RaySearch Annual Review 2020

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SOFTWARE INNOVATION: REIMAGINING THE FUTURE OF CANCER TREATMENT RaySearch’s vision of comprehensive cancer care is grounded in our close relationships with clinical customers – whether that’s jointly developing new products and functionality or providing the support and service that oncology clinics need to deliver enhanced patient outcomes at scale. Through 2020, our technology and commercial teams maintained the focus on long-term growth and diversification with the launch of the RayCommand treatment control system and the RayIntelligence oncology analytics and machine learning platform. Meanwhile, the pace of innovation shows no sign of slowing for our established treatment planning system RayStation and next-generation oncology information system RayCare. More than ever, RaySearch remains a collective endeavor and a huge thank you goes out to our staff, our clinical and technology partners, and our growing customer base around the world. We hope you enjoy reading about the sustained progress across RaySearch’s core activities in 2020 – research, development, clinical validation and customer service – as well as looking forward to our ambitious growth and innovation agenda for 2021 and beyond.



RayStation centers in 40 countries


RayCare partners in 7 countries


Particle Therapy Centers selected RayStation


granted patents worldwide


partnerships with 19 clinics & universities and 17 equipment manufacturers


RaySearch offices around the world


RaySearch employees as of December 2020


employees in research and/or development


nationalities of RaySearch staff


average age of RaySearch staff




CONTENTS 1. Software innovation 2. Contents 4. Letter from the CEO Innovation, Collaboration, Adaptation

6. 2020 highlights 8. Innovation at RaySearch 10. An innovation business puts the customer first Interview with Björn Hårdemark

12. Joined-up thinking in proton therapy Interview with Martin Janson

14. Collaboration is key for research impact Interview with Kjell Eriksson

16. Software innovation: it’s all about proximity Interview with Henrik Friberger

18. Our products RayStation, Ray Care, data-driven oncology, machine learning and RayIntelligence. Interviews with Emil Ekström, Eeva-Liisa Karjalainen and Fredrik Löfman

30. RayStation customer experience Leeds Cancer Centre

34. RayCare customer experience Heidelberg University Hospital

38. Global services 40. Delivering excellence in customer service Interview with Niclas Borglund

44. RaySearch around the world Interviews with Marc Mlyn, Peter Kemlin and Lars Jordeby

54. Product innovation: it’s better together Interview with Ida Blom


Why RaySearch 56. Industry partners

Read why users choose our products.

58. Clinical partners 62. Adaptive ways of working

28. Monya Hase

64. An unprecedented challenge Interview with Lotta Larsson

66. Sustainability

32. Mike Nix

68. RayLab – a new office in the making Interview with Maria Andersson

70. Management team

37. Kai Schubert

52. Vivien Li

60. Eduard Gerškevitš



letter from the ceo


INNOVATION, COLLABORATION, ADAPTATION Against the backdrop of COVID-19 and ongoing societal and economic disruption, RaySearch has doubled down on the fundamentals: innovative new products, continuous improvement of existing software, and clinical partnerships that inform our technology and commercial strategy. Throughout 2021 we continue to embrace our necessarily modified ways of working and collaborating while moving forward with cautious optimism to deliver our vision for comprehensive cancer care. GROWTH THROUGH DIVERSIFICATION Despite the operational impact of the pandemic, the RaySearch development teams registered impressive progress along multiple fronts in 2020. We ended the year with the launch of two high-profile new products – RayIntelligence® and RayCommand®* – both of which underpin significant diversification of our software portfolio.

As our “engine-room” for data-driven oncology and machine learning, RayIntelligence provides a cloud-based analytics system to inform the planning, optimization and management of cutting-edge cancer treatments. This softwareas-a-service (SaaS) platform integrates seamlessly with our RayStation* treatment planning system (TPS) and RayCare* oncology information system (OIS), enabling cancer clinics to consolidate, structure and interrogate their fragmented data stores to individualize treatment protocols * Subject to regulatory clearance in some markets.

and enhance patient outcomes. There are tools for deep analysis of trends and performance; dashboards for an at-aglance overview of clinical activities; while the structured data enables clinics to define datasets that are suitable for training machine learning models. RayIntelligence is a departure in other ways as well, with an annual subscription license model that allows customers to spread their software investment over an extended timeframe. Elsewhere, the focus is on hardware integration. The RayCommand treatment control system (TCS) offers unified management and control of key systems in the radiotherapy treatment room – the treatment machine, treatment couch, imaging systems and patient positioning devices. The goal: to ensure safe and effective patient care while offering a more consistent user experience and enhanced workflow efficiency – regardless of the type of treatment machine. As such, we see this B2B product as a catalyst for innovation and increased competition in the radiotherapy equipment market, encouraging new-entrant system vendors to integrate RayCommand rather than developing their own TCS from scratch. KEEP EVOLVING, KEEP IMPROVING The evolution of our core software products also continued at pace last year. New versions of RayStation (10A and 10B) added support for high-dose-rate brachytherapy planning and proton therapy planning for the treatment of eye cancer. Equally significant, the latest iteration of the software’s Monte Carlo dose calculation engine is already shaping up as a game-changer for planning workflows at proton therapy

letter from the ceo

clinics. In parallel, we released new versions of RayCare (4A and 4B) offering improved integration with RayStation, interfaces for connection with Varian’s TrueBeam treatment machines, and support for multiple parallel patient treatments and workflows. Special acknowledgement here goes to the RaySearch Clinical Advisory Board, a global network of nine leading cancer clinics that’s proved itself instrumental in positioning RayCare as a next-generation OIS. Out in the market, the RayStation customer base now numbers 740 clinics in 40 countries, with new licenses sold to more leading cancer centers in 2020 – among them the Centre Eugène Marquis (France), Taipei Medical University Hospital (Taiwan), Dankook University Hospital (South Korea), and the Clatterbridge Cancer Centre (UK). We also saw tentative signs of recovery in North America towards year-end with a major order from the world-renowned Johns Hopkins Medicine in December. For context, Johns Hopkins has been using RayStation for proton therapy planning since 2017, though this latest purchase expands its installation to cover five of the health system’s clinics. The revenues from our RayStation user base give RaySearch a solid and resilient financial foundation in what’s likely to remain a challenging business context through 2021. REIMAGINING THE ‘NEW NORMAL’ Operationally, it’s encouraging to report no major challenges in relation to RaySearch’s R&D effort or delivery capacity as a result of the pandemic. It’s been a collective effort all the way over the past 12 months and a huge thank you goes to all of our staff teams – not least for their flexibility, creativity and dedication as we, by necessity, have re-engineered our core functions around largely digital and virtual workflows. Nonetheless, we’re very much looking forward to getting back together again in physical space (rather than virtual space) with colleagues, customers and our clinical and industrial partners.

With this in mind, preparations are progressing well for the relocation later this year of RaySearch corporate headquarters to RayLab, our own purpose-built office complex on the Hagastaden life-sciences campus in Stockholm. This spectacular facility will enable us to reimagine what it means to be an innovation business by promoting cross-functional collaboration and connection; providing state-of-the-art facilities for customer engagement and training; as well as opening up dedicated space for staff recreation and reflection. With the company now at over 400 employees globally, it’s also

reassuring to know that RayLab has capacity to accommodate up to 800 people – leaving us plenty of scope to grow into our new surroundings. ENHANCED EFFICIENCY IS MANDATORY While the uncertainties associated with COVID-19 will likely be with us for the foreseeable – at least until national and regional vaccination programs approach full coverage – we remain optimistic about RaySearch’s long-term strategy for comprehensive cancer care. If anything, the need for accelerated digital transformation of the oncology workflow has been amplified by events of the past 12 months. Early in the pandemic, for example, the World Health Organization found that one in three countries in the European region reported partially or completely disrupted cancer services, while some national snapshots indicate that as many as 10% or more of new cancer cases may have gone undiagnosed in the past year.

Put simply, cancer centers and their care teams are going to need all the tools at their disposal if they are to diagnose, treat and manage – at scale – the inevitable post-COVID surge in cancer cases in the most efficient and effective way possible. Mälarsjukhuset in Eskilstuna, Sweden, offers an instructive case study in the art of the possible. In spring of last year, Mälarsjukhuset’s medical physics team fasttracked clinical deployment of RayStation’s deep-learning segmentation algorithms – a move that reduced the time spent on patient contouring for radiotherapy planning by as much as 75% versus manual or semi-automatic methods. While the initial decision was driven by staff shortages as a result of COVID, the long-run efficiency gains can only help the Mälarsjukhuset team as it recalibrates for the post-pandemic setting. Going forward, it falls to RaySearch as a core technology partner to show oncology care providers, large and small, how they can similarly flex their approach through software-driven innovation – a strategy that will ultimately deliver workflow efficiencies while giving more patients access to the best possible cancer care, wherever they are, and whenever they need it.

Johan Löf CEO and Founder, RaySearch Laboratories




2020 HIGHLIGHTS Making the most of a challenging year, RaySearch persevered the pandemic via creative and adaptive ways of doing business. Resources were reallocated to virtual events in lieu of in-person congresses and meetings; product installations and user trainings were held remotely, and temporary licenses were granted to some clinics pro bono such as CHU Liege, and CHUV Lausanne. Despite travel restrictions, promising expansions occurred in Eastern Europe, Africa and Latin America, with sustained momentum in APAC, Europe and North America.

EUROPE/ AFRICA Utilizing a machine learning algorithm in treatment planning system RayStation®*, Mälarsjukhuset in Eskilstuna, Sweden, has made significant time savings in dose planning for radiation therapy. The algorithm in question is a deep learning method for contouring organs. The decision to implement this advanced technology was made to save time, thereby alleviating the prevailing shortage of doctors specialized in radiation therapy at the hospital – which was also exacerbated by the COVID-19 situation. University Medical Centre Maribor (UKC Maribor) in Slovenia placed an order for treatment planning system RayStation in November 2020. UKC Maribor became the 700th customer to choose the system, and Slovenia became the 40th country with RayStation customers. RayStation and next-generation oncology information system (OIS) RayCare®* are now in operation at the brand new Particle Therapy Interuniversity Centre Leuven (PARTICLE). The center is the first proton therapy clinic in the world with the combination of RayCare and IBA’s single-room proton therapy device Proteus ONE. Haaglanden Medical Center, Leiden University Medical Center, and Haga Hospital in the Netherlands have chosen RayStation. Following a joint request for tenders and a wide variety of tests, the evaluation committee found RayStation to be the best-value system available. Oslo University Hospital, home to one of the world’s largest cancer clinics, acquired RayStation for use at Norway’s first national proton therapy center. The order was placed in Q1, and installation and user training took place remotely during Q2-3. Despite misgivings in the early onset of the pandemic, the process was successful. RayStation is now in clinical use at the two proton centers currently established in Spain: Quirónsalud and Clínica Universidad de Navarra. The Kingdom of Morocco’s Ryad Oncologia Clinic and two Groupe Les Oliviers sites became the first cancer centers in north Africa to order treatment planning system RayStation. RayStation has been chosen to provide access to advanced treatment planning features that were previously unavailable in the north African market. Axim Nuclear & Oncology will now be supplying RayStation to the radiotherapy market in South Africa.


AMERICAS RaySearch demonstrated the release of RayStation 10B in December 2020 at ASTRO, including a new functionality support for brachytherapy planning. In line with the company’s aim to support as many treatment delivery systems as possible, RayStation features automatic channel reconstruction in combination with powerful dwell time optimization to make the creation of high-quality brachytherapy plans more expedient and consistent.

RaySearch and TAE Life Sciences reached agreement on RayStation support for the Alphabeam System for BNCT. RayStation will work in conjunction with TAE Life Sciences’ proprietary dose calculation software for the Alphabeam System, which can be configured for single- or multi-room BNCT centers. Clínica El Rosario in Colombia became the first RaySearch customer in South America to go live with treatment planning system RayStation for Accuray’s Radixact System. The clinic has also ordered oncology information system RayCare.

