Linear Accelerator (LINAC) The Oncology department is situated Lucky for one young cancer patient in 1956 that

Henry Kaplan, MD, had already come to Stanford with an unusual goal: to turn a device used by the physicists on campusthe linear acceleratorinto a tool for fighting cancer. That patient, a 2-year-old boy suffering from a tumor in his eye, was the first to undergo X-ray treatment from a medical linear accelerator that Kaplan developed with campus physicists. The treatment saved the child's sight and he lived the rest of his life with his vision intact. Fifty years and 40 million patients later, medical linear accelerators have become the backbone of radiation therapy for cancer worldwide. Roughly half of all cancer patients receive radiation therapy, primarily from the rays generated by a linear accelerator. The device also has a number of other medical uses. Its radiation can quell the rejection of an organ transplant, suppress the immune systems of patients undergoing blood and marrow transplantation, and correct certain neurological and cardiovascular disorders. The medical linear accelerator is a dramatic example of what can be achieved when researchers from different academic disciplines converge to solve a problem. This 50-year-old achievement was a precursor to the multidisciplinary approach now called translational medicine.

History of the medical linear accelerator: 1952: Henry Kaplan and Edward Ginzton begin building a medical linear accelerator. 1956: The first medical linear accelerator in the Western Hemisphere is installed at Stanford Hospital in San Francisco. 1959: Stanford medical school and hospital move to the Palo Alto campus, bringing the medical linear accelerator. 1962: Kaplan and Saul Rosenberg begin trials using the linear accelerator with chemotherapy to treat Hodgkin's disease, an approach that dramatically improves patient survival. 1994: First use of the CyberKnife, invented at Stanford, which uses sophisticated computerized imaging to aim a narrow X-ray beam precisely. 1997: Stanford pioneers the use of intensity-modulated radiation therapy, which combines precise imaging with linear accelerators that deliver hundreds of thin beams of radiation from any angle. 2004: Implementation of four-dimensional radiotherapy, which accounts for the motion of breathing during imaging and radiation delivery. 2006: 50th anniversary of the Stanford medical linear accelerator.

Overview
Targeted treatments making cancer a manageable disease The right dose. The right place. The right time. Varian delivery systems enable clinicians to pick the best treatment option with a wide range of practical therapy choices. To enhance the effectiveness of these treatments, Varian also offers unparalleled real-time position management and exacting dose output - vital tools for achieving personalized cancer care and making cancer a manageable disease. The Right Dose for Fewer MUs The Varian Clinac delivers the exact prescribed dose to the patient in the lowest number of monitor units (MUs) possible - without sacrificing efficacy - every time. Reliable dose - Varian's real-time beam steering and dual sealed ion chamber helps ensure that optimal beam symmetry, flatness, and dosimetry are delivered throughout all gantry angles. Fast treatment times - a unique energy switch to deliver the highest possible dose rates for all energies. Precise treatment - accurate beam control results in improved conformity to the tumor and sharp images Waveguide - produces a very stable, sharp beam spot. Gridded gun - fast beam-on, beam-off control. Energy switch - enables delivering high doses quickly. Bending magnet - maintains the small, sharp beam focal spot.

The Right Place for the Highest Conformity Delivering the dose to the right place is a function of industry leading products working in concert. These innovations include the highest resolution multileaf collimator (MLC), the most capable dynamic control software, the best treatment plan for driving delivery, and the most precise beam control. Varian machines enable clinicians to use all three major IMRT methods - sliding window, step and shoot, and dynamic conformal arc - either separately or in the same treatment.

Treatment planning software - the intuitive interactive design of Eclipse enables clinicians to reach plan goals quickly and minimize critical structure doses while achieving the desired conformity. Multileaf collimator - treat even the smallest lesions. IMRT - quickly treat IMRT fields up to 34 x 40cm, thanks to fast leaf speed, high precision, and interdigitation capabilities. Stereotactic treatments - Trilogy provides high dose and precise resolution for intracranial and extracranial stereotactic radiosurgery and radiotherapy. The Right Time for Precision Personalization Clinicians around the world depend on Varian systems to deliver treatment at the right time - the instant the tumor is on target. Whether it's day-to day repositioning of the patient or managing motion during treatment, Varian has developed the necessary Dynamic Targeting Image-Guided Radiotherapy (IGRT) process tools: cone-beam CT, radiographic, fluoroscopic, ultrasound, optical, and gating. With Varian systems, clinicians can personalize each patient's care based on their needs and your individual clinical protocol. Breast: Respiratory gating enables improved dose targeting. Head and Neck: Cone-beam CT provides quick positioning, verifying, and monitoring.

