Shahid Akhter, editor, ETHealthworld , spoke to Dr Vadhiraja BM, HOD and Consultant, Radiation Oncology, Manipal Hospitals, to know more about the advent of Radiaxact X9 with synchrony technology and its level of precision in treating tumours.

Tumour Tracing and Tracking: Latest Advancement
Tumours with respiration or breathing move up to 2 – 5 cms, especially in the lung, liver, and pancreas. We did not have any technology to track this so far. When we see 10 – 15 years back the treatment of the tumour was with a broad field encompassing the normal structures. But with advancements in technologies, we now precisely target these tumours. Tumour tracking is one such technology where we can target the tumour without excessive dose to the surrounding normal structures. So earlier there were technologies like holding the breath or active breath coordinator wherein he or she used to ask the patients to take a deep breath and hold for 20 seconds and during that time the radiation beam used to be switched on and we used to treat the tumour. And then we had to ask the patient to breathe normally and again ask them to take a deep breath and hold and the treatment used to happen only in the breath-hold period. But this was quite cumbersome for the patients as they had to take a deep breath and hold for 20 seconds, nearly 10 – 20 times during the treatment. Another technology is real-time positioning in some of these machines wherein the patient keeps breathing normally but the treatment happens only during one of the phases of respiration, that is during inspiration.

Since the tumour treatment happens only in one phase of the respiration, the overall treatment time used to be almost 30 – 45 minutes which was also cumbersome to the patient. So, in this Radiaxact X9 with synchrony technology, the greatest advantage for the patient who has tumours in the lung, liver, or pancreas. This technology basically helps in tracking the tumour and treating it exactly without giving an excess dose to the surrounding structures. This is introduced in India for the first time, and it was introduced in the world in 2019. Earlier to this, we had different technologies to address this respiratory movement by breath-hold or by real-time positioning, which used to take a longer time. But since this technology is available for the first time in India, this technique is useful for those patients with tumours in the lung, liver, or pancreas. It is most convenient for the patient who undergoes this treatment.

Radiaxact X9 with synchrony technology: Patient Awareness
Radiaxact X9 with synchrony technology is not known to many, whether it is the patients or doctors other than the oncologists. In this technology, sometimes the patients come to the hospital and ask whether they are eligible for undergoing treatment in this machine because they get information from various sources or online. But it is the doctor who is going to decide whether the patient is fit for this technology or whether he or she would benefit from this synchrony technology. Once we see the patient and after investigations, once we have all the diagnostic reports, we see whether the patient is eligible for this technology and then decide whether we can take up this patient and we inform the patient and make them aware whether they are going to benefit from this technology and then subject them for synchrony technology.

Radiaxact X9 with Synchrony Technology: Advantages
This technology has the greatest advantage in tracking the tumour with respiration. In addition, it also has image-guided radiation capability and adaptive radiation treatment. It is also advantageous in treating the patients wherein we have to treat a long length field especially in children with medulloblastoma wherein we treat craniospinal irradiation (CSI). It is also advantageous in patients who have multiple metastases either in the head, chest, and pelvis and we must treat these three sites in one go. In this machine, we can position the patient and target all these areas in one set-up and in one go. Whereas in other machines probably we must position three times to come inside and reposition the patient and then we must treat separately all these three sites individually. With this machine, we have the advantage that all three sites or multiple sites can be treated in one go.

The Radiaxact X9 series is much faster and has a higher energy linear accelerator and the binary high-speed multi-leaf collimator are much faster, and the rotation of this machine is much faster. Thereby with all these three things happening simultaneously, the machine can treat the patient in a shorter period of time compared to the earlier series of helical tomotherapy.