ASIA-PACIFIC RayStation-supported accelerator-based BNCT system in Japan received the world’s first market clearance as a medical device. RayStation is now in clinical use with boron neutron capture therapy (BNCT) – along with treatment machine from Sumitomo Heavy Industries, Ltd. (SHI) – at two leading cancer clinics in Japan. The accelerator-based BNCT system and dose-calculation program from SHI obtained market clearance in spring 2020. Clinicians at Southern Tohoku General Hospital in Koriyama, Fukushima, treated the first patient with the combination of SHI’s BNCT treatment delivery equipment and RayStation on May 26, 2020. The clinical launch at Osaka Medical College in Osaka followed shortly thereafter.

Yonsei Cancer Center became the first clinic in the Asia-Pacific region to choose RayCare and RayStation for superconducting carbon gantry rooms. Yonsei Cancer Center in Seoul, South Korea, was the first clinic in the Asia-Pacific region to adopt oncology information system RayCare. The center has also ordered an additional RayStation system for carbon-ion radiation therapy treatment planning. Queensland’s Royal Brisbane and Women's Hospital selected RayStation to plan for Varian treatment machines. Royal Brisbane and Women's Hospital (RBWH) has entered a new era of cancer treatment by replacing its former photon planning system with treatment planning system RayStation. The adaptive workflow functionality and multi-criteria optimization capabilities of RayStation will help sustain RBWHs position as one of the region’s most-advanced treatment centers.

* Subject to regulatory clearance in some markets.




THE FUTURE OF HEALTH CARE: NEW DEVELOPMENTS RaySearch® is consistently committed to advancing cancer treatment through innovation. In 2020, RayStation® 10B* added support for brachytherapy planning and a new GPU Monte Carlo algorithm, which cut final dose computation times to less than five seconds, thus revolutionizing planning workflows at proton clinics. Highlights of RayCare® 4B* include a more unified experience with the RayStation® treatment planning system and support for multiple parallel treatments and workflows, putting the user experience front and center. Another exciting 2020 milestone was the launch of RayIntelligence®, a cloud-based oncology analytics system which will integrate with RayStation, and automatically extract its patient and treatment data for visualization and analysis. This will enable healthcare providers to generate actionable insights from their real-world data.

* Subject to regulatory clearance in some markets.




AN INNOVATION BUSINESS PUTS THE CUSTOMER FIRST Despite the ongoing flux arising from the COVID-19 restrictions, RaySearch has maintained its focus on long-term growth opportunities, releasing two new products at the end of 2020: the RayCommand®*treatment control system (TCS) and the RayIntelligence® oncology analytics and machine learning platform. For Deputy CEO Björn Hårdemark, it helps that core business functions adapted swiftly and effectively to the new model of remote working – though he’s already anticipating a return to face-to-face collaboration with colleagues and customers as RaySearch gears up for the move into its new RayLab headquarters later next year.

While the company has maintained impressive momentum in terms of production capacity over the past 12 months, it’s evident that Hårdemark and the senior management team are starting to miss those informal conversations and serendipitous connections that only happen when people spend time together in the same office – rather than on a video conference. “We’re an innovation business,” Hårdemark explains, “and while working remotely is fine for the regular day-to-day R&D activity, there is a dryness when it comes to brain-storming and working out genuinely innovative ideas. The new RayLab building presents a fantastic opportunity in this regard – a working environment hardwired to encourage internal collaboration and engagement with partners and customers.” COMMAND AND CONTROL Throughout 2021, Hårdemark and the RaySearch business development team are focused on building market visibility and engagement for the newly launched RayCommand and RayIntelligence – albeit with two very distinct customer segments. RayCommand, for example, is RaySearch’s first B2B software product and, as such, is being positioned as a general-purpose TCS to support new-entrant vendors in the radiotherapy equipment market. Put simply, RayCom* Subject to regulatory clearance in some markets.

mand offers unified management and control of key systems in the radiotherapy treatment room – the treatment machine, treatment couch, imaging systems and patient positioning devices. All of which translates into a more consistent user experience and enhanced workflow efficiency – regardless of the type of treatment machine. “RayCommand represents a logical division of labor and a significant market efficiency,” notes Hårdemark. “We’ve had a lot of interest already from alternative radiotherapy OEMs who are keen to integrate our TCS rather than build their own.” Their interest is not unexpected given that RayCommand is the result of a three-year R&D collaboration involving one of those alternative vendors – Advanced Oncotherapy (AVO), a UK-based developer of next-generation proton therapy systems. Like AVO, early-adopting customers can see that it makes little commercial sense to reinvent the wheel, with all the investment and resource that’s needed to develop a new TCS from scratch.


With the launch of RayCommand and RayIntelligence, we’re really seeing where the boundaries lie between our different software products and how these products should interface in the best possible way.

Another key development partner is MedAustron, an Austrian cancer center specializing in proton and carbon-ion therapy. Here the radiation oncology team is currently road-testing RayCommand in a clinical setting, the ultimate goal being to link up the RayStation treatment planning system (TPS) and RayCare®*oncology information system (OIS) in an all-RaySearch software installation. Put another way: a unified user experience that provides a transferable template for future clinical deployments of RayCommand. In terms of the product roadmap, Hårdemark is optimistic about the long-run commercial opportunity for the new TCS. “We’re investing heavily in RayCommand functionality over the next few releases,” he notes, “and we think it will ultimately make sense to open up sales conversations with the more established radiotherapy OEMs as well.” INTELLIGENT ONCOLOGY Meanwhile, data-driven oncology and machine learning provide the raison d’être for the introduction of RayIntelligence. This cloud-based software-as-a-service (SaaS) platform will enable oncology clinics to collect, structure and analyze their diverse and often siloed data sources to enhance – and ultimately personalize – the planning, optimization and management of cutting-edge cancer treatments.

Currently RayIntelligence comprises two core building blocks: RayData delivers large-scale data aggregation, storage and search functionality, while RayAnalytics provides structuring, transformation and dashboarding of data for easier consumption by end-users. Also in the

works is RayMachine, a pipeline for training, versioning, validation and approval of machine learning models across the oncology workflow. “RayIntelligence offers coherent evolution and diversification of our software portfolio,” notes Hårdemark. “The cloud-based implementation provides a natural home for data analytics and machine learning capabilities, allowing RayIntelligence to connect seamlessly with RayStation and RayCare – observing, collecting and learning in the process.” At a more granular level, RayIntelligence provides users with tools for deep analysis of trends and performance, dashboards for an at-a-glance overview of clinical activities, while the structured data enables clinics to define datasets that are suitable for training machine learning models. Another innovation is the commercial model, with access to RayIntelligence via an annual subscription that allows customers to start using RayIntelligance without the need for an upfront capital investment. “One thing is clear,” concludes Hårdemark. “With the launch of RayCommand and RayIntelligence, we’re really seeing where the boundaries lie between our different software products and how these products should interface in the best possible way. What’s more, because the products share a lot of common building blocks, we are now working toward the concept of ‘RayWorld’ – a system of interlinked software components that form the basis for our different products as well as integration points for products from our many industrial partners.”


JOINED-UP THINKING IN PROTON THERAPY With dedicated clinical facilities proliferating, proton therapy is fast becoming a standard treatment option in radiation oncology – the result of a dose distribution that sees the radiation payload deposited over a narrow depth range with reduced collateral damage to adjacent healthy tissue and nearby organs at risk. Martin Janson, RaySearch’s senior product manager for proton therapy, explains why sustained, user-driven software innovation makes RayStation®* the treatment planning system (TPS) of choice for established and new-entrant proton treatment centers.

Janson, who has been part of the RaySearch ® development team for 14 years, interprets his product management role on an expansive canvas. For starters, he’s the company’s internal domain expert for all things proton therapy – responsible for prioritizing new proton requirements from customers and partners and feeding those requests into the RayStation development roadmap. At the same time, he’s active along several other coordinates, whether that’s supporting the development teams; training service team colleagues on new proton therapy features in RayStation; working closely with sales and marketing on customer engagement and education; or talking to proton clinics about ideas for joint R&D projects. A BIG YEAR FOR PROTONS “RaySearch has been extremely successful with proton therapy innovations for RayStation,” explains Janson, “and 2020 was especially notable in this regard, reinforcing our position as the TPS market-leader for proton planning.” A case in point is the latest iteration of the software’s Monte Carlo dose calculation engine which, thanks to its graphics processing unit (GPU)-based implementation, offers accurate and extremely fast dose computations – typically less than five seconds. “The GPU is fantastic at parallel pro* Subject to regulatory clearance in some markets.

cessing and represents a revolution in performance for our proton Monte Carlo dose engine,” notes Janson. “Those ultrafast computation times enable robust evaluation of multiple treatment plans and, ultimately, a more personalized solution for every patient.” Another significant milestone in 2020 was the launch of RayOcular to support the complex planning requirements when using proton therapy to treat rare eye cancers. While this is a niche application just now, clinical interest is ticking up. “RayOcular will improve the planning and outcomes for clinics that have worked with proton-based treatments of eye cancers for many years,” says Janson. The breakthrough is adding MR and CT capabilities into the mix so that clinical users can decrease their margins to ensure better sparing and reduced toxicity – capabilities that should in turn encourage new players to adopt proton therapy for the treatment of ocular cancers. The release of RayStation 10B* at the end of last year also saw the software’s machine learning capabilities extended to support the automated planning of pencilbeam-scanned proton treatments. In other words: oneclick automated planning to generate treatment plans with


a quality to match manual plans generated by a clinic’s best treatment planners. “We now have proton auto planning with real robustness, offering significantly enhanced standardization of plans across specific disease indications and patient cohorts,” notes Janson. By extension, there are also opportunities to automatically provide treatment alternatives to a physician by creating a series of auto plans with different emphasis. “One planning strategy, for example, might favor greater coverage of the target, while another might prioritize the sparing of healthy tissue,” Janson adds. THE PROTON ROADMAP If 2020 was a banner year for the introduction of proton-related functionality in RayStation, it seems there are plenty more innovations in the works for 2021 and 2022. Near term, one key focus for Janson and his colleagues is a parameter called linear energy transfer (LET) – i.e. the rate at which protons lose their energy when traversing through the patient – and its integration within the treatment planning process.

Besides the physical dose, LET is an important factor for the biological response of a proton beam, with higher LET corresponding to enhanced cell death – an effect, to date, that is not accurately accounted for in proton planning. “If you can access LET in the optimization, you can create treatment plans in such a way that the high LET is kept away from any organs at risk and localized within the tumor,” explains Janson. “Proton clinics are eager to get hold of this capability, so we will market it heavily upon release.” On a parallel development track is proton arc therapy, a next-generation treatment modality in which radiation is delivered continuously (rather than from just three or four angles) as the gantry rotates around the patient. Right now, proton arc therapy remains a work-in-progress and is not part of routine clinical practice. That’s why RaySearch is working closely with IBA, the Belgian proton therapy OEM, to ensure joined-up development of treatment planning functionality to align with the anticipated release of the first proton arc delivery systems for clinical use – likely towards the end of 2021. “Watch this space,” Janson concludes. “We’re having monthly meetings with our colleagues at IBA, as well as the cancer centers engaged in evaluation and optimization of the proton arc treatment planning and hardware, to ensure that everything comes to market at the same time.”

" Ultrafast computation times, typically less than five seconds, enable robust evaluation of multiple treatment plans and ultimately, a more personalized solution for every patient."


COLLABORATION IS KEY FOR RESEARCH IMPACT Internal and external collaborations are the lifeblood of the applied research program at RaySearch, underpinning sustained product innovation that will ultimately benefit clinical customers and enhance patient outcomes. For Kjell Eriksson, the company’s Chief science officer, the task is to provide oversight and guidance for those diverse research efforts while ensuring alignment versus RaySearch’s long-term commercial and technology strategy.

