CobraLeaf Presentation 2013

25.11.2013 1 1

Stefan Ueltzhöffer

© 2013 Precisis AG

The all new mechanical Add-on MLC for Co-60 teletherapy

25.11.2013

CobraLeaf®

• Background

• Worldwide application Co-60

• Rationale for CobraLeaf

• Specifications

• CobraLeaf

• Development

• Dosimetry

• Workflow

• Safety

• Advantages

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Content

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Cobalt worldwide

© 2013 Precisis AG

• 2 types of treatment machines: Cobalt vs. Linac

• Cobalt: Power independent, low maintenance, lower cost

• Linac: High sophisticated electron gun, high cost + maintenance

• > 2.000 Co60 machines worldwide + > 30 new installations per yr

Distribution of RT machines by regions

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Dirac Database of IAEA

Cobalt worldwide

© 2013 Precisis AG

http://www-naweb.iaea.org/nahu/dirac/map.asp

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Region Region Number RT Centers Clinical Accel. Co60 TPS Med. Phys

Caribbean Subtotal 32 25 22 27 59

Central Africa Subtotal 7 8 7 10 22

East Africa Subtotal 8 4 8 9 18

East Asia Subtotal 1933 1147 592 2105 1472

Eastern Europe and Northern Asia Subtotal 397 439 464 560 999

Indian Ocean Islands Subtotal 2 1 3 3 5

Mexico and Central America Subtotal 107 87 75 106 74

Middle East Subtotal 187 282 102 215 499

North Africa Subtotal 69 76 46 81 166

North America Subtotal 2787 4085 158 326 2085

South Asia Subtotal 350 204 384 280 225

Southeast Asia Subtotal 124 149 83 107 215

Southern Africa Subtotal 41 63 15 43 54

Southern and Western Pacific Subtotal 66 164 2 119 239

Temperate South America Subtotal 117 129 53 89 124

Tropical South America Subtotal 359 405 145 238 402

West Africa Subtotal 14 10 8 15 28

Western Europe Subtotal 1035 2532 108 1581 2701

Gesamtergebnis 7635 9810 2275 5914 9387

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Problem

Rationale

© 2013 Precisis AG

Solution

• Re- / New development for specific task

• Cobalt only

• Close cooperation with

(Best Theratronics, Ottawa, Canada)

• No MLC for Cobalt available, despite demand

• Limitations of current techniques, modern techniques (e.g. IMRT) not available

• Linac MLC too expensive (~ 300.000 €)

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CobraLeaf device

25.11.2013 8 © 2013 Precisis AG CobraLeaf attached to Cobalt machine

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MLC:

• 3D conformal

• Single Focus + Rounded Leaf-Ends

• Leaf width 10 mm / Field size 20x30 cm2*

Mechanical:

• Independencies

• Robustness

• Inserted in Lower enclosure

• Combinable with standard wedges

Cobalt:

• Co-60: 1.17 MeV und 1.33 MeV

* at 80 cm SAD / Quelle: Wikipedia, Ali et al. 2012 PMB

Specifications

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Adapter in lower enclosure

Specifications

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Development

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Drive: Passive Pneumatics*

High power / low maintenance

Leaf material: Brass

Low cost

Innovative Leaf and Drive concept

Development

*patent pending

= 8.47 g/cm3

μCuZn39Pb3 = 0.4311 cm-1

HVL = 1.6079 cm

6*HVL = 9.65 cm ≙ 1.563 %

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Setup Cut

Development

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Full view

Development

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Details

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Workflow

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Planning

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Field preparation

• Import of DICOM or

any field outline file

• Fully automated

processing

• Adaptation if required

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Milling

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Template

Individual shape

Reusable base

Pneumatics

Leaves

Field Template

Motion Drive

Tools for faster process – opening / closing

Tools for faster process - Pumping

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Template insertion - > Leaf adjustment

