Proton Therapy
Equipped with Hong Kong’s first proton therapy (PT) system, the HKSH Proton Therapy Centre at A Kung Ngam in 2023 marks a significant advancement in cancer care. PT offers a highly precise and effective treatment option for various cancers by utilising protons—positively charged particles—to target and destroy tumours. The unique physical properties of protons allow a sharp peak (The Bragg Peak) of radiation energy to the tumour, followed by a rapid energy falloff which significantly minimises the exposure to surrounding healthy tissues and vital organs. This precise targeting not only enhances treatment outcomes but also reduces both short-term and long-term side effects, making proton therapy a safer and more effective alternative to conventional radiation therapy. PT treatment is especially suitable for children and retreatment case, in which sparing of healthy tissues which are still developing or have been previously irradiated is of paramount.
The HKSH Proton Therapy Centre employs advanced techniques such as pencil beam scanning, which delivers millimeter-wide proton beams with sub-millimeter accuracy, ensuring the tumour receives the full radiation dose while sparing nearby healthy tissues.
MR-guided proton therapy (MRgPT)
MRgPT is utilised to enhance treatment accuracy. By combining MRI’s superior soft tissue imaging with proton therapy’s precision, adjustments can be made during treatment based on daily changes in tumour size and position. This innovative approach maximises tumour control while minimising side effects, providing patients with a safer and more effective treatment experience.
Key Features:
- Enhanced precision: The unique physical attribute of proton therapy enables the proton beam to precisely target tumour cells, minimising damage to surrounding healthy tissues and organs.
- Reduced side effects: Due to its targeted approach, proton therapy reduces the risk of short-term and long-term side effects compared to conventional radiation therapy.
- Paediatric-friendly: Proton therapy is particularly well-suited for treating
paediatric cancers, as it spares developing tissues and reduces the risk of inducing secondary cancers later in life. - Sustained quality of life: Patients are often able to maintain quality of life during and after proton therapy, with relatively minimal disruption to daily activities.
Related Specialties:
Photon-counting CT Simulator
As the world’s first photon-counting CT simulator, this system represents a significant advancement in medical imaging, offering unprecedented spatial resolution and spectral sensitivity for radiotherapy planning. By utilising direct signal conversion technology that counts individual X-ray photons, it eliminates electronic noise and significantly reduces artifacts caused by metal implants or bone, providing superior soft-tissue contrast and precise tumour delineation.
This enhanced visualisation capability allows clinical oncologists to contour target volumes with exceptional accuracy and optimise dose delivery to malignant tissues while sparing adjacent organs at risk, ultimately facilitating more effective and personalised radiation therapy regimens.
Unity MR Linac
The Elekta Unity MR-Linac with Comprehensive Motion Management (CMM) introduces cutting-edge radiation therapy capabilities, offering a highly precise and personalised treatment option for cancer patients. The Unity system integrates state-of-the-art 1.5 Tesla MR imaging with advanced radiation therapy, MR Guided Radiation Therapy (MRgRT), enabling real-time, continuous visualisation of the tumour and its surrounding anatomy throughout the treatment process. This allows for high-precision dose delivery while sparing healthy tissues.
The introduction of True Tracking and automatic gating functionalities marks a significant advancement in cancer treatment. True Tracking continuously monitors the 3D position of the tumour in real time without requiring any markers, while automatic gating ensures that the radiation beam is precisely delivered to the tumour by pausing treatment if the tumour moves outside of the planned target area. This groundbreaking technology, first implemented in the Asia-Pacific region at our hospital, enables clinicians to treat tumours in areas subject to movement, such as the lungs and abdomen, with unparalleled accuracy.
Key features:
- Real-time tumour tracking that continuously monitors the 3D position of the tumour, ensuring precise delivery of radiation even in the presence of motion.
- Automatic gating that instantly pauses radiation delivery if the tumour moves outside the defined treatment area, enhancing safety and effectiveness.
- Streamlined workflow without additional setup or hardware, allowing for efficient treatment sessions and improved patient comfort.
- The ability to treat a wide range of tumours, including those in the thorax and abdomen, where organ motion due to breathing or other factors may pose challenges.
- Comprehensive Motion Management enables more patients to benefit from precision radiation therapy, reducing side effects and improving outcomes.
