1. Volumetric Modulated Arc Therapy (VMAT)
Lindsay Gerner
Jessica Nyquist

2. Description Rotational 360 degree radiation therapy treatment
Photons are used
Beam is continually shaped during treatment
Shaped to the tumor
Specific to each angle
Every angle is achievable with arc therapy
Targets tumor directly
Spares more normal tissue and organs at risk
Tomotherapy and Arc Therapy are the only two forms of arc based therapy
Tomotherapy requires a specific machine
VMAT can be achieved by a conventional linear accelerator

3. Background Varian: Rapid Arc Therapy
Elekta: Volumetric Modulated Arc Therapy
Implemented in over 300 locations worldwide
Idea described in 1995
Dr. Cedric Yu
Referred to as IMAT (Intensity Modulated Arc Therapy)
Introduced in 2007
VMAT tested in Europe in 2007
The Royal Marsden Hospital in Suttok, UK
General Hospital Vienna in Austria

4. Cancers Pancreatic Cancer Prostate Lung CNS tumors Pelvic Malignancies
Not found until very advanced
Works well for sparing normal surrounding tissue
Prostate
Lung
Ex: Mesothelioma
CNS tumors
Close proximity to many critical structures
Ex: Malignant glioma
Pelvic Malignancies
Ex: Anal, rectal, and gynecologic cancers
Head and Neck
Beneficial for sparing the many critical structures that surround head and neck tumors
Ex: Parotid, esophageal, pharyngeal, and brainstem cancers

5. Process Treatments are planned by sophisticated computer software
Extensive planning takes several days for dosimetrist, doctor, and physicist to plan
Tumor contours are perfected
Size, shape, and location of tumor is identified
Therapists roles do not change significantly when utilizing arc therapy
Patient positioning
Patient marking (tattooing)

6. Treatment Administered 5 times weekly for two to three weeks
Radiation remains active while gantry is rotating around patient
50% faster than IMRT
Treatments can be as quick as 2 minutes
Complex cases can take up to 5 minutes

7. Cost Radiation Charges Insurance Doctor’s fee Films Treatment Planning
Verification films
Equipment use & supplies
Daily therapy
Insurance
Coverage is similar to traditional radiation therapy

8. Results Eligible patients Treatment outcomes
Cancers previously mentioned
May not be necessary for simple setups or palliative patients
Treatment outcomes
Improved accuracy
Less patient side effects due to normal tissue spared

9. Advantages and Disadvantages
Uninterrupted field delivery
Linear Accelerator is used
40cm X 40cm maximum field size
45cm from source to patient
Continuous dose rate
50% faster than IMRT
Treatments can be as quick as 2 minutes
Complex cases can take up to 5 minutes
Reduces dose to organs and normal tissue
Non coplanar technique
Rotational treatment

10. Photos
Elekta VMAT. Retrieved from
Varian Rapid Arc. Retrieved from

11. References
Eppinga, W., Lagerwaard, F.,M.D.PhD., Verbakel, W., Slotman, B., & Senan, S. (2010). Volumetric modulated arc therapy for advanced pancreatic cancer. Strahlentherapie Und Onkologie, 186(7), doi:
Scorsetti, M., Fogliata, A., Castiglioni, S., Bressi, C., Bignardi, M., Navarria, P., Santoro, A. (2010). Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients. Radiation Oncology, 5, 93. doi:
Web, S. (June, 2009). Volumetric-modulated arc therapy: its role in radiation therapy. Medical Physics Web. Retrieved from
ELEKTA. (2014). Next generation arc therapy for faster treatments, lower radiation dose to the patient. Elekta. Retrieved from techniques/delivery-techniques/elekta- vmat.html?utm_source=vmat&utm_medium=redirect&utm_campaign=redirects
Volumetric Modulated Arc Therapy. (June, 2009). Volumetric Modulated Arc Therapy. Swedish Cancer Institute. Retrieved from of-radiation-therapy/volumetric-modulated-arc-therapy-vmat