Precision medicine: meet two medical physicists who are making it possible

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Hello, and welcome to the Physics World Weekly
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podcast.
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This episode explores
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precision medicine.
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From the perspective of 2 leading medical physicists.
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It's produced in partnership with Ip am, the
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institute of physics and engineering in medicine,
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which owns the journal physics in medicine and
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biology,
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and and this episode is supported by p.
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Our guests are anna barnes,
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director of the King's technology
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evaluation center at King's College London,
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and president of Ip
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and Nikki Wilde, who is head of radiotherapy
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physics at the mid and south Essex
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Nhs foundation trust.
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They joined Physics World's Tammy Freeman in a
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wide ranging
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conversation that defines the key concepts of precision
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medicine.
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And looks at how they're being implemented by
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medical physicists
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using magnetic resonance
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imaging, radiotherapy
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and other technologies.
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This podcast is supported by Pt,
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a global leader for dos
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and Qa
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solutions.
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Complex treatment techniques like adaptive radiotherapy,
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nec a high degree of accuracy in dose
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delivery.
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End to end Qa can help eliminate errors.
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With the new Ruby insert for adaptive radiotherapy.
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Pt
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is the first to provide an independent end
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to end solution for adaptive radiotherapy
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Qa.
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Equipped with 2 prostate organ sets, the adaptive
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ruby insert accounts for daily changes in organ
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shape and position and allows users to measure
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dose in each organ.
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In conjunction with the Ruby phantom.
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This new insert enables medical physicists
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to check key steps of the adaptive
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workflow.
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From image
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registration and plan
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adaptation to dose
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verification.
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Technology driven medical advances have enabled the introduction
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of precision medicine technique into the clinic.
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Whether this is targeting at risk
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populations with specific screening programs,
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tailoring interventions to particular patient subgroups
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or truly personalized diagnostics and treatments designed for
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individuals,
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the overriding aim is to deliver the right
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procedure to the right patient.
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And underlying the application of these innovative techniques
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is the ongoing research and development work by
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medical physicists and clinical engineers.
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To take a closer look at the development
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of precision Medicine.
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I'm joined today by Anna barnes,
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director of the King's technology
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evaluation center in London, I'm President of I
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the Institute of Physics and engineering in Medicine.
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And Nikki Wilde, Head of Radio
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Physics at the mid and South Essex Nhs
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Foundation Trust in the Uk. Hello, Anna and
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Nikki. Welcome to the podcast.
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So first of all, can you briefly explain
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what's meant
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precision medicine and personalized medicine, and the differences
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between the 2.
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So I think actually, pun tammy. By You
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made a good summary of it there in
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the in the introduction where the precision part
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is around trying to target.
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Appropriate
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treatment and diagnostics
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at groups of patients,
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rather than 1 size fits all,
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whereas the person lies is very much based
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on that
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individual's
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health profile, whether it be gene therapy or
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immunotherapy,
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or or indeed their, own individual ana when
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it comes to things like
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external beam radiotherapy
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or even,
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their own,
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tailor made molecular therapy doses for their size
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and shape and sex.
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Looking first to the development of new techniques
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for diagnosing and monitoring disease and what's roles
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to medical physicists and clinical engineers play in
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developing these new approaches.
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1 of the first things I think about,
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and my career has always been in imaging,
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medical imaging is, you know, how can we
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adapt the imaging environment for,
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the different patients that we have,
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coming through our scanners, and that might be
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to do with size, height, shape, whether or
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not someone's a little bit claustrophobic, whether someone
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has sensitive hearing,
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whether or not they have some sort of
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special implant that means that we have to
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be careful
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about the environments in which we're scanning them.
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Or, we might use special protocols in,
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in Ct or Mri where we can,
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get the best imaging signal around
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metal based implants that people have in order
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to, you know, improve their their lives or
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or indeed to to to treat them.
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I think then you have
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on the,
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engineering side,
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you have a group of,
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staff health professionals in the hospital whose
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particular
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job it is is to maintain and organize
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all of the medical equipment
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that is dedicated to
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patient health whether that be diagnostics
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or,
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simply monitoring people while they have their Opus
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stay hospital. And there's a lot of work
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that gets done around making that ergonomic,
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appropriate in places like Icu or busy, high
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dependency ward units, but also sometimes if we're
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working in things like,
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respiratory clinics or sleep clinics where you, organize
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the
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physiological measurement around the patient,
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in order to be able to understand
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their,
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special needs and,
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diagnostics
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around their experience of their illness or pathology.
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There's a lot more that gets done in
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in in radiotherapy between planning. I'm gonna hand
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them to Nikki to say a little bit
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about that. Yeah. I mean, Nikki maybe you
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could sort of explain how they help.
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In developing various different types of cancer treatments.
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Yeah. Sure.
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So ready care, as you can imagine, is
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highly technical discipline.
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And so
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it's
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very multi disciplinary in in it's
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and it's
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makeup.
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So we... As well as the clinical scientists
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and,
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engineers we you have clinical technologies or d
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we have clinic clinical
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oncologists,
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contribute as well to development.
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So but really,
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it is led in my opinion. Not might
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be bit controversial by
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by the physics staff,
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whatever from whatever staff group they come from.
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So... And if you think about it really,
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you're already therapy since the very first treatment
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back in 18 96,
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as been personalized, we point
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x rays at a tumor
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and,
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avoid
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the healthy issue around it, and that really
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is what happened has happened since way back
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in 18 96, course,
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the changes and then and the advances in
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technology,
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have meant a lot of changes
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and a lot of benefits to patients.
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So really like that
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the role of the
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physics,
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staff group,
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to the clinical scientists they're evolving research and
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development and developing new technique,
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making sure that they're implemented safely, make sure
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that their quality is assured. They look after
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the equipment to make sure that, what is
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delivered is what we think it's delivering.
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The engineers have the job of looking after
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this terribly complex,
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equipment to getting more complex really with every
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passing year.
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And then we are the clinical technologies who
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act
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actually really
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dig down on a patient level,
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who,
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generate, treatment plans that are very specific to
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that particular patient.
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If we think how a linear accelerator is
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built,
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for example, it's,
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very complex
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bit of machinery that...
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In a way generates x rays in the
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same way that diagnostic x rays machine do,
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but at a very much higher level so
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that we can
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penetrate the patient and treat.
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Deep seated tumors.
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Though we have... So we have the electron
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gun,
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again, in similar way the actual... Filament,
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in diagnostic machines.
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Those is electrons are accelerated to very high
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energies
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throughout down a wave guide accelerated by microwaves,
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those electrons hit a target,
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and that's producers
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x rays.
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The x rays obviously, have to be then
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focused onto the patient, so we have a
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lot of shielding
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issues. We have to make sure that,
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the x rays are only coming out in
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1 direction. And also, we want to be
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able that
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for that
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being to come in at a lot of
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different angles so that we can optimize for
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the patient.
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So we have a the gan tree rotates
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around 03:60 degrees. Couch will rotate, an internal
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c can rotate as well. So we can
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get
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really d angles in any any angle relative
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to the patient. And that that
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focus of that
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rotation is a iso center that is a
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diameter of 2 millimeters. So for these very
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heavy machines at odds on multiple of tons,
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that the engineer in behind that is really
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quite spectacular.
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Radiotherapy is are great example because as you
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say, each...
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Patient has their individual dose prescription. And then
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with these sort of more advanced technologies and
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the rotation and the more accurate targeting,
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I guess, sort of over the last decades.
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You've been able to target tumors more and
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more precisely for each patient.
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Yes. And actually, just to add to that,
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I I guess the best way to sort
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of sum up is you couldn't take someone
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else's treatment plan. And put it onto another
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patient and expect it to be exact, you
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know, deliver the same thing. It has to
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be redone all over again because it it's
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done for every single patient that comes along.
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Yeah. And also, just this week, I read
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about a new study investigating the use of
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genetic markers.
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To predict whether a particular patient is likely
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to have sort of really adverse effects to
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radiotherapy.
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I mean, I guess that's sort of a
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real of new cutting edge. Emerging
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approach. But that... You know, I guess that's
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more
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personalization. Yes. This is really promising
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actually it's something that's been talked about for
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quite a while, but we've not had the
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technology I suppose behind it,
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to be able to use that information, but
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I think... I mean, you see it every
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day, and some patients will have a better
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reaction to ready therapy some patients will have
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00:11:40,750 --> 00:11:40,910
worse.
285
00:11:41,564 --> 00:11:43,239
Skin reactions to radiotherapy therapy than not the
286
00:11:43,239 --> 00:11:45,814
patients. Even though they're having exactly the same
287
00:11:46,511 --> 00:11:47,787
personalized treatment,
288
00:11:49,399 --> 00:11:51,179
you you do see that difference
289
00:11:52,200 --> 00:11:53,160
in reaction,
290
00:11:53,800 --> 00:11:55,660
in different patient groups. So
291
00:11:56,375 --> 00:11:57,654
This is... Yeah, This is going to be
292
00:11:57,654 --> 00:11:59,735
really exciting going forward so it can really
293
00:11:59,735 --> 00:12:01,115
personalize that treatment
294
00:12:02,134 --> 00:12:04,221
even if it's down to radiotherapy not being
295
00:12:04,221 --> 00:12:06,283
the most appropriate even if it comes them
296
00:12:06,283 --> 00:12:08,743
down something else being more appropriate for that
297
00:12:08,743 --> 00:12:10,304
patient. But I think
298
00:12:10,742 --> 00:12:12,333
you know, you could get really granular on
299
00:12:12,333 --> 00:12:14,560
this and say things like, you know, if
300
00:12:14,560 --> 00:12:15,060
someone
301
00:12:15,594 --> 00:12:18,954
has less radio sense. Activity and doesn't suffer
302
00:12:18,954 --> 00:12:20,809
so much from the the dermatitis
303
00:12:21,425 --> 00:12:23,817
cause. You could maybe think about, you know,
304
00:12:23,977 --> 00:12:26,105
really boosting that that dose
305
00:12:26,945 --> 00:12:29,824
to to the the primary tumor. And then
306
00:12:29,824 --> 00:12:30,544
those that,
307
00:12:31,504 --> 00:12:35,360
that are particularly sensitive to to the radiation
308
00:12:35,679 --> 00:12:37,360
in in areas that we don't want to
309
00:12:37,360 --> 00:12:38,000
be sensitive.
