Three platforms were used: Cyberknife™, Varian Trilogy™, and Truebeam™ STX (11 (link)). Cyberknife™ uses a compact 6-MV linear accelerator mounted on a computer-controlled robotic arm with six rotation axes that permit the use of 1200 treatment positions, of which 80–120 are usually necessary to treat most lesions. Throughout the treatment delivery, two orthogonally positioned diagnostic x-ray cameras provide images of the patient’s anatomy. Bony landmarks or implanted fiducial markers were used to compare the patient’s planning CT to allow for continuous adjustment (intra-fraction correction) based on the patient’s positioning (12 (link)). For Varian Trilogy™ and Truebeam™ STX, a cone-beam CT was acquired and pre-treatment shifts were made to match the planning scan after immobilization of the patient and isocentric set-up. Via beam modulation and occasionally using RapidArc™ technology, dose is delivered both efficiently and conformally (13 (link), 14 (link)). For the 40 locally advanced or recurrent malignant skull base tumors (SBT) in our study, 26 were treated with Cyberknife™, 8 were treated with Varian Trilogy™, and 6 were treated with Truebeam™ STX.
Truebeam stx
Manufactured by Agilent Technologies
Sourced in United States, Japan
The TrueBeam STx is a medical linear accelerator system designed for advanced radiation therapy treatments. It is capable of delivering various radiation beam types, including photon and electron beams, for the treatment of a wide range of cancers. The system features advanced imaging and motion management capabilities to ensure precise and accurate targeting of the tumor during treatment.
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Lab products found in correlation
Truebeam, by Agilent Technologies (4 mentions)
Balb c athymic nude mice, by Orient Bio (3 mentions)
Perfect pitch, by Agilent Technologies (2 mentions)
Acuros xb, by Agilent Technologies (2 mentions)
Eclipse, by Agilent Technologies (2 mentions)
Eclipse tps v13, by Agilent Technologies (1 mentions)
Fitc annexin 5 fluos staining kit, by Roche (1 mentions)
Facscalibur, by BD (1 mentions)
Cellquest pro, by BD (1 mentions)
Millennium 120 leaf mlc, by Agilent Technologies (1 mentions)
Eclipse treatment planning system v15, by Agilent Technologies (1 mentions)
As1200, by Agilent Technologies (1 mentions)
Hd120 mlc, by Agilent Technologies (1 mentions)
Primus, by Siemens (1 mentions)
Eclipse version 10, by Agilent Technologies (1 mentions)
Hd120 multileaf collimator, by Agilent Technologies (1 mentions)
Cyberknife g4, by Accuray (1 mentions)
Obi system, by Agilent Technologies (1 mentions)
Exactrac, by Brainlab (1 mentions)
Varian trilogy, by Agilent Technologies (1 mentions)
58 protocols using truebeam stx
1
Stereotactic Radiotherapy for Skull Base Tumors
2
Proton Therapy and VMAT Comparison
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The proton therapy system used (Sumitomo Heavy Industries, Ltd., Tokyo, Japan), which has an energy range of 70–230 MeV, was equipped with a universal nozzle that can switch between the PS and LS methods. Truebeam STx (Varian Medical Systems, Palo Alto, CA, USA) was used for the VMAT treatment. All three treatment plans were generated using Version 13.7 of Eclipse (Varian Medical Systems, Palo Alto, CA, USA).
3
Comparative Evaluation of HVMAT and VMAT Radiotherapy
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The prescribed dose was 45.0 Gy in 1.8 Gy per fraction to the PTV. A total of 72 treatment plans comprising 36 HVMAT plans paired with the 36 VMAT plans of each patient were made. All plans were designed in two full coplanar arcs, with one rotating clockwise (181° to 179°) and the other one rotating counterclockwise (178° to 182°). For HVMAT, both arcs contained one half‐beam field with the left or right side shielded, respectively. Figure 1 shows the design of the two opposite‐shielded half‐beam fields used in HVMAT planning. For VMAT, the arc rotations were the same as for HVMAT, but the fields were unshielded. Two arcs were optimized simultaneously in both types of planning.
