{"id":"brachytherapy-iort-machines-roadmap","name":"Brachytherapy, intraoperative and skin radiotherapy machines: afterloaders, theatre linacs and office X-ray units","route":"/roadmaps/brachytherapy-iort-machines-roadmap/","eras":[{"era":"1986-2006","title":"Remote afterloaders","description":"Nucletron's Selectron HDR (K852842) and microSelectron HDR (K864210) were cleared in 1986, its second version in 1996 and the v3 in 2006; the GammaMed line from Mick Radio-Nuclear in 1989 passed through later owners to Varian, and Varian's VariSource followed. Remote loading removed staff exposure and high-dose-rate sources made treatment outpatient.","status":"historic","refs":[{"id":"brachytherapy-afterloaders","kind":"technology","name":"Remote afterloaders for HDR brachytherapy","route":"/technologies/brachytherapy-afterloaders/","status":"standard-of-care","tldr":"The machine that makes modern brachytherapy safe for staff: a shielded safe holding one tiny, intensely radioactive source on a cable, which it drives out through tubes into applicators inside the patient, dwells at programmed positions, and pulls back before anyone re-enters the room."},{"id":"brachytherapy","kind":"technology","name":"Brachytherapy","route":"/technologies/brachytherapy/","status":"standard-of-care","tldr":"Brachytherapy places a radioactive source directly inside or next to the tumour."},{"id":"elekta","kind":"company","name":"Elekta","route":"/companies/elekta/","tldr":"Elekta is the Swedish radiotherapy company behind Unity, the leading MR-linac, and Gamma Knife."},{"id":"varian","kind":"company","name":"Varian (Siemens Healthineers)","route":"/companies/varian/","tldr":"Varian is the largest radiotherapy equipment maker and is running the first human FLASH proton trials."}],"trials":[],"papers":[]},{"era":"2007-2018","title":"Current afterloader generation","description":"GammaMedplus iX (K071381, 2007), Flexitron (K070574, 2007; Elekta claims up to 30 per cent faster treatment from internal data), SagiNova (K142986, 2015), with a miniaturised cobalt-60 source option, and BRAVOS (K181903, 2018), with a pre-treatment checklist and camera-based quality assurance. microSelectron, VariSource iX and MultiSource no longer appear on their makers' current product lists.","status":"current","refs":[{"id":"brachytherapy-afterloaders","kind":"technology","name":"Remote afterloaders for HDR brachytherapy","route":"/technologies/brachytherapy-afterloaders/","status":"standard-of-care","tldr":"The machine that makes modern brachytherapy safe for staff: a shielded safe holding one tiny, intensely radioactive source on a cable, which it drives out through tubes into applicators inside the patient, dwells at programmed positions, and pulls back before anyone re-enters the room."},{"id":"elekta","kind":"company","name":"Elekta","route":"/companies/elekta/","tldr":"Elekta is the Swedish radiotherapy company behind Unity, the leading MR-linac, and Gamma Knife."},{"id":"varian","kind":"company","name":"Varian (Siemens Healthineers)","route":"/companies/varian/","tldr":"Varian is the largest radiotherapy equipment maker and is running the first human FLASH proton trials."},{"id":"eckert-ziegler","kind":"company","name":"Eckert & Ziegler","route":"/companies/eckert-ziegler/","tldr":"German isotope and radiopharmaceutical services company supplying Lu-177, Ga-68 generators, Ac-225 development, and contract manufacturing."}],"trials":[],"papers":[]},{"era":"1998-2025","title":"Radiotherapy in the operating theatre","description":"Mobetron (K981112, 1998), INTRABEAM (K051055, 2005; 600 in 2016; 700 in 2025), LIAC (2012) and LIAC HWL (2018), and NOVAC 11 (2012). TARGIT-A supported low-energy X-ray IORT for selected women; ELIOT found more in-breast recurrence with electrons.","status":"current","refs":[{"id":"iort-systems","kind":"technology","name":"Intraoperative radiotherapy machines (INTRABEAM, Mobetron, LIAC, NOVAC)","route":"/technologies/iort-systems/","status":"established","tldr":"Machines small enough to wheel into an operating theatre, so a surgeon and radiation oncologist can give one dose of radiation to the tumour bed while the patient is still under anaesthetic. Some use low-energy X-rays from a probe, others a mobile electron beam."},{"id":"intraoperative-radiotherapy","kind":"technology","name":"Intraoperative radiotherapy (IORT)","route":"/technologies/intraoperative-radiotherapy/","status":"established","tldr":"Giving a single large dose of radiation directly to the tumour bed during surgery, with normal organs moved out of the way; used mainly in breast cancer as an alternative to weeks of external radiotherapy."},{"id":"targit-a","kind":"trial","name":"TARGIT-A (targeted intraoperative radiotherapy)","route":"/trials/targit-a/","status":"mixed","tldr":"One dose of radiotherapy given inside the breast while the patient is still asleep, instead of three to six weeks of daily hospital visits. Cancer control was close enough to count as equivalent, slightly more cancers came back in the breast, and fewer women died of causes other than breast cancer."},{"id":"carl-zeiss-meditec","kind":"company","name":"Carl Zeiss Meditec","route":"/companies/carl-zeiss-meditec/","tldr":"Carl Zeiss Meditec makes Intrabeam, a miniature X-ray source used to give a single dose of radiation to the breast tumour bed during surgery, and the Kinevo surgical microscopes whose blue-light and infrared modes make brain tumours glow during resection."},{"id":"intraop-medical","kind":"company","name":"IntraOp Medical","route":"/companies/intraop-medical/","tldr":"IntraOp makes the Mobetron, a mobile electron-beam machine that can be wheeled into an operating theatre to give a single, targeted dose of radiation to the tumour bed during cancer surgery, and it is also being used in the first human trials of ultra-fast FLASH radiotherapy."