310
00:12:38,799 --> 00:12:40,179
Is is all these wonderful,
311
00:12:40,879 --> 00:12:42,595
3 d technique and
312
00:12:43,695 --> 00:12:44,575
with all the
313
00:12:45,455 --> 00:12:48,014
the the rise in computing power has meant
314
00:12:48,014 --> 00:12:49,154
that you can really
315
00:12:49,948 --> 00:12:52,182
look at how you can target the tumor
316
00:12:52,182 --> 00:12:53,560
from many different angles,
317
00:12:54,336 --> 00:12:56,865
but spa the areas that
318
00:12:57,462 --> 00:12:59,057
you know, on on the skin on the
319
00:12:59,057 --> 00:13:02,485
surface that that could really flare up. And
320
00:13:02,485 --> 00:13:04,239
and that's what I think is totally amazing
321
00:13:04,239 --> 00:13:05,409
is that you can
322
00:13:05,846 --> 00:13:07,514
you know, if we start folding in this
323
00:13:07,514 --> 00:13:10,000
extra information, we can really start personal
324
00:13:10,454 --> 00:13:12,360
to every single person that comes in.
325
00:13:13,393 --> 00:13:13,869
Absolutely.
326
00:13:14,584 --> 00:13:15,243
And then
327
00:13:16,030 --> 00:13:17,780
Looking at the diagnostic side,
328
00:13:18,576 --> 00:13:21,360
for example, Mr imaging, how has that being
329
00:13:21,360 --> 00:13:21,860
personalized?
330
00:13:22,964 --> 00:13:24,393
Okay. So I'll start from the point of
331
00:13:24,393 --> 00:13:25,901
view of sort of the the big stuff,
332
00:13:25,980 --> 00:13:27,092
and then I'll go in
333
00:13:27,489 --> 00:13:29,790
on on every time a a patient goes
334
00:13:29,790 --> 00:13:31,711
into the scanner. So... I mean,
335
00:13:32,743 --> 00:13:33,299
first of all,
336
00:13:35,046 --> 00:13:36,420
the American market
337
00:13:36,953 --> 00:13:39,573
about 10 years ago started to make extra
338
00:13:39,573 --> 00:13:40,685
large magnet.
339
00:13:41,336 --> 00:13:42,607
With extra large,
340
00:13:43,799 --> 00:13:45,468
we call it the bore, which is the
341
00:13:45,468 --> 00:13:47,796
tunnel that that patients go into because
342
00:13:48,424 --> 00:13:50,437
there's an obesity epidemic in
343
00:13:50,813 --> 00:13:52,725
in in America, and they will find it
344
00:13:52,725 --> 00:13:55,115
that they couldn't fit people into the scanner.
345
00:13:55,609 --> 00:13:57,385
And and and you have to be careful
346
00:13:57,443 --> 00:13:59,038
because if you squish people in too much,
347
00:13:59,197 --> 00:14:00,256
then you end up
348
00:14:00,633 --> 00:14:03,504
concentrating where the the microwaves come and and
349
00:14:03,504 --> 00:14:04,620
and you can burn people.
350
00:14:05,195 --> 00:14:06,715
And we we definitely don't want happening.
351
00:14:07,434 --> 00:14:09,455
The other thing is that they created,
352
00:14:09,995 --> 00:14:11,675
what's called open bore magnets,
353
00:14:12,487 --> 00:14:14,875
where, it's not a closed tunnel, and again,
354
00:14:14,954 --> 00:14:16,546
that can help with people who are big,
355
00:14:16,626 --> 00:14:18,536
but also people who are claustrophobic your fabric.
356
00:14:19,650 --> 00:14:20,924
Then the next thing is that,
357
00:14:21,974 --> 00:14:24,604
you can design, so we we have
358
00:14:25,401 --> 00:14:28,031
receiver coils that fit over the head, but
359
00:14:28,031 --> 00:14:31,015
also on the body and the wrists and
360
00:14:31,151 --> 00:14:33,457
legs and so all of those have being
361
00:14:33,457 --> 00:14:33,775
designed,
362
00:14:34,809 --> 00:14:36,638
not necessary. I would say more sort of
363
00:14:36,638 --> 00:14:37,353
precision medicine.
364
00:14:37,830 --> 00:14:39,341
Because small sort of groups of patient,
365
00:14:40,072 --> 00:14:40,788
rather than,
366
00:14:41,822 --> 00:14:44,130
personalized. Because you don't have a specific coil
367
00:14:44,130 --> 00:14:44,846
for each patient.
368
00:14:47,249 --> 00:14:47,728
But
369
00:14:48,127 --> 00:14:49,643
and and each of the manufacturers will do
370
00:14:49,643 --> 00:14:52,196
something slightly different. So, you know, 1 of
371
00:14:52,196 --> 00:14:54,670
the manufacturers likes to have soft flexible coils.
372
00:14:55,084 --> 00:14:56,839
That fit onto the body, so it's quite
373
00:14:56,839 --> 00:14:58,913
comfortable and they're very light, whereas some of
374
00:14:58,913 --> 00:15:01,226
the other ones, other vendors like to have
375
00:15:01,226 --> 00:15:03,618
big large heavy coils being have less of
376
00:15:03,618 --> 00:15:03,778
them.
377
00:15:05,549 --> 00:15:06,907
And and they do things that way.
378
00:15:08,185 --> 00:15:08,904
And then
379
00:15:09,623 --> 00:15:11,541
you could do quite clever things with,
380
00:15:12,674 --> 00:15:16,186
with the pulse sequencing that the actual way
381
00:15:16,186 --> 00:15:16,926
that the
382
00:15:17,703 --> 00:15:18,203
electromagnetic
383
00:15:18,581 --> 00:15:20,657
radiation is delivered into the body and and
384
00:15:20,657 --> 00:15:21,056
and
385
00:15:21,709 --> 00:15:23,138
in order to get the signal back.
386
00:15:24,805 --> 00:15:26,313
And the way we do that is that
387
00:15:26,313 --> 00:15:27,686
you can do things where
388
00:15:28,218 --> 00:15:29,115
that there's a
389
00:15:30,224 --> 00:15:31,742
development recently that
390
00:15:32,221 --> 00:15:34,379
you call Whisper gradient. So I don't know
391
00:15:34,379 --> 00:15:35,897
if for any of you've been into an
392
00:15:36,137 --> 00:15:38,707
Mri scanner, but it's really loud. Like, you
393
00:15:38,707 --> 00:15:40,298
get some of these resident effects and it's
394
00:15:40,298 --> 00:15:42,366
bang bang bang bang bang. And that's that's
395
00:15:42,366 --> 00:15:44,457
frightening for people or for children
396
00:15:44,911 --> 00:15:46,104
or for people who have...
397
00:15:47,074 --> 00:15:50,093
You know, sensitivity to hearing. So they've, you
398
00:15:50,093 --> 00:15:53,055
can mathematically create a model and then
399
00:15:53,509 --> 00:15:53,906
deliver,
400
00:15:55,200 --> 00:15:56,500
much less noisy
401
00:15:59,919 --> 00:16:02,259
ways of of of of getting the the
402
00:16:02,399 --> 00:16:03,200
acquiring the signal,
403
00:16:04,092 --> 00:16:05,922
that's 1 way. The other way is we
404
00:16:05,922 --> 00:16:08,410
we use computing and mathematical modeling
405
00:16:08,945 --> 00:16:09,445
to
406
00:16:10,297 --> 00:16:11,354
decrease the time
407
00:16:11,808 --> 00:16:12,206
taken.
408
00:16:13,174 --> 00:16:15,159
So for people again who are across Pho
409
00:16:15,159 --> 00:16:15,952
or for children,
410
00:16:17,064 --> 00:16:19,683
you have super far sequences, which mean you
411
00:16:19,683 --> 00:16:21,404
could still get the same information, but they're
412
00:16:21,524 --> 00:16:22,794
in a fraction of the time that you
413
00:16:22,794 --> 00:16:23,533
would normally
414
00:16:24,224 --> 00:16:26,448
collect them. This if I'm really interesting, and
415
00:16:26,527 --> 00:16:28,433
I would like to understand this more so
416
00:16:28,433 --> 00:16:30,737
personally being of that age of having had
417
00:16:30,737 --> 00:16:33,474
my my first m scan recently.
418
00:16:35,117 --> 00:16:36,014
I was a bit
419
00:16:37,022 --> 00:16:39,086
sister to why we still do it this
420
00:16:39,086 --> 00:16:39,404
way.
421
00:16:40,451 --> 00:16:41,564
Whereas in Mri,
422
00:16:41,961 --> 00:16:42,915
you have a special,
423
00:16:44,107 --> 00:16:45,459
breast coil, which is a bit like a
424
00:16:45,459 --> 00:16:46,094
bra, really,
425
00:16:46,810 --> 00:16:49,035
and far more comfortable. But, of course, if...
426
00:16:49,289 --> 00:16:50,730
Taste a little longer than if you're if
427
00:16:50,730 --> 00:16:51,370
you're having,
428
00:16:52,250 --> 00:16:53,070
before plain on.
429
00:16:54,009 --> 00:16:56,009
And then also, because so you have a
430
00:16:56,009 --> 00:16:57,289
static magnetic field,
431
00:16:58,661 --> 00:17:00,734
which which we make as homogeneous as possible.
432
00:17:00,894 --> 00:17:02,010
But then as soon as you put a
433
00:17:02,010 --> 00:17:02,728
body into it,
434
00:17:03,844 --> 00:17:05,598
it dis it disrupts it and disturb it
435
00:17:05,598 --> 00:17:06,555
and changes everything,
436
00:17:07,049 --> 00:17:07,527
So
437
00:17:08,643 --> 00:17:11,137
physicists will work hard on creating
438
00:17:13,268 --> 00:17:15,341
pulse sequences that are suitable for...
439
00:17:17,115 --> 00:17:18,394
Certain areas of the body,
440
00:17:19,035 --> 00:17:20,015
and then the radio,
441
00:17:20,315 --> 00:17:22,394
he's the person no 1 does the acquisition
442
00:17:22,394 --> 00:17:23,615
can tweak those
443
00:17:24,968 --> 00:17:27,924
specifically for the size and shape and fact
444
00:17:27,924 --> 00:17:29,143
density and
445
00:17:31,612 --> 00:17:34,949
blood perfusion area, etcetera for that particular patient
446
00:17:34,949 --> 00:17:37,515
that's in there right now, and you can
447
00:17:37,968 --> 00:17:39,001
change things around,
448
00:17:40,209 --> 00:17:40,709
and
449
00:17:41,883 --> 00:17:43,558
get the best issue that you can really,
450
00:17:44,196 --> 00:17:45,950
for that person he's in there right now.
451
00:17:46,349 --> 00:17:48,603
Yeah. It's interesting because these are the technology
452
00:17:48,741 --> 00:17:50,674
development obviously you're wanting to get, you know,
453
00:17:50,835 --> 00:17:53,414
better imaging and sort of better, diagnostic
454
00:17:53,794 --> 00:17:55,875
outcomes. But also there's the side of making
455
00:17:55,875 --> 00:17:58,490
it more comfortable for the patient and less
456
00:17:58,928 --> 00:18:01,480
distressing and loud noises is, etcetera. So... Yeah.