This new functionality offers patients with complex or hard-to-treat tumours a non-invasive, real-time adaptive treatment option that enhances therapeutic outcomes while minimising impact on healthy tissues. Elekta Unity with CMM represents the next generation of precision cancer care, providing clinicians with the tools they need to manage tumours with the highest degree of accuracy.
MR Guided Radiation Therapy (MRgRT)
Radiation therapy has evolved significantly since the 1990s, thanks to advances in radiological imaging and computer technology. While CT scans have been a staple in 3D dosimetry and treatment verification due to their spatial resolution and geometric accuracy, they have limitations in soft tissue visibility. This is where MR Guided Radiation Therapy (MRgRT) steps in.
Why MRI?
MRI offers superior detail in soft tissue and tumour definition, which is crucial for precise treatment. Unlike traditional radiological imaging, MRI uses no radiation during image acquisition, making it safer for repeated use in tumour localisation and treatment verification. This not only reduces radiation exposure for patients but also enhances accuracy in targeting tumours.
How MRgRT Works
MRgRT is an advanced technique that integrates MRI directly into the radiation therapy workflow. With MRI, changes in tumour geometry can be detected during daily treatments, allowing for real-time adjustments in radiation dosage. This adaptability minimises the risk of missing the tumour and helps protect healthy tissues, improving overall treatment effectiveness.
The Technology Behind MRgRT: Unity MR Linac
At the heart of MRgRT is the Unity MR Linac system. This cutting-edge technology seamlessly combines the precision of MRI with radiation therapy, offering a new level of accuracy and safety in cancer treatment.
Radixact X9
The Radixact X9 TomoTherapy® System represents the next generation of helical radiation therapy technology, offering a powerful and efficient solution for delivering precise radiation treatments across a broad range of cancer cases. This advanced system ensures that both routine and complex treatments are delivered with exceptional accuracy.
Key Features:
- Reduced Treatment Times: The system is designed to shorten both scan times and treatment delivery times, enhancing efficiency while maintaining precision.
- Personalised Treatment: Radixact X9 supports the delivery of individualised treatments, adapting to the specific needs of each patient, regardless of the complexity of the case.
- Daily Volumetric Verification: With its integrated Computed Tomography imaging system, the Radixact X9 provides daily volumetric verification, ensuring precise targeting and adjustment throughout the treatment course.
- Versatile Coverage: The system delivers image-guided, intensity-modulated radiation therapy (IG-IMRT) to most parts of the body, making it suitable for a wide variety of cancer types.
- Adaptive Radiation Therapy: By tracking anatomical and dose changes during treatment, the Radixact X9 can initiate adaptive therapy, ensuring that the treatment remains effective as the patient's anatomy evolves.
Tomotherapy
Tomotherapy is a cutting-edge radiation therapy system that combines Image-Guided Radiation Therapy (IGRT) and Intensity-Modulated Radiation Therapy (IMRT). This combination allows for exceptional precision and accuracy in targeting tumours while minimising the impact on surrounding healthy tissues.
Unmatched Precision: Continuous 360° Delivery
Unlike conventional radiation machines, which deliver radiation from only a few directions, Tomotherapy delivers radiation continuously from all angles around the patient. This is made possible by a linear accelerator (linac) mounted on a CT scanner-like ring gantry. The unique ring gantry design enables the system to deliver radiation in a continuous 360° helical pattern.
Using a patented multi-leaf collimator (MLC), the radiation beam is divided into small, narrow "beamlets," allowing for greater modulation and more precise dose distribution. As the patient lies on a couch that moves in and out of the machine, this dynamic system ensures a smooth, continuous treatment process.
Tailored Treatment Plans for Optimal Results
Powerful computer programs assist radiation therapists in creating customised treatment plans for each patient. These plans focus the radiation dose on the tumour while minimising exposure to healthy tissue. Tomotherapy excels at delivering fast and precise stereotactic radiation therapy and can treat multiple lesions in a single session. This offers a significant advantage over conventional linear accelerators, which often require separate treatments for each lesion.
Superior Accuracy: Daily Imaging for Adaptive Radiation Therapy
The exact location of a tumour can vary daily due to internal organ movement and the patient’s positioning during treatment. With Tomotherapy, a CT scan is taken before each session to capture a three-dimensional view of the patient’s anatomy that day. By integrating these daily images with the planning CT images, the patient’s position can be precisely adjusted to ensure radiation is directed exactly where it is needed.
