Elekta’s radiation therapy machines are a thing of engineering beauty. Not only does the state-of-the-art tech inside literally save lives, but they also look breathtaking – crisp, white, and futuristic. These LINACs, or linear accelerators, take precision medicine to a new level – all part of Elekta’s strategy to give hope to everybody dealing with cancer. In the US, one in two women and one in three men will develop cancer in their lifetime. Thankfully, we’re better able to fend off cancer now than ever before. Radiation therapy is playing an increasingly important role in the fight against the Big C, with advances in technology allowing us to better target and personalize our care. Our producer George Powell visited Elekta’s HQ in the UK to meet Chris Flint, remote command center lead and part of the remote services team, and Chris Gilpin, director of service and lifecycle marketing.

Elekta is a company focused on precision radiotherapy solutions for the delivery of radiotherapy to cancer patients. We have several different ways of doing that with our different systems. We have external beam radiotherapy, which is delivering radiation from outside the body, inside to the tumor, and we also have internal beam radiotherapy, which is delivering radiotherapy directly into the tumor. At our cornerstone campus in Crawley is our latest linear accelerator called Harmony Pro. This is a system that’s been designed specifically to allow hospitals to treat a higher number of patients, get higher productivity, increased versatility in the way that they’re treating different tumor types and different patients.

The imaging modality we use here to be able to see the tumor is CT-based, just as you’d expect in a diagnostics facility in a hospital. This is what we call a CT Linac. We also have our latest innovation, the MR Linac. This is a new frontier in radiotherapy, which combines a linear accelerator with an MRI scanner. With MRI, we can see greater visualization, especially of soft tissue, so for areas of the body like the prostate, we’re able to see a much higher definition than ever before. MR Linac was something that many years ago people thought was impossible; to combine a magnet, where you get a magnetic field, with radiotherapy, with a radiation beam. Our engineers have been able to combine the two things, which really changes the game in terms of how we can deliver radiotherapy to cancer patients.

The Elekta Unity System is a combination of the linear accelerator plus the MR device and is the first and only high-field MRI LINAC on the market with a 1.5 Tesla magnet, which is what you’d see in a diagnostic imaging department. This is really a game changer in the field, as you’re able to see so much more than you ever could before. The goal of radiotherapy is twofold: deliver as much radiation to the tumor as possible, and as little radiation to the healthy tissue and organs at risk. How we do that is twofold: we want to be able to shape the radiation beam specifically to the tumor size, which is done through a combination of hardware and software, and we also want to be able to see what we’re treating. Our two modalities of CT imaging, and also MR – MR being the gold standard – allows us to better do that so we can better shape the radiation to the tumor and avoid as much healthy tissue as possible.

One of our key strategies at Elekta right now is Access 25, which is all about helping facilities around the world to get better access to cancer care. The World Health Organization estimates that new cancer cases will grow from 18 million in 2020 to 28 million new cases by 2040, so we’re seeing cancer cases rising in every single part of the world. What we’re also seeing is a shortage of linear accelerators – an estimated gap of around a 15,000 in the number of LINACs needed worldwide. With 50-60% of cancer patients requiring radiotherapy as part of their treatment, this means that some countries or regions around the world are underserved. One of our drivers right now is how do we provide better access to care for these regions that need it more. We do that through our portfolio of different levels of product. Our entry level products allow centers to get up and running, maybe they’re starting a new radiotherapy programme, so this is one of our key drivers.

One of the things that we have to bear in mind in more remote parts of the world is how to service and maintain those machines – especially in areas where maybe there isn’t a workforce or the expertise. This is where tools like IntelliMax® become really important. We can monitor these machines from a central location, we can see what’s happening, and we can predict there’s going to be any downtime. We can also predict if something’s going to happen that could potentially be an issue for that customer. Unity is a brand-new innovation, brand new technology, so there’s a lot of unknowns. IntelliMax® collects data from those systems to understand some of the pain points for interruptions – or terminations, as we call them to our customers. This goes back through engineering and fixing some of those underlying issues through product releases. We can then see over time how the reliability of these machines has improved, and we have the data to prove it.

One of the most amazing things about IntelliMax® is that we can resolve more than 30% of product issues remotely now using remote assistance, which avoids around two hours of clinical downtime per predictive occurrence. With 80% of our install base connected to IntelliMax®, this has a massive impact on our ability to service systems and avoid downtime.

