Elekta: Connecting the world to fight cancer

“This is an innovation… something people thought was impossible. It really changes the game in how we deliver radiotherapy to cancer patients.”

Fighting cancer is not an easy task. Each body responds differently and each tumor is unique - so treatment must be personalized and precise. But, as companies like Elekta push forward advancements in the field, cancer care is becoming more targeted and effective than ever before.

Elekta is a company creating cutting-edge linear accelerators, devices that deliver life-saving radiation therapy. In this episode we meet Chris Gilpin, Chris Flint and Mark Range at the company’s HQ in the UK. Find out how radiation therapy works, and why it’s playing an increasingly important role in cancer prevention. Get up close with the machines and take a tour through the factory to see how they’re built. And learn how Elekta’s IntelliMax system is bringing radiotherapy to underserved and remote countries all over the world.

We also hear from Howard Heppelmann who heads up PTC’s Industrial Internet of Things division. He explains how ThingWorx enables Elekta to respond rapidly to issues, and communicate quickly with their customers, so treatments go uninterrupted. 

Find out more about Elekta here.

Find out more about ThingWorx here.

Your host is Paul Haimes from industrial software company PTC. 

Episodes are released bi-weekly. Follow us on LinkedIn and Twitter for updates.

This is an 18Sixty production for PTC. Executive producer is Jacqui Cook. Sound design and editing by Ollie Guillou. Location recording by George Powell. Music by Rowan Bishop.

Transcript

Welcome to Third Angle. In this episode, we meet a company creating cutting edge cancer-fighting technology.

I’m your host, Paul Haimes from industrial software company PTC. In this podcast we share the moments where digital transforms physical, and meet the brilliant minds behind some of the most innovative products around the world, each powered by PTC technology.

Elekta’s radiation therapy machines are a thing of engineering beauty. Not only does the state-of-the-art tech inside literally save lives, but they also look breathtaking –crisp, white, and futuristic. These LINACs, or linear accelerators, take precision medicine to a new level – all part of Elekta’s strategy to give hope to everybody dealing with cancer. In the US, one in two women and one in three men will develop cancer in their lifetime. Thankfully, we’re better able to fend off cancer now than ever before. Radiation therapy is playing an increasingly important role in the fight against the Big C, with advances in technology allowing us to better target and personalise our care. Our producer George Powell visited Elekta’s HQ in the UK to meet Chris Flint, remote command centre lead and part of the remote services team, and Chris Gilpin, director of service and lifecycle marketing.

So Elekta is a company that’s really focused on precision radiotherapy solutions, which is really for the delivery of radiotherapy to cancer patients. And we have several different ways of doing that with our different systems. We have external beam radiotherapy, which is delivering radiation from outside the body inside to the tumour, and we also have internal beam radiotherapy, which is delivering radiotherapy directly into the tumour. 

We’re in the executive briefing centre of our cornerstone campus in Crawley. And what we’re looking at now is our latest linear accelerator called Harmony Pro. This is a system that’s been designed specifically to allow hospitals to treat a higher number of patients, get higher productivity, increased versatility in the way that they’re treating different tumour types and different patients. This is what we call a CT Linac. So the imaging modality we use here to be able to see the tumour is CT-based as you’d expect in a diagnostics facility in a hospital. Our latest innovation in Elekta is what we call the MR Linac. And this is really a new frontier in radiotherapy which is combining a linear accelerator with an MRI scanner. The benefit of that is that with MRI, we can actually see greater visualisation, especially of soft tissue, so areas of the body like the prostate, we’re able to see a much higher definition than ever before. MR Linac was something that many years ago people thought was impossible; to combine a magnet, where you get a magnetic field, with radiotherapy, with a radiation beam. And actually, the engineers at Elekta have been able to combine the two things, which really changes the game in terms of how we can deliver radiotherapy to cancer patients. 

So now we’re in front of the Alexa Unity system. And this is the new device that I mentioned, which is the combination of the linear accelerator plus the MR device. This is actually the first and only high-field MRI Linac on the market with a 1.5 Tesla magnet, which is what you’d see in a diagnostic imaging department. This is really a game changer in the field, in the fact that you’re able to see so much more than you ever could before. The goal of radiotherapy, for those who maybe aren’t aware, is really twofold: it’s to deliver as much radiation to the tumour as possible, and as little radiation to the healthy tissue and organs at risk. So that’s really what we want to achieve. And how we do that is twofold. We want to be able to shape the radiation beam specifically to the tumour size, which is done through a combination of hardware and software. And also, we want to be able to see what we’re treating, and our two modalities of CT imaging and also MR, MR being the gold standard, allows us to better do that so we can better shape the radiation to the tumour, and we can avoid as much healthy tissue as possible. 