457
00:18:01,640 --> 00:18:03,714
And that... That's really interesting. Yeah. Well, No
458
00:18:03,714 --> 00:18:05,149
know Just gonna ask Nikki, actually.
459
00:18:05,788 --> 00:18:06,825
So in terms of
460
00:18:07,383 --> 00:18:08,911
external beam therapy delivery.
461
00:18:09,466 --> 00:18:10,974
Do you feel like there has been...
462
00:18:11,847 --> 00:18:13,830
Because we haven't really talked about mold room
463
00:18:13,830 --> 00:18:16,468
technicians, which is phenomenal, really, delivery and and
464
00:18:16,468 --> 00:18:18,780
how we make life a bit more comfortable
465
00:18:18,780 --> 00:18:20,695
for the patients when they're having the treatment
466
00:18:20,695 --> 00:18:20,934
delivered.
467
00:18:21,971 --> 00:18:24,204
Yes. It's having it is really important that
468
00:18:24,204 --> 00:18:25,775
patients are comfortable because they're on
469
00:18:27,407 --> 00:18:29,181
a flatbed couch, which is
470
00:18:29,796 --> 00:18:31,468
inherently uncomfortable, and they,
471
00:18:32,264 --> 00:18:33,856
their treatment can... They could be on the
472
00:18:33,856 --> 00:18:36,607
bed, so it is 05:10 minutes. So
473
00:18:37,306 --> 00:18:39,064
we won't stay as still as possible. They're
474
00:18:39,064 --> 00:18:40,902
not gonna stay as still as possible if
475
00:18:40,902 --> 00:18:42,714
they're massively uncomfortable. So
476
00:18:43,393 --> 00:18:44,212
we have a
477
00:18:44,590 --> 00:18:46,346
have a range of accessories that we can
478
00:18:46,346 --> 00:18:46,846
use
479
00:18:47,862 --> 00:18:50,177
from, sort of foot stocks to needs to
480
00:18:50,177 --> 00:18:50,895
pull to,
481
00:18:51,705 --> 00:18:53,555
they had neck shells, which
482
00:18:54,325 --> 00:18:55,993
because there are so many organs at risk
483
00:18:55,993 --> 00:18:57,502
when you're treating your head and neck cancer.
484
00:18:59,504 --> 00:19:01,821
Usually relatively close to the tumor. It's really,
485
00:19:02,061 --> 00:19:04,938
really important that they stay and still join
486
00:19:04,938 --> 00:19:06,077
the treatment. So,
487
00:19:06,456 --> 00:19:08,708
these shells are fixed in 3 or 5
488
00:19:08,708 --> 00:19:10,147
places to the couch,
489
00:19:11,105 --> 00:19:12,085
and they're formed
490
00:19:12,464 --> 00:19:15,181
very closely to the patient's skin, so they
491
00:19:15,181 --> 00:19:15,500
can't,
492
00:19:16,712 --> 00:19:19,097
they can't move. And 1 of the great
493
00:19:19,097 --> 00:19:21,800
advancements that we're just implementing and a lot
494
00:19:21,800 --> 00:19:23,708
of centers in the Uk also so are
495
00:19:23,708 --> 00:19:26,444
doing is is something called surface guided radiotherapy.
496
00:19:27,372 --> 00:19:30,013
So surface guided radiotherapy therapy uses light
497
00:19:30,861 --> 00:19:31,099
to,
498
00:19:31,892 --> 00:19:32,184
reflect
499
00:19:32,783 --> 00:19:34,537
off the patient. So it's sort of structured
500
00:19:34,537 --> 00:19:35,037
light
501
00:19:36,053 --> 00:19:36,553
in
502
00:19:37,648 --> 00:19:38,467
in the ceiling
503
00:19:39,003 --> 00:19:39,503
that,
504
00:19:40,120 --> 00:19:42,686
reflects off the patient reflected back And because
505
00:19:42,686 --> 00:19:45,075
of the disturbance of the structured light,
506
00:19:45,792 --> 00:19:48,760
the computers can construct 43D
507
00:19:49,216 --> 00:19:50,411
outline of the patient,
508
00:19:51,144 --> 00:19:52,984
So this in itself can make treatment a
509
00:19:52,984 --> 00:19:54,424
lot more accurate. And
510
00:19:54,984 --> 00:19:56,204
you know, in it in it's
511
00:19:57,065 --> 00:19:59,658
1 of its most spoken about benefit is
512
00:19:59,952 --> 00:20:02,597
reducing the need with tattoos because we still
513
00:20:02,733 --> 00:20:03,686
hundred years later,
514
00:20:04,877 --> 00:20:08,055
tattooing patients to to, set them up initially
515
00:20:08,373 --> 00:20:09,742
on the on the truman machines.
516
00:20:10,460 --> 00:20:10,960
But
517
00:20:12,375 --> 00:20:13,732
as you can imagine, these head and neck
518
00:20:13,732 --> 00:20:16,286
shells are quite claustrophobic. They literally cover the
519
00:20:16,286 --> 00:20:16,740
hole
520
00:20:17,099 --> 00:20:18,697
of the face and the head down to
521
00:20:18,697 --> 00:20:20,455
the shoulders pad and neck patients as well.
522
00:20:21,734 --> 00:20:24,691
So this technology, this new technology called surface
523
00:20:24,691 --> 00:20:25,510
guided radiotherapy
524
00:20:25,903 --> 00:20:28,371
will allow us to remove the whole of
525
00:20:28,371 --> 00:20:29,507
the central part
526
00:20:30,042 --> 00:20:32,191
of the shell so that patients can have
527
00:20:32,191 --> 00:20:33,725
a much kind
528
00:20:34,180 --> 00:20:36,209
experience much less claustrophobic
529
00:20:36,747 --> 00:20:37,226
experience.
530
00:20:38,184 --> 00:20:40,818
And actually, just... I mean, that... That's that's
531
00:20:40,818 --> 00:20:42,575
really good news because even when we went
532
00:20:42,575 --> 00:20:44,012
through the, you know, the years of having
533
00:20:44,012 --> 00:20:44,810
to wear the mask,
534
00:20:45,782 --> 00:20:47,477
I felt having that
535
00:20:48,092 --> 00:20:49,048
breath right there,
536
00:20:49,765 --> 00:20:52,210
is quite disturbing. And if you're sort of
537
00:20:52,409 --> 00:20:53,849
and also at the same time you can't
538
00:20:53,849 --> 00:20:55,470
move your head. It must be quite
539
00:20:56,009 --> 00:20:56,970
upsetting for people.
540
00:20:57,529 --> 00:20:58,890
I I liked what I saw,
541
00:20:59,450 --> 00:21:00,490
a few years ago,
542
00:21:02,503 --> 00:21:02,822
where,
543
00:21:03,460 --> 00:21:04,976
some of the centers who were doing the
544
00:21:04,976 --> 00:21:05,476
pediatric,
545
00:21:06,730 --> 00:21:08,086
head and neck treatments,
546
00:21:09,203 --> 00:21:10,718
because it was an all labor mask, and
547
00:21:10,718 --> 00:21:12,567
they kinda make it out of this It's
548
00:21:12,567 --> 00:21:15,436
quite a... I think a light material isn't
549
00:21:15,436 --> 00:21:17,508
it? Because it obviously, it needs to not
550
00:21:17,508 --> 00:21:19,580
att any of the x rays.
551
00:21:20,233 --> 00:21:21,747
And it make it into a mesh, but
552
00:21:21,747 --> 00:21:24,457
they did superhero masks on it, which I
553
00:21:24,457 --> 00:21:26,370
think was lovely idea, and and that's a
554
00:21:26,370 --> 00:21:27,167
different level of,
555
00:21:28,456 --> 00:21:31,081
personalized medicine. Right? Yeah. So very skill for
556
00:21:31,081 --> 00:21:34,342
mel technicians out there. Yes. Berry. Yeah. Can
557
00:21:34,342 --> 00:21:35,853
produce things like that. Yep.
558
00:21:36,742 --> 00:21:39,123
So another area of medicine that's used to
559
00:21:39,123 --> 00:21:41,266
lot is a nuclear medicine, so this is
560
00:21:41,266 --> 00:21:43,727
like scans such as pet and spec scans.
561
00:21:44,617 --> 00:21:46,313
Could 1 of you comment on
562
00:21:46,850 --> 00:21:48,285
personalization in nuclear medicine?
563
00:21:49,162 --> 00:21:50,060
Yeah. Definitely.
564
00:21:50,757 --> 00:21:51,257
So
565
00:21:51,952 --> 00:21:53,965
for those of that for those of you
566
00:21:53,965 --> 00:21:56,845
that aren't so familiar, with this form of
567
00:21:56,845 --> 00:21:59,505
of radiation. So we talked a bit about
568
00:21:59,805 --> 00:22:00,945
external beam radiotherapy,
569
00:22:01,819 --> 00:22:02,938
we've also talked about,
570
00:22:04,217 --> 00:22:06,454
you know, x rays, which are, usually, if
571
00:22:06,454 --> 00:22:07,733
you have a Ct scan or an x
572
00:22:07,733 --> 00:22:09,491
rays scan come from outside and they go
573
00:22:09,491 --> 00:22:12,212
through your body. K. The different att termination
574
00:22:12,212 --> 00:22:13,982
properties of the tissues in the body
575
00:22:14,434 --> 00:22:15,544
on on a screen.
576
00:22:16,654 --> 00:22:18,558
With this version, we take
577
00:22:19,130 --> 00:22:20,589
what called radio pharmacy.
578
00:22:20,890 --> 00:22:22,269
So this is molecules
579
00:22:22,809 --> 00:22:23,049
that,
580
00:22:23,849 --> 00:22:26,144
have some sort of either metabolic
581
00:22:26,663 --> 00:22:28,518
job function in the body
582
00:22:29,374 --> 00:22:30,490
or maybe some,
583
00:22:31,207 --> 00:22:34,556
receptor type function, and then we replace 1
584
00:22:34,556 --> 00:22:36,824
of the within that molecule with a radio.
585
00:22:38,395 --> 00:22:40,647
And the most commonly 1 use in medicine
586
00:22:40,705 --> 00:22:41,205
is,
587
00:22:42,617 --> 00:22:43,254
and that's,
588
00:22:44,290 --> 00:22:47,355
terms essentially pure gamma emit, much lower lower
589
00:22:47,413 --> 00:22:49,167
energy than the stuff that Nikki was talking
590
00:22:49,167 --> 00:22:49,326
about.
