Clinical routine with Exac Trac Dynamic Surface

In the latest Brainlab Journal article, explore how the Radiotherapy Institute in Creil, Amethyst Radiothérapie France is revolutionising cancer treatment through SGRT, tattooless treatment and the breath hold workflow.

Now, with both ExacTrac Dynamic® and ExacTrac Dynamic Surface® for patient positioning and monitoring they are able to enhance daily clinical routines and ensure top-notch care for patients from all across the Sud l’Oise region of France.

Article below:

SGRT & Tattooless Treatment – How Radiotherapy Institute in Creil Is Improving Daily Clinical Routine with ExacTrac Dynamic Surface

We were excited to sit down with Andres Huertas, MD, radiation oncologist, and Pierre-Alexandre Rigaud, medical physicist, both from the Radiotherapy Institute for the Sud l’Oise region in Creil, France which is part of Amethyst Radiotherapy Group.

Dr. Huertas and Mr. Rigaud discuss with us the value of the latest radiotherapy techniques and technology in the treatment of cancers. The clinic, located within the medical campus of the public hospital Groupe Hospitalier Public du Sud de L’Oise Creil (GHPSO), is equipped with both ExacTrac Dynamic and ExacTrac Dynamic Surface systems for patient positioning and monitoring during radiation treatment for cancer. The clinic expanded in 2010 after becoming part of the Amethyst Radiotherapy Group and patients come from all over the region for advanced and comprehensive cancer care.

You have already been using ExacTrac Dynamic on your TrueBeam linac for over three years. What made you decide to equip your other linac with ExacTrac Dynamic Surface?

Dr. Huertas: “Our first ExacTrac Dynamic system has greatly benefitted our patients presenting with indications that benefit from stereotactic radiosurgery and body radiation therapy. The addition of ExacTrac Dynamic Surface, the new surface-only system by Brainlab, allows us to standardize the department: We are now able perform tattooless prepositioning for all our treatments. Furthermore, we are able to split clinical indications between the two machines depending on patient needs and the type of treatment to be performed.

Now that you have two ExacTrac systems, how do you plan to coordinate the daily clinical routine of the department between the technologies?

Dr. Huertas: “We will continue to perform cranial stereotactic radiosurgery (SRS) by leveraging the unique benefits that ExacTrac Dynamic brings to such treatments, like the X-Ray verification and active correction in six degrees of freedom, even at non-coplanar angles. With the breath hold workflow we have already treated over 200 breast patients and about 100 lung, adrenal gland and some liver cases. For such indications, the automated breath hold gating functionality is crucial as it ensures safe and accurate irradiation that avoids the heart and other critical organs. Our plan for the future is to perform primarily SRS and breath hold treatments on ExacTrac Dynamic and to focus more on thoracic, pelvic and other breath hold cases on ExacTrac Dynamic Surface.

What do you value most in the new ExacTrac Dynamic Surface Breath Hold Workflow?

Mr. Rigaud: “What we really like about the new workflow is that the software has been designed with the needs of clinicians in mind. For example, the simple feedback display for the patient in the bunker and on the control-room display, where they can easily see when they have reached the planned breath hold level, is a tool that provides reassurance to the patient that they are positively contributing to the success of the treatment. In turn, this gives us the confidence that we are performing a precise treatment. One of the major factors contributing to the accuracy is that the system automatically captures a reference surface for monitoring at breath hold level during external positioning imaging. This is a real game changer, providing the highest accuracy on the market for this treatment, as we can be sure that we are treating the tumor as planned. Last but not least, the preparation for the treatment is very simple and straightforward – no additional camera is needed in the CT room, we simply acquire two planning CTs, one at breath hold and the other in free breathing.

What are the benefits of tattooless workflows in your opinion and how exactly does ExacTrac Dynamic Surface help you achieve this? 

