NHMRC Early Career Fellowship awarded to Dr Doan Trang Nguyen

11 October 2017

Dr Doan Trang Nguyen is the recipient of the highly competitive and prestigious NHMRC Early Career Fellowship. Trang has made many contributions to different projects in the group and we are delighted that she will continue to work with us for the next four years. Congratulations Trang!

Clinical translation of our research

August and September 2017

  • The Breathe Well device, developed from our research, was used for the CT simulation session of a breast cancer patient at Gosford, its first use in Australia. Every Breathe Well patient who would otherwise not have been offered deep inspiration breath hold has a 50% reduction in cardiac dose, and a 50% reduction in long term cardiac risk. Sean Pollock, our former PhD student, is now leading the first clinical use of BreatheWell in Australia. Through the NHMRC Development Grant and National Breast Cancer Foundation Grant, Elisabeth, Kuldeep and Ricky have been working towards the safe and efficient use of our device for breast cancer patients.
  • The first SPARK prostate cancer patient was treated at Liverpool Hospital, the first time KIM has been used on an Elekta linear accelerator. The patient came from Goulburn, a 2-hour drive and was very happy to have 5 days rather than 8 weeks of treatment. The use of KIM on Elekta demonstrates its applicability on almost all modern cancer radiotherapy systems and will pave the way for further KIM studies, such as the LARK liver cancer trial, in many more centres. Along with a multidisciplinary effort from the Liverpool team, Trang, Saree and Emily spent many nights and weekends getting KIM working on Elekta, building on code Ricky has written.
  • The Peter MacCallum Cancer Centre became the third site to treat prostate cancer patients using KIM. Trang travelled to Melbourne to install the software and returned to oversee the first successful patient treatment.
  • At RNSH, the 6th SPARK prostate cancer patient started treatment with KIM-guided MLC-tracking and the 8th LIGHT-SABR lung cancer patient started treatment with Calypso-guided MLC tracking. These treatments were performed under the care of Jeremy, Vince, Trang, Elisabeth and Emily using code that Ricky was central in developing.

Success for our PhD students at AAPM

8 August 2017

The American Association of Physicists in Medicine held its annual meeting in Denver, Colorado in July. A number of our researchers presented at this leading international conference and it was particularly successful for our two PhD student presenters.

Suzanne Lydiard was awarded 2nd place in the John R. Cameron Young Investigator Symposium competition for her presentation “First Cardiac Radiosurgery MLC Tracking Results”. There were over 300 applications for this category.

Vincent Caillet's presentation “MLC Tracking for Lung SABR Reduces the Dose to Organs-At-Risk and Improves the Geometric Targeting of the Tumour” was selected as one of the five Best in Physics (Therapy) from over 1000 submissions. This paper was also selected as one of four FaceBook Live interviews.

Partnering with Siemens Healthineers to develop 2nd generation 4D CT project

25 July 2017

Four-dimension (4D) computed tomography (CT) enables imaging of the lungs, chest and abdomen while patients breathe. We were fortunate to be early pioneers in the development and clinical application of the initial (first generation) 4D CT technology which is now widely adopted for cancer patient imaging around the world. Even with its wide adoption, the first generation 4D CT can be improved by better communication between the patient’s breathing and the CT itself. Over the years we have developed robust methods to overcome some of the challenges of the first generation technology. We are pleased that we have agreed to a research partnership with Siemens Healthineers that will enable us to advance the research of second generation technology. This project will enable some of the methodology that Ricky, John, Kinga, Spencer, Sean and Paul developed to be experimentally realised, paving the way for a future clinical trial.

Arrival of the ARTIS pheno robotic cancer imaging system


ARTIS pheno robotic cancer imaging system

24 July 2017

The ARTIS pheno robotic imaging system (Siemens Healthineers) arrived at the University of Sydney today. The purchase is funded primarily from an Australian Cancer Research Foundation grant and it will be installed in the Hybrid theatre of the Charles Perkins Centre. We will have a world-unique x-ray imaging system with which to experimentally investigate our methods for better machine-human interactions and real-time feedback. The power of the ARTIS pheno for cancer imaging applications is its flexibility. The robotic multi-axis gantry can be placed in virtually any position and programmed with a variety of trajectories. Precise and easy to control longitudinal and transverse movements of the robot itself and the variable isocentre make it perfect for imaging. This project will be led by A/Prof Ricky O’Brien.