},{"id":"sit-sordina-iort","kind":"company","name":"SIT Sordina IORT Technologies","route":"/companies/sit-sordina-iort/","tldr":"SIT Sordina IORT Technologies is an Italian maker of mobile electron accelerators that give radiotherapy in the operating theatre, the LIAC and LIAC HWL, and now also sells the NOVAC 11."}],"trials":[{"id":"targit-a","name":"TARGIT-A (targeted intraoperative radiotherapy)","route":"/trials/targit-a/","outcomes":[{"endpoint":"Local recurrence at 5 years","primary":true,"unit":"%","arms":[{"name":"Targeted intraoperative radiotherapy","n":1140,"value":2.11,"note":"absolute difference against external beam 1.16 percent, 90 percent confidence interval 0.32 to 1.99, within the 2.5 percent non-inferiority margin"},{"name":"External beam radiotherapy","n":1158,"value":0.95}],"source":"https://doi.org/10.1136/bmj.m2836"},{"endpoint":"Overall survival, long-term follow-up (median 8.6 years)","unit":"hazard ratio","arms":[{"name":"Targeted intraoperative radiotherapy against external beam","value":0.82}],"hr":0.82,"ci":[0.63,1.05],"p":"0.13","source":"https://doi.org/10.1136/bmj.m2836"},{"endpoint":"Mortality from causes other than breast cancer","unit":"hazard ratio","arms":[{"name":"Targeted intraoperative radiotherapy against external beam","value":0.59}],"hr":0.59,"ci":[0.4,0.86],"p":"0.005","source":"https://doi.org/10.1136/bmj.m2836"}],"setting":"Women aged 45 or over with invasive ductal carcinoma up to 3.5 cm, cN0 to cN1, eligible for breast conservation: a single dose of targeted intraoperative radiotherapy given during lumpectomy, with external beam radiotherapy added where pathology found higher risk, against a standard course of whole-breast external beam radiotherapy","enrolled":2298,"enrolledNote":"2,298 women were randomised in the pre-pathology stratum reported in 2020; the ClinicalTrials.gov record NCT00983684 gives a registered total of 3,451 across both strata of the trial programme.","enrolledBasis":"randomised"}],"papers":[]},{"era":"1978-2023","title":"Skin cancer in the clinic","description":"Superficial and orthovoltage X-ray units, from the Therapax 150A (K781084, 1978) and Gulmay's DARPAC 2000 (1996) to Sensus's SRT-100 (2013), image-guided versions with ultrasound (2013, 2015), SRT-100+ (2018) and Xstrahl's RADiant (2023). Electronic brachytherapy, Xoft Axxent (2005) and Esteya (2013), uses a miniature X-ray tube instead of a radioactive source.","status":"current","refs":[{"id":"superficial-radiotherapy","kind":"technology","name":"Superficial and orthovoltage radiotherapy for skin cancer","route":"/technologies/superficial-radiotherapy/","status":"established","tldr":"Low-energy X-rays that stop within a few millimetres, used to cure basal and squamous cell skin cancers where surgery would scar or is not wanted."},{"id":"electronic-brachytherapy-systems","kind":"technology","name":"Electronic brachytherapy (Xoft Axxent, Esteya)","route":"/technologies/electronic-brachytherapy-systems/","status":"established","tldr":"A miniature X-ray tube, switched on and off electrically, that does the job of a radioactive seed: it is placed in or on the tumour and gives a short-range dose, with no radioactive source to store or replace."},{"id":"sensus-healthcare","kind":"company","name":"Sensus Healthcare","route":"/companies/sensus-healthcare/","tldr":"Sensus Healthcare makes a family of superficial X-ray machines used in dermatology offices to treat basal and squamous cell skin cancers and keloids without surgery."},{"id":"xstrahl","kind":"company","name":"Xstrahl","route":"/companies/xstrahl/","tldr":"Xstrahl is a British maker of superficial and orthovoltage X-ray therapy machines for skin cancer and of preclinical radiation research platforms."},{"id":"icad","kind":"company","name":"iCAD (RadNet)","route":"/companies/icad/","tldr":"Long-standing mammography computer-aided detection company whose ProFound AI was the first cleared for 3D mammography; acquired by RadNet in July 2025."}],"trials":[],"papers":[]},{"era":"Next","title":"Brachytherapy where it is missing","description":"Brachytherapy is a mandatory part of curative cervical cancer treatment and expertise is declining in some regions. Cobalt-60 afterloaders need fewer source changes, which is the basis of OnCo's proposal for low-cost cobalt brachytherapy in every regional centre.","status":"emerging","refs":[{"id":"idea-acc-frugal-hdr-brachytherapy","kind":"idea","name":"Low-cost cobalt-60 brachytherapy for cervical cancer in every regional centre","route":"/ideas/idea-acc-frugal-hdr-brachytherapy/","tldr":"Cervical cancer cannot be cured by external radiotherapy alone; it needs brachytherapy, internal radiation that LMIC radiotherapy centres frequently lack or cannot keep running because iridium-192 sources must be replaced every three months. Cobalt-60 sources last about five years and give equivalent doses, so funding cobalt units for every regional centre closes a well-understood cure gap."},{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/","tldr":"A cancer that could be eliminated by HPV vaccination and screening. For those who develop it, immunotherapy and a tissue-factor ADC have improved survival."},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/","tldr":"Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce."},{"id":"b-workforce","kind":"bottleneck","name":"Not enough oncologists, nurses, pathologists, physicists","route":"/bottlenecks/b-workforce/","tldr":"The number of people with cancer is rising faster than the workforce trained to treat them."}],"trials":[],"papers":[]}],"watch":[]}