Varian responds to New York Times article

Over the past few days, there have been a number of articles published on the safety of linear accelerators.  In fact, radiation therapy is one of the safest and most effective treatments for cancer.  Like much of the technology we use today (airplanes and automobiles, for example), there is always a marginal risk of danger, often tragic, and even more often due to human error.  The letter below issued from Varian Medical Systems highlights this point:

January 25, 2010

Dear Customer:

You may have seen the New York Times article on January 24th, “Radiation Offers New Cures and Ways to Do Harm.”

Like you, we are committed to saving lives, and so we are deeply saddened by these events. We realize that you may get questions from patients and others, stemming from exposure to this news story. We have therefore pulled together some simple talking points that we hope will be of use to you.

If you receive any questions from patients, you can tell them that:

•   Radiation therapy is one of the safest, most effective ways to treat cancer. There were an estimated 35 million radiotherapy treatments on Varian machines last year. Errors do occur, but they are extremely rare, with fewer than 0.0001 percent of treatments involving an incident that puts a patient at risk of harm.

•   Varian has added protective features designed to prevent a tragic accident like the one that occurred in New York in 2005. Safety enhancements include checks designed to verify that essential treatment data are not missing or altered from a plan that has been approved by the authorized clinical staff member. In addition, the machine instruction sets must be consistent with the particular treatment mode that has been selected. Should a discrepancy be detected, the system requires the authorized person to correct it before a treatment can be delivered.

•   Therapy machines are continuously improved to help clinicians deliver treatments more safely.

•   You may also wish to remind your patients of the procedures you use to ensure the safety and effectiveness of their highly-customized and personalized treatments.

Patient safety is our primary consideration as we work to provide you with the tools you need to treat and cure cancer. For your further information, we are attaching the materials that we circulated to customers several years ago, after one of the incidents profiled in the New York Times article. The details might be helpful to you.

At Varian Medical Systems, it is our goal to put technologies into your hands that will continually enhance your ability to offer patients the safest and most effective forms of treatment possible. That is our promise to you.

If you have questions or comments, please contact us or your local representative.

Sincerely,
 
Tim Guertin
President and CEO
Varian Medical Systems 

Dow Wilson
President, Oncology Systems
Varian Medical Systems

PET/CT More Accurate than Some Routine Oncology Tests

January 13, 2010 – Compared to computed tomography (CT), mammography and other commonly used tests, positron emission tomography-computed tomography (PET/CT) scans of the whole body may more accurately detect cancer in individuals with related neurologic disorders, according to a report posted online today that will appear in the March print issue of Archives of Neurology, one of the JAMA/Archives journals.

Andrew McKeon, M.B., MRCPI, and colleagues at Mayo Clinic, Rochester, Minn., found paraneoplastic neurologic disorders occur in some people with cancer, including lung, breast or ovarian cancer, and may develop when cancer-fighting antibodies mistakenly attack cells in the nervous system. The researchers found that “patients with suspected paraneoplastic neurologic disorders, routine noninvasive oncologic evaluations may be unrevealing.”

The authors noted, “These standard evaluations include physical examination; computed tomography (CT) of the chest, abdomen and pelvis; mammography in women; and testicular ultrasonography and prostate-specific antigen testing in men.” Cancers underlying paraneoplastic neurologic disorders are typically small, restricted to one site and are often not detected until autopsy.

The researchers studied cases of 56 patients with suspected paraneoplastic neurologic disorders whose standard evaluations (including CT) did not reveal cancer. All of them underwent PET-CT at Mayo Clinic between 2005 and 2008.

Prior to undergoing PET/CT exams, the patients underwent a median of three other screening tests; the most common was CT of the chest, abdomen and pelvis. In 39 percent of the patients, PET/CT detected abnormalities suggestive of cancer, of whom 18 percent had cancer diagnoses confirmed by biopsy or another method. Nine of the 10 were early-stage cancers, and detection facilitated early treatment. Cancer remission was reported in seven patients and improvement in neurologic symptoms in five patients after a median (midpoint) of 11 months of follow-up.

While the authors noted they recognize the limitations of PET/CT, they said, “We favor this modality for initial oncologic evaluation of patients in whom a paraneoplastic neurologic disorder is strongly suspected. Elimination of whole-body imaging with CT alone before further imaging with PET/CT could reduce radiation exposure and the total financial burden of testing.”

This article was posted on the Imaging Technology News website on January 13, 2010.

ROS Customer’s in the News

The Animal Cancer Care Clinic in Ft. Lauderdale, FL was in the news recently for their new center that they opened in south Florida back in September.  ROS was the vendor of choice for The Animal Cancer Care Clinic and provided a turn-key equipment solution consisting of a refurbished Varian linear accelerator, refurbished GE CT simulator, a new Image Scan CR system and an assortment of physics and dosimetry equipment.