This daily CT scan also enables adaptive radiation therapy, allowing for adjustments to the treatment plan based on changes over time. This ensures that patients receive highly accurate treatments while reducing the risk of side effects and improving their quality of life.
Powered by the Radixact X9 TomoTherapy® System
The Radixact X9 TomoTherapy® system provides the advanced technology behind this innovative treatment, delivering precision, flexibility, and patient-centred care.
Adaptive Radiotherapy
Adaptive Radiotherapy is an advanced approach to radiation treatment that addresses changes in a patient’s body during the course of therapy. Throughout treatment, patients may experience changes such as weight loss or shifts in organ positioning, which can alter the original treatment plan. As shown in the diagram, the violet line represents the planned contour, while the yellow line shows the patient’s shape after three weeks of treatment.
To ensure accurate radiation delivery despite these changes, adaptive tomotherapy systematically accounts for inter-fractional contour changes and organ motion. By continually adapting the treatment plan to these changes, adaptive radiotherapy helps maintain optimal treatment precision throughout the course of therapy.
Clinical Benefits of Adaptive Tomotherapy
In lung cancer patients, weekly adjustments to tomotherapy plans can significantly reduce the radiation exposure to surrounding healthy tissues. For instance, the volume of the ipsilateral lung receiving radiation can be reduced by 17-23%. Additionally, radiobiological assessments of adaptive tomotherapy have shown a 13.2% increase in the complication-free tumour control rate, demonstrating the clear clinical benefits of this approach.
How It Works
Verification scans are performed regularly to ensure accurate patient setup and to monitor tumour evolution. These high-quality images allow the treatment team to assess the tumour’s response to radiation and adapt the treatment plan accordingly. This process not only ensures precise daily delivery but also enables the radiation therapy to be fine-tuned in response to the tumour's changing size and shape over time.
Powered by Radixact X9 TomoTherapy System®
At HKSH, adaptive radiotherapy is delivered using the state-of-the-art Radixact X9 TomoTherapy System®, which provides real-time feedback and allows for continuous optimisation of treatment plans.
CyberKnife M6
The CyberKnife® M6 Robotic Radiosurgery System offers a non-invasive alternative to surgery for treating tumours throughout the body, delivering high-dose radiation with remarkable accuracy. This advanced system is effective for both cancerous and non-cancerous tumours in areas such as the prostate, lung, brain, spine, liver, pancreas, and kidney.
Despite its name, the CyberKnife® does not involve any scalpels or incisions. As the world’s first and only robotic radiosurgery system capable of treating tumours across the body non-invasively, it provides a pain-free, non-surgical solution for patients with inoperable or surgically complex tumours, or those who prefer to avoid surgery.
Key Features:
- Precision and Flexibility: The CyberKnife® M6 system combines Multileaf Collimator (MLC) beam shaping, continual image guidance, and non-isocentric, non-coplanar treatment delivery to achieve sub-millimeter accuracy. It also tracks tumour movement caused by breathing, ensuring precise radiation delivery while sparing surrounding healthy tissues.
- Indication-Specific Tumour Tracking: With advanced robotic mobility and real-time tumour tracking, the system automatically adjusts the radiation beams, maintaining accuracy even for moving targets.
- Patient Comfort: Designed with patient well-being in mind, the CyberKnife® M6 uses a frameless, non-invasive approach, complemented by a soothing environment to ensure personalised and comfortable treatment experiences.
M6 CyberKnife®: Precision Without Surgery
The CyberKnife® M6 Robotic Radiosurgery System is a non-invasive, pain-free alternative to surgery for treating tumours anywhere in the body. This advanced system delivers high-dose radiation with extreme precision to both cancerous and non-cancerous tumours, including those in the prostate, lung, brain, spine, liver, pancreas, and kidney.
No Scalpels, No Cutting – Just Precision
Despite its name, CyberKnife® does not involve any scalpels or cutting. It is the world's first and only robotic radiosurgery system designed to treat tumours throughout the body non-invasively. This technology offers a surgical alternative for patients with inoperable or complex tumours, or for those who prefer to avoid surgery altogether.
