SUBANG JAYA, Sept 8 — Subang Jaya Medical Centre (SJMC) has launched Malaysia’s first ExacTrac Dynamic system, an advanced image-guided technology that delivers radiotherapy and radiosurgery with sub-millimetric precision.
Integrated with the hospital’s TrueBeam Linear Accelerator (Linac), the system uses surface guidance, thermal imaging, and X-ray monitoring to continuously track patient positioning and movement, even accounting for breathing.
This allows doctors to target smaller tumours with greater accuracy, reduce exposure to surrounding organs, and shorten the overall treatment process.
Changing How Complex Cases Are Treated
The new system has reshaped how complex cases are approached. Unlike conventional radiotherapy, stereotactic radiosurgery delivers highly focused radiation to a specific tumour, often in areas that are difficult to reach surgically.
The technique, while non-invasive, can achieve results comparable to surgery in eliminating or ablating disease, said Dr Winnie Ng, consultant clinical oncologist at SJMC.
“Stereotactic radiosurgery or radiotherapy is not surgery. It’s basically using radiation therapy to treat a specific site or target. Its effectiveness can be somewhat similar to surgery, because the approach is less invasive in terms of targeting, but at the same time, it’s able to deliver a good dose of radiation to the point where it can eliminate or ablate the disease.
“It’s a very safe, non-invasive procedure, typically used for patients with brain cancers or even other sites such as the prostate, spine, or lung — areas that are hard to reach.
“In particular with brain tumours, we have many surrounding organs at risk if a certain dose of radiation is exceeded,” Dr Ng said during a panel discussion at the launch of SJMC’s ExacTrac Dynamic system on August 22.
“So having an ExacTrac Dynamic system to delineate the area and ensure the dose is delivered accurately means the surrounding organs receive reduced exposure, making safe delivery and precision possible.”
Who Can Benefit, And How Patients Experience It
Not every patient is suited for stereotactic radiotherapy. Selection depends on tumour size, location, and clinical indication, Dr Ng said. While it is most commonly used for brain tumours, the technique is increasingly applied to the lungs, prostate, spine, and bone.
“Stereotactic radiotherapy can range from one to five fractions, and patients usually tolerate it well. We often offer steroids, such as dexamethasone, to reduce side effects like brain edema (swelling).
“Based on close monitoring, clinical surveillance, reviews, and prophylactic symptom management, patients remain relatively stable and smooth during treatment,” Dr Ng said.
She added that the technology has also improved patient comfort. For breast cancer, for instance, ExacTrac Dynamic eliminates the need for tattoo markers on the skin, replacing them with imaging-based positioning. “Women, in particular, may not want visible marks, so this makes treatment more comfortable and patient-friendly,” she said.
Reducing Collateral Radiation
One of the system’s key advantages lies in reducing unnecessary radiation margins. Traditionally, larger margins were added to account for potential patient movement during treatment, inadvertently exposing healthy tissue. ExacTrac Dynamic, however, detects even minute shifts in position and adjusts the beam in real time.
“In the past, with older radiotherapy machines, a larger margin had to be included to account for possible movement,” Dr Ng said.
“But as treatment and technology become more precise, movement can be minimised, accuracy enhanced, and margins reduced. This in turn reduces side effects from radiating unnecessary areas.”
Extending Precision Beyond Cranial Cases
Prof Dr Thierry Gevaert, head of medical physics at Free University of Brussels in Belgium, added that beyond cranial radiosurgery, ExacTrac Dynamic is especially valuable for tumours affected by breathing or other movement, as real-time monitoring allows instant adjustments to maintain precision. The system is now being applied beyond cranial cases.
“As we’ve said, we already know the technology provides accuracy for brain cases. The next step after cranial is the spine. The spine has vertebral anatomy we can use for positioning, so accuracy is achievable,” Dr Gevaert said.
“In the past, patients received 50 fractions, or maybe five fractions, because we could not reduce fractions further due to spinal cord dose tolerance. With this accuracy, we can deliver the dose in one, two, or three fractions, for example, to the spine.
“You reduce the number of fractions while still carrying the full dose because you are accurate. You don’t need large margins, so you can safely target the spine and other critical organs,” he added.
International adoption has further demonstrated its scalability. Dr Yoshiko Oshiro, chief of radiation oncology at Tsukuba Medical Centre in Japan, said the system has enabled up to 50 patient set-ups a day, improving throughput without compromising quality.
“So many cases have been used in Japan, particularly the spine, whereby you cannot harm the spinal cord. We need to treat it very carefully. And because of that precise, accurate technology, we can target it carefully, accurately, and safely,” Dr Yoshiko said.
Better Comfort For Patients
Beyond technical gains, the system incorporates patient-centred features. The open-face mask design allows patients to breathe more easily and maintain visibility during sessions, while tattoo-free positioning reduces anxiety associated with permanent marks.
Treatments are also generally shorter, with stereotactic radiotherapy delivering higher doses in fewer sessions compared to conventional radiotherapy that can stretch over several weeks.
“It is not only about delivering precise treatment, but also about making the process less daunting,” said Catherine Lee, SJMC’s director of cancer and radiosurgery services. “Features like the open mask, quick set-up, and shorter treatment time help patients feel more at ease while maintaining the highest safety standards.”
Rachel Woo, chief operating officer of SJMC, said the launch reflects the hospital’s broader strategy to advance precision medicine and improve patient care.
“The launch of ExacTrac Dynamic marks another important milestone for SJMC in advancing precision medicine. Every innovation we introduce is made with our patients’ well-being in mind,” Woo said.
Michael Ruemelin, director of sales radiation oncology Asia and Pacific, Brainlab Australia Pty Ltd, the technology’s developer, said: “The introduction of ExacTrac Dynamic expands access to highly precise and effective cranial and extracranial cancer treatments in Malaysia.
“Our long-standing collaboration with SJMC reflects a shared vision to bring the latest medical technologies to the region, enhance treatment capabilities, and broaden access to advanced care.”