Front and center among those broader priorities is RaySearch’s vision for comprehensive cancer care – a vision that will manifest through convergence of RayStation ®* and RayCare ®* towards a unified system for planning, optimizing and managing patient care across a range of treatment modalities. The first step down this road, moving beyond RaySearch’s traditional core base in radiation oncology, came at the end of 2019 with the release of a dedicated RayStation module for chemotherapy planning. Now, Eriksson and his team are laying the foundations for further diversification with a suite of RayStation tools to support surgeons with the planning of operations for tumor removal. “Ultimately the goal is co-planning of radiotherapy, medical oncology and surgery within the same software platform,” he explains. CUTTING EDGE A prototype surgery module is already in the works to inform planning and decision-making relating to partial liver resection. “The clinician will be able to visualize the tumor in relation to other substructures and blood vessels in the * Subject to regulatory clearance in some markets.

liver – identifying where to cut and what the remaining liver volume will look like after the tumor is removed,” says Eriksson. That research effort will intensify this summer, with clinical partners helping to evaluate the surgery prototype and further develop its functionality. “The bigger picture is compelling,” Eriksson adds, “with many other organs and disease indications likely to follow after clinical validation of this initial use case in the liver.” Another headline theme for Eriksson and colleagues is automation of the radiation oncology workflow – including segmentation, treatment planning, as well as clinical decision support for individualized patient treatments. A case study in this regard is RaySearch’s high-profile clinical partnership with MD Anderson Cancer Center in Houston, Texas, where one of several joint projects under way is seeking to develop and validate an automated dose-tracking capability across all of a patient’s treatment fractions. The aim: to harness meaningful clinical results and data-driven insights that will form the basis of adaptive radiation therapy. “We’re working together to build a framework for data anal-


MACHINE UTILIZATION RaySearch’s sustained investments in R&D are evidenced through formal collaborations with a global network of more than 30 clinical partners. Yet in-house R&D collaboration is no less important, with Eriksson’s 23-strong research team working closely with the RaySearch development department on continuous improvements designed to utilize a range of treatment machines to their full potential. One joint area of focus right now is the use of stereotactic radiosurgery (SRS) to treat multiple metastases in the brain – a complex procedure where intelligent angle selection is critical to avoid unnecessary dose to healthy tissue between the tumor targets. In a case with many metastases, for example, manual selection of the angles for SRS is a non-trivial task that can take several hours of planning time – even for an experienced medical physicist. “What we have done so far is develop an algorithm that optimizes the collimator angles of arc beams to avoid irradiating healthy brain,” notes Eriksson. “We’ll now continue to add more degrees of freedom with the ultimate goal being to reduce treatment time and planning time, as well as increasing the plan quality.” Fig1– Shows a typical beam configuration for SRS case, in particular for a three metastases case. Fig2–Shows a penalty map for a three metastases SRS case. A penalty map indicates areas of high and low penalty for each gantry angle with respect to a certain collimator angle.

ysis and result reporting using the RayAnalytics module within our new RayIntelligence platform,” notes Eriksson. As such, RayAnalytics is effectively “mining” the MD Anderson patient database to identify robust triggers for adaptive replanning based on how the tumor or organs at risk are responding to radiation treatment. A parallel track of the RaySearch/MD Anderson collaboration is seeking to embed automation in the radiation oncology workflow, streamlining and packaging a range of manual procedures into automated routines within a RayStation and RayCare setting. “Ultimately our plan is to provide these workflows as MD Anderson-certified templates to other clinical customers,” Eriksson adds. FOCUS ON RADIOBIOLOGY Meanwhile, Eriksson’s team is also eyeing longer-term R&D opportunities around the use of radiobiological effects to expand the so-called “therapeutic window”. RaySearch

is a partner in the European Union-funded HYPERBOOST consortium, for example, which is evaluating the clinical potential of a process known as hyperthermia – basically the heating of tumors to 40-44 °C as a means of enhancing the effectiveness of radiotherapy or chemotherapy. Another radiobiology initiative with Lausanne University Hospital (CHUV) in Switzerland is working on FLASH radiotherapy of deep-seated tumor targets using very-high energy electron beams. Here the RaySearch team has developed a prototype Monte Carlo dose computation engine to support ultrafast radiation treatment at dose rates several orders of magnitude beyond current clinical norms while minimizing collateral damage to adjacent healthy tissues. “One thing is certain,” Eriksson concludes. “Clinical research partnerships will remain central to our delivery of advanced software products and innovations shaping the cancer care of tomorrow.”


SOFTWARE INNOVATION: IT’S ALL ABOUT PROXIMITY As Director of development, Henrik Friberger heads up a cross-disciplinary team of 165 staff comprising physicists, application developers, testers, imaging specialists and UX engineers. Working alongside colleagues from product management and the research and machine learning departments, they’re the engine-room of technology innovation at RaySearch, driving cutting-edge functionality for upcoming software releases as well as the introduction of new products.

Technology and innovation notwithstanding, it’s the close relationship with clinical customers that sets RaySearch apart – whether jointly developing new products and functionality with large research hospitals or providing the support and service that smaller clinics need to deliver enhanced patient outcomes. “Proximity to the clinical customer is paramount in order to understand what the enduser needs – and why,” says Friberger.

the treatment room – the treatment machine, treatment couch, imaging systems and patient positioning devices. As such, that means a more consistent user experience and enhanced workflow efficiency regardless of the type of treatment machine. That “machine agnosticism” will, more broadly, make life easier for new-entrant radiotherapy equipment vendors, allowing them to integrate RayCommand rather than developing their own TCS from scratch.

Equally, there’s a requirement to innovate at pace to meet the needs of existing users while supporting new-customer acquisition – an imperative that informs day-to-day activity across the development program. “I don’t have to manufacture that urgency,” adds Friberger, “because development staff are part of the collective conversation with clinical customers and, in turn, are extensively involved in shaping, prioritizing and owning what we do in terms of the product roadmaps.”

It was also a big year for RayStation®*, with the 10B* release in December incorporating support for high-doserate brachytherapy planning. This new module is already opening up sales conversations with a diverse and established user base – not surprising given that around onethird of clinics that provide external-beam radiotherapy also offer brachytherapy services. “A single treatment planning system that can handle both external-beam and brachy modalities is a big advantage for the clinics in terms of staff training, workflow efficiency and IT support,” notes Friberger.

INNOVATING AT PACE Throughout 2020, Friberger and his team registered impressive progress on product innovation – and along multiple coordinates. The launch of the RayCommand ®* treatment control system (TCS), the latest extension of the RaySearch product line, is a case in point. For end-users, RayCommand offers unified management and control of key systems in * Subject to regulatory clearance in some markets.

Another 2020 development that looks set to yield new sales conversations this year and beyond is the launch of a dedicated interface between the RayCare ®* oncology information system (OIS) and Varian’s TrueBeam linear accelerators. Part of the RayCare 4B* release, this interop-


Proximity to the clinical customer is paramount in order to understand what the end-user needs.

erability will significantly expand the market potential of RayCare, allowing customers to streamline their workflows with a next-generation OIS that can schedule radiation therapy sessions and track treatment progress across a suite of treatment machines from multiple OEM vendors – Varian included. In a similar vein is RaySearch’s collaboration with US radiotherapy equipment maker Accuray, with the partners working together to implement RayStation and RayCare as a unified treatment planning system and OIS for the latter’s robotic CyberKnife treatment machine. That functionality is on track for general release later this year, with the Swiss Medical Network, one of Switzerland’s largest private clinic groups, likely to be first among the early-adopting customers to treat patients using the integrated RaySearch®/ CyberKnife® system. CONVERGENT THINKING Ongoing, the convergence and optimization of fragmented cancer-care workflows remains a core objective for the RaySearch development group. A “lighthouse customer” in this regard is MedAustron, an Austrian cancer center specializing in proton and carbon-ion therapy and related research. With the commissioning of a third treatment room well advanced at its facility south of Vienna, MedAustron is now seeking to rearchitect its approach to treatment man-

agement, planning and delivery so that it’s in position to scale up patient throughput by 50% from 2022. To deliver this growth, MedAustron, which has been using RayStation for treatment planning since 2016, will migrate to an “all-RaySearch” software installation – replacing its current custom OIS with RayCare and using the RayCommand TCS to provide the link between RayCare and RayStation. “Our job is to make life easier for our customers,” explains Friberger, “so what we are building for MedAustron is a suite of functionality to glue together RayStation, RayCare and RayCommand into a unified user experience – three products effectively appearing as one.” Significantly, this is also general-purpose functionality that will be suitable for other clinical customers with appropriate workflow reconfiguration. EMBRACING CHANGE Given the operational challenges arising from the COVID-19 restrictions, Friberger is also keen to formally acknowledge the teamwork, spirit and adaptability of his staff over the past 12 months. “I’ve been impressed with the way the development group has embraced our necessarily modified ways of working and collaborating during this period – both internally and with external partners. They’ve been as creative, resourceful and dedicated as always. It’s important to celebrate that.”



Ekström, as his job title suggests, is at the sharp-end of RayStation product development, overseeing a 90-strong cross-disciplinary team comprising computer scientists, UI/UX specialists, physicists, algorithm developers and testers. Their remit: to translate RayStation product strategy – which is owned and articulated at executive board level – into continuous improvement and product innovation for a diverse clinical customer base that runs to well over 700 cancer centers in 40 countries.

A patient-centric product roadmap and a relentless focus on user experience: these are the fixed points that define the operational and strategic priorities for Emil Ekström, chief functionality owner of RaySearch’s treatment-planning system RayStation®*.

Collectively, Ekström and colleagues share a near-obsessive focus on user experience. As such, the team mindset is not only to enhance the speed and efficiency of the algorithms with every release, but to make RayStation software as intuitive and friction-free as possible. “That means smooth workflows, not too many clicks, and access to the tools you need when you need them,” Ekström explains. DIVERSIFY AND UNIFY A case in point is the launch of high-dose-rate (HDR) brachytherapy planning in the RayStation 10B* release at the end of last year – a natural progression given RaySearch’s aim of supporting as many radiotherapy modalities and treatment machines as possible within RayStation. For context, HDR brachytherapy involves the temporary insertion of a small radioactive source inside the patient to yield highly targeted dose delivery to the tumor while minimizing damage to adjacent healthy tissue. The technique can be used alone or in conjunction with other therapies to treat a range of indications, including prostate, breast, head-and-neck and skin cancers.

Thanks to this new module in RayStation, clinics are now able to use the same treatment planning system for HDR brachytherapy and external-beam radiotherapy, yielding

* Subject to regulatory clearance in some markets.


A key driver is simplification – the convergence towards a more efficient and unified clinical workflow. significant upsides in terms of staff training and patient throughput. “A key driver here is simplification – the convergence towards a more efficient and unified clinical workflow,” notes Ekström. “The possibilities of combining external-beam radiation treatment and brachytherapy are further enhanced by tools for working with multiple image sets, image deformation and dose summation.”

intra- and inter-fractional tumor motion and deformation – changes in the position or geometry of the tumor during the delivery of a single fraction as well as over the entire treatment course. “For the end-user,” notes Ekström, “these tools provide rapid decision support through the display of different robustness metrics versus the clinical goals of the treatment.”

Last year also saw significant progress regarding RayStation’s evolving support for treatment planning in proton therapy. Most notably, the latest iteration of the software’s Monte Carlo dose calculation engine is already shaping up as a game-changer for planning workflows at proton therapy clinics. Through the utilization of multiple graphics processing units (GPUs), the dose engine offers “very accurate and extremely fast computations…with final dose computation times of less than five seconds”, according to Ekström. The ultra-fast computations leave time to create and explore even more possible treatment plans as a means to find the best option for every single patient.

