Alberta Cancer Foundation

Transforming Radiation Treatment

Photograph of Dr. Nawaid Usmani, lead of the Northern LIGHTs program by John Ulan.

After 15 years of development and endless hours of research, a machine with Alberta-made/developed technology is one step closer to providing game-changing treatment for cancer patients.

This pioneering technology combines the imaging capabilities of an MRI with the radiation abilities of a linear accelerator (Linac) to accurately target tumours. Funded by the Alberta Cancer Foundation, Alberta Health Services and others two years ago, the Northern LIGHTs program launched a clinical trial this past September to study and confirm the safety and effectiveness of this Linac-MR at the Cross Cancer Institute (CCI) in Edmonton.

By blending these two technologies, the Linac-MR offers real-time imaging during radiation treatments and has the capability to shorten treatment time and negate damage to healthy organs.

“We’re at the point where we’re getting ready to start treating patients,” says Northern LIGHTs program lead Dr. Nawaid Usmani. “It’s really exciting to be able to finally use this technology to do that.

”For decades, doctors have used CT-based technology to see inside the body to better target tumours with radiation.

“CT is really good to see inside the body,” says Usmani. “But it’s not able to see all of the organs or tumours inside the body clearly. MR can visualize some organs or tumours more clearly. It’s like going from black and white pictures to colour pictures where you are able to appreciate some details more clearly with MR.”

Dr. Gino Fallone is a medical physicist and began work on the Linac-MR over a decade ago. Fallone and his research team developed two prototypes at the CCI, demonstrating that it was possible to safely combine a Linac with an MR machine. Since then, the team has developed a Linac-MR ready to be used clinically in the Northern LIGHTs program.

Before Fallone’s research began, Usmani says it was generally thought that combining MRIs with radiation machines was “impossible.”

“The worry was that the radiation machines would interfere with the MRIs, and vice versa. But with Fallone’s research, they realized that it’s not only possible to combine the two technologies, but they started developing it themselves.”

In addition to being difficult to see on CT scans, some tumours are in organs prone to movement during radiation, such as lungs, prostates and stomachs. By having a live visual of the cancer, this technology is designed to target radiation at cancers more precisely while limiting radiation to the healthy tissue in the area.

“The exciting thing with this technology is not only that we can see things better than before, but we can actually watch the tumours during treatment,” says Usmani. “This way, if the tumour moves out of the way of radiation through breathing or some other natural process, we can correct or stop the treatment temporarily until it comes back to the right place. By doing that, we will hopefully have fewer side effects and less risk of long-term damage to normal tissues.”

Photograph of the Linac-MR by John Ulan.

Until the spring of 2021, the Northern LIGHTs team was testing the Linac-MR on “water phantoms” in the basement of the CCI, where they used containers of water filled with sensors to test to see if the technologies were working as expected.

After “rigorous testing,” Usmani says the team received regulatory and ethics approval this year to start using this technology on patients. They began imaging prostate, liver and central nervous system tumours in volunteer patients over the summer. The imaging process will take approximately a year. At the same time, the program will begin clinical trials to start treating patients later in 2021.

“We feel confident the machine is precise and that it’s able to do things safely,” he says.

Usmani became the program lead of the Northern LIGHTs initiative two years ago. As a radiation oncologist for14 years, Usmani specialized mainly in prostate cancer and was keen to get involved with this research with Fallone. He says he believes this technology will “help transform the way we treat prostate cancer.”

Radiation for prostate cancer currently takes 20 sessions on average to avoid damage, but Usmani says he hopes this new technology will reduce that number to five sessions.“

I think this will revolutionize radiation oncology and cancer treatment,” says Usmani. “There were a number of tumour sites we didn’t think we’d be able to treat safely with radiation because we couldn’t see the tumours clearly or focus the radiation precisely enough, so I think it’s very exciting that we’ll be able to improve our radiation treatments with this, and hopefully improve our patients’ outcomes in the long term as well.”