[{"command":"openDialog","selector":"#drupal-modal","settings":null,"data":"\u003Cdiv id=\u0022republish_modal_form\u0022\u003E\u003Cform class=\u0022modal-form-example-modal-form ecl-form\u0022 data-drupal-selector=\u0022modal-form-example-modal-form\u0022 action=\u0022\/en\/article\/modal\/5782\u0022 method=\u0022post\u0022 id=\u0022modal-form-example-modal-form\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cp\u003EHorizon articles can be republished for free under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence.\u003C\/p\u003E\n \u003Cp\u003EYou must give appropriate credit. We ask you to do this by:\u003Cbr \/\u003E\n 1) Using the original journalist\u0027s byline\u003Cbr \/\u003E\n 2) Linking back to our original story\u003Cbr \/\u003E\n 3) Using the following text in the footer: This article was originally published in \u003Ca href=\u0027#\u0027\u003EHorizon, the EU Research and Innovation magazine\u003C\/a\u003E\u003C\/p\u003E\n \u003Cp\u003ESee our full republication guidelines \u003Ca href=\u0027\/horizon-magazine\/republish-our-stories\u0027\u003Ehere\u003C\/a\u003E\u003C\/p\u003E\n \u003Cp\u003EHTML for this article, including the attribution and page view counter, is below:\u003C\/p\u003E\u003Cdiv class=\u0022js-form-item form-item js-form-type-textarea form-item-body-content js-form-item-body-content ecl-form-group ecl-form-group--text-area form-no-label ecl-u-mv-m\u0022\u003E\n \n\u003Cdiv\u003E\n \u003Ctextarea data-drupal-selector=\u0022edit-body-content\u0022 aria-describedby=\u0022edit-body-content--description\u0022 id=\u0022edit-body-content\u0022 name=\u0022body_content\u0022 rows=\u00225\u0022 cols=\u002260\u0022 class=\u0022form-textarea ecl-text-area\u0022\u003E\u003Ch2\u003ERadiotherapy needs to become more individualised \u003C\/h2\u003E\u003Cp\u003E\u003Cstrong\u003EDr Verellen, what have been the big recent achievements in radiotherapy?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003EIn the past, developments in radiotherapy were driven by a sort of pendulum motion between clinical experience and radiobiology. This is what happened over the last decades. Today, however, it is juggling between biology, clinical experience and technological improvements. With these new technologies we can improve targeted delivery of doses, what we need now is to be even more accurate in assessing delivered dose and feed this back into our radiobiological models. If we do that on a voxel level \u2013 an improved three dimensional imaging \u2013 we might start to understand the true radiobiology of tumours and healthy tissues, and this is what research projects should go for.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EDo you think the Horizon 2020 programme could help with that?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003EFrom a personal point of view, I believe we need to move to truly individualised biological intervention using ionizing radiation. We think we are almost there, but we are not there yet. Just as a surgeon needs to see his scalpel and the tissue that he is cutting, we need to see our scalpels better (the treatment beam) and where the beam is going on a cellular level (inside the patient during treatment delivery, not based on some CT-scans or MRI images acquired a few days before treatment). This requires more efforts in imaging and assessing treatment response, and adapting our strategies in real-time. So looking at the challenge posed by Horizon 2020, we need to develop tools for accurate assessment of dose, integrated into inter-fractional (from day-to-day) and intra-fractional (dealing with respiration and peristaltic motion of anatomy) dose accumulation, and we need to understand this from the biology inside the patient, not just in petri-dishes. This requires more communication between biology and physics. We need to collaborate more through projects working on these issues.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EWhat else could radiotherapy gain from Horizon 2020?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003E\u003Cblockquote class=\u0022tw-text-center tw-text-blue tw-font-bold tw-text-2xl lg:tw-w-1\/2 tw-border-2 tw-border-blue tw-p-12 tw-my-8 lg:tw-m-12 lg:tw--ml-16 tw-float-left\u0022\u003E\n \u003Cspan class=\u0022tw-text-5xl tw-rotate-180\u0022\u003E\u201c\u003C\/span\u003E\n \u003Cp class=\u0022tw-font-serif tw-italic\u0022\u003E\u2018Reimbursement should be results driven, more than simply being payment for the technology (or drug for that matter) itself\u2019\u003C\/p\u003E\n \u003Cfooter\u003E\n \u003Ccite class=\u0022tw-not-italic tw-font-normal tw-text-sm tw-text-black\u0022\u003EProfessor Dirk Verellen, director of the medical physics group at the Medical Faculty of the Free University of Brussels\u003C\/cite\u003E\n \u003C\/footer\u003E\n\u003C\/blockquote\u003E\nHorizon 2020 includes provision for research relating to patient safety. We have seen the development of very complicated new machines in our field. So we have been adapting and improving to make machines safer, but they are much more complex, and we have not changed our fundamental safety procedures. Many of our key safety tests reflect older technology, and since we have added new procedures and features we have never really redesigned the control process to reflect the characteristics of these new procedures, which are becoming extremely complicated.