Radiation project hits target
12 July 2011
In radiotherapy, a long term goal has been to improve the accuracy of radiation treatment, so that more targeted doses can be delivered, while reducing the impact on neighbouring tissues.
Highly focussed treatment is now a reality, and so is a new challenge that accompanies it, namely the need for high precision delivery. Without this, focussed radiotherapy creates the potential for a different problem – missing the target and delivering high treatment doses to healthy tissue.
A small privately funded team of specialists, focussed on improving the effectiveness of radiotherapy recognised this issue and, applying their own advanced software and tracking techniques, developed solutions to track both a patient’s position and breathing and to regulate the delivery of the high energy X-ray beam accordingly. The result is an integrated system, allowing control of radiotherapy delivery to very high levels of accuracy.
This study looks at how their small but dynamic company turned this technology into a clinically applicable system and after forging a fruitful partnership with an established design, prototyping and manufacturing house, is now delivering a world class solution into the radiotherapy market, on a worldwide basis.
Bringing the skill-sets together
London-based Vision RT was formed in August 2001 to develop patient positioning and respiratory motion tracking solutions. Following four years of intense development, the company launched AlignRT in August 2005 - a fast and accurate revolutionary 3D imaging solution for patient set-up and real-time tracking during radiation therapy. As a non-invasive system, AlignRT does not require the use of any markers and adds no further irradiation.
Today, Vision RT’s primary focus is still to deliver solutions for the radiotherapy market and it delivers real-time 3D surface imaging technology that is unrivalled in the industry. In support of this, Vision RT engaged in a strong and successful partnership with a respected design, prototyping and manufacturing house.
‘Bringing Instruments to Life’ is what Integrated Technologies Ltd (ITL) does. It has been doing so with great success for 35 years and its strength lies in its ability to support customers throughout every stage of the concept, design, development, prototyping and manufacturing cycle. Also with its specialist skills in the medical sector, its way of working fits naturally with Vision RT’s business needs.
Gideon Hale, VP Operations, commented: “Our relationship with ITL began in 2006 and in short, it is everything we had hoped for from a manufacturing partner, taking us to the next level delivering fully certified, high quality systems, in volume, to a worldwide customer base”. And from ITL’s perspective? Well Vision RT is the ideal customer; delivering a high tech’ product with a growing business forecast into a market where ITL is already well established and able to make a significant contribution to its success.
The challenges to growth
When producing high value system-level products for specialist applications and selling in ‘non-commodity’ (i.e. relatively low) volumes, it can be notoriously difficult to fund the initial production ramp, due to the risks of high inventory costs based on early stage business forecasts and erratic market penetration with early adopters.
In addition, the sales process itself can present challenges, as proved to be the case for early sales of AlignRT. Securing a commitment from a clinical early adopter such as a US private hospital for example, can be difficult as it is a three-stage process.
Firstly the clinicians must be convinced by the concepts and principles, after which the capabilities & benefits must be effectively communicated to the users (Radiotherapists). Only with these in place can the broader business case be argued with, for example, the hospital financiers.
Furthermore, with the majority of early engagements in the US, much of the hospital funding is private and the consequence of this, perhaps unsurprisingly, is that they can be very demanding in terms of delivery expectations and lead-time.
So unlike dealing with a large institution or government-funded organisation (where any commitment will likely take many months to secure), working with the private sector can lead to sudden unpredictable demand, which in turn calls for great understanding and flexibility from any manufacturing partner. Not only will they need to manage the normal impact of product and component lead-times, but also the very high demands on quality and reliability of the system configuration for the delivery.
The Market opportunity
The US is Vision RT’s primary market from a revenue perspective, with more commercial interest and although the regulatory processes are at least as strict as in Europe, decision making is driven more directly by the end users. The market is less constrained by either corporate or government purchase control, reflecting the largely private nature of medical business and the ability for each individual health company to manage its own assets.
In October 2010, Vision RT announced that it had signed a distribution agreement with Varian Medical Systems, allowing Varian to offer Vision RT’s motion management products to its customers. This is a major opportunity for Vision RT as Varian has the largest share of the radiotherapy market.
Hale added: “Varian audited ITL and on the basis of this forthcoming business, ITL represented us very well, doubling the size of our production cell on their shop floor”.
In addition to the UK, ITL has the potential to provide production facilities to Vision RT at its manufacturing location in China, further extending Vision RT’s international presence.
A solution
With these challenges and also the market opportunities open to the launch of the AlignRT system, the company needed a manufacturing partner that it knew it could rely on, not only to provide professionally manufactured, ISO 13485 certified products but also that would be supportive in the face of uncertain forecasts and business patterns.
Having worked previously with ITL, Gideon Hale had first-hand knowledge of its strengths in these areas; knowing how proactive they would be in solving these issues on the fly and to be ready to commit to a long term strategy and invest in a high cost, systems level business model. So with these challenges in mind, ITL was engaged and a successful long-term partnership began.
Hale said: “As a small company, the high cost of inventory for these systems has always been a challenge for us and, without a warehouse, we were not historically able to build from buffer stock, but built sub-systems to customer forecast and configured systems to order. Full system configuration and pre-shipment tests were all carried out in house, before delivery and commissioning on-site. Since engaging with ITL, they have made significant commitments of their own to support these processes and as a result our lead-time, production quality and system configuration and control have all benefited greatly.
“To be honest we quite often present them with a bit of a moving target when it comes to delivery dates, and ITL always respond admirably to the challenge! I recall one particular time where ITL committed to purchase based on our forecast, buying stock for something like fifty cameras, but deployment was slower than predicted and ITL was able to hold much of this stock for us for almost a year. The fact that the management at ITL were so prepared to absorb the impact of such issues from a strategic perspective says everything about their approach. It is during challenges that the strength in a relationship is built and it is where ITL shines.”
Vision RT’s preferred approach to addressing the many possible complex variants of system configuration is to produce a ‘Standard System specification’ and deliver a ‘customisation box’ for each specific customer configuration.
Norma Jack, Operations Manager at Vision RT is responsible for scheduling and purchasing and manages the interface with ITL on a day-to-day basis. She commented: “With stronger buying power than us, ITL now manages much of our outsourcing, and handles factory inspections by regulatory bodies for Vision RT. The team’s ability to spot issues at the system test phase and ensuring the right set-up for each customer, has been a major area of improvement for us, and our customers have measurably benefited from this in reduced installation snags and support calls.
“The production staff are a real asset to ITL. They know the Vision RT product well and are excellent at proactively spotting potential issues early on. Specifically Steve McGuire in the production team really cares about getting it right and seems to have a ‘sixth-sense’ of something not 100%, which he will pursue to a solution. The result is that his team is effective at pre-empting problems from showing up at customer premises, which is hugely valuable to us”.
The Results
The results of this partnership speak for themselves. Annual sales of AlignRT systems have exploded from just a handful in 2006, to over 40 multi-camera systems shipped in 2010 – a major achievement that is down to the professionalism of both parties working together.
In fact since the initial engagement with ITL in 2006, Vision RT has shipped over 150 high value, one, two and three camera systems and the current run rate of approximately 50 systems per year is expected to grow further as the company expands its presence in Europe.
Norma Jack adds, “Over the last year especially and during some very challenging delivery issues in the November/ December 2010 snow period, we have really come to appreciate the support of our manufacturing partner – when the chips are down, ITL responds”.
With a growth factor of twelve since their initial engagement, Vision RT has every intention to take advantage of ITL’s skills and industry knowledge as a key player in its business success; the future for this partnership looks very encouraging.
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