Cutting edge collaboration creates world leaders in radiation treatment

Dr. James Robar
Dr. James Robar, Nova Scotia Health Chief of Medical Physics, Dalhousie University Faculty of Medicine, Director of MSc and PhD Medical Physics

Innovation in health care can take the form of a giant leap, a series of small refinements or a combination of the two. But innovation is always the product of collaboration and strong relationships and in this case, was helped along by a chance meeting in the hallway of a conference facility in Vienna. 

Radiation oncology profiles its world-class leader and their focus of research and development (R&D) 

In 2018, Dr. James Robar, Chief of Medical Physics, Nova Scotia Health and Director of MSc and PhD Medical Physics program at Dalhousie University, was on the selection committee to find a new head of Radiation Oncology at Dalhousie University’s Faculty of Medicine. He was pleased to see Dr. Jean-Philippe Pignol’s name on the list, having read and respected his work on nanoparticle-aided radiotherapy. 

That same year, Dr. Robar attended a medical convention in Vienna. In a chance encounter he ran into Dr. Pignol between sessions. They recognized each other immediately. 

“We spent a lot of time talking about R&D, about the fertile ground for medical R&D that had been created in Halifax by Dalhousie and Nova Scotia Health, and about how important it is to create a conduit for ideas and developments to reach patients – we were both very much interested in industry engagement.” And in that, a relationship was formed. Dr. Pignol was appointed as Chair of Radiation Oncology at Dalhousie and Head of Radiotherapy at the QEII Health Sciences Centre in Winter 2018. 

According to Dr. Drew Bethune, QEII surgical oncologist and senior medical director of the Provincial Cancer Program, “Nova Scotia was attractive to Dr. Pignol for various reasons. Our radiotherapy team was well formed. We’ve got 12 PhD medical physicists here in Halifax who have been doing brilliant world-class research, inventing technology that is used around the world.” 

Dr. Pignol came to Halifax from the Netherlands, a wealthy country with state-of-the-art radiation oncology equipment, including two Cyberknife units and a proton accelerator. The insurmountable cost of this equipment would be too much for Nova Scotia to bare, so he began to think of creative solutions to build on the strengths of the medical physics team. “What’s our future, where do we go? We don’t have the capital that bigger centers and cities have, but people are talented and have the imagination to do great things. It’s very impressive.” 

Using new techniques to deliver cutting edge care

The physics group in Halifax had invented a new way of doing radiotherapy, called trajectory-based radiotherapy. It is a three dimensional way of programming radio therapy machines to be very precise. 

According to Dr. Bethune, “With this technique, it’s not about creating the beam, it’s about aiming it. They’re smart beams that let you avoid critical structures.” 

Dr. Robar explained, “Think about a tumor inside the body surrounded by a lot of organs at risk. Imagine a very complex path of that beam which is continuous, and continually avoids all of the healthy structures around it. This allows us to pick some very intelligent treatment plans that minimize the intersection of radiation beams with all of the healthy tissues. And in our medical physics group, we have spent years developing algorithms that do just that.” 

The other major benefit, according to Dr. Robar, is that it’s efficient. Radiation therapy is fractionated, meaning patients need to return to hospital for treatment every day for a period of time. “For prostate cancer, for example, the typical number of daily fractions is 20.

With this technology, the data suggests we can reduce the number of fractions to 4 or 5.” The implications for patients and improving access to care are significant said Dr. Pignol, “This will let patients go back to their normal lives without side effects the next day.” 

Introducing Cyberknife technology 

Dr. Pignol witnessed the cutting edge work of Dr. Robar’s team of medical physicists and radiation oncologists and suggested taking it one step further. 

His idea was to combine two pieces of existing technology into one treatment unit, specifically to pair the flexibility and precision of Cyberknife with an MRI scanner. 

Cyberknife is typically used in tandem with a CT scanner for image guidance. CT scans show bone and muscle, not soft tissue. “If we want to be more precise in defining the target requiring radiation treatment, MRI is the best option. MRI has superior soft tissue contrast so you can see nodes and sequences” 

“We could have a Cyberknife alone, and that would be beneficial for patients. We could have an MRI alone, also beneficial for patients. But combining the two will make us unique. Add on trajectory-based technology, and we will be world leaders in radiation treatment.”

Initiating a path for commercialization

In addition to the patient benefits, Dr. Robar believes the real value of this work will be found in industrial engagement and collaboration. “If you don’t commercialize, the likelihood of these ideas becoming reality worldwide is very low.” 

Nova Scotia Health department of medical physics has filed and licensed many patents on their innovative work with the help of Doris Grant, Senior Director of Innovation at the organization. 

Dr. Robar has great confidence in her leadership and ability to move their ideas forward. ”I have the utmost confidence in the support and leaders at Nova Scotia Health to help us bring this to fruition and deliver value to Nova Scotians.” 

Dr. Pignol shared this confidence as the profile of this work builds. “Nova Scotia is incredibly creative. There are huge opportunities here for innovation, partnership, excellence. Our idea – to combine Cyberknife with trajectory-based delivery and MRI technology – is a good example of that, a small concept that will have a big, transformative impact.”

This article was originally published in Nova Scotia Health Research and Innovation annual report 2020 (pdf)