The linear accelerator – or linac – that’s used to deliver radiation treatments to cancer patients is one of the most complicated devices that exists within healthcare. Training medical physicists on how to use such machines requires instruction in the fundamental physics of beam acceleration, and how these principles apply to the clinical device. Trainees also need access to the linac itself, but such systems are only available when not in use for patient treatments. The devices can be easily damaged if set up incorrectly, and risk unwanted radiation exposure if used in the wrong way.

Some years ago, these concerns inspired Marco Carlone, then a medical physicist at the Princess Margaret Cancer Centre in Canada, to develop a linac simulator, aptly named the SIMAC. The simulator is an online teaching tool that’s designed to train people to use medical linacs. The idea is to provide a real-time simulated radiation beam that’s accessible round the clock from any PC, and enables trainees to safely operate a virtual linac without any of the related risks. In October 2019, Carlone founded Linax Technologies to commercialize this simulator. 

What was your motivation for developing SIMAC?

Today, linac training is mainly performed by hands-on learning. One of the reasons that I created an online simulator was to allow people to have access to a linac without having to actually be at one physically. Linacs are large, complicated machines and, in many ways, also highly dangerous. If used incorrectly they could expose the trainee to radiation. Another challenge when teaching people how to operate a linac is that if the device isn’t left in the correct state, it could harm a patient afterwards.

An online tool takes these problems away, allowing unsupervised access to linacs. The student doesn’t need to have someone with them to ensure that they are using the device correctly. They can also feel free to experiment with the device and learn how it works by changing parameters that you wouldn’t want to change on a machine that’s used in the clinic.

What made you decide to start a company?

I have a background in linear accelerator engineering, but about 20 years ago, I changed fields into medical physics. It was always apparent to me that there was a gap in approach between the people who design and build linacs, and the people who ultimately use them. The first time that I built a simulated linac environment was about six years ago, with grants from my institution and other sources. That was helpful in getting some people together to work on this, but as soon as the money ran out, the project slowed down quite a bit. At the same time, a lot of people had given me feedback that this approach was very useful. So, I thought it would be helpful to have a more continuous way of keeping the project going and keeping it sustainable through a commercial model.

There was a gap in approach between the people who design and build linacs, and the people who use them

Who are the target users for SIMAC?

At present, the linac simulator is designed for young medical physicists who would like to understand the functioning of the device, while learning how the physics of the accelerator relates to the clinical properties that they would likely see in the clinic. For example, users can see how adjusting the energy of the machine affects its clinical properties, which would be important for things like treatment planning or quality assurance. 

One of my main drivers is making linac training and learning available to anyone who wants it. In developing countries, one of the challenges with these highly advanced machines is training people to use them when there isn’t anyone locally who can teach this and access to resources is sometimes difficult. The ability to teach people anywhere in the world is something I’ve been trying to do since this idea dawned on me. 

I’m hoping that an online community, through a company like Linax Technologies, will allow people to have access to the materials they need in order to operate very complicated equipment, to create plans for their patients that are safe, and to communicate with anybody they’d like to in order to improve that. 

Do you have any advice for someone wanting to commercialize their own research?

The most important thing that I have learned is to focus on the people who are going to use your product – it sounds like a simple thing to say but it’s sometimes difficult to understand. As an example, when I built the simulator, I thought that all medical physicists would be interested in this because they all recognize the importance of linacs and will want to understand how they work. And while that was true, I found that not many people were willing to spend money on it. 

So one of the reasons why I’m focusing this on a specific segment – early-career medical physicists – is because those are the people who really need technologies like this, not just for their own knowledge, but also to help them with their career and to be more effective in what they do. It’s important to understand how people are using your product and what they are using it for. That will drive how you make decisions around how you develop it and what to focus on. The other problem with a start-up company is that you have very limited resources, and you have to make sure that you put your energy into things that will be valuable for the company moving forward.

How are you planning to develop SIMAC further?

Ultimately, the goal of Linax Technologies is to simplify radiotherapy. The name of my company is a hybrid of Linux and linac. Linux is an open-source operating system, and in my mind, radiotherapy is really an open-source community. We don’t do anything in radiotherapy unless the whole community endorses it, whether that be through the literature or via conferences. So what I’d like to do with Linax Technologies is provide a means to do that, starting with the linear accelerator, but hopefully expanding to other areas of radiotherapy and making the necessary information available to anyone who wants it. 

It’s quite an ambitious goal. I’m starting very small with one core problem – how to make your linac work – but I’m hoping we’ll be able to expand that out into other areas that would be helpful for people, in developing countries or anywhere else.