Prostate: All the right tools for treatment include ultrasound-based guidance.

Clinac 21EX/23EX and Platinum Linear Accelerator

High performance, Maximum efficiency.

Clinac EX linear accelerators are high-performance systems with:

An instant beam-on with dynamic treatment control The greatest number of energy options to treat the widest range of patients The most precise focal spot size for optimum portal imaging The highest dose rates across the energy spectrum for greater throughput These capabilities, combined with optional integrated Varian multileaf collimation and electronic portal imaging systems, enable clinicians to perform the most advanced computer-driven intensity-modulated radiation therapy (IMRT) treatments, as well as conventional therapy techniques.

Features and Capabilities

Standard Features:

Two selectable photon beam energies Selectable dose rate up to 600MU/min Choice of electron energies to meet clinical needs, with electron applicators included Tight isocenter alignment of the gantry, couch, collimator, and imagers Reproducible, stable, and accurate machine positioning Exact couch for accurate reproducible patient positioning Modes for special clinical procedures, e.g. high dose total skin electron mode and total body X-ray mode Enhanced dynamic wedge saves time and the need to reenter the treatment room Auto field sequencing Dynamic procedure modes for photon arcs SmartConnect remote access technology provides access to Varian customer support expert assistance and online remote analysis Optional Features:

MLC - the widest range of multileaf collimator (MLC) resolution choices on the market Real-time Position Management (RPM) system for respiratory gating system PortalVision - megavoltage imaging with optional Portal Dosimetry On-Board Imager kV imaging system (OBI) - high-quality, low dose imaging for verification and repositioning of patient prior to treatment

 Clinac iX Linear accelerator

An innovative platform for today. A solid foundation for the future. The Clinac iX is a streamlined, high-performance and reliable platform that incorporates a broad range of imaging and treatment options, including dynamic motion management. Every Clinac linear accelerator is built on the new, high-performance iX platform, and every system can be custom configured. That means every facility always starts with the best and builds forward. This combination of quality and customization allows clinicians to meet the specific needs of each site, and to ensure that future treatment advances are always within reach. Features and Capabilities Standard Features: Up to three photon beams Range of electron energy choices High dose rate stereotactic radiosurgery Low dose rate therapy Respiration-synchronized image acquisition Tight isocenter alignment of the gantry, couch, collimator, and imagers Reproducible, stable, and accurate positioning Automated image acquisition Reproducible online image matching Remote control of imager position Exact couch, remote control of patient position, and improved positional accuracy Compact stand Efficient command center, ergonomically designed for therapists' comfort, and designed to follow clinical workflow, with fewer controls to manage Optional Features:

Multileaf collimator - the widest range of multileaf collimator (MLC) resolution choices on the market Auto field sequencing - automate field delivery for maximum efficiency Advanced dynamic procedures - used with the MLC option to create true 3D doses with intensity modulated techniques Beam matching - to existing or other new Clinac linear accelerators Special procedure support - total body electron treatment, high dose total skin electron mode, and total body photon mode PortalVision - megavoltage imaging with optional Portal Dosimetry On-Board Imager kV imaging system (OBI) - high-quality, low dose imaging for verification and repositioning of patient prior to treatment Cone-beam CT - based imaging and repositioning - an option with the OBI system Real-time Position Management (RPM) system for respiratory gating

Clinac 2100C Linear Accelerator Family

Peak performance day-to-day, year in, year out.

The Clinac 2100C linear accelerator is the most widely selected medical accelerator in the world, treating thousands of patients every day. The standard-bearer of the industry, the Clinac 2100C linear accelerator has the highest uptime in the industry.

Features and Capabilities

Standard Features:

Two selectable photon beam energies Selectable dose rate up to 600MU/min Choice of electron energies to meet clinical needs, with electron applicators included Tight isocenter alignment of the gantry, couch, collimator, and imagers Reproducible, stable, and accurate machine positioning Exact couch for accurate reproducible patient positioning Modes for special clinical procedures, e.g. high dose total skin electron mode and total body X-ray mode Enhanced dynamic wedge saves time and the need to reenter the treatment room SmartConnect remote access technology provides access to Varian customer support expert assistance and online remote analysis Optional Features:

MLC - the widest range of multileaf collimator (MLC) resolution choices on the market Auto field sequencing - automate field delivery for maximum efficiency Advanced dynamic procedures - used with the MLC option to create true 3D doses with intensity modulated techniques Low dose rate option - 580mu/min dose rate selection Laser guard collision detection system

Clinac 6EX Linear Accelerator

Cost efficient, full function

The Clinac 6EX linear accelerator enables clinicians to augment their multienergy machines with a single-energy configuration optimized for small rooms where space and shielding are a design issue. From conventional to stereotactic techniques, and fully dynamic intensity-modulated radiation therapy (IMRT) support, the Clinac 6EX linear accelerator is a cost effective choice for the busy oncology department. Configured for the latest treatment techniques, the Clinac 6EX has the tightest mechanical and dosimetric specification of any single-energy machine.