Dr. Huertas: “There is great value in surface-guided patient prepositioning and set-up for patients, as they are no longer marked with permanent and invasive tattoos that constantly remind them of their cancer treatment. Patients have found that tattooless treatments not only provide a cosmetic benefit but may reduce their anxiety, making the whole procedure more comfortable for them. For us, the advantage is that we can perform prepositioning that is comparable in accuracy and speed, and we don’t have to deal with the tattooing process, which can be very time consuming and tedious.”

Mr. Rigaud: “When we started transitioning from laser-based to tattooless prepositioning, we established that the precision of prepositioning with ExacTrac Dynamic Surface is as accurate as with lasers, but more straightforward and seamless. With the ExacTrac Dynamic Surface technology we can track patient surface anatomy directly, via a structured blue light projected onto the patient, which is acquired by two stereoscopic cameras. In this way we can very accurately track the surface without the need for any skin markings. We really appreciate the ease and speed of this setup process.”

What additional value do you see in relying solely on ExacTrac Dynamic and ExacTrac Dynamic Surface technologies in your department? 

Dr. Huertas: “Our staff, especially the radiation therapists (RTT), truly appreciate the ease of use of the Brainlab software and how the ExacTrac user interface allows them to make accurate but quick decisions as the treatment progresses. Because the software is the same on both systems, our RTTs were able to master the new ExacTrac Dynamic Surface system within days of installation. For example, they can use the ExacTrac Dynamic system one day and then switch to ExacTrac Dynamic Surface the next day without any problems. We feel that this standardization really helps us to streamline our clinical routine. In addition, patients can be easily moved between the two systems as they share one common patient database giving us further flexibility in our patient scheduling.”

What is your vision for the future development of the department in terms of hypofractionated treatments and SBRT? 

Dr. Huertas: “Nowadays, radiotherapy is going toward hypofractionation or extreme hypofractionation, to benefit more patients. This is backed up by more and more solid prospective data and will require an adaptation in our practice, from both medical and technical viewpoints. Delivering more dose per fraction comes with a higher risk for each fraction which can be mitigated by using advanced patient positioning and monitoring, which we feel confident in doing given the capabilities ExacTrac Dynamic offers combining SGRT and IGRT.

We have already started to use the system for lung and liver SBRT and plan to use it for prostate SBRT with the implanted marker workflow, given the features such as automated marker detection and active intrafraction motion management via stereoscopic X-Ray monitoring ExacTrac Dynamic offers. When we perfect our program for such treatments, we can always upgrade the ExacTrac Dynamic Surface to the complete system, which should be simple and quick, and therefore of great value for us.”

Amethyst Radiotherapy Secures €300m in Financing from Ares Management to Accelerate Growth Across Europe

Amsterdam, June 12th 2024 – In a significant stride towards enhancing access to advanced cancer treatment, Amethyst Radiotherapy Group has secured a landmark €300 million financing agreement with Credit funds managed by Ares Management Corporation (“Ares”), a leading global alternative investment manager.

This investment positions Amethyst as a leading player in the European oncology sector, as it continues to accelerate its expansion.

Facilities provided by Ares aim to fuel Amethyst’s ambitious growth plans, enabling investments in cutting-edge radiotherapy technologies and the establishment of new treatment centres across Europe. By broadening its footprint, Amethyst aims to bring innovative cancer care to more patients, addressing the escalating demand for accessible and high-quality oncological services.

This partnership with Ares marks a pivotal moment for Amethyst and the patients we serve,” said Stéphane Carré, CEO of Amethyst Radiotherapy. “With their support, we can intensify our efforts to deploy the latest treatment innovations and elevate the standard of cancer care throughout Europe.

Amethyst’s CFO, Andrew Nelson, echoed the sentiment, stating, “The facilities secured will support strategic acquisitions and capacity enhancement, positioning us firmly among the frontrunners to redefine the European cancer treatment landscape. We are delighted to be working with Ares, and we are confident that they will be an excellent partner for Amethyst in the years ahead.

