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News emerging from several leading organizations and vendors in the radiation therapy arena came in at a fast pace in the first part of 2024. In this feature, our editorial team focuses on sharing the latest news, advancements and partnerships which serve as a representative sampling of the pace, progress and purposeful patient focus of innovation. With global partnerships and regional installations gaining visibility, radiation oncologists, treatment planning specialists and, increasingly, those leveraging machine learning toward improved and more knowledge-based care, are partnering in unprecedented ways.
Radiation Oncology Physician Groups Unite to Ensure Patient Access to Cancer Care
The largest professional societies representing radiation oncology physicians in the United States announced a partnership, detailed in a Jan. 30, 2024, written statement, with the goal of reforming radiation oncology Medicare payments to expand and enhance access to high quality care for people with cancer. ITN featured this news, and shares portions of that update here as this remains a critical priority impacting both practitioners and patients.
Leaders of the American College of Radiation Oncology (ACRO), the American College of Radiology (ACR), the American Society for Radiation Oncology (ASTRO) and the American Society of Clinical Oncology (ASCO) stressed the need for a unified approach to create meaningful change on this critical issue.
Medicare payments for radiation therapy services have been cut by 23% since 2013, threatening patient access to cancer care in communities across the country, with further cuts likely in coming years. ACRO, ACR, ASTRO and ASCO are committed to working together to ensure that cost-effective, high value cancer care services are available for Medicare beneficiaries and all patients, while positioning the specialty for innovative breakthroughs in cancer treatment for future generations. The organizations’ leaders believe that payment reform is an essential path forward for the future of the specialty. Broad congressional interest in radiation oncology and Medicare physician payment reform provides a robust backdrop for potentially transformative action this year.
ACRO President Dwight Heron, MD, MBA, FACRO, FACR, FASTRO, said, “As four of the largest groups representing innovative and comprehensive cancer care, our coalition will leverage its wealth of expertise across the spectrum of health policy and economics to ensure the practice of radiation oncology remains sustainable in both community and hospital-based settings to the benefit of cancer patients for many years to come.”
ASCO Board Chair, Everett Vokes, MD, FASCO, said, “The Association for Clinical Oncology supports collaboration across the cancer community and with policymakers toward needed payment reform that supports patient access to high-quality, equitable cancer care.”
ASTRO’s Radiation Oncology Case Rate program (ROCR) reports that it will address inadequacies of the current payment system. The societies are seeking input from their members and other stakeholders on payment reform, as they ask policymakers to address the urgent threat facing cancer treatment access. They are committed to supporting radiation oncology professionals, both in hospital and freestanding office settings, to secure fair, stable reimbursement. Payment reform in radiation oncology also must address disparities faced by patients in rural and underserved communities.
The groups’ leaders expressed confidence that their partnership will ensure continued access close to home to compassionate, technologically advanced, life-saving treatments for patients diagnosed with cancer. They also expressed a commitment to this important advocacy initiative to protect and enhance access
to radiation therapy services for patients today and tomorrow.
Vendor Developments Enhance Patient Care, Ease RO Workload
The large number of news updates reporting on collaborations laser-focused on personalized patient care guided by stronger imaging warranted our editorial team’s expanded coverage in this issue. In sharing a summary of the most recent announcements and the first part of the year, we’re anticipating the second half of 2024, especially with ASTRO24 in late September in Washington, DC, will deliver even more not-to-be-missed innovations and clinical studies to enhance both diagnoses and personalized care.
In early 2024, Varian, a Siemens Healthineers company, made news on many fronts.
Varian and Nova Scotia Health announced on Jan. 4 that they had formed an unprecedented 10-year, $175 million CAD multi-disciplinary oncology partnership (MDOP) designed to deliver value across the Nova Scotia Health system by accelerating the patient journey from screening to survivorship. Nova Scotia has a population of over 1 million with an incidence of cancer that is above average.
The multi-disciplinary oncology partnership agreement reflects the synergistic value of the Siemens Healthineers and Varian combination, where the combined company is actively working on optimizing patient care across the cancer care pathway by pioneering solutions to enhance workflows, improve efficiencies, and make treatments more precise. With this agreement, Nova Scotia Health expands the scope of the previous oncology transformation agreement and will unify oncology patient data across oncology disciplines throughout the entire province by installing a suite of Varian software.
In March, Varian announced it received 510(k) clearance from the US Food and Drug Administration (FDA) for its TrueBeam and Edge radiotherapy systems featuring HyperSight imaging solution. The company noted this solution adds new capabilities and workflows across the entire suite of linear accelerators, adding that HyperSight empowers clinicians to accurately tailor treatments to each individual patient with the goal of improving patient outcomes.
Ahead of last year’s Annual Meeting of the American Society for Radiation Oncology, ASTRO23, Varian reported that by joining forces with Siemens Healthineers, a global leader in imaging, it is working to expand its imaging capabilities to provide solutions with improved accuracy and quality.
Advancing intelligent cancer care by leveraging the latest technology, Varian’s RapidPlan utilizes machine learning (ML) models that have learned the relationship between patient geometry and dose from existing treatment plans. It is integrated into the Eclipse dose optimizer, offering flexible knowledge-based planning, easy model configuration, and shared models.
