Hello, and welcome to the Physics World Weekly
podcast.
This episode
explores how the concept of humanitarian
engineering
can be used to provide
high quality cancer care to people in low
and middle income countries
around the world.
Our guests are 2 medical physicists
from the University of Washington in the US,
and they've contributed to the ebook
Humanitarian
Engineering
for Global Oncology.
Here they are in conversation with Physics World's
Tammy Freeman.
Cancer is increasing in prevalence around the globe
with reports estimating that by 2030,
more than 2 thirds of cancer related deaths
will occur in low and middle middle income
countries.
As such, it becomes more important than ever
to develop affordable,
sustainable technologies for cancer care.
One way to address this emerging
need is via humanitarian
engineering,
a method that focuses on projects that are
affordable,
sustainable, and based on local resources.
This approach forms the central theme of a
newly published ebook
entitled
Humanitarian
Engineering for Global Oncology.
In this text, a series of contributing authors
take a look at various ways to address
the worldwide need for access to quality cancer
care with a particular focus on radiation therapy.
I'm joined today by the book's editor, Eric
Ford,
professor and director of physics at the University
of Washington,
and coauthor,
Aphiya York, a medical physicist at the University
of Washington's Department of Radiation Oncology.
Welcome to the podcast, Eric and Thea.
Yeah. Thank you, Tammy. It's nice to be
here. Thank you. First of all, I wondered
if you could provide a quick overview of
what's meant by the concept of humanitarian
engineering.
Sure. I guess I can start. I,
humanitarian engineering, I think,
one simple way to think about it is
that it's
a kind of a look at technology, but
putting the person or the patient at the
center.
And so that kinda changes the way that
you develop
do development. Right?
And that especially is important for,
you know, the marginalized
and underserved
and,
in the anywhere in the in the world,
but especially globally
where on a global scale, there's some acute
needs
for health care, especially in low and middle
income countries.
So I think that's probably, like, the simple
definition that I would use.
Yeah.
I I agree with Eric.
And and, you know, like Eric mentioned, these
are, like, community, you know, centered designs, like,
you know, technologies
that have been designed with, you know, like,
underserved communities in mind.
And when you read this book, you would
see a recurring theme, like, in the book
where almost everything that we're talking about has
to do with affordability.
Right? Like, how can these technologies that are
being designed be afforded by,
you know, communities
or, you know, countries or environments
that might otherwise not be able to, you
know, like, purchase them or afford them. And
and it requires,
you know, we're physicists here talking about, like,
humanitarian
engineering,
you know, in global health. So, you know,
obviously, it requires, like, a cross disciplinary
approach, you know,
bringing in, you know, some, you know, economic,
approaches, you know, engineering approach, physics in in
our context,
and public health initiatives
to solve, you know,
issues that, you know, better serve these individuals
in in in underserved communities. Yeah.
Much of the book focuses on radiotherapy,
which is one of the central components of
cancer care.
Now delivering radiation usually requires large complex systems
such as linear accelerators or linacs.
Is access to these systems a problem in
resource limited settings?
It is. It is a very huge concern,
and this has been the, you know,
one of the,
largest conversations
in our field in radiation, you know, therapy
when we talk about,
global radiotherapy,
one of the things that we talk about
is how can we increase the access to
linear accelerators,
this radiation delivering
equipment to these individuals. When you go to
the
IAEA, the International Atomic Energy Agency, you know,
website,
they have a database called the direct database,
which is a directory of, radiotherapy
centers.
And it looks at all these, like, countries
and how many radiotherapy equipment
are in these countries and the distribution. And,
clearly,
when you look at that map, you can
see a very faint, you know,
map for
low and middle income countries. So this is
a clear, you know, issue,
in LMICs.
And,
again, whenever people come back to the table
to talk about, you know, access to radiotherapy
care, most of the conversations start from there.
How can we improve the number of machines
in this area so that patients who have
cancers in this environment
can have access to radiotherapy?
Yeah. I think the other thing that we
should
think about at the beginning of
the discussion about this is to, you know,
like you said, Tammy, the book focuses a
lot on radiation therapy, but there's there's other
things in the book as well, surgery, diagnostic
essays, and other things, AI, advanced imaging.