Michael Dennis, Co-Head of European Credit at Ares Management, expressed confidence in Amethyst’s vision, noting, “We are thrilled to support Amethyst Radiotherapy in its vital mission to deliver high-quality, advanced cancer treatments across Europe. We have confidence in Amethyst’s strategic vision and long-term value creation potential, and we look forward to seeing the impactful advancements in healthcare outcomes that our partnership is expected to enable.

As major players in the private oncology sector vie for market share, Amethyst’s strategic financing deal with Ares solidifies its position as a formidable force, poised to drive transformative change in cancer care accessibility and quality throughout the region.

As featured in: and FinSMEs

A new centre in Romania

A new Amethyst center opened in July 2021, at Timisoara (in the south-west of Romania) providing ambulatory treatment for all cancer types patients. This center is very similar to the Cluj center, with Radiotherapy Department equipped with BigBore Phillips CT, 2 mirrored ELEKTA LINACS providing VMAT/IMRT 6/10 MV with Agility fast MLC and a Medical Oncology Department functioning as Day Unit Hospital. Nutrition and psychological support will be provided in the center.

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Opening of the first private radiotherapy center in Vienna

Amethyst increases the treatment capacity by 20% Vienna.

In Austria around 40,000 people develop cancer every year. About 60 percent of the sick need radiation therapy. There are currently 15 linear accelerators (“Linac” for “linear accelerator”) in operation in Vienna. This means that up to 6,000 patients can be treated per year. It was planned to open another center for radiation oncology and radiation therapy in Vienna in May 2020. Due to the effects of the corona pandemic, the opening had to be postponed to October 1, 2020. The facility is being built and operated by the international company “Amethyst Radiotherapy” on the grounds of the Wiener Privatklinik in 1090 Vienna, Pelikangasse 15. “With our additional linear accelerator, 600 more patients can be treated per year. This is particularly important because time is an essential factor in the treatment process for cancer patients,” explains Dr. Paul Stuchetz, Managing Director Amethyst Radiotherapy Austria. The Amethyst Center for Radiation Oncology and Radiation Therapy is designed in such a way that it can be expanded to include an additional linear accelerator; For example, 17 linear accelerators for radiation therapy will be available in Vienna in the future and the treatment capacity will be significantly increased by up to 1,200 therapies per year – this corresponds to 20 percent. Former Minister of Health Dr. Andrea Kdolsky is very pleased with the opening of the new location: “With every new linear accelerator, the waiting time for a radiation therapy place is shortened. Due to the high capacity with now 16 Linacs in full operation in Vienna, waiting times are significantly reduced. Each additional Linac saves lives.”

Amethyst Radiotherapy is planning further centers for radiation oncology and radiation therapy in Austria and will thus lead to a further increase in treatment capacity. Amethyst Radiation Therapy is Europe’s fastest growing private cancer treatment facility. Amethyst combines the expertise of Europe’s leading cancer experts and the latest and most advanced techniques and equipment to provide patients with the best possible treatment. The focus here is on radiation oncology. Amethyst Radiation Oncology and Radiation Therapy Centers offer the most precise and advanced cancer treatments available. In 2019 alone, Amethyst medical teams comprising more than 100 doctors in ten centers treated over 15,000 cancer patients. The Amethyst Group is a private healthcare facility whose owners have been operating in the European healthcare and pharmaceutical market for 20 years. Amethyst was founded in 2010 and focuses on making the latest radiation therapy technologies available at all locations. Amethyst’s goal is to ensure that cancer patients receive reliable, modern, and operational medical services. Amethyst, a high-performance partner in the healthcare sector, is currently represented with ten centers in five European countries. Amethyst will continue its rapid growth and will operate up to 20 centers with 40 linear accelerators in the coming months.

