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

Visiting masters student Svenja Ipsen second in the Young Investigator’s competition at AAPM

Svenja Ipsen

Svenja Ipsen

22 July 2014

University of Luebeck masters student and Endeavour Award recipient, Svenja Ipsen was awarded second place out of over 300 applications in the Young Investigator’s competition at AAPM today. Svenja excellent presentation titled Radiosurgery Beyond Cancer: Real-time Target Localization and Treatment Planning for Cardiac Radiosurgery under MRI Guidance was one of the conference highlights. Her abstract was also selected as one of four to be given a press release - see the abstract and some media coverage below:


Prof. Paul Keall being interviewed about the project

AAPM Virtual Press Room


Emma Colvill, PhD students awarded highest scoring abstract for EPI2k14

Emma Colvill

Emma Colvill, PhD student

10 June 2014

PhD Student Emma Colvill's abstract titled “Clinical Implementation of MLC Tracking Improves the Agreement Between the Planned and Delivered Doses for Prostate VMAT Treatments” has been awarded a travel grant for the highest scoring abstract submitted to EPI2k14. The EPI organisers in Aarhus, Denmark told Emma that: ‘It is a great pleasure to announce you have been awarded one of the two travel grants for your abstract. The travel grant consists of EUR 1000 + free registration. Since your abstract was the highest scoring it has been selected for oral presentation in the Session “Best abstracts”.’ Emma also received an NTCRU travel grant to attend the EPI meeting.

Enid Eslick, Ph.D., M.Sc. receives her masters degree in Medical Physics

Enid Eslick

Enid Eslick, Ph.D., M.Sc.

30 May 2014

Dr Enid Eslick graduated with her Masters of Science in Medical Physics today. A great balancing act with study, parenthood (including a baby in the middle), work and running a clinical trial. Enid's thesis is titled "Proposed Design and Shielding Requirements of a Compact and Economical Linear Accelerator Treatment System." She completed her Ph.D. in Biophysics in 2010 at the University of Technology, Sydney. Her research project involved using atomic force microscopy to measure and characterise the physical properties of live cells. She commenced working in the Radiation Physics Laboratory in November 2010. Prior to her PhD she has worked as a junior physicist in the Radiation Oncology Department at the Royal Prince Alfred Hospital. She is a member of the American Association of Physicists in Medicine.

Dr Fiona Hegi and Dr Jeremy Booth win ASTRO Basic Science Abstract Awards

Dr Fiona Hegi

Dr Fiona Hegi

Dr Fiona Hegi, based at Nepean Hospital and Dr Jeremy Booth at RNSH won the American Society of Radiation Oncology (ASTRO) Basic Science Abstract Award in the Physics category for their abstracts titled, “Can 4D-CT Ventilation Imaging Replace Technegas V-SPECT For Functionally Adaptive Radiotherapy? First Results”]] and [[“First Clinical Implementation of Electromagnetic Transponder-Guided MLC Tracking.” These awards (Dr Yuanyuan Ge, based at USyd, received one in 2012) are a wonderful validation of the importance of the work the Radiation Physics Laboratory and our collaborators are doing internationally and only given to a tiny fraction of the 1000 plus abstracts submitted to ASTRO.

World first trial to improve prostate cancer care

MLC Tracking

Photo by James Brickwood

28 November 2013

Researchers and clinicians from the University of Sydney and the Northern Sydney Cancer Centre are leading a world first clinical trial using a tracking system to improve prostate cancer radiotherapy treatment.

The multileaf collimator (MLC) tracking system uses the Calypso system, a GPS-like device to track the position of the prostate to continuously target the tumour with sub-millimetre accuracy as it moves during therapy.

A prostate can move up to 1.5 centimetres during a radiation treatment session and in current practice the tumour is positioned before treatment, but this motion is not monitored or corrected for during treatment.

MLC is a computer-controlled device with numerous narrow slats or leaves that can be moved in and out to create apertures of different sizes. This tool is used to shape and reshape the radiotherapy treatment beam during treatment to match the three-dimensional shape of the area being targeted.

In addition to shaping the treatment beam, the MLC responds to signals from a tiny set of transponders implanted into the prostate to follow the tumour as it moves.

The trial's lead clinician Dr Tom Eade said the use of MLC tracking will potentially improve the accuracy of radiation delivery and reduce the impact on surrounding healthy tissue and sensitive structures such as the rectum and bladder.

"Royal North Shore Hospital has a history of implementing some of the most advanced radiotherapy in Australia and this is reflected in our excellent patient outcomes at the Northern Sydney Cancer Centre," he said.

"But today is the first time we will follow the tumour continuously during treatment. This breakthrough may potentially change the paradigm of prostate cancer treatments, opening the opportunity for patients to have their cancer cured with radiation in just 1-2 weeks of treatment with very low side effects," said Dr Eade.

University of Sydney Medical School's Professor Paul Keall said having a radiation beam continuously target the prostate means that the prostate will receive more than 98 per cent of the radiation dose planned.

"We are recording the estimated treatment improvements with MLC tracking, as well as recording the actual patient outcomes.

"Based on prior data we estimate that tumour dose misses, which can be up to 30 per cent in current practice, can be reduced to below two per cent," Professor Keall said.

The revolutionary use of MLC tracking also has the potential to reduce prostate cancer radiation therapy from an eight week program to just five days, as the greater level of accuracy could make it possible to safely deliver higher doses across fewer treatment sessions.

"This shorter treatment course is better for patients and more cost-efficient," Dr Eade said.

About: Prostate cancer is the most common cancer diagnosed in Australia and the third most common cause of cancer death. It is more common in older men, with 85 per cent of cases diagnosed in men over 65 years of age.

The trial is the culmination of a 14-year research project initially started by Professor Keall. It is being supported by Varian Medical Systems to undertake the study at the Northern Sydney Cancer Centre at Royal North Shore Hospital.

Professor Keall said the team hoped the MLC tracking technology could extend to other cancers such as lung, pancreas and liver tumours in the future.

Thirty prostate cancer patients will be the first to benefit from MLC tracking technology during this current clinical trial.

Those interested in participating in the trial can call the Northern Sydney Cancer Centre on 02 9463 1199.

Congratulations to Fiona, Danny, Jin and Emma!

January 4, 2013

The end of 2012 brought with it some great success for the Radiation Physics Lab! Fiona Hegi was one of the successful recipients of the NHMRC Postgraduate Scholarship ($94k), Danny Lee received an APA scholarship offer, Jin-Aun Ng Received a $10k grant for research support for the study “Radiation Beam Gating with Kilovoltage Intrafraction Monitoring for Prostate Radiotherapy: First Clinical Implementation” through the Northern Translational Cancer Research Unit (NTCRU), and Emma Colvill was the recipient of one of the best presenter awards at ‘MedPhys12’, the Student Research Symposium of the ACT/NSW Branch of the ACPSEM. Congratulations to all!