Partnerships Deliver Proton Therapy and Clinical Workflow Solutions
Mevion Medical Systems, a global provider of compact proton therapy solutions, and RaySearch Laboratories AB announced their continued commitment to developing new proton therapy solutions in a shared statement issued in October 2023. The collaboration, according to the update, leverages both companies’ domain expertise in the advancement of innovative solutions for HYPERSCAN IMPT, adaptive therapy, proton arc therapy and FLASH proton therapy. A quick look at updates from each company is presented here, reflective of the fast pace of innovation and partner collaboration.
For its part, Mevion Medical Systems, headquartered in Littleton, Mass., with a presence in Europe and Asia, has also made news with healthcare organizations recently.
In June, Atlantic Health System, an integrated healthcare system setting standards for quality health care in New Jersey, Pennsylvania and the New York metropolitan area, and Mevion Medical Systems, a leading provider of compact single-room proton therapy systems, announced Atlantic Health System’s plans to acquire and install a MEVION S250-FIT Proton Therapy System at the Carol G. Simon Cancer Center, located at Morristown Medical Center in New Jersey. The proton system is scheduled to be installed in 2025, and once in use will usher in a new era of cutting-edge radiation oncology services.
The company reports that, along with the tremendous benefits for patients, the collaboration signifies a major achievement, as Atlantic Health System is set to become one of the world’s pioneers in transforming a conventional LINAC vault to install the FIT proton therapy system. The FIT Proton Therapy System is the first and only full proton therapy system that can be seamlessly installed in an existing LINAC vault, significantly reducing the size, cost, and complexity of proton therapy.
Adding to the plethora of news on the radiation therapy front from Mevion, the company announced two major updates with partner organizations in late 2023.
Charlotte, N.C.-based Atrium Health Levine Cancer announced it achieved a groundbreaking milestone with the delivery and start of installation of a state-of-the-art proton accelerator unit from Mevion in December 2023. Weighing 15 tons, the equipment will serve as the powerhouse for proton beam therapy at Atrium Health Levine Cancer Proton & Advanced Radiation Center, upon completion of installation next year.
Kansas City Proton Institute (KCPI), the first physician-led proton therapy center in the Midwest, which recently opened its new facility, announced that the first four patients were treated on Dec. 19, with the region’s first Mevion compact proton therapy system, the MEVION S250i Proton Therapy System.
Keeping Up with Innovations Making News
Since the start of 2024 and up to just days before ITN sent this issue to press, RaySearch Laboratories AB made several significant announcements. The first was news of its launch of RayStation 2024A, the latest version of the company’s comprehensive treatment planning system.
This new version brings enhancements to important clinical workflows. The system supports a wide range of treatment machines, providing one control center for all treatment planning needs, reports the company. This version also adds the possibility to select fixation and support devices per plan and sub-plan, also adding improved flexibility when making combined treatment plans for a patient. It also brings the possibility to define clinical planning goals for both the combined plan and the constituent sub-plans, and evaluate correspondingly. This enhances the workflow further for evaluation of combinations of treatment plans. Other improvements include adjustments to improve and ease transfer of treatment plans to various oncology information systems for delivery and faster saving of plan data, as well as a new tool used for segmentation of blood vessels in the lungs.
In February, RaySearch announced that The Royal Marsden NHS Foundation Trust, a specialist cancer center in the UK, will be the first in the world to implement online adaptive radiation therapy (OART) with RaySearch’s treatment planning system RayStation and oncology information system RayCare, including the new ARTemis OART solution under development — in combination with the Radixact Treatment Delivery System from Accuray.
Notably, the Royal Marsden has been using RayStation for conventional treatment planning since 2016. RaySearch further offered that, with funding from The Royal Marsden Cancer Charity, the center recently acquired two additional Radixact treatment delivery machines from Accuray with the intention to utilize these machines for OART. These and other partnership collaborations continue to seek and find meaningful solutions to top priority concerns in radiation therapy.
In late May, RaySearch Laboratories AB and C-RAD announced a collaboration agreement, aiming at jointly developing innovative solutions and products to enhance the quality of radiation therapy.
The focus of the collaboration is to investigate how the C-RAD surface scanning technologies can be utilized during treatment planning in RaySearch’s treatment planning system RayStation. Today, the surfaces from the C-RAD surface guided radiation therapy system, Catalyst+, are used during imaging and treatment. Making the Catalyst+ surfaces available in RayStation has many potential applications. One such application is to extend a cone beam CT image that has a limited field-of-view by using information from the surface scanning. This will lead to more complete representation of the patient’s anatomy, which in turn results in a more dependable basis for clinical decisions.
Also this past May, RaySearch Laboratories AB announced its release of the latest version of RayCare, the next generation oncology information system. RayCare 2024A features interoperability with Varian TrueBeam linear accelerators and an enhanced experience for radiotherapy treatment management, improving usability and efficiency of treatment management.
