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Case study: Elekta

Elekta showcases governments’ critical role in disruptive healthcare technology. By Giulia Thompson, head of system physics, Elekta.

About your organisation 

Elekta is a leader in precision radiation medicine. Our 4,000+ employees worldwide are committed to ensuring everyone in the world with cancer has access to – and benefits from – more precise, personalised radiotherapy treatments. With approximately 800 people, Elekta’s largest site for research and development (R&D) and manufacturing is in Crawley, UK.

What are the physics-based technologies that you are developing in your business?

Elekta has been pioneering the integration of imaging with the radiotherapy delivery system, image-guided radiation therapy (IGRT), to improve precision and accuracy of treatment. IGRT combines linear electron accelerator (linac) technology, radiation beam control, monitoring and shaping, imaging, dose calculation algorithms, and machine and patient quality assurance (QA).

What was your innovation journey like?

Almost 20 years ago, Elekta introduced the first medical linac with 3D x-ray imaging capability, through customer collaboration. Collaborative research continued to propel IGRT innovation, with a new concept of a linac integrated with a high-field 1.5 Tesla (T) magnetic resonance imaging (MRI) system pioneered by University Medical Centre Utrecht (UMCU) in the Netherlands.

MRI provides superior soft-tissue image contrast and real-time imaging simultaneously with treatment. Advanced MRI techniques can be used to assess tumour response assessment all without patient exposure to x-rays. While this was conceived in 1999, real progress was enabled by the Dutch government’s funding of UMCU to work with Elekta and Philips (our MR technology partner) in 2007.

In 2009, the first prototype installation enabled the proof of concept and pioneering research by UMCU, resulting in substantial further investment by Elekta.

Elekta Unity patient in magnetic resonance imaging scanner

A patient and the Elekta Unity MRI scanner

In 2012 the Elekta MR-linac Consortium was founded, counting leading cancer centres around the world, including in the UK the Institute of Cancer Research (ICR) and Royal Marsden NHS Foundation Trust (RMH), and The Christie NHS Foundation Trust, among it members. External funding received by ICR (a £10m Medical Research Council grant, with additional support from The Royal Marsden Cancer Charity) enabled the system installation at ICR/RMH.

The significant development effort enabled Elekta to benefit from R&D tax credits/incentives, which supported the business case and further investment in innovation.

In 2018, the commercial product, Elekta Unity, was CE-marked. Within Elekta, a cross-functional team of nearly 300 people were involved globally, with the Crawley site leading the effort as the system integrator. Recently, Elekta received the 100th order of the system from St George’s Hospital in Christchurch, New Zealand. Looking back at our innovation journey, this is truly an amazing milestone, making us extremely proud that our Unity technology is now helping patients in 14 countries, across five continents.

“Elekta Unity is enabling new paradigms in radiation oncology, delivering treatment with unprecedented visual confidence and opening future opportunities for real-time personalised treatment therapy.”

– Kevin Brown, distinguished scientist, Elekta

What is your approach to achieving physics-based innovation?

Committing to such a big project whilst also maintaining our existing product portfolio presented a challenge and so capital was invested to increase our R&D spend, which enabled us to develop the necessary capabilities.

We also faced key technical challenges relating to (a) the effect of the high magnetic field (1.5T) from the MRI system on the linac radiation beam generation and (b) the mutual effect of strong radiofrequency (RF) fields on treatment delivery and image quality. In order to overcome these challenges, (a) the design of a typical diagnostic MRI system was significantly modified by Philips, to minimise its impact on the linac; (b) the linac design was substantially modified by Elekta to enable its correct operation in the magnetic field (e.g. by selecting MR-compatible materials); (c) an RF cage integral to the MR scanner was designed to remove mutual interferences.

Additionally, the use of MR technology in a different application posed new manufacturing challenges, which resulted in the requirement of new performance specifications. Another challenge was the lack of suitable third-party, off-the-shelf QA tools, which we therefore had to develop in-house instead.

The innovation also introduced challenges for clinical users, who were facing a new treatment paradigm. The MR-linac research consortium enabled our customers to investigate, gather and publish evidence, and share experiences and best practices. As an expert working group, the consortium provided other clinics with guidance and a path to adoption of the new technology, as a first step towards developing clinical evidence that will form the basis of differential reimbursement for this technology.

The addition of MR imaging during the treatment is increasing the associated costs and therefore will require an additional reimbursement from payers in order to be sustainable. However, to implement this additional reimbursement we need to demonstrate that this technological innovation improves clinical outcomes and this is why clinical evidence development is a crucial step.

A radiographer from Elekta Unity planning a consultation with patient next to computer screens

A radiographer planning consultation

How have you gained the skills and knowledge to drive out innovation?

Elekta’s strong partnership with Philips, as well as having Philips staff seconded at Elekta, was key to the success of MR and radiotherapy technology (RT) as our respective skills are complementary. To drive MR-guided radiotherapy, it was very important to work with a diagnostic leading company like Philips.

Our understanding of customer requirements was also greatly enhanced by having our physicists and engineers working closely with the research consortium scientists, with some Elekta staff even based on site.

We recruited outside of our traditional radiotherapy domain and added MRI experts (physicists, radiographers and engineers) to our R&D teams, as well as to other areas of the organisation, e.g., operations and product management.

“Elekta Unity is an example of how governments can play a critical role in enabling the development and introduction of disruptive technology in healthcare.”

– Kevin Brown, distinguished scientist, Elekta

What has the result of your journey been?

Elekta Unity is enabling new paradigms in cancer care. High-field (1.5T) MRI guidance enables clinicians to:

  • quickly assess and adapt the radiotherapy treatment, with the potential for higher dose to the tumour;
  • reduce toxicity for healthy tissues; and
  • reduce visits for the patient to the cancer centre.

To date, 26 Elekta Unity systems are clinically operational around the world and more than 2,000 patients have been treated. The system has been used for the treatment of over 30 different anatomical sites. More than 360 scientific papers have been published. Unity has generated a whole new business line for Elekta, with a triple-figure growth of employees in the UK. The main competency centre for the new technology system is in Crawley, with new state-of-the-art facilities and teams covering the whole lifecycle, from research to supply, installation and maintenance.

From the original concept to a commercial product in clinical use, the innovation journey of Elekta Unity has taken almost 20 years and is still evolving.

Moreover, we have created a platform that is supporting new exciting research. An example of this is the use of imaging biomarkers to determine the individual’s response to their therapy and to adapt their treatment accordingly, leading towards increasingly personalised care for cancer patients.

Elekta MR-linac radiation beam

MR-linac radiation beam and magnetic field illustration

What tips would you give to businesses developing commercial services underpinned by physics and requiring innovation?

1. Strong partnerships with technology, research, and clinical organisations, alongside team cross-functionality (e.g., with physicists, engineers, radiographers, oncologists and regulatory experts), are key to success.

2. External funding, e.g., from government or charities, is critical for initial de-risking of new technology and support of early users.

  • These case studies were commissioned by the IOP from CBI Economics