New Radiotherapy Software To Be Showcased at ASTRO

Radiation therapy technology is advancing as quickly as ever—but where previous decades have seen improvements in precision, localization, and patient outcomes, experts are now turning their attention to other areas for improvement. For 20 years, Dr. Marco Carlone has been a medical physicist specializing in linear accelerator installation, servicing, and quality assurance, and he recently founded Linax Technologies, the creator of the linear accelerator simulator SIMAC. We had the good fortune to sit down with him to get his unique perspective on where the radiation therapy industry is, where it’s going, and his own path to success as a leader in this field.

His newest project, SIMAC, is a radiation beam simulator that will be an invaluable training tool for linear accelerator technicians. In the future, he’ll work with his team to expand SIMAC’s use into other applications, from servicing and repairs to treatment planning. Prior to developing SIMAC, Marco spent 20 years working as a medical physicist in clinical and academic settings. He began his career as a systems engineer servicing Siemens linacs.

Carlone is not only a leader in the technology of linear accelerators, but also an engaged thinker on topics of treatment accessibility. He shared his thoughts on both of these topics with us, along with his career development and the challenges of developing new technologies in this industry.

Tell us briefly about the SIMAC subscription service you are developing. What does it do and who is it for?

Simac is a linear accelerator simulator: a digital representation of a medical linac that lives in the cloud. It simulates how the linear accelerator makes its radiation beam, including all of the real machine’s components. Users can configure the linear accelerator however they’d like, and the result is a radiation beam with depth dose and profiles that accurately predict the properties of one made by a real machine.

We think of it as being like a flight simulator for airplanes but also an advanced beam model for linear accelerators. It lets the user “drive” an accelerator without having to worry about incorrect adjustments that harm the machine.

This is great for linac service technicians. It’s quite difficult to get access to a linear accelerator for training; our product solves the tension between linacs needing to be online to treat patients, and technicians needing to practice on them for the considerable time it takes to learn all the different failure modes.

In addition to training, SIMAC is also a highly configurable beam model for linear accelerators. In radiotherapy, beam models are the heart of our treatment planning systems, and much of the progress in radiotherapy over the last 25 years has been in developing very accurate beam models. The SIMAC beam model gives the user, typically a physicist, the ability to configure almost anything in the linear accelerator—such as gun current, RF driver, and RF waveforms—and then see how this affects the beam’s depth dose and profiles. Based on that, the physicist can decide the best quality assurance approach for the linac after it’s repaired.

What inspired you to develop this tool?

I’ve been a medical physicist for over 20 years, but before that, I worked at a small company in Ottawa that makes linear accelerators for industrial uses. We also represented Siemens Canada for their installations and servicing of the Siemens radiotherapy linacs. So, when I started working in the clinic, I saw right away that there was a knowledge gap between what medical physicists knew about linear accelerators and how the machines actually worked. I also saw that front-line service technicians speak a different language from the physicists, and vice-versa. They worried about different things when linacs were down.

The result was unnecessary stress when linacs were being serviced, and often, the quality assurance done after linac repairs was either excessive or incorrect. In both cases, the repairs took longer than needed, and that wasn’t good for our patients.

So, I started doing a lot of teaching about linear accelerators, first in courses for physicists, and then in an organized professional development course designed for both physics residents and service technicians.

As I’d tell students at the beginning of the courses: Linear accelerators are not rocket science, but they are particle accelerators. There are lots of different, complicated components that must work together in a specific way. The teaching took time, and I often felt it wasn’t getting through.

So, one day I had the idea that each part of the linac could be modelled simply, and putting everything together into a single model may not be that difficult. My boss supported the idea, and we hired a student to do the first programs. This worked really well, and I’ve been building the tool ever since.

What are your biggest challenges at the moment?

We want to build SIMAC into a cloud-based service that can be used not just for training, but for all aspects of managing radiotherapy linacs: servicing and repairs, linac commissioning and quality assurance, and eventually, treatment planning.

Right now, we’ve launched our first products and revenues have just started to come in, but we still need to expand the market so the revenues can support product and technology development and growth. To do this, we need a large team of highly skilled people. We also need to get our message out so the radiotherapy community understands how Simac can help them.

This all takes work, and I am super grateful for my young team of developers and physicists, who are very talented and committed to our company’s mission and vision. Making sure the team has the resources it needs to continue is really my biggest worry right now.

In your opinion, what should the radiotherapy industry be worried about at the moment?

I think that the biggest issue the radiotherapy community has is to understand how important our treatments are to our patients.

I think we are losing perspective on where we are in the development of radiation as a cure for cancer. For the past 60 years or so, linear accelerators have developed to the point where we can create extremely complex plans, with thousands of control points that must be configured, and then deliver this in a couple minutes. The treatment plans I see today are so conformal, have such small margins, and can be localized to within a couple millimeters. Compared to the plans I saw when I started in radiotherapy in the early 1990s, these really do look like magic.

 

But it’s not magic; it’s the result of a lot of work and development by the entire radiotherapy community. There is always a lot of talk in our community about the next big thing. IMRT, IGRT, and VMAT were so hugely successful that surely there must be the next thing on the horizon, and the first to develop it will be rewarded. MR-linacs and FLASH therapy come to mind.

But what if radiotherapy works so well that we don’t need any major new changes, and instead, the next big thing is for many more patients to have access to it, more easily and at less cost?

Today, there are still only about 13,000 linacs (including Cobalt-60 units) in the world. Considering that there are 7 billion potential cancer patients, and that radiation is an important part of the treatment that half will receive, I don’t think 13,000 is anywhere near enough.

So, I think the radiotherapy industry should focus on dramatically increasing access to radiation treatments. There have been many studies (Glicksman et al., Lievens et al., Gillan et al., Dunscombe et al., Lin et al.) that show that even in developed economies, patients who live more than a few hours from a radiotherapy center often choose not to have radiation. Where I live in British Columbia, some patents live a seven-hour drive from the nearest cancer center. This is too far.

About the Subject:

Marco Carlone is the founder of Linax Technologies Ltd. He has over 25 years of experience in radiation oncology as a medical physicist and linear accelerator manufacturing. He is past-president of the Canadian Organization of Medical Physicists and has been an invited speaker to radiation oncology conferences on four continents and has over thirty peer reviewed publications and five patents.

You can visit him at ASTRO on October 23 – 25 in San Antonio, TX at Radiology Oncology Systems’ Booth 954.