• read more about SMART


    SMART Cancer Center: Safer, Better, Cheaper.

    • Arc techniques minimize second cancers
    • 6 MV LINAC provides maximum sparing of critical organs
    • 3D Treatment significantly reduces costs
  • Educate yourself


    Patient Education through Physician Education.

    • Franklin County Cancer Committee
    • Franklin County Breast Care Team
    • American Cancer Society Resource Center


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SMART Targeting: Stereotactic Multiple Arc Radiation Therapy

MR (left) & CT (right) scans

PROS: Dr. Robert L. McLaurin, Jr., founder of Precision Radiation Oncology Systems, invented proprietary tumor targeting technology that enables the use of Magnetic Resonance Imaging (MRI) to improve the precision focus of therapeutic radiation aimed at malignant tumors. MR Image guidance was integrated into existing Virtual Simulator software to create an MRI-based Virtual Simulator in PROSPLAN. The development of this superior targeting technology spawned a conceptual re-design of radiation treatment clinics that are equally effective, yet safer, than conventional clinics.

MR-IGRT stands for Magnetic Resonance Image Guided Radiation Therapy. The foundation of the enterprise is the intellectual property that provides direct integration of MR images for 3-D Radiation Treatment Planning (RTP). It is described in detail in a process patent entitled “Automatic Image Registration of Magnetic Resonance Imaging Scans for Localization, 3-Dimensional Treatment Planning, and Radiation Treatment of Abnormal Lesions,” US Patent # 5,800,353. Earlier 3-D RTP systems were based on CT scan technology to create the “virtual patient.” Because of the superior anatomic definition provided by MR scans, it is now universally recognized that integration of MR Images into the treatment planning process represents a significant therapeutic advance.

SMART: Stereotactic Multiple Arc Radiation Therapy is an incremental improvement over conventional 3D-CRT. It integrates the inherent advantages of “Arc” treatment techniques. Arc treatment delivers the beam while the radiation source is rotating around the patient. The advantage of this technique derives from the fact that virtually all tumors have rounded surfaces.

There has never been a square tumor, or a hexagonal one or an octagonal one. The common 4 or 6 or 8-field plans using a finite number of static portals cannot provide as good a fit to the tumor, because the Arc technique enables us to “bend” the isodose curves to conform more precisely to the target contour. Simple geometry dictates that the greatest area that can be contained in a given perimeter is a circle. All of the “extra” area contained in other shapes exposes additional normal tissue to unnecessary radiation.

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Preventing Fatal Second Malignancies from IMRT

Risk of Fatal Second Malignancies from Intensity Modulated Radiation Therapy From Kry and Followill.

Saving Lives and Saving Money by Employing an Innovative Alternative to IMRT

SMART exclusively employs 6 MV beams because of the risks inherent in high-energy beams. High-energy beams produce increased radiation scatter and neutron contamination. These problems are exacerbated by IMRT, and are the root cause of the enhanced risk of fatal second malignancies. (from Kry and Followill)

Research has also shown that 6 MV beams produce the optimal treatment plans.  A recent study exploring the effect of beam energy on treatment plan quality in the modern era of sophisticated treatment planning demonstrates that, “for plans with comparable target coverage, critical structure sparing is best achieved with 6 MV beams.”

IMRT: Intensity Modulated Radiation Therapy is a relatively recent innovation in the history of Radiation Oncology. It employs sophisticated computer treatment planning software and hardware to focus the damaging effects of radiation on the malignant tumor while reducing the dose to nearby normal tissues.  It is a major technologic advance over the prior state-of-the-art technique of 3D Conformal Radiation Therapy (3D-CRT).

Years of accumulated data fail to show that IMRT produces any improvement in survival compared to 3D-CRT. Nonetheless, Medicare pays approximately $45,000 per patient for IMRT vs. $12,000 for 3D-CRT. The evidence does demonstrate that IMRT provides a small reduction in proctitis, but that advantage is more than offset by a dramatic increase in the risk of fatal second malignancies.

The Institute for Clinical and Economic Review (ICER) conducted a thorough analysis in 2007 comparing IMRT to 3D-CRT for the treatment of localized prostate cancer.Their findings confirm that IMRT produces no survival benefit.  ICER concluded that the clinical effectiveness of IMRT is not superior to the established standard, and the comparative value of IMRT is low.

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SMART Center: Select Megavoltage Accelerators in Radiation Therapy.

Superior targeting technology established the premise for development of new, low cost, state-of-the-art radiation treatment centers that include specific refinements designed to enhance patient comfort and improve safety. As advanced treatment planning evolved, a paradigm shift emerged: the precision and accuracy of the targeting technology surpassed the earlier predominance of the raw power of the Linear Accelerator in determining the effectiveness of treatment (smart bomb analogy). With advanced radiation treatment planning, 6 MeV accelerators provide clinical characteristics that are fundamentally superior to higher energy machines. They are also safer for patients and personnel, producing far less scatter radiation and neutron contamination, thereby dramatically reducing the risk of fatal second mailgnancies.

Discover more of our innovations.