But, you know, what why is radiation
therapy so important, you know, when you think
about humanitarian engineering? It's it's really because it's
one of the major pillars
of
what is used
for cancer care of patients. Right? You know,
roughly half of patients
should
get radiation therapy, but for you know, often
for curative intent. But like Afiya said,
you know, there's a huge gap in terms
of what the access is there across the
globe.
You know, and it's also very cost effective
when it's done. If you think about like,
you know, for example,
a breast cancer patient who,
has treatment after
surgery, for example. I mean, the part
of that treatment is really key to her
achieving
cure and from the disease. It it's, you
know, it's gonna be much less likely. The
outcome is gonna be much usually, in many
cases, much worse if the full treatment isn't
available. Right? Or head and neck cancer patient.
Right? That's somebody
who often can be treated with curative intent
with a radiation therapy approach
that preserves the voice, preserves swallowing,
can preserve
taste, and, you know, and that preserves nutritional
status, which then means the patient doesn't suffer
from nutritional problems later. Right? So there's many
downstream effects and many,
cost savings to the healthcare system and to
people as well. Right? Because these treatments can
be very financially
toxic to patients.
And so we wanna do it the right
way with really low toxicities, but you have
to have all the tools
in your tool belt in order to be
able to do it the right way. And
this that's the
reason that the gap is so important to
address. Yeah. So, I mean, how how can
the manufacturers
help address this disparity in resources?
Are they
working to design
lower cost, more efficient
systems?
Yeah.
So we've addressed some of these, like, in
the book. One of those, with them is
the Halcyon,
which,
is designed by one of the radiation,
equipment manufacturers.
The Halcyon
increases, you know, the throughput,
so you can treat patients, like, in less
than 10 minutes, which is half the time
that you will treat patients with
the current, you know,
linox, which are CR Linox,
that is mostly used by a lot of
us, like, in in our hospitals.
And
given,
like, you know, Eric Eric mentioned,
because there's lack of, you know, radiotherapy
machines in low and middle income countries. You
have a lot of people waiting in line
to be treated, you know, on on the
available CRM Linacs.
So machines like the Halcyon, which increases, you
know, the throughput, reduces the time that you
can get patients through the machine, helps clears
these, like, backlogs or waiting times that, you
know, are in these areas.
And, also, you know, other people are manufacturing
the upright, you know, radiotherapy,
systems where the patient sits and it's slowly
rotated around a fixed, you know,
beam machine. And so,
these, you know, are very compact
in nature.
You need very little,
shielding, which can be a cost, you know,
an upfront cost when you're designing
radiotherapy,
rooms,
and you need very little bunkers
because you don't need a big room
to install,
you know,
these
machines. And so you have people addressing them,
and and I'll let doctor Ford, you know,
take the other,
technologies,
you know, in the space.
Yeah. I mean, I think that's a really
good example of
humanitarian engineering in action. You know? It's the
system that Afiya mentioned. That was
you know, I I guess for people who
don't know these,
radiation therapy machines, they're linear accelerators. You know?
They typically operate up to 6 megawatts,
you know, high energy, high output.
You know, they date back to 19 fifties.
Right? So the technology has been around for
a long time.
Yeah. But, this one was a redesign, and
it was it was,
introduced in the commercial market in in 2017,
but just sort of rethinking it. So, like,
you know, in a in a normal machine,
if you let the user pick, like, say
let's say, 6 different energies to treat with.
Right? In In this one, you don't do
that. You just give them one energy.
And and you'd, like, just simplify everything, make
it simple, make it robust to different users.
And I think the other interesting thing about
that example is
that,
it's sort of a good example of what,
what I what you hear people call bidirectional
learning. So in other words,
you know,
we learn from,
say, a country in,
East Africa and the country in East Africa
learns
from us,
like, back and forth learning. Because what, you
know, what happened with that system was it
was in designed with the intention to be
robust and, you know, rugged and very, you
know, harsh environments around the world. But then
what what people found was that there was
a huge demand for it in
in the US and in Europe, in places
that have a lot of resources because it
just you know, like, a a few was
mentioning, like, the throughput is so much better.
You treat somebody in in 10 minutes, get
them through, you know, and and it just
all sure works works. So it was kind
of like a win win kinda scenario, which
A very good example of that. Yeah. It's
just very
satisfying to see that. Right? Like, where everybody
is benefiting the whole, you know, around the
world.
Absolutely.
Have one here.
We have one in our clinic. Yeah. Yeah.
