Humanitarian engineering can improve cancer treatment in low- and middle-income countries

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Hello, and welcome to the Physics World Weekly

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podcast.

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This episode

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explores how the concept of humanitarian

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engineering

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can be used to provide

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high quality cancer care to people in low

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and middle income countries

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around the world.

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Our guests are 2 medical physicists

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from the University of Washington in the US,

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and they've contributed to the ebook

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Humanitarian

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Engineering

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for Global Oncology.

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Here they are in conversation with Physics World's

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Tammy Freeman.

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Cancer is increasing in prevalence around the globe

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with reports estimating that by 2030,

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more than 2 thirds of cancer related deaths

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will occur in low and middle middle income

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countries.

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As such, it becomes more important than ever

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to develop affordable,

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sustainable technologies for cancer care.

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One way to address this emerging

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need is via humanitarian

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engineering,

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a method that focuses on projects that are

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affordable,

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sustainable, and based on local resources.

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This approach forms the central theme of a

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newly published ebook

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entitled

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Humanitarian

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Engineering for Global Oncology.

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In this text, a series of contributing authors

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take a look at various ways to address

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the worldwide need for access to quality cancer

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care with a particular focus on radiation therapy.

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I'm joined today by the book's editor, Eric

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Ford,

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professor and director of physics at the University

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of Washington,

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and coauthor,

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Aphiya York, a medical physicist at the University

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of Washington's Department of Radiation Oncology.

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Welcome to the podcast, Eric and Thea.

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Yeah. Thank you, Tammy. It's nice to be

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here. Thank you. First of all, I wondered

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if you could provide a quick overview of

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what's meant by the concept of humanitarian

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engineering.

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Sure. I guess I can start. I,

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humanitarian engineering, I think,

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one simple way to think about it is

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that it's

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a kind of a look at technology, but

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putting the person or the patient at the

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center.

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And so that kinda changes the way that

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you develop

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do development. Right?

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And that especially is important for,

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you know, the marginalized

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and underserved

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and,

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in the anywhere in the in the world,

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but especially globally

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where on a global scale, there's some acute

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needs

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for health care, especially in low and middle

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income countries.

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So I think that's probably, like, the simple

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definition that I would use.

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Yeah.

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I I agree with Eric.

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And and, you know, like Eric mentioned, these

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are, like, community, you know, centered designs, like,

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you know, technologies

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that have been designed with, you know, like,

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underserved communities in mind.

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And when you read this book, you would

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see a recurring theme, like, in the book

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where almost everything that we're talking about has

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to do with affordability.

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Right? Like, how can these technologies that are

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being designed be afforded by,

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you know, communities

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or, you know, countries or environments

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that might otherwise not be able to, you

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know, like, purchase them or afford them. And

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and it requires,

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you know, we're physicists here talking about, like,

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humanitarian

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engineering,

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you know, in global health. So, you know,

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obviously, it requires, like, a cross disciplinary

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approach, you know,

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bringing in, you know, some, you know, economic,

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approaches, you know, engineering approach, physics in in

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our context,

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and public health initiatives

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to solve, you know,

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issues that, you know, better serve these individuals

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in in in underserved communities. Yeah.

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Much of the book focuses on radiotherapy,

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which is one of the central components of

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cancer care.

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Now delivering radiation usually requires large complex systems

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such as linear accelerators or linacs.

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Is access to these systems a problem in

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resource limited settings?

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It is. It is a very huge concern,

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and this has been the, you know,

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one of the,

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largest conversations

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in our field in radiation, you know, therapy

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when we talk about,

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global radiotherapy,

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one of the things that we talk about

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is how can we increase the access to

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linear accelerators,

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this radiation delivering

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equipment to these individuals. When you go to

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the

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IAEA, the International Atomic Energy Agency, you know,

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website,

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they have a database called the direct database,

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which is a directory of, radiotherapy

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centers.

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And it looks at all these, like, countries

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and how many radiotherapy equipment

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are in these countries and the distribution. And,

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clearly,

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when you look at that map, you can

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see a very faint, you know,

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map for

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low and middle income countries. So this is

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a clear, you know, issue,

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in LMICs.

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And,

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again, whenever people come back to the table

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to talk about, you know, access to radiotherapy

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care, most of the conversations start from there.

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How can we improve the number of machines

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in this area so that patients who have

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cancers in this environment

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can have access to radiotherapy?

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Yeah. I think the other thing that we

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should

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think about at the beginning of

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the discussion about this is to, you know,

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like you said, Tammy, the book focuses a

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lot on radiation therapy, but there's there's other

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things in the book as well, surgery, diagnostic

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essays, and other things, AI, advanced imaging.

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But, you know, what why is radiation

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therapy so important, you know, when you think

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about humanitarian engineering? It's it's really because it's

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one of the major pillars

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of

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what is used

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for cancer care of patients. Right? You know,

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roughly half of patients

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should

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get radiation therapy, but for you know, often

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for curative intent. But like Afiya said,

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you know, there's a huge gap in terms

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of what the access is there across the

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globe.

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You know, and it's also very cost effective

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when it's done. If you think about like,

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you know, for example,

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a breast cancer patient who,

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has treatment after

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surgery, for example. I mean, the part

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of that treatment is really key to her

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achieving

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cure and from the disease. It it's, you

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know, it's gonna be much less likely. The

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outcome is gonna be much usually, in many

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cases, much worse if the full treatment isn't

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available. Right? Or head and neck cancer patient.

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Right? That's somebody

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who often can be treated with curative intent

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with a radiation therapy approach

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that preserves the voice, preserves swallowing,

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can preserve

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taste, and, you know, and that preserves nutritional

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status, which then means the patient doesn't suffer

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from nutritional problems later. Right? So there's many

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downstream effects and many,

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cost savings to the healthcare system and to

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people as well. Right? Because these treatments can

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be very financially

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toxic to patients.

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And so we wanna do it the right

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way with really low toxicities, but you have

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to have all the tools

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in your tool belt in order to be

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able to do it the right way. And

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this that's the

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reason that the gap is so important to

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address. Yeah. So, I mean, how how can

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the manufacturers

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help address this disparity in resources?

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Are they

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working to design

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lower cost, more efficient

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systems?

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Yeah.

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So we've addressed some of these, like, in

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the book. One of those, with them is

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the Halcyon,

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which,

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is designed by one of the radiation,

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equipment manufacturers.

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The Halcyon

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increases, you know, the throughput,

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so you can treat patients, like, in less

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than 10 minutes, which is half the time

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that you will treat patients with

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the current, you know,

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linox, which are CR Linox,

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that is mostly used by a lot of

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us, like, in in our hospitals.

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And

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given,

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like, you know, Eric Eric mentioned,

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because there's lack of, you know, radiotherapy

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machines in low and middle income countries. You

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have a lot of people waiting in line

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to be treated, you know, on on the

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available CRM Linacs.

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So machines like the Halcyon, which increases, you

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know, the throughput, reduces the time that you

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can get patients through the machine, helps clears

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these, like, backlogs or waiting times that, you

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know, are in these areas.

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And, also, you know, other people are manufacturing

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the upright, you know, radiotherapy,

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systems where the patient sits and it's slowly

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rotated around a fixed, you know,

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beam machine. And so,

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these, you know, are very compact

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in nature.

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You need very little,

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shielding, which can be a cost, you know,

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an upfront cost when you're designing

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radiotherapy,

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rooms,

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and you need very little bunkers

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because you don't need a big room

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to install,

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you know,

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these

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machines. And so you have people addressing them,

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and and I'll let doctor Ford, you know,

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take the other,

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technologies,

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you know, in the space.

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Yeah. I mean, I think that's a really

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good example of

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humanitarian engineering in action. You know? It's the

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system that Afiya mentioned. That was

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you know, I I guess for people who

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don't know these,

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radiation therapy machines, they're linear accelerators. You know?

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They typically operate up to 6 megawatts,

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you know, high energy, high output.

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You know, they date back to 19 fifties.

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Right? So the technology has been around for

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a long time.

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Yeah. But, this one was a redesign, and

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it was it was,

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introduced in the commercial market in in 2017,

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but just sort of rethinking it. So, like,

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you know, in a in a normal machine,

280
00:10:52,290 --> 00:10:53,889
if you let the user pick, like, say

281
00:10:53,970 --> 00:10:57,009
let's say, 6 different energies to treat with.

282
00:10:57,009 --> 00:10:58,285
Right? In In this one, you don't do

283
00:10:58,285 --> 00:10:59,745
that. You just give them one energy.

284
00:11:00,285 --> 00:11:02,845
And and you'd, like, just simplify everything, make

285
00:11:02,845 --> 00:11:05,325
it simple, make it robust to different users.

286
00:11:05,325 --> 00:11:07,404
And I think the other interesting thing about

287
00:11:07,404 --> 00:11:08,785
that example is

288
00:11:09,165 --> 00:11:09,485
that,

289
00:11:10,370 --> 00:11:12,289
it's sort of a good example of what,

290
00:11:13,250 --> 00:11:15,829
what I what you hear people call bidirectional

291
00:11:16,049 --> 00:11:17,509
learning. So in other words,

292
00:11:17,970 --> 00:11:18,629
you know,

293
00:11:19,169 --> 00:11:20,389
we learn from,

294
00:11:21,409 --> 00:11:22,929
say, a country in,

295
00:11:23,825 --> 00:11:26,164
East Africa and the country in East Africa

296
00:11:26,225 --> 00:11:26,725
learns

297
00:11:27,264 --> 00:11:28,004
from us,

298
00:11:28,384 --> 00:11:30,464
like, back and forth learning. Because what, you

299
00:11:30,464 --> 00:11:32,225
know, what happened with that system was it

300
00:11:32,225 --> 00:11:34,865
was in designed with the intention to be

301
00:11:34,865 --> 00:11:38,389
robust and, you know, rugged and very, you

302
00:11:38,389 --> 00:11:40,870
know, harsh environments around the world. But then

303
00:11:40,870 --> 00:11:42,549
what what people found was that there was

304
00:11:42,549 --> 00:11:44,330
a huge demand for it in

305
00:11:45,110 --> 00:11:47,750
in the US and in Europe, in places

306
00:11:47,750 --> 00:11:49,590
that have a lot of resources because it

307
00:11:49,590 --> 00:11:51,350
just you know, like, a a few was

308
00:11:51,350 --> 00:11:53,610
mentioning, like, the throughput is so much better.

