RAYSEARCH | REVIEW | 2019
2019 IN NUMBERS
A YEAR OF COLLABORATIVE INNOVATION RaySearch is committed to advancing cancer treatment through innovation. Our advanced software systems are developed from the ground up by RaySearch experts in research, development, and machine learning, as well as in collaboration with leading industry and clinical partners. Our company reached several milestones in 2019. For example, we celebrated the tenth anniversary of our treatment planning system RayStation*, expanded into exciting new markets and segments, received FDA clearance for machine-learning functionality* and announced that we are moving to new headquarters. In these pages, we look back over a year of collaborative innovation and forward to many more to come.
2019 IN NUMBERS
622
11
in 39 countries
around the world
RAYSTATION CENTERS
8
373
in 5 countries
as of December 2019
RAYCARE PARTNERS
RAYSEARCH EMPLOYEES
56
195
use RayStation
in research and/or development
PARTICLE THERAPY CENTERS
EMPLOYEES
18
24
worldwide
of RaySearch staff
GRANTED PATENTS
NATIONALITIES
19
39
with clinics, universities and equipment manufacturers
of RaySearch staff
PARTNERSHIPS
*Subject to regulatory clearance in some markets.
RAYSEARCH OFFICES
AVERAGE AGE
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SUMMARY OF CONTENTS
CONTENTS 04
LETTER FROM THE CEO
06 2019 IN REVIEW FEATURED ARTICLES
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INNOVATION AT RAYSEARCH RaySearch continues to transform specialist healthcare with breakthrough innovation by foregoing a conventional R&D setup. Research:
12 LONG-TERM THINKING CALLS FOR CLEAR PRIORITIZATION Development:
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ACCELERATED DEVELOPMENT: THE POWER OF PARTNERSHIPS Machine learning:
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GOING MAINSTREAM WITH MACHINE LEARNING
PAGE 16 Head of machine learning Fredrik Lรถfman (far left) and some members of his team.
OUR PRODUCTS
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DESIGNED TO PLAY WELL WITH OTHERS Learn of the latest news and enhancements in RayStation, RayCommand and RayCare. RayStation:
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NEW HORIZONS IN TREATMENT PLANNING RayPlan:
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UPGRADING PATIENT CARE RayCommand:
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MEETING DEMAND HEAD ON
PAGE 20 Connecting systems can drive innovation,reach and quality of care.
RayCare:
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AUTOMATED SUPPORT
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SERVICE GOES GLOBAL Niclas Borglund, Director of Service, discusses how the Service team is growing and the skills his personnel need to deliver world-class frontline support.
Production: RaySearch Laboratories Photographers: Petter Karlberg, Jonas Eng, Sander de Wilde and Lou Russo Printers: ร tta.45 Tryckeri AB Paper: Munken Kristall 150g (inlay) and 300g (cover) This magazine is printed through a sustainable process.
SUMMARY OF CONTENTS
GLOBAL MARKETS
34 RAYSTATION AROUND THE WORLD 38 MARKET FOCUS: GERMANY AND AUSTRIA 40 MARKET FOCUS: ASIA PARTNERSHIPS
42 ACCELERATING ONCOLOGY INNOVATION Ida Blom, business relationship manager, discusses the importance of partnerships to oncology innovation. PAGE 30 RaySearch delivers world-class frontline support.
44 INDUSTRY PARTNERS 46 CLINICAL ADVISORY BOARD HR SUPPORTING COMPANY GROWTH
50 SUPPORTING COMPANY GROWTH AND TRANSFORMATION HR manager Lotta Larsson and her team support company growth in several ways — most recently with organizational transformation and sustainable leadership. The working environment:
52 DRIVING AWARENESS Organizational transformation:
54 LONG-TERM VALUE CREATION PAGE 50 Organizational transformation and sustainable leadership.
58 20 YEARS OF INNOVATION 60 MEET OUR MANAGEMENT TEAM 62 REACHING NEW HEIGHTS
WHY RAYSEARCH PAGE 18, 28, 48, 56 Read why users use our products.
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letter from the ceo
LETTER FROM THE CEO INNOVATE, CONSOLIDATE, ACCELERATE That mantra served RaySearch well in 2019, a year of significant achievement and progress across all our activities: research, development, clinical validation and customer service. Through 2020, we will intensify our collective endeavors as RaySearch approaches its 20th anniversary with an ambitious development roadmap that will drive new-customer acquisition and compelling growth opportunities.
Johan Löf Founder and CEO
RELENTLESS INNOVATION The pace of innovation across the RaySearch product portfolio shows no sign of slowing— the result of our sustained investments in R&D and ongoing collaboration with our global network of clinical and technology partners. We ended 2019 with the 9B release of our treatment planning system RayStation. Among a raft of enhancements is a new module for chemotherapy treatment planning*— the first step of many beyond RaySearch's core domain of radiation oncology. Last year also saw machine learning functionality being put through its paces by clinical customers. The Princess Margaret Cancer Centre in Canada is now treating prostate cancer patients using machine-learning-generated plans in RayStation**— a world first. Now two years old, our next-generation oncology information system RayCare is generating interest from clinics around the world. RayCare customers added in 2019 include the Swiss Medical Network, one of Switzerland’s two largest private clinic groups; Yonsei Cancer Center in Seoul, South Korea; and Provision CARES Proton Therapy Center in Florida, US. Carrying that momentum into 2020, we achieved a significant milestone in February for our strategic collaboration with IBA when we completed all validation tests for the integration of RayCare with the vendor’s proton therapy system. Testing took place at the UZ Leuven Hospital in Belgium and represented a crucial step in the hospital’s roll-out of proton therapy for the treatment of cancer patients. * Subject to regulatory clearance in some markets. ** Plan review, approval and export were performed in the clinically
deployed version available on the Canadian market.
letter from the ceo
Development of our treatment control system, RayCommand*, is also proceeding to plan, with initial commercial release scheduled for December 2020. For the end user, RayCommand represents a technology for online adaptive radiotherapy, offering unified control and management of key systems in the treatment room — including the treatment machine, patient couch, imaging systems and patient positioning devices. CONSOLIDATE AND DIVERSIFY Consolidation was another defining theme for us in 2019, with the research, development and machine learning teams laying the groundwork for significant diversification of our product offering. In December, we will release RayIntelligence, a suite of data-driven products (RayData, RayAnalytics and RayMachine) that will give clinics the robust data infrastructure they need to fast-track implementation of machine learning across the radiation oncology workflow. RayIntelligence* will integrate with RayStation and RayCare to further optimize and individualize patient treatments. This will be done by learning from prior clinical experience and the work of other cancer centers. Operational management will also benefit, with RayIntelligence using data-driven insights into process bottlenecks, and cost/efficiency issues as the patient moves from reception, consultation and treatment planning all the way into the treatment room and subsequent clinical follow up. There are significant opportunities to fast track the evaluation of treatment response versus tumor control and radiation toxicity. There’s plenty more to come. Our teams are busy specifying software tools to support surgeons in planning surgical procedures* for tumor removal — as well as assisting their work inside the operating theatre. Ultimately, the vision is for RayStation and RayCare to provide a unified system for the planning, optimization and management of combined cancer treatments across multiple modalities — medical, radiation and surgical oncology. SMALL CLINICS, BIG OPPORTUNITIES Commercially, RaySearch continues to operate from a position of strength. 11 of the 20 highest-ranked cancer clinics in the US are RayStation customers. Day in, day out those top-tier clients are redefining what’s possible in radiation oncology and, not surprisingly, they set an exceptionally high bar for their treatment planning systems. Validation aside, it’s gratifying to know that so many pioneering clinics in the US and globally put their trust in RaySearch — our scientists, our engineers and our products.
Conversely, our market share is still limited among smaller clinics in the US. These centers, which account for around 80 percent of the total number of radiation therapy clinics, typically rely on one or two treatment machines sourced from a single supplier. Our task in 2020, as we intensify our efforts to build market share in North America, is to work closely with these smaller clinics. That means demonstrating the operational benefits and clinical impact that RayStation can deliver within their treatment programs. More broadly, it falls to us to show smaller clinics how they can reduce and redirect their capital spending into ongoing software-driven innovation. This strategy will ultimately keep their clinical performance at the cutting edge for longer, giving more patients access to the best possible cancer treatment, wherever they are. IT'S ALL ABOUT THE PEOPLE It’s our close relationship with clinical customers that sets RaySearch apart — whether jointly developing new products and functionality or providing the support and service that users need to deliver enhanced patient outcomes. With this in mind, our North American offices in Silicon Valley and New York City consolidated their presence as regional service hubs in 2019 with a ramped-up schedule of training workshops for RayStation customers. The Silicon Valley office in Santa Clara also provides strong connections to US technology partners such as Accuray, Mevion Medical Systems and ProNova. Closer to home, preparations are gathering pace for the 2021 relocation of RaySearch global headquarters to our own purpose-built office complex located in the Hagastaden life-sciences district in Stockholm. With the company set to pass 400 employees globally by mid-2020, it’s good to know that we have capacity to accommodate up to 800 people, leaving us plenty of scope to grow into our new surroundings over the coming years. Summer 2020 is a very special milestone for RaySearch. In June, it will be 20 years since I launched the company, building the business on the back of my PhD dissertation on the optimization of radiation therapy. It’s been a collective effort all the way and a huge thank you goes out to all our fantastic staff, clinical customers and technology partners. In fact, everyone who’s helped us get from there to here, and of course, where we’re heading next.
Johan Löf Founder and CEO
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2019 IN REVIEW
2019 IN REVIEW 2019 marked the 10th anniversary of the first order of treatment planning system RayStation. The first customer was the proton center Westdeutsches Protonentherapie-zentrum Essen in Germany.
NEW RELEASES RAYSTATION 9A* was released in June
ORDERS AND INSTALLATIONS EUROPE
RayStation was installed at the Isala Oncologisch Centrum in the Netherlands, as well as at five leading cancer clinics in the UK: Cambridge, Cardiff, Manchester, Middlesbrough and Preston. Other major orders came from the Proton Therapy Center in Czechia, AKH Vienna/Medical University of Vienna in Austria, and the Swiss Medical Network in Switzerland, which placed an order for both RayStation and RayCare.
AMERICAS
The Oklahoma Proton Center in Oklahoma City, OK, chose RayStation, as did the Moffitt Cancer Center in Tampa, FL.
ASIA-PACIFIC
RayStation was chosen for the Shanghai Proton and Heavy Ion Center (SPHIC) in Shanghai, China.
2019 with support for treatment machines with dual-layer multi-leaf collimator (MLC) and non-rotating jaws. 9B* was released in December and offers support for chemotherapy planning and next-level machine learning capabilities, as well as further integration with RayCare.
RAYCARE 3A* was released in July 2019 with a new RayCare workflow engine that supports modular patient workflows. This advanced feature enables the evolution of the patient workflow by adding modules of tasks when different clinical decision points are reached. 3B* was released in December and provides new features for managing radiation treatment planning: a plan overview workspace enables further automation of the planning process by utilizing workflows and tasks to trigger RayStation scripts. * Subject to regulatory clearance in some markets.
NEW PARTNERSHIPS RaySearch and Vision RT, a leader in surface guided radiation therapy, entered into a long-term development partnership. The partnership has the potential to improve processes, such as adaptive radiotherapy workflows.
