Clinical advantages of the Integral Quality Monitor System
The Integral Quality Monitor (IQM) System is completely integrated into the clinical workflow of the modern radiation therapy department. It is the first system on the market able to measure the accuracy of the treatment beam in real-time during the actual patient treatment. The new, patented detector technology measures the treatment beam with unrivaled precision, ensuring that your patients receive the treatment dose as prescribed. IQM is also the first system in the market that monitors the accuracy of the treatment delivery fully automatically without ANY user interaction. Simply attach the detector in the morning. Press the ON button and everything else works as an automated background process.
Watch the following video to learn more about the exciting new features of the IQM System or click this link to watch the German version of the video.
Integral Quality Monitor receives Innovation Award 2017
The Integral Quality Monitor (IQM) System won the 2017 Innovation Award of the German state Rhineland-Palatinate. The Rhineland-Palatinate Minister for Economic Affairs, Volker Wissing, presented Innovation awards to six companies in five categories at a ceremonial event at the Chamber of Commerce in Trier (Germany).
The Innovation Award Rhineland-Palatinate was awarded for the first time in the year 1988 and is one of the oldest innovation awards in Germany. It is jointly awarded by the Ministry of Economic Affairs, Transport, Agriculture and Viticulture and a task group of the Chambers of Industry and Commerce (IHK) and the Chamber of Handicrafts (HWK).
In his welcoming address, Minister Wissing outlined the importance of continuous innovation for economic growth in the Rhineland Palatinate region, as well as for the wider German economy. The state of Rhineland-Palatinate currently ranks No. 4 among the 16 German states in worldwide exports.
After the award ceremony, Minister Wissing visited the iRT booth to learn more about the innovative functionalities of the IQM System.
First IQM installation in France
The Centre d’Oncologie et de Radiothérapie du Parc in Auxerre is pioneering a new safety standard for Radiation Therapy Treatment in France.
Implementing IQM will enable the clinicians in Auxerre to be the first Radiation Therapy professionals in France to verify the delivery of highly complex treatment techniques in real-time. “IQM’s real-time verification will allow us to verify the correct application of the treatment beam at every single control point” says Jean-Yves Gosselin, Medical Physicist at the Radiotherapy Center in Auxerre. “This new technology finally allows us to verify the treatment delivery as a process during every single treatment fraction.”
The installation, acceptance, commissioning and training of the IQM System was performed between the 13th and 15th of September. After the physical integration of the IQM System into the department network a thorough acceptance protocol was performed. The signal reproducibility, signal linearity and dose rate dependency were verified, with these acceptance measurements showing excellent results. Evaluating the detector performance using the specifically designed QA Test field concluded the acceptance process.
Commissioning the IQM System’s calculation algorithm required measuring various square and rectangular field sizes to determine the Area Output Factors (AOF) as well as a sequence of off-axis square fields to verify the IQM Detector’s chamber sensitivity map. The calculation commissioning was verified by comparing calculated and measured signals for a standard series of segments.
When the system was ready for deployment the Medical Physicist was trained by the iRT staff. A number of clinical IMRT and VMAT treatment plans were employed for the user training.
In the coming weeks and months, the responsible Medical Physicists Jean-Yves Gosselin and Aurélien Vasseur will extensively test the IQM System prior to its first use during a patient treatment fraction. “We need to thoroughly evaluate this new technology and gain sufficient experience” he explains. “Our initial impression during the installation was very positive. The installation and training was very fast and very simple and it was a pleasure to work with the iRT staff.”
iRT Systems showcased IQM at ASTRO 58 in Boston
With the headline “Verification has never been easier – Patient treatment has never been safer” we presented the IQM System at the 58th ASTRO Conference in Boston.
We noticed a significant difference in the quality of our conversations with ASTRO attendees. Many of our visitors already knew something about the exciting and innovative functionalities of the IQM System, and they wanted to learn more about its immediate impact on patient safety by minimizing the treatment delivery risk. The IQM “live” cases we demonstrated included automated verification of some highly complex treatment techniques. The visitors learned about the tremendous impact the IQM system has, reducing the verification workload and increasing verification efficiency.