Yeah. Right. We do. Yeah. Yeah. That's it's
an interesting thing because if you,
you know, if you go around the world
and you say, okay. Like, here's some technology
that you could use in your in your
clinic. It's low cost. The first question is
gonna be, do do you use that in
your clinic? Yeah.
If not, why not? It's a great question.
Right? I mean,
like,
why yeah. Because
the the motivation behind that question is we
wanna deliver high quality care, world class care,
care that's delivered in premier centers
Yeah. For the benefit of our patients.
So,
you know, we wanna make sure we can
do that. And is it so you have
to be able to answer in the positive
to that question. Right? Exactly.
And and to add to what Eric said,
like, if you go tell somebody that this
is so good, the questions, if it's that
good, why are you not using it? Right?
And if you you use it, you can
speak better to it, and and we do.
We have it here. We see the advantages
of that, you know,
system and,
yeah.
Excellent. So this is basically manufacturers
developing
lower cost,
easier to use, maybe lower maintenance systems that,
you know, more people can get hold of
and use.
Yeah. Yeah. And they're you know, honestly, they're
not you know, the force the market forces
don't always drive things in that direction. Right?
And I think that's one of the reasons
why a book like this is important is
to sort of, you know, shed some light
on what the different
aspects
of the problem are and help people understand
it. Because, you know, the market forces will
will sometimes just
push the solution organically into,
whatever, like, a local minimum, so to speak,
right, where it's like it works in an
environment like,
you know, New York City or,
you know, Paris, but, like, you know, does
it work in Kampala?
You know?
It's a it's a good example.
Okay. So this is, we're talking about external
radiotherapy here, but but there's another type, which
is brachytherapy.
Does this treatment can you offer this with
sort of lower expenses and running costs than
external beam radiotherapy?
Yeah. The capital is lower. The capital outlay
is lower.
So that and it's, you know, probably about
a third of what it costs to,
to, you know, put in a external beam
therapy machine. I'm talking about the X-ray machines.
If we talk about protons, then we need
to have a whole another discussion about coughs.
Sure. A lot more expensive. But,
anyway, yeah, it's May 3rd. Like, also the
radiation shielding, like, Afiya was mentioning before the
shielding their shielding needs, you have to build
concrete walls around your around your machine so
people are safe. So
that's less of a con a concern because
you can make it thinner because the energies
are lower. Right?
So, yeah, all of those are lower expenses.
But,
you know, having said that, there are other
things that are more complicated. So you have
ongoing expenses
where you have to these are radioactive sources,
the high specific activity sources, typically uranium 192.
And if you use uranium 192, it has
to be changed out every 3 months. Right?
Mhmm. Yeah.
So so okay. So here here's actually another
good example of
the systems engineering human
humanitarian engineering kind of approach, which is that
could we use a different type of radioactive
source? Right? Uranium 1 92 developed for historical
reasons. It was sort of a replacement for
radium back in the day. And
but, you know, it's not the only solution.
It's a very good good choice because it
has a very high specific activity, meaning you
can make a very small source that you
can introduce them into a catheter inside the
patient.
Typically, these are used for gynecological treatments as
one of the major
treatments for cervical cancer, which is a major
women's health issue.
But could you could you redesign it? So
so people did. They redesigned it with a
cobalt source, a cobalt 60 source,
and that has a half life of 5
years. So you don't have to replace the
sources often, which obviously has many advantages if
you, you know, practical advantages.
So, you know, these cobalt sources are not
common in the US or Europe. It's typically
still iridium, but,
you know, the the symmetry is fairly similar.
I don't know. We should pro we probably
also should talk about staffing when we talk
about
brachytherapy
because
it's a lot more complicated.
Right? Yeah.
Training the staff to, you know, do the
procedures for the brachytherapy,
the the brachytherapy procedures. And that takes us
into, like, a space where we start talking
about the unavailability
of these, you know, staff in in in
underserved, you know, environmental resources.
And I think it's a very good segue
to, you know, like, why AI could be
very useful in this space
where, you know, you can train individuals, like,
remotely on how to, you know, perform these
breaky procedures
without putting them in the environment of, you
know, these complex, you know,
equipment or or devices.
One thing Eric made such an excellent point.
I feel like I don't have anything to
add, but one thing that I wanted to
add to, you know,
his point was comparatively.
