{"slug":"machines-wave3","tag":"machines-wave3","variants":["machines-wave3"],"description":"No description yet","count":35,"kinds":{"technology":7,"company":10,"trial":9,"roadmap":5,"idea":4},"related":[{"slug":"proposal","tag":"proposal","shared":4}],"records":[{"id":"upright-radiotherapy-positioning","kind":"technology","name":"Upright radiotherapy positioning (Leo Cancer Care Marie, P-Cure, Mevion S250-FIT)","route":"/technologies/upright-radiotherapy-positioning/","status":"emerging","tldr":"Instead of lying on a couch under a rotating machine, the patient sits or perches on a chair that turns in front of a fixed beam. Because the heavy beam line no longer has to rotate, a proton machine can fit in an ordinary radiotherapy room."},{"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":"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":"rotating-gamma-radiosurgery-systems","kind":"technology","name":"Rotating gamma and hybrid cobalt systems (Our United TaiChi, MASEP Infini, Akesis Galaxy, GammaPod)","route":"/technologies/rotating-gamma-radiosurgery-systems/","status":"established","tldr":"Cousins of the Gamma Knife that spin a smaller number of cobalt-60 sources around the head or body, some built into the same gantry as a linear accelerator. Several were developed in China and are cleared in the United States."},{"id":"oncology-infusion-chairs","kind":"technology","name":"Oncology infusion and treatment chairs","route":"/technologies/oncology-infusion-chairs/","status":"standard-of-care","tldr":"Most chemotherapy is given to people sitting in a reclining chair for one to several hours, and with scalp cooling sometimes longer. The chair is a regulated but low-risk medical device, and almost nothing has been published about whether it is comfortable or safe for skin over long sessions."},{"id":"limb-cryocompression-devices","kind":"technology","name":"Limb cryocompression devices for chemotherapy nerve damage (Paxman Neuropathy System, Hilotherm ChemoCare)","route":"/technologies/limb-cryocompression-devices/","status":"emerging","tldr":"Machine-cooled wraps that chill and gently squeeze the hands and feet during chemotherapy, in the hope of keeping drug away from the nerves that cause numbness and tingling. They are the machine version of frozen gloves, and the trials so far give mixed answers."},{"id":"manual-cold-caps","kind":"technology","name":"Manual cold caps (Penguin and other frozen-gel caps)","route":"/technologies/manual-cold-caps/","status":"established","tldr":"Gel caps frozen in a cooler or dry ice and changed every 20 to 30 minutes by the patient or a helper, the older and portable alternative to scalp-cooling machines. None holds an FDA clearance for preventing hair loss."},{"id":"our-united","kind":"company","name":"Our United Corporation","route":"/companies/our-united/","tldr":"Our United is a Chinese maker of radiotherapy machines whose TaiChi family includes a linear accelerator, a cobalt rotating gamma unit and a hybrid of the two, all cleared by the US FDA."},{"id":"masep","kind":"company","name":"MASEP Medical Science and Technology Development (Shenzhen)","route":"/companies/masep/","tldr":"MASEP is a Shenzhen maker of rotating cobalt gamma radiosurgery systems, including the Infini, cleared by the US FDA in 2011."},{"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."},{"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":"panacea-medical-technologies","kind":"company","name":"Panacea Medical Technologies","route":"/companies/panacea-medical-technologies/","tldr":"Panacea Medical Technologies is an Indian maker of radiotherapy equipment whose Siddharth-II linear accelerator is cleared by the US FDA."},{"id":"best-theratronics","kind":"company","name":"Best Theratronics","route":"/companies/best-theratronics/","tldr":"Best Theratronics of Ottawa makes cobalt-60 teletherapy machines, the Theratron Equinox, still used where linear accelerators are hard to run and maintain."