TrueBeam STx with Novalis technology

Minimally invasive radiation therapy


Radiation therapy is one of the most powerful weapons we have to fight cancer. A radiation beam is released destroying the tumors. It can be used alone or in combination with surgery and/or chemotherapy. It is a noninvasive outpatient procedure that requires no anesthesia.

At iTAcC, radiation therapy is based on the TrueBeam-STX system.

When compared to conventional linear accelerators, it is a versatile integrated radiotherapy and image-guided radiosurgery platform which can treat moving tissues with unprecedented levels of accuracy and speed. It is considered to be the most accurate, reliable and complete linear accelerator in existence. It has been defined as the level of excellence needed for any radiotherapy treatment while at the same time providing radiotherapy with a novel conceptminimally invasive radiotherapy.

Adventages of the TrueBeam STx over other linear accelerators

  • Brings together and improves classical radiation treatments in accuracy and speed. It allows for the management of very high doses of radiation in only a few seconds and at selected body points.
  • It opens the possibility of treatment in patients when the indication of radiotherapy had been ruled out, giving way to new therapeutic options for patients with abdominal metastasesnon-resectable liver tumors (primary and metastatic) pancreatic cancer and primary or metastatic lung tumors when surgery has been ruled out.
  • Precision is the standard for treatments done with Truebeam-STX.  It has a number of systems that guarantee accuracy:
    1. RapidArc system
    2. The OBI device (Onboard Image). It allows for positioning the patient in the exact location for treatment and carry out Image guided radiotherapy 2D/2D safely.
    3. With the “cone beam CT” a CT can be done directly while the patient is inside the accelerator. It identifies bony structures and soft tissues in order to make sure the treatment position is correct and ensures that the tumor position is exact throughout treatment. It also performs high precision image guided radiotherapy 3D/3D.
    4. Exac Trac System for Image Guided Radiation Therapy (IGRT), X-ray detector setup in the treatment room and separate from the accelerator. This system allows for localizing the treatment area, using bony structures or implanted markers carrying out IGRT 2D/3D.
    5. A “Respiratory gaiting” system detects organ movement and carries out treatment with the same precision as if the organs were static; radiating only when the lesion is within the radiation beam. This system allows for a unique adaptation of the treatment and reduces the irradiation of healthy tissues.
    6. The robotic table 6D (moves within the three linear axes of space and the three angular axes of the same coordinate with IGRT and “Respiratory gaiting” systems.
    7. Dynamic micromultileaf.
    8. Devices for restraining, repositioning and correct location of the patient during treatment of each specific body area.
    9. Modules for stereotactic radiosurgery techniques.

team of experts employs all the technological advances incorporated into the TrueBeam STX permitting high-therapeutic efficacy while at the same time minimizing side effects under a more precise and selective localization of the tumor cells to be treated.

Treatment techniques

This device allows the following techniques to be carried out in a safe and precise manner in comparison to other types:

This type of treatment is done in only one volume and not in sections as in the case of the antiquated tomotherapy, avoiding uncertainties regarding patient movement during treatment.

Radiosurgery is noninvasive and allows for the administration of a high dose of radiation to small intracranial lesions in an extremely precise and accurate manner. The goal is the destruction or necrosis (cell death) of the treated lesion. This technique is called “radiosurgery” because the results are similar to those obtained by radical surgery, but:

  • Completely noninvasive.
  • Without anesthesia
  • Only a few outpatient sessions are required (1 to 5).

Multi-phase treatment:

  1. Design and planning phase: Prior to treatment it is necessary to create a customized immobilization system. For treatments with TrueBeam-STx a highly tolerable thermoplastic mask is used (frames anchored to the skull by screws are no longer required). Subsequently, a series of planning tests are done by computed axial tomography (CAT), magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA) in order that the neurosurgeon along with the team of iTAcC specialists (neuroradiologists and radiation oncologists) develop a personalized treatment plan in relation to the characteristics of the lesion to be treated.
  2. Once the design and planning phase has been finalized and the quality control protocol carried out, then radiosurgery commences under the supervision of the multidisciplinary team, responsible for the treatment plan (neurosurgeon, radiation oncology specialists, and neuroradiologists).

The session lasts only a few minutes. The majority of the time is dedicated to ensuring that all planning parameters are met and to guarantee the accuracy of all the process steps.  In this way the treatments are done with sub-millimeter accuracy. The radiation delivery lasts only a few seconds and is painless.  Once the treatment is finished the patient is able to continue his or her professional or family life with complete normality.


Indications for radiosurgery of the brain are supervised by a neurosurgeon. It is a technique indicated in the following cases:

  • Brain metastases
  • Brain tumors
  • Meningiomas
  • Schwannomas (neurinomas)
  • Pituitary tumors
  • Arteriovenous malformations
  • Trigeminal Neuralgia
  • Movement disorders
  • Epilepsy
  • Some psychiatric disorders.

In any case, the decision is always made jointly between a team of specialists in Neurosurgery, Neurology, Radiation Oncology and Neuroradiology.

The radiation can be focused on any tumor of the body while protecting healthy tissues. This is done thanks to the sub-millimetric precision of the Truebeam-STX along with the exhaustive work of our team of physicists which has obtained accuracy inferior to a tenth of a millimeter (Isocentro Image).  We consider that our team is extremely reliable for carrying out radiosurgery treatments and stereotactic body radiation therapy (SBRT).

The implementation of image-guided radiotherapy (IGRT) over a linear accelerator reduces the inherent uncertainties in other systems. It can be carried out with low levels of toxicity or none at all reinforcing the idea that radiotherapy is minimally invasive.

Radiosurgery treatments with TrueBeam STX, image guided (IGRT) along with the correct use of both “respiratory gaiting” systems connected to the robotic table give the impression of surgical treatments in some cases.  One of the main differences is that there is no need for incisions or to place invasive devices such as frames anchored to the skull (GammaKnife).  Punctures are not necessary for placing follow-up marks within the body (Cyberknife).  Without a doubt this greatly improves patient comfort during treatment.

Adaptive radiotherapy uses daily verifications.  They are made using IGRT for doing sequential adaptations according to tumor progression.  If the tumor decreases or increases during treatment, it is detected by our computers and the treatment is adapted to the new conditions.  This supposes a significant improvement in long-term treatments, as in the case of lymphomas, lung cancer, head and neck tumors.  The protection of healthy tissues is improved as well as preventing therapeutic mistakes that could happen in non-adaptive treatments.

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