How much does the LINAC model matter?

[duckcalldan]

Today I had my sim visit at my RadOnc’s facility. Great staff, very positive experience, feeling ready to proceed with my VMAT sessions in a couple of weeks. I asked them if I could take a look at the LINAC I’ll be using, and a nurse asked the tech “Will it be the True Beam or the IX?” The answer was the IX.

When I got home and looked it up, it seems the Varian IX is a 20 year old model with less precision and older on-board imaging tech than the True Beam. I know that the people administering my RT are a more critical variable than the equipment, but is it advisable to push for my treatments on the True Beam? I only get one shot at full pelvic RT and I want to make sure that I don’t regret my decision. I am not getting a barrier like SpaceOAR by the way.

[Tall_Allen]

The linac doesn't matter. Better imaging only matters for SBRT, not for 28 fractions. Usually, it has cone beam CT or stereo X-rays.

[GP24]

I would try to get radiated with the newest radiation system. You have to ask them soon, after they have done the radiation plan they will not change anymore.

[duckcalldan in reply to GP24]

I messaged my RadOnc as soon as I got home. He’s very good at replying so fingers crossed.

I’m wondering if they prefer that IMRT folks use the older machine, leaving the True Beam open for SBRT patients.

[duckcalldan]

And I just got a reply from my RadOnc:

“Hi Dan, thanks for the question. In reality the machines are capable of delivering the same great treatment for most patients. The truebeam has more bells and whistles and can do some treatments the ix can't. The imaging is a little better with the truebeam which is needed depending on the case. It also has a "6 degrees of freedom couch" which is pretty cool along with intrafraction monitoring among other things. We'll review in more detail when I see you again.

I reviewed your case with my team. We'll be using the truebeam for you. The extra technological options on the truebeam will be needed with our treatment plan and daily setup. Thanks!

Chris”

So I am happy about that. I only get one chance for full pelvic RT so it might as well be the best tech possible. And yes, he’s on a first name basis with me.

[Kayakbob in reply to duckcalldan]

What a great relationship you have with your rad onc ! He takes your input seriously, without becoming defensive. Best of luck with your treatment.

[duckcalldan in reply to Kayakbob]

He’s really a great guy. Young, got his medical training in the Army medical school in Bethesda, and his residency at National Cancer Institute NIH/Walter Reed. He was the head RadOnc at the nearby joint military base here in WA before switching to the civilian world.

[Don_1213 in reply to Kayakbob]

I'll 2nd that. This is a guy you want to hang on to..

FWIW - my RadOnc also didn't ask for SpaceOar either - he said on the TrueBeam he didn't feel he needed it. I had asked about using a barrier.

He also didn't do the gold seeds (markers)—he said it made the technicians lazy. They'd focus on the markers instead of the important thing—the actual tumor. I also suspect (from your bio) that "large, extraprostatic extension" probably has something to do with the machine selection.

Good luck with your treatment - I think you're in good hands. Hopefully you've found an equally capable medical oncologist.

[j-o-h-n]

Just make sure they plug it in..........

Merry Christmas.

Good Luck, Good Health and Good Humor.

j-o-h-n