At ASTRO 58 we introduced the new IQM+ feature – the first expansion of the IQM System. IQM+ extends the IQM functionality with an automated log-file analysis. IQM+ works exactly like IQM, as long as all measurements are within the user’s acceptance criteria. However, as soon as IQM+ detects a clinically relevant deviation, it initiates an automated log-file analysis. Within 10 seconds IQM+ presents the analysis results. Leaf positioning errors, gantry angle changes, and jaw movement variations and other treatment delivery variations are automatically highlighted to indicate the possible cause of the deviation that IQM+ detected in real-time. The absence of any errors in the log-file analysis can indicate a potential mis-calibration or related causes.
IQM+ not only detects even the smallest treatment delivery errors in real-time, but provides immediate information about the cause of the detected error.
Minister of Health visits iRT Systems
IRT was pleased to welcome the Rheinland-Pfalz Minister of Health, Sabine Baetzing-Lichtenthaeler, to our offices in Koblenz on August 22nd.
Minister Baetzing-Lichtenthaeler was accompanied by Detlev Pilger, German Member of Parliament, Joachim Hofmann-Goettig, Mayor of the City of Koblenz, Thomas Hammann, Director of Koblenz Business Growth and Development, Matthias Nester, Chairman of the Board at Sparkasse Koblenz, Brigitte Herrmann, Executive Director at Venture Capital Mittelrhein/Investitions- und Strukturbank Rheinland-Pfalz, and Joachim Deboeser, an iRT Systems friend and trusted advisor.
The main focus of the Minister’s visit was the potential for improving patient safety in radiation therapy. Minister Baetzing-Lichtenthaeler took the opportunity to acquaint herself with the innovative IQM technology and its variety of applications in the clinical routine of a modern radiation oncology department. The increasingly complex systems and processes utilized in today’s radiation therapy demand an independent, automatic and reliable method of verification.
The IQM System is the first to automatically verify the dose and geometric accuracy of the therapeutic beam during the patient treatment, individually at each control point, in real-time.
For the first time ever, the IQM technology allows the dose and geometric accuracy of the therapeutic beam to be verified at each individual control point through each patient treatment fraction. Any significant deviation in beam delivery is automatically detected preventing the patient from a potentially harmful mistreatment. Like an automobile airbag, IQM protects the patient from unexpected errors
IQM is truly unique – the only dose verification system in the world that directly improves patient safety in radiation therapy.
The presentation highlighted IQM’s streamlined workflow. From importing the patient’s treatment plan to documenting the treatment delivery at the last treatment fraction, all IQM processes run as fully automated background processes. IQM requires no user interaction at all. This truly automatic approach converts every treatment fraction into an independent verification of the linear accelerators beam delivery performance. IQM dramatically increases the frequency of verification measurements – while reducing the time and effort required for verification. This more efficient approach to verification measurements makes more linear accelerator’s and staff capacity available for patient treatment.
IQM allows a faster and safer introduction of new treatment techniques into the clinical routine of every radiation therapy department. IQM verifies the delivery of hypo-fractionated treatments in real-time and is uniquely suited to verify new and highly precise treatment techniques: the smaller the field size, the more sensitive the IQM detector is for even very small deviations.
Improving patient safety during radiation therapy was the main topic of the discussion that followed the IQM presentation. The group also recognized the important benefit of making treatment verification more effective, as well as the way IQM can facilitate the adaption of new treatment techniques. The ability of seamlessly monitoring the treatment dose at every patient fraction as well as the automatic documentation of the correct treatment delivery at every single control point will provide significant support during the clinical implementation of the European Directive 2013/59 Euratom requirements.
All participants agreed that the IQM System belongs in every modern radiation therapy department.
Minister Baetzing-Lichtenthaeler’s visit concluded with a tour of the IQM production facilities for a closer look at “Quality Made in Germany”. In fact, every component of the IQM detector is made entirely in Germany by selected suppliers within a 3-hour travel distance. Each IQM system is carefully assembled, configured and thoroughly inspected at our facility in Koblenz. After a final dosimetric checkout at a linear accelerator, the system is packed for shipment.
“It is really impressive what has been achieved here at iRT Systems” stated Minister Baetzing-Lichtenthaeler during a radio interview, “IQM will strongly improve patient safety and quality assurance in radiation therapy. We as state government will not just stay in contact with iRT Systems, but will actively support this new and exciting technology.”
iRT Systems presents “real-time monitoring during patient treatment” at the ESTRO 35 in Turin
Following are some impressions of the iRT booth at the ESTRO 35 in Turin
“Performance Study of an automated real-time monitoring system for SBRT treatments” by Makan Farrokhkish, Princess Margaret Cancer Centre, Toronto
Click on the following video link to watch the presentation by Makan Farrokhkish from the Princess Margaret Cancer Centre, Toronto during the ASTRO 57 in San Antonio.