Here is the news story:

http://www.miamiherald.com/news/broward/communities/story/1426253.html

US Oncology emphasises importance of CT scans in cancer care

As an organization that supports more than 1300 oncologists who treat more than 750,000 cancer patients each year, we at US Oncology read with interest the recent discussions regarding the use of CT scans. We take cancer care and the health of cancer patients very seriously. To advance the delivery of quality care for Americans fighting cancer, US Oncology strongly supports evidence-based guidelines and treatment pathways and encourages their continued development and utilization.

After reviewing the latest research, we strongly believe that the benefits of appropriately-used CT imaging for cancer patients continue to outweigh the risks associated with exposure to low-dose radiation. Medical imaging is an integral part of the cancer diagnostic and treatment process. It is essential to accurately diagnose and stage the disease, and has a profound impact on decision-making on initial treatment, monitoring of response to treatment, adjustment of therapy, and in follow-up.

Radiation oncology today is inextricably linked to imaging with respect to treatment planning and delivery. Much of what we are able to achieve with dose-conformality, dose-escalation to disease, and normal tissue sparing is due to high quality imaging. It is essential in optimizing the quality of care a cancer patient receives.

Patient health and safety is always of the utmost importance. Appropriate utilization of any medical technology is critical to overall health care quality. However, a misplaced fear of CT scans could result in less than optimal management of certain patients. We, therefore, urge caution when evaluating the recent discussions and encourage patients to talk with their physicians about the right choices for their particular circumstances on the basis of all the available evidence.

CT Scans Linked to Cancer

By SHIRLEY S. WANG

(See Corrections & Amplifications item below.)

The risk of cancer associated with popular CT scans appears to be greater than previously believed, according to two new studies published Monday in the Archives of Internal Medicine.

The findings support caution against the overuse of CT scans and other medical technologies that use radiation. The studies also bolstered the rationale behind controversial new breast-cancer screening guidelines, which pushed back the recommended age for annual mammograms to 50 from 40. Mammograms also use radiation, but in smaller doses.

The CT — short for computerized tomography scan — can detect injuries and tumors. Its use has tripled in the U.S. since the early 1990s to more than 70 million in 2007. Though it has long been known that radiation increases a person’s chance of getting cancer, the exact risk of these scans wasn’t clear.

One of the studies, which examined more than 1,000 adult patients at four hospitals, projected that the dose of radiation received in a single heart scan at age 40 would later result in cancer in 1 in 270 women and 1 in 600 men.

Risks were lower for those who received a head CT scan: 1 in 8,100 women and 1 in 11,080 men would likely develop cancer from the radiation, the study said.

Doses of radiation from the scans varied wildly, according to the study, even within the same procedure at the same hospital.

Some patients got only one-tenth the radiation that others got, according to Rebecca Smith-Bindman, the first author on the study and a professor of radiology and biomedical imaging and epidemiology and biostatistics at the University of California San Francisco.

The findings raise questions about why radiation doses differ, and whether the variation is acceptable. “These are doses we should be concerned about,” said Dr. Smith-Bindman. “They don’t have to be this high.”

The variation in radiation exposure for any particular CT procedure is likely due to such factors as a lack of standardized settings, and differences in how the radiologists and technologists use the technology for different patients, according to Dr. Smith-Bindman.

A radiation dose that is too low, for example, could yield a picture that isn’t clear enough to reveal abnormalities.

The second study analyzed data from several databases and estimated that 29,000 future cancers could be related to CT scans received in 2007, with the greatest number of cancers projected in the abdomen and pelvis.

The cancer risk was greatest for young patients, this study found. For instance, a female who received an abdominal scan at age 3 had a 1 in 500 chance of developing cancer because of the radiation from that scan. That figure dropped to 1 in 1,000 by age 30, and 1 in 3,333 at age 70.

Overuse of radiation-based tests is a concern when they are performed to diagnose patients who have a known abnormality. But the concern is even greater when they are performed for screening purposes, said Amy Berrington, an investigator at the National Cancer Institute and an author on both papers. “You’re exposing a lot of healthy people” to radiation,” she said.

The doses of radiation received from mammograms are much smaller than from CT scans, yet the small cancer risk should be weighed when deciding whether to undergo routine breast-cancer screening, Dr. Berrington said.

In loosening the mammogram guidelines last month, a federally funded task force of physicians cited, among other factors, the potential harm from testing.

Despite these concerns, CT scans provide “great medical benefit,” she said. “On an individual basis, if the scan is justified, then the benefits should outweigh the risks.”