25.11.2013 26 © 2013 Precisis AG Device attached to Cobalt machine

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Irradiation

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Penumbra

Dosimetry

In plane: 1.29 cm

Cross plane: 1.25 cm

Field 10 x 10 cm

Depth 10 cm,

SAD 80 cm

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Leakage

Dosimetry

Leakage 1,92%

Interleaf: < 2,4%

Gap: 6%

0 50 100 150 200 2500.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

1.1

1.2

Position (pixel values)

Rela

tive leakage n

orm

aliz

ed t

o a

vera

ge

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Concept

Safety

Implementation of various measures to

prevent errors and damages

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No setup errors possible

Safety

Planning PC

CNC Milling

Corner bars

CNC Index pin

Template blank & milled shape

Drill (Home position)

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Templates

Defined holes

Indexing pins

Prevents rotation or off-centre

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Interlock

Base coding (###)

Connector in

CobraLeaf

Tray + Wedge No. (###) Prevents wrong fields

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Advantages

• Increased safety

• Better conformity

• Combinable with wedges

• Modern 3D techniques

Treatment

• Power independent

• Instant installation

Usability

• Mechanical parts, no wearing

• Long intervals

Maintenance

• Quick return

Investment

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Testimonials of Key opinion leaders, Radiotherapy

Opinions

© 2013 Precisis AG

Prof. Dr. Wolfgang Schlegel, DKFZ, Germany

“So far, such radiation collimators were available only for linear accelerators,

with CobraLeaf, the shape of the leaves is adjusted manually. But this is a

great advancement over previously used rectangular radiation beams.”

Prof. Dr. Lokesh Viswanath M.D, Kidwai Memorial Institute of

Oncology in Bangalore (KMIO), India

“There is a real and urgent need to demonstrate to the world, that a cost-

effective 3D CRT, which is the basic minimum standard of care in Radiation

Therapy can be given on a Telecobalt Machine with a MLC. A simple low cost

accessory like this will benefit many patients throughout the world, especially

in many developing nations. Hence, we deeply appreciate the effort by

Precisis AG and DKFZ to bring this to the market.”

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Thank you for the attention

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Backup

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Material & Methods

Dosimetry

Material

PTW IC

Theratron Elite80 (Ø1.5cm) &

Theratronics Equinox (Ø2.0cm)

GafChromic EBT Film

PTW Phantom/Virtual Water

Methods

80cm/85cm/100cm SSD

pdd & skin dose

Interleaf & End2End Leakage

Penumbra: 80% / 20%

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read more…

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Background & Partners

Entwicklungspartner

© 2013 Precisis AG

• Small (10 empl.) medical device developer / manufacturer

• Specialized in precision techniques in Neurosurgery + Radiotherapy

• Cooperation partner of DKFZ

• State funded, world renown Cancer Research institution

• 2500+ employees, 1000+ scientists

• Long history in MLC development (formerly with Siemens)

• 2011: Joint idea of using Know-how in MLC technology to develop new device

for large need in developing / emerging countries

(300+ employees), CA based market leader for Cobalt machines

supports (technical + marketing) as add-on to their machines

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Precisis

Kontakt

© 2013 Precisis AG

Resources

• IAEA, 2011: Inequity in Cancer Care: A Global Perspective

• IAEA, 2008: Setting up a radiotherapy progamme

• AMPICON, 2012: Baumann et al.: A manual Multileaf Collimator for use in Cobalt-60 Teletherapy.

Proceedings of 33rd Annual Conference of the Association of Medical Physicists of India, 2012 (O-02 12070902)

• Web: Cobraleaf / DKFZ / Best Theratronics / PR09/12 / Embassy Info / PR12/12

Stefan Ueltzhöffer Head of Innovation Management

Project Manager CobraLeaf

Precisis AG · Hauptstr. 73 · 69117 Heidelberg

Tel: +49 6221 6559300 / mobile: +49 177 7523924

E-Mail: [email protected] · www.cobraleaf.com · www.precisis.de