The Peter MacCallum Cancer Centre in Melbourne, Australia is the country’s top facility for cancer treatment, research and education. Seeing over 30,000 cancer patients every year, Peter Mac is always searching for new ways to improve patient experiences and outcomes, and innovating to get better results from its treatment technologies. How they found a way to improve the delivery of radiation therapy for breast cancer - the most commonly encountered condition at the hospital - is a perfect example of this.
“We needed a way to get a video signal from the radiotherapist in the control room to a patient lying on a treatment couch,” said David Lapthorne, a Radiation Engineer at Peter Mac. “This helps the radiotherapists, doctors and patients be on the same page and makes the results significantly better.”
The Usual Treatment
Treatment for breast cancer involves a multitude of steps, but one of the most crucial is radiation therapy. Precisely targeted doses of radiation are highly effective at destroying cancer cells in the body, and are used to kill off tumors or lingering cancer cells after surgery.
At Peter Mac, this is done by having a patient lie under a linear accelerator machine, where a radiotherapist in a control room operates the machine remotely and applies targeted doses of radiation to the breast tumor. Because of the way internal organs move slightly when breathing, the best way for the doctor to apply treatment is to have patients use a method called Deep Inspiration Breath Holding (DIBH), which elevates the tumor to a more exposed and advantageous position, allowing for more precise dosage applications.
“As they breathe, the camera system measures chest height and breathing cycle which gets shown on the console display. The radiotherapist then tries to synchronize it so chest height and tumor would be in the same spot every time a dose is applied,” explained Mr Lapthorne.
This presented a problem though. While the doctor and radiotherapist could see the patient’s breathing pattern through the integrated display, the patient was left in the dark as to how much she should inhale and when to hold. The only way to collaborate was for the radiotherapist to give the patient commands through an intercom system, which resulted in a bit of a guessing game between them. Sometimes the patient inhaled too much and sometimes too little.
More Precisely On Target
This issue helped Mr. Lapthorne and the Radiotherapy department come up with an innovative solution. Instead of having just the radiotherapist monitoring the display alone, they wanted to give the patient access to it as well. This would allow the patient to control her own breathing accordingly and make destroying the tumor a much more collaborative effort.
To do this, Mr. Lapthorne decided to integrate a wireless video link into their radiotherapy room. “We originally went with a wired system, but found that in this hospital setting where a lot of older people visit, the wires were too much of a hazard to keep around. We scrapped that and went with a wireless feed instead.”
To get the display from the control room to the patient in the radiotherapy room, the department started by using a DVI splitter amplifier which split the display graph (DVI output) from the Truebeam into 2 separate DVI feeds. One DVI is fed back to the Truebeam’s computer monitor while the other was converted to HDMI and fed into a Teradek Cube 255.
Mr. Lapthorne set the Cube into Access Point (AP) mode, a feature which allows it to broadcast its own wireless network for video distribution. Two iPad mini’s, both connected to the Cube’s wireless network, were distributed: one iPad mini was given to the radiotherapist and another mounted to a stand which held it above the patient’s bed.
These iPads used Teradek’s Teraview iOS app, which automatically pulled the Cube’s display graph feeding in from the control room 5 meters away. With just milliseconds of latency, the patients are seeing a near-live feed of their breathing measurements, while the radiotherapist could see the same feed and be on the same page as the patient.
Peter Mac’s new iPad monitoring system has given the hospital a way for the patient and radiotherapist to work together to ensure the tumor is more precisely targeted. Using the iPad screen above them, patients on the treatment couch are now able to know exactly how much to inhale and when to hold their breath. This allows the radiotherapist to administer beams with much greater accuracy, increasing the amount of cancer cells destroyed and reducing overall procedure time.
But more importantly, this also reduces the amount of surrounding healthy cells that are destroyed in the process, which is especially important in the treatment of breast cancer. According to a study published by the Journal of Medical Radiation Sciences, radiation therapy in the left breast can destroy healthy cells in the heart, which can result in major long-term cardiac complications. When the patients can better utilize DIBH, this reduces the amount of healthy cell casualties around the heart.
After several months of implementing the Cube and seeing 5-10 patients a day with it, it’s become an essential part of Peter Mac’s breast cancer clinical process.
“The whole purpose is to create a faster and more effective clinical process for our patients,” said Mr. Lapthorne. “Here at Peter Mac, we know the routines and procedures can be a daunting experience. That’s why we decided to incorporate Teradek technology which gives our patients more insight into their treatment and helps make their whole visit as seamless as possible.”
While using wireless video for cancer treatment is certainly unconventional, it’s provided the Peter Mac Cancer Centre with an ingenious solution to their clinical needs, resulting in healthier and happier patients. In a situation where every step of the process is critical to one’s short-term and long-term well-being, having such reliable and robust technology gives doctors and radiotherapists the confidence that they’re delivering the best treatment they can, and patients the reassurance that their conditions are being tackled with the latest and greatest in healthcare tech.