INTEGRATE TO ACCUMULATE Meanwhile, tighter integration between RayStation and RaySearch’s oncology information system RayCare®* remains an ongoing priority. As such, RayStation now supports a task list shared with RayCare for improved workflow management. “This helps the treatment planner to keep track of what tasks to perform for a specific patient in the same way as in RayCare,” explains Ekström. The 10B RayStation release also makes it possible to write scripts that access RayStation and RayCare at the same time, automating repetitive work-steps that cut across both products.

ROBUST PLANNING Robustness was another prominent theme for the RayStation development team in 2020. The creation of robust treatment plans and the evaluation of robustness prior to treatment delivery are non-trivial challenges in radiation oncology. At a granular level, the quality of a radiation treatment plan depends strongly on the ability to deal with uncertainties that may originate from patient set-up as well as from changes in the patient anatomy.

More broadly, argues Ekström, the long-term vision for RayStation remains as compelling today as it’s always been: to integrate all the tools users need for treatment planning, for almost all machines and modalities, with everything implemented consistently in one and the same system. The upcoming RayStation 11A* release represents another important step along that road with the addition of support for Accuray’s CyberKnife® machine, a robotic treatment system that delivers stereotactic radiosurgery and stereotactic body radiation therapy.

With this in mind, RayStation’s “robust optimization framework” provides tools to compute and assess multiple error scenarios with different uncertainty settings. What’s more, that framework has now been extended to take into account

“Underpinning it all,” Ekström concludes, “there’s the ultrafast and accurate dose computation, powerful optimization and robustness tools, plus various ways to automate repetitive tasks. That is RayStation.”


RAYCARE: A LESSON IN ONCOLOGY LOGISTICS RayCare®* is a next-generation oncology information system (OIS) designed from the ground up to address the complex logistical challenges facing the cancer clinics of today – and tomorrow. As chief functionality owner Eeva-Liisa Karjalainen explains, that means efficient coordination of multiple treatment modalities with a relentless focus on clinical resource optimization, workflow automation and data connectivity. Karjalainen, for her part, heads up a 50-strong cross-functional product team comprising system developers, technical testers, system architects and clinical specialists. “Beyond my day-to-day operational remit, I’m also a member of the RayCare and RayWorld steering committees,” she explains. “The RayWorld steering committee is the RaySearch forum for coordinating the strategic roadmaps across our full product portfolio – RayCare included.” The RayCare roadmap, in turn, is guided by inputs from the RaySearch Clinical Advisory Board, a global network of nine high-profile oncology clinics – among them MD Anderson Cancer Center (US), Princess Margaret Cancer Centre (Canada) and Universitäts Klinikum Heidelberg (Germany). “The partners provide deep insights and broad domain knowledge to shape our long-term product strategy,” notes Karjalainen. “As such, the Board has been instrumental in the development and positioning of RayCare as a next-generation OIS as opposed to a variation on existing themes.” MAINTAINING MOMENTUM Within that higher-level framework, Karjalainen and her team notched up no shortage of impressive clinical and technological milestones throughout 2020. In Belgium,

* Subject to regulatory clearance in some markets.


for example, the Particle Therapy Interuniversity Centre Leuven (PARTICLE) became the first clinic to treat patients using RayCare and IBA proton therapy systems. The OIS is deployed in tandem with RayStation for treatment planning and IBA’s Proteus ONE, a single-room proton therapy machine that combines pencil-beam scanning and isocenter volumetric imaging capabilities. “It’s been a solid start with the new RayCare clinical workflow,” says Karjalainen, “and demonstrates the Leuven team’s confidence with the RaySearch product suite.” Elsewhere, the Swiss Medical Network, one of Switzerland’s largest private clinic groups, has taken the first step towards a full RayCare deployment with RayCare Flow, a way to automate the treatment planning workflow in RayStation®*, enhancing operational efficiency and workload visibility in the process. Also last year the Yonsei Cancer Center in Seoul became the first clinic in Asia-Pacific to purchase RayCare, selecting the OIS and RayStation as the backbone of its new carbon-ion therapy program for difficult-to-treat tumor sites. USER-CENTRIC INNOVATION In terms of product innovation and continuous improvement, the launch of RayCare 4B* in December is emerging as a potential “game-changer” – thanks in large part to an interface that enables connection into Varian’s TrueBeam radiotherapy machines. “Put simply,” says Karjalainen, “combining the workflows, scheduling and resource management of RayCare with the TrueBeam treatment machine opens up a much larger addressable market. It’s a development that’s been driven not just by our Clinical Advisory Board but by the wider radiation oncology community as well.”

As for the detail, the interface has been specified under an interoperability agreement with Varian and is designed to seamlessly connect RayCare into the TrueBeam operating systems in the radiotherapy control room. The Varian side of the interface will follow in conjunction with a new TrueBeam release under a planned regulatory submission, currently targeted for later this year. THE RAYCARE ROADMAP Regarding the longer view, Karjalainen sees RayCare opportunities taking shape along three main coordinates. For starters, there are efficiency gains to be had from more informed decision-making around resource optimization and clinical budget allocation. “RayCare helps customers understand how their workflows can be improved – and especially how those workflows can be automated,” she explains. “There’s also the connectivity gain – fostering openness by breaking down data siloes in cancer care, so that we can tie everything together from diagnosis to treatment and follow-up.”

At the heart of it all is the patient. Right now, RayCare provides a powerful vehicle for clinical collaboration, bringing all of the oncology disciplines together in one place to coordinate, deliver and manage patient care. Over time, however, there’s a planned Patient Portal on the RayCare roadmap that will enable the patient to participate in that collective conversation. “It’s not rocket science,” concludes Karjalainen. “Outcomes are improved all round when patients are actively engaged in shaping their own treatment and care.”




The commercial launch of RayIntelligence® heralds a new era of cloud-based, data-driven oncology. "In every respect, a collective achievement from a group of engineers and scientists who combine deep domain knowledge with a passion for collaboration and a laser focus on the customer’s needs." – Fredrik Löfman, Head of Machine Learning at RaySearch



The clinical roll-out of machine learning technologies represents an inflection point in radiation oncology, promising innovation and transformation – at scale – across the planning, delivery and management of cancer treatment programs. For Fredrik Löfman, Head of RaySearch’s machine learning group, the operational upsides for oncology clinics are compelling – and already within reach.

“Machine learning is all about increased efficiency, consistency and automation of the core clinical workflows in radiation therapy,” explains Löfman. That’s a broad canvas: think tumor and organ segmentation, optimized treatment planning, and the end-game of online adaptive radiotherapy tailored to the unique needs of each patient. “Our portfolio of pretrained machine learning models has scaled significantly since January,” he notes, “while the rest of this year is all about the commercial introduction of these models, accelerating uptake and gaining further clinical validation from early-adopters.” That process, it seems, is well under way. Consider the usecase at Mälarsjukhuset in Eskilstuna, Sweden. In spring of last year, against a backdrop of COVID-induced staff shortages, Mälarsjukhuset’s medical physics team fasttracked clinical deployment of RayStation’s deep-learning segmentation algorithms – a move that reduced the time spent on patient contouring for planning of pelvic and prostate radiotherapy by as much as 75% versus manual or semi-automatic methods. Put simply, RayStation’s deep-learning functionality* – trained and validated on a cohort of around 350 prior clinical cases – automatically creates contours of the patient’s organs at risk in the tumor near-environment. Clinical staff at Mälarsjukhuset are then able to review and, as necessary, fine-tune the segmentation, such that contouring now only takes 10-15 minutes per patient (versus up to an hour previously).

* Subject to regulatory clearance in some markets.


“The Eskilstuna team was incredibly efficient,” says Löfman, “ implementing our deep-learning algorithms in a secure and efficient way to realize immediate operational efficiencies.” What’s more, RaySearch’s newly released head-and-neck model, developed and trained in collaboration with researchers at the University of Turin, promises even bigger time savings, with automatic contouring of 35 critical structures (versus just five for the pelvic model). “Over time, we aim to cover all the main disease sites for radiotherapy treatment,” notes Löfman. “We have the methodology, the algorithms and the infrastructure within RayStation®. In the 2021 release schedule, for example, we will introduce pretrained deep-learning models for autosegmentation of structures in the breast region (including lymph nodes) as well as other structures relevant in radiotherapy planning.” MODEL BEHAVIOURS Alongside clinical “go-live” of deep-learning segmentation, Löfman and his cross-disciplinary team – 20 scientists and engineers split across planning, imaging and analytics subgroups – have been preparing the ground for a step-function expansion of machine learning-enabled automation in treatment planning. Here, RaySearch’s machine learning models are used to predict and optimize 3D spatial dose, with in-built strategies to automatically generate a set of deliverable treatment plan candidates. The result: fast-track comparison of treatment plan options followed by selection of the optimal plan for each patient in terms of tumor coverage, conformality and tissue sparing. “Unlike traditional manual planning, the radiation oncology team will start the day with, say, five candidate plans for each patient scheduled to receive treatment,” explains Löfman. “They’ll quickly review those plans, pick the most suitable, and then either fine-tune or approve that plan straight away.”

A long-standing R&D collaboration with the Princess Margaret Cancer Centre in Toronto will see nine validated and pretrained machine learning models included as part of the RayStation 11A* release (with at least 10 more pretrained models to follow in the 11B* release next year). Example sites include prostate, breast, head-and-neck, liver, rectum, brain and lung – most of them incorporating

different stages and treatment protocols. Worth noting as well that RayStation 11A will include RaySearch’s first pretrained machine learning model for proton therapy planning (another head-and-neck model). “Clinics can tune and commission these models on their own local data and treatment protocols,” explains Löfman. “They can also share models without sharing their patient data.” All of which streamlines the path to clinical translation, with users able to “plug-and-play” rather than the far more onerous task of collecting data and then training their own models. MODEL COLLABORATIONS Down the line, ambitious plans are taking shape for a RaySearch-hosted central repository to promote sharing and co-development of machine learning models across the radiation oncology community. The vision: an interactive hub to facilitate multicenter collaboration, promote best practice and accelerate clinical innovation on machine learning treatment protocols. The specifics: think quality assurance and benchmarking of models; version handling and regression testing; as well as monitoring of model distribution. “There are significant opportunities arising from colocation,” says Löfman. “A unified repository will allow cancer centers to upload or download a diverse portfolio of machine learning models – evaluating, comparing and benchmarking them for research or clinical purposes.”

Taking the long view, it’s data – and lots of it – that will accelerate machine learning innovation in the radiation oncology workflow – and ultimately the realization of optimized treatments and enhanced patient outcomes. “In order to train and validate machine learning models that can be distributed across borders and across continents,” notes Löfman, “it’s going to be vital to build and share large-scale data sets that researchers, clinics and industry can access in an unbiased and representative way.” The future’s bright, Löfman concludes. “Underpinned by cloud-based analytics platforms like RayIntelligence, a new era of data-driven decisionmaking will redefine what’s possible in comprehensive cancer care."


RayIntelligence REIMAGINGING ONCOLOGY WITH RAYINTELLIGENCE The commercial launch of RayIntelligence® heralds a new era of cloud-based, data-driven oncology, argues Fredrik Löfman, Head of Machine Learning at RaySearch. Here he explains how the software will enable cancer clinics to consolidate, structure and interrogate their fragmented data stores to improve decision-making on treatment protocols and enhance patient outcomes at scale.

WHAT’S THE HEADLINE TAKE ON RAYINTELLIGENCE? RayIntelligence gives oncology clinics a robust and scalable suite of software tools to collect, structure and analyze their diverse and often siloed data sources – capabilities that pave the way for new levels of personalization in the treatment and care of cancer patients. Right now, the product comprises two core building blocks: RayData delivers consolidated data warehousing – essentially large-scale data aggregation, storage and search – while RayAnalytics provides structuring, transformation and dashboarding of data for easier consumption by end-users. Also in the works is RayMachine, a pipeline for training, versioning, validation and approval of machine learning models across the oncology workflow.