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Amethyst Radiotherapy reaches the United Kingdom

Amethyst Radiotherapy expands its footprint into the UK through the acquisition of the 100% share capital of Medical Equipment Solutions Limited (MESL) – a specialised provider of intracranial radiation treatments (using the GammaKnife platform) at Queen Square Radiosurgery Centre in London and the Thornbury Radiosurgery Centre in Sheffield.

Amethyst Radiotherapy now operates twelve radiotherapy centres across six countries with a further twenty either in planning and/or development.

Group CEO, Ludovic Robert, says: “Amethyst Radiotherapy aims to build on the established reputation of Queen Square Radiosurgery Centre, London, and the Thornbury Radiosurgery Centre in Sheffield to provide the best possible, evidence based treatment for patients with previously hard to treat brain lesions.”

Adding: “Amethyst is rigorously focused on delivering the highest quality of service for patients, working in close partnership with leading NHS Centres of Excellence, Neurosurgeons and Oncologists as well as private payors and providers across the wider health economy.” Amethyst expects to further develop its service footprint across the UK. Amethyst Radiotherapy has appointed Stefan Doroszkowski to lead the UK business roll-out. Stefan has worked +25 years across the industry for a wide range of public and private payors and providers.

About Gamma Knife:* Gamma Knife is a non-invasive stereotactic radiosurgery platform that involves no scalpel or incision – it is not a knife at all. Instead, GammaKnife uses up to 201 precisely focused beams of radiation to control malignant and non-malignant tumors, as well as vascular and functional disorders in the brain, without harming surrounding healthy tissue.

Patients are typically in and out of the hospital in a day, and back to their normal routines soon after treatment. GammaKnife radiosurgery may be used in place of – or in addition to – traditional surgery or whole brain radiation, depending on a patient’s diagnosis.

* Gamma Knife is a registered trade-mark of Elekta ( All rights reserved

1er radiotherapy treatments in stereotactic conditions at Creil clinic

On February 7th, we inaugurated radiotherapy treatments in stereotactic conditions in Creil (France). Amethyst Radiotherapy is the very first one to propose these state-of-the-art treatments in the department of Oise, hence enabling patients of the region to have their treatment delivered close to their home.

Radiotherapy in stereotactic conditions is a very high precision irradiation technique, which allows to treat with great efficiency small lung cancers and metastases (brain, lung, bone), in a limited number of sessions, often 3 to 5 and, in less than 15 days, with few side effects.

This achievement is the result of major financial investment – in a new linear accelerator and a last-generation repositioning system – combined with a strong commitment of the medical team to always provide the best possible treatments and experience for the patient.

Inauguration of new Linear Accelerator in La Garenne-Colombes

On 8th of November 2019, the center Amethyst of La Garenne-Colombes in France inaugurated its new linear accelerator and opened its premises to medical partners.

Our radiation oncologists gave a tour of the clinic installations to their peers while explaining the latest radiotherapy techniques, including radiation therapy in stereotactic conditions.

Professor Cosset focused on prostate cancer, Dr. Haie-Meder presented brachytherapy treatments and Dr. Chaurin provided an update in Ear, Nose and Throat treatments.

Amethyst New Opening: Rome

May 2017 marks the first day of the new Amethyst centre in Rome. The grow of the Amethyst network has now reached the Italian Peninsula.

Located in the picturesque Isola Tiberina, an island located inside the Tiber river, the centre stems from a partnership between Amethyst and Fatebenefratelli order, which has run the San Giovanni Calibita Hospital since 1585. The centre is located inside the hospital building. It develops around the ruins of the temple of the ancient roman god of medicine, Aesculapius.

The island has served since the III century BCE as the healthcare centre of Rome. The new investments planned by Amethyst on the site aim at creating a quality-focused, high-technology radiotherapy centre by revamping and completely renovate the existing department.

The centre is equipped with two last generation Varian Linacs complete of all accessories. A shuttle service is also available for all people who have difficulties reaching the Island.