Makan presented some exciting results of their pre-clinical evaluation of the IQM system with the title “Performance Study of an automated real-time monitoring system for SBRT treatments”.
The full presentation can also be downloaded here.
“Real-time detection of deviations in radiotherapy beam delivery using a head-mounted detector” by Martijn Kusters, Radboud UMC Nijmegen
Click on the following video link to watch the presentation by Martijn Kusters from the Radboud University Medical Center, Nijmegen, The Netherlands during the ASTRO 57 in San Antonio.
Martijn presented some exciting results of their pre-clinical evaluation of the IQM system with the title “Real-time detection of deviations in radiotherapy beam delivery using a head-mounted detector”.
The full presentation can also be downloaded here.
“Meet the minds behind IQM” Panel Discussion during ASTRO 57 San Antonio
Click on the following video link to watch the panel discussion of Dr. David Jaffray, Dr. Mohammad Islam (both from Princess Margaret Cancer Centre, Toronto) and Juergen Oellig (iRT Systems) during the ASTRO 57 in San Antonio.
iRT Systems participated for the 1st time at an ASTRO Annual Meeting in San Antonio
Following are some impressions of the iRT booth at the ASTRO 2015
Integral Quality Monitor featured in medicalphysicsweb article
Quality assurance (QA) is an essential part of any radiation treatment, ensuring the accuracy of equipment set-up and precise and safe delivery of radiation to the patient. Only a small set of selected linac QA tests is performed daily, or prior to a complex treatment fraction, but what happens during the actual beam delivery?
To answer this, German start-up iRT is creating what it says is a completely new approach to radiotherapy QA. The company’s Integral Quality Monitor (IQM), developed in collaboration with the Princess Margaret Cancer Centre in Toronto, is a real-time beam verification system that monitors the accuracy of radiation delivery throughout each patient treatment without any user interaction.
“IQM continuously reviews every segment of every beam during every treatment fraction,” explained iRT’s managing director Jürgen Oellig. “It is the first intra-fractional verification system available on the market.” If beam delivery deviates from the prescribed plan at any point, the treatment can be paused or halted. “This device replaces error management with error prevention – errors cannot find their way to the patient any more,” he added.
As well as improving patient safety, the IQM also increases efficiency, said Oellig. He described an example radiotherapy centre treating 700 patients per year, 300 of which are complex intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT) cases. Each linac requires daily QA, plus routine annual and monthly checks. The IMRT and VMAT treatments also require pre-treatment QA, leading to an average of 650 verification sessions per year.
“So if each patient receives 20 fractions, and IQM is used to measure every fraction, this adds 14000 QA sessions,” Oellig told medicalphysicsweb. “It’s a completely different level – for the first time it is possible to make every patient treatment into a verification session.“
Keep it simple
Unlike existing QA systems, which comprise arrays of hundreds of detectors, the IQM uses a single large-area ion chamber. The IQM detector comprises three 1.5 mm-thick aluminium plates: two polarizing electrodes sandwiching a collector electrode. Spatial sensitivity is achieved by linearly varying the separation between electrodes across the chamber.
The IQM is positioned directly underneath the linac collimator, enabling the treatment beam to pass through the ion chamber. Oellig noted that the device does not impact the beam quality. It does attenuate the beam slightly – by 6.5% and 5% for 6 and 18 MV photons, respectively – but this attenuation is homogenous over the entire field and can thus be accounted for during treatment planning.
The IQM system is fully automated at all stages, only requiring export of a DicomRT Plan data from the treatment planning system. The IQM’s calculation algorithm uses these imported data to calculate an expected signal for each individual beam segment, based on the prescribed monitor units (MU), field size, field shape and location. The IQM chamber sensitivity map used in this calculation comprises a matrix of 801 x 801 data points, equivalent to a grid of 641601 data points. The system then expands each calculated signal into a “corridor”, to allow tolerance for expected daily linac fluctuations, and displays this inner corridor in green. In addition, a user-defined outer corridor, which separates acceptable from potentially harmful deviations, is displayed in red…
Follow this link to read the complete article on www.medicalphysicsweb.org.