591
00:22:50,363 --> 00:22:52,196
And in that case, we inject it into
592
00:22:52,196 --> 00:22:52,650
the
593
00:22:53,008 --> 00:22:54,863
per patient, and then we have
594
00:22:56,116 --> 00:22:58,188
radiation detectors around the body, which then,
595
00:22:59,462 --> 00:23:00,020
capture the,
596
00:23:01,622 --> 00:23:03,682
radiation coming out of the body, and then
597
00:23:03,682 --> 00:23:04,158
using
598
00:23:04,633 --> 00:23:06,218
mathematical modeling techniques, we can then,
599
00:23:08,218 --> 00:23:09,892
show where in the body it's coming from.
600
00:23:10,291 --> 00:23:12,704
Okay? So the reason that's important
601
00:23:13,081 --> 00:23:14,755
is that you might want to look at
602
00:23:14,755 --> 00:23:16,484
specific functions within the body
603
00:23:17,161 --> 00:23:19,388
So you might want to label something that
604
00:23:19,388 --> 00:23:21,161
looks at people's digestive system
605
00:23:21,615 --> 00:23:23,127
or someone's kidney function.
606
00:23:23,777 --> 00:23:26,393
Or someone's receptor to function in their brain.
607
00:23:27,662 --> 00:23:30,595
And the way that that this part is
608
00:23:31,324 --> 00:23:33,630
So you've got the sort of purse the
609
00:23:33,630 --> 00:23:35,379
precision side of it, which is your taking
610
00:23:35,379 --> 00:23:37,708
a specific radio pharmacy
611
00:23:38,083 --> 00:23:40,230
and targeting it at a particular function in
612
00:23:40,230 --> 00:23:40,707
the body.
613
00:23:41,359 --> 00:23:43,916
But then the personalization bit comes where you
614
00:23:43,916 --> 00:23:46,253
have to adjust the amount that you're injecting
615
00:23:47,351 --> 00:23:48,550
around the size and weight.
616
00:23:49,601 --> 00:23:52,013
Of that person, particularly pediatrics.
617
00:23:53,823 --> 00:23:56,307
And and more so, I think you know,
618
00:23:56,386 --> 00:23:58,057
when we go forward when we have this
619
00:23:58,057 --> 00:23:59,114
range of different
620
00:23:59,569 --> 00:24:02,115
Bmi. We have we also have guidelines around,
621
00:24:02,274 --> 00:24:03,045
you know, someone's
622
00:24:03,720 --> 00:24:05,546
has you high Bmi than we need to
623
00:24:05,546 --> 00:24:07,770
inject slightly more than we would someone else.
624
00:24:09,835 --> 00:24:10,335
And
625
00:24:11,026 --> 00:24:13,107
that's something you can medicine side, And then
626
00:24:13,107 --> 00:24:15,968
we also have pos emission with slightly different
627
00:24:15,968 --> 00:24:16,286
kind of,
628
00:24:17,716 --> 00:24:19,862
source of the gamma rays that we'd detect.
629
00:24:21,150 --> 00:24:21,469
Through,
630
00:24:22,026 --> 00:24:22,526
pos
631
00:24:22,981 --> 00:24:23,140
annihilation.
632
00:24:24,015 --> 00:24:25,709
That's mainly flu
633
00:24:26,721 --> 00:24:27,539
radio pharmaceuticals
634
00:24:29,278 --> 00:24:29,778
and
635
00:24:31,498 --> 00:24:31,894
we,
636
00:24:33,401 --> 00:24:35,383
again, we have to adjust for the patients.
637
00:24:35,954 --> 00:24:36,454
Weight
638
00:24:36,830 --> 00:24:38,902
in order to be able to get the
639
00:24:38,902 --> 00:24:39,141
best,
640
00:24:40,017 --> 00:24:40,894
the best images.
641
00:24:42,248 --> 00:24:44,161
The next step from that is that we
642
00:24:44,161 --> 00:24:44,638
would
643
00:24:46,328 --> 00:24:48,961
you can then use this information to work
644
00:24:48,961 --> 00:24:49,461
out
645
00:24:50,318 --> 00:24:51,137
how much
646
00:24:51,914 --> 00:24:52,414
therapeutic
647
00:24:53,763 --> 00:24:55,911
radio pharmacy tool called you could
648
00:24:56,627 --> 00:24:59,434
inject. So with a tech in the fluoride,
649
00:24:59,888 --> 00:25:00,445
a flu,
650
00:25:01,019 --> 00:25:03,119
That's just for imaging we have low energy
651
00:25:03,740 --> 00:25:04,220
gamma rays.
652
00:25:05,980 --> 00:25:07,819
When we want to treat, we can use
653
00:25:07,819 --> 00:25:09,849
alpha part, or beta particle
654
00:25:10,304 --> 00:25:10,542
radiation,
655
00:25:11,179 --> 00:25:14,361
and we'll have already labeled it with the
656
00:25:14,361 --> 00:25:14,861
particular
657
00:25:15,648 --> 00:25:16,148
pharmaceutical
658
00:25:16,524 --> 00:25:18,433
it's gonna go to the right organ that
659
00:25:18,433 --> 00:25:19,707
needs to be treated,
660
00:25:20,343 --> 00:25:22,355
and then you can work out from their
661
00:25:22,412 --> 00:25:25,140
imaging, scan, the imaging version. If you like
662
00:25:25,140 --> 00:25:27,716
the sort of benign version of the Radio
663
00:25:27,855 --> 00:25:28,355
pharmaceutical.
664
00:25:29,850 --> 00:25:32,086
Then we can work out very precisely how
665
00:25:32,086 --> 00:25:34,114
much we need deliver of the
666
00:25:34,807 --> 00:25:36,181
treatment the ion,
667
00:25:37,032 --> 00:25:37,532
bit
668
00:25:39,179 --> 00:25:41,501
for that particular patient. To So that's very
669
00:25:41,501 --> 00:25:43,015
much. In the same way that you have
670
00:25:43,015 --> 00:25:45,086
external being radiotherapy is that you have, you,
671
00:25:45,325 --> 00:25:46,281
your planning Ct,
672
00:25:46,839 --> 00:25:48,831
you, deli it or the organs you want
673
00:25:48,831 --> 00:25:49,070
to,
674
00:25:49,787 --> 00:25:51,415
avoid. So and then also
675
00:25:52,743 --> 00:25:53,720
and then deliver
676
00:25:54,253 --> 00:25:56,501
the optimum treatment to the primary,
677
00:25:57,035 --> 00:25:58,942
then with the nuclear medicine way of doing
678
00:25:58,942 --> 00:26:00,394
things, which which now has got this sort
679
00:26:00,394 --> 00:26:01,694
of trendy name called the.
680
00:26:02,315 --> 00:26:03,855
So therapy diagnostics,
681
00:26:05,115 --> 00:26:07,034
is you you do the imaging part,
682
00:26:07,928 --> 00:26:08,986
you get a really
683
00:26:09,364 --> 00:26:12,237
excellent map of where that radio ice tote
684
00:26:12,237 --> 00:26:13,355
will go. What's sorry, radio
685
00:26:13,993 --> 00:26:14,472
Will go.
686
00:26:16,162 --> 00:26:18,177
And then you can look at you can
687
00:26:18,235 --> 00:26:19,133
completely then
688
00:26:19,829 --> 00:26:20,329
calibrate
689
00:26:20,945 --> 00:26:22,322
how much of the
690
00:26:22,699 --> 00:26:25,839
treatment pharmacy, call. You delivered based on
691
00:26:26,451 --> 00:26:28,064
what... How much was delivered,
692
00:26:28,437 --> 00:26:30,344
for each person when you did the imaging.
693
00:26:30,900 --> 00:26:32,384
And that's... I I
694
00:26:33,141 --> 00:26:35,448
So did... There's really exciting new treatments around
695
00:26:35,448 --> 00:26:37,278
prostate cancer for this of this metastatic.
696
00:26:38,313 --> 00:26:41,041
But actually, there's lots of molecular.
697
00:26:42,466 --> 00:26:42,943
Available.
698
00:26:43,978 --> 00:26:45,251
It's not that well known.
699
00:26:46,445 --> 00:26:48,594
And I think it's a really exciting new
700
00:26:48,594 --> 00:26:49,094
area
701
00:26:49,724 --> 00:26:52,435
and I think that we should... I I
702
00:26:52,435 --> 00:26:54,350
think maybe because radiation had a bit of
703
00:26:54,350 --> 00:26:55,865
a bad press,
704
00:26:56,742 --> 00:26:58,338
maybe that's part of the reason it hasn't
705
00:26:58,338 --> 00:26:59,215
been so popular.
706
00:27:01,139 --> 00:27:01,639
And
707
00:27:02,889 --> 00:27:04,638
but I think this a really exciting stuff
708
00:27:04,638 --> 00:27:07,047
especially when it comes to looking at people's
709
00:27:07,342 --> 00:27:07,581
individual.
710
00:27:08,233 --> 00:27:09,052
Immune systems
711
00:27:09,429 --> 00:27:11,204
and genes and
712
00:27:12,935 --> 00:27:14,073
that dictate
713
00:27:15,008 --> 00:27:17,965
their response to that radio pharmaceutical as well
714
00:27:17,965 --> 00:27:20,134
in the same way that the radiation sensitivity
715
00:27:20,269 --> 00:27:21,223
sensitivity levels.
716
00:27:22,573 --> 00:27:24,345
And I think that if we
717
00:27:25,133 --> 00:27:27,528
if we are able to push forward as
718
00:27:27,528 --> 00:27:29,523
a as a country that can start
719
00:27:30,162 --> 00:27:32,317
manufacturing its own radio isotopes for medicine.
720
00:27:33,448 --> 00:27:35,356
That we can really push this forward and
721
00:27:35,356 --> 00:27:35,856
become
722
00:27:36,390 --> 00:27:38,378
really sort of a a world center if
723
00:27:38,378 --> 00:27:40,866
you like for for therapy delivery
724
00:27:41,493 --> 00:27:42,922
Yeah. I mean, that sounds like a technique
725
00:27:42,922 --> 00:27:45,167
that's just, you know, ideal for real
726
00:27:45,699 --> 00:27:47,603
personalization to eat each patient. That that sounds
727
00:27:47,603 --> 00:27:48,397
really exciting.
728
00:27:49,366 --> 00:27:51,218
And and then moving back to radiotherapy,
729
00:27:51,752 --> 00:27:54,400
and a 1 emerging area here is adaptive
730
00:27:54,457 --> 00:27:54,957
radiotherapy.
731
00:27:55,904 --> 00:27:58,381
In which you use images of the patient
732
00:27:58,381 --> 00:28:02,317
recording during the treatment course to adapt the
733
00:28:02,456 --> 00:28:03,275
planned treatment
734
00:28:04,541 --> 00:28:05,970
could you maybe me Nikki tell me a
735
00:28:05,970 --> 00:28:06,844
bit more about this?
