Upstate’s team of radiation oncologists cares for patients in Oneida, Syracuse and Oswego. From left are Paul Aridgides, MD, Seung Shin Hahn, MD, Anna Shapiro, MD, Alexander Banashkevich, MD, Jeffrey Bogart, MD, Michael LaCombe, MD, and Michael Mix, MD. (PHOTO BY SUSAN KAHN)
BY AMBER SMITH
Workers in California, Switzerland, England and Canada built the precision cancer-fighting technology that occupies Upstate Radiation Oncology at the newly renovated Oneida office.
Pieces of the TrueBeam Radiotherapy System are put together only after they are all delivered to the medical office where patients will go for care — in this case, 605 Seneca St., off of Route 5 in Oneida.
TrueBeam provides state-of-the-art radiotherapy and radiosurgery, and its new location in Oneida is convenient to cancer patients east of Syracuse. Already in use at the Upstate Cancer Center in Syracuse and another satellite office in Oswego, the TrueBeam can be used for many types of tumors, including tumors that are hard to reach surgically. TrueBeam is particularly well suited for treating tumors that move, such as lung, liver and pancreas cancer, as well as cancers in critical locations, such as prostate cancer, breast cancer, colorectal cancer, gynecologic cancer and brain tumors.
The largest pieces of the TrueBeam machine, which weighs more than 9 tons when fully assembled, traveled in a tractor trailer from the Varian Medical Systems headquarters in Palo Alto, Calif. The truck arrived the weekend before Thanksgiving.
Getting the TrueBeam up and running required a lot more than simply plugging it in.
Most of the reconstruction work for the medical office building had to be completed before the TrueBeam arrived, said Jeff Buckman, practice administrator for the radiation oncology department. “Once the machine comes in, you don’t want to be stirring up dust.” The room that would hold the TrueBeam, called the “vault,” had to be prepared with radiation shielding, electrical conduits and a spot where the TrueBeam would be anchored to the ground.
When the truck arrived, a 10-person rigging crew unloaded and positioned the TrueBeam inside the office, where it stands about 9 feet tall and 15 feet long. Its “arms” came from Switzerland. The generator that gives the arms their movement came from Canada. The “couch,” where patients lie during treatment, came from England.
The TrueBeam Radiotherapy System.
So did the Varian installation engineer, Mike Jones of Liverpool, England. He arrived with cases of his own tools, digital volt meters, oscilloscopes and more. It was his job to introduce all the pieces of Upstate’s TrueBeam to one another through software updates and a lengthy series of calibrations and tasks outlined in a notebook.
A steel box the size of a refrigerator contains the brain of the TrueBeam, in a room down the hall from where patients are treated. Cables string out the back of the box. Computer monitors sit on a countertop nearby, where radiation technicians observe patients during treatment. A chiller is mounted to the roof of the medical office so that the TrueBeam can be cooled by water.
One of Jones’ tasks was to set the TrueBeam’s “isocenter.” That’s the center point in space around which the sophisticated architecture of the machine rotates. It’s critically important, since radiation oncologists and medical physicists plan precision radiation treatments that depend on synchronized imaging, patient positioning, motion management, beam shaping and dose delivery. The isocenter is the reference point for everything.
Once Jones completed his installation of the TrueBeam, Upstate medical physicists Weidong Li and Sean Tanny and others did the commissioning, which means they input data, checked specifications and completed another set of measurements, working from a 165-page reference document.
Working together, the engineer and medical physicists aligned the lasers and made sure the symmetry of the beams was adjusted. Also, the software had to be integrated between the TrueBeam console and the computer server, which is located in Syracuse and shared with the TrueBeam at the Upstate Cancer Center headquarters.
All told, the active installation and commissioning process was about six weeks, not counting the pre-delivery preparations. Jan. 9 was the opening.
Here’s how it works for patients
They are positioned exactly for each treatment, and their tumor is identified through advanced integrated image guidance. The TrueBeam delivers radiation through several beams at different angles and intensities — all directed at the tumor and usually lasting only a few minutes. Radiation is concentrated on the tumor, avoiding the healthy cells and tissue surrounding the tumor.
Such customized treatment minimizes side effects and provides hope for greater cure rates.
Cancer Care magazine winter 2018 issue
This article appears in the winter 2018 issue of Cancer Care magazine.