Features and Capabilities

Standard Features:

Industry leading beam output, stability, and dynamic dose delivery Compact design for easy site preparation Selection of 4MV or 6MV photon energy configuration Dose rates up to 600MU/min Tight treatment isocenter for stereotactic applications Exact couch SmartBeam IMRT capability, featuring dynamic dose-sculpting software Autofield sequencing Optional Features:

High resolution multileaf collimator ( 80 leaf or 120 leaf) High speed beam gating for respiration motion management Low dose, high resolution PortalVision megavoltage imaging system with automated imager positioning Stereotactic components

Varian Medical Systems Introduces Revolutionary New TrueBeam System for High-Precision Image-Guided Radiotherapy and Radiosurgery
New technology enables a radical new approach that expands radiotherapy treatment options for even the most challenging cases New York, NY - April 14, 2010 - Varian Medical Systems (NYSE:VAR) today is announcing the introduction of a new line of "super" accelerators designed to advance the treatment of lung, breast, prostate, head and neck, and other types of cancer. The TrueBeam platform for imageguided radiotherapy and radiosurgery is the first fully-integrated system designed from the ground up to treat a moving target with unprecedented speed and accuracy. Varian unveiled the new line last night at a special event conducted here for members of the cancer treatment community. "We took everything clinicians told us they wanted to enable next-generation treatments, and we challenged ourselves to engineer a completely new treatment platform," said Tim Guertin, president and CEO of Varian Medical Systems. "TrueBeam is the culmination of those efforts." A TrueBeam system uses a completely re-engineered control system and a multitude of technical innovations to dynamically synchronize imaging, patient positioning, motion management, and treatment delivery. "It opens the door to the development of new and improved approaches for treating cancer and other medical conditions commonly treated with image-guided radiotherapy and radiosurgery," Guertin said. "We've also given TrueBeam a patient-friendly look with a beautiful sleek design, but it's what's under the covers that makes this system so special. It's intuitive, intelligent, and we think it is a game changer." Designed to be a versatile platform, a TrueBeam system can be used for all forms of advanced external-beam radiotherapy including image-guided radiotherapy and radiosurgery (IGRT and IGRS), intensity-modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT) and RapidArc radiotherapy. The product line includes TrueBeam STx, specially configured for advanced radiosurgery.

Faster, More Precise Systems

A TrueBeam system can deliver treatments up to 50 percent faster with a dose delivery rate of up to 2400 monitor units per minute, double the maximum output of earlier, industry-leading Varian systems. This makes it possible to offer greater patient comfort by shortening treatments, and to improve precision by leaving less time for tumor motion during dose delivery. "Intelligent" automation further speeds treatments with an up to five-fold reduction in the number of steps needed for imaging, positioning and treating patients. A standard intensity-modulated treatment that would typically take ten minutes can be completed in less than two minutes. Complex radiosurgery that typically takes 40 minutes to an hour, can be completed in just 5 to 20 minutes. "When we introduced RapidArc radiotherapy, we were thrilled to see treatments done in about 2 minutes," said Guertin. "With TrueBeam, RapidArc treatments can now be completed in about a minute." The precision of a TrueBeam system is measured in increments of less than a millimeter. This accuracy is made possible by the system's sophisticated architecture, which establishes a new level of synchronization between imaging, patient positioning, motion management, beam shaping, and dose delivery technologies, performing accuracy checks every ten milliseconds throughout an entire treatment. Over 100,000 data points are monitored continually as a

treatment progresses, ensuring that the system maintains a "true isocenter," or focal point of treatment. "This increased level of precision will make it possible for doctors to treat a moving lung tumor as if it were standing still," said Guertin. "By synchronizing treatment with tumor position changes throughout the respiratory cycle, doctors will be able to reduce the margin of healthy tissue affected by the treatment beam." The TrueBeam system also delivers Varian's new 'gated' RapidArc radiotherapy, which compensates for tumor motion by synchronizing imaging with dose delivery during a continuous rotation around the patient. "This exciting new capability makes RapidArc an even more powerful tool for treating cancers of the thorax, such as lung and liver cancer, when tumor motion is an issue," Guertin said. Other innovations built in to the TrueBeam system include:

A streamlined treatment console with a modern, graphical, easy-to-use interface that consolidates all controls for imaging, treatment, and motion management. Treatment processes and workflows are simplified and easy to learn, with prompts, messages, and a "follow the light" guidance system that enhances safety by guiding therapists through the steps of even the most complex treatments. "One button" IGRT enables the therapist to spend more time attending to the patient, and less time managing the technology.

