Massive introduction of Image-Guided treatment units

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Linear accelerator by Elekta. This new type is called Synergy. It is equiped with a flat panel EPID system and an X-ray system with flatpanel for Cone Beam CT imaging. 

In 2002 the first of five new megavolt treatment rooms is taken into use. A new type of linear accelerator of the Elekta Company is installed. These treatment machines are fitted with a multi-leaf collimator (MLC) and an EPID system. The first new machine is also equipped with a prototype of the new Cone Beam CT (CBCT) imaging system. Over the following years seven more modern linear accelerators of Elekta are installed in the Netherlands Cancer Institute (NKI), each with an EPID and an MLC and three are also equipped with the CBCT system. With this expansion the Radiotherapy Department has at its disposal ten megavolt machines in total, one of which is destined for research and development activities in a cooperation with Elekta.  

In this important breakthrough in image-guided radiotherapy, the NKI has chosen to start a lasting collaboration with the Elekta Company. In this way the acquired expertise in software engineering and image processing is introduced in an international collaboration. The NKI participates in a consortium of cancer centres that collaborate with the Elekta Company in the development of image-guided radiotherapy. Partners in the consortium are amongst others the Christie and Holt Radium Institute in Manchester, UK, Harvard University Medical Centre in Boston, USA, the Princess Margaret Hospital in Toronto, Canada, and the NKI. This group is still expanding.

In the period 2000-2008 the NKI also invested in advanced diagnostic equipment. The new equipment includes two fast Siemens multislice CT-scanners that make small details clearly visible and can also make visible the movement of organs within the timing of a typical radiation treatment.  The images of MRI, PET-CT and SPECT-CT scanners are also applied in the planning of the treatment and functional imaging widens the possibilities for precise insight in the location and structure of tumours and metastases and in the treatment possibilities.

The hardware and software for treatment planning is replaced by the very advanced Pinnacle system, a Philips product. Twenty-five work stations become operational in a newly built treatment planning department in the heart of the radiotherapy department. For all patients that require this, the new complex treatments can be designed and carried out. The preparation of the treatment now reaches the level necessary to really benefit from the possibilities of the CBCT accelerators with MLC, such as IMRT and stereotactic irradiation. In the window on the time line in 2008 "Treatment planning for a moving tumour" an example is given of the procedure for the preparation and execution of an image-guided irradiation.