Right? He talks about the upfront cost and
the cost of operating the brachytherapy,
you know, devices.
But, also,
it's less, you know, costly to maintain those
equipments
compared to the external beam, you know, devices,
which are very, you know, heavy machinery,
have so many moving packs, you know, which
can be, you know, much more expensive. And,
also, you know, if you set up your
brachytherapy,
program
very well,
you you,
the sessions for brachytherapy are very minimal. It's
like 5 sessions, 3 sessions, sometimes 1, unlike
your external beam, you know, treatments, which can
go for weeks and patients have to come
in, you know, like, every day. So that's
some of the contrast there between, you know,
the brachytherapy
procedures and, you know, the external beam, which
tends to have some advantages for patient who
have to travel hours on end to get
to the nearest radiotherapy
centers.
Yeah. It's,
I think that's a really good point. It's,
very practical, very usable in an environment like
that because they're very short course treatments. Right?
And it's very necessary. Like, if you if
you if you don't do the brachytherapy
part of it,
the cure rates are much lower. And we
know that there's very solid data on that.
So, you know, it's
and, you know, I mean,
just the control of cervical cancer is like
a it's it's a major public health issue
in
a lot of parts of the world,
especially,
outside of,
you know, the high human development index countries,
like,
over 90% of,
cervical cancer cases are
diagnosed in low and middle income countries.
So be and it's because of the screening
patterns. Right? So this is a failure
of the public health system,
that because
vaccines and screening work. Right? That's why there's
not that much cervical cancer
Yeah. Problem in in, like, the US, for
example. But,
you know, it needs to be addressed,
and this is a practical
way to do it. It it's, you know,
relatively low
cost technology,
but, you know, you just, you got, you
got to kind of
be organized about it and have it in
place. And,
Yeah. And and so it sounds like,
brachytherapy
and external beam perhaps,
will be used for treating different types of
cancer.
Yeah. I mean, it it it's cut I
mean, partly clinical, partly practical. So
the thing is in brachytherapy, you can introduce,
an, you know, an an applicator. So like
a
basically a little holder for the reactive source
that puts it exactly where you need, like,
into the cavity of a patient. Right? So
and that the you know, so it's just
like in cervical cancer, that's something you can
do. Right? Or prostate cancer can be treated.
Early stage prostate cancer can be treated with
needles inserted into the prostate. But, you know,
not all cancers are
accessible that way. Like, if you think about
a cancer in the lung, it's gonna be
very hard for you to introduce a needle
into the lung in a way that's gonna
be safe for a patient. Right? And people
have done it, but it's very it it's
very, very challenging. There's Yeah. Limitations to what
you can safely do. And this is one
of the things is you wanna do
this in a way that's noninvasive
and is safe for the patient.
A lot of times,
there's not great access to surgery. That's one
of the other major hurdles in in in
areas of the world. There's a chapter in
the book about that, about surgery,
the issues around that. But,
yeah. So it's sort of just a combination
of the clinical need and the practical
applicability of what can be done with brachytherapy.
Okay.
So we've talked about advances in hardware, but
how could things like artificial intelligence
improve access to high quality treatments?
AI is, you know, like,
rapidly, like, gaining a lot of, like I
I think at this point, it's gained a
lot of momentum, like, around us and everything
that we do.
In in in radiation therapy,
especially when you look at the benefits of
AI for,
low resource environment, which clearly we've seen that
things that are designed for those environment tends
to benefit everybody.
You look at, like, how
rapidly we can create radiotherapy treatment plans that
are very specific
to, you know, patients that are undergoing,
radiation treatment.
AI can help, you know, create very precise
plans, that, you know, can be done at
a much faster rate. Hence, we can create
more plans that can, you know, treat more
patients.
In in doctor Ford's, like, you know, field
of expertise, which is very quality and safety,
AI can help, you know, for for for
us as medical physicists when the treatment plants
are created,
we have to check, you know, the plans
for equality, the beam the machine,
you know, beam parameters, and other things. If
you have a very good AI tool, it
can help, you know, check the quality of
the treatment plan and even look at, you
know, if there are any, like, missing, you
know,
parameters
that, you know, were not included, like, in
the treatment.
And this could be a very good safety
check before, you know, the plants end up,
you know, on patients.
So, you look at, you know, all the
things that we do as physicists, for example,
like image, you know,
guidance where we have to do, like, imaging,
you know, for precise
radiation targeting for patient.
