The healing force of digital transformation Nano-X

University of Sydney’s Professor Paul Keall and astrophysicist Ilana Feain have combined decades of knowledge to develop a revolutionary radiation therapy system.

The Australian Institute of Health and Welfare (AIWH) estimates that around three in 10 Australians die from cancer before the age of 85. Of those unlucky enough to have a brush with the ‘Big C’, 50 per cent will undergo radiation therapy.

Unfortunately, current radiation therapy machines are large, expensive and need to be housed in massive bunkers to contain the radiation. They also need large numbers of highly skilled people to operate and maintain them. All these factors mean that most – if not all – radiation therapy machines are situated in major cities, despite there being an urgent need for them in regional centres. Indeed, the world needs another 9000 radiation therapy machines.

Transforming radiation therapy through technology

Enter the University of Sydney and the medical device startup, Nano-X Pty Ltd. Director of the University of Sydney Radiation Physics Department, Professor Paul Keall, has drawn on his decades of experience in the radiotherapy field to develop a revolutionary new radiation therapy machine. Nano-X’s radiation therapy device promises to be one-fifth the price of current machines, requires fewer people to tend to it, takes up less space and needs less shielding than current machines.

According to Nano-X CEO, Phil Prather, the cancer radiotherapy system will use many of the same components as current generation devices. Like those devices, Nano-X generates radiation by emitting photons and it is those photons that deliver the radiation to hopefully kill the cancer cells.

Imaging technology adapting in real-time
 
What no one has done before is pair the traditional photon-emitting device with a 3D-imaging system and a cylinder that rotates inside the device. 

“The idea is that the patient will lie on a couch inside the cylinder,” says Prather. “We then gently rotate the cylinder, imaging the target tissue and adapting the beam in real-time. Every other cancer radiotherapy system relies primarily on a CT scan that was taken the day before at best, sometimes even two weeks ago, so they’re assuming the tumour is in same spot and same shape.
 
“By using advanced software and some very clever algorithms, we’re able to adjust the filters very quickly to treat that patient’s tumour exactly as it looks like while the patient is on the couch. It’s a very big difference. With a traditional radiation therapy system, the patient is adapted to the machine. Instead, we’re using technology to adapt the machine to the patient on a continuous, real-time basis.”

Real-time imaging a game-changer

The advantages of the real-time image analysis are huge. With traditional radiation therapy, the patient undergoes a CT scan, then the machine operators use lasers to precisely align the patient using exactly the same settings as when the CT scan was done.

They need to be in exactly the same position, says Prather. “Head, shoulders, everything needs to be in the same position and stay in the same position. The problem is our bodies change all the time. We breathe, we eat and drink, our bodies continually undergo basic physiological changes. For example, treatment for a lung tumour entails 15 to 30 minutes of therapy. People have to breathe in that time and, as a result, the tumour will move in that time.

While it will be impossible to know for sure until clinical trials are held, Prather believes there is a good chance the toxic effects of the radiation will be less than with the current technology. “We can be much more specific. We’ll be able to treat just the tumour with a much smaller amount of healthy tissue being irradiated.”

Traditional radiation therapy systems rotate three tonnes or more of high-tech machinery with sub-millimetre precision around a patient who has to be held very firmly in place with a set-up process that can require several people. By flipping the traditional design on its head and rotating the patient, it will be possible to build the machine much more lightly with a smaller footprint and it will be less expensive as a result.

Moving from a hardware to a software solution

“By rotating the patient, instead of the machine, we’re eliminating all the complexity of a hardware solution and moving it to a software solution,” says Prather. “The Nano-X system should also eliminate a lot of fixed costs because there will be less wear and tear on the system and we expect it will not need the same level of maintenance.”

Because the radiation beam will be pointed down at the one spot and radiation therapy facilities are usually housed in a basement, there will be much less need for radiation shielding. Mainly backscatter will need to be contained at the side and on the top – the bulk of the radiation will be absorbed by the earth. This will make it feasible for regional hospitals, and in time it may well be possible to house a Nano-X system inside a large truck.

When the Nano-X radiation therapy system is in operation, it will generate lots of data – how many patients, how much radiation they are being given, how long the treatment takes. These systems will provide a wealth of data to hospital administrators, according to Prather. “It’s the old saying: if you can’t measure it, you can’t manage it. With this system we’ll be able to better manage radiation therapy.”

Nano-X is planning to have a working prototype by the middle of 2017 that it can use for trials and to seek regulatory approval. Once these are in place, Prather is confident there will be a good path towards commercialisation for the device.

For people living in rural and regional Australia forced to travel long distances for radiation therapy, it can’t come soon enough. Digital transformation like Nano-X’s radiation system supported by sophisticated imaging technology is what’s going to push the world forward in finding a better treatment for cancer.