is not an experienced tattoo artist. This is a new product shown by Civco on the ASTRO expo floor.

An example of a synthetic CT scan dataset created from an MRI dataset for use in radiotherapy treatment planning so an additional CT scan is not needed. This example is from Siemens Healthineers at the 2021 American Society of Radiation Oncology (ASTRO) meeting. The image on the left is the MRI image, and the image on the right is a synthetic CT created from the MRI dataset. A few vendors are showing this technology that allows use of MRI soft tissue imaging to created CTs to avoid extra scans.

ITN Editor Dave Fornell with Walter Curran, M.D., FACR, FASCO, cheif medical officer of GenesisCare Global at ASTRO 2021. They met to do a video interview on trends in oncology, including prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging for prostate cancer.