Products/Radiotherapy/Intraoperative radiation therapy (IORT)/

LIAC HWL: the best way to perform IOeRT – S.I.T.

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LIAC HWL is the latest and most advanced model of SIT mobile electron linear accelerators: a reliable device to implement a modern and successful IOeRT program.

LIAC HWL is available in two models:
-model 10 MeV, with energies 4, 6, 8 and 10 MeV;
-model 12 MeV, with energies 6, 8, 10 and 12 MeV.

FLEXIBLE & EASY TO USE

LIAC HWL’s weight is only 570 kg (1257 lb) and its flexible architecture allows a fast hard-docking procedure ensuring proper coverage of any anatomic region where the IOeRT treatment shall be delivered.

LIAC HWL “captures” the scene in the OR only when the target is ready to be irradiated and leaves immediately after treatment is delivered.

EASY TRANSPORTATION

Because of its dimensions, LIAC HWL can be easily moved via its remote control from one operating room to another and from one floor to another by using any stretcher elevator, ensuring its use during the same day in multiple operating theaters.

POWERFUL & SAFE

LIAC HWL high mobility when combined with its high dose rate (IOeRT irradiation time is less than 2 minutes), ensures the implementation of faster and more reliable operating procedures. LIAC HWL allows the user to deliver the IOeRT dose to the target very fast, avoiding fluids and bleeding potential interfering with dose deposition.

The appropriate energy and applicator selection allows the treatment of any volume of clinical interest (target) with a thickness up to 3.2 cm inside the 90% isodose (3.8 cm inside the 80% isodose).

A radioprotection disc is temporarily inserted between the mammary gland and the chest wall in order to fully protect the healthy tissue underneath.

NO NEED OF SHIELDING OR STRUCTURAL MODIFICATIONS TO THE OPERATING ROOM

LIAC HWL has been specifically designed in order to minimize scatter radiation.

No additional barrier, fixed or mobile is needed inside the operating room. The new design allows the highest possible workload: over 300 patients per year without any additional shielding in a standard operating room.

EXTRAORDINARY STABILITY

The latest technology developments were applied to LIAC HWL to offer the user a superior stability. SIT systems make the difference for their stability and LIAC HWL even elevates the threshold up to a level never seen before.

FAST COMMISSIONING

LIAC HWL allows the hospital to perform IOeRT treatment only 5 days after its delivery thanks to a very sophisticated software developed on Monte Carlo simulation.

LIAC HWL commissioning is performed in accordance with primary international protocols through the use of standard dosimetric instrumentation, as well as use of proprietary software based on a Monte Carlo Simulation.

The use of such software allows to dramatically reduce dosimetric characterization of the accelerator to three days following the system’s acceptance test performed at the main factory. The clinical dosimetry of the totality of combinations (4 energies x 9 diameters of the applicator x 4 bevel angles) is immediately available, allowing to avoid the whole experimental characterization of the system.

Scientific publications are backing up this method and today the correspondence between the simulated and experimental data is incredibly precise.

PLUG & PLAY INSTALLATION

LIAC HWL is a plug & play device. It is sufficient to connect the mobile unit and the control unit by a dedicated cable. LIAC HWL installation only requires availability of:
-socket (230/110 mono-phase + ground V 50/60 Hz);
-acoustic and optical signaling system (where required).

Just 5 days after delivery at its destination site, the system is ready for the first IOeRT treatment.

BREAST & MULTI-CANCER APPLICATION

More than 30,000 patients diagnosed with neoplastic diseases have been treated worldwide with LIAC HWL.

Two protocols developed for the treatment of breast cancer are adopted internationally: the ELIOT protocol for breast single dose (entirely realized with SIT IOeRT systems) and the HIOB protocol for breast boost.

IOeRT Single dose and IOeRT Boost are today supported by ESTRO and ASTRO guidelines. Many more non breast studies demonstrate IOeRT effectiveness and today 8 IOeRT indications are recommended by NCCN guidelines for Soft Tissue Sarcoma, Rectal Cancer, Colon Cancer, Pancreatic Adenocarcinoma, Cervical Cancer, Endometrial Cancer, Uterine Sarcoma and Bladder Cancer.

LIAC HWL APPLICATORS

LIAC HWL collimates the dose to the target through applicators made of medical grade PMMA. This solution allows a very high surface dose especially designed to treat targets surgically exposed. Experimental data also showed PMMA is the best available material to limit any stray radiation coming from beam-applicator interaction.

Standard supplied applicators diameters are: 30, 40, 50, 60, 70, 80, 90, 100, 120 mm.

Applicators available bevel angles are: 0°, 15°, 30° and 45° offering both circular and elliptical fields. LIAC HWL recognizes automatically which applicator is attached at the radiant head. Thanks to the combination of available diameters, bevel angles and energies, LIAC HWL offers up to 144 different dosimetric fields.

LIAC HWL RADIOPROTECION DISCS

The radioprotection disc is intended to be used for the protection of healthy tissue during breast carcinoma IOeRT treatment. Two types of disc are available: suturable and non-suturable radioprotection disc.

Suturable radioprotection disc consists of two discs, one made of AISI 316L steel and one made of PTFE, both biocompatible medical grade. The disc has 4 holes along the crown, enabling it to be temporarily sewed to the tissue located immediately under the tumor bed ensuring patient protection and the ability to perform a safe IOeRT treatment.

Non-suturable radioprotection disc consists of two discs, one made of AISI 316L steel and one made of Tecapeeck, both biocompatible medical grade.

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MECHANICAL ARM

A mechanical arm holder is also available: it holds securely and safely the applicator in any desired position during the docking procedure performed for IOeRT; it is compact and light and can be easily attached to any operating table and ready for immediate use. No additional power or air connections are required.

Research sources

Commissioning, dosimetric characterization and machine performance assessment of the LIAC HWL mobile accelerator for Intraoperative Radiotherapy
https://www.sciencedirect.com/science/article/pii/S0939388920300635

The only shielding needed may be the beam absorber, in order to protect downstairs areas (IORT dedicated linac radiation protection: A novel approach, G. Felici et al., Physica Medica 12/2018; 56:271-272., DOI: 10.1016/j.ejmp.2018.04.357; IORT & stray radiation: comparison of 2 commercial linacs, Stevens P et al., (2019), ESTRO 38, DOI:10.13140/RG.2.2.25173.88804).

LIAC HWL Radiation Protection

With LIAC HWL, SIT launched the first IOeRT accelerator capable of operating in any standard operating room, solving completely any radiation protection issues.

LIAC HWL technology demonstrated its value and effectiveness even when installed in countries with a very strict approach to radiation protection like Belgium.

Today, SIT is able to simulate and determine, using input data, LIAC HWL radiation protection behavior according to a given architectural space. Such extraordinary and patented radiation protection performances, combined with LIAC HWL compact design and light weight, ensure the system fitting into any standard OR avoiding architectural modification.

According to NCRP 151, in a standard non-shielded operating room no specific protection is required for upstairs and patient level, with a weekly workload around 100 Gy/week (5 full dose or 10 boost treatment).