Interest Grows in Low-Dose Radiation for Covid-19

In 2013 Edward Calabrese, a toxicologist from the University of Massachusetts, Amherst, and a colleague were pining over century-old data on any evidence of whether low-dose radiation therapy could be utilized to combat certain types of illness and disease. Surprisingly, they did find proof that small amounts of radiation were moderately effective in combating pneumonia.

The research showed that doctors reported reduced symptoms within hours of a single dose of X-ray exposure. At that time, only a few people noticed the findings from Calabrese, and they were dismissed, only just being mentioned in a few publications. However, that all changed when Covid-19 came around. People were rushing to find any treatment that would prove even relatively effective against the novel coronavirus, and its devastating pneumonia that is the hallmark of the disease.

“Back in February, I started getting just dozens and dozens and dozens of emails from radiation oncologists – people who treat cancer patients with targeted radiation. And they had come across our paper, and they thought that this might be a vehicle by which they could help suffering and dying COVID patients perhaps survive,” Calabrese said. “Clinical trials are now going on across the country.”

At least a dozen trials worldwide are being tested for low-dose radiation therapy (LDTR), as a treatment to pneumonia related to Covid-19. The theory is that radiation to the lungs will halt the runaway inflammation responsible for the devastating pneumonia that leads to the course of some Covid-19 patients.

Read more on the developments of this article here.

Acceletronics is an independent service company dedicated to delivering the best equipment performance and reliability from Linear Accelerators and CT Scanners across all major brands and models. We provide premium customer experience throughout the USA with our team of highly qualified oncology equipment and dedicated service specialists.

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How Covid-19 is Impacting Radiation Oncology in the U.S.

As we continue to move forward in 2020 with Covid-19 seemingly expanding wider, oncologic care is finding itself in an uncommon and challenging dilemma between the goal to protect patients who are susceptible to Covid-19 while also trying to provide the important treatment they need in appropriate time frames so not to jeopardize treatment outcomes.

Unfortunately, those patients who have cancer are particularly susceptible because of their age, health, and immunosuppression from ongoing cancer therapy. With about 50% of cancer patients receiving radiation therapy, radiation departments around the county have needed to adapt in a situation that is uncharted, requiring ultra-sterile environments, and sometimes uncomfortable processes that would not have been necessary before the Covid-19 era.

Radiotherapy institutions are contemplating major questions that can impact not only the quality of their patient’s treatments, but also their patient’s health and the medical staff who serve them. Comprehensive measures are being taken to mitigate risk from exposure and spread. Patients and medical personnel are oftentimes required to enter separate entrances before they take a sperate screening, with appointments broken out in separate intervals to minimize extensive overlap in the waiting room. For patients who are COVID-19 positive and need radiation treatment, all equipment must be sterilized, and extra precautions are taken than those who are Covid-19 negative. Treatment breaks are another issue for recently diagnosed Covid patients, as the CDC (Centers for Disease Control and Prevention) guidelines require a 14-day minimum quarantine, increasing treatment package and time sacrificing confidence in local control.

A new mindset for department operations is also developing with the use of telemedicine, which has become paramount in mitigating exposure for patients and health care workers while also lowering the number of employees in facilities. While these precautions are necessary and positive for maintaining the spread of Covid, we need to make sure that patients do not feel socially isolated or neglected by their health care providers in such a great time of uncertainty as this. Patients are already trying to overcome the emotional impact of a cancer diagnosis and, world pandemic or not, we need to make sure these patients get all the care they deserve.

Read More: https://appliedradiationoncology.com/articles/the-impact-of-covid-19-on-radiation-oncology-department-workflow-in-the-united-states

Focused Ultrasound Provides Hope in Combating the Deadliest Brain Tumor

Jason Sheehan, M.D., Ph.D., a neurosurgeon from UVA Health, has paved the way in focused ultrasound to treat glioblastoma, which is the most aggrieved and deadliest brain tumor currently known. 

The University of Virginia School of Medicine, led by Dr. Sheehan, is pioneering a technique that hits cancer cells with a drug, sensitizing them to sound waves, then exposes them with focused ultrasound. The research is early, but tests on cell samples in lab dishes look promising. 

Researchers’ results suggest that the technique has “Substantial potential for treatment of malignant brain tumors and other challenging oncology indications…” Other areas in which the process could be performed are lung and breast cancer, melanoma, and other cancers that typically are handled with traditional radiation oncology treatment options. The team predicts that the procedure will be especially useful in treating cancers in sensitive areas of the body that pose a challenge to access.

“Sonodynamic therapy with focused ultrasound offers a new therapeutic approach to treating patients with malignant brain tumors,” said Dr. Sheehan. “This approach combines two approved options, (the drug) 5-ALA and focused ultrasound, to produce a powerful tumoricidal effect on several different types of glioblastomas.’

Read more about this innovative treatment here.

Improvements in Medical Imaging Reduces X-Ray Radiation Exposure

Utilizing X-ray image technology has been a staple in today’s medicine; however, it does create a significant risk to patients and medical personnel. Standard machines that offer X-ray treatments such as CT scanners, fluoroscopes, and mammography devices produce a considerable amount of hazardous radiation and are not very effective. 