RaySearch and Mevion Medical Systems extended their strategic collaboration to further advance capabilities of the Mevion proton therapy system with HYPERSCAN and the unique Adaptive ApertureÂŽ proton multi-leaf collimator in the treatment planning system RayStation.
Swiss Medical Networks, one of Switzerland's two leading private clinic groups, has joined the RaySearch Clinical Advisory Board as a clinical partner.
2019 IN REVIEW
FIRST PATIENTS TREATED
MARKETS AND SEGMENTS
EVENTS ATTENDED
MedAustron in Austria went clinical with RayStation for carbon-ion therapy. Heidelberg University Hospital in Germany began using RayStation for treatment planning using Monte Carlo photon dose planning and carbon ion therapy. ZON-PTC in the Netherlands entered clinical use with RayStation 8B and HYPERSCAN.
RaySearch entered into a long-term distribution agreement with Medeqi in Russia for RayStation. There is a strong need in the country for improved and upgraded medical equipment.
RaySearch was on show at the annual congress of the European Society for Radiotherapy and Oncology (ESTRO) in Milan, Italy, and at the 58th Annual Conference of the Particle Therapy Co-Operative Group (PTCOG 58) in Manchester, UK.
Anderson Regional Cancer Center becomes the first center in the US to treat cancer patients using RayStation and the TomoTherapy® treatment delivery system. John Hopkins Proton Center at Sibley Memorial Hospital in Washington DC used RayStation together with Hitachi’s proton therapy system. Canada’s Princess Margaret Cancer Centre treated its first ever patients with plans generated with machine-learning generated plans.
RaySearch was awarded a significant supply agreement with the U.S. Department of Veterans Affairs, part of America’s largest integrated health care system, serving nine million veterans each year, of which around 40,000 are newly diagnosed cancer patients.
RaySearch presented the new system releases at the annual meetings of the American Society for Radiation Oncology (ASTRO) in Chicago, IL, at the 61st Annual Meeting of the American Association of Physicists in Medicine (AAPM) in San Antonio, TX, and at the 105th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), also in Chicago, IL.
India’s first proton center treated its first patient with RayStation and IBA’s Proteus®PLUS. Thailand's Lopburi Cancer Hospital became the first in the country to clinically use RayStation with Accuray Radixact®.
RaySearch received new regulatory clearance for RayStation from the Chinese authorities NMPA (previously CFDA). RaySearch can now continue to supply RayStation to customers in China.
Our sales team was present at several high-profile events, such as the Particle Therapy Conference in China, the Asia Oceania Federation of Organizations for Medical Physics (AOFMP) in South Korea, JASTRO and Japanese AAPM Medical Physics in Japan, plus ESTRO meets ASIA in Singapore.
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INNOVATION AT RAYSEARCH
INNOVATION
INNOVATION
INNOVATION Since day one, the RaySearch mission has been to design and deliver groundbreaking technologies that enable oncology teams to deliver the best possible cancer treatment. 20 years on, clues to how we continue to transform specialized healthcare can be found in our capacity for truly breakthrough innovation, which extends beyond the constraints of a conventional R&D setup.
INNOVATION AT RAYSEARCH
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10 INNOVATION AT RAYSEARCH
Collectively, the research, development and machine learning teams at RaySearch account for more than half of all our employees and work closely together to bring advanced systems to market.
Deputy CEO Björn Hårdemark has been instrumental in building up research and development capacities since the company’s early days and remains engaged in knowledge and competence handover between departments. Maintaining a robust innovation capacity across the company is crucial to the ongoing success of RaySearch. For this reason, we have not one, but three innovation departments: research, development and now machine learning. Collectively, these units count for more than half of all our employees and they work closely together to bring our advanced software to market. Principal activities of our researchers span internal projects within image analysis, physics, planning and radiation biology. They also initiate and maintain collaborations with leading cancer clinics worldwide, such as MD Andersson Cancer Center and Massachusetts General Hospital in the US, Princess Margaret Cancer Center in Canada, University Hospital Heidelberg in Germany, and University Medical Center Groningen in the Netherlands. “As an example, we have been working for many years with the team at University Medical Center Groningen on many aspects of proton planning. One interesting area is the use of radiobiological modelling to decide when it is most beneficial to use proton therapy. The university team has developed selection criteria which we together
have made available in RayStation. This contributes to maximizing the benefit of the proton therapy program in the Netherlands.” The goals of the research department are both complex and ambitious. In addition to advancing new functionality, they are involved in reinforcing the credibility of RaySearch within the radiation therapy community by presenting at conferences, writing algorithm descriptions, and performing literature reviews. RaySearch greatly values the allocation of time and resources for exploration and scientific investigation. “By making sure that the researchers are not always involved in the development cycle, they can focus on what they do best, which is investigating and exploring ways to improve cancer treatment. A natural part of innovation that it is difficult to know beforehand is what works for what purpose. Prototyping and working iteratively is often the best way to achieve results; sometimes in unexpected ways.” When the decision is made to include new or improved functionality in an upcoming release, the research and machine learning departments collaborate closely with the development team to make sure that the end result is at once safe, efficient and user friendly. Development is organized into competence groups and scrum teams. The teams are created and changed to fit the development goals for the next few product releases at a time. Established in 2018 and expanded in 2019, the machine learning team at RaySearch is responsible for
INNOVATION AT RAYSEARCH 11
some of last year’s most exciting advancements—including being granted FDA 510(k) clearance for deep-learning organ segmentation and automated planning for a key model. This groundbreaking technology was developed by our in-house machine learning department in collaboration with researchers at the Princess Margaret Cancer Centre and Techna Institute, crystalizing years of cutting-edge research led by medical physicists and computer scientists. RayStation represents the first applications of machine learning in a treatment planning system on the radiation oncology market; producing high-quality radiation treatment plans in only minutes, without the need for any user intervention. “Organizing machine learning separately has been hugely successful. It is a separate set of expertise that sits between research and development. It’s very refreshing to establish a new team with new leadership that is able to come in and get on with developing exciting new capabilities.” With efficiency and quality of care firmly front of mind, a natural progression is for RayStation and RayCare to support all major types of cancer treatment: radiation therapy, chemotherapy, and surgery. RayStation 9B, released in December 2019, offers support for chemotherapy planning with a new module for management and prescription of chemotherapy treatment. “We harness our expertise in planning to support different treatment options. We aim to assist medical professionals with the decision-making process between treatment options. Advanced computerized planning has long
been a natural component in radiation treatment planning. Now, there is a growing interest to apply similar techniques to surgery planning. In a surgical procedure, a lot of decisions are necessarily taken during the procedure itself. But there are many aspects that can be determined ahead of time, and we realize that many of the tools we originally designed for radiation treatment planning can be applied to surgery.” The ambitious aims of the research, development, and machine learning departments at RaySearch creates the constant need for new researchers, developers, and machine learning specialists ready to help us pioneer the next era of healthcare. “We are always keen to hear from talented and motivated people with different personalities, knowledge sets, experiences, and perspectives that can help take our company to the next level.”
JOIN THE FIGHT AGAINST CANCER RaySearch is always keen to hear from potential new employees to get involved with several exciting new products in the pipeline, and countless research projects are ongoing. We need more talented and motivated people to help us pioneer the next frontier of medicine. Joining us will give you a career boost, combined with exciting challenges and the chance to contribute to something truly worthwhile. Check out our career pages on www.raysearchlabs.com
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LONG-TERM THINKING CALLS FOR CLEAR PRIORITIZATION Successful applied research is as much about choice and prioritization as it is about creativity and innovation. Chief science officer Kjell Eriksson discusses the value of a collaborative and dynamic team culture, where scientists and engineers are open to new questions, new ideas and new ways of working.
RESEARCH
PROTOTYPE
DEVELOPMENT
HOW DOES RAYSEARCH TAKE THE LONG VIEW? We must work with all the pieces of the puzzle to see where the field of oncology is heading. It’s easy to see the many possibilities out there and the challenge is to narrow them down and figure out what problems we should start working on. A big part of my role is to prioritize opportunities, working collectively with senior management and the wider steering committee responsible for our product development roadmaps. My team feeds into that prioritization process by managing several of our research collaborations with clinics. We have a lot of prominent research hospitals within the RaySearch network. All of them operate at the cutting-edge of radiation oncology and cancer treatment. They represent an incredible source of ideas and market intelligence for us. HOW IS THE RESEARCH DEPARTMENT ORGANIZED? I lead a team of 24 staff split across three competence groups: physics and radiobiology; planning and optimization; and image analysis and machine learning. We also have three MSc students and two PhD students as part of a long-standing collaboration with the KTH Royal Institute of Technology in Stockholm.
PRODUCTS
Our research staff need to be able to work autonomously. Many of our projects involve one or two people working on a very specific task, though it’s noticeable that as the company grows so too do those project teams. Last year, we had five people working on the development and introduction of our chemotherapy treatment-planning module in RayStation 9B. This is the first time we’ve pushed beyond our core domain of radiation oncology. WHAT’S CHANGED SINCE YOU JOINED RAYSEARCH? I’ve had the opportunity to evolve as an engineer and researcher as the company has grown. These days, my job is to take an overview of all the new developments that we are evaluating and working on. We have maintained our spirit and values as we’ve scaled. People at RaySearch are open to questions, new ideas and new ways of working. HOW DOES AN IDEA BECOME A RELEASE? Ideas for new functionality come from many different directions — from our clinical customers, colleagues in the Service team, sometimes our CEO. We evaluate a new idea before building a prototype that goes out to our clinical partners for testing. If the response is positive, a member of
INNOVATION AT RAYSEARCH 13
Chief science officer Kjell Eriksson (second right) and some members of his team.
the research team will then work closely with colleagues in development to incorporate it into an existing system; performing all the necessary integration, testing and validation along the way. Further down the line, our service colleagues out in the field will gather customer feedback so that we can iterate and optimize the new functionality as needed. HOW DO YOU STAY CLOSE TO WHAT THE CUSTOMERS WANT? Research partnerships with clinical customers play a crucial role in delivering sustained product innovation. Customers have a lot of great ideas and are always seeking better solutions. We can’t run with every new idea, so it’s essential we filter and prioritize rigorously. The annual RayStation User Forum helps in this regard. AND WITH RADIOTHERAPY EQUIPMENT VENDORS? Equipment vendors are another important reference point. A good example is the ongoing work involving staff from the research and development groups to strengthen and diversify our support for a range of particle-therapy techniques and beamlines. Last year, alongside new features for proton and carbon-ion planning, we extended the scope of RayStation to cover boron neutron-capture therapy (BNCT). This emerging modality has shown promise in clinical trials to treat malignant brain tumors, which are difficult to combat with conventional techniques. The BNCT planning application
is the result of collaborations with the BNCT equipment makers Sumitomo Heavy Industries and Neutron Therapeutics. It represents a significant milestone in the wider roll-out of BNCT technology. WHAT ARE YOU LOOKING FORWARD TO? The research effort is proceeding along a number of fronts, though many of the principal drivers are already evident. Automation will continue to transform the radiation oncology workflow in terms of segmentation, treatment planning, as well as clinical decision support using historical data for individualized patient treatment. Our ideas for comprehensive cancer care will also figure prominently, with RayCare enhancing workflow efficiency, resource allocation and quality assurance across medical, radiation and surgical oncology. Another intriguing opportunity is the exploitation of radiobiological effects to expand the ‘therapeutic window’. Examples include the use of hyperthermia treatment to heat a tumor and increase its sensitivity to radiation. Also, the use of FLASH radiation therapy to deliver ultrafast radiation treatment at dose rates several times greater than current clinical norms while minimizing collateral damage to healthy tissue and organs at risk. These advances have significant clinical potential and could become important functional building blocks in future releases of RayStation. Exciting times!