309
00:11:53,705 --> 00:11:55,784
You treat somebody in in 10 minutes, get

310
00:11:55,784 --> 00:11:57,865
them through, you know, and and it just

311
00:11:57,865 --> 00:11:59,945
all sure works works. So it was kind

312
00:11:59,945 --> 00:12:02,985
of like a win win kinda scenario, which

313
00:12:03,225 --> 00:12:05,544
A very good example of that. Yeah. It's

314
00:12:05,544 --> 00:12:06,205
just very

315
00:12:06,570 --> 00:12:09,129
satisfying to see that. Right? Like, where everybody

316
00:12:09,129 --> 00:12:11,450
is benefiting the whole, you know, around the

317
00:12:11,450 --> 00:12:11,950
world.

318
00:12:12,490 --> 00:12:12,889
Absolutely.

319
00:12:13,290 --> 00:12:14,190
Have one here.

320
00:12:14,970 --> 00:12:17,450
We have one in our clinic. Yeah. Yeah.

321
00:12:17,450 --> 00:12:19,434
Yeah. Right. We do. Yeah. Yeah. That's it's

322
00:12:19,434 --> 00:12:21,274
an interesting thing because if you,

323
00:12:21,834 --> 00:12:23,034
you know, if you go around the world

324
00:12:23,034 --> 00:12:25,774
and you say, okay. Like, here's some technology

325
00:12:26,475 --> 00:12:28,075
that you could use in your in your

326
00:12:28,075 --> 00:12:31,274
clinic. It's low cost. The first question is

327
00:12:31,274 --> 00:12:33,434
gonna be, do do you use that in

328
00:12:33,434 --> 00:12:34,509
your clinic? Yeah.

329
00:12:35,389 --> 00:12:37,549
If not, why not? It's a great question.

330
00:12:37,549 --> 00:12:38,610
Right? I mean,

331
00:12:39,230 --> 00:12:39,730
like,

332
00:12:40,269 --> 00:12:41,490
why yeah. Because

333
00:12:42,110 --> 00:12:45,950
the the motivation behind that question is we

334
00:12:45,950 --> 00:12:48,690
wanna deliver high quality care, world class care,

335
00:12:48,785 --> 00:12:51,045
care that's delivered in premier centers

336
00:12:51,424 --> 00:12:53,205
Yeah. For the benefit of our patients.

337
00:12:53,825 --> 00:12:54,325
So,

338
00:12:54,785 --> 00:12:56,545
you know, we wanna make sure we can

339
00:12:56,545 --> 00:12:58,065
do that. And is it so you have

340
00:12:58,065 --> 00:13:00,165
to be able to answer in the positive

341
00:13:00,225 --> 00:13:02,644
to that question. Right? Exactly.

342
00:13:03,819 --> 00:13:05,579
And and to add to what Eric said,

343
00:13:05,579 --> 00:13:07,899
like, if you go tell somebody that this

344
00:13:07,899 --> 00:13:09,740
is so good, the questions, if it's that

345
00:13:09,740 --> 00:13:11,839
good, why are you not using it? Right?

346
00:13:12,699 --> 00:13:15,100
And if you you use it, you can

347
00:13:15,100 --> 00:13:18,034
speak better to it, and and we do.

348
00:13:18,034 --> 00:13:19,894
We have it here. We see the advantages

349
00:13:20,115 --> 00:13:21,254
of that, you know,

350
00:13:21,714 --> 00:13:22,934
system and,

351
00:13:23,475 --> 00:13:23,975
yeah.

352
00:13:24,514 --> 00:13:26,774
Excellent. So this is basically manufacturers

353
00:13:27,154 --> 00:13:27,654
developing

354
00:13:28,195 --> 00:13:29,014
lower cost,

355
00:13:29,360 --> 00:13:32,559
easier to use, maybe lower maintenance systems that,

356
00:13:32,559 --> 00:13:34,159
you know, more people can get hold of

357
00:13:34,159 --> 00:13:34,899
and use.

358
00:13:35,679 --> 00:13:38,000
Yeah. Yeah. And they're you know, honestly, they're

359
00:13:38,000 --> 00:13:40,179
not you know, the force the market forces

360
00:13:40,240 --> 00:13:42,559
don't always drive things in that direction. Right?

361
00:13:42,559 --> 00:13:43,919
And I think that's one of the reasons

362
00:13:43,919 --> 00:13:46,514
why a book like this is important is

363
00:13:46,514 --> 00:13:49,475
to sort of, you know, shed some light

364
00:13:49,475 --> 00:13:50,615
on what the different

365
00:13:50,995 --> 00:13:51,495
aspects

366
00:13:51,954 --> 00:13:53,954
of the problem are and help people understand

367
00:13:53,954 --> 00:13:56,194
it. Because, you know, the market forces will

368
00:13:56,194 --> 00:13:57,334
will sometimes just

369
00:13:58,129 --> 00:14:00,309
push the solution organically into,

370
00:14:02,929 --> 00:14:05,009
whatever, like, a local minimum, so to speak,

371
00:14:05,009 --> 00:14:07,250
right, where it's like it works in an

372
00:14:07,250 --> 00:14:08,309
environment like,

373
00:14:08,769 --> 00:14:10,789
you know, New York City or,

374
00:14:11,090 --> 00:14:13,615
you know, Paris, but, like, you know, does

375
00:14:13,615 --> 00:14:14,754
it work in Kampala?

376
00:14:15,455 --> 00:14:16,035
You know?

377
00:14:16,495 --> 00:14:18,115
It's a it's a good example.

378
00:14:20,654 --> 00:14:23,394
Okay. So this is, we're talking about external

379
00:14:23,695 --> 00:14:26,575
radiotherapy here, but but there's another type, which

380
00:14:26,575 --> 00:14:27,315
is brachytherapy.

381
00:14:29,370 --> 00:14:31,610
Does this treatment can you offer this with

382
00:14:31,610 --> 00:14:34,570
sort of lower expenses and running costs than

383
00:14:34,570 --> 00:14:35,870
external beam radiotherapy?

384
00:14:37,450 --> 00:14:40,169
Yeah. The capital is lower. The capital outlay

385
00:14:40,169 --> 00:14:40,829
is lower.

386
00:14:42,014 --> 00:14:44,815
So that and it's, you know, probably about

387
00:14:44,815 --> 00:14:46,595
a third of what it costs to,

388
00:14:47,855 --> 00:14:50,415
to, you know, put in a external beam

389
00:14:50,415 --> 00:14:53,055
therapy machine. I'm talking about the X-ray machines.

390
00:14:53,055 --> 00:14:54,654
If we talk about protons, then we need

391
00:14:54,654 --> 00:14:56,580
to have a whole another discussion about coughs.

392
00:14:56,820 --> 00:14:59,059
Sure. A lot more expensive. But,

393
00:14:59,779 --> 00:15:02,200
anyway, yeah, it's May 3rd. Like, also the

394
00:15:02,420 --> 00:15:04,980
radiation shielding, like, Afiya was mentioning before the

395
00:15:04,980 --> 00:15:07,059
shielding their shielding needs, you have to build

396
00:15:07,059 --> 00:15:09,779
concrete walls around your around your machine so

397
00:15:09,779 --> 00:15:11,855
people are safe. So

398
00:15:12,315 --> 00:15:14,634
that's less of a con a concern because

399
00:15:14,634 --> 00:15:16,475
you can make it thinner because the energies

400
00:15:16,475 --> 00:15:17,615
are lower. Right?

401
00:15:18,634 --> 00:15:20,815
So, yeah, all of those are lower expenses.

402
00:15:21,195 --> 00:15:21,695
But,

403
00:15:22,315 --> 00:15:23,995
you know, having said that, there are other

404
00:15:23,995 --> 00:15:25,914
things that are more complicated. So you have

405
00:15:25,914 --> 00:15:26,894
ongoing expenses

406
00:15:27,570 --> 00:15:29,990
where you have to these are radioactive sources,

407
00:15:30,050 --> 00:15:33,509
the high specific activity sources, typically uranium 192.

408
00:15:33,970 --> 00:15:35,889
And if you use uranium 192, it has

409
00:15:35,889 --> 00:15:37,990
to be changed out every 3 months. Right?

410
00:15:38,210 --> 00:15:39,110
Mhmm. Yeah.

411
00:15:39,490 --> 00:15:41,570
So so okay. So here here's actually another

412
00:15:41,570 --> 00:15:43,029
good example of

413
00:15:43,514 --> 00:15:45,115
the systems engineering human

414
00:15:45,834 --> 00:15:48,654
humanitarian engineering kind of approach, which is that

415
00:15:49,115 --> 00:15:51,454
could we use a different type of radioactive

416
00:15:51,595 --> 00:15:54,894
source? Right? Uranium 1 92 developed for historical

417
00:15:54,954 --> 00:15:57,214
reasons. It was sort of a replacement for

418
00:15:57,355 --> 00:15:59,360
radium back in the day. And

419
00:16:00,779 --> 00:16:02,539
but, you know, it's not the only solution.

420
00:16:02,539 --> 00:16:04,940
It's a very good good choice because it

421
00:16:04,940 --> 00:16:07,259
has a very high specific activity, meaning you

422
00:16:07,259 --> 00:16:09,259
can make a very small source that you

423
00:16:09,259 --> 00:16:11,820
can introduce them into a catheter inside the

424
00:16:11,820 --> 00:16:12,320
patient.

425
00:16:12,695 --> 00:16:15,174
Typically, these are used for gynecological treatments as

426
00:16:15,174 --> 00:16:15,995
one of the major

427
00:16:16,375 --> 00:16:18,774
treatments for cervical cancer, which is a major

428
00:16:18,774 --> 00:16:19,914
women's health issue.

429
00:16:20,534 --> 00:16:22,695
But could you could you redesign it? So

430
00:16:22,695 --> 00:16:24,534
so people did. They redesigned it with a

431
00:16:24,534 --> 00:16:26,549
cobalt source, a cobalt 60 source,

432
00:16:27,350 --> 00:16:29,110
and that has a half life of 5

433
00:16:29,110 --> 00:16:31,110
years. So you don't have to replace the

434
00:16:31,110 --> 00:16:35,350
sources often, which obviously has many advantages if

435
00:16:35,350 --> 00:16:37,289
you, you know, practical advantages.

436
00:16:37,750 --> 00:16:39,830
So, you know, these cobalt sources are not

437
00:16:39,830 --> 00:16:42,495
common in the US or Europe. It's typically

438
00:16:42,495 --> 00:16:43,875
still iridium, but,

439
00:16:44,254 --> 00:16:46,754
you know, the the symmetry is fairly similar.

440
00:16:48,894 --> 00:16:50,334
I don't know. We should pro we probably

441
00:16:50,334 --> 00:16:52,254
also should talk about staffing when we talk

442
00:16:52,254 --> 00:16:52,754
about

443
00:16:53,294 --> 00:16:53,794
brachytherapy

444
00:16:54,574 --> 00:16:55,074
because

445
00:16:55,589 --> 00:16:56,970
it's a lot more complicated.