BreatheWell use at UC Davis

3 July 2017

Our collaborator, Dr Tokihiro Yamamoto, has been using Audiovisual (AV) biofeedback for improving breathing training for lung cancer patients in PET and CT imaging procedures. He is now at the University of California, Davis, and is interested in the role of AV biofeedback for CT ventilation. UC Davis recently obtained ethics approval for a deep inspiration breath hold (DIBH) study using the same technology. The UC Davis team is using the BreatheWell software to provide AV biofeedback in the trial. With a short turnaround we have upgraded their hardware and software, sending Dr Elisabeth Steiner to UC Davis to provide training and support for the BreatheWell software. The first patient was scanned last week and will be treated this week under Elisabeth’s guidance. In the words of the lead physicist:
“We had successfully enrolled and CT scanned our first patient yesterday using the BreatheWell unit here at UC Davis. The two new units are easy to use and the software is very user-friendly. Elisabeth has provided tremendous help in setting up the units and training our staff. Overall, thank you very much for your generosity and support. We will keep enrolling patients to this study.”

This is an important milestone in translating our technology to patient care. The development and implementation of the BreatheWell software has been led by Kuldeep Makhija and Elisabeth Steiner .

First clinical use of the kilovoltage intrafraction monitoring (KIM) system

17 May 2017

The kilovoltage intrafraction monitoring (KIM) system uses the image-guidance system mounted on a standard linear accelerator to determine the 3D position of fiducial markers located in the prostate, enabling it to monitor a tumour's position and rotation prior to and during stereotactic body radiotherapy (SBRT). It has been developed over the last decade in the Radiation Physics Laboratory. The first clinical use was performed in March 2016 at the Calvary Mater Newcastle Hospital, NSW. The results were recently published in Radiotherapy and Oncology (123: 37-42) and featured in the Medical Physics Web research news.

KIM was applied to measure and correct for target motion during SBRT for prostate cancer. The system is designed to warn the radiation therapist when tumour motion exceeds a threshold. Once alerted, the treatment can be paused for the couch to be shifted. This treatment represents, to the best of our knowledge, the first time a cancer patient’s tumour position and rotation have been monitored in real-time during treatment. The 6 DoF KIM system has sub-millimetre accuracy and precision in all three translational axes, and less than 1° accuracy and 4° precision in all three rotational axes.

The benefits to the patient are better tumour targeting and tighter treatment margins, potentially leading to a reduced risk of toxicity to surrounding normal tissues. KIM is being employed in the SPARK and LARK clinical trials.

First Images on the MRI-Linac

17 February 2017

The Australian MRI-linac program is a 16 million dollar project at Liverpool hospital to build a Magnetic Resonance Imaging (MRI) device combined with a Linear Accelerator, which is used to treat cancer using radiotherapy. MRI is safer and provides better imaging of soft tissues compared with existing imaging technologies used in radiotherapy. Combining a MRI with a linear accelerator is an engineering challenge and the MRI-Linac at Liverpool hospital is one of only four in development internationally. The first images on the MRI-Linac were acquired on 16th Feb 2017, followed a day later by the first images with the beam on. A major breakthrough for the program.

The Australian MRI-Linac Program awarded an NHMRC program grant

4 February 2017

The Australian MRI-Linac Program comprises researchers from the Radiation Physics Lab, the Ingham Institute of Applied Medical Research and the Centre for Medical Diagnostic Technologies at the University of Queensland. The program is led by Prof Keall and supported by an NHMRC Program grant. The MRI-Linac is in development at Liverpool hospital and the recent renewal of the program grant will assist in delivering this next generation cancer therapy to Australian cancer patients.

The Australian MRI-Linac Program: Transforming the science and clinical practice of cancer radiotherapy
NHMRC Program Grant: $7,001,475

Funding Success

November and December 2016

Congratulations to the team on fellowship and grant funding success!