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ACCELERATED DEVELOPMENT: THE POWER OF PARTNERSHIPS Director of development Henrik Friberger is dedicated to product innovation and continuous improvement that benefits clinical customers and enhances patient outcomes. His long-term goal is the convergence and optimization of fragmented workflows by improving efficiency and consistency across treatment management, planning and delivery.
Director of development Henrik Friberger (second right) together with Emil Ekström, Head of Competence; Eeva-Liisa Karjalainen, Vice Product Owner for RayCare; and Malin Larsson, Senior UX Designer.
HOW DOES RAYSEARCH DELIVER INNOVATION? RaySearch is a development company from the ground up. I lead a team of 150 staff who work side by side with colleagues from research and machine learning. We bring together a diverse range of competencies — physicists, computer scientists, application developers, testers, imaging and UI specialists — to deliver new functionality for upcoming software releases. We’re also responsible for the introduction of new products, such as our RayCommand treatment control system. In every case, the priority is clear: deliver innovation and continuous improvement that will benefit clinical customers and ultimately enhance treatment outcomes for cancer patients. HOW DO YOU MAINTAIN INNOVATION ACROSS THE COMPANY? There’s a lot of communication between me and the heads of research and machine learning to make sure we’re all aligned. The more strategic decisions on the product development roadmap involve wider discussions and inputs from the CEO, deputy CEO and chief functionality owners for our systems.
INNOVATION AT RAYSEARCH 15
It’s essential that developments are prioritized, based on what our clinical customers and partners are telling us, as well as our own research and innovation insights. The task then is to deliver them in a structured, consistent way that meets regulatory standards. One of our biggest challenges is to manage necessary trade-offs to ship new products and enhanced functionality at pace. HOW DO YOU KEEP ALIGNED AND COORDINATED? We team up. There’s lots of cross-fertilization and integration across the different departments. We build cross-functional project teams comprising specialists tasked with owning and delivering new functionality and releases out of development and into the market. It’s a fluid and open working model. In fact, the release later this year of our new machine-learning products, collectively badged RayIntelligence, will see staff from my team co-opted into the machine learning group to support the roll-out to customers. DOES YOUR LONG CAREER HELP? It helps a lot. I was employee #6 in spring 2001. I started out as a C++ developer, so to a large extent I know how our products are built and by whom. I used to say that I knew everyone here, what they have done, what they are working on now, and what their skills are. However, we have grown significantly in the last couple of years and it is hard to keep up. Knowing the staff is a real plus when we’re putting together project teams — in terms of getting the right mix of people, domain knowledge and collective capability. It also helps more broadly with personal development and progression, finding new roles and internal career paths for team members. HOW IMPORTANT ARE PARTNERSHIPS? They are crucial and a real differentiator of our mindset here at RaySearch. We develop and introduce new products and functionality by working closely with our clinical customers, making sure we have a diverse mix of partnerships. We collaborate with eight clinical customers on RayCare. Some are large university hospitals that are heavily into research; some are smaller clinics more focused on daily patient throughput. The priority for RayCare in 2020 is to grow the installed base and advance the functionality with the help of these clinical collaborations. It’s a win-win. Our partners get a new release of RayCare every couple of months to road test the software. We get
lots of feedback very early in the development cycle so we can be certain that what we are building will be of value to the customers. 2020 is a big year for RayStation as well. We’re making further enhancements to the machine learning functionality that we successfully released in 2019. We’ll be adding brachytherapy planning by year-end as well as support for Accuray’s robotic CyberKnife treatment system. There are several other new features in the works that we are convinced will be well received by our customers.
It’s really important that our software is snappy, with smooth workflows and access to the tools you need, when you need them. HOW TO KEEP PUSHING BOUNDARIES It starts and ends with our people. There’s a thorough recruitment process to identify bright, talented and passionate candidates who take pride in being software developers. We’re looking for scientists and engineers who are hungry to contribute, who want to keep learning, and who can work independently or with colleagues and partners as the need arises. From there, the focus on innovation is all about recognizing and tapping the benefits that technology can bring — using the latest software methodologies, GPU cards or multithreading, for example, to make our products run as fast as possible. It’s really important that our software is snappy, with smooth workflows and access to the tools you need, when you need them. Just streamlining a computation from one minute to five seconds can make a huge difference to the user. A medical physicist using RayStation can work in a completely different way, maintain focus and generate a much better treatment plan.
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GOING MAINSTREAM WITH MACHINE LEARNING Head of machine learning Fredrik Löfman is on a mission to translate the collective promise of automation and big-data technologies into the clinical and commercial mainstream. In the process, he and his team are rethinking radiation oncology and patient care.
That rewrite is already under way. At the annual congress of the European Society for Radiotherapy and Oncology (ESTRO 38) in Milan in spring 2019, two innovations were front and center for the official European launch of RayStation: automated organ segmentation and automated treatment planning. “In combination, these are core-enabling technologies for the clinical implementation of online adaptive radiotherapy. The end game is personalized treatment plans, tailored to the unique needs of each patient and delivered in minutes rather than hours.” Fast forward a few months to the news that Princess Margaret Cancer Centre (PMCC) in Toronto is treating patients with localized prostate cancer using machine learning-generated plans in RayStation—proof positive that the technology is entering the clinical mainstream. The ongoing phase of the study, results of which will be published formally later this year, presents clinicians with two blinded treatment plans: one manually generated; the other via machine learning. Patients proceed to treatment delivery after standard peer review and quality assurance of the preferred plan. “Things have really taken off for machine learning over the past 18 months. We’ve had lots of interest from established clinical customers, as well as prospective customers and new partners reaching out.” The short-term priority for Fredrik and his colleagues is to maintain pace and capitalize on all the momentum they’ve generated so far. “The algorithms are in place in the products and we have regulatory clearance,” he adds. “We have a portfolio of trained machine-learning models, so the next phase is to scale clinical uptake and gain further validation of machine learning.” Alongside early adopters like PMCC and Massachusetts General Hospital, Fredrik is encouraged to see other prominent RaySearch clinical partners implementing their own
Head of machine learning Fredrik Löfman (far left) and some members of his team.
machine-learning programs. A case in point is the University of Texas MD Anderson Cancer Center, where the team is evaluating machine-learning and analytics tools in RayStation to simplify data extraction in the adaptive workflow for radiotherapy. “This is probably the most data-intensive part of radiation oncology, and the first time we have implemented a prototype to automatically extract data from this workflow and visualize it to support clinical decisions.” IT’S ALL ABOUT THE DATA Down the line, it’s data that’s shaping up to be the biggest barrier to wide-scale adoption of machine learning by radiation oncology clinics—specifically, the availability, accessibility and standardization of patient and workflow data to support optimized treatments and enhanced patient outcomes. Put simply: it doesn’t matter how good the algorithms are if the end user cannot supply the data needed to train the models in clinical practice. With this in mind, Fredrik and his team are road testing RayIntelligence, a trio of data-driven new products. Ray-
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MACHINE LEARNING GOES CLINICAL The first-ever patient radiation therapy treatment plans were generated using machine learning at the Princess Margaret Cancer Center in 2019. All patients suffered from localized prostate cancer and were successfully treated as part of a comprehensive evaluation study by the hospital in Toronto, Ontario. PMCC is one of the largest facilities of its kind in the world. It is a pioneer of medical, surgical and radiation oncology, embracing the latest technologies and international best-practices. RaySearch released machine learning features in RayStation 8B* in late December 2018. The features were developed in collaboration with PMCC medical physicist Dr. Tom Purdie and computer scientist Dr. Chris McIntosh of Toronto’s Techna Institute. These were the first applications of machine learning in a treatment planning system on the radiation oncology market, producing high-quality radiation treatment plans without user intervention. That said, plans are always reviewed and approved by humans before delivery. * Subject to regulatory clearance in some markets.
Data, RayAnalytics and RayMachine will offer clinics the robust data infrastructure they need to fast track implementation of machine learning across the radiotherapy workflow. Slated for release in December 2020, the three products will deliver consolidated data warehousing (RayData); structuring, transformation and dashboarding of data for easier consumption (RayAnalytics); and the pipeline for training, versioning, validation and approval of machine-learning models (RayMachine). “These products will underpin access to machine-learning models across multiple institutions, regionally and globally, while also providing building blocks to centralize and allow models to learn from the vast amounts of data generated by multicenter clinical trials.” THE (NEXT) NEXT BIG THING Fredrik’s machine learning team is set to deliver a datadriven revolution in radiation oncology. The group of 18 scientists and engineers split across planning, imaging and analytics subgroups are drawn from the automotive,
finance and streaming industries. “Medical or healthcare experience is useful but not essential. What we look for in our people is competence first and foremost in building scalable software systems, as well as handling and transforming large quantities of data.” Diversity of skills and domain knowledge is essential given the breadth of opportunities on the RaySearch development roadmap. Near term, there’s a machine-learning prototype for treatment planning in proton therapy that’s due to get its first outing this summer at the Particle Therapy Co-Operative Group (PTCOG) Meeting in Taiwan. “PTCOG is a great venue to give the prototype visibility,” adds Löfman. “We’ll use the opportunity to gather feedback from proton experts who may be interested in collaborating to iterate and optimize the functionality in the clinic.” More broadly, Löfman predicts rapid progress towards fully automated workflows for certain radiotherapy protocols, as well as the use of machine-learning tools to support clinicians with tumor volume delineation — a source of significant uncertainty in treatment planning today. It all points, he concludes, to greater unification in the way that cancer patients are treated: “Although machine learning means that radiation therapy will be more individualized —taking data cues from prior clinical experience and multimodality imaging—it will also mean greater commonality and standardization in the way specific tumors are treated across different clinical institutions.”
18 WHY RAYSEARCH
WHY RAYSEARCH 19
The digital transformation of patient care is a defining characteristic of this era. RaySearch helps alleviate any teething problems in the adoption of technologies such as machine learning, with user-friendly solutions designed to make the health-care sector more efficient. Prof. Dr. Dr. JĂźrgen Debus
Deputy managing director, NCT Heidelberg and medical director, Heidelberg, Germany
JĂźrgen is the managing director and medical director of radiation oncology and therapy at the National Center for Tumor Diseases in Heidelberg, Germany. He is also the medical director of the Department of Radiation Oncology and Radiation Therapy at Heidelberg University Hospital and director of the Heidelberg Ion Beam Therapy Center and the Heidelberg Institute for Radiation Oncology.