Key Features of CyberKnife® M6
- Unmatched Clinical Precision: The CyberKnife® M6 combines the precision of Multileaf Collimator (MLC) beam shaping with continual image guidance and robotic flexibility. This system delivers radiation with sub-millimeter accuracy, even for tumours that move with breathing. The non-isocentric, non-coplanar treatment delivery system ensures that surrounding healthy tissue is spared while the tumour receives the full dose.
- Tumour Tracking with Motion Correction: Using sophisticated tumour tracking, robotic mobility, and advanced collimation, CyberKnife® M6 automatically adjusts to tumour movements caused by breathing, ensuring continuous precision throughout the treatment session.
- Patient-Centreed Design: The system's frameless and non-invasive treatment approach focuses on patient comfort, with a soothing environment and personalised care, allowing for efficient treatments tailored to each individual.
With CyberKnife® M6, patients have access to cutting-edge technology that offers both precision and comfort, making it a superior choice for treating complex tumours without the need for surgery.
Versa HD
The Versa HD™ linear accelerator employs advanced beam-shaping technology and high-dose delivery to provide precise and efficient treatment for Stereotactic Radiotherapy (SRT) and Stereotactic Radiosurgery (SRS). It seamlessly integrates the flexibility of conventional radiotherapy techniques with the latest imaging capabilities, making it ideal for treating a wide variety of tumours across the body.
Key Features:
- Faster Treatment Times: The Versa HD™ accelerates treatment with industry-leading multi-leaf collimator (MLC) leaf travel speeds, ultra-low transmission, and high-dose rate delivery, significantly reducing treatment times.
- Efficient SRS/SBRT Delivery: The system delivers Stereotactic Body Radiotherapy (SBRT) and SRS treatments efficiently, providing accurate, high-dose radiation therapy within a reasonable timeframe.
- Minimised Exposure to Healthy Tissue: With reduced non-therapeutic radiation doses, Versa HD™ minimises exposure to nearby organs-at-risk, potentially reducing side effects and lowering the risk of secondary cancers.
- Customisable Configurations: The system can be tailored to meet specific clinical needs, allowing for custom configurations depending on the complexity of the treatment.
- Advanced Imaging for Soft Tissue: Featuring state-of-the-art imaging technology, the Versa HD™ provides soft tissue visualisation during treatment, ensuring accurate tumour targeting and adaptation as needed.
Stereotactic Body Radiation Therapy (SBRT)
Stereotactic Body Radiation Therapy (SBRT) is an advanced form of radiation therapy designed to deliver high doses of radiation with extreme precision in fewer sessions compared to conventional treatments. SBRT is primarily used to treat tumours in various parts of the body, including the lungs, bones, liver, and prostate. As a non-invasive alternative to surgery, SBRT is an ideal option for elderly patients or those in poor health who are unable to undergo surgical procedures.
High Precision, Fewer Treatments
SBRT’s effectiveness relies on its ability to deliver concentrated doses of radiation in fewer treatments while maintaining extreme precision. This is particularly important when dealing with critical areas of the body. To ensure accuracy, advanced patient immobilisation and tumour tracking devices are utilised. These include:
- Abdominal compression devices
- Active Breathing Control devices
- Fiducial marker implants
These technologies help to stabilise the patient during treatment, reducing movement and ensuring that radiation is delivered precisely to the tumour site.
Ensuring Accuracy with Advanced Imaging
Before each treatment, volumetric imaging is performed to verify the patient’s positioning and ensure the radiation is targeted at the correct location. This imaging provides a three-dimensional view of the tumour and surrounding anatomy, allowing for real-time adjustments and increased accuracy.
Versatile Treatment Integration
SBRT can be combined with a range of advanced radiation techniques, including tomotherapy, image-guided intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). Additionally, the latest technologies such as CyberKnife M6 and Unity MR Linac are equipped to deliver SBRT, offering patients the most cutting-edge treatment options available.
Volumetric Modulated Arc Therapy (VMAT)
At HKSH , we are proud to offer Volumetric Modulated Arc Therapy (VMAT), an advanced radiotherapy technology available through the state-of-the-art Versa HD Accelerator from Elekta.
What is VMAT?