Usually, the X-ray machines have silicone-based detectors to which most of the radiation passes through, creating the health risks so many face when participating in treatment. 

However, researchers at Los Alamos and Argonne National Laboratories have developed an X-ray detector that is comprised of calcium titanium oxide. These titanium oxide detectors are more sensitive than silicone-based and will allow the  X-ray imaging system to reduce the radiation they deliver and improve their image fidelity. 

Another positive of the new detector is its core. The new detector contains a thin film of perovskite that can be sprayed onto surfaces; this is unlike silicone devices that need metal deposition and high temperatures to be created.

“Potentially, we could use ink-jet types of systems to print large scale detectors,” added Tsai. “This would allow us to replace half-million-dollar silicon detector arrays with inexpensive, higher-resolution perovskite alternatives,” said Hsinhan (Dave) Tsai, a postdoctoral felloe at Los Alamos National Laboratory, in a press release. 

Watch a Los Alamos video about the new detector here.

The Linear Accelerator: What is It and How Does It Work

A linear accelerator (LINAC) is a machine most often used for delivering external radiation therapy to those dealing with cancer. The device uses a variety of methods to customize high energy x-rays to mirror an individual tumor’s shape so that radiation can be administered as accurately as possible. 

LINAC devices efficiently target and destroy cancer cells while protecting surrounding healthy tissue, making this type of treatment more effective with fewer side effects. 

How exactly does this equipment work?

The linear accelerator is used to treat solid tumors in all areas of the body. A radiation oncologist will run several diagnostic measures to determine the size, shape, and location of the tumor. Afterward, the oncologist will determine what level of radiation dosage will be used. The media radiation physicist and dosimetrist will evaluate how to deliver the prescribed amount of radiation and calculate the amount of time it will take to administer over time. 

After the preliminary diagnostics for administration are prescribed, the LINAC is adjusted and customized to fit the shape of the radiation beam to conform to the individual tumor properties. Using microwave technology similar to that used in radar, the LINAC’s “waveguide,” then accelerates electrons and sends them to collide with a heavy metal target to produce high-energy x-rays. As the rays exit the machine, they are shaped to match the tumor’s outlines and directed towards the tumor area.

Specific protocols and safety measures are conducted to ensure that the beam cannot exceed the prescribed dose or travel outside of the pre-determined bounds that could damage healthy skin. 

During the treatment, you will lie on a moveable couch or seat beneath a part of the linear accelerator called a gantry. Your radiation therapist will use lasers to ensure that your treatment area is administered precisely. Your radiation therapist will also assist in helping your body to remain positioned for optimum beam exposure to the right areas. 

Radiation can be focused on any area of the body from any angle by rotating the gantry and moving the treatment couch. During treatment, you will be continuously monitored by the technologist for position, accuracy, and comfort. 

Reference Link: https://www.adventisthealth.org/cancer-center/our-technology/varian-linear-accelerator/

American College of Radiology Issues New Guidelines for Non-Urgent Treatments

On May 6th, 2020, the American College of Radiology (ARC) released new guidelines that can help radiology practices resume non-urgent treatments safely. Treatments that are considered non-urgent are mammograms, oncologic and orthopedic imaging, and image-guided biopsies. Most of these treatments do not include radiation therapy that often involves the use of Linear Accelerators and CT scanners

As Coronavirus cases continue to drop in most areas, radiology practices are starting to resume non-urgent care practices to patients. “Radiology practices largely followed the World Health Organization, Centers for Disease Control and Prevention, and SCP guidance to postpone non-urgent care. While local conditions prevent a single prescriptive strategy to resume such care, general principles can apply in most settings…” said American College of Radiology Commission on Quality and Safety Chair, Jacqueline A. Bello, M.D., FACR. 

Read more about the ACR guidelines here

Recent Developments in Artificial Intelligence and Radiation Therapy

“AI (artificial intelligence) can help treatment planners and dosimetrists by saving a lot of time doing simpler and more repetitive tasks…,” explained Steve Jiang, Ph.D., director of the medical artificial intelligence and automation lab of the Dept. of Radiation Oncology, University of Texas Southwestern. 

For those unfamiliar with AI, we are referring to computer or machine intelligence systems that can perform tasks that usually require human intelligence, such as visual perception, speech recognition, decision-making abilities. 

Discussions about how AI will impact humanity have been occurring for many years in many industries; however, AI has been making headway into the radiation therapy and oncology fields within the past few years. 

Two such companies making the technological leap in AI for radiation oncology and treatment planning are Varian and RaySearch – both have developed machine-learning technologies to automate treatment plans.

“The fully automated system takes in the patient imaging and the target defined by the physician, and out on the other end comes a fully deliverable therapy plan,” said Kevin Moore, Ph.D., DABR, deputy director of medical physics and associate professor, University of California San Diego.