20 OUR PRODUCTS
DESIGNED TO PLAY WELL WITH OTHERS Thousands of manufacturers of medical devices, equipment and information systems are deployed across the globe. In most cases, these devices, equipment and systems do not interconnect, which in turn limits their value and influence on patient care. We believe that all medical devices and information systems should be designed to be interoperable. Connecting systems can drive innovation, reach and quality of care. RaySearch works hard to make health care more connected and open by developing secure, flexible systems that help build a more interconnected and transparent oncological environment. Because when health care is open, everyone will benefit.
OUR PRODUCTS 21
22 OUR PRODUCTS
NEW HORIZONS IN TREATMENT PLANNING After a decade on the market, RayStation continues to break new ground in radiation therapy treatment planning. In 2019, a cluster of new capabilities and installations further reinforced RaySearch as a market leader. Chief functionality owner Emil Ekström reviews some of the highlights.
WHAT’S NEW IN RAYSTATION RayStation 9B offers several enhancements. Most notable are the support for medical oncology, additional machine-learning capabilities, and further integration with our oncology information system RayCare. Support for medical oncology comprises a new module for management and prescription of chemotherapy treatments. This includes tools to build a library of regimen templates to be used and adapted for individual patients. Improved support for large image datasets, support for Siemens Dual Energy CT in dose calculation, seated treatments and full support for Hitachi proton treatment machines and Toshiba carbon ion systems are also included in the new release. WHAT MAKES RAYSTATION SUCH AN INNOVATIVE SYSTEM? It’s part of a bigger picture. We are committed to keeping RayStation fully independent and, at the same time, as compatible with as many other software systems and treatment delivery machines as possible. We created the integrated environment of RayStation and RayCare as part of a wider vision to eliminate hospital silos with a suite of advanced systems. Our customers respond really positively when we share our philosophy of harmonized information and treatment planning systems. Product names
are less interesting to them than the consistent drive to save time, reduce risk of error and make sure medical specialists have access to the data they need when they need it. HOW DOES THE PROCESS WORK? RaySearch started out as a company developing plugins for other treatment planning systems. Over the years, the company has acquired deep knowledge in radiotherapy and finally decided to develop its own full-blown treatment planning system. Since then, developing the different functionalities in RayStation has been an ongoing project, divided into several releases, currently two per year. We continually receive feedback from our customers, and there are always new machine vendors and other companies with which to partner. RayStation Product Management Team makes decisions regarding new enhancements and capabilities for every release. Another useful source of input comes from the RayStation User Meetings and User Forums, as they are called in the US. Bringing users from different clinics together for a few days to discuss workflows and collect feedback is a valuable way for us to develop RayStation in the right way.
OUR PRODUCTS 23
We have a fast pace of development because we want to ensure that our customers have access to cutting-edge functionality. We incorporate customer enhancement requests as soon as we can. We’re committed to developing RayStation for the future, which includes working on features that have not yet been asked for. That’s what keeps us innovative and true to our mission to advance cancer care. As we release two major versions of RayStation each year, we are upholding our commitment to bringing the latest developments to market as soon as possible. RayStation and RayCare go hand in hand, and the seamless integration of the two systems is reflected in the simultaneous releases, where major features in RayStation support RayCare, and vice versa. PLEASE SHARE SOME HIGHLIGHTS OF 2019 2019 was another growth year for the development team. We now have 11 teams working exclusively on RayStation, including physicists, algorithm developers, image-processing specialists, software engineers and testers. On top of that, we have researchers, UX developers and clinical experts. In terms of functionality, again, one of the more important advancements of 2019 was adding support for planning of chemotherapy treatment. Incorporating medical oncology signals a big shift for the company towards providing truly comprehensive cancer treatment. We received a lot of orders for RayStation last year. The system was chosen by several leading cancer centers in the Americas, Europe and the Asia-Pacific region, which consolidated our position as a leading provider of advanced treatment planning systems to the oncology sector. One of the highlights for me last year was when the first patients were treated using carbon ions with treatment plans created in RayStation. Another was when the first patients were treated with machine learning-generated plans.
DESIGNED WITH USERS IN MIND User experience (UX) is the process that software design teams use to provide easy and enabling encounters with products. Senior UX designer Malin Larsson is responsible for creating the look and feel of all RaySearch systems. “We went for a very modern look and feel when designing the user interfaces,” says Malin, a trained radiation physicist with a background as an application specialist and service professional. “We want RaySearch systems to be easy to use but also feel elegant and timeless. The dark background helps contoured images stand out. Navigation is based on Windows standards, so users quickly get comfortable using our software.” The UX team is currently working to ensure consistency across RaySearch products. “We are also involved in providing support for new functionalities, such as chemotherapy, with a new graphical interface, nomenclature and other things that ultimately help create positive experiences for our users,” adds Malin.
24 CASE STUDY: RAYPLAN
A patient undergoes radiation therapy treatment.
UPGRADING PATIENT CARE Pursuit of the highest-possible quality of patient care is the objective of medical professionals the world over. At Centre GRAY in France, radiation therapists, oncologists and physicists believe the way to deliver best-in-class cancer treatment is through advanced planning software in conjunction with the latest hardware. When the time came to modernize the equipment at the clinic, RayPlan® was selected to realize the full potential of a newly installed linear accelerator.
According to the Société Française Radiation Oncology, France is one of the leading countries in the world in the fight against cancer. Some of France’s cancer institutions are over two centuries old. Medical institutions in France are renowned for providing treatment options for cancer patients of all kinds. The country’s major cancer institutes reported in 2018 that survival rates for men and women had increased from 72 percent to 94 percent in the previous decade. Centre GRAY in Maubeuge has made innovative cancer treatment available to 300,000 inhabitants of the Sambre-Avesnois region for more than 20 years. The clinic belongs to the Amethyst Radiotherapy Group, a fast-growing private cancer treatment institution, which also has clinics in Austria, Italy, Poland and Romania. Technological innovation is at the heart of the Centre GRAY’s drive for excellence in cancer treatment and patient care. The medical physicists, radiotherapists and dosimetrists there pride themselves on the quality of their technical platform, which means that upgrading and modernizing is crucial to maintaining high degrees of quality care.
CASE STUDY: RAYPLAN 25
RayPlan has enabled us to have better treatment planning in less time and ensure the best quality treatments for our patients.
UNRIVALED COMPATIBILITY Fadi Abboud, medical physicist at Centre GRAY, firmly believes in the potential of advanced software to improve patient care. Following a thorough evaluation process, the new hardware was chosen for its ability to provide stereotactic treatments with anatomically guided accuracy. The cutting-edge linac was installed in 2017. When the time came to choose a treatment planning system, RayPlan offered the clinic unrivaled compatibility with linacs, oncology information systems and a third-party QA. RayPlan was installed in 2019. Software licenses fall into the capital expenditure category. Radiation therapy equipment represents a significant investment and acquiring carefully designed software is essential to realizing the full potential of the hardware. RayPlan is a more cost-effective and streamlined version of RayStation. Both are designed to help tackle challenging and complex demands at modern cancer centers and both can be used to plan for electrons and photons on traditional linacs, for protons on various delivery systems, and for Accuray’s helical TomoTherapy system. TREATMENT PLANNING COMPETITION RayPlan was put to the test again in 2019 when Fadi came in first place in the Radiotherapy Plan Competition, organized by Radiation Knowledge and recognized by the International Atomic Energy Agency. The competition seeks to encourage radiotherapy professionals to share practical knowledge as a way of ensuring that cancer patients receive the best-possible quality of treatment, regardless of their geographic location.
The team at Centre GRAY
26 OUR PRODUCTS
MEETING DEMAND HEAD ON Treatment control system RayCommand is the latest addition to our suite of advanced oncology software. It bridges treatment planning, information systems and actual treatment. Functionality owner Rickard Holmberg talks about the latest advancements.
“RaySearch announced in 2018 that a treatment control system was in the works,” he says. “The decision was tied to an order for treatment planning system (TPS) RayStation and oncology information system (OIS) RayCare from Advanced Oncotherapy plc (AVO) in the UK for its first proton therapy facility. Our developers couldn’t resist the opportunity to provide a comprehensive software solution for patient-facing radiation therapy.” “The opportunity presented to us by AVO meant we would look at treatment control, not just planning. During the requirement phase with AVO, we established that RayCommand would send plans from RayStation to the delivery machines and record the results. RayCommand is built on the same platform as RayStation for regulatory purposes but has a different use case. Proton system vendors often require advanced software to integrate with different treatment planning systems and oncology information systems. Interoperability with treatment delivery devices is a crucial element of RayCommand. It is designed to be portable between hardware systems, unlike the most common case where hardware and software are locked together.” Just as RayStation is designed to harmonize the planning phase, and RayCare unifies access to information, RayCommand simplifies workflows in the treatment room. “We visited clinics several times to film and take notes on how treatment rooms function. A lot is still done manually, and so previous steps and doses need to be remembered.
Correcting procedures when the patient is present can be stressful, so we simplified the user interface to make everything more streamlined.” Together with our other systems, RayCommand is designed to contribute towards providing an outstanding software solution for any size or type of cancer clinic. “A core element of all RaySearch software is interoperability and we want to advance cancer treatment regardless of linear accelerators the clinic has installed.” In June 2019, MedAustron in Austria, one of the most advanced clinics in the world, selected RayCommand as its treatment control system. RayCommand is currently under development and the launch is preliminarily scheduled for the second half of 2020.
CONNECTATHONS: PUTTING INTEROPERABILITY TO THE TEST Over the past decade, researchers and developers from RaySearch have attended IHE-RO connectathons. They provide unique opportunities to test the interoperability of our systems in a structured environment together with other vendors to the healthcare industry.
OUR PRODUCTS 27
AUTOMATED SUPPORT FOR CLINICIANS Documenting cancer treatment can be complex and time-consuming. It involves numerous computer systems even within a single clinic and is rarely supported by appropriate workflows. Oncology information system (OIS) RayCare meets the demand for user-friendly and workflow-oriented software that supports the future of patient care. Eeva-Liisa Karjalainen, vice product owner of RayCare, explains how.
Documenting cancer treatment can be tiresome and time-consuming. It involves numerous computer systems even within a single clinic and is rarely supported by appropriate workflows or connections between systems. Oncology information system (OIS) RayCare responds to the demand for user-friendly and workflow-oriented software that supports the future of patient care. Eeva-Liisa Karjalainen, vice product owner of RayCare, explains how. A 2016 study referenced in The New Yorker discovered that clinicians spend around two hours doing computer work for every hour spent face to face with a patient. “Medical professionals are in danger of information fatigue,” says Eeva-Liisa. “An OIS should be intuitive and easy to use so clinicians can spend more time with their patients and less time looking for data or documenting their work.” One way to do this is through the use of automation. Computerizing mundane tasks and workflows promises not only to reduce administration, but also to enhance clinical efficiency and patient safety. “The newly added feature in RayCare of task-based support for RayStation scripting means we’re now in a position to automate all steps in the workflow — from preparing image acquisition through to plan approval. This year, 2020, we are also developing advanced scripting in RayCare to enable users to further eliminate routine manual work.”