736
00:28:07,717 --> 00:28:10,178
Yes. Of course it's a very exciting area,
737
00:28:10,813 --> 00:28:11,265
and
738
00:28:12,738 --> 00:28:14,411
very alimony if he likes it. I'd like
739
00:28:14,411 --> 00:28:16,424
to... If I can go back to
740
00:28:16,960 --> 00:28:19,190
what radiotherapy therapy looked like when I started
741
00:28:19,190 --> 00:28:19,929
and radiotherapy,
742
00:28:20,957 --> 00:28:22,707
34 years ago, just to kind of put
743
00:28:22,707 --> 00:28:24,139
it in some kind of context.
744
00:28:24,776 --> 00:28:25,014
So,
745
00:28:26,526 --> 00:28:28,435
hard to believe now,
746
00:28:29,231 --> 00:28:29,525
but
747
00:28:30,683 --> 00:28:33,500
when we were treating patients with radiotherapy
748
00:28:33,879 --> 00:28:36,516
to localize the tumor to sort of work
749
00:28:36,516 --> 00:28:37,555
out where we were treating,
750
00:28:38,206 --> 00:28:40,214
we used to have ortho x rays
751
00:28:40,666 --> 00:28:41,960
and a doctor would
752
00:28:42,491 --> 00:28:44,975
draw on those x rays in a altered
753
00:28:45,269 --> 00:28:45,824
China graph.
754
00:28:46,712 --> 00:28:47,212
To
755
00:28:48,301 --> 00:28:51,159
say where they actually wanted the treatment to
756
00:28:51,159 --> 00:28:52,588
be focused on and we had to work,
757
00:28:54,827 --> 00:28:55,327
some
758
00:28:56,259 --> 00:28:57,612
magic, really. But based on the fact that
759
00:28:57,612 --> 00:28:59,839
we didn't really have planning Ct routinely at
760
00:28:59,839 --> 00:29:02,403
that point, we'd take a outline of the
761
00:29:02,403 --> 00:29:04,579
contour with a bit of sold ring wire,
762
00:29:05,675 --> 00:29:06,814
and work it out,
763
00:29:07,351 --> 00:29:08,330
that way. So,
764
00:29:09,426 --> 00:29:13,024
from that, take so been in 19 90
765
00:29:13,024 --> 00:29:15,570
to to now. The change has been for
766
00:29:15,570 --> 00:29:17,183
phenomenal it's been a very
767
00:29:17,732 --> 00:29:20,937
exciting time to be in in radiotherapy.
768
00:29:22,267 --> 00:29:24,119
So just sort of from that
769
00:29:25,145 --> 00:29:26,259
and, you know, a lot of it is
770
00:29:26,259 --> 00:29:27,077
driven by,
771
00:29:27,690 --> 00:29:30,315
increased capacity, computer power, computing power.
772
00:29:31,269 --> 00:29:32,994
You know, from that, we then had the
773
00:29:33,590 --> 00:29:34,463
planning Ct,
774
00:29:35,019 --> 00:29:35,519
which
775
00:29:37,162 --> 00:29:39,305
it started off you it as a as
776
00:29:39,305 --> 00:29:41,607
a slot in the diagnostic x rate department,
777
00:29:42,098 --> 00:29:42,835
But now
778
00:29:43,603 --> 00:29:44,816
departments have their own,
779
00:29:45,188 --> 00:29:45,742
at least 1,
780
00:29:46,851 --> 00:29:47,802
largest centers even more.
781
00:29:49,324 --> 00:29:52,275
Ct that is specifically for radiotherapy therapy planning.
782
00:29:52,434 --> 00:29:55,088
So we scan them in in the treatment
783
00:29:55,226 --> 00:29:55,545
position,
784
00:29:56,821 --> 00:29:59,076
the Ct scans get exported to
785
00:29:59,627 --> 00:30:00,127
a
786
00:30:00,502 --> 00:30:01,957
planning treatment planning system
787
00:30:02,492 --> 00:30:04,163
where the organs at risk,
788
00:30:04,959 --> 00:30:07,983
we talked about before are outlined and, the
789
00:30:07,983 --> 00:30:08,461
treatment,
790
00:30:09,272 --> 00:30:10,569
volume the actual tumor
791
00:30:10,946 --> 00:30:12,700
is outlined on a slice by slice. So
792
00:30:12,700 --> 00:30:14,635
we get a much more 3 d
793
00:30:15,410 --> 00:30:16,980
representation of what we're trying to treat
794
00:30:17,498 --> 00:30:19,331
and the advancement in that area of course,
795
00:30:19,411 --> 00:30:22,360
which I'm very excited about is, Ai artificial
796
00:30:22,360 --> 00:30:22,679
intelligence.
797
00:30:23,476 --> 00:30:23,715
So,
798
00:30:24,353 --> 00:30:25,070
deep learning,
799
00:30:25,483 --> 00:30:27,654
and algorithms are being developed
800
00:30:28,268 --> 00:30:31,552
literally as we speak that can do that
801
00:30:31,688 --> 00:30:33,041
automatically in seconds. They can,
802
00:30:34,648 --> 00:30:37,440
outline, for example, for prostate cancer, they could
803
00:30:37,440 --> 00:30:39,673
outline the rec, the bladder and the small
804
00:30:39,673 --> 00:30:41,130
bowel, seminal these,
805
00:30:45,111 --> 00:30:45,611
to
806
00:30:46,547 --> 00:30:47,526
in a massively
807
00:30:48,142 --> 00:30:50,557
shorter time that it would take either
808
00:30:51,094 --> 00:30:52,689
a number of the physics staff or or
809
00:30:52,689 --> 00:30:53,965
a doctor to outline those.
810
00:30:55,418 --> 00:30:57,096
So that... That's where we're sort of proceeding
811
00:30:57,096 --> 00:30:58,854
there. And that that speed is actually important,
812
00:30:59,174 --> 00:31:00,952
especially when we come on things like the
813
00:31:01,172 --> 00:31:04,296
online adaptive radiotherapy that I will eventually get
814
00:31:04,296 --> 00:31:04,852
to our promise.
815
00:31:08,264 --> 00:31:10,192
And then we add such of the advancement
816
00:31:10,248 --> 00:31:10,565
of
817
00:31:11,938 --> 00:31:14,096
the the technologies on the linear accelerator like
818
00:31:14,096 --> 00:31:16,413
multi leaf c. So these are tiny little
819
00:31:16,413 --> 00:31:16,913
fingers
820
00:31:17,612 --> 00:31:19,690
of tungsten that can move in and out,
821
00:31:19,944 --> 00:31:20,423
to
822
00:31:21,540 --> 00:31:23,376
to like to conform to the tube window
823
00:31:23,376 --> 00:31:25,850
no chew is a square. Or queue right
824
00:31:25,850 --> 00:31:26,749
is it. So,
825
00:31:27,286 --> 00:31:29,451
there were... Was that kind of development. There
826
00:31:29,451 --> 00:31:29,849
was the,
827
00:31:30,724 --> 00:31:32,337
first of all, we used statically.
828
00:31:33,747 --> 00:31:34,962
Now then moved
829
00:31:36,066 --> 00:31:38,470
actually, while the beams on, generating a dynamic,
830
00:31:39,874 --> 00:31:41,064
flu of dose,
831
00:31:42,333 --> 00:31:42,833
and
832
00:31:43,935 --> 00:31:45,283
we we'll moved on to be able to
833
00:31:45,283 --> 00:31:46,735
use more and more
834
00:31:47,107 --> 00:31:50,224
fields so that we could focus right in
835
00:31:50,438 --> 00:31:51,255
on the tumor
836
00:31:52,759 --> 00:31:54,852
sort of of spreading out,
837
00:31:55,388 --> 00:31:57,221
the the the lower doses,
838
00:31:58,828 --> 00:31:59,938
to the other organs at risk.
839
00:32:01,047 --> 00:32:02,077
And then we sort of moved on to
840
00:32:02,077 --> 00:32:05,008
the imaging side, which is where we really
841
00:32:05,008 --> 00:32:05,508
started
842
00:32:06,054 --> 00:32:08,915
to be able to see the possibility of
843
00:32:08,915 --> 00:32:09,415
adaptive
844
00:32:10,107 --> 00:32:11,640
online adaptive radiotherapy
845
00:32:12,014 --> 00:32:13,229
in the future. So
846
00:32:15,049 --> 00:32:16,806
in the again, when I started, it was
847
00:32:16,806 --> 00:32:19,940
plain film stuck in a in a cassette
848
00:32:20,318 --> 00:32:21,116
underneath the patients,
849
00:32:21,755 --> 00:32:24,883
that was particularly sen to these energies, that
850
00:32:24,883 --> 00:32:26,899
we went onto those being electric
851
00:32:28,313 --> 00:32:28,473
images.
852
00:32:29,510 --> 00:32:31,286
And then we moved on to having
853
00:32:31,758 --> 00:32:32,258
k
854
00:32:33,507 --> 00:32:34,779
generators and,
855
00:32:35,177 --> 00:32:35,677
imaging
856
00:32:36,131 --> 00:32:37,642
ortho to the treatment being.
857
00:32:38,357 --> 00:32:39,605
And so we could start seeing
858
00:32:40,042 --> 00:32:41,873
playing a K images and then finally Comb
859
00:32:41,873 --> 00:32:44,340
beam Cts, and the the quality of the
860
00:32:44,420 --> 00:32:47,148
Comb Ct again is increasing rapidly
861
00:32:48,172 --> 00:32:49,465
with time with their
862
00:32:50,313 --> 00:32:50,813
intelligence
863
00:32:52,296 --> 00:32:54,357
of the the new algorithms being able to
864
00:32:54,357 --> 00:32:55,175
really generate
865
00:32:55,802 --> 00:32:56,699
super quality
866
00:32:57,313 --> 00:33:00,097
on treatment images. So I think where we
867
00:33:00,097 --> 00:33:00,597
are,
868
00:33:01,529 --> 00:33:02,029
almost
869
00:33:02,895 --> 00:33:04,958
as a as a routine for most patients
870
00:33:04,958 --> 00:33:06,331
having megawatts ready
871
00:33:07,021 --> 00:33:08,871
now in the Uk. They will have
872
00:33:09,481 --> 00:33:10,458
cone beam Ct
873
00:33:11,243 --> 00:33:13,476
in treatment position prior to each treatment.
874
00:33:13,954 --> 00:33:15,491
Radiotherapy therapeutic treatments have
875
00:33:16,346 --> 00:33:18,738
risk patients have treatments, let's up with different
876
00:33:18,738 --> 00:33:19,750
fractions, so the treated
877
00:33:20,345 --> 00:33:23,282
daily usually wanted to Friday ever 1 to
878
00:33:23,282 --> 00:33:23,759
6 weeks.