446
00:16:57,509 --> 00:16:58,809
Right? Yeah.

447
00:16:59,509 --> 00:17:02,629
Training the staff to, you know, do the

448
00:17:02,629 --> 00:17:04,009
procedures for the brachytherapy,

449
00:17:06,710 --> 00:17:10,005
the the brachytherapy procedures. And that takes us

450
00:17:10,005 --> 00:17:12,805
into, like, a space where we start talking

451
00:17:12,805 --> 00:17:13,705
about the unavailability

452
00:17:14,085 --> 00:17:16,565
of these, you know, staff in in in

453
00:17:16,565 --> 00:17:19,384
underserved, you know, environmental resources.

454
00:17:19,845 --> 00:17:21,684
And I think it's a very good segue

455
00:17:21,684 --> 00:17:24,669
to, you know, like, why AI could be

456
00:17:24,669 --> 00:17:26,529
very useful in this space

457
00:17:27,149 --> 00:17:29,630
where, you know, you can train individuals, like,

458
00:17:29,630 --> 00:17:32,029
remotely on how to, you know, perform these

459
00:17:32,029 --> 00:17:32,929
breaky procedures

460
00:17:33,710 --> 00:17:35,789
without putting them in the environment of, you

461
00:17:35,789 --> 00:17:37,484
know, these complex, you know,

462
00:17:38,045 --> 00:17:40,144
equipment or or devices.

463
00:17:41,085 --> 00:17:43,484
One thing Eric made such an excellent point.

464
00:17:43,484 --> 00:17:45,085
I feel like I don't have anything to

465
00:17:45,085 --> 00:17:47,325
add, but one thing that I wanted to

466
00:17:47,325 --> 00:17:48,525
add to, you know,

467
00:17:49,164 --> 00:17:50,865
his point was comparatively.

468
00:17:51,404 --> 00:17:53,890
Right? He talks about the upfront cost and

469
00:17:53,890 --> 00:17:55,509
the cost of operating the brachytherapy,

470
00:17:56,529 --> 00:17:57,670
you know, devices.

471
00:17:58,849 --> 00:17:59,509
But, also,

472
00:17:59,809 --> 00:18:03,009
it's less, you know, costly to maintain those

473
00:18:03,009 --> 00:18:03,509
equipments

474
00:18:03,809 --> 00:18:07,684
compared to the external beam, you know, devices,

475
00:18:07,684 --> 00:18:09,544
which are very, you know, heavy machinery,

476
00:18:09,924 --> 00:18:12,404
have so many moving packs, you know, which

477
00:18:12,404 --> 00:18:14,964
can be, you know, much more expensive. And,

478
00:18:14,964 --> 00:18:17,444
also, you know, if you set up your

479
00:18:17,444 --> 00:18:17,944
brachytherapy,

480
00:18:19,125 --> 00:18:19,625
program

481
00:18:20,085 --> 00:18:20,904
very well,

482
00:18:21,769 --> 00:18:22,909
you you,

483
00:18:23,450 --> 00:18:26,329
the sessions for brachytherapy are very minimal. It's

484
00:18:26,329 --> 00:18:29,450
like 5 sessions, 3 sessions, sometimes 1, unlike

485
00:18:29,450 --> 00:18:32,009
your external beam, you know, treatments, which can

486
00:18:32,009 --> 00:18:34,009
go for weeks and patients have to come

487
00:18:34,009 --> 00:18:36,144
in, you know, like, every day. So that's

488
00:18:36,144 --> 00:18:38,224
some of the contrast there between, you know,

489
00:18:38,224 --> 00:18:38,884
the brachytherapy

490
00:18:39,904 --> 00:18:42,705
procedures and, you know, the external beam, which

491
00:18:42,705 --> 00:18:45,904
tends to have some advantages for patient who

492
00:18:45,904 --> 00:18:48,224
have to travel hours on end to get

493
00:18:48,224 --> 00:18:49,525
to the nearest radiotherapy

494
00:18:49,825 --> 00:18:50,325
centers.

495
00:18:52,419 --> 00:18:53,220
Yeah. It's,

496
00:18:54,339 --> 00:18:57,079
I think that's a really good point. It's,

497
00:18:58,500 --> 00:19:01,220
very practical, very usable in an environment like

498
00:19:01,220 --> 00:19:03,974
that because they're very short course treatments. Right?

499
00:19:04,535 --> 00:19:07,174
And it's very necessary. Like, if you if

500
00:19:07,174 --> 00:19:09,035
you if you don't do the brachytherapy

501
00:19:09,654 --> 00:19:10,474
part of it,

502
00:19:10,855 --> 00:19:13,174
the cure rates are much lower. And we

503
00:19:13,174 --> 00:19:15,914
know that there's very solid data on that.

504
00:19:16,259 --> 00:19:17,640
So, you know, it's

505
00:19:17,940 --> 00:19:19,240
and, you know, I mean,

506
00:19:19,619 --> 00:19:21,940
just the control of cervical cancer is like

507
00:19:21,940 --> 00:19:24,259
a it's it's a major public health issue

508
00:19:24,259 --> 00:19:24,759
in

509
00:19:25,140 --> 00:19:26,519
a lot of parts of the world,

510
00:19:26,900 --> 00:19:27,400
especially,

511
00:19:28,339 --> 00:19:29,055
outside of,

512
00:19:30,095 --> 00:19:32,914
you know, the high human development index countries,

513
00:19:33,215 --> 00:19:33,715
like,

514
00:19:34,255 --> 00:19:35,795
over 90% of,

515
00:19:36,414 --> 00:19:38,035
cervical cancer cases are

516
00:19:38,414 --> 00:19:40,434
diagnosed in low and middle income countries.

517
00:19:40,815 --> 00:19:42,735
So be and it's because of the screening

518
00:19:42,735 --> 00:19:44,355
patterns. Right? So this is a failure

519
00:19:44,720 --> 00:19:46,099
of the public health system,

520
00:19:47,680 --> 00:19:48,339
that because

521
00:19:48,880 --> 00:19:51,119
vaccines and screening work. Right? That's why there's

522
00:19:51,119 --> 00:19:52,740
not that much cervical cancer

523
00:19:53,039 --> 00:19:55,119
Yeah. Problem in in, like, the US, for

524
00:19:55,119 --> 00:19:56,099
example. But,

525
00:19:57,119 --> 00:19:58,820
you know, it needs to be addressed,

526
00:19:59,394 --> 00:20:00,694
and this is a practical

527
00:20:02,275 --> 00:20:04,535
way to do it. It it's, you know,

528
00:20:04,994 --> 00:20:06,214
relatively low

529
00:20:06,994 --> 00:20:07,894
cost technology,

530
00:20:08,595 --> 00:20:10,355
but, you know, you just, you got, you

531
00:20:10,355 --> 00:20:11,335
got to kind of

532
00:20:11,920 --> 00:20:13,839
be organized about it and have it in

533
00:20:13,839 --> 00:20:14,740
place. And,

534
00:20:15,519 --> 00:20:17,299
Yeah. And and so it sounds like,

535
00:20:18,240 --> 00:20:18,740
brachytherapy

536
00:20:19,279 --> 00:20:20,820
and external beam perhaps,

537
00:20:21,440 --> 00:20:23,759
will be used for treating different types of

538
00:20:23,759 --> 00:20:24,259
cancer.

539
00:20:24,634 --> 00:20:26,475
Yeah. I mean, it it it's cut I

540
00:20:26,475 --> 00:20:29,055
mean, partly clinical, partly practical. So

541
00:20:29,434 --> 00:20:31,934
the thing is in brachytherapy, you can introduce,

542
00:20:33,835 --> 00:20:36,075
an, you know, an an applicator. So like

543
00:20:36,075 --> 00:20:36,575
a

544
00:20:37,279 --> 00:20:39,599
basically a little holder for the reactive source

545
00:20:39,599 --> 00:20:42,159
that puts it exactly where you need, like,

546
00:20:42,159 --> 00:20:45,200
into the cavity of a patient. Right? So

547
00:20:45,359 --> 00:20:47,039
and that the you know, so it's just

548
00:20:47,039 --> 00:20:48,960
like in cervical cancer, that's something you can

549
00:20:48,960 --> 00:20:51,515
do. Right? Or prostate cancer can be treated.

550
00:20:51,515 --> 00:20:53,355
Early stage prostate cancer can be treated with

551
00:20:53,355 --> 00:20:55,835
needles inserted into the prostate. But, you know,

552
00:20:55,835 --> 00:20:57,535
not all cancers are

553
00:20:57,914 --> 00:20:59,914
accessible that way. Like, if you think about

554
00:20:59,914 --> 00:21:01,914
a cancer in the lung, it's gonna be

555
00:21:01,914 --> 00:21:03,855
very hard for you to introduce a needle

556
00:21:04,109 --> 00:21:05,549
into the lung in a way that's gonna

557
00:21:05,549 --> 00:21:07,869
be safe for a patient. Right? And people

558
00:21:07,869 --> 00:21:09,569
have done it, but it's very it it's

559
00:21:09,710 --> 00:21:12,429
very, very challenging. There's Yeah. Limitations to what

560
00:21:12,429 --> 00:21:14,109
you can safely do. And this is one

561
00:21:14,109 --> 00:21:15,730
of the things is you wanna do

562
00:21:16,349 --> 00:21:17,809
this in a way that's noninvasive

563
00:21:18,109 --> 00:21:19,650
and is safe for the patient.

564
00:21:20,285 --> 00:21:21,184
A lot of times,

565
00:21:22,444 --> 00:21:25,244
there's not great access to surgery. That's one

566
00:21:25,244 --> 00:21:27,644
of the other major hurdles in in in

567
00:21:27,644 --> 00:21:29,565
areas of the world. There's a chapter in

568
00:21:29,565 --> 00:21:31,184
the book about that, about surgery,

569
00:21:32,149 --> 00:21:33,769
the issues around that. But,

570
00:21:34,309 --> 00:21:36,549
yeah. So it's sort of just a combination

571
00:21:36,549 --> 00:21:38,250
of the clinical need and the practical

572
00:21:39,109 --> 00:21:41,210
applicability of what can be done with brachytherapy.

573
00:21:41,909 --> 00:21:42,409
Okay.

574
00:21:42,869 --> 00:21:45,835
So we've talked about advances in hardware, but

575
00:21:45,835 --> 00:21:48,015
how could things like artificial intelligence

576
00:21:48,634 --> 00:21:50,815
improve access to high quality treatments?

577
00:21:52,235 --> 00:21:53,674
AI is, you know, like,

578
00:21:53,995 --> 00:21:56,154
rapidly, like, gaining a lot of, like I

579
00:21:56,154 --> 00:21:57,515
I think at this point, it's gained a

580
00:21:57,515 --> 00:21:59,835
lot of momentum, like, around us and everything

581
00:21:59,835 --> 00:22:00,815
that we do.