During the past year, the team behind RayCare has added features and improvements to all areas of the product. Major areas of development include modularized digital workflows across the oncology disciplines that can be tailored to specific patient needs, while further improving productivity. The workflows are designed to be highly configurable, and tasks for specific staff members can be created automatically, triggered by defined events. The system continually monitors the status of the workflow. The moment a task is completed, RayCare can actively select the next step in the process without further user interaction. This capability ensures that actions are always taken in the correct order, in line with protocols. Additional improvements have been made to the patient chart. It has been extended to include workspaces for managing medications, problems and allergies. A patient chart summary provides a user-friendly overview. “Our aim is to provide comprehensive patient care. We want to help break down silos between treatment specialties by having one patient chart and patient workflow that the whole care team can get behind to deliver better and safer treatments.” Some clinics that are curious about enhancing their OIS, opt for RayCare Flow — a licensed configuration that seamlessly connects the powerful workflow management capabilities of RayCare and RayCare PACS with treatment planning system RayStation. The first RayCare Flow installations are expected to go live in the first half of 2020. “RayCare Flow has sparked a lot of interest among RayStation customers as a companion package to boost productivity. It optimizes the treatment planning process by providing automated task management for all the steps in the workflow. RayCare becomes the environment from which treatment planning is coordinated and multiple data sources are managed.” In 2019, the following clinics ordered RayCare: MedAustron (Wiener Neustadt, Austria), Swiss Medical Network (Genolier, Switzerland), Provision Cares Proton Therapy Center (Winter Garden, USA), Yonsei University Health System (Seoul, Korea). Two clinics went live: Heidelberg University Hospital in Germany, and University Medical Center Groningen in the Netherlands.
28 WHY RAYSEARCH
WHY RAYSEARCH 29
As a new user of RayPlan, I expected it would be difficult for me to get a good position in the radiotherapy plan competition in 2019, but I was wrong. RayPlan enabled me to become the champion with its ultra-fast computation speed and user-friendly interface.� Fadi Abboud
Medical physicist at Centre GRAY
Fadi is in charge of initial calibration and commissioning of all newly acquired equipment at Centre GRAY. He performs regular treatment machine function and accuracy checks and provides support to clinical computer systems through ongoing QA, backup and new software installations.
30 GLOBAL SERVICE
SERVICE GOES GLOBAL RaySearch provides training and technical support to clinicians in many countries around the world, which poses both logistic and linguistic challenges. Director of Service Niclas Borglund explains how growing the service team and continuous dialogue with RaySearch customers are crucial to providing first-class service.
GLOBAL SERVICE 31
32 GLOBAL SERVICE
SERVICE TEAM GOES GLOBAL Today, more than 90 application specialists, physics specialists and IT specialists deliver exciting new features and help RaySearch customers become part of the process. Here, Niclas discusses how the service team is growing, and the skills his personnel need to deliver world-class frontline support.
Niclas Borglund, Director of Service
WHAT’S THE FOCUS OF SERVICE TODAY? Our main focus is to expand and strengthen the service team in a sustainable way. RaySearch has several kinds of specialists available for our customers, wherever they are. We provide service and/or distributor support across Europe, North and South America, and the Asia-Pacific region. Our global team is made up of service-minded experts, who are skilled at listening to our customers and helping to solve their problems and ultimately improve treatments for their patients. They play a crucial role in training users to use exciting new features and involving our customers in the product development process. We invite all customers to make enhancement requests for features they’d like to see or something that doesn’t feel right for them. We then work together with the development team to improve our systems even more. HOW DO YOU TRANSFER KNOWLEDGE? We maintain a close connection to the development team, and so provide additional testing and feedback before each new software release. Most service employees have clinical experience, so know how our systems work in practice. We also host regular meetups, where the service
GLOBAL SERVICE 33
and development teams meet in person to discuss new features and get up to speed with new versions. We also have RayCommunity—a fantastic tool that all of our customers can use to share experiences with other users, log cases and give feedback. We see it as part of our collective contribution towards advancing healthcare. We have around 5,000 members and there’s a lot of knowledge being shared. I recommend any customer to log in to Ray Community and watch the latest service video to get a feel for what RayCommunity is about.
WHAT WERE THE HIGHLIGHTS OF 2019? The highlight for the service team was that we were able to advance our support for RayCare. RayCare is getting a lot of attention and has the potential to be a gamechanger for the way cancer centers are run. We continued to expand our team in 2019, with the incorporation of our first machine-learning engineer. Now, our customers have a go-to person to collect data and create models using machine learning. We now offer consultancy services from professional service specialists for our customers to set up optimal workflows. Also worth noting, is that our support for carbon ion therapy treatments matured in 2019. Carbon ion is gaining importance in our portfolio and we are ready to offer the best-possible support. WHAT ARE YOU LOOKING FORWARD TO IN 2020? Cancer treatment is segmented into different treatment types and RaySearch is committed to harmonizing the different disciplines: radiation therapy, chemotherapy and surgery. We aim to unify the different teams working within the same treatment clinic and support them with advanced information systems that can help them choose between types of therapy.
WHAT DOES AN APPLICATION SPECIALIST DO? Annelie Johansson has been with RaySearch for nearly six years. With a professional medical background, Annelie joined the quickly growing Service department to onboard and mentor new colleagues, liaise with RayStation customers, and create relevant new training programs: “I teach dosimetrists, medical oncologists, physicists and radiotherapists how to use our software via training sessions held on-site or here in Stockholm. For example, I went to Germany to give a training session in RayStation for the carbon ion therapy team at Heidelberg and the people there were really enthusiastic about using it for the first time. It’s always a very interesting experience to visit our customers to see how different clinics work.”
WHAT DOES A MACHINE LEARNING ENGINEER DO? Adnan Hussein joined the company in 2019. He has a data science background, having studied engineering physics and writing a master thesis on artificial intelligence. He supports users with training of machine-learning models so that they can contour and prepare treatment plans. “Customer contact is central to everything I do. Machine learning is dependent on the quality of the data that clinics provide, so it’s vital we maintain close research collaborations and connections with our customers. Sometimes clinics want to do scripting with their own model with my help, sometimes we do it together, and sometimes I take the data and do the modelling for them.”
34 RAYSEARCH AROUND THE WORLD
RAYSTATION CENTERS [TOTAL]
622
WHERE YOU CAN FIND US RaySearch centers, offices and distributors are divided into three regions: Americas, Europe/Africa and Asia-Pacific/Middle East. We provide local support in local languages so our customers feel at home with RaySearch.
AMERICAS
202
RAYSEARCH AROUND THE WORLD 35
EUROPE/AFRICA
195
ASIA-PACIFIC/MIDDLE EAST
225
RAYSTATION CENTERS [622) RAYSEARCH OFFICES (11) RAYSEARCH DISTRIBUTORS (18)
36 AMERICAS & EUROPE
AMERICAS 2019 was another eventful year for RaySearch in the Americas, with major orders, trade fairs, exciting new partnerships and a supply agreement with the U.S. Department of Veterans. President and CEO of RaySearch Americas, Marc Myln, explains more. Among the notable orders and installations that happened in North America in 2019, is the order of RayStation for The Moffitt Cancer Center in Tampa, Florida. The center is recognized as one of the most prominent cancer centers in the US. The choice of RayStation followed a tender process which included extensive testing and evaluation performed by the center’s clinical team. RayStation was selected based on its wide array of features and user-friendly interface. The James M. Slater, MD Proton Treatment and Research Center at Loma Linda University Medical Center, US, chose RayStation to replace its existing systems for photon and proton therapy planning, following another tender process. The center has treated more than 17,500 patients with proton therapy, more than any other facility in the world. With several treatment delivery systems in house, the goal was to improve the continuity of care across all modalities and introduce advanced treatment approaches. RayStation will be used in combination with photon and proton therapy systems from Varian, Siemens and Optivus. Anderson Regional Cancer Center in Meridian, Mississippi, became the first center in the US to treat cancer patients using RayStation and the TomoTherapy® treatment delivery system from Accuray. The center began using RayStation in 2013 with its conventional linear accelerators which provided significant benefits for workflow and patient treatments. Anderson has worked closely with RaySearch and Accuray to join the technologies and is now using RayStation for all radiation treatment planning, which is providing substantial gains in efficiency. The Oklahoma Proton Center in Oklahoma City, Oklahoma, selected RayStation as its treatment planning system. The selection was made due to RayStation’s superiority on the
proton therapy treatment planning market. Familiar with the advantages of RaySearch’s products and the desire to implement new technologies at the center, the management team decided to upgrade the proton delivery system and the treatment planning system. The order contains the high-end technologies used in advanced proton therapy treatment planning, such as pencil beam scanning, automatic planning tools, deformable registration, dose tracking, adaptive therapy and photon planning tools for comparative planning. Attended events is a big part of our work in the Americas. They bring together different players in the medical equipment ecosystem — clinicians, dosimetrists, physicists through to management figures and other specialists — and provide a platform for sharing insights and updates. In July, we presented the latest releases of RayStation and RayCare at the Annual Meeting of the American Association of Physicists in Medicine (AAPM). The event took place in San Antonio, Texas, and offered us a chance to attend panel discussions, courses and workshops on a wide range of emerging and practical topics. In December, we demonstrated the machine-learning capabilities of RayStation at the 105th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA 2019) in Chicago, Illinois. Artificial intelligence and machine learning were in the spotlight at RSNA 2019 as an estimated 50,000 visitors packed Chicago’s McCormick Place to get hands-on experience with new technologies and explore the latest medical research. RaySearch and Mevion Medical Systems are leaders in the field of proton therapy and have collaborated since 2014. We announced in 2019 that we are now strengthening our strategic collaboration to further advance capabilities with Mevion’s HYPERSCAN® proton therapy system and the unique Adaptive Aperture® proton multi-leaf collimator (pMLC) in RayStation. RaySearch signed a contract in 2019 with the United States Department of Veterans Affairs to become one of the agency's preferred providers of radiation therapy software to hospitals within the Veterans Health Administration. The Veterans Health Administration is America’s largest integrated health care system, serving approximately nine million veterans each year, of which around 40,000 patients are newly diagnosed cancer patients. RaySearch now has customers in South America. Clínica El Rosario in Colombia went live in January 2020 with RayStation® for Accuray’s Radixact® System and placed an order for RayCare®. We look forward to working with more clinics in this exciting region.
AMERICAS & EUROPE 37
EUROPE Europe is home to some of the oldest cancer research centers in the world. Peter Kemlin, director of sales and marketing, shares market insights for this, one of the major global markets for RaySearch technologies. WHAT WAS THE STRATEGY FOR 2019? Our strategy was to strengthen our position in existing markets, as well as explore Eastern Europe, which has shown interest in our systems. We also wanted to reinforce the sales teams and provide more training and technical support in the region. We’ve invested substantial resources to take RaySearch software clinical, with a lot of training and hands-on support during go-live processes. We always try to do everything locally, and in local languages. This is highly appreciated by our customers. We avoid the one-size-fits-all approach and view Europe not as a single market, but rather as a complex one with different cultures, regulations and skillsets. WHICH ARE OUR STRONGEST MARKETS? The UK had another successful year in 2019. We reached our targets in terms of sales and installations and further reinforced our position as a leading supplier to the medical sector. Today, we have a market share of 40 percent of around 70 cancer clinics in the UK. The UK has a long history of independent treatment planning, and high ambitions about how they run cancer clinics. This is precisely the type of market where we do well. Benelux (Belgium, the Netherlands and Luxembourg) is another. They have high skill levels and a history of adopting advanced technologies. We are also excited about our first clinic in Czechia, Proton Therapy Center Czech (Prague PTC) in the capital, Prague.