AI tools can help, you know, take images
rapidly, look at you know, analyze those images,
and look at patients set up to reduce,
like, setup uncertainty.
So,
you look at how much it can help
in our field of practice, and
it it it it it helps, like, increase
access to a lot of people because if
you don't have, you know, planners or you
don't you have, like, you're less you're understaffed.
If you have AI tools and you know
how to use them, how to troubleshoot them,
I think it helps a lot to reduce
this global burden in, you know, staffing or
even machine authority. Yeah. I think that's a
really important point is, like, there's this gap,
the gap in technology that we've talked about,
but there's also a gap in
in in staff and train you know, how
like, staff that are trained to
operate, you know, in an environment like this
and know all the ins and outs of
what, you know, a cancer care practices
needs. Right? And
we know that. There's a study that came
out in The Lancet this year,
Zhu et al. And
they made some estimates of staffing shortages in
in in the field of oncology and radiation
oncology specifically.
And they said basically
in all the different professional groups that are
involved, so this is the doctors, the
the people who deliver the the care of
their Asian therapists, the medical phys basically, there
there had to be a 70%
growth of people.
Like, so, you know, 1.7 times as many
people over the next,
basically
less than 20 years.
So and and and we also know that
that's an underestimate.
So, like,
you know, that in the context where right
now, we're
just really swimming to kinda keep our head
heads just above water. I mean, even honestly
in the in the United States.
So,
and, you know, huge growths in East Asia,
China, India, Japan.
So there's just this huge gap that probably
is gonna be nearly impossible to to close
in any any foreseeable way in in the
next less than 20 years.
So so yeah. So this is where some
of these tools can really help. Like, a
few of us saying, I think,
you know, it it's it targets efficiency.
It also targets the quality of care of
what we're what we're doing, like,
in a way that can be very beneficial.
There's a chapter in the book about,
about
automatic treatment planning, which is one of the
the things we just talk about. So,
you know, and I think that's a great
example. It's this this group at MD Anderson,
Lawrence Court is the PI,
and,
they're they've developed a tool called the radiation
planning assistant.
Yep. And so and and it's now FDA
approved and being used in clinics,
including at MD Anderson.
And and, basically, you know, the idea is
you just it's it's AI
tools under the hood
that essentially you know, like, from the user's
point of view, you click the button and
a a plan is made. Whereas previously, that
would take, you know, many hours of some
highly skilled person doing that work. Yeah. Right?
So it's there and it's working and, you
know, it and so I think it's really
gonna
change the way that care is done.
Yeah. And and to add the cherry on
top, Eric is right. That's chapter 3, by
the way, for those who didn't be listening
to the
I I I just felt like I had
to add that to it.
Then to add to Eric's point, you know,
this,
aggregation plan assistant
has been used in South Africa.
You know, and,
you would be, like, for to to treat,
like, cervical cancer,
which in our, you know, part of the
world, and when I sell part of the
world here in North America and, you know,
in high income countries, we don't do 4
field boxes in that. These are very simple,
you know, plans.
It's a huge improvement.
Right? It's like this was done on a
4 field box of a colon cancer, you
know, patient and and and done seamlessly.
Right? And that's a a typical example of
how these, like, engineering
devices
that are
designed to help, you know, environment
that,
you know, are are less resourced and understaffed.
And for somebody who's listened, it's like, oh,
but South Africa is, you know, very advanced
compared to a lot of, like, you know,
the African countries.
But, like, this was a very useful, you
know, like,
application,
an example of how this can be translated
and was easily translated
in in a place that was very much
needed.
Excellent.
So another chapter in the book looks at
radiotherapy
biomaterials,
and the these are things used, for example,
to improve targeting or to boost the immune
system
or even, to release drugs or increase the
effects of the radiation.
Can you explain how these biomaterials
could save time or money in the clinic,
and why they might be particularly useful for
low resource settings?
Yeah. I mean, I think this is a
more future looking
view of things. But the basic idea is
you're gonna improve the therapeutic ratio of the
treatment that you're already delivering. So in other
words, that means,
either more effectiveness or less toxicity or hopefully
both for the same dose. And so do
you know, you could offer you could deliver
less
dose from the radiation treatment for the same
effect. So an example of that would be
high,
atomic number,
nanoparticles, like gold nanoparticles.
