Novant Health Cancer Institute radiation oncology centers are using the Varian TrueBeam linear accelerator (LINAC) to more safely and efficiently treat brain and prostate cancers.

The system now delivers HyperArc stereotactic radiosurgery and triggered imaging to ensure more accurate targeting than conventional treatments, said medical physicist Lalith Kumaraswamy, PhD, director of physics at Novant Health Cancer Institute.

HyperArc’s intracranial therapy targets several brain metastases at once, rather than one at a time. And Triggered Imaging enables delivery of higher doses with fewer fractions by targeting only the prostate and avoiding healthy organs including the bladder and rectum.

Triggered imaging allows the LINAC to monitor tumor location and movement in real time to deliver faster and more comfortable treatments. This improved efficiency saves time for the patient and the clinician.

Fewer fractions mean reduced side effects and far less time spent driving to appointments. HyperArc and triggered imaging especially benefit those patients living in rural areas who travel long distances every day for radiation treatment.

“It treats multiple brain metastases simultaneously in minutes, not hours,” Kumaraswamy said. “And with triggered imaging, many patients, especially prostate patients, only have to travel to the clinic five times or less instead of 30.”


  • More precisely treats brain mets and benign tumors including meningioma and acoustic neuroma
  • Treats multiple brain mets simultaneously in minutes, not hours

HyperArc treats brain mets more efficiently than Gamma Knife, the gold standard radiosurgery for brain cancer, Kumaraswamy said. Additionally, HyperArc delivers the same conformal dose to tumors, but much faster. That’s because the technology can target and destroy several lesions simultaneously, while Gamma Knife treats only one at a time. The experience is better overall for the patient, Kumaraswamy said.

“Using high-resolution cameras, we are constantly monitoring the patient’s movement, so there’s no need for them to wear a head frame as Gamma Knife requires,” he said. “With HyperArc, the patient just wears a mask to stabilize. There are very few side effects, and patient comfort increases tremendously.”

HyperArc also cuts treatment time considerably, while many Gamma Knife patients struggle to undergo therapy for several hours at a time.

“When brain mets patients are already in a fragile situation, it becomes very difficult to go through that procedure,” Kumaraswamy said. “But with HyperArc, I see patients going in and out with no complaints.”

Triggered imaging

  • Enables clinicians to deliver no more than five fractions for certain prostate cases
  • Uses fiducial markers to track a tumor’s movement beyond the radiation beam
  • Reduces side effects by ensuring the beam avoids healthy tissue

Before triggered imaging, there was no convenient method for clinicians to pinpoint the prostate during treatment, Kumaraswamy said. Instead, they had to expand the radiation area, which risked irradiating critical organs. Because of this, clinicians had to break a total radiation dose into as many as 30 fractions, and patients were burdened with the stress of daily travel for treatment.

But now, some intermediate and low-risk prostate patients can complete treatment in only five visits. This is made possible by the ability of triggered imaging to focus on the prostate’s location with improved accuracy by reducing the size of the radiation field.

Kumaraswamy and his physics and dosimetry team works with the oncologists to deliver precise radiation in less time, which helps to preserve surrounding tissue.

“With triggered imaging, we can precisely target the prostate and deliver a higher dose,” he said. “That means fewer side effects for the patient.”

Oncologists implant fiducial markers in the prostate to track tumor movement outside of the radiation field. X-rays constantly monitor and ensure that the cancer cells remain within the treatment area. So if the patient moves, the beam pauses treatment until the tumor re-enters the field.

The Varian TrueBeam LINAC’s HyperArc and triggered imaging technologies are offered at Novant Health Forsyth Medical Center, Novant Health Kernersville Medical Center, Huntersville Medical Center, Wallace Cancer Institute, Weisiger Cancer Institute. Novant Health Cancer Institute - New Hanover (Radiation Oncology)

To work with a linear accelerator at one of Novant Health Cancer Institute’s locations, or to refer a patient, please call or fax:

Novant Health Forsyth Medical Center:

  • Phone 336-718-5095
  • Fax 336-718-9895

Novant Health Kernersville Medical Center:

  • Phone 336-564-4090
  • Fax 336-564-4595

Novant Health Rowan Medical Center:

  • Phone 704-210-6870
  • Fax 704-210-6877

Novant Health Huntersville Medical Center:

  • Phone 704-316-6630
  • Fax 704-316-6631

Novant Health Presbyterian Medical Center:

  • Phone 980-302-6100
  • Fax 980-302-6105

Novant Health New Hanover Regional Medical Center:

  • Phone 910-662-8444
  • Fax 910-667-6733