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iRT Systems showcased IQM research status at the AAPM 2015 in Anaheim
iRT Systems showcased the current research status of the IQM System at the 57th AAPM Meeting in Anaheim.
The 57th AAPM meeting had an amazing turnout for iRT Systems, who participated for the first time at the world’s largest Medical Physics conference.
The promise “Verification has never been easier – Patient treatment has never been safer” attracted more than 150 visitors, who wanted to learn more about the unique features of the world’s first intra-fractional verification system.
The discussion included the significant impact of the IQM system to reduce the treatment delivery risk and to increase patient safety. We demonstrated the automated verification of the most complex treatment techniques and the tremendous impact of the IQM system on the reduction of verification staff workload and the considerable increase in verification efficiency.
We presented a variety of “live” cases among one is showing the fully automated verification of a hypofractionated SBRT treatment technique for Stomach Cancer using a x6FFF ARC treatment with 2400 MU/min for a total delivery of 5500 MU.
IQM verifies this highly complex treatment as a fully automated background monitoring without ANY user interaction.
We already look forward to our next exhibition at the 53rd SAAPMB congress & expert meeting in Bloemfontein (South Africa)
iRT Systems celebrated pre-launch of the IQM System
iRT Systems celebrated the pre-launch of the IQM System at the 3rd ESTRO Forum in Barcelona and almost 170 visitors celebrated with us.
The 3rd ESTRO Forum was an overwhelming success for iRT Systems, who participated for the first time in a congress exhibition.
With the promise “Verification has never been easier – Patient treatment has never been safer” the IQM System was shown for the first time to the public.
Although we have already received a lot of positive feedback during our extensive beta-testing, we could not predict how the product would be received by a larger Radiation Therapy audience.
The reaction was extremely encouraging.
The feedback ranged from “Amazing…” to “Awesome…”, from “This needs to be part of every Linac…” to “We will definitely buy one of those…” and reassures us that the IQM System meets a strong need for reducing treatment delivery risk, for managing the increasing treatment complexity, for reducing staff workload and for improving verification efficiency.
We already look forward to our next exhibition at the World Congress on Medical Physics & Biomedical Engineering in Toronto.
3rd ESTRO Forum presentation:
“Quality assurance with the IQM system – The Radboud UMC experience”
by Richard Canters, Martijn Kusters, RadboudUMC, Nijmegen, The Netherlands
On Monday, April 27th, Richard Canters from Radboud UMC in Nijmegen, the Netherlands presented some of the results that he acquired while beta-testing the Integral Quality Monitor System.
The presentation took place at the iRT Systems booth during the 3rd ESTRO Forum.
Mr. Canters and his colleagues investigated the measuring stability of the system.
They also investigated the feasibility of implementing the beam attenuation of the IQM Detector as a tray factor in their Philips Pinnacle treatment planning system.
The team further examined the IQM System’s ability to detect errors in the treatment delivery process.
Finally they evaluated whether IQM can replace their current pre-treatment QA approach using the Scandidos Delta 4 system.
The measurement stability test was executed on a series of IMRT plans applied on the IQM system over a month-long period. The average deviation was found to be between 0.60% and 1.00%.
The beam attenuation was verified using a waterphantom system.
They measured PDD’s as well as OAR’s and they detected a slight beam hardening effect, but all differences that they measured (D10, Symmetry, Flatness, etc.) were below 1%.
After these initial tests they felt confident enough about the system to proceed with error sensitivity tests on various clinical IMRT and VMAT plans.
At first they changed the MU setting in a single segment and checked whether the IQM System was able to detect the change.
They furthermore investigated if the system could detect a change in size for a single segment.
All their MU changes (down to 2MU change in a single segment) were detected by the IQM System.
Changing the size of a single segment was clearly detectable down to a difference of 2mm.
They repeated the same tests with the Scandidos Delta 4 system to consider whether they could use IQM for pre-treatment QA.
Both systems showed similar sensitivity and specificity for the errors introduced into the treatment plans.
Mr. Canters summarized that IQM is suitable for detecting small errors during beam delivery.
He and his colleagues found that IQM can operate with no user interaction and that it closes the verification circle of the treatment planning system, the R&V system and the treatment delivery system.
He concluded that IQM does an excellent job in real-time monitoring of the treatment beam delivery, noting that the error detection sensitivity and specificity seems to be sufficient for clinical practice and that pre-treatment QA with IQM has the potential to save a lot of time.
