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Improving Personalized Cancer Care in Less Developed Countries

International Day of Medical Physics Spotlight


EmpowerRT is a new, social enterprise startup with a mission to help people in developing countries by improving cancer radiation therapy without spending millions of dollars on modern treatment technology. We spoke with its founder, Sha Chang, Ph.D., FAAPM, DABR, about the mission of EmpowerRT. In support of their mission, Sun Nuclear has provided a device to EmpowerRT for commissioning. As we celebrate International Day of Medical Physics, EmpowerRT is a prime example of this year’s theme – Medical Physics for Patient Benefit.


Why did you create EmpowerRT?

Cancer is the second leading cause of death globally, with an estimated 9.6 million related deaths in 2018. What is even more surprising is that approximately 70% of deaths from cancer will occur in Low to Middle-Income Countries (LMICs).1 This huge disparity between High-Income Countries (HICs) and Low-Middle Income Countries (LMICs) is simply unacceptable.

While there have been significant advancements in radiation therapy technology, these modern digital solutions are simply too expensive for cancer clinics in LMICs and require clean power and water, technology infrastructure, and highly trained professionals. These solutions are currently not affordable nor easily adoptable.

EmpowerRT was formed to bring clinically-proven, low cost solutions that have been successfully used to control cancers in HICs for the same cancers that are contributing to an extremely high mortality rate in LMICs. Our vision is to see a world where people in every country can have access to standard of care radiation therapy, regardless of income.

How does EmpowerRT support cancer clinics in less developed countries?

Intensity Modulated Radiation Therapy (IMRT) is the standard of care for many cancers in the U.S. and other HICs today but is still unavailable for the majority of cancer radiotherapy clinics in LMICs. EmpowerRT enables these clinics an IMRT solution on their existing treatment machines using largely their current workflow. Before commercial IMRT solutions first became available, the University of North Carolina at Chapel Hill (UNC) developed a recyclable compensator-based IMRT solution and used it clinically for 14 years before it was replaced by the modern automated solution widely used in HICs today.

EmpowerRT offers user-friendly IMRT treatment planning software, simple-to-use compensator fabrication technology, and service and training, including patient safety training, to LMICs clinics. EmpowerRT is giving the clinically proven, simple IMRT solution a second life in low resource clinics in LMICs. We can enable these clinics to deliver better cancer treatments now and, at the same time, prepare them for a smooth transition to the modern digital solutions in the future.


Image courtesy of EmpowerRT

A simple device fabrication, the compensator is placed on the exit window of the linac to create an intensity modulated field. It can be recycled for multiple uses.

UNC pioneered the use of compensator with an in-house developed software in the clinic for 14 years and published many papers on its success. Over time, of course, radiation oncology technology became more sophisticated, and UNC ceased using the compensator in favor of modern radiotherapy solutions that include IMRT technology.

EmpowerRT is currently commercializing the same compensator-based IMRT solution that UNC has used for decades and aims to bring it to cancer clinics in LMICs.

For clinics in less developed countries whose existing linacs have not been equipped with modern technology like IMRT, the compensator device is an ideal solution to support personalized radiation therapy cancer care. It’s simple, low-cost and clinically proven. With user-friendly software and expert guidance and training, it’s a viable and affordable solution to enable resource-limited cancer clinics to reduce treatment toxicity for their cancer patients.

You just returned from your first clinic where you are implementing the compensator technology. How did you work with them to get this program started?


Yes, we travelled to Zambia to meet with our early adopter: Cancer Diseases Hospital in Lusaka, Zambia. Prior to going on-site, we conducted remote training on commissioning the treatment machines as well as the compensator IMRT beams. In addition to our technology, we used a MapCHECK™ array donated by Sun Nuclear, in support of collecting commissioning data. We also trained clinic staff on the software for treatment optimization.

During our site visit, we met with the team there to understand their clinical workflows and identify the right people to receive training, so they can be the in-house experts for their clinic.

In Spring of 2019, we plan to go back to Zambia to prepare for treating the first patient.

EmpowerRT is looking to grow. What other sites are you targeting?

We are looking to bring the EmpowerRT solution to cancer centers in Peru, India, Honduras, Vietnam and Brazil, aiming for ten customers by 2019. Over 50% of clinics in these countries have outdated radiotherapy equipment that could be improved with EmpowerRT. We hope to get additional funding and donations so that we can continue to bring the EmpowerRT solution to cancer clinics worldwide. We estimate 4-5 million people are living with cancer in less developed countries where oncology equipment is outdated.

Fresh off our visit to Zambia, we are excited for the potential of this enterprise. It’s exciting to see the impact we can make. From our staff to donors like Sun Nuclear and partners like the Clinton Health Access Initiatives, we are looking forward to empowering more sites worldwide in the coming years.

If you would like more information about EmpowerRT or its solution, you can reach them at empowerRT@gmail.com.

1World Health Organization