582
00:22:01,900 --> 00:22:03,759
In in in radiation therapy,

583
00:22:04,059 --> 00:22:06,140
especially when you look at the benefits of

584
00:22:06,140 --> 00:22:07,039
AI for,

585
00:22:07,740 --> 00:22:10,539
low resource environment, which clearly we've seen that

586
00:22:10,539 --> 00:22:12,619
things that are designed for those environment tends

587
00:22:12,619 --> 00:22:13,920
to benefit everybody.

588
00:22:14,474 --> 00:22:15,615
You look at, like, how

589
00:22:16,474 --> 00:22:19,755
rapidly we can create radiotherapy treatment plans that

590
00:22:19,755 --> 00:22:20,734
are very specific

591
00:22:21,275 --> 00:22:23,535
to, you know, patients that are undergoing,

592
00:22:24,075 --> 00:22:25,214
radiation treatment.

593
00:22:25,755 --> 00:22:28,095
AI can help, you know, create very precise

594
00:22:29,190 --> 00:22:31,269
plans, that, you know, can be done at

595
00:22:31,269 --> 00:22:33,750
a much faster rate. Hence, we can create

596
00:22:33,750 --> 00:22:36,150
more plans that can, you know, treat more

597
00:22:36,150 --> 00:22:36,650
patients.

598
00:22:37,669 --> 00:22:39,829
In in doctor Ford's, like, you know, field

599
00:22:39,829 --> 00:22:42,329
of expertise, which is very quality and safety,

600
00:22:43,024 --> 00:22:45,105
AI can help, you know, for for for

601
00:22:45,105 --> 00:22:47,265
us as medical physicists when the treatment plants

602
00:22:47,265 --> 00:22:47,924
are created,

603
00:22:48,304 --> 00:22:50,384
we have to check, you know, the plans

604
00:22:50,384 --> 00:22:52,565
for equality, the beam the machine,

605
00:22:52,865 --> 00:22:55,500
you know, beam parameters, and other things. If

606
00:22:55,500 --> 00:22:57,660
you have a very good AI tool, it

607
00:22:57,660 --> 00:22:59,579
can help, you know, check the quality of

608
00:22:59,579 --> 00:23:01,900
the treatment plan and even look at, you

609
00:23:01,900 --> 00:23:03,900
know, if there are any, like, missing, you

610
00:23:03,900 --> 00:23:04,400
know,

611
00:23:05,099 --> 00:23:05,599
parameters

612
00:23:06,220 --> 00:23:08,940
that, you know, were not included, like, in

613
00:23:08,940 --> 00:23:09,599
the treatment.

614
00:23:10,045 --> 00:23:11,884
And this could be a very good safety

615
00:23:11,884 --> 00:23:14,525
check before, you know, the plants end up,

616
00:23:14,525 --> 00:23:15,904
you know, on patients.

617
00:23:16,525 --> 00:23:18,765
So, you look at, you know, all the

618
00:23:18,765 --> 00:23:21,244
things that we do as physicists, for example,

619
00:23:21,244 --> 00:23:22,769
like image, you know,

620
00:23:23,089 --> 00:23:25,750
guidance where we have to do, like, imaging,

621
00:23:26,369 --> 00:23:27,750
you know, for precise

622
00:23:28,049 --> 00:23:30,070
radiation targeting for patient.

623
00:23:30,690 --> 00:23:33,430
AI tools can help, you know, take images

624
00:23:33,490 --> 00:23:36,710
rapidly, look at you know, analyze those images,

625
00:23:37,134 --> 00:23:39,794
and look at patients set up to reduce,

626
00:23:39,855 --> 00:23:40,914
like, setup uncertainty.

627
00:23:41,615 --> 00:23:42,115
So,

628
00:23:42,654 --> 00:23:44,575
you look at how much it can help

629
00:23:44,575 --> 00:23:46,755
in our field of practice, and

630
00:23:47,134 --> 00:23:49,794
it it it it it helps, like, increase

631
00:23:49,855 --> 00:23:51,855
access to a lot of people because if

632
00:23:51,855 --> 00:23:54,549
you don't have, you know, planners or you

633
00:23:54,549 --> 00:23:56,809
don't you have, like, you're less you're understaffed.

634
00:23:57,349 --> 00:23:59,190
If you have AI tools and you know

635
00:23:59,190 --> 00:24:02,009
how to use them, how to troubleshoot them,

636
00:24:02,309 --> 00:24:04,309
I think it helps a lot to reduce

637
00:24:04,309 --> 00:24:07,304
this global burden in, you know, staffing or

638
00:24:07,304 --> 00:24:09,625
even machine authority. Yeah. I think that's a

639
00:24:09,625 --> 00:24:12,664
really important point is, like, there's this gap,

640
00:24:12,664 --> 00:24:14,664
the gap in technology that we've talked about,

641
00:24:14,664 --> 00:24:16,045
but there's also a gap in

642
00:24:16,505 --> 00:24:18,825
in in staff and train you know, how

643
00:24:18,984 --> 00:24:21,029
like, staff that are trained to

644
00:24:21,509 --> 00:24:24,630
operate, you know, in an environment like this

645
00:24:24,630 --> 00:24:26,470
and know all the ins and outs of

646
00:24:26,470 --> 00:24:28,890
what, you know, a cancer care practices

647
00:24:29,830 --> 00:24:31,210
needs. Right? And

648
00:24:31,750 --> 00:24:33,269
we know that. There's a study that came

649
00:24:33,269 --> 00:24:34,890
out in The Lancet this year,

650
00:24:36,214 --> 00:24:37,515
Zhu et al. And

651
00:24:38,134 --> 00:24:40,855
they made some estimates of staffing shortages in

652
00:24:40,855 --> 00:24:43,015
in in the field of oncology and radiation

653
00:24:43,015 --> 00:24:44,075
oncology specifically.

654
00:24:44,455 --> 00:24:45,835
And they said basically

655
00:24:46,214 --> 00:24:48,295
in all the different professional groups that are

656
00:24:48,295 --> 00:24:50,555
involved, so this is the doctors, the

657
00:24:50,990 --> 00:24:52,830
the people who deliver the the care of

658
00:24:52,830 --> 00:24:55,549
their Asian therapists, the medical phys basically, there

659
00:24:55,549 --> 00:24:56,930
there had to be a 70%

660
00:24:57,230 --> 00:24:58,609
growth of people.

661
00:24:58,990 --> 00:25:01,070
Like, so, you know, 1.7 times as many

662
00:25:01,070 --> 00:25:02,369
people over the next,

663
00:25:03,150 --> 00:25:03,650
basically

664
00:25:04,269 --> 00:25:05,650
less than 20 years.

665
00:25:06,154 --> 00:25:07,755
So and and and we also know that

666
00:25:07,755 --> 00:25:08,734
that's an underestimate.

667
00:25:09,274 --> 00:25:10,095
So, like,

668
00:25:10,954 --> 00:25:13,115
you know, that in the context where right

669
00:25:13,115 --> 00:25:14,014
now, we're

670
00:25:14,315 --> 00:25:16,875
just really swimming to kinda keep our head

671
00:25:17,034 --> 00:25:19,194
heads just above water. I mean, even honestly

672
00:25:19,194 --> 00:25:20,575
in the in the United States.

673
00:25:21,059 --> 00:25:21,559
So,

674
00:25:22,099 --> 00:25:24,419
and, you know, huge growths in East Asia,

675
00:25:24,419 --> 00:25:25,960
China, India, Japan.

676
00:25:26,500 --> 00:25:29,480
So there's just this huge gap that probably

677
00:25:29,859 --> 00:25:32,740
is gonna be nearly impossible to to close

678
00:25:32,740 --> 00:25:35,275
in any any foreseeable way in in the

679
00:25:35,275 --> 00:25:36,815
next less than 20 years.

680
00:25:37,115 --> 00:25:39,515
So so yeah. So this is where some

681
00:25:39,515 --> 00:25:41,355
of these tools can really help. Like, a

682
00:25:41,355 --> 00:25:42,575
few of us saying, I think,

683
00:25:42,955 --> 00:25:45,455
you know, it it's it targets efficiency.

684
00:25:45,995 --> 00:25:48,075
It also targets the quality of care of

685
00:25:48,075 --> 00:25:49,559
what we're what we're doing, like,

686
00:25:51,059 --> 00:25:52,840
in a way that can be very beneficial.

687
00:25:53,059 --> 00:25:55,160
There's a chapter in the book about,

688
00:25:57,140 --> 00:25:57,640
about

689
00:25:58,019 --> 00:26:00,180
automatic treatment planning, which is one of the

690
00:26:00,180 --> 00:26:01,875
the things we just talk about. So,

691
00:26:02,835 --> 00:26:04,115
you know, and I think that's a great

692
00:26:04,115 --> 00:26:06,934
example. It's this this group at MD Anderson,

693
00:26:07,795 --> 00:26:09,255
Lawrence Court is the PI,

694
00:26:09,954 --> 00:26:10,454
and,

695
00:26:10,994 --> 00:26:13,494
they're they've developed a tool called the radiation

696
00:26:13,555 --> 00:26:14,454
planning assistant.

697
00:26:14,920 --> 00:26:17,960
Yep. And so and and it's now FDA

698
00:26:17,960 --> 00:26:19,500
approved and being used in clinics,

699
00:26:19,880 --> 00:26:21,259
including at MD Anderson.

700
00:26:22,039 --> 00:26:23,960
And and, basically, you know, the idea is

701
00:26:23,960 --> 00:26:26,059
you just it's it's AI

702
00:26:27,160 --> 00:26:28,460
tools under the hood

703
00:26:29,079 --> 00:26:31,765
that essentially you know, like, from the user's

704
00:26:31,765 --> 00:26:34,085
point of view, you click the button and

705
00:26:34,085 --> 00:26:36,404
a a plan is made. Whereas previously, that

706
00:26:36,404 --> 00:26:38,325
would take, you know, many hours of some

707
00:26:38,325 --> 00:26:41,125
highly skilled person doing that work. Yeah. Right?

708
00:26:41,125 --> 00:26:43,285
So it's there and it's working and, you

709
00:26:43,285 --> 00:26:45,809
know, it and so I think it's really

710
00:26:45,809 --> 00:26:46,309
gonna

711
00:26:46,690 --> 00:26:48,069
change the way that care is done.

712
00:26:48,529 --> 00:26:50,609
Yeah. And and to add the cherry on

713
00:26:50,609 --> 00:26:53,009
top, Eric is right. That's chapter 3, by

714
00:26:53,009 --> 00:26:54,609
the way, for those who didn't be listening

715
00:26:54,609 --> 00:26:54,929
to the

716
00:26:56,130 --> 00:26:57,490
I I I just felt like I had

717
00:26:57,490 --> 00:26:58,869
to add that to it.

