Compatible with 95% of existing radiotherapy systems, Beam Adaptation is an affordable technology that has the potential to improve the outcomes for millions of cancer patients globally.

 

Cancer Is a Moving Target.

Even when a patient is lying perfectly still, there are dynamic processes happening inside the body. The heart is beating and the lungs are breathing, which can cause a cancerous tumour to move from 0.2mm to 7mm.

In standard radiotherapy, the radiation beam is set to a large aperture size that allows for possible tumour movement, in an attempt to ensure the cancer target receives full coverage with radiation.

What this means for the patient is that their healthy tissue receives a radiation dose, increasing radiation side effects (toxicity). In a worst-case scenario, parts of the tumour move outside of the treatment beam and don’t receive the planned dose.

A World-first Solution

To hit moving tumours during radiotherapy and avoid hitting healthy tissue, we have pioneered the targeting of the tumour via radiation ‘Beam Adaptation’. Beam Adaptation dynamically shapes the radiation to target the tumour as it moves, to ensure the radiation beam always hits the tumour and spares the surrounding healthy tissue.

The first clinical trial was launched in 2011 at Royal North Shore Hospital for patients with prostate cancer, with 28 patients successfully treated. In 2014, a first-in-world treatment of lung cancer patients was completed.

How does Beam Adaptation work?

Beam Adaptation is a system that changes the shape and position of the radiation beam in real-time, to follow the movement of the tumour.

Beam adaptation uses the real-time information from the radiation therapy system’s existing on-board imaging equipment, and uses this to adapt the shape and position of the radiation beam.

Beam Adaptation – Current Status

We are the first and the only site in the world treating patients with Beam Adaptation. There is currently an ongoing clinical trial at Royal North Shore Hospital, “LIGHT-SABR” which will treat 20 patients.

Beam Adaptation – Future

Future clinical trials will look at treating different cancer sites, treating multiple tumours at once, and using Beam Adaptation in conjunction with different imaging techniques.

Currently some high-end radiotherapy systems are capable of adapting the beam to the tumour, but there are only a handful of these systems in the world. Radiotherapy systems are a considerable financial acquisition for a hospital, with high-end systems taking decades to be xxxx. There is no commercially available solution that can be installed in to existing systems.

While some high-end radiotherapy systems are now capable of adapting the beam to the tumour, they are inaccessible to most cancer treatment centres due to their high cost. To replace an entire radiotherapy system is an enormous financial investment, typically only considered when a system reaches its end of life and is decommissioned.

Our Beam Adaptation technology is the only solution designed to be compatible for installation on 95% of radiotherapy machines already in use today. This makes it an affordable and achievable way for cancer centres all over the world to offer cutting-edge treatment to cancer patients.

Publications

Toftegaard J, Keall PJ, O’Brien R, Ruan D, Ernst F, Homma N, Ichiji K,
Poulsen PR. Potential improvements of lung and prostate MLC tracking investigated by treatment simulations. Med Phys. 2018 May;45(5):2218-2229. doi:10.1002/mp.12868. [More Information]

Ipsen, S., Bruder, R., O’Brien, R., Keall, P., Schweikard, A., Poulsen, P. (2016). Online 4D ultrasound guidance for real-time motion compensation by MLC tracking. Medical Physics, 43(10), 5695-5704. [More Information]

Wisotzky, E., O’Brien, R., Keall, P. (2016). Technical Note: A novel leaf sequencing optimization algorithm which considers previous underdose and overdose events for MLC tracking radiotherapy. Medical Physics, 43(1), 132-136. [More Information]

Ruan, D., Keall, P., Sawant, A. (2015). Method and System for Real-Time DMLC-based Target tracking with Optimal Motion Compensating Leaf Adaptation S09-154. Patent No. 8971489.

Colvill, E., Booth, J., O’Brien, R., Eade, T., Kneebone, A., Poulsen, P., Keall, P. (2015). Multileaf Collimator Tracking Improves Dose Delivery for Prostate Cancer Radiation Therapy: Results of the First Clinical Trial. International Journal of Radiation Oncology: Biology Physics, 92(5), 1141-1147. [More Information]

Colvill, E., Poulsen, P., Booth, J., O’Brien, R., Ng, J., Keall, P. (2014). DMLC tracking and gating can improve dose coverage for prostate VMAT. Medical Physics, 41(9), 1-10. [More Information]

Ravkilde, T., Keall, P., Grau, C., Hoyer, M., Poulsen, P. (2014). Fast motion-including dose error reconstruction for VMAT with and without MLC tracking. Physics in Medicine and Biology, 59(23), 7279-7296. [More Information]

Suh, Y., Murray, W., Keall, P. (2014). IMRT Treatment Planning on 4D Geometries for the Era of Dynamic MLC Tracking. Technology in Cancer Research and Treatment, 13(6), 505-515. [More Information]

Falk, M., Pommer, T., Keall, P., Korreman, S., Persson, G., Poulsen, P., af Rosenschold, P. (2014). Motion management during IMAT treatment of mobile lung tumors-A comparison of MLC tracking and gated delivery. Medical Physics, 41(10), 1-8. [More Information]

Keall, P., Colvill, E., O’Brien, R., Ng, J., Poulsen, P., Eade, T., Kneebone, A., Booth, J. (2014). The first clinical implementation of electromagnetic transponder-guided MLC tracking. Medical Physics, 41(2), 020702-1-020702-5. [More Information]

Pommer, T., Falk, M., Poulsen, P., Keall, P., O’Brien, R., Petersen, P., af Rosenschold, P. (2013). Dosimetric benefit of DMLC tracking for conventional and sub-volume boosted prostate intensity-modulated arc radiotherapy. Physics in Medicine and Biology, 58(7), 2349-2361. [More Information]

Ruan, D., Keall, P. (2011). Dynamic multileaf collimator control for motion adaptive radiotherapy: an optimization approach. 2011 IEEE Power Engineering and Automation Conference (PEAM 2011), Piscataway, New Jersey, United States of America: (IEEE) Institute of Electrical and Electronics Engineers. [More Information]

Ravkilde, T., Keall, P., Hojbjerre, K., Fledelius, W., Worm, E., Poulsen, P. (2011). Geometric accuracy of dynamic MLC tracking with an implantable wired electromagnetic transponder. Acta Oncologica, 50(6), 944-951. [More Information]

Fledelius, W., Keall, P., Cho, B., Yang, X., Morf, D., Scheib, S., Poulsen, P. (2011). Tracking latency in image-based dynamic MLC tracking with direct image access. Acta Oncologica, 50(6), 952-959. [More Information]

Falk, M., af Rosenschold, P., Keall, P., Cho, B., Poulsen, P., Povzner, S., Sawant, A., Zimmerman, J., Korreman, S. (2010). Real-time dynamic MLC tracking for inversely optimized arc radiotherapy. Radiotherapy and Oncology, 94(2), 218-223. [More Information]

Collaborating Hospital:

Royal North Shore Hospital

Contact:

For more information or to discuss this project, contact:

Professor Paul Keall
paul.keall@sydney.edu.au