The first Novalis Tx linear accelerator in the UK - the latest robotic radiosurgery treatment system - was launched in February at the new Clatterbridge Cancer Centre, Liverpool.

The state of the art system, which combines high tech radiation delivery systems with modern image guidance and motion management tools, supports the UK Department of Health's recent cancer strategy to help drive improvements in cancer survival statistics through investment in radiotherapy. Later this year two further Novalis Tx machines are due to become operational in Edinburgh and Manchester.

Primarily the Novalis Tx system - which costs £2.5 million – enables stereotactic radiosurgery (SRS) treatments that are used to target lesions in the brain such as brain secondaries and recurrent gliomas, and some benign conditions such as acoustic neuromas or functional disorders such as arteriovenous malformations and trigeminal neuralgia.

"The technology allows us to track and treat difficult-to-treat cancers, such as tumours really deep in the brain where open surgery is too dangerous. Another great benefit of the knifeless Novalis Tx treatment over open brain surgery is the incredibly reduced recovery times for patients. Most treatments can be performed as a day case or will require a minimum hospital stay compared to open surgery," said Mohsen Javadpour, a Consultant Neurosurgeon at The Walton Centre NHS Foundation Trust, Liverpool.

But it is the flexibility of the Novalis Tx system that makes it so valuable, explained Brian Haylock, Clinical Director of Radiotherapy at Clatterbridge Centre for Oncology. In addition to offering stereotactic radiosurgery to cranial lesions, the device can also treat conditions outside the brain unlike some other radio surgery equipment.

"Our business plan for introducing the machine was based on the fact that as well as enabling stereotactic radiosurgery treatments we're also able to offer a working linear accelerator that can deliver a routine radiotherapy service to patients with breast, prostate and lung tumours," said Haylock, adding that in addition to offering 150 stereotactic radiosurgery patients treatments they hope to treat an additional 2,600 routine patients (26,000 fractions of treatment).

The high through-put is made possible by the fact that some complex treatments that take up to an hour with other technology can be completed in just 15 to 20 minutes.

The Novalis Tx radiosurgery platform, produced by Varian Medical Systems and BrainLAB, utilises a powerful linear accelerator, which rotates around the patient to target radiation beams at tumours from virtually any angle. A set of sophisticated image guidance and motion management tools provide clinicians with detailed 3-D information about the shape, size and position of the targeted lesion.

Key features of the technology include the ability to perform frameless radiosurgery, where doctors no longer have to immobilise patients in a stereotactic frame. This is made possible by the fact that after the patient lies down on the treatment couch two X-ray images visualise the exact position of the patient and enable the sophisticated couch (with a robotic tilt mechanism that can move in six planes) to position the treatment site perfectly in the centre of the beam. If shifts greater than 0.5 mm occur, the procedure is halted and the couch repositions the patient.

"It makes a big difference to the comfort of patients when you don't have to immobilise them with frames," said Javadpour.

Additional features include a high-definition multi-leaf collimator that shapes the treatment beam so that it matches the irregular shape of the tumour from every angle, thereby avoiding damage to the healthy surrounding tissue. This is in contrast to other radiotherapy devices that use circular beams that do not match the exact shape of the tumour from every angle.

The system can also be used for stereotactic body radiotherapy (SBRT) where it is used to target lesions in the body, such as lung tumours.