CobraLeaf Presentation 2013
2 likes999 views
The document discusses the development of CobraLeaf, a new mechanical multileaf collimator (MLC) addon for cobalt-60 teletherapy machines. It was developed to address the widespread use of cobalt-60 therapy worldwide and lack of MLC availability for these machines, limiting modern treatment techniques. The CobraLeaf MLC uses innovative brass leaf and passive pneumatic drive designs to provide a low-cost yet robust and safe solution. Dosimetric measurements show penumbras of 1.29cm in-plane and 1.25cm cross-plane with low leakage. Key opinion leaders have expressed support for CobraLeaf in improving safety, conformity and enabling 3D techniques for developing nations dependent on cobalt-60 therapy.
CobraLeaf Presentation 2013
- 1. 25.11.2013 The all new mechanical Add-on MLC for Co-60 teletherapy Stefan Ueltzhöffer © 2013 Precisis AG 25.11.2013 1
- 2. CobraLeaf® • Background • • Rationale for CobraLeaf • • Worldwide application Co-60 Specifications CobraLeaf • Development • Dosimetry • Workflow • Safety • Advantages Content © 2013 Precisis AG 25.11.2013 2
- 3. Cobalt worldwide • 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 © 2013 Precisis AG 25.11.2013 3
- 4. Cobalt worldwide Dirac Database of IAEA http://www-naweb.iaea.org/nahu/dirac/map.asp © 2013 Precisis AG 25.11.2013 4
- 5. 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 © 2013 Precisis AG 25.11.2013 5
- 6. Rationale Problem • No MLC for Cobalt available, despite demand • Limitations of current techniques, modern techniques (e.g. IMRT) not available • Linac MLC too expensive (~ 300.000 €) Solution • Re- / New development for specific task • Cobalt only • Close cooperation with (Best Theratronics, Ottawa, Canada) © 2013 Precisis AG 25.11.2013 6
- 7. CobraLeaf device © 2013 Precisis AG 25.11.2013 7
- 8. © 2013 Precisis AG CobraLeaf attached to Cobalt machine 25.11.2013 8
- 9. Specifications 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 © 2013 Precisis AG * at 80 cm SAD / Quelle: Wikipedia, Ali et al. 2012 PMB 25.11.2013 9
- 10. Specifications Adapter in lower enclosure © 2013 Precisis AG 25.11.2013 10
- 11. Development © 2013 Precisis AG 25.11.2013 11
- 12. Development Innovative Leaf and Drive concept Drive: Passive Pneumatics* Leaf material: Brass High power / low maintenance *patent pending © 2013 Precisis AG Low cost μCuZn39Pb3 HVL 6*HVL = = = = 8.47 g/cm3 0.4311 cm-1 1.6079 cm 9.65 cm ≙ 1.563 % 25.11.2013 12
- 13. Development Setup Cut © 2013 Precisis AG 25.11.2013 13
- 14. Development Full view © 2013 Precisis AG 25.11.2013 14
- 15. © 2013 Precisis AG 25.11.2013 15
- 17. Workflow © 2013 Precisis AG 25.11.2013 17
- 18. Planning © 2013 Precisis AG 25.11.2013 18
- 19. Field preparation • Import of DICOM or any field outline file • Fully automated processing • Adaptation if required © 2013 Precisis AG 25.11.2013 19
- 20. Milling © 2013 Precisis AG 25.11.2013 20
- 21. Template Individual shape Reusable base © 2013 Precisis AG 25.11.2013 21
- 23. Tools for faster process – opening / closing
- 24. Tools for faster process - Pumping
- 25. Template insertion - > Leaf adjustment © 2013 Precisis AG 25.11.2013 25
- 26. © 2013 Precisis AG Device attached to Cobalt machine 25.11.2013 26
- 27. Irradiation © 2013 Precisis AG 25.11.2013 27
- 28. Dosimetry Penumbra In plane: 1.29 cm Cross plane: 1.25 cm Field 10 x 10 cm Depth 10 cm, SAD 80 cm © 2013 Precisis AG 25.11.2013 28
- 29. Dosimetry Leakage Leakage 1,92% Interleaf: < 2,4% Gap: 6% 1.2 Relative leakage normalized to average 1.1 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 © 2013 Precisis AG 0 50 100 150 Position (pixel values) 200 250 25.11.2013 29
- 30. Safety Concept Implementation of various measures to prevent errors and damages © 2013 Precisis AG 25.11.2013 30
- 31. Safety No setup errors possible Planning PC CNC Milling Drill (Home position) Template blank & milled shape CNC Index pin Corner bars © 2013 Precisis AG 25.11.2013 31
- 32. Templates Defined holes Indexing pins Prevents rotation or off-centre © 2013 Precisis AG 25.11.2013 32
- 33. Interlock Base coding (###) Connector in CobraLeaf Prevents wrong fields © 2013 Precisis AG Tray + Wedge No. (###) 25.11.2013 33
- 34. Advantages Treatment • Increased safety • Better conformity • Combinable with wedges • Modern 3D techniques Usability • Power independent • Instant installation Maintenance • Mechanical parts, no wearing • Long intervals Investment • Quick return © 2013 Precisis AG 25.11.2013 34
- 35. Opinions Testimonials of Key opinion leaders, Radiotherapy 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 costeffective 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.” © 2013 Precisis AG 25.11.2013 35
- 36. Thank you for the attention © 2013 Precisis AG 25.11.2013 36
- 37. © 2013 Precisis AG 25.11.2013 37
- 39. © 2013 Precisis AG 25.11.2013 39
- 40. Dosimetry Material & Methods 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% © 2013 Precisis AG 25.11.2013 40
- 41. read more… © 2013 Precisis AG 25.11.2013 41
- 42. Entwicklungspartner Background & Partners • 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 © 2013 Precisis AG 25.11.2013 42
- 43. Kontakt Precisis 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: s.ueltzhoeffer@precisis.de · www.cobraleaf.com · www.precisis.de 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 © 2013 Precisis AG 25.11.2013 43