Innovation aside, it’s important to acknowledge the high-functioning team of people responsible for getting RayIntelligence to market. In every respect, a collective achievement from a group of engineers and scientists who combine deep domain knowledge with a passion for collaboration and a laser focus on the customer’s needs. EXPLAIN HOW THE BUILDING BLOCKS WORK TOGETHER We’re using a “hybrid cloud” architecture, with the Ray-

Data module providing the on-premises component. As such, RayData integrates directly within the clinic’s IT network, where it is responsible for extracting data from the treatment planning system RayStation. Future releases will expand that coverage to include the RayCare oncology information system (OIS) and RayCommand treatment control system (TCS), while open APIs will enable clinics to access data from a range of third-party OIS, picture archiving and communication systems (PACS) and hospital information systems (HIS). Following extraction, data are uploaded to the Amazon Web Services (AWS) cloud for further analysis, with RayData providing an advanced search query interface, a dashboard for visualizing transferred data, as well as an interface for connecting third-party business intelligence tools. RayAnalytics, in turn, offers a dedicated cloud environment for computational transformation and visualization of uploaded data. It’s powerful functionality: an array of pregenerated dashboards enables end-users to search, merge and interrogate patient data sets, opening up opportunities over time to support their clinical trials, research studies and the training of machine learning models.


The cloud-based nature of RayIntelligence will ultimately encourage greater collaboration between oncology clinics.

SO THIS IS ALL ABOUT CLOUD-BASED ONCOLOGY ANALYTICS? That’s right. This is a new departure for RaySearch and there’s a lot of innovation going on – not just in terms of the enabling software but also the commercial model. The RayIntelligence license, for example, is based on an annual subscription, which means that customers can spread their software investment over an extended timeframe. The financial driver here is that even in the best of times – let alone the middle of a pandemic – the upfront capital outlay on a traditional software license can prove a blocker for smaller clinics – although worth noting that subscription cost scales with the customer’s data storage footprint. HOW WILL THE ROLL-OUT WORK WITH THE CLINICS? A key feature of RayIntelligence is that it’s straightforward – given the cloud-based nature of the product – to switch on evaluations with prospective customers. The user simply clicks on a link to access a demonstrator version with example use-cases. If they like what they see, there’s a friction-free process to sign up for the annual subscription. Underpinning it all, of course, is bulletproof cybersecurity and authentication, with all data encrypted

both in transit and at rest. Users are authenticated with the credentials of their clinic, while uploaded data are stored in AWS close to the clinic for low latency. AND THE LONG VIEW ON RAYINTELLIGENCE? We’re positioning RayIntelligence as the enabling framework for data-driven oncology – effectively a set of cloud-based software tools to enhance the availability, accessibility and standardization of patient, treatment, workflow and outcome data. What’s more, our expectation is that the cloud-based nature of the product will ultimately encourage greater collaboration between clinical institutions, both regionally and globally. Think federated access to big data and machine learning models that, in turn, will inform operational best practice in the planning, optimization and management of combined cancer treatments across multiple modalities. Clinical innovation grounded in real-world data: that’s the future of cancer care.



We at Providence also very much appreciate the level of technical support we receive from RaySearch. We are lucky to work with the same support engineers, who know our environment Monya Hase

Sr. Applications Manager, Oncology, Clinical Research & EPIC BeaconClinical and Revenue Cycle Applications, Providence St. Joseph Health, USA

Providence St. Joseph Health has developed a very strong partnership with RaySearch® over the years. We implemented our first instance of RayStation® in 2014 at our Providence Regional Cancer Partnership in Everett, Washington. Since then we have expanded RayStation to eight Radiation Oncology departments, making RayStation our enterprise system standard for treatment planning. With the acquisition of the St. Joseph’s health system, we will be adding RayStation to more sites in the near future. In 2020 we consolidated all of our separate installations onto a single enterprise platform that takes advantage of server resources, as well as the new enterprise license model that RaySearch offers. This has greatly simplified our application architecture and how we technically support it. Our partnership with RaySearch has also grown in

the way of validation and development. Our largest site in Seattle, Washington has been piloting the machine learning capabilities to perform auto-contouring. This has the potential to significantly speed up the contouring process and improve the efficiency of our treatment planning process. This same site is also assisting RaySearch on strengthening their brachytherapy module. We at Providence also very much appreciate the level of technical support we receive from RaySearch. We are lucky to work with the same support engineers, who know our environment. If an issue arises, we are always able to get support quickly and the same engineer sees it through to resolution. Overall, the technical and sales teams at RaySearch have excellent prompt customer service, which makes for an easy and open working relationship.


RAYSTATION CUSTOMER EXPERIENCE – LEEDS CANCER CENTRE Located on Level-2 of the Bexley Wing at St James's Hospital, Leeds Cancer Centre’s radiotherapy department is one of the largest singlesite centers of its kind in the UK. The center’s clinicians deliver personalized treatment plans using machine learning functionalities available in treatment planning system RayStation®.

UP-TO-DATE TREATMENT, CARE AND SUPPORT Leeds Cancer Centre opened in 2008 and is part of Leeds Teaching Hospitals NHS Trust, which has more than 18,000 employees. More than 7,500 new patients are treated annually from a catchment population of around 2.8 million people. Specialists at Leeds Cancer Centre diagnose and treat cancer for the people of the city and the nearby Yorkshire region, providing some of the most up-to-date treatment, care and support for cancer patients.

Radiation therapy treatments available include external beam radiotherapy, brachytherapy and gamma knife. A total of ten clinical linear accelerators (linacs) are installed at the center, along with two dedicated research-funded linacs with advanced image-guided radiation therapy capabilities. DEEP LEARNING SEGMENTATION Pertinent functionalities include deep learning segmentation for lung contouring during breast radiation therapy. The latest innovation in this area is the RaySearch thorax deep-learning auto-contouring (DL-AC) solution, which outperforms AutoBreast. ACCURATE CONTOURING During breast radiation therapy planning, accurate lung contouring is crucial for estimating the organs at risk dose. Previously, automatic lung contours produced by

the AutoBreast method in RayStation typically required manual editing to improve accuracy. Clinicians at Leeds Cancer Centre found that RaySearch thorax DL-AC model provides fast and excellent performance for ipsilateral lung contouring in the hypofractionated breast radiation therapy scenario. Given the positive results from RaySearch thorax DL-AC model, radiation oncologists in Leeds are now working closely with RaySearch to develop other machine learning models for the safe and effective clinical implementation at other treatment sites.


The standard functionality available in RayStation is impressive, and is sure to enhance our treatment planning processes. We’re confident that the improved functionality and efficiency savings will bring major benefits to the patients that we treat at the Leeds Cancer Centre. John Lilley

Head of External Beam Radiotherapy Physics, Leeds Cancer Centre, UK



RayStation's machine learning technology has opened up new and exciting possibilities both in the clinic, and for research. We are excited to partner with RaySearch to develop new applications and drive the clinical implementation of AI in Leeds. RaySearch's rapid and responsive customer support has been key to our successful collaboration in this cutting edge work. We were able to implement a traceable and quality managed ML segmentation approach in Leeds which will result in considerable improvements in efficiency and consistency of contouring for our patients. Dr. Mike Nix

Principal Clinical Scientist (R&D) Dept of Medical Physics and Engineering, Leeds Cancer Centre, UK.



A READILY ACCESSIBLE OIS Heidelberg has selected RayStation® as its sole treatment planning system, consolidating several existing systems. RayStation was chosen for conventional photon beam therapy in 2015, and the hospital subsequently ordered the world’s first clinical release with support for helium ion therapy.

Heidelberg has used RayCare ®*clinically since May 2019, managing about 2,200 patients with RayCare workflows. In combination with RayStation, it forms the central system for some very vital areas: managing relevant patient data, and communication and workflow support. RayCare is integrated with the hospital information system (HIS) which is the master system for all patient records and identifiers. EFFICIENCY GAINS All patients treated at HIT, on the TomoTherapy unit, or at one of the conventional Elekta machines, are now managed using RayCare workflows customized to the specific needs of the clinic. These cover all patient tasks — from the first contact through to the start of the treatment. A SYSTEM FOR TOMORROW’S WORKFLOWS Through integrating RayCare and RayStation with their existing hospital systems and activities, Heidelberg University Hospital has achieved smoother coordination of patient care and better use of time and resources. The challenge into the future is the integration of all patient-individual factors into multidisciplinary treatment approaches that are both individualized and adaptive.



RayCare enables us to unify our workflows where possible and keep them specific where needed. With a single system, we can centralize planning workflow support and resources, communication and QA checkpoints. The whiteboard function gives us an excellent overview of the patient throughout the treatment process, and it can be used to follow-up and manage the workflow tasks. Dr. Kai Schubert

Medical Physicist at the Department of Radiation Oncology and Radiation Therapy, Heidelberg University Hospital, Germany.




We provide the best possible support to our customers and partners through high quality training, fast product delivery, and knowledge transfer for the benefit of the patient.




Training the customer, listening to the customer and learning from the customer: this is the mantra that drives Niclas Borglund, Director of Service for RaySearch, and his global team of applications, IT and physics specialists as they create the conditions for cancer treatment centers to get the best from their RaySearch software in day-to-day clinical practice.

“Our role begins and ends with a five-star training experience for the end-user,” explains Borglund. In this way, the service team ensures that customers are supported fully in their use of RaySearch ® software – a partnership that ultimately helps oncology clinics to deliver enhanced treatment outcomes for their cancer patients. “Our applications and physics specialists combine deep domain knowledge of product functionality with a user-centric view of how best to apply the software in a clinical setting,” he adds. TRAINING REIMAGINED Given the sustained impact of COVID-19, however, Borglund and his colleagues were forced into a root-and-branch overhaul of the RaySearch training program during 2020. “Traditionally, our introductory training takes place on site at the customer’s clinic,” he explains. “As they progress onto advanced functionality, we then invite more experienced users across to our dedicated training facility here in the Stockholm head office or our New York or Santa Clara training centers in the US.”

That tried-and-tested model suddenly proved a non-starter last spring, at which point the training program migrated to an all-online experience. Adaptation was swift and largely seamless, notes Borglund, who is full of praise for the way his team flexed its approach – learning an awful lot about online education in double-quick time. He concedes there are significant upsides to the online model – not least the aggregate time/cost savings for customers and RaySearch


The service organization is very mature for our flagship treatment planning system RayStation – we’ve got it covered. It’s now time to write a new rulebook on service and support as the clinical user base scales for these emerging software products.

staff given that there’s no need to travel; also the inherent scalability that allows more attendees to participate in online training sessions. Post-pandemic, it’s pretty clear that online will remain an essential component of a new-look blended training model. Nevertheless, the service team is eager to resume face-toface training and customer engagement – hopefully next year in some countries as vaccination programs ramp up. “Training the customer in their clinic is an important first step in the relationship and sets the tone for the entire experience with our products,” Borglund explains.

product demonstrations at the customer’s clinic to support their sales colleagues. “Many members of the service team have been recruited directly from cancer treatment centers where they were using RayStation or a competing treatment planning system,” notes Borglund. “That first-hand clinical perspective is a fundamental part of the initial sales dialogue and the long-term relationships we go on to establish with our end-users.”

“All of the communication thereafter becomes so much easier,” he adds, “and there are certainly more questions and increased levels of interaction in a face-to-face setting versus virtual. As in any school classroom, it’s also much easier for the trainer to see if the key learning points are hitting home than it is on a video screen.”

Further along the engagement continuum, operational responsibility for customer experience passes to Borglund and his team as soon as a clinic becomes a live customer. “We take care of software installation and integration within the clinic’s network and IT environment,” he explains. “Service team IT specialists are responsible for installing our products, the related databases and backups, as well as putting in place remote access to facilitate customer support.”