  • Elisabeth Steiner was awarded a pilot study grant to support from the National Breast Cancer Foundation to support the BraveHeart study at RNSH. The ultimate goal of this program is to reduce long term cardiac toxicity and improve the quality of life of breast cancer patients.
  • Andy Shieh was awarded an NHMRC Early Career Fellowship and a Career Development Fellowship from the Cancer Institute NSW for the project Real-time In-vivo Imaging during Lung Cancer Radiotherapy. These Fellowships will give additional support for the markerless lung cancer tracking project.
  • Ricky O’Brien was lead investigator on High Precision Radiotherapy: Dual Cardiac and Respiratory Motion Management funded by Cancer Australia. This grant will allow us to build a research program around the Zeego robotic c-arm system to be installed in February 2017.
  • An NHMRC Development grant, Nano-X: A new class of cancer radiotherapy system, was awarded to the Nano-X team to further develop an innovative technology that will increase the availability of radiotherapy.

Medical Device Fund Grants to Nano-X and Respiratory Innovations

10 October 2016

Dr Ilana Feain accepted a $2.58M award on behalf of Nano-X and Dr Sean Pollock accepted a $1.3M award on behalf of Respiratory Innovations from the NSW Health minister at NSW Parliament House today. The Medical Device Fund Grants to our spin-off companies represent years of R & D at the University of Sydney followed by development and commercial activities within the companies.

Nano-X is developing a new class of cancer radiotherapy systems that will extend the availability and applications of current radiotherapy. Respiratory Innovations is testing Breathe Well, an interactive feedback system for facilitating regular patient breathing that enhances the safety of radiotherapy treatment.

First Australian MRI-Linac experimental results in press

16 August 2016

In a major milestone for the Australian MRI-Linac program, and a huge effort by a large team of people, the first experimental results from the phase I (Sonata) prototype have been published. Gary Liney led the work that has been accepted in Med Phys: Technical Note: Experimental results from a prototype high-field inline MRI-Linac.

Real-time adaptive radiotherapy on a standard linac

29 June 2016

In a world first we have brought together clinically for the first time the two experimental real-time technologies, Kilovoltage Intrafraction Monitoring (KIM) and Multileaf Collimator (MLC) tracking. This milestone is important as it demonstrates that real-time adaptation, of finding the target and hitting the target in real-time, can be performed on a standard linear accelerator. A/Prof Ricky O’Brien’s software development has been central to the KIM and MLC-tracking projects and Dr Doan Tran Nguyen has led the programming and experimental validation to get this to the clinical testing stage. Our long-time collaborator, Prof Per Poulsen, has also been central to KIM, MLC tracking and the dose reconstruction tool that we use to estimate the clinical benefit of these technologies. Dr Jeremy Booth has been leading a massive clinical effort from the RNSH team that developed the QA, clinical workflow, fallback strategies and patient safety methods, not to mention the clinician team who entrusted their patient care to this technology.

First lung cancer patient treated with Calypso-guided MLC tracking at RNSH

29 October 2015

In a project 15 plus years in the making, the first lung cancer patient was treated with Calypso-guided MLC tracking at RNSH today. The patient benefited in three ways:

  • First, his planning target volume was 50% smaller than the commonly used ITV method resulting in much lower normal tissue being irradiated.
  • Second, the motion observed during treatment, over 2cm, was more than twice that observed during the 4DCT, potentially leading to an under dose if tracking had not been used.
  • Third, the interplay effect is eliminated with MLC tracking.

This treatment represents a major milestone for the group and for radiation oncology. Many people have contributed to this program over the years and for this study, and key in the current study were Jeremy Booth, Ricky O'Brien, Vincent Caillet and Emma Colvill.

Also, yesterday, the second version of KIM was clinically used yesterday, with the major improvement allowing overlapping markers in the axial plane and thus making KIM more accessible. Ricky O'Brien, Doan Trang Nguyen, Jeremy Booth and Vincent Caillet have been leading this work. And last night, with Per, we tested his board that allows us to lower the x-ray dose which could benefit future KIM patients.

A big day!

Calypso-guided MLC tracking at RNSH

Calypso-guided MLC tracking at RNSH

Prostate Cancer MLC Tracking Trial Treatments Complete!!

27 July 2015

Today was the 858th and final fraction of the 28 patient Calypso-guided MLC tracking study. A huge amount of work over many years by a large number of people, particularly Emma Colvill who has been guiding the clinical study, Ricky O'Brien whose code improvements have driven the safe delivery of the treatments, and Jeremy Booth and the RNSH team with their attitude of ‘let’s make this happen (safely)’. Next up Calypso-guided MLC tracking for lung (LIGHT SABR).