879
00:33:25,823 --> 00:33:28,141
So, they get on the bed the made
880
00:33:28,141 --> 00:33:30,286
as comfortable as possible with the mobilization kit,
881
00:33:30,762 --> 00:33:32,193
they have their Comb beam Ct,
882
00:33:32,749 --> 00:33:34,656
and that is matched to what their planning
883
00:33:34,735 --> 00:33:35,689
Ct looks like.
884
00:33:36,897 --> 00:33:39,445
This in a way is adaptive therapy because
885
00:33:39,445 --> 00:33:41,674
they were moving the patient to close and
886
00:33:41,674 --> 00:33:41,992
matched,
887
00:33:42,630 --> 00:33:43,767
match the position
888
00:33:45,272 --> 00:33:47,183
that they were in where they had a
889
00:33:47,183 --> 00:33:48,776
planning Ct, which is what the treatment was
890
00:33:48,776 --> 00:33:49,094
planned on.
891
00:33:50,209 --> 00:33:51,266
But this is only
892
00:33:51,960 --> 00:33:54,522
geographical adaptive share it to me In this
893
00:33:54,522 --> 00:33:55,499
case, we're only
894
00:33:56,192 --> 00:33:57,010
moving in
895
00:33:57,782 --> 00:34:00,009
6 degrees of freedom in some cases, mostly
896
00:34:00,009 --> 00:34:02,651
4 degrees of freedom. To to to match
897
00:34:02,651 --> 00:34:04,405
every day as close as possible to the
898
00:34:04,405 --> 00:34:05,863
planning Ct. But that
899
00:34:06,319 --> 00:34:08,792
can't account for changes in anatomy.
900
00:34:09,589 --> 00:34:11,079
As I said, these patients are coming
901
00:34:11,599 --> 00:34:12,897
well, 1
902
00:34:13,275 --> 00:34:15,191
once a day for sort of, 05:10,
903
00:34:15,510 --> 00:34:18,545
15 treatments and patients anatomy to changes in
904
00:34:18,545 --> 00:34:19,902
that time if we go back again to
905
00:34:19,902 --> 00:34:21,273
the example of state.
906
00:34:21,991 --> 00:34:22,651
A prostate
907
00:34:23,108 --> 00:34:25,761
is actually quite mobile based on
908
00:34:26,139 --> 00:34:28,052
how full the bladder is, how full the
909
00:34:28,052 --> 00:34:28,531
rec is.
910
00:34:29,807 --> 00:34:30,626
And so
911
00:34:31,738 --> 00:34:33,437
if we want to do proper
912
00:34:34,614 --> 00:34:37,251
online, adaptive radiotherapy but I adapting to the
913
00:34:37,251 --> 00:34:38,690
patient every single day,
914
00:34:39,740 --> 00:34:41,569
We need to be able to image that,
915
00:34:42,206 --> 00:34:43,797
and we need to be able to actually
916
00:34:43,797 --> 00:34:45,012
alter the dos symmetry.
917
00:34:46,039 --> 00:34:47,953
Of the plan to recalculate it if you
918
00:34:47,953 --> 00:34:49,946
like, on the Cone Ct rather than rely
919
00:34:49,946 --> 00:34:51,881
on the original treatment plan
920
00:34:52,418 --> 00:34:54,911
to recalculate it to adjust for those
921
00:34:55,224 --> 00:34:58,173
changes on that particular day and then treat.
922
00:34:59,688 --> 00:35:01,681
This... There's still a lot of,
923
00:35:02,637 --> 00:35:03,489
issues with this
924
00:35:05,196 --> 00:35:06,410
exciting technology.
925
00:35:07,894 --> 00:35:09,188
There... And there are probably
926
00:35:09,641 --> 00:35:12,199
2 main types of I'm land adaptive really
927
00:35:12,518 --> 00:35:13,235
For external be,
928
00:35:14,032 --> 00:35:15,784
Must be careful too. This is only external
929
00:35:15,784 --> 00:35:16,581
being ready therapy.
930
00:35:17,935 --> 00:35:18,333
And,
931
00:35:19,369 --> 00:35:19,767
1 is,
932
00:35:20,658 --> 00:35:22,006
Based on Comb beam Ct,
933
00:35:22,482 --> 00:35:23,909
and the other is based on Mr.
934
00:35:24,940 --> 00:35:26,788
So the mr is
935
00:35:27,239 --> 00:35:28,405
the Mr Ak is
936
00:35:28,924 --> 00:35:31,102
extraordinarily exciting. I think every
937
00:35:31,641 --> 00:35:35,078
clinical scientist we're their clinical scientist in the
938
00:35:35,078 --> 00:35:37,475
country probably secretly cranes want to play with
939
00:35:37,475 --> 00:35:37,975
because
940
00:35:38,526 --> 00:35:39,241
they really are,
941
00:35:40,035 --> 00:35:41,806
very exciting. So the
942
00:35:42,259 --> 00:35:43,632
case of an that that
943
00:35:44,561 --> 00:35:45,435
patient is image.
944
00:35:46,943 --> 00:35:47,102
Again,
945
00:35:48,313 --> 00:35:50,171
artificial intelligence is used to make a start
946
00:35:50,231 --> 00:35:52,148
on what we should be treating what we
947
00:35:52,148 --> 00:35:53,506
should be, saving,
948
00:35:53,985 --> 00:35:54,485
and
949
00:35:54,880 --> 00:35:57,440
that physics staff and clinical oncology then adjust
950
00:35:57,440 --> 00:35:58,340
that to what
951
00:35:58,640 --> 00:36:00,239
they think it should be, and then the
952
00:36:00,239 --> 00:36:00,900
plan is
953
00:36:01,199 --> 00:36:01,699
regenerated,
954
00:36:02,570 --> 00:36:04,717
and then, a, patient is treated on that
955
00:36:04,717 --> 00:36:06,626
new plan. And all the time,
956
00:36:07,262 --> 00:36:09,092
and this is probably the difference between the
957
00:36:09,251 --> 00:36:09,648
Ml in act,
958
00:36:10,539 --> 00:36:13,594
and the comb Ct Lin that
959
00:36:13,972 --> 00:36:15,249
I'll become more and more popular in the
960
00:36:15,488 --> 00:36:15,648
Uk.
961
00:36:16,686 --> 00:36:18,522
Is that they can also image joint treatment,
962
00:36:18,681 --> 00:36:21,087
and they can always they can also beam
963
00:36:21,087 --> 00:36:24,190
off joint treatment. So you've got... You drawn
964
00:36:24,190 --> 00:36:26,418
around on the sag, for example, where the
965
00:36:26,418 --> 00:36:28,419
tumor is. And you're watching it on the
966
00:36:28,419 --> 00:36:30,402
ml while the treatment is being delivered. If
967
00:36:30,402 --> 00:36:33,180
the patient takes deep breath coughs, and that
968
00:36:33,180 --> 00:36:34,211
tumor moves out,
969
00:36:34,862 --> 00:36:37,248
of the treatment volume, then the beam automatic
970
00:36:37,248 --> 00:36:40,192
switch off. That is so cool. And that
971
00:36:40,192 --> 00:36:42,101
even it just... There are a lot of
972
00:36:42,101 --> 00:36:44,190
technical problems with them Marlin x, which is
973
00:36:44,190 --> 00:36:45,090
why they're not
974
00:36:45,630 --> 00:36:47,230
widely rolled out yet.
975
00:36:48,590 --> 00:36:51,630
The... First of all, the magnetic field doesn't
976
00:36:51,630 --> 00:36:51,789
affect
977
00:36:52,762 --> 00:36:53,878
on the radiation fields,
978
00:36:55,394 --> 00:36:56,612
and the Rf
979
00:36:57,069 --> 00:36:57,888
radio frequency
980
00:36:59,222 --> 00:37:01,296
on the Lin affects the Mr and the
981
00:37:01,456 --> 00:37:03,005
Mr radio frequencies
982
00:37:03,777 --> 00:37:06,083
affect the Lin act. So there's been some
983
00:37:06,083 --> 00:37:08,548
very clever advances in the engineering of these
984
00:37:08,548 --> 00:37:09,422
machines to try and,
985
00:37:10,218 --> 00:37:12,385
the... To the Rf cage for Ml lin
986
00:37:12,385 --> 00:37:13,905
act, for example, is inside the lin. It's
987
00:37:13,905 --> 00:37:15,424
not in the room as it is doug.
988
00:37:16,784 --> 00:37:18,304
It's actually inside the,
989
00:37:19,105 --> 00:37:19,744
inside the Lin.
990
00:37:20,319 --> 00:37:21,778
Casing itself. So
991
00:37:23,755 --> 00:37:25,033
they take quite a bit of time to
992
00:37:25,033 --> 00:37:25,992
treat at the moment,
993
00:37:27,031 --> 00:37:30,235
what we need is advances in skills mix.
994
00:37:30,633 --> 00:37:32,465
You know it's quite difficult to get a
995
00:37:32,465 --> 00:37:32,784
consultant.
996
00:37:33,341 --> 00:37:36,289
Clinical oncologist, down, every retirement patient as a
997
00:37:36,289 --> 00:37:36,789
treatment
998
00:37:37,900 --> 00:37:39,440
and and the physics
999
00:37:39,980 --> 00:37:40,300
staff,
1000
00:37:41,260 --> 00:37:43,579
are, you know, well placed to really advance
1001
00:37:43,579 --> 00:37:44,079
their,
1002
00:37:44,780 --> 00:37:45,280
understanding,
1003
00:37:45,579 --> 00:37:45,980
and their,
1004
00:37:47,032 --> 00:37:48,628
their skills in this area.
1005
00:37:49,346 --> 00:37:51,100
Ai needs to advance probably a bit more,
1006
00:37:53,174 --> 00:37:56,125
because we do need these quicker treatment times.
1007
00:37:57,495 --> 00:37:58,633
The Com Ct
1008
00:37:59,568 --> 00:38:00,387
online adaptive
1009
00:38:00,764 --> 00:38:01,503
is being
1010
00:38:02,199 --> 00:38:03,952
adapted very widely in the Uk at a
1011
00:38:03,952 --> 00:38:04,644
minute. And that's
1012
00:38:05,164 --> 00:38:06,862
That is because there aren't the complexities
1013
00:38:07,401 --> 00:38:10,617
around e mr. There aren't the
1014
00:38:12,367 --> 00:38:13,423
complexities around
1015
00:38:16,660 --> 00:38:18,648
having the right staff at the right place
1016
00:38:18,648 --> 00:38:20,570
for a long period of time, And they're
1017
00:38:20,570 --> 00:38:22,553
also considered cheaper for actually, I have to
1018
00:38:22,553 --> 00:38:23,822
say. But, and,
1019
00:38:24,695 --> 00:38:27,130
they also show, a lot of
1020
00:38:27,727 --> 00:38:30,298
exciting advancement so that we really can
1021
00:38:31,950 --> 00:38:32,450
make
1022
00:38:32,827 --> 00:38:34,043
it as personalized
1023
00:38:34,659 --> 00:38:35,536
as possible.