THE ENGAGEMENT CONTINUUM If product training and education underpin what the global service team is all about, it’s worth noting that service specialists also engage with the customer along a much broader continuum. In pre-pandemic times (and eventually post-pandemic), that interaction typically gets under way well before any sales contract is signed. At scientific conferences and tradeshows, for example, applications specialists will usually be found alongside development colleagues giving on-booth software presentations to existing and prospective customers. Service staff are also central to RaySearch’s team-based sales approach, giving

Through 2021 and 2022, Borglund's priority is to broaden and deepen the service team's know-how across RaySearch's evolving software ecosystem - with particular emphasis on the RayCommand ®* treatment control system (TCS) and the RayIntelligence ® oncology analytics and machine learning platform, in addition to further optimizing the RayCare ®*oncology information system (OIS). “The service organization is very mature for our flagship treatment planning system RayStation®* – we’ve got it covered,” he concludes. “It’s now time to write a new rulebook on service and support as the clinical user base scales for our emerging software products.”


RAYCOMMUNITY: JOIN THE COLLECTIVE CONVERSATION RayCommunity is part of the collective conversation with our global customer base – a portal where you can chat with other users, watch training videos, get in touch with our support staff about enhancement requests, and lots more. As soon as your RaySearch system is installed, we’ll set up a RayCommunity account for your team. If you are already a customer and would like to join the community, please send an email to: community@raysearchlabs.com


I like that RayStation is constantly innovating and trying to improve their products. They do seem to take customer feedback to heart! – Dosimetrist, Americas RaySearch is open to ideas of their customers and responsive. I like the future possibilities and all the enhancements RaySearch is bringing to our clinic with safety in mind. Making our jobs safer and more effective is a positive thing. – Dosimetrist, Americas We really appreciate the ease of use of the system, the ability to script and automate processes, but mostly that feedback is taken so well and feature requests are quick to make it to the program. – Physicist, Americas Changing from our previous system to RayStation allowed us to generate a vast number of plans, of high quality with a higher level of efficiency compared to our previous system. A reasonably easy interface to navigate. Plans could be optimized and parameters changed efficiently without having to wait for extended calculation times before a plan's efficacy could be observed. – Customer, Australia Best TPS for protons. Allows fully integrated robust optimization and evaluation. – Customer, Europe


Your support staff are key in promoting your product, and teaching users how use it. You listen to the customer, you have good people, and you have a great product. – Dosimetrist, Americas I came into my current role with no physics/ dosimetry background. One year later, I am confidently writing scripts that interact with RayStation to streamline our physics/dosimetry processes. RayStation is just that usable. Customer support and WebEx trainings have also been invaluable. – Customer, Americas Having used two other planning systems prior to RayStation, I can tell you, the speed makes ALL the difference. I love the ability to compare different planning techniques quickly. – Dosimetrist, Americas Best TPS on the market! Rapid development of new features and improvements, easy to learn, with an excellent user interface. – Physicist, Europe


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.


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RAYCARE CENTERS Total in 8 countries




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Sales and consumer trends are affected by many factors, not least of which are the major societal changes that stem from a global pandemic. The effects of COVID-19 on the B2B sales arena have been universal, and the medtech industry has had to adapt in unique and innovative ways in order to acclimate.

Marc Mlyn, President and CEO of RSA discusses how the company has kept pace.

be active in 2021 and beyond as research data continues to show the benefits of proton therapy,” notes Mlyn.

“The pandemic certainly impacted hospital’s purchasing decisions in 2020,” reports Mlyn. “For the most part, hospitals shut down their purchasing processes in late Q1 to make sure that they would be prepared if things got even worse.”

This remains true despite the additional challenges presented by the radiation oncology alternative payment model (APM) introduced in the United States. “Because RayStation with its very fast GPU calculations and artificial intelligence planning make the platform very efficient, we expect that this will be even more welcomed in an insurance environment with fixed reimbursement for a subset of patients,” he adds.

Despite challenging times, there were significant purchases and installations in the north american market in 2020. Noteworthy examples are Providence Health and Services system, who extended their footprint to include more centers while consolidating and centralizing their data center operations, in collaboration with RaySearch®. Like Providence, Banner Medical System also moved towards a centralized data center to unite several geographically separate facilities. “In general, we expect to see these trends continue. Centralizing operations leads to significant savings in management and expansion,” Mlyn explains. The University of Texas MD Anderson Cancer Center extended their RayStation® installation including their proton center. RaySearch’s presence within the VA system as an approved vendor was also strengthened following a significant purchase from the Minneapolis Veterans Association. The University of Kansas purchased RayStation for their new proton center, demonstrating that the proton market is alive and well. “Although many proton centers put their plans on a short hold due to COVID, we were not made aware of any cancelled projects. We expect this market to

”Proton therapy continues to be a hot topic in the industry, although we are now seeing smaller centers being considered with 1 or 2 rooms compared to the 4 or 5 room projects from the past,” Mlyn points out. “Our takeaway from 2020 is that customers are being very selective about what they are buying in the present circumstances.” RIDING THE STORM OUT – ADAPTING THE SALES STRATEGY FOR 2020 ”We had high expectations for 2020 – the plan was to continue pressing forward with RayCare ® and RayCare Flow.“ Mlyn says. ”We also expected a very high volume of demos, onsite visits and shows.  After a very successful Q1, we began shifting to virtual sales as the COVID-19 pandemic hit. We had to think on our feet in changing times, with the unhindered progress of sales and support functions being of vital importance to the company.”

”In general, and as can be expected, the pandemic prompted shifts and adaptations to how we do business. Hospitals


were forced to re-think their budgets to allow for adequate supplies of personal protective equipment, ventilators, medications, and other necessities,” states Mlyn.  ”Onsite visits to clinics were put on hold for fear of virus spread.  All in-person training was cancelled, and all shows and regional meetings were put on hold. Of course, sales operations benefit from face to face contact and in-person discussion, so this naturally affected our sales efforts.” The situation called for a quick, but well thought out assessment of how to maximize sales success in unprecedented times, while staying connected to, and available for customers. “Luckily, RSA was already designed as a virtual company, even though we have two physical offices, one in New York City, and one in Santa Clara, California. All staff had strong virtual capabilities before the pandemic hit (internet, video conferencing tools, etc.), so converting to remote training and demos was not difficult.” Fortunately, customer service was largely unaffected, and all installations were performed remotely and in cooperation with hospital IT departments. “We also agreed to take part in all virtual tradeshows to support professional organizations and our partners wherever possible. We reallocated resources that would have otherwise been spent on travel and live events and put them into virtual support,” Mlyn notes. “We loaned clinical licenses to several sites to allow additional virtual access since staff could not sit together in one room to look at plans. Overall, our customers have benefitted from our ability to shift to efficient and secure remote interactions.” Another notable event in 2020 was the increase in “ransomware” attacks in the Radiation Oncology arena. “Our products were generally unaffected”, Mlyn reassures. “We assisted several customers with their efforts to recover from these events, and we have recommended additional safety measures which we hope will help further protect our customers from these attacks in the future. We are pleased to say the company fared reasonably well in 2020 considering the circumstances, and we are looking forward to 2021 and beyond on stable ground, and with resolute optimism.”

MARKET SEGMENTS IN FOCUS   The US and Canada are mature and stable market segments with many RaySearch customers, and South America continues to grow. ”In 2020 we also continued to develop the markets in Latin America, bringing on several distributors and selling RayStation in Colombia, including one of the first RayStation / Accuray Radixact™ installations. We signed on 4 distributors in LATAM and are in discussion with additional ones as we speak,” Mlyn explains. “As with the rest of the world, LATAM is still heavily affected by COVID, however, we are hopeful that business operations in that region will return to pre-COVID status in the near future.”   WHAT LIES AHEAD RayCare, support for Accuray’s CyberKnife®, and an active proton market are on the map for late 2021 and 2022. RSA forges ahead with a strong market performance, which testifies to a solid standing with customers even in the most challenging of times. “We will continue to build and foster the genuine connections that we have with our customers, particularly in times of uncertainty, where consumer confidence is paramount,“ concludes Mlyn. “To continue to provide the same high-quality service and support that we are known for, on a consistent basis, will always be mission critical for us.”


EUROPE/MIDDLE EAST/ AFRICA OVERALL STRATEGY FOR 2020 We concentrated our efforts on further improving communication around efficiency and placed a central focus on machine learning. Many of our strategic collaborations were advanced with the intention of accelerating machine learning development. Prime examples were Leeds Cancer Centre and Princess Margaret Cancer Center, with whom collaboration worked very well in the remote environment we were operating in due to COVID-19.

"Our goals were to reduce planning time in general and shorten time between planning and treatment. Work has intensified on pre-trained planning and segmentation models – with the aim of releasing many new models by 2021," Peter Kemlin, Director of sales and marketing stated. OVERCOMING CHALLENGES In addition to on-going research collaborations, we managed to find many other innovative ways to stay connected to our customers and partners during the pandemic. 2020 required a quick and effective change of interaction from us. With reallocation of resources, we shifted from live congresses to virtual events, and all training was conducted in a digital format. We began to host several webinars, which we saw a robust and enthusiastic response to. Apart from good content, we believe it is the ambition and thirst for knowledge of our customers combined with the convenience of the digital format that makes our webinars so popular. People can tune into a webinar without much interruption to their focus on everyday tasks.   Our digital user meetings were also a big success. The remote format allowed more people from the clinics to attend, since it did not require so much absence from their daily work environment. We were able to pull off an exceptional level of quality and value although this was a new arena for this type of event. Never in our physical user meetings did we see such high numbers attending.   The 9th annual European RayStation user meeting was held in our own RayStudio in the Stockholm headquarters, with impressive participation levels - over 600 participants. Our staff truly pulled together to make EUM as rewarding as possible for all attendees. Virtual meeting rooms allowed customers and staff to interact and network safely and effectively. People were able to remain

engaged and recreate interactions, discussions, and the formation of working groups to brainstorm ways to improve software development, which has always been the backbone of our business. RaySearch Americas also held their 9th annual RayStation user meeting last December in a virtual environment. In a true collaborative effort, stages were built in the Empire State Building, and we also utilized the staff and RayStudio in Stockholm. With over 800 participants registered, we were able to bring the user meeting presentations to a larger audience than ever before. The program received rave reviews from attendees for applicable content and engaging presentations that addressed clinical needs. Even in a virtual environment, we were able to offer various treatment technique tracks that allowed for smaller group breakout sessions and discussions, such as physics, scripting, protons and more. Going forward, we are planning in-person meetings for 2021. We will also live stream and record the user presentations, making these a true “hybrid event”. RaySearch deeply believes in the benefit of these meetings for knowledge sharing with our customers, and as an opportunity for our development staff to hear from the clinicians who are using the software every day. Together, we are continuing to improve RayStation®* through close collaboration and communication.


LOOKING AHEAD RayStation 11A* will offer planning support for Accuray’s Cyberknife® system. Machine learning enhancement and development will continue, making RayStation an even more complete and attractive product. There is a growing interest in brachytherapy planning support, and we are striving to meet this need in the market, as it is an important element in oncology treatment modalities.

RayCare® 5A* will introduce new features for radiation therapy management and RayTreat, the RayCare control room application, now has interoperability support for treatment delivery with the Accuray CyberKnife system. We will continue to build upon RayIntelligence®, our cloudbased oncology analytics system, and RayCommand®*, our treatment control system. These are the newest additions to our product portfolio, and we look forward to nurturing and developing this technology to improve patient care throughout the entire cancer treatment process.



REFLECTING ON 2020 2020 was a banner year for the APAC region, where we saw significant growth and development in several areas.

"We’re very pleased to announce that we launched a new subsidiary in Australasia, starting with a regional business director and an application specialist, allowing both the sales and service components to be established at inception" Lars Jordeby, Director of sales for the region states. "We look forward to seeing this area further materialize on the RaySearch® map." Relations with the Japanese market, and our collaboration with local distributor Hitachi remain on an upward trajectory - with 156 customers as of this year - and counting. Japan is our most active APAC market and a consistently stable customer base for RaySearch.