So one of our key strategies at Elekta right now is something that we call Access 25. And this is all about helping facilities around the world to get better access to cancer care. There’s some statistics out there from the World Health Organisation that estimate new cancer cases are going to grow from 18 million in 2020 to 28 million new cases by 2040. So we’re seeing, in every single part of the world, cancer cases rising. And what we also see is there’s a shortage of linear accelerators. And it’s estimated to be around a 15,000 gap in the number of Linacs needed worldwide. When you consider that 50-60% of cancer patients require radiotherapy as part of their treatment, we still see that some countries or regions around the world are underserved in a number of systems that they have per million population. One of our drivers right now is how do we provide better access to care for these regions that need it more. We do that through our portfolio, we have different levels of product from more entry level allowing centres to get up and running, maybe they’re starting a new radiotherapy programme. So this is one of our key drivers.

One of the things that we have to bear in mind when we’re doing this, of course, is that while we’re in more remote parts of the world, how we’re going to be able to service and maintain those machines moving forward, especially in areas where maybe there isn’t such a kind of workforce or the expertise in certain parts of the world. This is where tools like IntelliMax® have also become really important, that we can, from a central location, we can monitor these machines, we can see what’s happening, we can predict if there’s going to be any downtime, or we can predict if something’s going to happen that could potentially be an issue for that customer.

And then speaking to Unity as well, brand new innovation, brand new technology, releasing that out onto sites, there’s going to be a lot of unknowns. So we’re using IntelliMax® to collect a lot of data from those systems to understand some of the pain points for interruptions – or terminations, as we call them to our customers – and then feeding those back through engineering, and then fixing some of those underlying issues through product releases. And then we can see over time that the reliability of these machines has improved, and we have the data to prove it.

One of the most amazing things about IntelliMax® is that we can actually resolve more than 30% of product issues remotely now using this remote assistance, which actually avoids about over two hours of clinical downtime per predictive occurrence. With 80% of our install base connected to IntelliMax®, this is having a massive impact on our ability to service systems and avoid this downtime that we’ve mentioned.

So we’ve gone outside now, and we’re walking from our main office building to the manufacturing facility, which is just over the road. So it’s very handy for us to be able to go and see the products and also take customers. Customers love to be able to see how the systems are made – often when they’re installed in the hospital, they don’t get to see all the intricacies of the machine. So this is an area where they really get to see deep inside how the system is built up.

My name is Mark Range, I’m the manufacturing manager for production here in Crawley, and this factory manufactures the linear accelerator. In this area of the factory, this is what we call the main line. So basically, it’s the production flow line for the main linear accelerator. So, this is where the large parts all come together. As we progress further down the assembly line, as all of the parts are fitted, the machine comes to the final stage, where we are now, where the machine is complete and it just goes through some basic checks. Once this is complete, it goes into one of the test bays along the back of the factory where we do all of the pre-test, and the pre-test is where we power up the machine for the first time so it can be quite noisy in here. 

This is a machine shop where we are machining the copper cells for the waveguides. This is the agility test area. So this is the beam shaping head with the MLC, which is the multileaf collimator. So the Linac that you saw out in the production line, that is where we produce the radiation. And this device here, the multileaf collimator does the final beam shaping before it reaches the patient. So you can hear that noise in the background. What’s going on here, we are running through some endurance testing on the agility head. And we basically have 160 tungsten leaves which can move independently to create the shape that is required for us to treat the specific size and shape of the tumour in the patient.

I guess we take a step back and just talk about how the radiation is produced. So in the machine shop where we were, we saw the copper cells being manufactured. So they get raised into a long tube, where at one end we inject electrons, and we accelerate electrons using RF, down the length of the waveguide, close to the speed of light. Those electrons are then focused and directed to a tungsten source where photons are produced. And those photons are the radiation. At the point where it strikes the target, as it’s known, it’s producing photons in all directions. So there’s a lot of lead and tungsten shielding to prevent it going where we don’t want the radiation to go. And then these leaves, just to try and describe a picture, we’ve got a bank on each side with 80 leaves on each side, which can place in to each other or pull out from each other. So basically, photons coming out in all directions, we shield all of that apart from where we want it to come out. And that is what the multileaf collimator does. It just opens or closes a shape to allow photons to pass through. Almost like theatre lights, you can direct them with the flaps at the side. 