718
00:27:00,414 --> 00:27:02,654
Then to add to Eric's point, you know,

719
00:27:02,654 --> 00:27:03,134
this,

720
00:27:03,615 --> 00:27:04,994
aggregation plan assistant

721
00:27:05,295 --> 00:27:06,835
has been used in South Africa.

722
00:27:07,775 --> 00:27:08,894
You know, and,

723
00:27:09,295 --> 00:27:12,095
you would be, like, for to to treat,

724
00:27:12,095 --> 00:27:13,394
like, cervical cancer,

725
00:27:13,909 --> 00:27:15,829
which in our, you know, part of the

726
00:27:15,829 --> 00:27:17,109
world, and when I sell part of the

727
00:27:17,109 --> 00:27:18,710
world here in North America and, you know,

728
00:27:18,710 --> 00:27:21,269
in high income countries, we don't do 4

729
00:27:21,269 --> 00:27:24,169
field boxes in that. These are very simple,

730
00:27:24,230 --> 00:27:25,210
you know, plans.

731
00:27:25,845 --> 00:27:27,224
It's a huge improvement.

732
00:27:27,525 --> 00:27:29,444
Right? It's like this was done on a

733
00:27:29,444 --> 00:27:31,765
4 field box of a colon cancer, you

734
00:27:31,765 --> 00:27:34,664
know, patient and and and done seamlessly.

735
00:27:35,044 --> 00:27:38,085
Right? And that's a a typical example of

736
00:27:38,085 --> 00:27:39,464
how these, like, engineering

737
00:27:39,845 --> 00:27:40,345
devices

738
00:27:40,779 --> 00:27:41,519
that are

739
00:27:41,900 --> 00:27:43,759
designed to help, you know, environment

740
00:27:44,380 --> 00:27:44,859
that,

741
00:27:45,180 --> 00:27:48,000
you know, are are less resourced and understaffed.

742
00:27:48,140 --> 00:27:49,900
And for somebody who's listened, it's like, oh,

743
00:27:49,900 --> 00:27:52,140
but South Africa is, you know, very advanced

744
00:27:52,140 --> 00:27:53,500
compared to a lot of, like, you know,

745
00:27:53,500 --> 00:27:54,640
the African countries.

746
00:27:55,174 --> 00:27:57,414
But, like, this was a very useful, you

747
00:27:57,414 --> 00:27:58,234
know, like,

748
00:27:59,654 --> 00:28:00,154
application,

749
00:28:00,934 --> 00:28:03,595
an example of how this can be translated

750
00:28:03,654 --> 00:28:04,954
and was easily translated

751
00:28:05,494 --> 00:28:07,414
in in a place that was very much

752
00:28:07,414 --> 00:28:07,914
needed.

753
00:28:08,779 --> 00:28:09,279
Excellent.

754
00:28:09,660 --> 00:28:12,539
So another chapter in the book looks at

755
00:28:12,539 --> 00:28:13,039
radiotherapy

756
00:28:13,579 --> 00:28:14,079
biomaterials,

757
00:28:15,099 --> 00:28:17,179
and the these are things used, for example,

758
00:28:17,179 --> 00:28:20,220
to improve targeting or to boost the immune

759
00:28:20,220 --> 00:28:20,720
system

760
00:28:21,404 --> 00:28:24,845
or even, to release drugs or increase the

761
00:28:24,845 --> 00:28:26,144
effects of the radiation.

762
00:28:26,765 --> 00:28:28,625
Can you explain how these biomaterials

763
00:28:28,924 --> 00:28:31,345
could save time or money in the clinic,

764
00:28:31,484 --> 00:28:33,565
and why they might be particularly useful for

765
00:28:33,565 --> 00:28:34,705
low resource settings?

766
00:28:36,109 --> 00:28:37,630
Yeah. I mean, I think this is a

767
00:28:37,630 --> 00:28:39,169
more future looking

768
00:28:39,470 --> 00:28:41,869
view of things. But the basic idea is

769
00:28:41,869 --> 00:28:45,149
you're gonna improve the therapeutic ratio of the

770
00:28:45,149 --> 00:28:47,069
treatment that you're already delivering. So in other

771
00:28:47,069 --> 00:28:48,210
words, that means,

772
00:28:49,525 --> 00:28:52,644
either more effectiveness or less toxicity or hopefully

773
00:28:52,644 --> 00:28:54,964
both for the same dose. And so do

774
00:28:55,125 --> 00:28:57,384
you know, you could offer you could deliver

775
00:28:57,525 --> 00:28:58,025
less

776
00:28:58,565 --> 00:29:01,365
dose from the radiation treatment for the same

777
00:29:01,365 --> 00:29:03,390
effect. So an example of that would be

778
00:29:05,150 --> 00:29:05,650
high,

779
00:29:06,109 --> 00:29:07,009
atomic number,

780
00:29:08,029 --> 00:29:09,650
nanoparticles, like gold nanoparticles.

781
00:29:10,269 --> 00:29:12,130
And because of the high z

782
00:29:12,589 --> 00:29:14,130
of the material, they actually,

783
00:29:14,750 --> 00:29:17,410
have a enhanced radiation effect is probably

784
00:29:18,109 --> 00:29:20,764
most of physicists listening would understand.

785
00:29:21,944 --> 00:29:24,105
And so that, you know, that allows lower

786
00:29:24,105 --> 00:29:27,224
doses, potentially shorter treatments if you can get

787
00:29:27,224 --> 00:29:29,164
through more of the treatment more quickly.

788
00:29:30,105 --> 00:29:31,884
Maybe more accurate targeting.

789
00:29:32,505 --> 00:29:34,184
For example, if you can put something in

790
00:29:34,184 --> 00:29:38,019
there that has an high z material that

791
00:29:38,480 --> 00:29:42,000
can enhance the visibility on CT imaging. Yeah.

792
00:29:42,240 --> 00:29:44,500
So that can help with targeting and visualization

793
00:29:44,720 --> 00:29:45,380
for targeting.

794
00:29:45,840 --> 00:29:48,345
So, yeah, there's lots of different ways that

795
00:29:48,424 --> 00:29:49,325
can happen.

796
00:29:50,025 --> 00:29:52,105
Okay. And and you mentioned, for example, the

797
00:29:52,105 --> 00:29:52,845
use of,

798
00:29:53,944 --> 00:29:55,964
nanoparticles that enhance the

799
00:29:56,265 --> 00:29:57,484
effect of the radiation.

800
00:29:58,025 --> 00:30:00,444
And I guess this allows you to give

801
00:30:00,505 --> 00:30:01,404
fewer fractions,

802
00:30:02,025 --> 00:30:04,980
so that's in turn gonna reduce cost and,

803
00:30:04,980 --> 00:30:06,740
you know, make things more convenient for the

804
00:30:06,740 --> 00:30:07,240
patient.

805
00:30:09,059 --> 00:30:11,220
Yeah. Exactly. Yeah. If you look at, like,

806
00:30:11,220 --> 00:30:11,880
for example,

807
00:30:12,580 --> 00:30:15,140
early stage prostate cancer and the new trials

808
00:30:15,140 --> 00:30:17,619
that are coming out have come out about

809
00:30:17,619 --> 00:30:19,835
how to treat that, If you can treat

810
00:30:20,375 --> 00:30:21,674
in 7 fractions,

811
00:30:22,775 --> 00:30:25,815
let's say instead of 39 fractions, this fraction

812
00:30:25,815 --> 00:30:27,974
is a day of treatment. So so, you

813
00:30:27,974 --> 00:30:29,575
know, you get your treatment done in 7

814
00:30:29,575 --> 00:30:30,075
days

815
00:30:30,454 --> 00:30:31,980
versus 39 days.

816
00:30:32,299 --> 00:30:34,059
I mean, you can I think all of

817
00:30:34,059 --> 00:30:36,779
us even without any direct experience can imagine

818
00:30:36,779 --> 00:30:38,779
the impact of that on a place like

819
00:30:38,779 --> 00:30:41,279
Sub Saharan Africa? Right? I mean, where sometimes

820
00:30:41,339 --> 00:30:41,839
the

821
00:30:42,539 --> 00:30:44,865
travel time to a clinic is days. Like,

822
00:30:45,424 --> 00:30:46,224
you know, and I,

823
00:30:47,585 --> 00:30:49,825
spend some time in in Uganda where we

824
00:30:49,825 --> 00:30:51,984
have a partner clinic, and, you know, that's

825
00:30:51,984 --> 00:30:54,644
a country of 40,000,000 people, one clinic

826
00:30:55,025 --> 00:30:56,865
where people can get treated, which is great.

827
00:30:56,865 --> 00:30:58,384
They do a very advanced care in this

828
00:30:58,384 --> 00:31:00,065
in this clinic, but it's only one clinic.

829
00:31:00,065 --> 00:31:02,359
They're gonna expand to more clinics

830
00:31:02,820 --> 00:31:04,359
in the near future. But

831
00:31:04,660 --> 00:31:05,320
right now,

832
00:31:06,340 --> 00:31:09,160
you know, you can you can imagine

833
00:31:10,099 --> 00:31:12,660
a large number of people traveling for 7

834
00:31:12,660 --> 00:31:14,500
days to get treatment. It's a little harder

835
00:31:14,500 --> 00:31:15,160
to imagine

836
00:31:15,815 --> 00:31:18,535
many people traveling for 39 days and all

837
00:31:18,535 --> 00:31:20,634
this involved in that. Get treatment. Right?

838
00:31:21,894 --> 00:31:22,394
Yeah.

839
00:31:22,934 --> 00:31:25,275
Eric is right. We have, you know, early

840
00:31:25,414 --> 00:31:28,230
data that shows that a lot of these

841
00:31:28,470 --> 00:31:31,450
patients are not completing the radiotherapy treatment.

842
00:31:31,750 --> 00:31:34,470
Right? Because they have to come every day,

843
00:31:34,470 --> 00:31:37,429
every day. And so sometimes, like and the

844
00:31:37,429 --> 00:31:40,549
the, you know, the variable reasons why this

845
00:31:40,549 --> 00:31:43,355
could be, you know, It could be fatigue.

846
00:31:43,414 --> 00:31:45,994
It could be, you know, financial, you know,

847
00:31:46,695 --> 00:31:48,474
reasons. It could be other socioeconomic

848
00:31:49,015 --> 00:31:49,515
factors.