},{"id":"cooler-heads-care","kind":"company","name":"Cooler Heads Care","route":"/companies/cooler-heads-care/","tldr":"Cooler Heads makes Amma, a portable scalp-cooling system cleared by the FDA in 2021 that a patient can wear away from the infusion chair."},{"id":"stemtech-medical-devices","kind":"company","name":"Stemtech Medical Devices","route":"/companies/stemtech-medical-devices/","tldr":"Stemtech Medical Devices of Navi Mumbai makes the Eva scalp cooling system, the most recent machine cleared by the FDA to reduce chemotherapy hair loss."},{"id":"hilotherm","kind":"company","name":"Hilotherm","route":"/companies/hilotherm/","tldr":"Hilotherm is a German maker of water-circulating cooling devices, including ChemoCare wraps for hands and feet used in trials to prevent chemotherapy nerve damage."},{"id":"scalp-trial","kind":"trial","name":"SCALP randomised trial of the Paxman cooler","route":"/trials/scalp-trial/","status":"positive","tldr":"Women having chemotherapy for early breast cancer were randomly assigned to wear a machine-cooled cap or not. About half of those who used the cap kept most of their hair; none of the others did."},{"id":"dignicap-cohort-trial","kind":"trial","name":"DigniCap pivotal cohort study","route":"/trials/dignicap-cohort-trial/","status":"positive","tldr":"Women with early breast cancer having chemotherapy without an anthracycline used the DigniCap cooling cap. Two thirds lost half their hair or less, against none of a small comparison group."},{"id":"fast-01","kind":"trial","name":"FAST-01 (proton FLASH for bone metastases)","route":"/trials/fast-01/","status":"completed","tldr":"The first clinical trial of ultra-fast proton radiotherapy, in ten patients with painful bone metastases in the limbs. Treatment ran without technical problems and side effects were like those of ordinary radiotherapy."},{"id":"fast-02","kind":"trial","name":"FAST-02 (proton FLASH for thoracic bone metastases)","route":"/trials/fast-02/","status":"active","tldr":"The second human study of ultra-fast proton radiotherapy, this time for painful bone metastases in the chest wall, close to the lungs and heart. Ten patients were treated with no moderate or worse side effects."},{"id":"ice-compress-swog","kind":"trial","name":"ICE COMPRESS (SWOG, cooling or compression of limbs to prevent neuropathy)","route":"/trials/ice-compress-swog/","status":"recruiting","tldr":"A large US trial testing whether cooling, squeezing or both protect the nerves in the hands and feet during chemotherapy. It is the trial expected to settle a question small studies have left open."},{"id":"control-cipn-trial","kind":"trial","name":"CONTRoL (cryotherapy against compression for neuropathy)","route":"/trials/control-cipn-trial/","status":"completed","tldr":"A small randomised trial comparing frozen gloves, tight gloves and loose gloves during taxane chemotherapy. Tight compression did best, partly because far more women kept it on than kept the cold gloves on."},{"id":"duke-cryocompression-gyn","kind":"trial","name":"Duke cryocompression trial in gynaecological cancer","route":"/trials/duke-cryocompression-gyn/","status":"positive","tldr":"Women having chemotherapy for gynaecological cancers wore a cooling-and-compression device. It reduced the numbness they reported, though a nerve test showed no difference."},{"id":"dfci-paxman-limb-cryocompression","kind":"trial","name":"Dana-Farber trial of the Paxman limb cryocompression system","route":"/trials/dfci-paxman-limb-cryocompression/","status":"recruiting","tldr":"A US study testing Paxman's machine that cools and squeezes the hands and feet during taxane chemotherapy to prevent nerve damage."},{"id":"nuh-limb-cryocompression-expansion","kind":"trial","name":"Singapore limb cryocompression expansion study","route":"/trials/nuh-limb-cryocompression-expansion/","status":"recruiting","tldr":"A Singapore study that builds on the earlier safety work with a cooling-and-compression device for the hands and feet, now in 200 patients."