These agility heads are also sold as upgrades. So every Linac we produce will have one of these heads on them. But we also sell these upgrades to some of the machines in the field which have older-style heads on them. This is a very versatile head of the machine where you can treat multiple targets, you can treat different tumour types, so it’s a really truly versatile solution. I think another thing to mention here is that you can see from the intricacies of the machine that it’s really important that we have service contracts with customers. And this is really where the IntelliMax® piece comes in that we can remotely monitor what’s happening with the system. Because it is so integrated is so complicated, it’s really important that we have those abilities.

Following on from that, the agility head is probably one of the areas where we get most of our data items from. So if you’re looking at this head here, there’s seven or eight different components where we raise predictive maintenance cases based on the data that we get out of the devices around the world. Predictive maintenance allows us to keep hospitals up and running longer. The worst thing that can happen in a hospital is for the linear accelerator to go down. They have huge amounts of patients to treat; a lot of hospitals are under huge stress to treat increasing number of patients. So we have tools like IntelliMax® allows us to see in advance if something’s going to go wrong or we need to get in there and check certain part of the system so that we can maintain uptime as much as possible and avoid any missed patient treatments, which really, we want to avoid.

That was Chris Gilpin, Chris Flint, and Mark Range from Elekta. Now, because they’re dealing with major life-threatening illnesses, Elekta’s IntelliMax® system is vital in allowing them to respond rapidly to issues and communicate quickly with their customers so treatments go uninterrupted. IntelliMax® runs on PTC Internet of Things platform ThingWorx. So let’s find out more about it. Time to meet our expert, Howard Heppelmann, who heads up PTC’s ThingWorx division.

Let’s start with just a quick understanding of what ThingWorx does as a technology. ThingWorx allows our customers to connect to devices that are placed in very remote areas of the field. In the case of Elekta, we’re talking about a hospital setting. But then, by being connected to those devices, it really gives the product itself a voice that can report back and speak back to the engineers and service professionals at Elekta, always making them aware of the health status of that equipment. It also enables analytics that allow the customers to become predictive in their service offerings with their clients. So Elekta has embedded ThingWorx in their devices. And by using ThingWorx, they’re able to remotely monitor these devices across all the hospital settings where those devices are deployed, and ensure that the health of those devices is performing as expected – and in many cases actually get ahead of and predict what issues might have otherwise occurred, and resolve those issues before they become interruptions in the hospital setting.

For Elekta, this level of service distinguishes them from other competitors who are offering similar products, because they’re able to guarantee their customers this high degree of availability, which in this case, the customer being in a hospital, is then in turn able to embed into a much more predictable service to their patients and a much more effective service to their patients. So for example, by remotely monitoring and connecting to this equipment, in the first year that Elekta deployed this, they were able to identify 600 preventative actions that were carried out. In terms of what that meant, it avoided interruption of treatments to more than 14,000 patientsElekta has joined a large list of PTC customers who’ve become more and more service oriented. Why do you think that is? And what is it specifically that ThingWorx does to offer customers the ability to become more service oriented?

I think if you take a look at what’s happening in the service industry today, there is a major transformation going on. If we back up, a few years ago, not so long ago, really most service was delivered in a break-fix kind of model. Obviously, as we’ve already discussed, Elekta now benefits from being able to be connected to these devices. And much of the service that they deliver is done remotely, avoiding expensive truck rolls, and more importantly for their customers, avoiding this critical downtime that would severely impact the hospital in the patient. In fact, 20% of the service issues that they are identifying have now been resolved without dispatching a technician by remotely servicing that equipment. 

But if we look forward, it doesn’t stop there. Really what we’re seeing is a transformation of the service delivery process that ultimately for many manufacturers, and I’m sure Elekta as well, is thinking about product as a service; not just selling a customer a product and maintaining that product, but really dialling in on what their customers care most about, which is the outcome. And so we’re seeing this transformation from the old break-fix model to currently a much more efficient and effective remote service and predictive service model. And ultimately, for many companies, it will end up in a product as a service model.