The treatment plans were designed using the Eclipse™ treatment planning system (TPS), version 11.5 (Varian Medical Systems, Palo Alto, CA, USA), for the linear accelerator, which was the Truebeam STx (Varian Medical Systems, Palo Alto, CA, USA) equipped with a high‐definition 120‐leaf multileaf collimator (MLC) with 2.5 mm leaves in the middle and 5 mm leaves on the sides. The maximum dose rate was set to 400 MU/min with 10 MV photon beams. The grid size for dose calculation was 2.5 mm. The anisotropic analytical algorithm, version 11.0.31, was used for volume dose calculation, and the progressive resolution optimizer, version 11.0.31, was used for planning optimization.
The treatment plans were designed using the Eclipse™ treatment planning system (TPS), version 11.5 (Varian Medical Systems, Palo Alto, CA, USA), for the linear accelerator, which was the Truebeam STx (Varian Medical Systems, Palo Alto, CA, USA) equipped with a high‐definition 120‐leaf multileaf collimator (MLC) with 2.5 mm leaves in the middle and 5 mm leaves on the sides. The maximum dose rate was set to 400 MU/min with 10 MV photon beams. The grid size for dose calculation was 2.5 mm. The anisotropic analytical algorithm, version 11.0.31, was used for volume dose calculation, and the progressive resolution optimizer, version 11.0.31, was used for planning optimization.
4
Varian TrueBeam STx EPID Measurements
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All measurements in this study were performed on a single Varian TrueBeam STx (software version 2.0) linac fitted with an aS1200 EPID and six degree of freedom couch.
5
Fractionated IMRT/VMAT for Breast Cancer
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All patients received either 50 Gy in 25 fractions of 2 Gy (CF) or 40.05 Gy in 15 fractions of 2.67 Gy (mHF), using 6 MV sliding window intensity-modulated radiotherapy (IMRT) or hybrid 6 and 10 MV volumetric modulated (partial) arc therapy (VMAT) [4 (link)]. A sequential normofractionated boost to the tumour bed (16 Gy in 8 fractions of 2 Gy) was given to patients with positive tumour margins, age ≤ 50 years, and age ≥ 51 in case of a high-grade tumour (≥pT2, HER2/neu positive, triple-negative, poor cell differentiation). The International Commission on Radiation Units and Measurements (ICRU) recommendations for dose limits of 95% to 107% were followed. All patients were treated on a TrueBeam STx (Varian Medical Systems, Palo Alto, CA, USA) linear accelerator in a supine position on a breast board. Left-sided WBI was performed in deep inspiration breath-hold (DIBH), if feasible.
Standard institutional skin care with a urea-based lotion (Eucerin UreaRepair PLUS 5%, Beiersdorf, Hamburg, Germany) was applied twice daily to the whole breast, from the first day of treatment onwards until completion. Patients presenting with grade ≥ 2 radiation dermatitis with moist desquamation and severe pain during radiation treatment, were prescribed topical corticosteroids, until symptoms resolved.
Standard institutional skin care with a urea-based lotion (Eucerin UreaRepair PLUS 5%, Beiersdorf, Hamburg, Germany) was applied twice daily to the whole breast, from the first day of treatment onwards until completion. Patients presenting with grade ≥ 2 radiation dermatitis with moist desquamation and severe pain during radiation treatment, were prescribed topical corticosteroids, until symptoms resolved.
6
Photon Beam Dosimetry Comparison
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Measurements and calculations were carried out in two different institutions (A and B). In both institutions, a Varian TrueBeam STx equipped with the HDMLC for a 6 MV WFF photon beam energy with flattening filter (WFF) and at a dose rate of 600 monitor units (MU)/min was used for dose delivery. Flattening filter‐free (FFF) photon beams were also used in one institution for comparison purposes. Doses were calculated using the anisotropic analytical algorithm (AAA) algorithm with a 1 mm calculation grid size in the Eclipse TPS v13 (Varian Medical Systems, USA). The effective spot size parameter was set to 0 mm. An angular resolution of 2 degrees was selected for dose calculations, as used in clinical practice.
