The new Aquilion Exceed LB of Canon Medical Systems has been devel-oped for a quick, smart and accurate CT simulation. With the largest gantry opening in the industry (90 cm), the user can position patients with exceptional precision.

The Aquilion Exceed LB makes use of advanced AI image reconstruction (AiCE) for an accurate depiction of tumors and surrounding critical organs. In combination with a true Field- of-View (FOV) of 70 cm, an extended FOV of 90 cm and a detector scope in the direction of 4 cm, the Aquilion Exceed LB makes the work flow more accurate, faster and more efficient, without making any concessions to the image quality or the reproducibility of the position of the patient.

As a clinical physicist, Dr. Kaatee plays a pivotal role at RIF. As a subject matter expert, he is ‘responsible for the adequate and proper clinical application of medical physics’, if his job could be described in one line. In practice this means that Dr. Kaatee applies his knowledge of physics, measuring techniques and the processing and interpretation of measurement data to facilitate the work of the radiotherapist and support the technologists as efficiently as possible.

This well-oiled system of 'man and machine' requires constant consultation and corrective adjustment to optimise the individualised care RIF offers its patients. “However technically advanced the Aquilion Exceed LB is, it is primarily a means for us to realise our aim: the treatment of patients. In my opinion, the crux of the treatment is the team of technologists and clinical physicists. Their expertise and skill in knowing how to use the Aquilion Exceed LB enables me to provide the best radiotherapy,” says Radiotherapist Drs. Annelies van der Geest. “I can be totally confident that this team will configure the equipment in the optimal way for each patient. The possibilities offered by the Aquilion Exceed LB are phenomenal, however no single patient is standard. We therefore constantly focus on the optimisation process.”

Dr. Kaatee gives an example that illustrates the individualised care described by Van der Geest. “A tumour is usually depicted on an MRI scan, after which the dose calculation is carried out on a CT scan. This means that you have to copy the target area, which is depicted on the MRI, to the CT scan. This scan must have excellent image quality, otherwise you cannot check the match and the patient is radiated in an inefficient way. To obtain the best scan and treatment protocols, the excellent image quality of the Aquilion Exceed LB is crucial,’’ says Dr. Kaatee.

Technologists Ragna Dik and Eddy van den Bosch, who are used to working with Canon Medical equipment, also appreciate the very high image quality of the new system. However, the RIF team still manages to introduce improvements in this respect. For example, the team has already optimised the head-neck scans by varying the spatial resolution and by using smart tricks to bring the 4D scans to the level required by RIF. They always think of the ultimate objective of their treatments: to carry out a treatment with the lowest radiation level, while achieving the best possible image quality.

One of the main advantages in relation to other systems, is the tremendous improvement in reconstruction speed. The reconstructions of the most advanced and frequently used 4D scans are available within a few minutes. It is also because of this time saving that 4D scans can be planned in a more flexible way than before.

The seamless interface with the Varian Respiratory Gating system (RGSC) is also responsible for the increased efficiency of the 4D scans. During a 4D scan, whereby the respiration signal is recorded with the Varian application, the complete signal is passed on, compared to the previous situation whereby only the triggers of the peaks were imported.

The advantage of this is that a good 4D scan can now also be made of patients with slower respiration rates. Even patients with a very slow respiration rate of 10 seconds can be scanned on the Aquilion Exceed LB with great accuracy.

Besides making life easier for the physicians, the Aquilion Exceed LB also makes the treatment more bearable for patients. Radiotherapist Drs. Annelies van der Geest: “For me as a professional, a feature such as Single Energy Metal Artifact Reduction (SEMAR) is a marvellous way to optimally depict the target area in the most challenging patients. However, our patients are clearly very enthusiastic about the fantastic user experience. This experience is evident in several ways. First of all, we are available when necessary. The greatly reduced reconstruction time is largely responsible for this. Because the reconstruction times are faster we can plan a 4D scan any time of the day.”

Moreover, it is necessary for radiotherapy patients to be positioned for the CT scan in the same way in which they will be radiated. This means that for radiotherapy treatment for breast cancer for example, they have to raise their arms when going into the scanner. For this, the large bore of 90 cm is an indispensable feature that offers the necessary flexibility. “Certainly if the patient is slightly claustrophobic, the advantage is considerable,” says Eddy van den Bosch. “And in this respect the speed of the scanner is also important.”

“RIF is clearly very happy with the new scanner,” concludes Dr. Kaatee, “and the ongoing cooperation with Canon Medical Systems. The connectivity of the Aquilion Exceed LB with hardware and software solutions such as the Varian RGSC system, Elekta Mosaiq Care Management software and the RayStation treatment planning system is excellent. Our engineers can use the system almost blindfolded.

The Canon Medical service team are available whenever we need them, but we do not really expect to see them with this new CT system. As was the case with our previous scanner, downtime does not apply with the Aquilion Exceed LB.” //