WHAT WERE THE SIGNIFICANT ORDERS? RayStation was installed at the Isala Oncologisch Centrum in the Netherlands, as well as at five cancer clinics in the UK: Cambridge, Cardiff, Manchester, Middlesbrough and Preston. We also received major order orders for RayStation from the AKH Vienna/Medical University of Vienna, and the Swiss Medical Network, which placed an order for both RayStation and RayCare. SHARE SOME EUROPEAN TRENDS As well as our strong market share in UK and Benelux, we are becoming the vendor of choice across the continent. We have very satisfied customers. Some of the most advanced users can be found in the UK and Benelux — they take RayStation one step further, using the scripting interface and other advanced functionalities. Over the past few years, RaySearch has become well known in Germany and France, where we occupy around a quarter of the current market. Many people ask us about what’s happening politically in the UK. RaySearch UK is a fully owned subsidiary, so we don’t expect that Brexit will impact our operations in the country in any significant way. DID YOU OVERCOME ANY DIFFICULTIES? One development I am particularly proud of is gaining acceptance from private clinics in France. They are starting to see the value of our advanced systems. As they represent 50% of the market, it’s a significant step forward for RaySearch in Europe. 2020 AND BEYOND There are strong ties in Europe between clinics and national health authorities, so tenders are commonplace, and funding is a complex process. For example, the procurement process at a cancer clinic in Germany or a Scandinavian country can take years as the clinics must apply for funding from a long list of committees and government finance departments. That said, we are naturally excited about the future in Europe. In 2020, we will continue to grow steadily and sustainably.
38 MARKET FOCUS
MARKETS: GERMANY & AUSTRIA Together, they are responsible for some of the most groundbreaking investments into cancer treatment anywhere in the world. Regional business director for RaySearch Germany, Markus Wenke, shares insights into the past year.
WHAT DID 2019 HOLD FOR THE GERMAN AND AUSTRIAN MARKETS? 2019 was another successful year for RaySearch in Germany and Austria. Many customers that started working with a small installation of RayStation parallel to their main treatment planning system — with one or maybe two licenses — are now replacing existing systems with RayStation to consolidate their planning environment. In Germany, we were awarded a tender from the University Hospital in Leipzig, one of our early RayStation users, to replace existing treatment planning. Our relationship to our partner hospital the University Hospital in Heidelberg was further strengthened in 2019 by the clinical use of RayCare together with Accuray’s TomoTherapy machines. With AKH Vienna, we managed to add an important customer and potential long-term partner to the Austrian market. They were a research customer, and the significant order of a clinical RayStation configuration consolidates their treatment planning environment. WHAT ARE THE MAIN REASONS FOR THIS SUCCESS? RaySearch is increasingly viewed in Germany and Austria as an innovative software provider that’s spearheading the development of treatment planning software with pioneering functionalities. Professors Widder and Georg at AKH Vienna, Professor Wolf at Leipzig, and Professor Debus at Heidelberg, are not only excellent partners, but also brilliant RaySearch ambassadors who help us reach out to new prospects.
Our team in Germany grew significantly, and we now employ six experts for physics, application and IT. Our focus on customer service and reliability in keeping our promises, such as regular releases of new software versions, are key to convincing our market of our ability to reinforce the RaySearch brand in Germany and Austria. After five years of constantly increasing visibility at regional events, such as regional DGMP meetings, the RaySearch Germany team has not only spread awareness of our brand, but also helped us have a close relationship to our users and also to many potential future customers. By attending as many workshops, symposia and teaching courses as possible throughout our region, we managed to reach out to a huge part of the community, and we are recognized as a serious player in the radiation therapy software market. WHAT ARE YOUR HOPES FOR 2020? Machine learning is receiving growing interest in the market, so we hope to be able to convince our customers of this new approach. Customers in Germany and Austria prefer fewer treatment planning systems, workstations and monitors and RayStation offers clinics unrivaled functionality, speed and improved workflows. There is still a lot to do, and the growing team is ready to support an increase of our market presence.
MARKET FOCUS 39
GERMANY
35 CUSTOMERS
in Germany & Austria
AUSTRIA
40 ASIA-PACIFIC
CHINA
Shanghai Proton and Heavy Ion Center
INDIA
Apollo Proton Cancer Centre
MARKETS: ASIA-PACIFIC The Asia-Pacific region was an exciting one for RayStation in 2019. Among the highlights of 2019 were new regulatory clearance and a large order from a proton and heavy ion center in China. In Thailand, RayStation was used in conjunction with Accuray’s Radixact® System for the first time, and the first patient was treated with RayStation at India’s first proton center. Lars Jordeby, sales director for the region, shares his thoughts about the past year.
THAILAND
Lopburi Cancer Hospital
ASIA-PACIFIC 41
INDIA FIRST PATIENT TREATED WITH RAYSTATION AT PROTON CENTER Apollo Proton Cancer Centre in Chennai was the first proton therapy center to be established in India and it has successfully conducted its first patient treatment. The center is equipped with RayStation and IBA’s Proteus®PLUS treatment delivery system in a multi-room configuration. Apollo Hospitals, one of Asia’s foremost integrated healthcare providers, selected RayStation in early January 2018 for proton therapy at the Apollo Proton Therapy Centre. The center was recently opened, and the first patient has just been successfully treated. RaySearch has a world-leading position in proton therapy treatment planning and RayStation was chosen for its comprehensive functionality and support for all major treatment delivery systems. The agreement includes modules for deformable registration, dose tracking, adaptive therapy and multi-criteria optimization.
THAILAND FIRST ASIA-PACIFIC HOSPITAL TREATS PATIENTS WITH RAYSTATION AND RADIXACT Thailand's Lopburi Cancer Hospital became the first in the country in 2019 to clinically use RayStation together with Accuray's Radixact® delivery system. The Lopburi team, led by Dr. Kriengkri Namthaisong, hospital director and Mr. Somsak Khaunchana, head of medical physics, recently installed the Radixact System, an innovative radiation therapy device that combines integrated CT imaging with a unique helical delivery platform enabling the delivery of radiation from 360 degrees around the patient. “RayStation is easy to use and enables highly accurate treatment planning,” says Sutthisak Kulpisitthicharoen, M.D., radiation oncologist at Lopburi Cancer Hospital. “We appreciate the multi-criteria optimization functionality, which is fast and gives the planner many possibilities. Contouring is precise and convenient, and the fallback planning feature means we can transfer treatment to an alternative machine if needed, without the need to re-plan. RayStation and Radixact are highly innovative systems, and the combination is excellent, particularly for complex cases.”
CHINA NEW REGULATORY CLEARANCE FOR RAYSTATION, SHANGHAI CENTER ORDER RaySearch received new regulatory clearance from Chinese authorities NMPA (previously CFDA) in 2019 for RayStation. We can now continue to supply our innovative and machine-independent treatment planning system to customers in China, the largest country by area in the Asia-Pacific region. “RayStation is designed for multimodality support of many different treatment delivery machines and is therefore well suited to the large and varied market in China, with many different types of treatment machines installed,” explains Lars. “China obviously has a large population, so speed and efficiency are important when offering treatment to as many patients as possible.” Elsewhere in China, the Shanghai Proton and Heavy Ion Center chose RayStation for its facilities in the New Pudong district. The order was the first of its kind outside of Europe and Japan, where RaySearch is the market leader among comparable centers. “This is an important order for RaySearch as carbon ion treatment planning in RayStation offers unique options to optimize personalized treatment plans along with proton and photon precision radiotherapy,” says Lars. “RayStation supports a wide range of treatment machines and provides one control center for all treatment planning needs, ensuring centers get greater value from existing equipment.”
ASIA-PACIFIC & MIDDLE EAST RAYSTATION CENTERS AUSTRALIA
7
KOREA
11
BAHRAIN
1
MALAYSIA
1
NEW ZEALAND
4
CHINA
40
EGYPT
2
QATAR
1
INDIA
3
SINGAPORE
2
INDONESIA
1
TAIWAN
1
IRAN
5
THAILAND
8
ISREAL
1
TURKEY
5
JAPAN
131
UAE
1
42 PARTNERSHIPS
ACCELERATING ONCOLOGY INNOVATION
PARTNERSHIPS 43
RaySearch is committed to collaboration and knowledge sharing. We work with clinics, manufacturers, other technology companies and cross-industry groups to advance cancer treatment. Our firm commitment to our partners includes a commitment to ensuring ongoing compatibility. Business relationship manager Ida Blom discusses the importance of partnerships to oncology innovation. Our industry and clinical partners are instrumental to the growth of our business and the pursuit of our company mission, explains Ida. When we team up with a manufacturer of medical equipment or a hospital, we commit to support their products or cancer clinic going forward. We learn from them through feedback on our advanced systems and they ensure that they remain at the forefront of software or clinical innovation. For example, a hardware manufacturer that doesn’t have its own treatment planning system can offer RayStation to potential customers for a much fuller package of sophisticated planning functionalities. Ecosystem thinking is front of mind when it comes to partnerships. We develop products together with a wide range of collaborators in several different countries. We work in an agile, non-exclusive way, so trust is crucial. We benefit from close relationships on management levels and proactively support product development of potentially market-leading products. I work with existing partners that want to extend the scope of their collaboration with us. I talk to potential new partners to find common ground and purpose. I always tell people that I have the most exciting position in the company.
In 2019, RaySearch entered into a long-term development partnership with Vision RT. We also extended our collaboration with Mevion Medical Systems to support HYPERSCAN™ technology and renewed our collaboration with Eckert & Ziegler BEBIG. We will deliver support for Accuray’s CyberKnife System in 2020. Treatment control system RayCommand is the newest member of the RaySearch product portfolio and with it comes a multitude of possibilities from a partner perspective. RayCommand will launch RaySearch into an exciting new era as we are now present in the actual treatment room and can connect to new hardware that we didn’t reach before. Our first RayCommand partner was Advanced Oncotherapy (AVO), a UK-based developer of next-generation proton therapy technology. AVO will use RayCommand for the first linac image-guided hadron technology (LIGHT) system at a proton therapy facility on Harley Street in central London. After 20 years in the business, RaySearch is no longer a newcomer; vendors and clinicians see us as a fast-moving, exciting and disruptive force in the industry.
44 INDUSTRY PARTNERS
INDUSTRY PARTNERS
Photon therapy
Proton therapy
ACCURAY (US) Accuray and RaySearch have a long-term collaboration agreement to develop and market fully-integrated solutions, combining RayStation and RayCare with TomoTherapy® and CyberKnife® treatment delivery systems. This enables greater flexibility for clinics with multiple treatment machines. Integration with RayCare brings the additional advantage of an independent oncology information system.
ADVANCED ONCOTHERAPY (UK) AO is a developer of proton therapy technology. The LIGHT system is a modular proton therapy system developed in a collaboration with the TERA project and CERN in Geneva, Switzerland. The system is designed for cost effectiveness and low maintenance, with features including multiple spot sizes and fast energy switching time. RayStation, RayCommand and RayCare will fully support the LIGHT system.