NHMRC Development Grant success for Breathe Well

24 March 2015

CIA Prof Paul Keall has been being successfully awarded an NHMRC Development Grant for Breathe Well: Improving cancer imaging and targeted radiotherapy using audiovisual biofeedback. The Breathe Well Audio Visual (AV) biofeedback device has been developed to assist cancer patients in breathing predictably during a course of radiotherapy. Breathe Well will overcome the deleterious consequences of irregular breathing and improve the therapeutic benefit of cancer imaging and targeted radiotherapy. In the Development Grant, a comprehensive clinical evaluation and technology assessment of the Breathe Well device will be performed in several
trials, with the flagship trial the prospective multi-institutional phase II randomised clinical trial ‘AVIATOR’. Successful completion of this
project will lead to a clinically proven, market-ready device that will be integrated with cancer imaging and targeted radiotherapy systems.

For more info see here

AV Biodfeedback

Figure 1. AV biofeedback system. Display screen and marker block on the abdomen shown. The visual display (centre) as seen by the subject (sans arrows) of the AV biofeedback system shows the guiding wave (white curve) and a marker position (marker block) in real time. The AV biofeedback system is compatible for both imaging (left) and treatment (right) environments.

Cancer Australia grant success times three!

16 December 2014

Researchers Chen-Yu Huang, Ricky O'Brien and Paul Keall have been successful in receiving nearly $1.5M from Cancer Australia and funding partners for the projects:

  • Real-time Six Degree of Freedom Tumour Motion Management in Cancer Radiotherapy. The rationale of this study is to adapt the radiation beam to the moving tumour by dynamically moving the MLC leaves in real time, so that the irradiated healthy tissue (blue area) surrounding the tumour can be greatly reduced by the proposed strategy relative to the current clinical practice. We will develop a real-time six degree of freedom (6 DoF; 3 DoF of translation and 3 DoF of rotation) tumour motion management system.
  • Reducing Thoracic Imaging Dose and Improving Image Quality in Radiotherapy Treatments The aim of this project is to reduce imaging dose, or alternatively improve image quality, in radiotherapy treatment rooms when imaging the thorax or upper abdomen using a technique known as four dimensional cone beam computed tomography. For the same image quality, we expect to reduce imaging dose by at least 50%.
  • SPARK: Stereotactic Prostate Adaptive Radiotherapy Utilising Kilovoltage Intrafraction Monitoring The SPARK trial will measure the cancer targeting accuracy and patient outcomes for 48 patients treated in five sessions as opposed to the conventional 40 sessions, with the reduced number of treatment sessions enabled by the KIM’s increased cancer targeting accuracy.

It's inspiring for the lab that early career researchers Huang and O'Brien were able to receive grants even in this tough funding environment.

Six Degree of Freedom

The ACRF Image-X Institute awared 2.5 million

13 November 2014

The ACRF will support the creation of a new cancer research institute the tune of $2.5M. The ACRF Image-X Institute: Eradicating Cancer through Innovation in Imaging and Targeted X-ray Therapy led by Prof Keall.

The institute will link technological innovation with cancer research and treatment, providing a site and forum where academia, medicine, industry and government can advance the science and clinical practice of cancer treatment. The institute will bring tangible real-world benefit to cancer patients undergoing cancer imaging and treatment procedures, with three interconnected themes.

This new institute will revolutionise cancer imaging, creating new and better cancer imaging methods that will allow more precise delineation of where to target the radiation treatment beams. More advanced cancer imaging will increase cure rates and reduce the human and economic costs of treatment-related side effects.

It will pioneer targeted radiotherapy where the x-ray beams are focused on the most aggressive and resistant cancers, increasing survival and reducing the chance of metastases.

They will enable global access to cancer radiotherapy by developing targeted X-ray radiotherapy systems that address both the high cost and limited availability of this important treatment technology: 135 countries around the world currently don’t have access to appropriate radiotherapy treatment.

See ACRF media release here


LAVA patient 1 recruited

28 October 2014

After much preparation, the first patient was recruited into the LAVA study today at the Chris O'Brien Lifehouse. A screening procedure was performed to determine whether AV biofeedback was more regular than their free breathing. This screening procedure determined that the patient's breathing with AV biofeedback was more regular than free breather, therefore AV biofeedback will be utilised for the remainder of their treatment planning and treatment delivery.