Our industrial partner Sumitomo Heavy Industries (SHI) has obtained market clearance for the manufacture and sale of the world’s first medical devices for BNCT. RayStation® supports BNCT contouring, image importing, plan creation and evaluation, and reporting tools. This is a promising development in terms of options for treating specific types of aggressive malignancies. Regulatory clearance was obtained for RayStation 7 in the Chinese market, and in 2020 we had several new orders from China in addition to new customers. Our Chinese customers represent a wide variety of different types of clinics, including RayStation and RayPlan® users, particle therapy clinics, with facilities of all sizes and scales utilizing an expanding number of treatment modalities not least particle therapy and carbon ion planning. We are able to sell our products directly to hospitals in addition to collaboration with domestic machine manufacturers. Thailand and Taiwan are picking up steam, as we are breaking ground in several countries in the southeast Asia region. We received multiple new orders from Thailand and Taiwan in 2020 – a very optimistic development, indicating this is a rapidly expanding and promising market for us. Yonsei Cancer Center in Seoul, South Korea is the first clinic in the Asia-Pacific region to adopt RayCare®, and the center has also ordered an additional RayStation system for carbon-ion radiation therapy treatment planning. We are seeing a greater interest in RayCare coming from the APAC region, and globally, as our customers have a vested interest in comprehensive cancer care with enhanced interoperability and optimal resource utilization. EFFECTS OF COVID-19 Many of the APAC countries were affected earlier than the rest of the globe, but we are fortunate in the fact that RaySearch was already well-established as an organization in those areas. We did not become isolated from our APAC customers, distributor network, or subsidiaries. We simply had to find new ways of working – which we did successfully.

Since our APAC subsidiaries were already well established in terms of the sales and service elements, adjustment and adaptation were made much easier. Even with restrictions in place, and on-site visits limited, it was still very possible to maintain proper contact to ensure business and customer relations would resume unimpinged. We conducted remote installations and sales and service training successfully, as we have done in both Europe and the Americas. Therefore, we were better able to brace ourselves during COVID’s main impact, and weather the storm rather than be knocked out by it. ONWARD FOR 2021 There is an ever-increasing interest in particle therapy, and we’re naturally optimistic about the treatment planning possibilities in this expanding field. We completed software deliveries to particle centers in Japan, China, and Taiwan in 2020, and are currently engaged in several particle projects across the globe which will continue into 2021 and beyond.

One can assume that there will be a need to sustain investment in technology once the market and the pandemic situation stabilizes. Efficiency of remote interactions has resulted in resource reallocation during this unprecedented time. When the smoke clears, clinics will want to get back on track with renewed vigor, and state of the art equipment allowing them to deliver the best possible treatments to their patients. The world doesn’t stand still in the face of pandemics. Planning solutions in oncology and other healthcare disciplines are still priority items. The demand for quality care in is not shelved because of a shift in focus during a global crisis. There will always be a need to increase efficiency and efficacy in the clinical setting, and hospitals and practitioners still need to fight cancer. RaySearch will continue to be there to meet their treatment planning needs. Even in critical times, our dedication to advancing cancer treatment never wavers.



RayStation addresses our customers’ growing demand for more comprehensive and intelligent treatment planning systems to improve clinical workflow, efficiency, and treatment quality. We support our customers working on the frontline in the fight against cancer with most advanced and innovative technology available in the market. This helps to improve the life quality of countless cancer patients in this region, making our work very meaningful. Vivien Li

Area Sales Manager, SE Asia, RaySearch Laboratories


PRODUCT INNOVATION: IT’S BETTER TOGETHER Collaborative innovation provides the cornerstone of RaySearch’s technology strategy thanks to a burgeoning partner network comprised of radiotherapy equipment vendors and leading cancer treatment centers. Business Relationship Manager Ida Blom engages prospective partners to establish strategic fit and common purpose while also extending the scope and depth of existing collaborations.

As the operational point of contact for industry and clinical partners, Blom works closely with RaySearch CEO Johan Löf and deputy CEO Björn Hårdemark. Their goal: to ensure that every partnership is a win-win. “The best partnerships require both sides to work at it, so we always look for strong commitment upfront,” explains Blom. “Equally the story you define at the outset is key for framing the long-term clinical /commercial upsides and what you will accomplish together.” THE POWER OF PARTNERSHIP Direct engagement with new partners has, of course, been hampered by the ongoing COVID-19 restrictions – not least the replacement of the major scientific conferences and tradeshows with virtual events. “Face-to-face dialogue really matters when initiating a new collaboration,” argues Blom, “because all of our partnerships are built on mutual trust established at director and senior management level.”

Yet while early-stage conversations are not so easy over the phone or on a video screen, Blom was pleased to see a new partnership inked with TAE Life Sciences (TLS) last summer, the culmination of a dialogue that got under way pre-pandemic in 2019. TLS is a US start-up venture that’s pioneering a next-generation treatment modality called boron neutron capture therapy (BNCT) for complicated and recurrent cancers such as glioblastomas or head and neck tumors. Under the terms of the agreement the RayStation® treatment planning system will be integrated as part of TLS’s Alphabeam BNCT treatment machine, working in tandem with the latter’s proprietary dose calculation software. “TLS is our third partner in the field of BNCT, joining Sumitomo Heavy

Industries of Japan and Neutron Therapeutics in the US,” says Blom. “The goal in each case is to accelerate the commercialization and clinical roll-out of hospital-based BNCT.” Meanwhile, 2020 also proved to be a productive year for RaySearch’s existing partnerships, even as those partnerships were forced to recalibrate wholesale to the “new normal” of largely online collaboration. Most notable is the launch of high-dose-rate (HDR) brachytherapy planning in the RayStation 10B* release in December. For context, brachytherapy is a radiotherapy technique commonly used to treat gynecological, prostate, breast, head-and-neck and skin cancers. A small radioactive implant is inserted into the patient’s tissue – directly into a cancerous lesion or close to it – so as to deliver a high dose of radiation to the tumor while minimizing damage to surrounding healthy tissue and organs at risk. With RayStation 10B, clinics are now able to use the same treatment planning system for HDR brachytherapy and external-beam radiotherapy, yielding significant operational benefits in terms of staff training and patient throughput. RaySearch’s collaboration with Eckert and Ziegler Bebig, a German company which specializes in brachytherapy treatment delivery systems, was fundamental to the development and commercial release of the new planning module, while the radiation oncology teams at AKH Vienna and Centre Antoine Lacassagne in Nice provided clinical validation of the software functionality and associated workflows. “It’s all about triangulation,” notes Blom. “Customer-driven software innovation is shaped and validated by our collaborations with domain experts in industry and clinical practice.”


REIMAGINING VIRTUAL ENGAGEMENT RaySearch staff teams moved swiftly in spring 2020 to re-engineer core business functions around largely digital workflows and online interaction. Yet the COVID-19 reset also provided an opportunity for Blom and colleagues to reimagine the “collective conversation” with RaySearch’s global partner program. Creative thinking was key, for example, to successful delivery of the 2020 virtual meeting of the RaySearch Clinical Advisory Board, a network of nine leading cancer clinics that supports the development and positioning of RayCare as a next-generation OIS. “We used a professional film crew and basically converted two training rooms here in the Stockholm head office into our own temporary TV studio,” explains Blom. “Delegates were impressed with the production values and the quality of engagement – it was like they were dialing into a broadcast newsroom. Another benefit is scalability, with the virtual format enabling wider involvement of RaySearch colleagues and more staff from our partners’ clinical teams.”

VARIATIONS ON A THEME It’s evident as well that looser, more informal partnerships provide opportunities to add value with RaySearch’s clinical customer base. One such is the collaboration with Japanese radiotherapy OEM Toshiba Energy Systems & Solutions, which is currently installing its carbon-ion therapy system at Yonsei Cancer Center in Seoul, South Korea.

With initial patient treatments scheduled for 2022, RaySearch staff are now working with colleagues from Toshiba and Yonsei to integrate the carbon-ion treatment machine with RayStation and the RayCare®* oncology information system. It’s work that builds on a previous col-

laboration with Toshiba and Yamagata University Hospital in Japan, with the latter also implementing RayStation in combination with Toshiba's carbon-ion therapy system. Another notable milestone in 2020 is RaySearch’s interoperability agreement with Varian, specifying an interface to seamlessly connect the workflows, scheduling and resource management of RayCare with the latter’s TrueBeam treatment machine. “Our vision is that we must collaborate to succeed,” concludes Blom. “Strength through partnership is very much the mindset here.”





ACCURAY (USA) 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 PLC (UK) AVO 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 (USA) 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 (USA) 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.


BORON NEUTRON CAPTURE THERAPY (BNCT) NEUTRON THERAPEUTICS (FINLAND & USA) 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. TAE LIFE SCIENCES (USA) TAE Life Sciences (TLS) is a privately held biotechnology company committed to developing new biologically targeted radiation therapy based on Boron Neutron Capture Therapy (BNCT). The company is focused on developing novel treatments to improve the lives of patients with invasive, recurrent, and difficult to treat cancers. RayStation development will incorporate support for TLS’s Alphabeam™ System.



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.

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 expansion of RaySearch business, and products from the partnership are marketed under the COMPASS® brand.

IMAGING 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.

VISION RT (UK) Vision RT defines the standard of care in Surface Guided Radiation Therapy. RaySearch is working together with Vision RT to deliver both improved integration and entirely new capabilities to radiation oncology professionals; enhancing workflow and improve clinical decision-making. Vision RT is part of the William Demant Invest (WDI) family, a leading Danish Medtech investor with a long-term investment perspective.


RAYSEARCH CLINICAL ADVISORY BOARD 2020 was a year of great accomplishments and unprecedented challenges as we worked to find solutions to stay connected with our board members in the midst of a pandemic. "An ongoing mutual trust and collective combination of knowledge, professional expertise and valuable experience is the common thread that nurtures our working partnerships," says Eeva-Liisa Karjalainen.

The first online meeting in RaySearch Clinical Advisory Board history was held in our in-house studio at Stockholm headquarters in October 2020. We adapted smoothly to the virtual environment, producing an extremely successful and enjoyable event with participation from all the partner clinics.

increasingly geared toward more advanced features and user experience, plus the notion of what all our software products can accomplish collectively. With that in mind, there is a strong focus on unifying our products and creating a superior user experience throughout the complete suite of products.

Some of our past year’s highlights include the addition of a new member: MedAustron, who will power all the steps in their patient workflow using RaySearch software: RayCare®, RayStation® and the newest addition to our product family RayCommand ® Additionally, Swiss Medical Network, who joined the board in 2019, went live with RayCare Flow.

An ongoing mutual trust and collective combination of knowledge, professional expertise and valuable experience is the common thread that nurtures our working partnerships, and we are both humbled and proud to be engaged in the fight against cancer in collaboration with all our valued board members.

Due to the strong development progress and enhanced maturity level of RayCare, we are now seeing a shift in the feedback coming from our advisory board members. The input we are receiving regarding innovation ideas is


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. RayStation is the first commercial treatment planning system in the world to support helium ion therapy, and Heidelberg Hospital's Ion Beam Therapy Center is the first in Europe with helium, supported by RayStation. Heidelberg has used RayCare clinically since 2019 to drive and support their RayStation planning workflows. 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 has been using RayCare clinically since September 2020.

PROVISION HEALTHCARE (USA) Provision became a RayCare partner in 2017. In 2014, the Provision CARES Proton Therapy Center, Knoxville, became the first center in the world to use RayStation for clinical proton treatments. Provision are using only RaySearch products to manage all patient treatments including treatment session management with RayTreat since 2018, with 48 users, and 18550 fractions delivered. UNIVERSITY HEALTH NETWORK (CANADA) UHN and RaySearch have enjoyed a successful and longstanding relationship via the Princess Margaret Cancer Centre, Toronto. In July 2018, we joined forces to further develop RayCare. Princess Margaret is one of the largest comprehensive cancer treatment facilities in the world. The center recently made a major expansion of its RayStation platform and is on the way to being one of the biggest RayStation installations in the world. 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. UMCG has been instrumental in the development of oncology information system RayCare, and have been using RayCare clinically since 2019.