849
00:31:49,894 --> 00:31:50,775
But I think,

850
00:31:51,174 --> 00:31:53,755
as Eric mentioned, what these, like, biomaterials,

851
00:31:54,295 --> 00:31:56,615
like, the advantage it gives, especially when you're

852
00:31:56,615 --> 00:31:57,115
given

853
00:31:57,420 --> 00:31:59,360
these, like, very because this

854
00:32:00,059 --> 00:32:02,480
39 days that the patients get to have,

855
00:32:02,539 --> 00:32:05,019
you're condensing the treatment that would have been

856
00:32:05,019 --> 00:32:07,420
spread out for those days into a very

857
00:32:07,420 --> 00:32:09,820
small time. Right? So it means that you're

858
00:32:09,820 --> 00:32:11,200
given very high radiation

859
00:32:12,045 --> 00:32:14,605
at one time compared to what would have

860
00:32:14,605 --> 00:32:17,005
been spread out over a couple of, you

861
00:32:17,005 --> 00:32:18,845
know, a period of time. So you leave

862
00:32:18,845 --> 00:32:19,904
very little room

863
00:32:20,205 --> 00:32:22,605
for error. So how do you improve, like

864
00:32:22,605 --> 00:32:25,345
Eric, you know, used the word, reducing toxicity

865
00:32:26,069 --> 00:32:28,329
for the patient, because you just wanna target

866
00:32:28,390 --> 00:32:29,450
the the tumor

867
00:32:29,909 --> 00:32:32,390
and spare, you know, the tissues around it.

868
00:32:32,390 --> 00:32:34,329
So developing these, like, biomaterials,

869
00:32:35,669 --> 00:32:37,609
that can be dig that are degradable

870
00:32:38,230 --> 00:32:40,869
helps you target, you know, the tumor very

871
00:32:40,869 --> 00:32:43,575
well and spare the surrounding tissues,

872
00:32:44,034 --> 00:32:46,534
and also some helps in better visualization

873
00:32:46,835 --> 00:32:49,474
when you don't have enough contrast between, you

874
00:32:49,474 --> 00:32:51,875
know, the surrounding tissues and the, you know,

875
00:32:51,875 --> 00:32:52,375
tumor

876
00:32:52,755 --> 00:32:53,494
as well.

877
00:32:54,034 --> 00:32:56,595
And and so, you know, it helps a

878
00:32:56,595 --> 00:32:57,414
lot in

879
00:32:57,740 --> 00:32:58,240
hyperfractionated

880
00:32:58,700 --> 00:33:01,519
cases where we cannot you know?

881
00:33:01,820 --> 00:33:03,980
First of all, we our we do our

882
00:33:03,980 --> 00:33:06,380
best not to do wrong, but then it

883
00:33:06,380 --> 00:33:08,940
leaves, like, very little room for error. So

884
00:33:08,940 --> 00:33:12,234
you wanna make sure that you're targeting precisely

885
00:33:12,855 --> 00:33:15,434
the tumor and and nothing else. Yeah.

886
00:33:16,375 --> 00:33:17,514
Okay. And then

887
00:33:17,974 --> 00:33:18,474
another

888
00:33:18,934 --> 00:33:21,494
really essential task that we haven't mentioned yet

889
00:33:21,494 --> 00:33:22,954
is, a cancer diagnosis.

890
00:33:23,609 --> 00:33:24,109
So

891
00:33:25,529 --> 00:33:27,769
you've included a chapter in the book looking

892
00:33:27,769 --> 00:33:30,890
at the emerging technology of polymer dots and

893
00:33:30,890 --> 00:33:32,269
how they're used in diagnostics.

894
00:33:33,049 --> 00:33:35,450
Can you describe what these polymer dots are

895
00:33:35,450 --> 00:33:37,289
and why you chose this as an example

896
00:33:37,289 --> 00:33:37,950
to include?

897
00:33:39,695 --> 00:33:41,934
That was an important thing to include, I

898
00:33:41,934 --> 00:33:44,434
thought, in the book, because it's an example,

899
00:33:45,535 --> 00:33:46,174
from another

900
00:33:46,815 --> 00:33:49,695
it serve as applications in other branches of

901
00:33:49,695 --> 00:33:50,195
oncology,

902
00:33:50,654 --> 00:33:52,195
for example, medical oncology.

903
00:33:53,920 --> 00:33:55,940
And the chapter describes,

904
00:33:58,160 --> 00:34:00,960
a fluorescent probe assay that was developed. And

905
00:34:00,960 --> 00:34:02,880
the PIs of this are a chemist, Daniel

906
00:34:02,880 --> 00:34:05,779
Chu, and who's a professor in of chemistry

907
00:34:06,080 --> 00:34:08,079
and and then working with Jerry Radich, who's

908
00:34:08,079 --> 00:34:10,744
a medical oncologist at the Fred Hutch. And

909
00:34:10,744 --> 00:34:12,125
so they've developed these,

910
00:34:14,664 --> 00:34:16,664
fluorescent probe assays. And so that, you know,

911
00:34:16,664 --> 00:34:18,984
that's that part of it is nothing new.

912
00:34:18,984 --> 00:34:21,065
You know, there's fluorescent probes that can be

913
00:34:21,065 --> 00:34:22,284
attached to a protein,

914
00:34:22,670 --> 00:34:24,430
and that, for example, can tell you how

915
00:34:24,430 --> 00:34:26,269
much of a protein is present in the

916
00:34:26,269 --> 00:34:26,769
blood.

917
00:34:28,110 --> 00:34:29,410
But true the traditional

918
00:34:30,670 --> 00:34:31,890
assays require,

919
00:34:32,510 --> 00:34:34,769
you know, very expensive equipment, a laser

920
00:34:35,385 --> 00:34:36,765
to fluorescent the protein,

921
00:34:37,385 --> 00:34:40,364
expensive optics, high end cameras, computing power.

922
00:34:40,824 --> 00:34:43,085
Right? So these polymer nanodots,

923
00:34:43,385 --> 00:34:46,505
they're like 30 nanometers or less. They're they're

924
00:34:46,505 --> 00:34:47,485
extremely bright

925
00:34:47,820 --> 00:34:49,820
and you can, and they're chemically stable. They

926
00:34:49,820 --> 00:34:51,599
can be easily conjugated to a

927
00:34:51,900 --> 00:34:54,160
protein. And so that allows you to

928
00:34:55,420 --> 00:34:56,480
do an assay

929
00:34:56,860 --> 00:34:59,420
in a much more sort of accessible way.

930
00:34:59,420 --> 00:35:02,204
Right? So they can then be used for

931
00:35:02,684 --> 00:35:06,364
assessing for protein biomarkers, for example, for cancer

932
00:35:06,364 --> 00:35:06,864
screening

933
00:35:07,244 --> 00:35:09,724
or even like tumor paint that's being used

934
00:35:09,724 --> 00:35:12,065
during surgery where you can have

935
00:35:12,605 --> 00:35:14,605
the ligand bind to tumor cells and then

936
00:35:14,605 --> 00:35:17,579
you can with under fluorescence, actually see where

937
00:35:17,579 --> 00:35:19,679
there's residual disease during surgery.

938
00:35:19,980 --> 00:35:21,039
That's another use.

939
00:35:21,579 --> 00:35:24,059
Okay. So so for guiding surgery, you you

940
00:35:24,059 --> 00:35:26,719
can see these, or for example, for testing,

941
00:35:27,339 --> 00:35:29,339
like a biopsy or a blood sample to

942
00:35:29,339 --> 00:35:30,880
look for cancer biomarkers?

943
00:35:31,954 --> 00:35:33,974
Yeah. There's this example of

944
00:35:34,835 --> 00:35:36,594
how you could use this to in the

945
00:35:36,594 --> 00:35:39,175
treatment of chronic myeloid leukemia.

946
00:35:40,275 --> 00:35:42,835
And for people who don't know about that,

947
00:35:42,835 --> 00:35:45,255
it's a it's a, you know, blood cancer,

948
00:35:46,650 --> 00:35:47,150
that

949
00:35:47,609 --> 00:35:50,329
can be pretty well managed for many patients

950
00:35:50,329 --> 00:35:50,829
now,

951
00:35:51,210 --> 00:35:53,289
but you need to have an assay to

952
00:35:53,289 --> 00:35:53,789
know

953
00:35:54,329 --> 00:35:55,070
how much

954
00:35:55,929 --> 00:35:58,089
if the disease is present, how much of

955
00:35:58,089 --> 00:36:00,010
it is, how it's responding to treatment for

956
00:36:00,010 --> 00:36:02,025
follow-up and so on. So that's very important

957
00:36:02,025 --> 00:36:04,025
in the management of that of that disease.

958
00:36:04,025 --> 00:36:05,864
Right? And so the way that it's done

959
00:36:05,864 --> 00:36:07,085
now is you measure

960
00:36:07,704 --> 00:36:10,905
the levels of the mRNA protein in the

961
00:36:10,905 --> 00:36:11,405
blood

962
00:36:11,864 --> 00:36:14,184
of this particular protein. And this is what

963
00:36:14,184 --> 00:36:17,219
drives CML is is this fusion protein of

964
00:36:17,219 --> 00:36:20,019
BCR ABL. The 2 genes get fused, and

965
00:36:20,019 --> 00:36:23,059
that's sort of necessary for CML to develop.

966
00:36:23,059 --> 00:36:24,900
So if you can measure the level of

967
00:36:24,900 --> 00:36:25,880
BCR ABL,

968
00:36:26,659 --> 00:36:27,640
in these assays,

969
00:36:28,034 --> 00:36:30,295
then you can tell how patients are responding.

970
00:36:30,355 --> 00:36:32,295
The the treatments that's used is

971
00:36:32,674 --> 00:36:33,155
is this,

972
00:36:34,434 --> 00:36:37,894
tarsine kinase inhibitor, Gleevec. That's the trade name.

973
00:36:38,355 --> 00:36:38,835
But,

974
00:36:40,594 --> 00:36:42,114
you know, you need the technology to be

975
00:36:42,114 --> 00:36:44,010
able to do that assay. So so so

976
00:36:44,010 --> 00:36:44,590
there are

977
00:36:45,130 --> 00:36:45,869
there are

978
00:36:47,050 --> 00:36:49,769
such devices out there. There's this big one,

979
00:36:49,769 --> 00:36:50,510
the Cepheid,

980
00:36:50,890 --> 00:36:53,309
and it's does quantitative PCR,

981
00:36:55,690 --> 00:36:58,824
polymerase chain reaction, but it's very expensive.