UNITED IMAGING HEALTHCARE (China) UIH is one of our latest strategic collaborations. Founded in 2011, UIH has developed the world’s first medical linear accelerator with fully integrated diagnostic-quality CT imaging to support adaptive therapy planning. RaySearch will adapt RayStation and RayCare to UIH’s CT and standard linacs. They will be the first conventional linacs to be integrated with RayCare.
IBA (Belgium) IBA, the global leader of proton therapy solutions entered into a long-term strategic alliance with RaySearch in 2016. Since then, we have customized RayStation and RayCare for IBA delivery solutions, and together we supply a complete solution for all software and hardware. Our aim is to deliver outstanding adaptive proton therapy treatment and enable clinics to use IBA treatment machines more effectively.
MEVION MEDICAL SYSTEMS (US) Mevion is a leading manufacturer of compact proton therapy systems. As part of the ongoing collaboration, RayStation development incorporates support for the latest features of Mevion treatment systems, such as HYPERSCAN technology. PRONOVA (US) Pronova provides proton therapy solutions for cancer treatment worldwide. Its proton therapy solution uses superconducting magnet technology in the cyclotron and treatment gantry to reduce the size, weight and power required to deliver proton therapy treatment.
INDUSTRY PARTNERS 45
Boron neutron capture therapy (BNCT) NEUTRON THERAPEUTICS (Finland & US) Neutron Therapeutics is a global company with locations in the US and Finland. The company has developed a complete single-room solution for Boron Neutron Capture Therapy (BNCT), including an accelerator-based neutron source, treatment room equipment, and a dose engine interface to RayStation. The first installation of the system will be at Helsinki University Hospital. SUMITOMO (Japan) Sumitomo developed the world’s first accelerator-based system for clinical BNCT — an advanced form of radiation therapy that targets cancer at the cellular level, destroying tumor cells with minimal damage to adjacent healthy tissue. Users of BNCT will have access to the full range of advanced functionality in RayStation.
Brachytherapy
Imaging
ECKERT & ZIEGLER BEBIG (Germany) E&Z Bebig is a leading European supplier of products for brachytherapy: a radiation therapy technique in which a small radioactive implant is inserted into the patient’s tissue, directly into the tumor or close to it. Brachytherapy is most commonly used in treating prostate cancer but can be applied to many other areas, including cancers of the brain, eye, lung and skin. Both RayStation and RayCare will be integrated with the Eckert & Ziegler BEBIG brachytherapy systems.
CANON MEDICAL SYSTEMS (Japan) Canon develops diagnostic imaging systems including CT, MRI, ultrasound, X-ray systems and clinical laboratory systems. Our collaboration will generate products to enable a more efficient workflow in the process of virtual simulation. These imaging and planning tools are expected to assist clinicians in determining the size and location of the tumor, planning beam directions and iso-center locations.
Quality assurance IBA DOSIMETRY (Germany) IBA Dosimetry is a leading supplier of advanced dosimetry and quality-assurance solutions for clinical and industrial applications of radiation physics. In 2006, RaySearch signed a long-term development and licensing agreement with IBA Dosimetry regarding a suite of products for quality assurance in IMRT and adaptive therapy. The agreement represented an important expansionof RaySearch business, and products from the partnership are marketed under the COMPASS® brand.
46 CLINICAL ADVISORY BOARD
RAYSEARCH CLINICAL ADVISORY BOARD:
GREATER THAN THE SUM OF ITS PARTS Defining the best systems for cancer treatment and exploring future oncology needs is the purpose of the RaySearch Clinical Advisory Board. Twice-yearly meetings between RaySearch experts and representatives from some of the world’s leading clinics provide a platform for collaborative product development with input from all sides. Eeva-Liisa Karjalainen is the development lead of the advisory board.
“The concept came from (RaySearch founder and CEO) Johan Löf, Eeva-Liisa says. Early on in the development of RayCare, he stressed the importance of working closely with end users, just as he had done during the development of RayStation. People at the cancer clinics of leading hospitals are uniquely qualified to inform us about their current and anticipated needs and RaySearch holds the unique position of not being bound by old technologies or legacy software. We have the necessary competences and resources to develop a next-generation oncology information system from scratch.” When the RaySearch Clinical Advisory Board was set up in 2015, it was unusual for a medical center to become so closely involved in software development. “The feedback we got from clinicians about an early prototype of RayCare played a massive role in the product development process. We’ve collaborated closely with our clinical partners ever since.” The advisory board is a platform for innovation, guidance and feedback, which are all instrumental in the development of RaySearch systems. “We offer insights into the development process and our partners give us guidance so that we meet the requirements of a future-proof OIS. RaySearch works with both large and small clinics in different parts of the world to make sure that we cover all needs and variations—from the user perspective but also in relation to interoperability and accessibility of data.”
Advisory board members meet with RaySearch product management twice a year, in tandem with our software release cycles. They provide an opportunity to see and discuss long-term aims and plan short-term actions. They involve presentations, workshops, hands-on evaluation and also sessions where members split up into multi-disciplinary focus groups geared toward specific topics like machine learning, data collection, clinical documentation, and comprehensive cancer care. “The potential of the clinical advisory board is greater than the sum of its parts. By that, I mean that the meetings offer members the chance to dream. Together, we drive leadership in medical oncology. The clinics get the opportunity to work with the product hands on, and discuss ideas for improvements with the aim of improving patient outcomes. This is something clinicians truly appreciate. For us at RaySearch, it’s a privilege to be part of that conversation.” All eight clinical partners are involved in the advisory board and four have already gone live with RayCare for clinical use. A new partner has come on board since the previous meeting: Swiss Medical Network, who will further widen the scope of the Clinical Advisory Board.
CLINICAL ADVISORY BOARD 47
CLINICAL PARTNERS
Radiotherapie Medische Oncologie Hematologie
HEIDELBERG AND MARBURG ION BEAM THERAPY CENTERS (Germany) These two prestigious sites in Germany are operational with proton and carbon ion therapy. Heidelberg University Hospital became a RayCare partner in 2018. RayStation was selected jointly by clinicians and researchers at HIT, MIT, Heidelberg University Hospital and the German Cancer Research Center. RaySearch will develop support for helium ion planning in RayStation and the new functionality will be validated jointly with HIT. IRIDIUM CANCER NETWORK (Belgium) ICN represents the close collaboration between all seven hospitals in Antwerp, Belgium, and shares a radiation therapy department. ICN became a RaySearch partner in 2015 and was the first to use RayCare clinically, just two months after the clinical release of the system. SWISS MEDICAL NETWORK (Switzerland) Swiss Medical Network is one of Switzerland's two leading private clinic groups. Its clinics provide first-class hospital treatment, care and assistance for all three of the country's main language regions. Swiss Medical Network became a clinical partner of RaySearch in 2019 and will begin installation of both RayStation and RayCare in 2020.
PROVISION HEALTHCARE (US) Provision became a RayCare partner in 2017. Provision was formed in 2005 with the aim of developing innovative healthcare solutions. In 2014, the Provision CARES Proton Therapy Center, Knoxville, became the first center in the world to use RayStation for clinical proton treatments. The Provision team continues to push the frontiers of radiation therapy. UNIVERSITY HEALTH NETWORK (Canada) Provision became a RayCare partner in 2017. Provision was formed in 2005 with the aim of developing innovative healthcare solutions. In 2014, the Provision CARES Proton Therapy Center, Knoxville, became the first center in the world to use RayStation for clinical proton treatments. The Provision team continues to push the frontiers of radiation therapy. UNIVERSITY MEDICAL CENTER GRONINGEN (Netherlands) UMCG was the first in the country to provide proton radiation therapy in addition to advanced photon irradiation techniques. The clinic is equipped with IBA’s ProteusPLUS two-gantry room configuration, pencil-beam scanning, and cone-beam CT capabilities. UMCG has been instrumental in the development of oncology information system RayCare since 2015.
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO (US) UCSF became a RaySearch partner in 2016. RayCare will support complex procedures and analyses at UCSF that are out of reach with current information management systems. An aim of the partnership is to develop a comprehensive approach to data infrastructure for clinical decision support. RayCare will enable UCSF to optimize resources and personalize patient care. UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER (US) MDACC and RaySearch formed a strategic alliance in February 2018 to create a new standard of care in radiation therapy by building new software components, enabling adaptive radiation therapy on a larger scale. We will focus on integrating advanced imaging into the treatment planning process to improve definition of tumor targets. The combination of RayCare and RayStation will provide a novel opportunity for more personalized treatment. UNIVERSITY OF WISCONSIN-MADISON (US) UWM became a RayCare partner in 2017. RayCare will support the department’s strong multidisciplinary approach to cancer care and its focus on cutting-edge techniques. The University, which has long tradition of radiation therapy treatment, has also implemented RayStation as its treatment planning system.
48 WHY RAYSEARCH
We appreciate the neutrality embraced by RaySearch since our clinic includes numerous planning systems and treatment machines. RaySearch has consistently kept ahead of the curve in software development. The high quality of customer support makes transitions to newer technologies seamless. Karen Stook
MS CMD is chief medical dosimetrist at UConn Health
Karen is chief medical dosimetrist at UConn Health, which has been improving the wellbeing of the citizens of Connecticut through innovative integration of research, education, and clinical care for close to 50 years. She practices a full range of treatment planning, from 3D through SRS and HDR. Karen has been instrumental in driving implementation of many of the novel planning and delivery technologies launched at UConn Health over the years, including IMRT, IGRT, Helical TomoTherapy, VMAT, SABR, multi-criteria optimization and DIBH.
WHY RAYSEARCH 49
50 SUPPORTING COMPANY GROWTH
SUPPORTING COMPANY GROWTH 51
SUPPORTING COMPANY GROWTH AND TRANSFORMATION HR manager Lotta Larsson and her team support company transformation in many ways. 2019 was a year of aligning company goals and adapting to company growth needs.
52 SUPPORTING COMPANY GROWTH
DRIVING AWARENESS As RaySearch continues to grow, with continuous recruitment processes and new offices opening up around the world, HR manager Lotta Larsson and her team support company growth in several ways— most recently with organizational transformation and sustainable leadership.
SUPPORTING COMPANY GROWTH 53
RaySearch is an organization where continual transformation is a natural part of the company growth process. With constant expansion and increased complexity of the product portfolio, it is crucial that the HR department performs strategic workforce planning that is well aligned with the company’s overall business objectives and long-term vision. Developing innovative software solutions to improve cancer care requires innumerable skilled employees. Therefore, in conjunction with efficient and agile workforce planning, HR drives awareness of RaySearch as a workplace where professionals from a broad range of backgrounds and disciplines can thrive. We need strong teams working across research, development and machine learning to bring to market our groundbreaking systems that are designed to improve clinical efficiency, wherever in the world they are used. One way for us to maintain a healthy supply of researchers and developers is through our master thesis projects. We generally offer several positions each year, currently within areas of both research, machine learning and within software/development. Many of our highly skilled and specialized employees enter the company through these projects. THE POTENTIAL OF NEW TECHNOLOGY Implementation of new HR technology is another way HR is supporting RaySearch in its transformation. New digital systems are not only important for successful hiring but are also powerful instruments for helping RaySearch make better data-driven decisions. New for 2019 is RayTalent, a new global HR management platform. It is a tool for managers, employees and HR to manage employee data and people-related processes in a structured, secure and efficient way. It is a way to streamline, automize and harmonize our processes and with easy access to statistics. One benefit is that we can identify where to best invest our resources to get impact and good return on investment. Employee engagement has great effect on business growth. HR has invested in technologies to create exceptional employee experiences, from onboarding to exit. In the hunt for the best talent, we see the benefit of our employee-referral program. Many of our current employees recommend RaySearch as an employer by sharing open positions to their friends and other contacts. Referrals represent a great way for us to find people who will fit well into both the job and our culture, which is a highly desirable outcome of a successful recruitment.
