There are only a handful of TrueBeam linear accelerators in Australia – and Wollongong Hospital has one. LISA WACHSMUTH takes a look at the state-of-the-art machine that is revolutionising cancer treatment.
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The patient lies completely still, a white mesh mask covering his face, while robotic arms encircle him and search for the deadly tumour inside.
The machine continuously monitors the minute movement of the tumour as the patient breathes and stirs slightly; only emitting a precisely sculpted dose of radiation when the target is in exactly the right place.
By integrating three-dimensional imaging with radiation therapy, the state-of-the-art piece of equipment is able to zone in - with sub-millimetre precision - and attack the cancer cells while minimising the damage to healthy, surrounding tissue.
''This allows us to 100 per cent customise the radiation therapy for each person - to provide bespoke care.''
The machine in question - the US-built Varian TrueBeam - has only been installed at four hospitals throughout Australia to date, including Wollongong Hospital.
The $3.8-million machine which became operational in January this year means that cancer patients in the Illawarra and Shoalhaven now have access to the best radiation therapy in the nation, indeed the world.
As well as its ability to target cancer more precisely than former models, the TrueBeam has the capacity to drastically reduce the time, and number, of treatments required.
Combined with two older-model linear accelerators at Wollongong and one at Shoalhaven Hospital, it offers community members prompt access to a cancer treatment that is, unfortunately, in high demand.
In 1997 - with two machines in operation at Wollongong Hospital - just over 700 courses of radiation therapy were delivered; in 2013 that had risen to 1000.
With the four machines now in play at the two hospitals, up to 2000 courses of treatment are now capable of being delivered in 2014.
Illawarra Shoalhaven Local Health District (ISLHD) director of cancer services Anthony Arnold said all machines were "matched" to allow patients to interchange between them.
What the new machine delivered - radiation - had not changed; rather it was how it delivered that dose that made the difference.
"The machine delivers high-energy X-rays and radiation targeting tumour cells," he said.
"The radiation damages the tumour cells, or breaks down their DNA, with the principle that once these cells are damaged, they die off.
"The new machine doesn't deliver a different type of radiation - what comes out of all the machines is identical - what's different is the extra features it brings including the ability to provide the highest level of accuracy possible.
"This helps us to minimise side-effects and make sure we're treating the right spot and not treating areas we're not intending to treat."
The pinpoint accuracy is made possible through what is called a Cone Beam CT, which can rotate around the patient and produce a three-dimensional CT scan.
"So instead of looking at a plain, two-dimensional X-ray, we are able to assess the patient in three dimensions in real-time," Arnold said.
"This allows us to track any changes - for instance if the tumour has shrunk, if any of the [lymph] nodes are bigger - and then the treatment can be modified to suit."
Because this type of linear accelerator - or linac - doesn't take a one-size-fits-all approach, ISLHD chief radiation therapist Justin Dixon said it could be used to deliver numerous forms of radiotherapy, allowing doctors to customise treatments for each patient.
"To make a comparison, these days you can't buy a car without airbags, ABS brakes and so on," Dixon said.
"In the same way, this new machine comes with all the most technologically advanced options as standard.
"That includes three-dimensional CTs, and that includes the fact that it is fully digital which means the radiation dose is far more controlled.
"So this allows us to 100 per cent customise the radiation therapy for each person - to provide bespoke care.
"So once a person consents to treatment and has an initial CT scan, our highly trained staff spend hours working out the best way to deliver their individual treatment."
Some of the machine's most advanced options are still being investigated for use at Wollongong Hospital. These include the ability to deliver higher doses of radiation in a shorter amount of time.
Mr Dixon said this could potentially shorten the treatment time from around 15 minutes to five minutes - a big difference for a patient being forced to stay unnaturally still.
"We've got the equipment, we've sent staff to training courses overseas and recruited new staff so they're all highly skilled," he said.
"Now we're developing strategies to bring even better care to patients by looking at all the options available to us.
"In this way, this latest machine enables us to future-proof the district's cancer treatment services, so we have the capacity to service more patients and in different ways, into the future."
About a quarter of patients undergoing radiation therapy in the ISLHD are battling breast cancer, while there are also high percentages of people with lung, prostate, head and neck and rectum cancers receiving treatment. Other cancers, and some non-malignant diseases, are also covered.
Treatment aims to eradicate cancer, but in some patients - where cancer has spread to the bones - radiation can also be used as a form of palliative care to lessen the pain and stop further cancer growth.
Radiation therapy is currently bulk-billed, meaning no out-of-pocket expenses for patients.
The new linear accelerator at Wollongong Hospital was unveiled in December last year at the official opening of the $14 million expansion to the Illawarra Cancer Care Centre.
A month earlier, a new $38.4 million cancer care centre at Shoalhaven hospital in Nowra had opened with its own linear accelerator.
Work on the two facilities started in April 2010 when the thenfederal Labor government announced funding of $12.1 million for the Wollongong centre and $24 million for the Nowra centre. Extra funding would come from the state government and through community fund-raising.
At the unveiling of the TrueBeam machine at Wollongong, NSW Health Minister Jillian Skinner called it a "magic piece of equipment" which would make a big difference to the treatment of cancer patients in the district.
Both machines took time to install, as they had to be fitted in concrete radiation bunkers before undergoing calibration and vigorous testing.
Staff control the machine and are able to communicate with patients via an adjacent control room.
ISLHD director of radiation oncology Chris Fox said the arrival of the new machines at Wollongong and Nowra had helped the district build its capacity to cater for patients along the South Coast.
Previously patients from the Shoalhaven had to travel to Wollongong for treatment, but the demand in that region is clear, with the new machine in Nowra already at 90 per cent capacity.
Meanwhile at Wollongong, with three machines, there is still the capacity to transfer patients from the Shoalhaven if need be.
"If the single machine in Nowra breaks down, it might take three days or more to fix, which is not good for someone who is in the middle of treatment," Fox said.
"Now we have spare capacity at Wollongong to enable those patients to continue with their treatment.
"It also means we have the capacity to address the increasing numbers of patients we are seeing, year to year."
Only a very small percentage of South Coast residents now travel to Sydney for radiation treatment, including children who use the facilities at Sydney Children's Hospital.
With this new machine, that requirement to travel will lessen further.
"[The TrueBeam] is something our entire department is proud of," Arnold said.
"To have the fourth one in the country, it's a major thing for our area.
"We really need people to understand that you don't need to go to Sydney to get the best radiation therapy available."