Dr. Moore said that “The comparisons were very good,” about tests that were made when SCSD began using the software in tandem with traditional treatment planning. After a human plan was developed, they ran the AI, and it only took 5-20 minutes to complete depending on the complexity of the plan. UCSD has now treated well over 1,000 patients with its AI-assisted planning. 

RaySearch has incorporated machine learning clinically since 2019. The system is trained to take the treatment planning computed tomography (CT) scans and automatically segment the anatomy and auto-contour to help speed the planning process. 

“The automated treatment planning system works by training the algorithm with curated sets of similar treatment plans, and it is able to detect the patients who are most similar to a novel patient and create a new treatment plan…,” explained Leigh Conroy, Ph.D., physics resident, at Princess Margaret Cancer Center, who has been working on the AI implementation. 

RaySearch is developing several other machine learning applications, including target volume estimation and large-scale data extraction and analysis.

Other highlights of AI technologies are adaptive AI-driven onboarding planning within the radiotherapy system, auto contouring for treatment plans, and creating MRI-derived CT scans for planning. To read more on these exciting technologies, read the full article here.  

RefleXion Receives Clearance from FDA for New X1 Machine

A significant stepping stone in radiotherapy occurred with the announcement by the therapeutic oncology company, RefleXion Medical. RefleXion Medical received clearance from the U.S. Food and Drug Administration (FDA) for three types of therapy; stereotactic body radiotherapy (SBRT), stereotactic radiosurgery (SRS), and intensity-modulated radiotherapy (IMRT). The groundbreaking new technology within the X1 machine will allow for more precise tumor location capabilities that can combine high-quality CT imaging. Within the X1 device, a linear accelerator offers technology that can rotate 60 times faster than standard linear devices. In this article, the CEO of RefleXion Medical is hoping that the X1 machine will treat not only the early stages of cancer but also offer thorough treatment solutions for those suffering from the most advanced stages. The transition of this company from a research-level, to now a commercial entity, has been a 10-year process. The company comes full circle by offering a new form of treatment with biology-guided radiotherapy (BgRT) into the market. 

Purchasing a Preowned Linear Accelerator – Great Quality at a Lower Cost

When choosing the medical equipment for your facility, it can be a difficult decision to find the best system that can provide treatments for patients while trying to stay inside a budget. Many radiation oncology centers struggle with the decision to purchase a new system vs. preowned refurbished medical equipment. If given a choice, a new linear accelerator will seem most appealing because of the updated technology and advanced features it offers. However, due to economic and other factors, it may not always be a reasonable option. Purchasing used and or refurbished medical equipment does not mean that your facility is stuck using out of date technology. There is still a lot of equipment available, allowing buyers the opportunity to receive the most up-to-date technology at a much lower price tag.

Starting a New Practice/ Facility

Purchasing used or refurbished medical equipment may be an excellent option for new clinics since they may not have the start-up capital for new products. If treatments are given to fewer patients (less than 8-10 times a day), and machine use is low, this will allow a business to start building up a revenue base for the practice. In the beginning, a facility may decide to buy newer equipment within 4-7 years while operating older equipment.

Having a Backup/ Relocation Plan

Many medical centers may be currently performing treatment with one system, so having a backup machine is a good plan to ensure patient schedules run without delay due to limited operating capacity. The process of replacing or supplementing a linear accelerator can extremely cumbersome, lasting 3 to 4 weeks in some cases. Having this long of a delay in treatment can be detrimental to patients that need treatment daily. One option to consider is to purchase a nearly identical, used linear accelerator and install it within a new location. Once the new center is operational, the company can remove and resell the original machine; This will ensure no disruption with patient care occurs and offer a smooth transition for relocation.

Room for Improvements

Purchasing a used linear accelerator will give your facility more room to grow and allow for cost-savings benefits. Many machines can receive upgrades later during their life since most original manufacturers or third-party companies offer upgradeable options for used equipment models. If the software is more important to your clinic than hardware, this option can be cost-effective since the software is typically more expensive than the hardware.  However, this option is not a perfect solution for all medical centers as each center will have specific requirements that may find new medical equipment to be a better choice.

As an independent LINAC service company, Acceletronics is dedicated to delivering the best equipment performance and services for linear accelerators and CT scanners across all major brands and models, as well as new and refurbished LINAC systems for sale.  More information can be found online at https://www.acceletronics.com/.



MRIdian Machines Create Precise Radiotherapy Methods

More than half of cancer patients that receive a diagnosis are most likely to be treated with a form of radiotherapy. Radiotherapy is a treatment that provides a high dose of radiation using a piece of equipment such as a linear accelerator and is aimed at a given area to eliminate cancer cells. Today’s technology has been very successful with these methods of cancer treatment. Still, even with precise planning, radiotherapy has many obstacles to overcome. Simple internal movements within the body such as breathing, bladder filling, digestion, or tensing up can impact the tumor movement up to half an inch, which may cause radiation to damage surrounding healthy cells and tissues. Engineers have developed a type of magnetic resonance linear accelerator (MR Linac) to combat these movement issues with live, detailed images of the tumor with higher accuracy. Read More on how this equipment can be utilized for precise treatments on patients.