Write to Shirley S. Wang at shirley.wang@wsj.com

Corrections & Amplifications:
Data for a chart on the rising use of CT scans that accompanies this article were from the IMV Medical Information Division. The information is incorrectly attributed to the National Council on Radiation Protection and Measurements.

Sentinel’s CPT Code 0197T added to fee schedule for 2010

Highmark Medicare Provider, the Medicare contractor for the states of Pennsylvania, New Jersey, Maryland, Delaware, and the District of Colombia, has added Sentinel’s CPT Code 0197T to their fee schedule for 2010.

The C-RAD Sentinel™ is an advanced laser-camera based system for patient positioning, real-time motion tracking, and respiratory gating. Radiology Oncology Systems (ROS) is the exclusive distributor for Sentinel in North America.

Sentinel Reimbursement

A radiation therapy clinic in Florida reports receiving reimbursement from a variety of miscellaneous commercial payers and Medicare supplements under CPT Code 0197T for the Sentinel device.

The C-RAD Sentinel™ is an advanced laser-camera based system for patient positioning, real-time motion tracking, and respiratory gating. Radiology Oncology Systems (ROS) is the exclusive distributor for Sentinel in North America.

Topex SRT-100 Top Ten List

We have just returned from the ASTRO 2009 Conference in Chicago.  Many prospective centers expressed interest in the Topex SRT-100 superficial radiotherapy system.  Here is what we heard from clients, and we’ve compiled a “Top Ten List” of what facilities like about the Topex SRT-100:

1 – Depth Dose treatment range at 50, 70 and 100kV and the overall energy output of the system

2 – Ease of treating ‘Wheel Chair’ patients over LINAC systems

3 – Operating features – auto filter change. fast warm-up, ease of use control console with Physicist screen, applicator sizes

4 – QA/QC features – RAD Check, replaceable applicator TIPS, Physicist measurement procedures and fixtures

5 – Quantity of end user TOPEX sites

6 – Low capital investment at $100K delivered, installed, and one year service.

7 – Short Installation and training time

8 – Physicist and Therapist training programs

9 – Tomo-Therapy user centers expressed interest as a means to treat skin cancer

10 – Approved CPT code for reimbursement

ROS Fall Newsletter

Greetings!

Dear Friends and Customers,

With healthcare reform and impending reimbursement cuts on the horizon, we at Radiology Oncology Systems, Inc. (ROS) are more committed than ever to helping our clients thrive in the current environment.

Our second newsletter arrives on the eve of ASTRO, and we are excited to have the opportunity to meet with many of you personally to discuss your plans for 2010. This newsletter highlights successes of one of our clients and profiles another of our associates. As always, we welcome any feedback, insights or opportunities to help promote what is important to you and your practice.

Customer Profile
An Interview with Scot Ackerman, MD

Dr. Scot Ackerman is a Board Certified Radiation Oncologist with several practices, including First Coast Oncology in Jacksonville, Florida.

ROS: What are some of the challenges that your practice will face in 2009? 

Dr. Ackerman: Our challenge is to effectively meet all the needs of our patients. As the health care environment changes, so do the needs of our patients.  While our specialty is Radiation Oncology, as a practice we have always focused on treating the whole person. Now more than ever our patients need assistance beyond traditional services. We have two social workers on staff to help our patients with all their needs, from navigating insurance coverage to coaching patients on how to talk to their children about cancer. Over the years we have learned that by anticipating and addressing both physical and emotional issues, our patients often have better outcomes and a more satisfying experience.

ROS: How are you able to expand your practice in a competitive area like Northeast Florida?

Dr. Ackerman: Over the last 10 years, our growth strategy has been pretty simple – we have carefully built key relationships with patients, referring physicians, and the community as a whole.  We offer highly personalized care along with the latest technological advances. We provide breast and prostate therapies that aren’t offered anywhere else in the area. But most importantly, First Coast Oncology is highly responsive to the needs of our patients and referring physicians.

ROS: What do you see as a necessary advancement for the radiation therapy community in 2009?

Dr. Ackerman: Approximately two-thirds of cancer patients will require some form of radiation therapy during treatment. With the impending changes in the health care environment, Radiation Oncologists must become activists by educating the public about the key role radiation therapy plays in the successful treatment of cancer.

ROS: What do you attribute to your success in the Radiation Oncology?

Dr. Ackerman: My success is directly attributed to building relationships.  Earning respect from my patients, my peers and my community has helped me create a successful practice, and has allowed me to do what I love best: practice medicine.

Employee Profile: Walter Bergman
Getting to know our ROS Team Members

Walter Bergman is a Senior Sales Manager at ROS in the New Products Team.

ROS Editor: What are your responsibilities at ROS?