1024
00:38:36,412 --> 00:38:38,579
Yeah you know, actually, nikki, I'm thinking. The
1025
00:38:38,579 --> 00:38:40,014
1 thing we haven't really spoke about is
1026
00:38:40,014 --> 00:38:42,008
bra therapy. Are there any sort of new
1027
00:38:42,008 --> 00:38:44,001
things going on there in terms of being
1028
00:38:44,001 --> 00:38:45,038
able to do...
1029
00:38:46,805 --> 00:38:48,713
Much more clever to symmetry in this space.
1030
00:38:49,269 --> 00:38:51,098
But you right actually. I mean bra therapy
1031
00:38:51,098 --> 00:38:51,757
is also
1032
00:38:52,450 --> 00:38:52,950
naturally
1033
00:38:53,643 --> 00:38:54,143
personalized.
1034
00:38:56,125 --> 00:38:58,364
The... For a long time, I think it's
1035
00:38:58,364 --> 00:38:59,264
fair to say
1036
00:38:59,565 --> 00:39:00,304
the techniques
1037
00:39:00,684 --> 00:39:02,444
weren't really changing very much.
1038
00:39:04,059 --> 00:39:04,619
But then,
1039
00:39:05,099 --> 00:39:06,720
again, with the advancement of
1040
00:39:07,180 --> 00:39:07,680
computing
1041
00:39:08,380 --> 00:39:09,840
power if you like. And
1042
00:39:10,460 --> 00:39:12,239
we've been able to develop
1043
00:39:14,062 --> 00:39:16,547
much newer techniques technique. So instead of the
1044
00:39:16,682 --> 00:39:18,055
cavity there's also instance
1045
00:39:18,587 --> 00:39:18,746
interstitial,
1046
00:39:19,778 --> 00:39:20,016
interstitial,
1047
00:39:21,781 --> 00:39:22,599
rec therapy
1048
00:39:23,690 --> 00:39:24,906
commonly used for prostate.
1049
00:39:25,838 --> 00:39:28,860
And so, in theater, the needles are inserted.
1050
00:39:29,913 --> 00:39:30,711
Into the prostate date.
1051
00:39:32,867 --> 00:39:34,085
And we
1052
00:39:34,783 --> 00:39:35,182
then,
1053
00:39:36,060 --> 00:39:38,376
calculate the dwell times because bra therapy is
1054
00:39:38,376 --> 00:39:38,876
basically
1055
00:39:39,188 --> 00:39:41,574
but those that don't know a a highly
1056
00:39:41,574 --> 00:39:42,074
active
1057
00:39:42,448 --> 00:39:44,357
iridium source on the end of a piece
1058
00:39:44,357 --> 00:39:44,914
of wire,
1059
00:39:45,629 --> 00:39:46,527
and that
1060
00:39:47,553 --> 00:39:48,053
can
1061
00:39:48,428 --> 00:39:48,928
insert,
1062
00:39:49,780 --> 00:39:51,235
in and out a patient,
1063
00:39:52,166 --> 00:39:52,405
with,
1064
00:39:54,409 --> 00:39:56,321
he can... And he can vary the dose
1065
00:39:56,321 --> 00:39:58,631
deposited by the 12 positions and also the
1066
00:39:58,631 --> 00:39:59,428
12 treatment times.
1067
00:40:00,145 --> 00:40:00,623
So
1068
00:40:01,594 --> 00:40:03,608
Yes, In natural fact you. You you are
1069
00:40:03,905 --> 00:40:04,723
completely personal
1070
00:40:05,419 --> 00:40:07,172
the treatment to the patient on that day.
1071
00:40:07,490 --> 00:40:10,639
The thing that will make it develop now
1072
00:40:10,780 --> 00:40:11,440
is that,
1073
00:40:12,940 --> 00:40:15,579
we didn't use to take into account or
1074
00:40:15,579 --> 00:40:18,231
tissue my We used to treat patients. As
1075
00:40:18,231 --> 00:40:19,262
if there were just water,
1076
00:40:20,214 --> 00:40:22,356
we can now look looking forward where we
1077
00:40:22,356 --> 00:40:23,649
can start and
1078
00:40:24,021 --> 00:40:24,498
absolutely.
1079
00:40:24,990 --> 00:40:27,309
Taking into account those differences in tissue in
1080
00:40:27,309 --> 00:40:30,269
homo although though it's really less sensitive to
1081
00:40:30,269 --> 00:40:31,329
external being radiotherapy.
1082
00:40:33,481 --> 00:40:34,378
We also
1083
00:40:34,831 --> 00:40:38,008
used to plan on Ct only. Now, we're
1084
00:40:38,008 --> 00:40:41,129
moving towards planning on Ct and arabic
1085
00:40:41,741 --> 00:40:44,150
is much better at showing no soft to
1086
00:40:44,150 --> 00:40:44,650
shoot
1087
00:40:45,190 --> 00:40:45,590
tumors,
1088
00:40:47,030 --> 00:40:47,430
and,
1089
00:40:48,710 --> 00:40:51,435
certainly moving away even from doing Ct in
1090
00:40:51,435 --> 00:40:53,923
the beginning, just using the Mri,
1091
00:40:54,935 --> 00:40:56,446
to to plan a patient's treatment.
1092
00:40:57,097 --> 00:40:59,006
Then there are there are exciting times. I
1093
00:40:59,006 --> 00:41:01,710
think the a bra therapy as well. III
1094
00:41:01,710 --> 00:41:03,858
mean, you know, didn't even just listening to,
1095
00:41:04,017 --> 00:41:05,074
Nikki, because I
1096
00:41:05,544 --> 00:41:08,021
I did my trainee back in 93, 95,
1097
00:41:08,261 --> 00:41:08,581
and then,
1098
00:41:10,179 --> 00:41:11,297
where where I did get to do some
1099
00:41:11,297 --> 00:41:13,590
radiotherapy, and then I moved into imaging
1100
00:41:14,189 --> 00:41:16,585
and and and sort of most recently into
1101
00:41:16,585 --> 00:41:17,864
magnetic resonance imaging.
1102
00:41:18,583 --> 00:41:20,281
Listening to you talk now
1103
00:41:21,155 --> 00:41:23,074
it's just so exciting, and I'm almost en
1104
00:41:23,074 --> 00:41:26,675
endless of the coming into the green pressure
1105
00:41:26,675 --> 00:41:29,003
now and you know, and if anyone is
1106
00:41:29,003 --> 00:41:30,672
out, there listening and they're thinking about it.
1107
00:41:30,911 --> 00:41:33,775
Yes, become a clinical scientist in the Nhs
1108
00:41:33,775 --> 00:41:36,081
is really cool. There's so much amazing.
1109
00:41:36,654 --> 00:41:39,052
New med medical technologies going on at the
1110
00:41:39,052 --> 00:41:41,209
moment that that you don't hear about normally
1111
00:41:41,209 --> 00:41:43,766
in the news say. Now regret it for
1112
00:41:43,766 --> 00:41:45,204
day. And every everyday is different.
1113
00:41:45,934 --> 00:41:48,155
Every day is differently. You could be doing
1114
00:41:48,155 --> 00:41:49,211
that. Personalized
1115
00:41:49,821 --> 00:41:50,797
patient specific
1116
00:41:51,566 --> 00:41:53,335
planning, or you could be
1117
00:41:53,803 --> 00:41:54,202
writing
1118
00:41:55,078 --> 00:41:57,309
you knew it the specification for replacement,
1119
00:41:58,185 --> 00:42:00,177
treatment planning system, or you could be,
1120
00:42:01,069 --> 00:42:02,208
going down and
1121
00:42:02,665 --> 00:42:05,219
analyzing the the the the dos on it
1122
00:42:05,219 --> 00:42:08,012
other treatment machine, everything single day different in
1123
00:42:08,012 --> 00:42:08,730
every single days.
1124
00:42:09,382 --> 00:42:09,699
Exciting.
1125
00:42:11,049 --> 00:42:12,161
That's great. I mean, it sounds like there's
1126
00:42:12,161 --> 00:42:13,987
been so many new developments, but also that
1127
00:42:13,987 --> 00:42:15,361
there's so much more
1128
00:42:15,734 --> 00:42:17,561
ongoing and more to come. So, I mean,
1129
00:42:17,719 --> 00:42:18,117
finally,
1130
00:42:18,608 --> 00:42:20,439
it's sort of looking into the future. Could
1131
00:42:20,439 --> 00:42:22,349
you perhaps envision en envision,
1132
00:42:22,907 --> 00:42:25,533
a new approach to precision medicine that might
1133
00:42:25,533 --> 00:42:27,603
just be on the horizon? Just an example
1134
00:42:27,603 --> 00:42:27,921
of that?
1135
00:42:29,452 --> 00:42:32,027
Thinking radiotherapy, there's you knew lots
1136
00:42:32,565 --> 00:42:34,502
exciting. Stuff still to come there's
1137
00:42:34,880 --> 00:42:36,418
what we call flash radiotherapy
1138
00:42:36,796 --> 00:42:38,347
where where we're treating
1139
00:42:39,358 --> 00:42:42,722
radiotherapy therapy very, very high doses in seconds
1140
00:42:43,415 --> 00:42:45,681
and so that and that chance to move
1141
00:42:45,898 --> 00:42:48,628
as much internal organs don't have an opportunity
1142
00:42:48,685 --> 00:42:49,880
to sq back.
1143
00:42:52,747 --> 00:42:53,280
So that
1144
00:42:53,799 --> 00:42:55,418
is still pretty theoretical,
1145
00:42:56,596 --> 00:42:59,413
but, it's very very exciting. There's
1146
00:43:00,671 --> 00:43:01,171
proton
1147
00:43:02,360 --> 00:43:04,828
treatment is still relatively rare,
1148
00:43:05,783 --> 00:43:07,477
but, you know, there's a there's a
1149
00:43:07,853 --> 00:43:09,467
future in that definitely and that
1150
00:43:09,858 --> 00:43:11,794
the difference with that and,
1151
00:43:14,324 --> 00:43:16,260
x rite treatment if you like
1152
00:43:17,115 --> 00:43:19,783
conventional radiotherapy therapy is that the
1153
00:43:20,238 --> 00:43:22,091
protons don't drop their energy
1154
00:43:23,660 --> 00:43:25,013
until they reach the end of their track.
