Software helps target radiation treatment for cancer

Back in the late 1980s, researchers at Varian Medical Systems Inc. had a vision for how to make radiation therapy for treating cancer more powerful, more efficient and much safer.

They just didn't have the technology they needed to get there.

"We didn't have the software that could do it, but the power of the computer was becoming sufficient that it could happen," says Dick Levy, chairman of Varian's board and former CEO of the company.

Varian leveraged the rapid pace of computing advancements of the 1990s to develop a more precise and effective way of delivering radiation therapy. The result is its product, SmartBeam Intensity Modulated Radiation Therapy (IMRT), a combination of hardware and software that pushed radiation therapy into a whole new realm of capabilities.

"The old radiation treatment compared to the new is like comparing a flashlight to a laser beam," Levy says.

SmartBeam IMRT enables oncology teams to precisely target cancer tumors while better protecting the surrounding healthy tissue, improving both quality of life for patients and clinical outcomes. SmartBeam IMRT earned Varian the top spot in the manufacturing category of the 2007 Computerworld Honors Program.

"IMRT was a revolution in the whole field, and Varian was instrumental in making this a reality for the user," says Arno J. Mundt, professor and chairman of the radiation oncology department at Moores Cancer Center, a part of the University of California, San Diego, Medical Center.

Pinpointing a tumor

Levy's flashlight/laser beam analogy isn't an exaggeration. Radiation therapy has been around since the 1940s, and it has without question saved countless lives, but earlier versions had limits. Conventional delivery methods can't configure the radiation beams to tumors, a design flaw that often results in damage to surrounding healthy tissue and organs. Nor can it adjust the dose delivered by each beamlet to target areas requiring more radiation.

"The whole point is to put as much dose on the tumor and the least amount on the healthy tissue that surrounds it. The biggest problem is making it conform to the tumor," says Varian CEO Tim Guertin, who was president of the company's oncology systems business when SmartBeam IMRT was made ready for the commercial market.

Traditional linear accelerators deliver radiation beams that create a rectangular shape. Therapists used lead blocks in an effort to shape the beams so the radiation would conform to a tumor's shape, explains Stan MansĀ­field, Varian's manager of emerging technologies and IT. It was a cumbersome process.

Then, in the late 1980s, Varian delivered its multileaf collimator, or MLC, a device that allows individual motorized leaves to move in and out of the beam's path during treatment to modulate the beam's intensity, thereby enabling the radiation therapy to conform more closely to the targeted site, according to Mansfield.

"And we thought, 'What if we could do that in real time and do that in conjunction with changing doses?' We thought we could do something new," he adds.

At the same time, medical facilities in Japan were using MLC in a conformal arc that rotated around patients, giving a three-dimensional dose of radiation therapy to the tumor rather than delivering it from just two directions (front and back).

Building on the model used in Japan, Varian delivered an IMRT prototype to clinicians at Memorial Sloan-Kettering Cancer Center in New York in 1995. The company introduced its commercial SmartBeam IMRT in 1999, and it quickly saw demand spike. It had 40 orders in 2000, and today more than 1,000 devices are in use around the world.

"It's both an evolution in technology and a revolution in terms of treatment methodology," Mansfield says.

Mansfield says the real power of IMRT comes from the fact that clinicians now have the ability to deliver radiation therapy using something called inverse planning, whereby they decide what dose is needed at what area and use the machine to make the calculations by running through thousands of algorithms.

"It's just not something a human could do [so quickly]. It would take you weeks or months," Mundt says.

In addition, Varian's Aria oncology information system was designed to optimize data management for clinics using SmartBeam IMRT. This oncology-specific electronic medical record allows clinicians to immediately access administrative, clinical and financial information, thereby linking medical and radiation oncology data in one system with elements of the IMRT treatment process.

New treatment capabilities

While research and development teams worked with clinicians to form a vision for SmartBeam IMRT, Levy recognized that Varian needed to change from a hardware company to a software firm if it was to succeed.

"Most of the evolutionary steps up to then were hardware improvements, but by 1988, it was clear that the future was going to be in software," says Levy, who was head of the company's medical business at the time.

Levy says Varian took an incremental approach to development, which helped the teams learn as they went, advancing the company's products as it hired more technologists and as its R&D team harnessed more technologies to deliver what the medical community needed.

"This was the perfect way of developing a product. We found strengths and weaknesses of the product, addressed them and then moved on," Levy says.

Varian hired technologists skilled in embedded controls, user interfaces and treatment planning, as well as experts in database technologies, Mansfield says. "We were building up those areas as we were figuring out how to adopt these technologies to solve the clinical problems," he explains.

With such expertise in place, Varian followed up its SmartBeam IMRT with On-Board Imager for IGRT (Image-Guided Radiotherapy), which allows clinicians to image and treat patients on a single machine that rotates around subjects to take X-rays and to deliver treatments from virtually any angle.

The On-Board Imager, which hit the market in 2004, produces high-resolution images of tumors and tracks changes in a tumor's shape, size and position. That capability, when coupled with SmartBeam IMRT, allows clinicians to be even more precise when targeting tumors.

Levy predicts more innovation in the years ahead. And, he says, as with the recent advancements in medical devices, future progress will involve optimizing IT applications.

"The whole secret of success in today's environment is not giving a better treatment," he says, "but giving a better treatment faster and more routinely and more safely."

Sidebar: At a glance: Varian Medical Systems

Varian Medical Systems Inc.

Palo Alto, Calif.

What it does: Makes equipment, accessories and software for treating cancer and other medical conditions. It has 4,400 employees worldwide, and its total annual revenue for fiscal 2006 was $1.6 billion.

Project champions: SmartBeam IMRT backers include Dick Levy, chairman of the board of directors and former CEO, and current CEO Tim Guertin, who was president of the oncology systems business from 1990 to 2005.

IT staff: About 25 software marketing personnel, 200 software engineers and 150 software service engineers work in Varian's oncology systems business worldwide. The company's IT organization consists of another 135 workers.

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