Medical science never stands still, and neither does RaySearch. Our relentless drive to do things better leads us to higher performance, accuracy, safety and usability and the HR team is supporting the company every step of the way.
THE IMPORTANCE OF A THRIVING WORKING ENVIRONMENT RaySearch offers outstanding staff benefits and excellent career development opportunities in a flexible and stimulating environment. We prioritize knowledge sharing, creativity, and collaboration, and we have some of the most talented and highly educated people in the industry. We encourage a healthy work/life balance and have created a strong social culture with regular events and activities for employees. We often think of company culture as desired behaviors to reach our strategic goals. Our objective is to create an inspiring and effective environment that supports our employees in their daily work. We want to promote the well-being and motivation of our employees and create an environment that stimulates innovation, collaboration, and effective sharing of knowledge, as well as an active and healthy lifestyle. This philosophy is also reflected in the design of our newly planned headquarters in an evolving life sciences hub of Stockholm. Here, we have configured workspaces in a way that will encourage greater collaboration and knowledge sharing across our teams. The location offers good opportunities for exercise with changing rooms for those who commute by bicycle to work, as well as time for recovery and reflection in the nearby park. Medical science never stands still, and neither does RaySearch. Our relentless drive to do things better leads us to higher performance, accuracy, safety and usability and the HR team is supporting the company every step of the way.
54 SUPPORTING COMPANY GROWTH
LONG-TERM VALUE CREATION At RaySearch, our strategy to stay at the cutting-edge of medical technology is to make innovation flow through every component of the company and bring exciting new software to market. Significant organizational restructuring initiated in 2019 supports this with the creation of small, cross-functional teams where employees get more time with their managers.
To paraphrase the former professor of business history at Johns Hopkins University and Harvard Business School, Alfred D. Chandler Jr., “organizational structure follows strategy.” He argued that organizations set their strategies and then organize themselves in a way that lets them carry out their strategies to full effect. At RaySearch, small, independent teams are the lifeblood of our organization and crucial to success. RaySearch ensures company-wide innovation by driving ambition, removing barriers and time constraints, and helping managers of these small teams to adjust to evolving ways of working. Small, agile teams are the organizational units through which short, project-based work gets done at RaySearch. Multidisciplinary teams — with employees from the research, development and machine learning departments— have implications for nearly every business function. Take the research team. Rather than concentrated in a specialized department concerned with scientific investigation, we embed medical physicists and research engineers in independent, cross-functional teams. There, they can work continually on high-value projects and learn from their peers in development and/or machine learning departments.
SUPPORTING COMPANY GROWTH 55
SMALL, AGILE TEAMS
Albin Fredriksson head of optimization
EXCITING OPPORTUNITY Rasmus Bokrantz manager of the algorithm group
Senior research engineer Rasmus Bokrantz became the manager of the algorithm group in November 2019. As well as conducting ongoing research into planning for surgery, he leads a team of algorithm developers, who are split into different scrum teams. Rasmus is a published researcher with several inventions, patents and patent applications to his name. They include System and Method for Planning a Radiation Therapy Treatment (2017) and Robust Radiotherapy Treatment Plan Generation (2014), both of which were filed together with Albin Fredriksson. “Becoming a manager was an exciting opportunity,” says Rasmus. “I’m learning as I go. So far, I’ve been closely involved in salary and performance reviews, recruitment and general staffing. I’ve been actively recruiting new team members, such as C++ developers and we’ve had a lot of applicants.” Thankfully, not all of his time is taken up with administration. “Even though around 50 percent of my time right now is spent on managerial duties, I expect to spend less time on them as I become used to the different internal processes.” “My research work involves improving multicriteria optimization for VMAT planning for photons, which is the most common radiation therapy treatment around today because it is so time efficient. I find ways to help users navigate treatment plans, which are then transformed without degrading the plan.”
Albin Fredriksson has been at RaySearch for 11 years. He started out at the company as a PhD student from KTH, specializing in robust optimization, before he became the author of a number of patents. The organizational transformation started in 2019 led to Albin, who is head of optimization in the research department, now has seven researchers reporting to him. “It’s about giving employees quality time with their managers, so they can discuss and grow as researchers. Some of our work can have a long-term focus, with projects lasting years, but we also work quickly — like when an important feature that hasn’t been included in the planning for the upcoming release is requested by customers. A specific example is the functionality protect for VMAT, which was included in RayStation 9B and developed in just a few weeks by a researcher. Small teams can get things done by harnessing expertise and agility.”
56 WHY RAYSEARCH
In Germany and Austria, RaySearch is increasingly viewed as an innovative software provider that’s spearheading the development of treatment planning software with pioneering functionalities. Our customers prefer fewer treatment planning systems, workstations and monitors, and RayStation offers unrivaled functionality, speed and improved workflows.� Markus Wenke
Regional business director Germany and Austria
Markus joined RaySearch in April 2015 as regional business director after working for several years in support roles for medical physicists and management positions, overseeing operations in Austria, Switzerland, Russia, and also South Africa and Sub-Saharan Africa.
WHY RAYSEARCH 57
58 20 YEARS OF INNOVATION
20 YEARS OF INNOVATION RaySearch was founded 20 years ago. Since then,RaySearch has evolved from the findings of PhD research into optimization of radiation therapy to a company that creates some of the world’s most advanced cancer treatment software. Today, treatment planning system RayStation and oncology information system RayCare are used at leading cancer centers worldwide—some of which now only use RaySearch software.
EXPANSION AND COLLABORATION THE JOURNEY BEGINS
RAYSEARCH LABORATORIES Founder and CEO Johan Löf entered the Scandinavian entrepreneurship competition Venture Cup in 1999. The idea built on the findings of his PhD research into optimization of radiation therapy at the KTH Royal Institute of Technology in Stockholm in Stockholm. He wanted to make a difference to cancer treatment and realized that software was the future. Following extensive work to develop algorithms and software, Johan registered a company: RaySearch Laboratories AB. A few months later, the company reached its first partner agreement, with Philips, the leading treatment planning system vendor at the time. A year or so later, RaySearch expanded its team of developers and delivered its first 131 software modules to hospitals via Philips. The company also relocated to larger offices and was listed on Nasdaq Stockholm stock exchange.
ORGANIZATIONAL GROWTH
2000–2004
RaySearch continued to expand via partnerships with proton-therapy specialists IBA Dosimetry, brachytherapy specialists Nucletron (now part of Elektra), TomoTherapy and medical equipment maker Varian Medical Systems. As part of its mission to foster close collaboration with the clinical world, RaySearch pioneered the field of adaptive radiation therapy together with Princess Margaret Hospital in Canada. In 2008, RaySearch began development of a complete treatment planning system and also entered into a research collaboration with Massachusetts General Hospital to develop multi-criteria optimization, which is today one of the key features of RayStation. The system was launched in 2009 and German clinic WPE placed the first order, for use in proton therapy treatment planning.
NEW MARKETS: US & BELGIUM
2005–2009
20 YEARS OF INNOVATION 59
CONSOLIDATING OUR PRESENCE
EXPORTING INNOVATION 510(k) clearance is obtained and the first order for RayStation in the US comes from Massachusetts General Hospital. The following year, RayStation is cleared for sale in China, one of the largest radiation therapy markets in the world. Sales for RayStation take off in 2014 after the fourth European subsidiary was established in Germany, ultrafast robust optimization receives FDA clearance. Major orders come from ProCure proton centers, Columbia University Hospital in New York City, and the first orders for RayStation from clinics in China, France, Norway and Spain. RaySearch also entered into a distribution agreement with Hitachi Medical Corporation and initiated an important collaboration within adaptive radiation therapy with University Medical Center Groningen.
The RaySearch headquarters move to brand new, customdesigned offices and a wide recruitment campaign marks a new phase of an accelerated global expansion. By October 2015, 240 cancer centers worldwide, eager to stay at the forefront of radiation therapy of cancer, have chosen RayStation as their treatment planning system. 2016 saw RaySearch receive many large orders for RayStation, which by now included support for Accuray’s TomoTherapy™ System. Johan Löf was chosen as EY Entrepreneur of the Year in 2017 and RaySearch established a machine learning department to continue advancing cancer treatment. Oncology information system RayCare was made commercially available — a significant milestone for the company and we opened a wholly owned subsidiary in Tokyo to meet demands from the Japanese market. The first order for RayCare arrived from Anderson Regional Cancer Center and the system was later used as the sole OIS for patient treatments at Provision Cares Proton Therapy, in combination with the treatment planning system RayStation. Canada’s Ottawa Hospital became the 500th RayStation-customer. In 2019, RaySearch entered into a long-term distribution agreement with distributor Medeqi in Russia for RayStation, was awarded a significant supply agreement with the U.S. Department of Veterans Affairs and received new regulatory clearance for RayStation from the Chinese authorities NMPA. RAYSEARCH EMPLOYEES 373 NEW MARKETS: GERMANY, CHINA, JAPAN, KOREA & INDIA
NEW MARKETS: FRANCE, SINGAPORE & UK
2010–2014
2015–2019
2020
60 RAYSEARCH MANAGEMENT
MEET OUR MANAGEMENT TEAM (LEFT TO RIGHT) PETRA JANSSON General counsel DAVID HEDFÖRS Quality and regulatory affairs director LARS JORDEBY Director of sales, Asia-Pacific & Middle East JOHAN LÖF Founder and CEO PETER KEMLIN Director of sales and marketing
RAYSEARCH MANAGEMENT 61
PETER THYSELL Chief financial officer NICLAS BORGLUND Director of service FREDRIK LÖFMAN Head of machine learning HENRIK FRIBERGER Director of development KJELL ERICSSON Chief science officer BJÖRN HÅRDEMARK Deputy CEO
62 NEW HEADQUARTERS
REACHING NEW HEIGHTS RaySearch will reach new heights in 2021 when we move to new headquarters. The structure is environmentally certified, and its distinct architectural expression of glass and a slanted facade will make it a landmark in Hagastaden — Stockholm’s ambitious new hub for life sciences. The interior represents the core values of RaySearch as an organization: innovation, long-term thinking, sustainability and high quality. This is embodied in an environment of modern solutions (innovation) mixed with classic features (long-term thinking). A peaceful and varied interior environment has been designed with an emphasis on high-quality natural materials, such as wood, stone and metal. Hagastaden boasts a large concentration of research and entrepreneurship in life science. World-leading education and research will be conducted at the Karolinska Institute, Stockholm University and the Karolinska University Hospital. Around half of the Stockholm region's life science companies are located within five kilometers of the area. The future of RaySearch is bright.