And because of the high z
of the material, they actually,
have a enhanced radiation effect is probably
most of physicists listening would understand.
And so that, you know, that allows lower
doses, potentially shorter treatments if you can get
through more of the treatment more quickly.
Maybe more accurate targeting.
For example, if you can put something in
there that has an high z material that
can enhance the visibility on CT imaging. Yeah.
So that can help with targeting and visualization
for targeting.
So, yeah, there's lots of different ways that
can happen.
Okay. And and you mentioned, for example, the
use of,
nanoparticles that enhance the
effect of the radiation.
And I guess this allows you to give
fewer fractions,
so that's in turn gonna reduce cost and,
you know, make things more convenient for the
patient.
Yeah. Exactly. Yeah. If you look at, like,
for example,
early stage prostate cancer and the new trials
that are coming out have come out about
how to treat that, If you can treat
in 7 fractions,
let's say instead of 39 fractions, this fraction
is a day of treatment. So so, you
know, you get your treatment done in 7
days
versus 39 days.
I mean, you can I think all of
us even without any direct experience can imagine
the impact of that on a place like
Sub Saharan Africa? Right? I mean, where sometimes
the
travel time to a clinic is days. Like,
you know, and I,
spend some time in in Uganda where we
have a partner clinic, and, you know, that's
a country of 40,000,000 people, one clinic
where people can get treated, which is great.
They do a very advanced care in this
in this clinic, but it's only one clinic.
They're gonna expand to more clinics
in the near future. But
right now,
you know, you can you can imagine
a large number of people traveling for 7
days to get treatment. It's a little harder
to imagine
many people traveling for 39 days and all
this involved in that. Get treatment. Right?
Yeah.
Eric is right. We have, you know, early
data that shows that a lot of these
patients are not completing the radiotherapy treatment.
Right? Because they have to come every day,
every day. And so sometimes, like and the
the, you know, the variable reasons why this
could be, you know, It could be fatigue.
It could be, you know, financial, you know,
reasons. It could be other socioeconomic
factors.
But I think,
as Eric mentioned, what these, like, biomaterials,
like, the advantage it gives, especially when you're
given
these, like, very because this
39 days that the patients get to have,
you're condensing the treatment that would have been
spread out for those days into a very
small time. Right? So it means that you're
given very high radiation
at one time compared to what would have
been spread out over a couple of, you
know, a period of time. So you leave
very little room
for error. So how do you improve, like
Eric, you know, used the word, reducing toxicity
for the patient, because you just wanna target
the the tumor
and spare, you know, the tissues around it.
So developing these, like, biomaterials,
that can be dig that are degradable
helps you target, you know, the tumor very
well and spare the surrounding tissues,
and also some helps in better visualization
when you don't have enough contrast between, you
know, the surrounding tissues and the, you know,
tumor
as well.
And and so, you know, it helps a
lot in
hyperfractionated
cases where we cannot you know?
First of all, we our we do our
best not to do wrong, but then it
leaves, like, very little room for error. So
you wanna make sure that you're targeting precisely
the tumor and and nothing else. Yeah.
Okay. And then
another
really essential task that we haven't mentioned yet
is, a cancer diagnosis.
So
you've included a chapter in the book looking
at the emerging technology of polymer dots and
how they're used in diagnostics.
Can you describe what these polymer dots are
and why you chose this as an example
to include?
That was an important thing to include, I
thought, in the book, because it's an example,
from another
it serve as applications in other branches of
oncology,
for example, medical oncology.
And the chapter describes,
a fluorescent probe assay that was developed. And
the PIs of this are a chemist, Daniel
Chu, and who's a professor in of chemistry
and and then working with Jerry Radich, who's
a medical oncologist at the Fred Hutch. And
so they've developed these,
fluorescent probe assays. And so that, you know,
that's that part of it is nothing new.
You know, there's fluorescent probes that can be
attached to a protein,
and that, for example, can tell you how
much of a protein is present in the
blood.
But true the traditional
assays require,
you know, very expensive equipment, a laser
to fluorescent the protein,
expensive optics, high end cameras, computing power.
Right? So these polymer nanodots,
they're like 30 nanometers or less. They're they're
extremely bright
and you can, and they're chemically stable. They
can be easily conjugated to a
protein. And so that allows you to
do an assay
in a much more sort of accessible way.