1155
00:43:25,172 --> 00:43:26,739
So there's much lower dose
1156
00:43:27,179 --> 00:43:29,414
coming into a patient with than with x
1157
00:43:29,414 --> 00:43:31,330
rays. And then they kinda of dump it
1158
00:43:31,330 --> 00:43:31,830
all
1159
00:43:32,208 --> 00:43:33,427
in 1 spot. So
1160
00:43:34,443 --> 00:43:36,694
again, lots of challenges with protons but,
1161
00:43:37,733 --> 00:43:39,331
very exciting prospects there.
1162
00:43:40,849 --> 00:43:42,628
The use of sen agents
1163
00:43:43,167 --> 00:43:45,165
could be get completely game changing.
1164
00:43:46,933 --> 00:43:48,843
There was a bit of work done previously
1165
00:43:48,843 --> 00:43:49,900
with the opening investing
1166
00:43:50,355 --> 00:43:51,889
around gold, and
1167
00:43:52,424 --> 00:43:54,515
gold, while the killed sen.
1168
00:43:55,782 --> 00:43:57,478
Skin cancers show that you needed
1169
00:43:57,855 --> 00:43:59,609
less radiation to get the same effect.
1170
00:44:01,204 --> 00:44:03,516
So there's... Yeah. There's a there's an awful
1171
00:44:03,516 --> 00:44:03,889
lot
1172
00:44:04,328 --> 00:44:06,264
going on that could really, really
1173
00:44:06,800 --> 00:44:07,758
benefit patients.
1174
00:44:09,034 --> 00:44:10,549
Yeah. That reminds me actually if I forgot
1175
00:44:10,549 --> 00:44:13,601
to say with the with the molecular therapy
1176
00:44:14,232 --> 00:44:16,296
is that there's also a group of,
1177
00:44:17,567 --> 00:44:18,067
treatments
1178
00:44:18,520 --> 00:44:19,020
that
1179
00:44:19,552 --> 00:44:21,640
where you basically put the
1180
00:44:22,109 --> 00:44:24,589
radioactive substance into little spheres,
1181
00:44:25,230 --> 00:44:26,989
and then inject them right into the middle
1182
00:44:26,989 --> 00:44:27,630
of the tumor,
1183
00:44:28,429 --> 00:44:29,069
and then they...
1184
00:44:29,949 --> 00:44:32,144
So so they just they just irr
1185
00:44:32,765 --> 00:44:34,845
what's around them, and that's really clever. So
1186
00:44:34,845 --> 00:44:36,305
atrium spears is 1
1187
00:44:36,925 --> 00:44:38,945
that's been developed. So I think there's more
1188
00:44:39,005 --> 00:44:39,805
more to be done there.
1189
00:44:40,619 --> 00:44:42,137
And that's that's when you start going to,
1190
00:44:42,217 --> 00:44:43,516
like, material science
1191
00:44:44,374 --> 00:44:46,610
as well, you know, like, how how can
1192
00:44:46,610 --> 00:44:47,110
you
1193
00:44:47,664 --> 00:44:50,565
box it into something that will only disintegrate
1194
00:44:50,704 --> 00:44:52,625
or or be protect, sort of let the
1195
00:44:52,625 --> 00:44:53,125
radioactivity
1196
00:44:53,905 --> 00:44:56,316
come out, but also protect it from the
1197
00:44:56,316 --> 00:44:58,061
rest of the body and and not be
1198
00:44:58,061 --> 00:44:59,887
toxic and, you know, lot lots are really
1199
00:44:59,887 --> 00:45:01,711
interesting stuff there. And then the other thing
1200
00:45:01,711 --> 00:45:01,870
that,
1201
00:45:03,393 --> 00:45:04,984
people maybe don't realize so much. That I
1202
00:45:04,984 --> 00:45:07,530
mentioned before about molecular therapy and then teaming
1203
00:45:07,530 --> 00:45:09,757
that with a men immunotherapy and genetics.
1204
00:45:10,726 --> 00:45:11,837
But there have been,
1205
00:45:12,472 --> 00:45:14,854
there has been work already done where you
1206
00:45:14,854 --> 00:45:16,521
can look at the
1207
00:45:18,604 --> 00:45:19,104
specific
1208
00:45:20,202 --> 00:45:21,740
receptors or or
1209
00:45:22,759 --> 00:45:24,137
transmitter that are being
1210
00:45:24,756 --> 00:45:25,795
expressed by tumors.
1211
00:45:27,641 --> 00:45:29,574
And then you can target those
1212
00:45:30,585 --> 00:45:32,677
so that they almost act like little magnets
1213
00:45:32,814 --> 00:45:34,963
so that whatever to the radio pharmacies call
1214
00:45:34,963 --> 00:45:35,574
that you've jet
1215
00:45:36,570 --> 00:45:39,117
or sort of get stuck on to those
1216
00:45:39,117 --> 00:45:40,572
receptors, and then they'll only
1217
00:45:41,744 --> 00:45:44,468
be irr the tumor that's that's some,
1218
00:45:47,262 --> 00:45:49,657
expressing those sectors, and and again, prostate cancer
1219
00:45:49,657 --> 00:45:51,573
is a good example of that.
1220
00:45:52,371 --> 00:45:53,385
There also some press
1221
00:45:53,902 --> 00:45:54,936
breast cancers as well.
1222
00:45:55,731 --> 00:45:56,447
But there's
1223
00:45:57,799 --> 00:46:00,400
the prostate specific antigen that's expressed by
1224
00:46:00,996 --> 00:46:02,691
those tumors within the body
1225
00:46:03,226 --> 00:46:04,124
can be targeted
1226
00:46:05,057 --> 00:46:05,557
using
1227
00:46:07,525 --> 00:46:09,847
desired radio pharmacy calls and and and it'll
1228
00:46:09,847 --> 00:46:11,938
only latch onto that and and give those
1229
00:46:12,313 --> 00:46:14,541
tumors of dose, which is minimizes side effects
1230
00:46:14,541 --> 00:46:14,938
and things.
1231
00:46:15,909 --> 00:46:17,504
And then you have sort of complicated thing
1232
00:46:17,504 --> 00:46:18,780
where you use said some of the tumors
1233
00:46:18,780 --> 00:46:19,280
are
1234
00:46:19,976 --> 00:46:22,130
expressing those sectors and some of the marks,
1235
00:46:22,369 --> 00:46:24,044
and and you can start sort of doing
1236
00:46:24,044 --> 00:46:25,501
a mix and match of
1237
00:46:25,972 --> 00:46:28,302
things too. But but all of that takes
1238
00:46:30,586 --> 00:46:31,859
multi disciplinary teams,
1239
00:46:32,829 --> 00:46:35,089
and and careful planning and careful
1240
00:46:35,630 --> 00:46:35,789
investigation.
1241
00:46:36,509 --> 00:46:38,449
So it... It's how do we
1242
00:46:39,150 --> 00:46:40,369
how do we deliver
1243
00:46:41,478 --> 00:46:43,541
universal health care at the same time as
1244
00:46:43,541 --> 00:46:45,311
having the space and time
1245
00:46:45,683 --> 00:46:48,619
to keep pushing forward all these exciting areas
1246
00:46:48,619 --> 00:46:50,462
so that you know, 10 for years from
1247
00:46:50,462 --> 00:46:50,701
now,
1248
00:46:52,291 --> 00:46:54,064
everybody gets their perfect
1249
00:46:54,598 --> 00:46:55,712
prescription that's just for them.
1250
00:46:56,681 --> 00:46:58,112
And that that's a challenge that,
1251
00:46:59,067 --> 00:47:00,259
I guess we all have to face.
1252
00:47:01,611 --> 00:47:03,383
Yeah. And challenge
1253
00:47:03,757 --> 00:47:06,317
what's certainly worth working towards Yes.
1254
00:47:07,512 --> 00:47:09,582
A lot of exciting things ahead where the
1255
00:47:09,582 --> 00:47:12,130
sounds of bit. Well, I mean, thanks very
1256
00:47:12,130 --> 00:47:14,335
much to both of you for speaking with
1257
00:47:14,533 --> 00:47:16,680
today. It's it's been really interesting to find
1258
00:47:16,680 --> 00:47:19,383
out more about this personalized medicine. So, yeah.
1259
00:47:19,702 --> 00:47:22,166
Thanks again. Thanks for voice me tammy.
1260
00:47:23,059 --> 00:47:23,380
I.
1261
00:47:24,099 --> 00:47:26,179
I've enjoyed it. I really enjoyed it. Yeah.
1262
00:47:26,339 --> 00:47:27,859
And he's been like captain Nikki as well.
1263
00:47:28,900 --> 00:47:30,739
Yeah. Thank you. Thank you. Been great.
1264
00:47:39,367 --> 00:47:42,581
That was Anna Barnes and Nikki Wilde in
1265
00:47:42,880 --> 00:47:44,077
conversation with Tammy Freeman.
1266
00:47:44,795 --> 00:47:46,472
I'm afraid that's all the time we have
1267
00:47:46,472 --> 00:47:47,510
for this week's podcast.
1268
00:47:48,003 --> 00:47:51,534
Thanks to Anna, Mickey and Tammy for their
1269
00:47:51,592 --> 00:47:53,505
insights into precision medicine,
1270
00:47:54,064 --> 00:47:56,536
and to our producer Fred Isles.
1271
00:47:57,348 --> 00:47:59,842
This podcast is supported by Pt
1272
00:48:00,778 --> 00:48:03,410
and produced in partnership with ip,
1273
00:48:03,968 --> 00:48:06,121
a special thanks to them both.
1274
00:48:07,335 --> 00:48:09,675
This podcast is supported by Pt,
1275
00:48:10,534 --> 00:48:11,195
the dos
1276
00:48:11,894 --> 00:48:12,295
specialist,
1277
00:48:13,015 --> 00:48:14,394
end to end Qa
1278
00:48:14,709 --> 00:48:17,603
is essential for complex treatment techniques.
1279
00:48:18,380 --> 00:48:20,636
Ruby for adaptive radiotherapy
1280
00:48:21,493 --> 00:48:22,312
by Pt.
1281
00:48:23,264 --> 00:48:24,723
Enables medical physicists
1282
00:48:25,261 --> 00:48:26,081
to validate
1283
00:48:26,460 --> 00:48:27,359
the entire
1284
00:48:27,898 --> 00:48:29,197
adaptive treatment
1285
00:48:29,576 --> 00:48:33,509
workflow. From reference plan generation to plan
1286
00:48:34,121 --> 00:48:35,177
adaptation and
1287
00:48:35,630 --> 00:48:35,868
verification.