There was a large turnout of both Lifehouse and University of Sydney staff and researchers to be present for this milestone in breathing guidance investigations. A number of studies have shown the benefits of using AV biofeedback to improve breathing motion regularity as well as image quality, however, this is the the first clinical investigation into the use of breathing guidance during a course of liver SBRT planning and treatment utilising an initial screening procedure to ensure the most regular breathing condition for each patient is utilised.

KIM patient 1 treated today

16 September 2014

After 7 years of mathematics, simulations, phantoms, QA and clinical testing, the first patient was treated with kilovoltage intrafraction monitoring (KIM) today at the Royal North Shore Hospital. The prostate cancer patient was treated with conventional fractionation in a dual arc VMAT treatment. The prostate had a posterior shift of near 3mm for most of the treatment but did not trigger a gating event per our >3mm for >5 second threshold. We are analysing the results of today’s treatment for geometric accuracy and dose reconstruction.

A multidisciplinary team of physicists, clinicians, therapists, software developers and industrial advocates have been involved in clinically realising KIM, a ‘world first’ treatment of using a single gantry-mounted imager to measure the 3D prostate position in real-time. It also caps Jin Ng’s PhD thesis, which he is due to submit the final version any day now, and Jin has made enormous contributions to the program since the clinical studies were started at RNSH.

As we have found with MLC tracking, there is a vast difference between working towards clinical implementation and actual clinical implementation as far as our understanding of the potential and limitations of new technology, as well as its perception by our peers. Today marks a real professional highlight, and an achievement we can take great satisfaction in.


The clinical process workflow for Kilovoltage Intrafraction Monitoring gating.

Sean Pollock, PhD student makes the three minute thesis finals

30 August 2014

Sean can talk! Congratulations to PhD student Sean Pollock who made it to the finals of the three-minute thesis competition held on Saturday August 30 during the University's open day. Sean's topic was Breathing Guidance For Cancer Patients: Audiovisual Biofeedback.

The Three Minute Thesis (3MT) is a competition for postgraduate research students to present their research topic to an intelligent, non-specialist audience in an engaging way. Participants had just three minutes to present a compelling presentation on their thesis topic and its significance. It's a great way for students to practice explaining their research to people who are not familiar with the field – skills that will serve them well when applying for funding or engaging media attention.

Sean Pollock

Sean Pollock - Three-minute Thesis finalist

Three-minute Thesis

Three-minute Thesis

For more info, visit the Three-minute Thesis Competition website.

NSW Medical Devices Commercialisation Training Program

26 August 2014

Dr Ilana Feain and Professor Paul Keall have been accepted into the NSW Medical Devices Commercialisation Training Program.

The focus will be on the Nano-X and Audiovisual Biofeedback Program, however the general knowledge transfer will be useful in bridging the gap between research and widespread clinical use for all of our programs.



Drs Fiona Hegi and Jeremy Booth win ASTRO Basic Science Abstract Award

Dr Fiona Hegi

Dr Fiona Hegi

PhD Student Dr Fiona Hegi and Dr Jeremy Booth have won a 2014 ASTRO Basic Science Abstract Award. Dr Hegi won for her abstract, Can 4D-CT ventilation imaging replace Technegas V-SPECT for functionally adaptive radiotherapy? First results, and Dr Booth won for First Clinical Implementation Of Electromagnetic Transponder-guided MLC Tracking. The ASTRO Basic Science Abstract Award recognizes up to 10 basic scientists (lead authors) of abstracts selected for presentation at the 2014 Annual Meeting, in the biology or physics categories. Up to five awards are available in each category. See the full list of awards here

Dr Ricky O'Brien receives CDIP and professional staff career development funding

Ricky O

Ricky O'Brien

5 August 2014

Late last month Dr Ricky O'Brien was awarded a University of Sydney Commercial Development & Industry Partnerships Grant for Improving 4D Cone Beam Computed Tomography Imaging to advance the 4D CBCT project. Plus, this week Ricky was awarded a University of Sydney professional staff career development fund grant to support trips to the AAPM and NKI (Netherlands Cancer Institute, home of van Herk, Sonke and others). Congratulations to Ricky!

4D CBCT Project

4D CBCT Project