Right? So they can then be used for
assessing for protein biomarkers, for example, for cancer
screening
or even like tumor paint that's being used
during surgery where you can have
the ligand bind to tumor cells and then
you can with under fluorescence, actually see where
there's residual disease during surgery.
That's another use.
Okay. So so for guiding surgery, you you
can see these, or for example, for testing,
like a biopsy or a blood sample to
look for cancer biomarkers?
Yeah. There's this example of
how you could use this to in the
treatment of chronic myeloid leukemia.
And for people who don't know about that,
it's a it's a, you know, blood cancer,
that
can be pretty well managed for many patients
now,
but you need to have an assay to
know
how much
if the disease is present, how much of
it is, how it's responding to treatment for
follow-up and so on. So that's very important
in the management of that of that disease.
Right? And so the way that it's done
now is you measure
the levels of the mRNA protein in the
blood
of this particular protein. And this is what
drives CML is is this fusion protein of
BCR ABL. The 2 genes get fused, and
that's sort of necessary for CML to develop.
So if you can measure the level of
BCR ABL,
in these assays,
then you can tell how patients are responding.
The the treatments that's used is
is this,
tarsine kinase inhibitor, Gleevec. That's the trade name.
But,
you know, you need the technology to be
able to do that assay. So so so
there are
such devices out there. There's this big one,
the Cepheid,
and it's does quantitative PCR,
polymerase chain reaction, but it's very expensive.
So so, you know, you can imagine
that sort of assay with
a simple nano dot type assay where you
can
do, you know, read it out just in
a small reader because it's so bright
and and very sensitive
and specific, then, you know, you can that
opens the doorway to do screening. So I
think this falls into a general
a general,
approach in in the public health space where
you've got it it's very in some cases,
very advantageous to combine screening with treatment.
Right?
Yeah. And and to do that, you need
the right screening tools and you need the
right treatment tools available
real time in the clinic. And an example
of that is the cervical cancer case where
there are,
you know, there are screening
tools available,
you know, but you need devices available as
well-to-do
treatment of early stage disease on-site. And if
you can't do both of those
together, it's gonna be very difficult in some
of these under resourced areas of the world.
Right? Like,
it it might work in North America. Right?
Like, patient comes in, you do a screening,
they find they find some evidence of disease,
so the patient comes back a week later
and gets the treatment. Right?
You can't do that
in
right? You right? If you can't do that
and you got I I agree. Yeah. It
just doesn't work. Yeah. There's you know, in
most cases.
You send somebody away, they're you know,
it's
a good chance they can't come back.
I know. I I agree with you. Like,
if you can have that combination
in in the environments that we are familiar
with,
I think that's, like, a huge game changer
for how these diseases would be managed, you
know,
in in in those places.
Yeah. Eric is right.
Okay. And then
the final chapter of the book
considers the education
of current and future
medical physicists,
radiotherapists,
oncologists,
etcetera.
Can you comment on the challenges with this
and and how this could be addressed?
I I think we've I reckon I we've
hinted at this, like, throughout, like, our, you
know, this conversation
that it's it's it's very clear that,
in in low and middle income countries or
underserved communities, we have, like, you know,
understaffing,
which relates back to, you know,
how many people are being trained,
you know, to do the work in in
in radiation therapy.
And I think,
in in our field, you know, in radiation
oncology, in medical physics,
we have a lot of, like, you know,
stakeholders
or, you know, individuals who are very,
interested in reaching out to these communities to
help fill that gap of education and training.
The several, you know, NGOs,
our,
you know, professional organizations,
the American Society For Aviation,
for American Society For Physicists and Medicine,
and then ASTRO, you know, are very,
involved in,
committees
that, you know,
reach out
to lower and middle income countries. We have
Eric and I, we're in this committee in
APM where it's called the ICAMP, the International
Council For,
you know, associate mentorship program,
where it is,
designed to get early career physicists involved,
for, you know, training and education
for, you know, physicists in low and middle
income countries.
So there's a clear gap. You know, there's
a clear need to train,
folks.
One of the reasons could be the,
lack of access
to these technologies that are otherwise available in
high income countries,
but are not available, you know, in low
you know, middle income countries.
Because if you read textbooks and you don't
have the, you know,
opportunity
to practice hands on, it doesn't really translate
very well. Right? And so one of the
ways that, you know, AI could help fill
this gap is having virtual education,
you know,
VR
type of trainings that can give folks this
hands on practical,
you know, approach,
to learning.