VMAT delivers highly precise, sculpted 3D-dose distributions by rotating the linear accelerator gantry in a full 360-degree arc around the patient. During this continuous rotation, the advanced planning algorithm controls the speed of the gantry, the shape of the multileaf collimator, and the dose rate of the radiation beam in real-time. This allows for the delivery of high doses of radiation to the tumour while minimising exposure to surrounding healthy tissues and organs at risk.
Benefits of VMAT
- Precision for Various Cancer Types: VMAT has been shown to be highly effective in treating a wide range of cancers, including cranial, head and neck, prostate, and cervical tumours.
- Faster Treatment Times: By using either complete or partial arcs, VMAT significantly reduces treatment times—from the 10-15 minutes required by conventional radiotherapy to as little as 2 minutes. Shorter treatment times help to reduce patient movement, further increasing the accuracy of treatment delivery.
- Increased Efficiency: Faster treatments also allow for more patients to be treated each day, helping to reduce waiting times and improve overall patient care.
VMAT is an innovative treatment option that provides faster, more accurate, and more efficient radiation therapy for patients, enhancing both outcomes and comfort.
Elekta Flexitron® Brachytherapy Machine
The Elekta Flexitron® Brachytherapy Machine offers advanced brachytherapy solutions, designed to provide precise and safe radiation treatments for various cancer types. With cutting-edge features, this system ensures optimal dose delivery and enhanced patient safety.
Key Features:
- 40-Channel Support: The system can support up to 40 channels, making it ideal for large-volume implants without the need for reconnections, ensuring a more seamless treatment process.
- 1mm Step Size: The 1mm step size allows for superior dose distribution and highly accurate treatment delivery, improving the precision of brachytherapy procedures.
- Absolute Source Positioning: The straightforward Absolute Source Positioning technology minimises the chance of errors, providing a streamlined and reliable treatment process.
- Enhanced Treatment Safety: The new source design ensures the highest level of safety during treatment, giving clinicians and patients confidence in the reliability of the system.
Remote High Dose Rate (HDR) Afterloading Brachytherapy
Remote HDR Afterloading Brachytherapy is a specialised treatment that uses a tiny radioactive source, typically Iridium-192, to deliver precise radiation doses at a short distance from the tumour. This method, administered via interstitial, intracavitary, or intraluminal application, allows for a high radiation dose to be concentrated locally on the tumour while minimising the dose to surrounding healthy tissues due to the rapid fall-off of radiation.
Brachytherapy is an effective treatment for various cancers, including:
- Cancers of the uterine cervix, uterine body, and vagina
- Interstitial boost in breast cancer treatment
- Recurrence and re-treatment of neck disease
- Intraluminal boost in esophageal cancer treatment
Image-Guided Brachytherapy (IGBT)
Image-Guided Brachytherapy (IGBT) utilises advanced imaging techniques such as Magnetic Resonance Imaging (MRI) to enhance the accuracy and effectiveness of brachytherapy. After the applicator is inserted, MR images are taken to provide precise positional information, ensuring that the radiation is delivered exactly where it’s needed.
Benefits of MRI-Guided Brachytherapy
- Superior Soft Tissue Visualisation: MRI provides detailed 3D images of both the target tumour and surrounding organs, improving the accuracy of treatment planning.
- Precise Needle and Applicator Placement: The advanced imaging enables highly accurate placement of the brachytherapy equipment.
- Improved Outcomes and Fewer Side Effects: By targeting the tumour more precisely, MRI-guided brachytherapy leads to better treatment results and fewer radiation-induced side effects.
Powered by Elekta Flexitron® Technology
Our HDR Brachytherapy treatments are delivered using the Elekta Flexitron® Brachytherapy Machine, offering patients the latest in high-precision cancer treatment.
Xstrahl 100 SXR Superficial X-Ray Machine
The Xstrahl 100 SXR Superficial X-Ray Machine offers a safe, painless, and highly effective treatment option for a variety of dermatological conditions, including skin cancers. This non-invasive therapy targets the skin's surface while minimising the risk of scarring.
Key Features:
- Safe and Painless: TheXstrahl 100 SXR delivers radiation directly to the skin’s surface, providing a non-invasive and painless alternative for treating skin conditions.
- Minimal Scarring: By focusing the radiation dose on the surface layer, the treatment minimises the risk of scarring, making it an ideal option for areas where cosmetic concerns are important.