Our factory in Crawley manufactures the linear accelerator. The production flow line for the main linear accelerator is where the large parts all come together. As we progress further down the assembly line, the parts are fitted before the machine comes to the final stage, where the machine is complete, and it goes through basic checks. Once this is complete, it goes into one of the test bays along the back of the factory where we do all of the pre-tests. This where we power up the machine for the first time, so it can be quite noisy. The machine shop is where we machine the copper cells for the wave guides, and we have an Agility test area. The multileaf collimator shapes the beam before it reaches the patient. We have 160 tungsten leaves which can move independently to create the shape that is required for us to treat the specific size and shape of the tumor in the patient.

The copper cells get raised into a long tube, where at one end we inject and accelerate electrons down the length of the waveguide, close to the speed of light. Those electrons are focused and directed to a tungsten source where photons are produced – those photons are the radiation. It’s producing photons in all directions so there’s a lot of lead and tungsten shielding to prevent the radiation going where we don’t want it to go. There’s a bank on each side with 80 leaves on each side to shield all of that apart from where we want it to come out. That is what the multileaf collimator does. It opens or closes a shape to allow photons to pass through. It’s almost like theatre lights, where you can direct the beam of light with flaps at the side. Every LINAC we produce will have one of these heads on them, but we also sell them as upgrades for machines which have older-style heads. It’s a very versatile head to treat multiple targets and different tumor types.

You can see from the intricacies of the machine that it’s really important that we have service contracts with customers. This is really where the IntelliMax® piece comes in. It allows us to remotely monitor what’s happening with the system. The agility head is probably one of the areas where we get most of our data items from. There are seven or eight different components where we raise predictive maintenance cases on based on the data that we get out of the devices around the world, which allows us to keep hospitals up and running longer. The worst thing that can happen in a hospital is for the linear accelerator to go down. A lot of hospitals are under huge stress to treat an increasing number of patients, so tools like IntelliMax® allow us to see in advance if something’s going to go wrong, or if we need to get in there and check the system so that we can maintain uptime as much as possible and avoid any missed patient treatments, which we want to avoid.

ThingWorx

Because they’re dealing with major life-threatening illnesses, Elekta’s IntelliMax® system is vital in allowing them to respond rapidly to issues and communicate quickly with their customers so treatments go uninterrupted. IntelliMax® runs on PTC’s Internet of Things platform ThingWorx, which allows customers to connect to devices that are placed in very remote areas of the field. By being connected to those devices, it means the product can report back to the engineers and service professionals, making them aware of the health status of that equipment and allowing customers to predict service offerings. By using ThingWorx, Elekta is able to remotely monitor devices across all the hospital settings where those devices are deployed and ensure that the health of those devices is performing as expected – and in many cases get ahead of and predict where issues might have otherwise occurred, resolving those issues before they become interruptions in the hospital setting.

For Elekta, this level of service distinguishes them from other competitors who are offering similar products because they’re able to guarantee their customers this high degree of availability – which, in this case, the customer being a hospital, is then able to embed into a much more predictable and more effective service to their patients. By remotely monitoring and connecting to this equipment, Elekta were able to identify 600 preventative actions that were carried out in the first year alone, meaning it avoided interruption of treatments to more than 14,000 patients. Elekta has joined a large list of PTC customers who’ve become more and more service oriented.

If you take a look at what’s happening in the service industry today, there is a major transformation going on. Not so long ago, most service was delivered as a break-fix model. Through being connected to these devices, much of the service Elekta delivers is done remotely, avoiding expensive truck rolls, and more importantly for their customers, avoiding critical downtime that would severely impact the hospital – and its patients. In fact, 20% of service issues identified are resolved without dispatching a technician. But it doesn’t stop there. We’re seeing a transformation of the service delivery process that is ultimately thinking about product as a service. Not just selling a customer a product and maintaining that product, but dialing in on what their customers care most about – the outcome. We’re seeing a transformation from the old break-fix model to something much more efficient and effective.

Thanks to Howard, and to Chris, Chris and Mark for giving us a glimpse behind the scenes at Elekta.

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This is an 18Sixty production for PTC. Executive producer is Jacqui Cook. Sound design and editing by Ollie Guillou. Location recording by George Powell. And music by Rowan Bishop.