University of Pittsburgh cancer experts establish D3 company to centralise advanced radiotherapy

Pittsburgh 27 March 2002Experts in radiation therapy have formed a new company, D3 Advanced Radiation Planning Services, which will greatly improve patient access to a promising cancer treatment called IMRT, or intensity modulated radiation therapy. Co-founded by the University of Pittsburgh Medical Center (UPMC) Health System, D3 will enable UPMC to rapidly implement IMRT throughout its extensive network of cancer centres which treat more than 25.000 patients annually.


Nearly half of all cancer patients receive ionising radiation therapy to treat their disease. During this therapy, high-energy beams are aimed at cancer cells to destroy them by permanently damaging their underlying genetic material. While these high-energy beams are targeted to the tumour site as precisely as possible, they often inadvertently injure healthy tissues which surround a tumour site. As a result, radiation oncologists have been limited in the doses of radiation that they can use to effectively destroy cancer.

IMRT is a state-of-the-art technology which enables clinicians to potentially improve outcomes for cancer patients by delivering extremely precise and shaped doses of radiation while protecting surrounding healthy tissue. IMRT administers a radiation field which consists of several hundred small beams of varying intensities that pass through normal tissue without doing significant damage, but converge to give a precise dose of radiation at the tumour site.

A vast improvement over standard radiation, IMRT allows delivery of higher radiation doses to destroy cancer cells while minimising normal tissue doses, thus limiting the adverse side effects from treatment. It is currently being used at the UPMC Cancer Centres to treat head and neck cancers, brain tumours, gynaecological cancers, and prostate cancer.

Using software from Varian Medical Systems, D3 will provide UPMC Cancer Centres with patient treatment plans over a broadband telecommunications network as well as training and other medical physics services needed for IMRT. It will ultimately offer its services to hospitals and freestanding clinics across the nation. The result will be to give cancer clinics and patients easier and more rapid access to this advanced form of radiation therapy.

Physicians at the UPMC Cancer Centres use an advanced type of IMRT manufactured by Varian which is fitted with a multileaf collimeter, a device with a series of computer controlled mobile apertures that subdivide radiation beams into many beamlets aimed in various directions, providing varying intensities of radiation. This type of IMRT also uses a dynamic delivery system, or a "sliding windows" technique which further optimises radiation delivery by improving its accuracy to specifically target areas in a tumour.

While the adoption rate of IMRT has been rapid, less than five percent of the world's radiotherapy centres are now treating cancer patients with this technique. Establishing IMRT services requires physics expertise and sophisticated treatment planning capabilities as well as linear accelerators to administer the treatment.

To implement advanced radiation therapy, including IMRT, UPMC has signed an agreement with Varian Medical Systems to supply equipment, including state-of-the-art linear accelerators, as well as software, for all of the UPMC Cancer Centres. Economies of scale will be achieved by centralising IMRT treatment planning through D3's telecommunications network. The new radiation therapy equipment and software, and the telecommunications links to D3 services, will result in the largest fully integrated and comprehensive IMRT network in the world.

"IMRT is a great improvement on standard radiation, but it requires expensive equipment and broad clinical experience which makes its installation and use prohibitive for many community-based hospitals and clinics", explained Jeffrey Shogan, M.D., deputy director for business affairs at the University of Pittsburgh Cancer Institute (UPCI). "D3 will enable UPCI's radiation oncologists to extend the highest quality in radiation treatment to patients in communities throughout western Pennsylvania where it was not previously accessible."

According to Ronald B. Herberman, M.D., director of UPCI and UPMC Cancer Centres and associate vice chancellor for cancer research, University of Pittsburgh, UPCI plans to launch the new company's services throughout its cancer centres over the next several months.

"As the world's first radiation oncology telemedicine company, D3 is making it possible for medical institutions anywhere in the country to provide patients with highly sophisticated radiation therapy without having to buy treatment planning software", stated Joe Nicholas, CEO of D3. "We will give clinics that lack physics resources or funding for new technology a means of implementing IMRT by combining centralised treatment planning with in-depth training on treatment delivery, verification, and quality assurance protocols."

Clinics and hospitals working with D3 will use Varian's SomaVision software to identify tumours and transmit patients' diagnostic images and dose prescriptions to D3. D3 will then use Varian's Eclipse and Helios software to develop treatment plans that map out precise beam angles, beam shapes, and exposure times needed to achieve the desired IMRT radiation dose intensities to the tumour. D3 will transmit the plans back to the clinics for approval by their radiation oncology staff, which administers treatment to the patient. Clinics will compensate D3 for treatment planning, and D3 will compensate Varian Medical Systems for the use of its software, on a "pay-per-plan" basis.

Radiation oncologists at UPCI, including Shalom Kalnicki, M.D., vice chairman for clinical affairs, department of radiation oncology, and Andrew Wu, Ph.D., director of medical physics at UPCI, were the first to introduce IMRT to patients in the greater Pittsburgh area. "IMRT conforms the radiation distribution tightly to the three-dimensional irregular shape of a tumour", explained Dr. Wu. "Instead of treating a tumour with a few large and uniform flat beams, as has been done in the past, we treat the tumour with many, many small beamlets with different intensities. The intensity of each of these individual beamlets is optimised, enabling us to directly target and destroy the tumour."

IMRT is combined with a process called inverse treatment planning to determine the best way to treat a patient. It relies on CT and MRI data from patients that is processed and analysed by a complex computer system to produce the ideal radiation dose distribution for that patient. "UPMC Cancer Centres is currently one of the top five institutions in the country in its volume of patients being treated with IMRT", stated Dr. Kalnicki. Dr. Kalnicki will serve as medical advisor for D3 and Dr. Wu will serve as its chief scientific officer.

Leslie Versweyveld

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