},{"id":"linac-machines-roadmap","kind":"roadmap","name":"Linear accelerator machines: from Clinac to AI-imaging linacs, rings and radiosurgery units","route":"/roadmaps/linac-machines-roadmap/","tldr":"The machine that gives most radiotherapy has been rebuilt every decade or so: sharper beams, then built-in scanners, then rings that treat faster, and now imaging good enough to replan on the spot. This is the chain of models, dated from the regulator's records."},{"id":"mr-and-biology-guided-radiotherapy-roadmap","kind":"roadmap","name":"MR-linacs and biology-guided radiotherapy: from a cobalt MRI machine to PET-guided beams","route":"/roadmaps/mr-and-biology-guided-radiotherapy-roadmap/","tldr":"Machines that watch the tumour while treating it: first with MRI inside the treatment machine, then with a PET scanner that steers the beam from the tumour's own signal. Dated from the FDA records."},{"id":"particle-therapy-machines-roadmap","kind":"roadmap","name":"Particle therapy machines: from Loma Linda to proton rooms in a linac vault, carbon gantries and FLASH","route":"/roadmaps/particle-therapy-machines-roadmap/","tldr":"Proton and carbon-ion machines began as building-sized accelerators and are shrinking towards a single room. This is the chain of models, from Loma Linda's hospital proton centre to compact cyclotrons, upright chairs, superconducting carbon gantries and FLASH."},{"id":"brachytherapy-iort-machines-roadmap","kind":"roadmap","name":"Brachytherapy, intraoperative and skin radiotherapy machines: afterloaders, theatre linacs and office X-ray units","route":"/roadmaps/brachytherapy-iort-machines-roadmap/","tldr":"The machines that put radiation inside or right next to a tumour: remote afterloaders that send a radioactive seed down a tube, accelerators small enough for an operating theatre, and low-energy X-ray units for skin cancer. Dated from the FDA records."},{"id":"chemo-chair-comfort-devices-roadmap","kind":"roadmap","name":"Comfort devices at the chemotherapy chair: scalp cooling, cold caps, limb cryocompression and infusion chairs","route":"/roadmaps/chemo-chair-comfort-devices-roadmap/","tldr":"The devices that make the hours in the chemotherapy chair more bearable and protect hair, nails and nerves: frozen caps, then refrigerated scalp-cooling machines cleared from 2015, portable coolers, cooling and compression for hands and feet, and the chair itself."},{"id":"idea-mach-upright-versus-supine-registry","kind":"idea","name":"A shared registry comparing upright and lying-down radiotherapy","route":"/ideas/idea-mach-upright-versus-supine-registry/","tldr":"Upright proton machines are being installed, cleared mainly for the head, neck and upper chest, without any head-to-head comparison with lying down. A proposal: every centre records set-up accuracy, comfort and side effects the same way so the comparison exists."},{"id":"idea-mach-cooling-off-the-chair","kind":"idea","name":"Finish scalp cooling away from the infusion chair","route":"/ideas/idea-mach-cooling-off-the-chair/","tldr":"Scalp cooling keeps patients in the chemotherapy chair for up to two hours longer, which limits how many people a unit can treat. Shorter cooling after the drip and portable coolers could free the chair without losing hair protection."},{"id":"idea-mach-infusion-chair-pressure-study","kind":"idea","name":"Measure skin pressure and comfort in oncology infusion chairs","route":"/ideas/idea-mach-infusion-chair-pressure-study/","tldr":"People having chemotherapy can sit in the same chair for many hours, often thin and in pain, yet nobody seems to have studied whether infusion chairs cause pressure sores or discomfort. A simple study could find out."},{"id":"idea-mach-cold-or-compression-by-adherence","kind":"idea","name":"Choose cold or compression for neuropathy by what patients can keep on","route":"/ideas/idea-mach-cold-or-compression-by-adherence/","tldr":"Frozen gloves, tight gloves and cooling machines all aim to protect the nerves during taxane chemotherapy, but many patients take the cold ones off. Matching the method to what each person tolerates may matter as much as which method is best on paper."}]}