Novalis Shaped Beam Surgery

What is Novalis?

Novalis, BrainLAB's dedicated system for non-invasive stereotactic radiosurgery (a high dose of radiation applied in a single session) or stereotactic radiotherapy (radiation administered in a series of treatment sessions) (SRS/SRT).

Novalis is the optimal tool to effectively and safely perform the advanced techniques of 3-D CRT, high resolution intensity Modulated Radio Surgery (IMRS) and Intensity Modulated Radio Therapy (IMRT) on tumors throughout the body.

IMRS : IMRT combined with accurate target positioning. Only the combination of IMRT with precise target positioning will allow to tailor the IMRT dose as tight as possible around target volume.

Cancer treatment with Novalis Novalis shapes the radiation beams to match the exact shape of the tumor or lesion by using micromultileaf collimator (mMLC). Even the irregularly shaped tumors or lesions receive doses of radiation totally consistent with what the physician prescribes. The result is the tumor or lesion receives its prescribed dose of radiation while avoiding critical tissues and organs. The mechanical accuracy of the Novalis system, as well as its precise localization and positioning technology, allows for the patient to reduce the total number of fractions for the treatment of certain indications, thus minimizing the cost per patient.

What cancers and illnesses can Novalis treat?

Separate beams of radiation attack the tumor from
various angles to spare healthy tissue in the brain

• Primary brain tumors
• Gliomas (astrocytomas, glioblastomas, oligodendrogliomas, ependymomas)
• Acoustic neuromas / acoustic schwannomas
• Pituitary tumors
• Meningiomas
• Brain metastasis
• Hepatocellular carcinoma
• Cholangiocarcinoma
• Liver metastasis
• Lung cancer

Non-cancerous conditions

• Arteriovenous malformations (AVMs)
• Cavernous malformations
• Trigeminal neuralgia
• Intractable seizures
• Parkinson's disease
• Extracranial disorders

Why would I like to choose Novalis for Treatment?

The primary advantages of stereotactic radiosurgery are its precision and minimal risk Equipped with highly sophisticated computer-based imaging techniques, Novalis delivers the radiation beam with a high precision and produces a sharp radiation dose gradient at the tumor and normal tissue boundary.

X-ray imaging for pre-treatment set-up verification

It may therefore be the treatment of choice for patients whose doctors cannot perform traditional surgery due to the increased risk of harming critical structures inside the brain. Tumors located deep in the brain or in other inoperable areas may be treated with Novalis . Novalis is also increasingly a treatment of choice for patients with multiple tumors in different areas of the brain or tumors throughout body. Novalis has an exceptionally high dose rate of 800 cGy/min, resulting in a total treatment time much shorter than that obtained with conventional linac or cobalt-based radiosurgery units.

Novalis Basic Principle

Novalis device is a high precision LINAC (linear accelerator) unit, which generates single energy x-ray (6 MV photon beam) and is equipped with an m3 High-Resolution Multileaf Collimator (52 leaves) with its fine 3mm leaves width at isocenter. Novalis has revolutionized radiosurgery by introducing conformal treatments that precisely tailor the dose to the shape of the tumor. The shape of treatment field ranges from 3 x 3 mm2 to 100 x 100 mm2.

The system is capable of performing dynamic and segmented IMRT or IMRS is the software for the inverse IMRT treatment plans. The m3 enables the delivery of superior homogenous dose distributions with a steep dose gradient-an essential requirement for SRS treatments.

The leaves of the m3 are automatically placed around the target for all beam angles with the desired margin. Risk organs may be automatically protected by the leaves, with manual adjustments possible at any time.

EXACTRAC PATIENT POSITIONING PLATFORM is an infared-based patient positioning platform, which relates the patient's current position to the planned position. The integrated real-time verification of the patient's positioning during treatment results in greater patient set-up accuracy compared to conventional skin markers. Furthermore, the automatic table movement provides greater efficiency during clinical continues and is suited for conformal and IMRS/IMRT treatments. Moreover, by using Image-guided technology (IGRT), Novalis has an x-ray image verification system (EXACTRAC X-RAY 6D) in order to assure the accuracy and reproducibility of pre-defined treatment set-up.

ExacTrac X-ray Adaptive Gating

Respiration induced motion of lung and liver tumors make the accurate delivery of radiation to these lesions particularly challenging. ExacTrac X-ray Adaptive Gating of BrainLAB is a new tumor tracking and targeting system. Due to Respiratory Gating, the system increases the treatment accuracy.

Novalis Treatment Procedure

Step 1 :

Fitting of the Headframe / Mask Attachment / Custom body support system.

The doctor will select the immobilizing device best suited for the patient's therapy.

The head ring works to hold reference markers in a fixed position in relation to your head during imaging and treatment for SRS. If you are undergoing fractionated stereotactic radiotherapy (SRT), a face mask will be used instead of the metal head ring. Its use is painless. For a lesion outside the brain, a custom body support system may be used instead.

Step 2 :

Diagnostic Imaging

After the immobilizing device is secured, you will undergo a series of diagnostic scans in order to precisely define the size and shape of the lesion and its relationship to other structures. During the diagnostic imaging the metal head ring / the face mask / custom body support system will be worn.

Step 3 :

Image Transfer and Planing

The radiosurgery team gathers information from the scans and enters it into the Novalis computer program to determine the precise target position, dosage and configuration of radiation beams. While the treatment is being planned, the patient will be free to move. Once the customized treatment plan has been completed, the patient will be positioned comfortably on a specially designed couch. Next, a series of carefully controlled quality checks using Novalis instruments are performed prior to treatment in order to assure that the radiation beams will be guided precisely to the chosen target positon.

Step 4 :

Treatment

The actual treatment session typically takes less than 30 minutes. This involves the movement of the Novalis machine around your head or your body as the focused beams converge on the target. Multiple radiation beams radiate the tumor from different angles. The invisible radiation is not felt at all.

Case Study

Hepatocellular carcinoma (HCC) 3-D conformal radiation therapy (CRT) is very useful for the unresectable and medical inoperable disease in liver cancer patients. The patients were treated with 3-D CRT which reduced the symptoms and resulted in a better quality of life after treatment.