982
00:36:59,444 --> 00:37:01,224
So so, you know, you can imagine

983
00:37:03,045 --> 00:37:04,585
that sort of assay with

984
00:37:05,045 --> 00:37:07,525
a simple nano dot type assay where you

985
00:37:07,525 --> 00:37:08,025
can

986
00:37:08,324 --> 00:37:09,844
do, you know, read it out just in

987
00:37:09,844 --> 00:37:11,704
a small reader because it's so bright

988
00:37:12,005 --> 00:37:13,065
and and very sensitive

989
00:37:13,500 --> 00:37:16,460
and specific, then, you know, you can that

990
00:37:16,460 --> 00:37:19,019
opens the doorway to do screening. So I

991
00:37:19,019 --> 00:37:21,119
think this falls into a general

992
00:37:22,619 --> 00:37:23,280
a general,

993
00:37:23,900 --> 00:37:27,199
approach in in the public health space where

994
00:37:27,654 --> 00:37:30,214
you've got it it's very in some cases,

995
00:37:30,214 --> 00:37:33,434
very advantageous to combine screening with treatment.

996
00:37:33,815 --> 00:37:34,315
Right?

997
00:37:34,694 --> 00:37:36,454
Yeah. And and to do that, you need

998
00:37:36,454 --> 00:37:38,694
the right screening tools and you need the

999
00:37:38,694 --> 00:37:40,154
right treatment tools available

1000
00:37:40,480 --> 00:37:42,719
real time in the clinic. And an example

1001
00:37:42,719 --> 00:37:45,380
of that is the cervical cancer case where

1002
00:37:45,840 --> 00:37:46,500
there are,

1003
00:37:46,960 --> 00:37:48,420
you know, there are screening

1004
00:37:49,039 --> 00:37:49,940
tools available,

1005
00:37:51,119 --> 00:37:53,680
you know, but you need devices available as

1006
00:37:53,680 --> 00:37:54,180
well-to-do

1007
00:37:55,085 --> 00:37:57,565
treatment of early stage disease on-site. And if

1008
00:37:57,565 --> 00:37:58,864
you can't do both of those

1009
00:37:59,324 --> 00:38:01,164
together, it's gonna be very difficult in some

1010
00:38:01,164 --> 00:38:03,164
of these under resourced areas of the world.

1011
00:38:03,164 --> 00:38:04,384
Right? Like,

1012
00:38:04,844 --> 00:38:07,164
it it might work in North America. Right?

1013
00:38:07,164 --> 00:38:09,344
Like, patient comes in, you do a screening,

1014
00:38:10,299 --> 00:38:13,199
they find they find some evidence of disease,

1015
00:38:13,420 --> 00:38:15,359
so the patient comes back a week later

1016
00:38:15,420 --> 00:38:16,960
and gets the treatment. Right?

1017
00:38:17,739 --> 00:38:19,039
You can't do that

1018
00:38:21,019 --> 00:38:21,500
in

1019
00:38:21,900 --> 00:38:24,114
right? You right? If you can't do that

1020
00:38:24,114 --> 00:38:26,434
and you got I I agree. Yeah. It

1021
00:38:26,434 --> 00:38:29,234
just doesn't work. Yeah. There's you know, in

1022
00:38:29,234 --> 00:38:30,054
most cases.

1023
00:38:30,594 --> 00:38:32,694
You send somebody away, they're you know,

1024
00:38:33,474 --> 00:38:33,974
it's

1025
00:38:34,355 --> 00:38:35,820
a good chance they can't come back.

1026
00:38:36,619 --> 00:38:39,039
I know. I I agree with you. Like,

1027
00:38:39,500 --> 00:38:41,119
if you can have that combination

1028
00:38:41,579 --> 00:38:43,820
in in the environments that we are familiar

1029
00:38:43,820 --> 00:38:44,320
with,

1030
00:38:44,699 --> 00:38:46,960
I think that's, like, a huge game changer

1031
00:38:47,019 --> 00:38:49,739
for how these diseases would be managed, you

1032
00:38:49,739 --> 00:38:50,204
know,

1033
00:38:50,765 --> 00:38:52,385
in in in those places.

1034
00:38:52,684 --> 00:38:54,144
Yeah. Eric is right.

1035
00:38:56,125 --> 00:38:57,425
Okay. And then

1036
00:38:57,724 --> 00:38:59,505
the final chapter of the book

1037
00:39:00,364 --> 00:39:01,744
considers the education

1038
00:39:02,204 --> 00:39:03,825
of current and future

1039
00:39:04,364 --> 00:39:05,344
medical physicists,

1040
00:39:05,789 --> 00:39:06,289
radiotherapists,

1041
00:39:07,550 --> 00:39:08,050
oncologists,

1042
00:39:08,429 --> 00:39:08,929
etcetera.

1043
00:39:10,269 --> 00:39:12,510
Can you comment on the challenges with this

1044
00:39:12,510 --> 00:39:14,130
and and how this could be addressed?

1045
00:39:17,914 --> 00:39:19,914
I I think we've I reckon I we've

1046
00:39:19,914 --> 00:39:22,954
hinted at this, like, throughout, like, our, you

1047
00:39:22,954 --> 00:39:24,014
know, this conversation

1048
00:39:24,554 --> 00:39:27,135
that it's it's it's very clear that,

1049
00:39:28,394 --> 00:39:30,954
in in low and middle income countries or

1050
00:39:30,954 --> 00:39:33,534
underserved communities, we have, like, you know,

1051
00:39:34,160 --> 00:39:34,660
understaffing,

1052
00:39:35,440 --> 00:39:37,860
which relates back to, you know,

1053
00:39:38,720 --> 00:39:40,660
how many people are being trained,

1054
00:39:41,039 --> 00:39:43,200
you know, to do the work in in

1055
00:39:43,200 --> 00:39:44,500
in radiation therapy.

1056
00:39:45,119 --> 00:39:46,340
And I think,

1057
00:39:47,844 --> 00:39:50,324
in in our field, you know, in radiation

1058
00:39:50,324 --> 00:39:52,184
oncology, in medical physics,

1059
00:39:52,485 --> 00:39:54,085
we have a lot of, like, you know,

1060
00:39:54,244 --> 00:39:54,744
stakeholders

1061
00:39:55,204 --> 00:39:57,305
or, you know, individuals who are very,

1062
00:39:57,765 --> 00:40:01,465
interested in reaching out to these communities to

1063
00:40:01,880 --> 00:40:05,180
help fill that gap of education and training.

1064
00:40:05,880 --> 00:40:07,660
The several, you know, NGOs,

1065
00:40:08,119 --> 00:40:08,599
our,

1066
00:40:08,920 --> 00:40:10,460
you know, professional organizations,

1067
00:40:11,320 --> 00:40:13,340
the American Society For Aviation,

1068
00:40:13,800 --> 00:40:17,019
for American Society For Physicists and Medicine,

1069
00:40:17,484 --> 00:40:20,304
and then ASTRO, you know, are very,

1070
00:40:21,324 --> 00:40:22,385
involved in,

1071
00:40:24,925 --> 00:40:25,425
committees

1072
00:40:25,885 --> 00:40:26,864
that, you know,

1073
00:40:27,164 --> 00:40:27,984
reach out

1074
00:40:28,525 --> 00:40:31,070
to lower and middle income countries. We have

1075
00:40:31,070 --> 00:40:32,750
Eric and I, we're in this committee in

1076
00:40:32,750 --> 00:40:35,969
APM where it's called the ICAMP, the International

1077
00:40:36,110 --> 00:40:37,409
Council For,

1078
00:40:37,710 --> 00:40:39,730
you know, associate mentorship program,

1079
00:40:40,110 --> 00:40:40,989
where it is,

1080
00:40:41,630 --> 00:40:45,329
designed to get early career physicists involved,

1081
00:40:46,385 --> 00:40:48,644
for, you know, training and education

1082
00:40:48,945 --> 00:40:51,105
for, you know, physicists in low and middle

1083
00:40:51,105 --> 00:40:52,005
income countries.

1084
00:40:53,105 --> 00:40:55,264
So there's a clear gap. You know, there's

1085
00:40:55,264 --> 00:40:57,204
a clear need to train,

1086
00:40:58,065 --> 00:40:58,500
folks.

1087
00:40:59,300 --> 00:41:01,219
One of the reasons could be the,

1088
00:41:01,619 --> 00:41:02,599
lack of access

1089
00:41:03,300 --> 00:41:06,420
to these technologies that are otherwise available in

1090
00:41:06,420 --> 00:41:07,559
high income countries,

1091
00:41:07,860 --> 00:41:09,780
but are not available, you know, in low

1092
00:41:10,179 --> 00:41:11,800
you know, middle income countries.

1093
00:41:12,114 --> 00:41:14,355
Because if you read textbooks and you don't

1094
00:41:14,355 --> 00:41:15,974
have the, you know,

1095
00:41:16,275 --> 00:41:16,775
opportunity

1096
00:41:17,075 --> 00:41:20,614
to practice hands on, it doesn't really translate

1097
00:41:20,835 --> 00:41:23,235
very well. Right? And so one of the

1098
00:41:23,235 --> 00:41:25,875
ways that, you know, AI could help fill

1099
00:41:25,875 --> 00:41:28,920
this gap is having virtual education,

1100
00:41:29,300 --> 00:41:29,940
you know,

1101
00:41:30,260 --> 00:41:30,760
VR

1102
00:41:31,140 --> 00:41:34,199
type of trainings that can give folks this

1103
00:41:34,260 --> 00:41:35,480
hands on practical,

1104
00:41:36,099 --> 00:41:37,079
you know, approach,

1105
00:41:37,699 --> 00:41:38,760
to learning.

1106
00:41:39,525 --> 00:41:41,444
Or, one of the things that, you know,

1107
00:41:41,444 --> 00:41:43,525
Eric is such a good advocate for is,

1108
00:41:43,525 --> 00:41:45,144
like, having those bidirectional,

1109
00:41:45,605 --> 00:41:46,085
you know,

1110
00:41:46,644 --> 00:41:49,444
knowledge transfer. So, for example, we went to

1111
00:41:49,444 --> 00:41:51,924
Uganda to learn from them. We're gonna bring

1112
00:41:51,924 --> 00:41:54,339
some folks to our clinic to learn from

1113
00:41:54,339 --> 00:41:56,679
us and look at you know, like, observe

1114
00:41:56,739 --> 00:41:59,699
how we practice, like, in our setting. It

1115
00:41:59,699 --> 00:42:01,480
is very important to give folks

1116
00:42:01,859 --> 00:42:04,579
that, you know, opportunity to get to see

1117
00:42:04,579 --> 00:42:06,760
that because it cannot be one-sided.

1118
00:42:07,139 --> 00:42:09,535
Right? We know what goes on. It's good

1119
00:42:09,535 --> 00:42:11,535
to have people learn what goes on here

1120
00:42:11,535 --> 00:42:13,375
so they can take it with them so

1121
00:42:13,375 --> 00:42:15,215
that they can, you know, practice in their

1122
00:42:15,215 --> 00:42:15,715
clinic

1123
00:42:16,015 --> 00:42:19,235
be depending on what resources are available

1124
00:42:19,775 --> 00:42:22,434
to them. So there's that, you know, challenge,

1125
00:42:23,420 --> 00:42:25,260
and and a lot of works that are

1126
00:42:25,260 --> 00:42:27,519
going on to support that.