7
Dose-Response Curve Determination for Radiochromic Film
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A sheet of film (20.3 × 25.4 cm2) was cut into 4 × 4 cm2 pieces using a guillotine cutter. Each film was irradiated to create a dose‐response curve. One corner of each piece of the film was marked to track the orientation of the film. A piece of film was carefully placed on the central axis (CAX) in a water‐equivalent phantom (Kyoto Kagaku Co., Ltd, Kyoto, Japan) with 10 cm of buildup material above and below the film. The source‐to‐film distance was set at 100 cm. Twelve pieces of EBT3 and EBT4 films were used to create a dose‐response curve. One film piece was left unirradiated for the background. Irradiation was performed using a field size of 10 × 10 cm2 of a 6 MV beam produced by a Varian TrueBeam STx (Varian Medical Systems, Palo Alto, CA) linear accelerator. A total of 11 pieces were irradiated at the dose levels of 25, 50, 100, 150, 200, 300, 400, 500, 600, 800, and 1 000 cGy. Prior to any film irradiation, linac calibration was verified using a Farmer‐type ionization chamber (Model N30013; PTW, Freiburg, Germany) connected to a RAMTEC electrometer (Toyo Medic, Tokyo, Japan). Beam symmetry with a field size of 15 × 15 cm2 was confirmed using an IC PROFILER 2 (Sun Nuclear Corporation, Melbourne, FL).
8
HyperArc Optimization for Stereotactic Radiotherapy
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The pCT sets and structure sets used for original treatment were retrospectively imported to the prototype TPS Eclipse (version 15.5) with beam data from the TrueBeam STx (Varian Medical Systems), which equips a 2.5‐mm leaf‐width MLC. HyperArc plans based on these sets were generated for each patient. The isocenter position is automatically set based on the selected target structures. These structures were used for collimator angle optimization. Arc geometry (four arc fields; one full coplanar arc with a 0° couch and three half noncoplanar arc fields a 315°, 45°, and 90° or 270° couch) arranged with a single isocenter automatically located on the basis of the distance between each lesion.20 , 23 The prescription dose was the same as that of the clinical treatment plan for 95% volume of the PTVall, and 6‐MV flattening filter‐free photon beams were used. In the optimization process, the minimum dose in the target structures was set at the prescription dose. An analytical anisotropic algorithm was used in dose calculations of all plans with a 1.25‐mm grid size. The HyperArc plan generated by this process was designated as the reference plan (Ref‐plan).
9
Robotic Couch-Based Patient Positioning in Radiotherapy
10
Radiotherapy for Oligometastatic Prostate Cancer
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Treatment decisions were based on multidisciplinary case discussions and the decision on local treatment was made with the objective to avoid and postpone systemic therapy. Radiotherapy was administered to all PSMA PET-detected lesions. The clinical target volume (CTV) was defined as the gross tumor volume (GTV) visible on PSMA PET (volume 50% of SUVmax) plus a safety margin of 2 mm (CTV = PET-GTV + 2 mm; safety margin of 1 mm in selected anatomic sites, e. g. vertebrae). All patients were treated at a Varian TrueBeam STX with daily IGRT and (in selected cases) use of the stereotactic Novalis STX system using standard immobilization devices. The standard fractionation regimen for oligometastatic disease was five fractions with a 7 Gy fraction dose. In one patient, two PET-positive lymph node metastases were treated with 50 Gy in conventional fractionation to an extended volume covering the node areas followed by a boost of 7 Gy × 2 to the PET-positive lymph nodes. In one patient, a single PET-positive lymph node adjacent to the esophagus was treated with four fractions of 7 Gy due to dose constraints. Treatment was given on consecutive working days without interruptions except at weekends.
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