Or, one of the things that, you know,
Eric is such a good advocate for is,
like, having those bidirectional,
you know,
knowledge transfer. So, for example, we went to
Uganda to learn from them. We're gonna bring
some folks to our clinic to learn from
us and look at you know, like, observe
how we practice, like, in our setting. It
is very important to give folks
that, you know, opportunity to get to see
that because it cannot be one-sided.
Right? We know what goes on. It's good
to have people learn what goes on here
so they can take it with them so
that they can, you know, practice in their
clinic
be depending on what resources are available
to them. So there's that, you know, challenge,
and and a lot of works that are
going on to support that.
Then I'll let Eric, you know, chime in
in as well with his thoughts. Yeah. No.
I totally agree. I don't have much more
to add to that. The need is huge.
I agree. I mean, I I guess,
if you think about a future where,
you know,
AI plays more of a role hopefully in
a positive way, we hope.
You know? But,
how do we make sure that it's doing
the job that it's supposed to do? Well,
you know, we need a
workforce of highly trained experts
who can oversee and manage the
the operations of of all these assistive tools
that we have. You know, for example, like,
you know, the products that are FDA cleared
now for mammography,
for AI reads of mammography
are often operating in combination with a radiologist.
Right? So it's not like the
the technology is just out there doing everything
in the autopilot mode. No. It needs some
oversight, and you need, you know, highly trained
people to Yeah. Be there working alongside it.
So it it's like it's almost like the
education need becomes even more with all these
Yeah. Tools.
Exactly.
And troubleshoot. Like, when something goes wrong, if
you're not well trained,
how how can you, you know, troubleshoot, like,
an AI device or an AI software?
You know? Or how do you even interpret
the results that that AI software is giving
you? Like, when do you know when to
double check it? Do you, like, take whatever
AI, like, output the AI software is giving
you as face value? Or Mhmm. You train
well trained enough to understand and interpret, you
know, those results. Totally. Yeah. It's that kind
of, like, unknown unknown. You know? Like, how
do you exactly.
Right? Like, you don't even know when to
ask the question sometime. Yeah. That's when you
really get into a danger. Yeah. Yeah.
So AI is gonna make a big difference,
but we still need the staff to ensure
that it's working properly.
Absolutely.
Without a doubt. Yeah. And then my final
question for you is, who are the targeted
readers for your book?
I think it's a wide spectrum of people
who might be interested in the topics in
this book. Mhmm. Health care professionals for sure
in the oncology space, but also beyond,
people in radiation oncology space for sure.
Public health, people interested in public health and
policy, I think you really benefit for some
of the ideas here. I'm also hoping that,
you know, some engineers
and people in the industry will pick this
up because Yeah. You know, there there's many
lessons here to be learned, many examples and
many sort of,
you know, paradigms for how
to think about the issues that I think
are productive.
Yeah.
You know, we talked about trainees, like Kaffia
was saying, but
the next generation,
early career people with an interest in this
these things
Yeah. I think, you know, they benefit from
reading through
these things.
Yeah.
Yeah. Okay. Great. Well, I mean, if our
listeners want to find out more, you can
find the ebook, Humanitarian
Engineering for Global Oncology,
on the IOPscience
website,
and it's part of the IOP book series
in Global Health and Radiation Oncology.
So take a look.
So, well, thanks again, Eric and Ofia, for
speaking with us today. Thank you. Thank you
for giving us the opportunity.
Great to be here.
That was Afiya York and Eric Ford of
the University of Washington,
and they were in conversation
with Physics World's Tammy Freeman.
Thanks to all 3 for a fascinating discussion.
I'm afraid that's all the time we have
for this week's podcast.
A special thanks to our producer, Fred Iles.
We'll be back again next week. But in
the meantime,
do check out the latest episode of the
Physics World Stories podcast.
Host Andrew Glester meets Mark Levinson,
a former
theoretical
particle physicist
who is now an acclaimed
filmmaker.
They chat about his latest work,
The Universe in a Grain of Sand,
which has been described
as a visually rich
meditation
on how science and art
both strive to make sense of the natural
world.
The episode
is called From Physics to Filmmaking,
Mark Levinson
on his new
documentary.
And you can find it on the Physics
World website
or at your favorite
podcast provider.