WB: My primary assignment here at ROS is Senior Sales Manager, New Products. I frequently travel around the country meeting with facilities, attending conferences and trade shows, and working with the New Products team. I work closely with the firm’s key partners, including Acceletronics, Theraview, C-Rad/Sentinel, Resonant Medical, Topex, and Radparts. I also manage both the New Product Sales Team as well as the Project Managers associated with our new product installations. Additionally, I work with our existing customer base to develop and provide clinical products and services for a more efficient Radiation Oncology/Radiology practice.

ROS Editor: What has been the most rewarding part of working at ROS?

WB: The most rewarding part of my role here at ROS is being in a facility after a successful product installation and seeing the “light go off” in the face of the clinicians, when they fully understand that they’ve made the right decision to purchase the right product, from the right company.  People do business with people they like, and I have had the fortunate track record of doing business with many good people.

ROS Editor: What are some of the daily challenges that you face?

WB: Creating and building product awareness is the biggest challenge in our division. We are constantly on the road, in and out of airports, rushing from one center to the next, and managing to maintain the enthusiasm that all of our customers and prospects deserve.  Also, being away from my beautiful two year-old daughter and amazing wife is sometimes tough as well.

ROS Editor: What are some of your hobbies?

WB: I consider myself an avid sportsman and have completed three ironman triathlons. I enjoy spending time with my family, watching Chargers football, mountain biking, surfing, teaching indoor cycling, and traveling.  Most recently, my hobbies have included such events as: mastering the “one-handed swing,” navigating crowds and confused vacationers at Sea World and the San Diego Zoo, and watching “Beethoven” and  “How the Grinch Stole Christmas” at least four times per week.

ROS Editor: Tell us about your most memorable ROS-related experiences.

WB: I probably shouldn’t. However, one would be sitting below the “Green Monster” at Fenway Park in Boston, with 50 great coworkers, a number of our amazing customers, sharing 100+ years of baseball history, while at a “work” event (ASTRO).  We pride our company in surrounding ourselves with incredible people; coworkers and customers.  It is a pleasure to come to work each day (except Mondays, obviously). 

Featured Products

IGRT technology has become the standard of care for any radiation therapy department. The need for accurate tumor localization has propelled the development of various image guided radiation therapy solutions. The RAD II KV Imager provides a unique yet flexible IGRT platform that can be bolted on to most brands of linear accelerators, improving treatment accuracy and enhancing department workflow.

The RAD II KV Imager offers two types of configurations: single-source and dual-source, depending on your needs and budget.

What’s new at ROS?

New Faces

Lee Laux

Lee Laux is the new sales manager of the ROS sales team. Lee is the sales manager of Resonant’s Clarity System as well as other products and services sold by ROS.

Lee Laux brings to ROS over 20 years of sales and management experience in the healthcare field, primarily in capital equipment and IT sales. Lee has worked with Adria Laboratories, Toshiba America Medical Systems, ADAC Laboratories, Cerner/GE and Elekta Inc. His broad experience in the healthcare arena, from capital equipment to information technology, allows him to bring his customers unique and strategic solutions that position them as market leaders.

Lee holds a BGS Degree from the University of Kansas. He has three children and has been married to his wife Pam for 25 years. A cigar aficionado, Lee enjoys playing and coaching ice hockey. He also likes to play golf.

With our best regards,

The ROS Team

Centers for Medicare and Medicaid Services (CMS) announced yesterday that it will NOT implement the proposed 19 percent Medicare physician payment cuts to radiation oncology for 2010!

In an unprecedented policy victory for ASTRO, the Centers for Medicare and Medicaid Services (CMS) announced yesterday that it will NOT implement the proposed 19 percent Medicare physician payment cuts to radiation oncology for 2010!  Instead, the agency will reduce radiation oncology payments by only 5 percent over a 4-year period.  In other words, the proposed 19 percent cuts for next year has been significantly reduced to only 1 percent for 2010, which will start Jan. 1.

CMS’s final ruling follows upon ASTRO’s most intensive advocacy campaign in its history, which resulted in more than 100 Members of Congress, cancer patient groups, and other key stakeholders urging the agency to stop the 19 percent cuts proposed in July.  To view the Congressional letters and other advocacy materials used to stop to the cuts, go towww.astro.org/medicarecuts.

An initial analysis of CMS’s ruling reveals that the agency agreed with ASTRO’s that its proposed increase on the assumed equipment utilization rate should not apply to radiation therapy equipment and that it needed to make several important adjustments to practice expense survey information specific to radiaiton oncology.  More details on CMS’s decision will be forthcoming in future news updates and discussed this week at ASTRO’s Annual Meeting in Chicago.  Feel free to stop by the ASTRO PAC booth in the Exhibit Hall where staff will be available to answer any questions.

Thanks and congratulations to the thousands of radiation oncology team members who participated in this successful effort!