The complete presentation will be available for download soon.
3rd ESTRO Forum presentation:
“Meet the minds behind IQM,”
a panel discussion with Dr. David Jaffray and Dr. Mohammad Islam
from the IQM development team, Princess Margaret Cancer Centre, Toronto
On Sunday, 26th of April we had the opportunity to discuss the intentions and advantages of the IQM System with Dr. David Jaffray and Dr. Mohammad Islam.
The discussion addressed questions that came up during numerous IQM presentations over the last two years.
Dr. Jaffray and Dr. Islam explained that the idea was born in 2001 based on the increased verification requirements introduced for complex treatment techniques like IMRT and VMAT. They saw the need for a device that verifies every single treatment fraction and is sufficiently robust to be used in daily clinical routine, one that is simple enough to avoid introducing another level of complexity and which is located at the last possible step of the treatment delivery process, to function as an additional safety layer between the treatment machine and the patient.
Dr. Jaffray and Dr. Islam also explained that the single detector design has the big advantage of incredible long-term stability. They outlined that similar technology has been applied in their department for more than 3 decades now, and that they aimed for the same kind of intrinsic stability and overall reliability.
Another topic of discussion was their goal to create a verification system that can verify any kind of beam produced by the treatment machine, independent of its complexity, and a twin goal to do this fully automatically during the patient treatment.
Especially this latter approach positions IQM as the optimal verification tool for hypo fractionated treatment techniques, as well as for future treatment techniques like online adaptive Radiotherapy.
A video of the panel discussion will be available soon on our homepage.
3rd ESTRO Forum presentation:
Preliminary tests with the IQM system – the University of Florence experience
by Dr. Stefania Pallotta from Careggi University Hospital Florence
On Saturday, 25th of April Dr. Stefania Pallotta from Careggi University Hospital Florence presented some of the results acquired during beta-testing of the Integral Quality Monitor System.
The presentation took place at the iRT Systems booth during the 3rd ESTRO Forum.
Dr. Pallotta investigated the inter-fraction and intra-fraction signal reproducibility of the IQM System on an Elekta Precise Linac.
The intra-fractional signal reproducibility test was based on 10 measurements of the IQM QA field (a complex IMRT field with 18 segments)
The inter-fractional signal reproducibility tests were based on
98 measurements of the IQM QA field,
72 measurements of a modified Head&Neck IMRT treatment plan (4 field technique) and
76 measurements of a modified pelvic IMRT treatment plan (5 field technique).
The intra-fractional signal reproducibility test show an average deviation of 0.04%,
while the inter-fractional signal reproducibility test show an average deviation of
0.15% for the IQM QA field,
0.28% for the Head&Neck IMRT treatment plan and
0.36% for the modified pelvic IMRT treatment plan.
The investigators concluded that IQM provides optimal performance for signal reproducibility of complex IMRT plans.
The complete presentation will be available for download soon.
iRT Systems wins “Pioneering Spirit” Award 2013
Mrs. Eveline Lemke, Minister of Economic Affairs presented the “Pioneering Spirit” Award 2013 to the two company founders, Thesi Roestel and Jürgen Oellig during the Award Ceremonies that took place on the 21st of November in Mainz.
The “Pioneering Spirit” Award is a joint initiative of the Investment and Economic Development Bank of Rheinland-Pfalz (ISB), the Volksbanken und Raiffeisenbanken bank groups and the Südwestrundfunk public television station.
Established in 1998, this award is presented every year to recognize the best start-up concepts in the German State of Rheinland-Pfalz.
The award ceremony took place in the beautiful foyer of the ISB in Mainz.
In her laudation Mrs. Lemke outlined that the jury was not just fascinated by the business concept of iRT Systems, but especially by the enthusiasm of the presentation.
The Investment and Economic Development Bank of Rheinland-Pfalz (ISB) is the state institution for business and housing development of the state of Rheinland-Pfalz. It supports medium-sized businesses, start-ups, innovations, expansions, municipal infrastructure, housing creation, and modernization of residential real estate.
Volksbanken und Raiffeisenbanken is a prominent, nationwide co-operative bank association in Germany.
Südwestrundfunk (SWR, “Southwest Broadcasting”) is a regional public broadcasting corporation serving the southwest of Germany, specifically the federal states of Baden-Württemberg and Rheinland-Pfalz.