1127
00:42:28,539 --> 00:42:30,860
Then I'll let Eric, you know, chime in

1128
00:42:30,860 --> 00:42:32,740
in as well with his thoughts. Yeah. No.

1129
00:42:32,740 --> 00:42:35,739
I totally agree. I don't have much more

1130
00:42:35,739 --> 00:42:38,364
to add to that. The need is huge.

1131
00:42:38,364 --> 00:42:40,304
I agree. I mean, I I guess,

1132
00:42:41,484 --> 00:42:43,824
if you think about a future where,

1133
00:42:45,244 --> 00:42:45,905
you know,

1134
00:42:46,364 --> 00:42:48,684
AI plays more of a role hopefully in

1135
00:42:48,684 --> 00:42:50,760
a positive way, we hope.

1136
00:42:51,800 --> 00:42:53,179
You know? But,

1137
00:42:54,840 --> 00:42:56,920
how do we make sure that it's doing

1138
00:42:56,920 --> 00:42:59,000
the job that it's supposed to do? Well,

1139
00:42:59,000 --> 00:43:00,539
you know, we need a

1140
00:43:01,159 --> 00:43:03,340
workforce of highly trained experts

1141
00:43:03,795 --> 00:43:06,135
who can oversee and manage the

1142
00:43:06,914 --> 00:43:09,714
the operations of of all these assistive tools

1143
00:43:09,714 --> 00:43:11,815
that we have. You know, for example, like,

1144
00:43:12,114 --> 00:43:14,194
you know, the products that are FDA cleared

1145
00:43:14,194 --> 00:43:15,175
now for mammography,

1146
00:43:15,714 --> 00:43:17,335
for AI reads of mammography

1147
00:43:18,559 --> 00:43:21,619
are often operating in combination with a radiologist.

1148
00:43:21,840 --> 00:43:23,780
Right? So it's not like the

1149
00:43:24,239 --> 00:43:26,820
the technology is just out there doing everything

1150
00:43:26,880 --> 00:43:28,880
in the autopilot mode. No. It needs some

1151
00:43:28,880 --> 00:43:31,199
oversight, and you need, you know, highly trained

1152
00:43:31,199 --> 00:43:33,965
people to Yeah. Be there working alongside it.

1153
00:43:33,965 --> 00:43:35,644
So it it's like it's almost like the

1154
00:43:35,644 --> 00:43:37,925
education need becomes even more with all these

1155
00:43:38,285 --> 00:43:39,025
Yeah. Tools.

1156
00:43:39,565 --> 00:43:40,065
Exactly.

1157
00:43:40,605 --> 00:43:43,244
And troubleshoot. Like, when something goes wrong, if

1158
00:43:43,244 --> 00:43:44,545
you're not well trained,

1159
00:43:45,320 --> 00:43:47,719
how how can you, you know, troubleshoot, like,

1160
00:43:47,719 --> 00:43:50,300
an AI device or an AI software?

1161
00:43:50,840 --> 00:43:52,840
You know? Or how do you even interpret

1162
00:43:52,840 --> 00:43:55,480
the results that that AI software is giving

1163
00:43:55,480 --> 00:43:57,400
you? Like, when do you know when to

1164
00:43:57,400 --> 00:43:59,500
double check it? Do you, like, take whatever

1165
00:44:00,005 --> 00:44:02,085
AI, like, output the AI software is giving

1166
00:44:02,085 --> 00:44:04,724
you as face value? Or Mhmm. You train

1167
00:44:04,965 --> 00:44:07,684
well trained enough to understand and interpret, you

1168
00:44:07,684 --> 00:44:10,244
know, those results. Totally. Yeah. It's that kind

1169
00:44:10,244 --> 00:44:12,085
of, like, unknown unknown. You know? Like, how

1170
00:44:12,085 --> 00:44:12,985
do you exactly.

1171
00:44:13,285 --> 00:44:15,579
Right? Like, you don't even know when to

1172
00:44:15,579 --> 00:44:17,579
ask the question sometime. Yeah. That's when you

1173
00:44:17,579 --> 00:44:19,679
really get into a danger. Yeah. Yeah.

1174
00:44:21,099 --> 00:44:23,260
So AI is gonna make a big difference,

1175
00:44:23,260 --> 00:44:25,340
but we still need the staff to ensure

1176
00:44:25,340 --> 00:44:26,639
that it's working properly.

1177
00:44:27,019 --> 00:44:27,519
Absolutely.

1178
00:44:28,139 --> 00:44:31,034
Without a doubt. Yeah. And then my final

1179
00:44:31,034 --> 00:44:33,295
question for you is, who are the targeted

1180
00:44:33,355 --> 00:44:34,655
readers for your book?

1181
00:44:37,195 --> 00:44:39,514
I think it's a wide spectrum of people

1182
00:44:39,514 --> 00:44:41,514
who might be interested in the topics in

1183
00:44:41,514 --> 00:44:44,414
this book. Mhmm. Health care professionals for sure

1184
00:44:44,750 --> 00:44:47,409
in the oncology space, but also beyond,

1185
00:44:48,670 --> 00:44:51,329
people in radiation oncology space for sure.

1186
00:44:52,429 --> 00:44:54,670
Public health, people interested in public health and

1187
00:44:54,670 --> 00:44:56,829
policy, I think you really benefit for some

1188
00:44:56,829 --> 00:44:59,244
of the ideas here. I'm also hoping that,

1189
00:45:00,265 --> 00:45:01,405
you know, some engineers

1190
00:45:01,785 --> 00:45:03,704
and people in the industry will pick this

1191
00:45:03,704 --> 00:45:07,144
up because Yeah. You know, there there's many

1192
00:45:07,144 --> 00:45:09,625
lessons here to be learned, many examples and

1193
00:45:09,625 --> 00:45:10,765
many sort of,

1194
00:45:11,710 --> 00:45:13,489
you know, paradigms for how

1195
00:45:13,950 --> 00:45:15,950
to think about the issues that I think

1196
00:45:15,950 --> 00:45:16,610
are productive.

1197
00:45:17,309 --> 00:45:17,710
Yeah.

1198
00:45:18,670 --> 00:45:20,989
You know, we talked about trainees, like Kaffia

1199
00:45:20,989 --> 00:45:21,969
was saying, but

1200
00:45:22,269 --> 00:45:23,250
the next generation,

1201
00:45:23,550 --> 00:45:25,309
early career people with an interest in this

1202
00:45:25,550 --> 00:45:26,110
these things

1203
00:45:26,804 --> 00:45:29,284
Yeah. I think, you know, they benefit from

1204
00:45:29,284 --> 00:45:30,025
reading through

1205
00:45:30,565 --> 00:45:31,304
these things.

1206
00:45:32,085 --> 00:45:32,585
Yeah.

1207
00:45:33,045 --> 00:45:35,605
Yeah. Okay. Great. Well, I mean, if our

1208
00:45:35,605 --> 00:45:38,085
listeners want to find out more, you can

1209
00:45:38,085 --> 00:45:39,704
find the ebook, Humanitarian

1210
00:45:40,164 --> 00:45:41,864
Engineering for Global Oncology,

1211
00:45:42,260 --> 00:45:43,159
on the IOPscience

1212
00:45:43,539 --> 00:45:44,039
website,

1213
00:45:44,579 --> 00:45:46,819
and it's part of the IOP book series

1214
00:45:46,819 --> 00:45:49,079
in Global Health and Radiation Oncology.

1215
00:45:49,619 --> 00:45:50,519
So take a look.

1216
00:45:51,219 --> 00:45:54,339
So, well, thanks again, Eric and Ofia, for

1217
00:45:54,339 --> 00:45:56,775
speaking with us today. Thank you. Thank you

1218
00:45:56,775 --> 00:45:58,234
for giving us the opportunity.

1219
00:45:58,694 --> 00:45:59,755
Great to be here.

1220
00:46:06,855 --> 00:46:09,894
That was Afiya York and Eric Ford of

1221
00:46:09,894 --> 00:46:11,594
the University of Washington,

1222
00:46:12,170 --> 00:46:13,550
and they were in conversation

1223
00:46:13,930 --> 00:46:16,110
with Physics World's Tammy Freeman.

1224
00:46:16,650 --> 00:46:19,789
Thanks to all 3 for a fascinating discussion.

1225
00:46:20,570 --> 00:46:22,329
I'm afraid that's all the time we have

1226
00:46:22,329 --> 00:46:23,630
for this week's podcast.

1227
00:46:24,010 --> 00:46:27,230
A special thanks to our producer, Fred Iles.

1228
00:46:27,905 --> 00:46:29,984
We'll be back again next week. But in

1229
00:46:29,984 --> 00:46:30,644
the meantime,

1230
00:46:31,025 --> 00:46:33,505
do check out the latest episode of the

1231
00:46:33,505 --> 00:46:35,525
Physics World Stories podcast.

1232
00:46:36,224 --> 00:46:39,445
Host Andrew Glester meets Mark Levinson,

1233
00:46:40,110 --> 00:46:40,769
a former

1234
00:46:41,150 --> 00:46:41,650
theoretical

1235
00:46:42,030 --> 00:46:43,090
particle physicist

1236
00:46:43,470 --> 00:46:45,170
who is now an acclaimed

1237
00:46:45,550 --> 00:46:46,050
filmmaker.

1238
00:46:46,910 --> 00:46:49,250
They chat about his latest work,

1239
00:46:49,550 --> 00:46:52,130
The Universe in a Grain of Sand,

1240
00:46:52,545 --> 00:46:53,764
which has been described

1241
00:46:54,065 --> 00:46:55,605
as a visually rich

1242
00:46:55,905 --> 00:46:56,405
meditation

1243
00:46:57,025 --> 00:46:58,964
on how science and art

1244
00:46:59,425 --> 00:47:02,324
both strive to make sense of the natural

1245
00:47:02,464 --> 00:47:02,964
world.

1246
00:47:03,585 --> 00:47:04,244
The episode

1247
00:47:04,545 --> 00:47:07,284
is called From Physics to Filmmaking,

1248
00:47:08,199 --> 00:47:09,019
Mark Levinson

1249
00:47:09,559 --> 00:47:10,539
on his new

1250
00:47:10,920 --> 00:47:11,420
documentary.

1251
00:47:12,119 --> 00:47:14,119
And you can find it on the Physics

1252
00:47:14,119 --> 00:47:15,019
World website

1253
00:47:15,320 --> 00:47:17,099
or at your favorite

1254
00:47:17,400 --> 00:47:18,460
podcast provider.