A newly-designed X-ray tube is optimized for generating high volumes of quality 3-D (conebeam CT) images. These 3-D images can be generated in 60% less time, with a 25% reduction in X-ray dose to the patient. A treatment couch that can be positioned with sub-millimeter accuracy in relation to imaging and beam delivery processes. A unique new non-clinical Developer Mode designed to facilitate collaboration with Oncology thought leaders interested in pioneering new treatment and imaging techniques.

"With its many new unmatched capabilities, we've created a new breed of accelerator with the versatility to improve conventional treatments and at the same time support the clinical development of treatment innovations that offer patients more options for fighting their disease," said Guertin. "TrueBeam takes us a significant step closer towards our goal of helping to save 100,000 more lives each year." Some of the motion management tools developed for the new TrueBeam system have been added to Varian's Trilogy platform and are being made available to customers with Clinac iX accelerators. "As we develop new capabilities for this system, we'll use what we learn to continually enhance our full line of treatment solutions, ensuring that we can continue to offer the widest spectrum of advanced solutions for meeting our diverse customers' needs," Guertin said. ABOUT VARIAN MEDICAL SYSTEMS Varian Medical Systems, Inc., of Palo Alto, California, is the world's leading manufacturer of medical devices and software for treating cancer and other medical conditions with radiotherapy, radiosurgery, proton therapy, and brachytherapy. The company supplies informatics software for managing comprehensive cancer clinics, radiotherapy centers and medical oncology practices. Varian is a premier supplier of tubes and digital detectors for X-ray imaging in medical, scientific, and industrial applications and also supplies X-ray imaging products for cargo screening and industrial inspection. Varian Medical Systems employs approximately 5,000 people who are located

at manufacturing sites in North America, Europe, and China and approximately 79 sales and support offices around the world. For more information, visit http://www.varian.com.

Trilogy Power. Precision. Versatility.

The new Trilogy system adds more powerful advanced motion management capabilities. Complete with Gated RapidArc and a new open motion management interface, these tools expand the options for treating moving tumors. Gated RapidArc utilizes the RPM system to monitor and adjust for tumor motion during a RapidArc treatment. The open interface can also be used with third party companies to connect their devices to Varian accelerators for the purpose of monitoring motion. This interface further demonstrates the open architecture design of the Trilogy system and provides support to third party companies to monitor tumor motion in real time. The power of Trilogy yields treatment times that are shorter, making the experience more comfortable for the patient. The precision of Trilogy allows you to spare healthy tissues to an extent that was unimaginable only a few years ago. The versatility of Trilogy enables treatment of a wide variety of patients using a single machine. All In One. Best In One. Varian offers the complete package in Trilogy:

Choose from a broad range of external beam therapies, including 3D CRT, IMRT, IGRT or DART using the Trilogy system. Multiple dose rate options up to 1000mu/min for efficient SRS delivery. 2D and 3D KV image guidance for higher quality imaging at lower doses.

Full 360 range of treatment delivery angles with positional couch angles. Stereotactic frame or frameless immobilization for patient positioning - treat any area of the body. Real-time Position Management (RPM) system - for gating perfectly timed beam delivery with minimal margins. Gated RapidArc with advanced motion management and open third-party interface. Portal Dosimetry IMRT treatment delivery verification. Dynamic high resolution MLC for exquisite beam sculpting. Delivery verification and quality assurance in Argus Linac and Argus IMRT quality assurance software. Clinical benefits:

Highest dose rate for shorter sessions. Faster treatment times. Tight isocenter alignments on all three axes. Targets the smallest lesions. Rapid on-board imaging. Reposition patients quickly and accurately. Cone-Beam CT, fine tune patient set ups with ultra-precise CT scans. Varian is not trying to make you follow our process, we provide you with the number one products that will support your processes. The Trilogy system is the first in a new generation of cancer care systems. A versatile system optimized for multiple forms of treatment, from radiation therapy to radiosurgery. The versatile Trilogy system delivers 3D conformal radiotherapy, IMRT, stereotactic radiosurgery, fractionated stereotactic radiation therapy, and intensity-modulated radiosurgery for cancer and neurosurgical treatment.