- No Anesthesia Required: Treatments are quick and straightforward, eliminating the need for anesthesia and reducing downtime for patients.
Superficial Radiation Therapy
Superficial Radiation Therapy is an effective non-invasive treatment for various forms of skin cancer, including basal cell carcinoma, squamous cell carcinoma, and Kaposi's sarcoma. Although skin cancers rarely metastasize to other parts of the body, they can invade surrounding tissues, making them malignant and requiring prompt treatment.
How Superficial Radiation Therapy Works
This treatment uses a low-energy x-ray beam with an energy range of 50-150 kV (kilovolts). The radiation penetrates only the top layers of the skin, allowing for effective treatment of the tumour while sparing deeper tissues. This approach minimises scarring and is especially useful in areas where surgical excision is difficult or where there is a high risk of disfigurement.
Applications and Benefits
- Non-Invasive Treatment: Superficial radiation therapy provides an alternative to surgery for patients, especially in cases where surgery is challenging due to reconstruction difficulties or cosmetic concerns.
- Adjuvant Therapy: In certain skin cancer cases, if a pathology report following surgery suggests a high risk of recurrence, adjuvant superficial radiation therapy can further improve the chances of a cure.
Cutting-Edge Technology
This therapy is delivered using the Xstrahl 100 SXR Machine, a state-of-the-art system designed specifically for treating superficial skin cancers with precision and minimal side effects.
MR Simulator for Radiotherapy Treatment Planning
Magnetic Resonance Imaging (MRI) is renowned for its exceptional soft tissue visualisation, making it a valuable tool in cancer treatment planning. The MR Simulator allows patients to be scanned in their treatment position, ensuring optimal alignment and accuracy in radiotherapy.
Key Features:
- Enhanced Tumour Visualisation: The MR Simulator provides superior soft tissue detail, allowing for clearer tumour visualisation, which is critical in cancer cases.
- Precise Treatment Planning: By scanning patients in their treatment position, the MR images offer excellent alignment with planning CT scans. This leads to highly accurate target and organ-at-risk contours, ensuring that the prescribed dose is delivered precisely to the target volume.
- Improved Dose Accuracy: The combination of MR imaging and treatment positioning helps to ensure that the radiation dose is accurately focused on the tumour, minimising exposure to surrounding healthy tissues.
Active Breathing Coordinator™ (ABC)
The Active Breathing Coordinator™ (ABC) is designed to reduce anatomical movement in the chest and abdomen caused by breathing during radiotherapy. This device aids patients in holding their breath during simulation and external beam radiotherapy, particularly for tumours in the breast, lung, liver, pancreas, and other thoracic areas.
Key Features:
- Breath-Hold Technique: The ABC system enables patients to perform Deep Inspiration Breath-Hold (DIBH), helping to immobilise the anatomy and minimise radiation exposure to surrounding healthy organs and tissues.
- Coached Breath Control: Patients receive coaching before simulation and treatment to ensure accurate and consistent breath-hold at a defined lung volume. This training helps optimise the effectiveness of the technique.
- Monitored Breath-Hold: The ABC device is equipped with a computer interface that monitors breath-hold periods, ensuring they are consistent. Patients control the balloon valve connected to a flow meter, which aids in maintaining the correct lung volume during each breath-hold.
HexaPOD™ evo RT System
The HexaPOD™ evo RT System is a fully robotic patient positioning system that significantly enhances precision in image-guided radiotherapy (IGRT). Traditional positioning systems only allow for adjustments along the 3 translational axes (X, Y, and Z), but the HexaPOD™ adds the capability to correct rotational movements (roll, pitch, and yaw), offering 6 degrees of freedom.
Key Features:
- Enhanced Positioning: The HexaPOD™ evo RT System enables full correction in all directions, including both translational and rotational axes, improving patient alignment and ensuring greater treatment accuracy.
- 6 Degrees of Freedom: With the ability to adjust roll, pitch, and yaw, the system allows for precise repositioning of the patient, correcting even the smallest misalignments.
- Increased Treatment Accuracy: By offering more comprehensive positioning control, the HexaPOD™ evo RT System enhances the precision of radiotherapy delivery, ensuring the radiation is accurately targeted while minimising the impact on surrounding healthy tissues.