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`Elekta Exhibit 1007
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`Page 1 of 3
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`Elekta Exhibit 1007
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`Page 2 of 3
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`

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`Proceedings of the 43rd Annual ASTRO Meeting
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`381
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`standard multileaf collimator by one or two steps of 20 when using multiple non-coplanar fields, there is no need for 3-mm
`micro-multileaf collimator in order to treat either spherical or complex GTVs.
`
`Situation
`
`One sphere (22 5-mm diameter) using 3-mm micro-multileaf collimator and 5 non-coplanar fields
`One sphere (22 5-mm diameter) using 9-mm standard multileaf collimator and 5 non-coplanar fields without collimator
`rotation
`One sphere (22 5-mm diameter) using 9-mm standard multileaf collimator and 5 non-coplanar fields with one collimator
`rotation of 20°
`Two spheres (15-mm diameter) using 3-mm micro-multileaf collimator and 5 non-coplanar fields
`Two spheres (15-mm diameter) using 9-mm standard multileaf collimator and 5 non-coplanar fields without collimator
`rotation
`Two spheres (15-mm diameter) using 9-mm standard multileaf collimator and 5 non-coplanar fields with one collimator
`rotation of 20°
`
`V95% - VGTV
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`0 000 ml
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`0 008 ml
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`0 008 ml
`0 050 ml
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`0 060 ml
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`0 056 ml
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`2299 Development of a New Linear Accelerator Mounted with Dual X-Ray Fluoroscopy Using Amorphous
`Silicon Flat Panel X-Ray Sensors to Detect a Gold Seed in a Tumor at Real Treatment Position
`
`Y. Takai1, M. Mitsuya1, K. Nemoto1, Y. Ogawa1, H. Matsusita1, S. Yamada1, H. Mostafavi2, M. Marc2, A. Jeung2, S.
`Manfield2
`1Radiation Oncology, Tohoku Unversity, Sendai, Japan, 2Ginzton Technology Center, VARIAN Medical Systems, Mountain
`View, CA
`
`Purpose: Set-up error and organ motion interferes with the accuracy of radiotherapy for extracranial tumors. We usually
`take a linacgram for verification of irradiation field, because the set-up accuracy is usually no better than 1.0 cm for body
`tumors. In the stereotactic radiotherapy, the position and movement of tumors should be detected before every treatment.
`Linacgram is not suitable for the verification of steretactic irradiation , because tumors (or gold seeds in the tumors) in
`the lower lung, liver or abdominal organ is not detected by that. So the purpose of this study is to develop the linear
`accelerator mounted with two fluoroscopy, using recently developed amorphous silicon (a-SI) flat panel to detect tumor
`position and movement for better daily positioning accuracy after a setup of a patient on the couch of the linear
`accelerator.
`Materials and Methods: Clinac 23EX (Varian Medical Systems) was mounted with dual X-ray generators (RAD II simulator:
`Haynes Radiation Ltd.) on the gantry with a 90 degree angle (each one was mounted at ⫾45 degree from the beam axis of the
`Clinac). The range of output kVp of this X-ray generator is 40 to 150 in 1 kVp increments digitally displayed, and exposure
`time is 8 ms to 10 seconds. Two sets of a-SI flat panel X-ray sensor (PaxScan 2520: Varian Medical Systems) were also
`mounted on the gantry at just the opposite places of the X-ray generators. The size of this flat panel and its imaging area are
`16.6 x 25.8 cm and 7.1 x 9.4 cm, respectively. The images from this sensor were obtained as 15 frames per second, and
`outputted as digital video signals.
`The image of a gold seed on a rotating disk or in a metastatic lung cancer of a patient with Ewing tumor was tried to be
`detected with these dual a-SI flat panel X-ray sensors. The size of rod shaped gold seed is 0.8 mm in diameter and 3 mm
`in length. This gold seed is implanted into the tumor of a patient using disposable sterile needle of which a gold seed is
`charged in the tip.
`Results: A picture of newly developed linear accelerator mounted with a dual fluoroscopy using a-SI flat panel X-ray
`sensors is shown in Figure 1. The images of gold seed on a rotating disk and in the lung cancer were clearly obtained by
`this system.
`Conclusion: The new linear accelerated system developed in this present study seems to be very useful for the set-up of a
`patient, and to verify the irradiation field just before irradiation. This helps to lessen the systematic error that is caused by body
`movement of a patient and so on. We are now investigating continuous monitoring of the tumor movement during irradiation
`using this new system.
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`Page 3 of 3