Diagnostic & Therapeutic Radiation Systems business unit was officially launched in January 2009, with a clear mission in mind: to provide complete and unique turn-key solutions to address the growing need for unique radiation oncology related solutions.

This business unit so far has three products:

• The Accuray CyberKnife is a Robotic Assisted Radiosurgery machine that can treat solid tumors anywhere in the body non-invasively with sub-millimeter accuracy.
• The Carl Zeiss Intrabeam is an Intraoperative Radiotherapy solution for breast cancer as well as brain, liver, and pancreas.
• SuperSonic Imagine Aixplorer Ultrasound machine uniquely has the Shear wave Imaging option which can be used for breast and liver cancer detection.

Accuray:- Robotically Assisted Stereotactic Radiosurgery

Carl Zeiss Intrabeam:- Intraoperative Partial Breast Radiation

INTRABEAM® was approved in Europe in 1999 for the IORT of all solid tumors. INTRABEAM® is used to irradiate brain tumors, tumors of the gastrointestinal tract 6 and skin cancer. Further indicators are currently being clinically tested. The greatest experience with INTRABEAM® is in breast Intraoperative Radio Therapy.

A fixed element of therapy management for breast cancer is the homogeneous irradiation of the breast (EBRT - external breast radiotherapy) with a linear accelerator. Even if there is a low risk of local recurrence, patients benefit from the radiotherapy. However, the EBRT represents over-therapy for some patients who, even without EBRT, would not suffer from a recurrence. For many patients, partial breast irradiation is the more favorable variant, applied either as a local boost prior to EBRT or, within the framework of clinical studies for patients with favorable prognosis factors, for single irradiation after breast-conserving therapy. Another key indicator for partial breast irradiation is the radiotherapy of the pre-irradiated breast in the event of local recurrence in which EBRT is no longer possible.

SuperSonic Imagine:- Portable Ultrasound Solution with Shear Wave Elastography

Worldwide, breast cancer has the highest incidence of all cancers in women and has a mortality rate in developed countries of 25%.

X-ray mammography is the “Gold Standard” primary exam used to detect breast cancers. It has a sensitivity (probability that the test indicates a potential abnormality ) of about 80%. However, this sensitivity decreases significantly when imaging dense breasts. Mammography, however, has some limits. For example, low mammography specificity (probability that the test provides better characterization) often leads to unnecessary biopsies.Other imaging techniques, such as ultrasound and MRI also have limiting factors. MRI machines have a very high sensitivity but have only a moderate specificity. The MRI machine is an expensive imaging modality and not readily available in all hospitals and clinics.

Ultrasound has a higher specificity than mammography but has the disadvantages of being user skill dependent and having varying results based on the quality of the system used. Breast lesions that are detected by mammography, ultrasound or MRI can be classified following the American College of Radiology standards named BI-RADS®. This classification takes into account different semiological criteria and scales them 1 to 6 (from benign to malignant). Adding criteria to the classification could help refine diagnosis. As it is common knowledge that tissue elasticity is related to pathology, tissue elasticity could be one of these parameters.

Associated with Ultrasound, Elastography assists in characterizing the differences in tissue elasticity. In the case of Static Elastography, the transducer is used to compress the tissue and the strain is calculated. This calculation gives a superimposed color map, on top of the B mode or black and white image, which represents tissue elasticity. This technique largely depends on the compression that is applied to the transducer and is difficult to reproduce and not quantitative but qualitative.

The Elastography technology created by SuperSonic Imagine is very different. ShearWave™ Elastography (transient) is reproducible, quantifiable and user-independent. An ultrasound shear wave is generated by the transducer (instead of a manual compression) and then the propagation speed in the tissue of this shear wave is measured. The speed at which the shear wave propagates is proportional to the square root of the tissue elasticity. In order to follow the shear wave propagation (speed of 1 to 2 m/s) it is mandatory to have an Ultrafast™ ultrasound system that can acquire images at a speed greater than 1000 per second.

This « New Wave » in ultrasound, using Ultrafast™ imaging creates a totally different Elastography imaging technique for the breast. Today, only ShearWave™ Elastography is capable of measuring true tissue elasticity in a reproducible and user-independent manner.