The intent of radiotherapy is to deliver therapeutic radiation precisely on target while avoiding healthy tissues, making accurate patient positioning and intra-fraction motion monitoring vital. Accordingly, the cancer care team at Miami Cancer Institute (MCI) consider C-RAD’s Catalyst+ HD and Sentinel™ 4DCT to be essential technologies in nearly every case they have encountered since they began using the solutions in 2020.
Catalyst+ HD is a complete SGRT (surface guided radiation therapy) solution for high-precision patient positioning, intra-fraction motion management and respiratory gating, while Sentinel 4DCT optical surface scanning enables 4DCT reconstruction and gating in the CT room. Both products work together in an end-to-end, seamless workflow solution.
“We use Catalyst+ HD for pretty much all of our cases,” says Ana Cecilia Botero, MD, a radiation oncologist at MCI, part of Baptist Health South Florida (Miami, Fla. USA). Dr. Botero is based at MCI’s freestanding Plantation, Florida facility. “These include gynecological malignancies, breast cancer—especially deep inspiration breath-hold [DIBH] cases—head-and-neck patients, and prostate cancer SBRT.”
Both Dr. Botero and Dr. Siju George, an MCI medical physicist, rely so critically on their C-RAD solutions that they have “locked” the ability to treat on their Varian linacs if Catalyst+ HD is unavailable.
“To this day, we have never had an instance in which the C-RAD products were unavailable for patient treatments,” Dr. Botero says.
“That’s how reliable the C-RAD products are,” she observes. “If they weren’t dependable, we wouldn’t lock ourselves out like that. The physics team and I are truly C-RAD dependent.”
In all indications, Dr. Botero has gained an appreciation for the ability, with C-RAD SGRT solutions, to decrease acute and late side effects.
“Catalyst+ HD and Sentinel give us peace of mind that we’re maximizing avoidance of organs at risk.”
“Especially now that we’re moving from not only chemotherapy, but also immunotherapy – sometimes patients get double or triple systemic therapies,” she says. “So, we’re ‘bombarding’ them and increasing the dose per fraction with radiotherapy. Preventing side effects and irradiation of uninvolved organs is extremely important, especially when you’re treating breast and prostate. Late side effects in the heart or lung – increased coronary artery disease or significant radiation pneumonitis – sometimes occur two to 10 years after treatment and we make all efforts to ensure they don’t develop in our patients. That makes us very cognizant of the importance of protecting healthy tissues. Catalyst+ HD and Sentinel give us peace-of-mind that we’re maximizing avoidance of organs-at-risk, for every fraction.”
Dr. Botero’s team began using the C-RAD products immediately for DIBH treatments of left-sided breast cancer patients. For patient positioning, Catalyst+ HD localizes the proper isocenter and applies couch shifts to fine-tune the patient localization. Catalyst+ HD, equipped with C-RAD’s respiratory module, ensures that the patient is executing the correct breath hold for DIBH; the treatment beam turns on when the patient’s breath hold is within tolerance and halts the beam when the patient’s breath hold is out of tolerance.
“Obviously, some patients cannot perform the breath hold technique for specific reasons—they may have chronic obstructive pulmonary disease or they’re elderly—but you would be surprised that with some minimal at-home training, most of them can do a DIBH technique. In three years, only one patient was unable to perform the required breath-holding,” she adds. “Then with Catalyst+ HD, not only can we position the patients easily, but the accuracy of the positioning and the delivery of the treatment are exceptional.”
Not only does Catalyst+ HD provide sophisticated set-up and positioning for a wide range of cases, but the clinical team also has noted it’s easy to learn to use and easily integrates into the MCI workflow, according to Dr. Botero.
“The learning curve for the therapists was very short and the interoperability of Catalyst+ HD with the Varian TrueBeam linac has been excellent,” she says. “From the ease and accuracy of the set-up to treatment delivery, Catalyst+ HD offers a very streamlined workflow. We aren’t causing any delay at all in patient set-up, which gives us confidence that we are delivering the treatment accurately.”
A key patient benefit has been the ability to avoid using tattoos for patient localization if patients object for religious or aesthetic reasons.
“If patients have an issue with tattoos, we can comply with their wishes and not use them,” Dr. Botero says. “In addition, for patients with complicated set ups, Catalyst+ HD helps a lot by decreasing set-up time.
“Overall, C-RAD products have been simple, user-friendly and reliable,” she adds. “They’re patient-friendly, easy for the therapists to use, and have made my work life better. I can rest assured knowing that I’m doing the right thing for my patients.”
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