Reflecting the fast pace of developments in this area, the company most recently announced a milestone in radiotherapy technology where RaySearch’s RayStation was used for the world’s first clinical treatment using OXRAY, a new treatment machine from Hitachi. The event took place on June 17 at Narita Memorial Hospital in Toyohashi, Japan.
OXRAY represents a pioneering radiotherapy system featuring a Gimbal-mounted beam delivery system. RayStation was used to drive its motion tracking functionality, dual-source CBCT image-guided radiotherapy for precise patient positioning, and dynamic swing arc capabilities. Developed in collaboration with Kyoto University Hospital, the company reported that the OXRAY system has been seamlessly integrated into RayStation through close collaboration between RaySearch and Hitachi.
The Growing Role of AI in Imaging, Diagnostics and Treatment Planning
Personalized treatment continues to be a high priority for radiation oncologists, and a number of recent studies have shed light on multiple ways that both identification and treatment are improving with new innovations and applications, especially in the artificial intelligence arena.
In early May, Avenda Health unveiled the results of a new UCLA study examining the role of AI in identifying tumor margins and predicting the efficacy of focal therapy treatments. The study, titled “Software to Determine Extent of Tumor Margins in Focal Therapy,” was presented at the 2024 American Urological Association’s (AUA) annual meeting by Wayne Brisbane, MD, assistant professor at UCLA Health. It demonstrated that Unfold AI, Avenda Health’s AI-powered cancer mapping technology, was a better predictor of focal therapy success than other factors, including the size or grade of the tumor.
The study found that Unfold AI’s patient-specific encapsulation confidence score (ECS), which is generated based on multiple patient data points, including MRI scans, biopsy results, PSA data and Gleason scores, is critical for predicting treatment success. While factors like cancer core length, the percentage of Gleason pattern 4, and ECS score were predictive of treatment success, only an ECS score greater than or equal to 0.7 demonstrated significant predictive value, with a success rate of 70% (confidence interval: 61-79%) and 68% (confidence interval: 51-85%), respectively. The company noted that these findings emphasize the importance of Unfold AI’s assessment of tumor margins in predicting treatment outcomes, surpassing the predictive capability of conventional parameters, and findings hold important implications for clinical practice.
In mid-June, another study by Avenda Health, newly published in The Journal of Urology, solidified the power of AI in oncology as a viable and accurate diagnostic tool, highlighting AI’s value in identifying the extent of prostate cancer with 85% accuracy. The AI healthcare company, which focuses on personalized prostate cancer care, reported the findings demonstrated the ability of artificial intelligence to accurately identify cancer in oncology imaging and diagnostics. Titled, “Artificial Intelligence Improves the Ability of Physicians to Identify Prostate Cancer Extent,” the study found AI-assisted cancer identification with Unfold AI, Avenda Health’s AI-powered cancer mapping technology, improved urologists’ and radiologists’ abilities in identifying cancer extent by 45x.
In this groundbreaking study, researchers compared the performance of physicians when using AI compared to when not using AI to create cancer margins that encompass all clinically significant prostate cancer while minimizing non-cancerous tissue within the margin. The study found AI-assisted cancer margins significantly outperformed cognitively defined and hemi-gland margins, with a balanced accuracy of 84.7% compared to 67.2% and 75.9%, respectively.
Importantly, AI-assisted margins reduced the underestimation of cancer extent, with a negative margin rate of 72.8% compared to 1.6% for cognitively defined margins. The results show Unfold AI can enhance accuracy in defining prostate cancer margins, leading to improved patient outcomes by informing better treatment strategies.
Authored by Sakina Mohammed Mota, PhD, and Alan Priester, PhD, and co-authored by Joshua Shubert, Jeremy Bong, James Sayre, PhD, Brittany Berry-Pusey, PhD, Wayne G Brisbane, MD, and Shyam Natarajan, PhD, this study demonstrates an AI-focused approach has the potential to elevate the efficacy of interventions, such as focal therapy, offering a significant advancement in prostate cancer management.
“This study is important because it shows the ability of AI to not only replicate expert physicians, but to go beyond human ability,” said Brisbane. “By increasing the accuracy of cancer identification in the prostate, more precise and effective treatment methods can be prescribed for patients.”
Unfold AI was just included in the American Medical Association’s (AMA) 2024 Current Procedural Terminology (CPT) code set. As a Category III code, Unfold AI will now be billable by insurance, improving access to this personalized prostate cancer care.
“It’s empowering for physicians to see this kind of innovation being validated through studies and recognized by the AMA,” said Avenda Health CEO Shyam Natarajan, MD. “Avenda Health is at the forefront of using AI to vastly improve tools at physicians’ disposal to more effectively treat patients.”
Clearly, unprecedented progress is being made at a fast pace in the radiation therapy space. The American Society of Radiation Oncology’s 66th Annual Meeting, ASTRO 2024, set for Sept. 29-Oct. 2 in Washington, DC, will showcase news and innovations to support radiation oncology providers. ITN will be there covering the outcomes of these latest collaborations, the vast range of newsmakers, newsworthy innovations, clinical studies and leadership initiatives to promote and advance provider wellness.
August 29, 2024 