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003ECan you explain a bit more about the safety techniques?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003EIf you look at the physics, a lot of time has been spent on validating and treating plastic dummies. But vendors are selling complex \u2018plug-and-play\u2019 machines in an environment where departments are frequently understaffed and under trained, which is a dangerous situation. Hospitals are buying machines without adapting their workflows to these new technologies. The interaction between machines and the living breathing (unpredictable) patient is a real challenge. In addition the software and hardware is being updated constantly, which carries many risks. The aim of radiotherapy can only be realised if we know that the correct tissue is treated in the correct patient with the correct dose and this must be accomplished in the most complicated of modern technological settings, so this is one of the big challenges and I think that the European Society for Radiotherapy\u0026nbsp;\u0026amp; Oncology could initiate collaborative projects into overcoming these challenges.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EDo you have any overriding ideas of where to start?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003EI believe we should move to a \u2018process oriented\u2019 rather than \u2018device oriented\u2019 quality management system. So you follow the patient though the processes and then identify the critical procedures where there may be a higher frequency of errors or risk, whether these errors can be easily detected or not and, if they would occur, how severe it would be (in short Failure Modes and Effects Analysis). And then you can score the difficulties and figure out the higher priorities in the safety procedure.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EYour sector is currently undergoing massive technological change, what challenges does that carry?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003EWe have to be careful that instead of technology looking for problems we should keep our focus on problems looking for technological solutions. We need to develop technology looking to solve issues within the challenge of healthcare budgets (low-cost, high-yield solutions). Technology for the sake of technology is a risk. For example, we are putting a lot of effort into new machines that allow us to track changes in patient anatomy due to respiration, but the clinical reality is that this is of interest for a small group of patients only, where tumours move more than a centimetre. We need to bear in mind that society pays for this, and let\u2019s face it, there will be cuts in the health care budgets. We don\u2019t necessarily need more budgets in health care, but a redistribution. Too much of the financial resources go to treatments that show limited benefit for the patient. The rise in expenses related to drugs and supportive drugs is but one example and we need new financing mechanisms such as Coverage with Evidence Development. One point I would like to make is that reimbursement should be results driven, more than simply being payment for the technology (or drug for that matter) itself. Radiation oncology is ideally placed to play a central and pivotal role in the management of cancer patients, and this position should be made clear to policy makers and patients. \u003Cdiv class=\u0022moreinfoblock\u0022\u003E\n \u003Ch3\u003ERadiotherapy in a nutshell\u003C\/h3\u003E\n \u003Cp\u003ERadiation therapy refers to the medical use of high-energy radiation to treat different types of cancer. It works by damaging the DNA of cancerous cells. The type of treatment depends on the tumour type, location, and stage, as well as the general health of the patient. This kind of treatment can be used to cure the patient or to relieve symptoms and reduce the suffering caused by cancer.\u003C\/p\u003E\u003Cp\u003ERadiation therapy can be delivered externally by a machine (external-beam radiation therapy), internally via injection into the bloodstream (systemic radiation therapy) or by placing radioactive material in the body close to cancer cells via catheters, wires, needles, seeds (brachytherapy).\u003C\/p\u003E\n\u003C\/div\u003E\n\u003C\/p\u003E\u003C\/textarea\u003E\n\u003C\/div\u003E\n\n \u003Cdiv id=\u0022edit-body-content--description\u0022 class=\u0022ecl-help-block description\u0022\u003E\n Please copy the above code and embed it onto your website to republish.\n \u003C\/div\u003E\n \u003C\/div\u003E\n\u003Cinput autocomplete=\u0022off\u0022 data-drupal-selector=\u0022form-8-vd-jtcedsg94zaf47jdt-bl0vnnhuyf1tmzhvhga0\u0022 type=\u0022hidden\u0022 name=\u0022form_build_id\u0022 value=\u0022form-8-vd_JtcEDSg94ZAf47JDt-bL0vnnHuYf1tMZhvHgA0\u0022 \/\u003E\n\u003Cinput data-drupal-selector=\u0022edit-modal-form-example-modal-form\u0022 type=\u0022hidden\u0022 name=\u0022form_id\u0022 value=\u0022modal_form_example_modal_form\u0022 \/\u003E\n\u003C\/form\u003E\n\u003C\/div\u003E","dialogOptions":{"width":"800","modal":true,"title":"Republish this content"}}]