MEDAUSTRON (AUSTRIA) MedAustron is a cutting-edge center for ion therapy and research, specialized in advanced cancer treatment using protons and carbon ions. The center is located in Wiener Neustadt, Lower Austria, around 50 km south of Vienna. MedAustron has been using RayStation for treatment planning since 2016 and have migrated to an “all-RaySearch” software installation – with RayCare OIS and RayCommand TCS to provide the link between RayCare and RayStation. UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER (USA) MD Anderson first began using RayStation in 2013 with conventional linear accelerators, later adding the TomoTherapy System and working closely with RaySearch and Accuray. The clinic now uses RayStation for all radiation treatment planning. RaySearch began collaboration in 2017 with the center to enable clinical implementation of RayCare in a complex and large-scale environment. By 2018, a strategic alliance was formed to enhance cancer radiation therapy through the utilization of adaptive radiation therapy (ART) and increase efficiency and automation of planning workflows. UNIVERSITY OF WISCONSIN-MADISON (USA) 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.



RayStation has allowed us to consolidate all of the external radiotherapy treatment planning under one roof. RayCare is well integrated with RayStation and has allowed us to have real-time patient tracking at different treatment planning stages, thus really streamlining our workflows. Eduard Gerškevitš, PhD

Head Of Medical Physics Service, Radiotherapy Centre , North Estonia Medical Centre, Estonia

Eduard is a medical physicist with 25 years of clinical experience. He has vast experience in commissioning and audits of radiotherapy equipment in different countries. He is a board member of MPWB.





By developing new and agile ways of working during a global pandemic, RaySearch has managed to maintain a productive pace, while keeping the health, safety and wellbeing of employees in the forefront. HR Manager Lotta Larsson talks about how the company has adapted for continued success during the COVID-19 pandemic.

AN UNPRECEDENTED CHALLENGE 2020 was a challenging year in many ways, but RaySearch has weathered the storm well. We have 11 subsidiaries in locations around the world, including China, and the HR team in Stockholm began receiving reports of COVID-19 early on in 2020 - but we could never have imagined the journey this pandemic would take the entire company on. When we transitioned to mainly working from home in March 2020, no one expected to be away from the office for very long at all. A TESTIMONY TO ADAPTABILITY Like many companies around the world, our operations have been substantially affected. One vital success to be proud of is that we have managed to maintain production at a continuously high level, which is a testimony to the organization’s adaptability. Switching to remote working for all of our employees within a matter of days was an unprecedented change. Naturally, it posed some new challenges – not least for HR and IT. One of the most crucial challenges was to keep employees actively connected and engaged.

to date about the company’s challenges and adaptations. Clear and regular internal communication was vital for a successful transition – especially in the early stages. SUCCEEDING TOGETHER The need for crisis and change management during the pandemic has meant a pivotal role for HR from the outset. Leadership and crisis communication have truly been put to the test, and it was clear that cooperation across teams and functions would be essential, as would having a consistent and unified voice in our communication. To this end, we appointed a COVID-19 Management Group, tasked with keeping staff and managers continuously informed via guideline updates, emails and information pages on the intranet.

During March, we ran regular meetings with cross-functional groups to gather updated news about the situation, make timely decisions about our responses and communicate the situation clearly to our people.

The technical solutions needed to manage this transition were already in place at the start of the pandemic, but had never been tested on this scale. The IT department has played a key role in our success for 2020, going the extra mile to support the entire organization.

SAFETY, PRODUCTIVITY AND SOCIAL RESPONSIBILITY Our objectives from the start of the pandemic have been to prioritize the health and safety of the employees, and to take responsibility for limiting the spread of COVID-19 in society. We have also pulled together to ensure continuous high productivity across all business functions, enabling deliveries and services to customers as expected.

Communication has been a vital element. People need to stay connected to their colleagues, and also be kept up

MONITORING THE WELLBEING OF OUR PEOPLE Our company and our success are founded on our people,


Our objective from the start of the pandemic has been to prioritize the health and safety of the employees. As a joint effort, we have also worked to ensure continuous high productivity in all business functions to allow deliveries and services to customers as expected.

and their health and safety have been paramount since the start of the pandemic. We adopted a policy of postponing travel and face-to-face customer meetings at an early stage, and HR has continuously monitored the wellbeing through regular online global surveys. We started out with daily global surveys focusing on how well people were coping with the transition to working from home. After the initial critical period of adaptation, we shifted to quarterly surveys to monitor wellbeing, leadership, productivity and motivation within the organization. AN AGILE APPROACH TO REMOTE WORKING During this extraordinary period, we have seen a magnificent volition from our employees to maintain the company’s performance levels. We have been able to maintain strong leadership globally, good internal communication and healthy, motivated employees. One of the major contributing factors to this success is our agile and flexible approach to working.

Employees have found innovative ways to maintain effective collaboration within project teams, using chat functions and open video channels to keep up the live dialog. We have also developed new approaches to recruiting staff and solving the logistics of remote onboarding. We have new employees who have not yet set foot in our offices or met their colleagues in person, but have nonetheless quickly become engaged and productive team members. This speaks volumes for the adaptability of our people and our organization.

Naturally, many of us miss social interactions and the ability to discuss and plan together in person. The interactions that took place by the coffee machine or in the lunchroom have largely been lost. To adjust, we have incorporated alternative ways to socialize, such as online quizzes, virtual after-work get-togethers, and online fitness and yoga sessions. Our people are driving these initiatives, which have been very successful. At the start of the pandemic, many employees experienced the flexibility to work from home as positive for worklife balance. But after the initial honeymoon phase, many have said they would prefer to spend most of their work time in the office. Working from home is not everyone’s preferred choice, so as a company we have strived to support our staff with any concerns about physical and mental wellbeing. We have put considerable effort into addressing issues such as good ergonomics at home, and we have encouraged the use of our health insurance services for access to care. It has also been important for us to keep the office open, so that employees have the option to come in to work if they need to, while ensuring compliance with safety guidelines. There will be a new version of “normal” when our offices fully reopen. As an employer, we must ensure that our people feel safe at work, while providing a space for collaboration and productivity that our employees are motivated to come to every day.


SUSTAINABILITY AT RAYSEARCH OUR VISION IS A WORLD WHERE CANCER IS CONQUERED. Our mission is to contribute to the continued advancement of cancer care by developing innovative software solutions that improve quality of life for cancer patients and save lives.


RaySearch offices around the world


RayStation centers in 40 countries



– Product and patient safety – Leading functionality for improved treatment outcomes – Resource efficiency to reduce environmental inpact

– Long-term profitability – High ethical standards



– Customers – cancer centers – Research institutions – Medical device suppliers

– Committed employees with a high level of expertise in an innovative culture – Social sustainability (work environment, gender equality, etc.)

SOFTWARE R&D – OUR CORE RaySearch’s entire business is permeated by patient safety and the safety around our products. To remain a leading manufacturer of medical software, and to meet the high demands and expectations of our stakeholders, safety, responsibility and high business ethics are crucial. Further, continuous innovation is a prerequisite for us to be successful and that is why more than half of our employees work within R&D.

A key part of the development of new RaySearch software products is to constantly contribute to increased resource efficiency in cancer care – in terms of time, quality, costs and materials. In this way, the environmental impact can be reduced. STRATEGIC PARTNERSHIPS ARE CRUCIAL Collaborating with strategic partners is key. In order for us to be able to develop the best, safest and most efficient software solutions, we collaborate with both leading equipment suppliers and the most prominent cancer clinics. Our entire development model is based on these partnerships, which provide us with extensive clinical knowledge and resources.

PROFITABLE AND SUSTAINABLE GROWTH For RaySearch, long-term profitability and high business ethics are of the utmost importance as this guarantees sustainable development for all our stakeholders. ATTRACTIVE EMPLOYER – PIONEERS WITH A CLEAR MISSION To succeed in achieving our vision, to overcome the enormous challenge that cancer poses for people around the world, we need to attract and retain committed and motivated employees with specialist competences in different areas. This requires a culture of pioneering spirit where we dare to challenge ourselves and think innovatively, with customers and patients in focus. Diversity and equality are also important parts of an innovative culture. Your gender, religious beliefs, sexual orientation or socioeconomic background will hopefully add flavor to our innovation, if you are a pioneer you will be a part of our team. At RaySearch, we aim to give all employees the same conditions and opportunities. We have maintained a – for the industry – high proportion of women. During 2020 as many as 35 percent of all employees were women. The focus on equal treatment and equality will continue during 2021.





The use of natural and tactile materials like stone, wood, and abundant greenery makes for a varied and welcoming interior. Lush landscaping, indoor garden areas, and plenty of places to relax, will invite people to meet and mingle – all while maintaining productivity.

Maria Andersson, Office & Facility Manager and RayLab Construction Project Manager reflects on the progress made in 2020.

THE SKY’S THE LIMIT Slated for opening in late 2021, the new RayLab is growing by leaps and bounds. The environmentally certified structure will be home to the new RaySearch® headquarters in Hagastaden, Stockholm’s leading life science hub.

Combining timeless elegance with modern innovation, RayLab will “bring the outdoors in”, with appealing and inspiring workspaces offering all the modern conveniences of urban dwelling, co-mingled with the lush and organic elements of nature and greenery. “We want to create a workspace where people feel energized, motivated and inspired. Work/Life balance is extremely important to RaySearch, and the new headquarters is designed with the objective of bringing more life into the daily work aspect,” Andersson explains. BUILDING THE DREAM It was only natural when the concept of the new headquarters was formed, that contentment, well-being, and sustainability were considered tantamount to logistics, form and function.

In addition to developing innovative software solutions to fight the battle against cancer, another important element in the driving force of the company is a deeply rooted investment in the health and wellness of its people. RaySearch staff will have their own bistro and rooftop terrace, a fully equipped exercise facility and changing rooms, a large bicycle room, and charging stations for electric vehicles among their amenities. “RayLab will be a place of innovation, but work and comfort do not have to be mutually exclusive,” affirms Andersson. SUSTAINABILITY IN ACTION RaySearch will retain and re-utilize 95% of the furnishings from their former office for use in the new building. “We can repurpose what we already have and purchase only what we need,” Andersson says. “Obtaining materials during a global pandemic, and keeping the project cogwheels turning is a challenge, but we manage, by being resourceful and responsible in our planning.” BRINGING IT ALL TOGETHER “When this project began in 2019 – the end game seemed a long way away. We had a vision of what we wanted to create, but at the time, that was all we had,“ Andersson recalls.

Large scale ventures like these require the collective effort of many. Designers, architects, engineers, and numerous contractors have to pull together to meet the needs of the client and bring their vision to life in a concrete way. “Every day, there is observable progress happening, and the vision comes to life a little bit more. It has been a source of great pride to work with such a dedicated team on this rewarding and meaningful project.”


MEET OUR MANAGEMENT TEAM (LEFT TO RIGHT) PETRA JANSSON General counsel DAVID HEDFORS 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


PETER THYSELL Chief financial officer NICLAS BORGLUND Director of service FREDRIK LÖFMAN Head of machine learning HENRIK FRIBERGER Director of development KJELL ERIKSSON Chief science officer BJÖRN HÅRDEMARK Deputy CEO


©RAYSEARCH LABORATORIES AB (PUBL) Sveavägen 44, SE-103 65 Stockholm, Sweden Tel: +46 (0)8 510 530 00 marketing@raysearchlabs.com www.raysearchlabs.com Annual Review: 2021–07–08

Articles from RaySearch Annual Review 2020