Expanding access to advanced cancer care in Thailand with Elekta Harmony
About Surin Hospital Division of Radiation Oncology
Location
Surin Province, Bangkok, Thailand
Staff
- 3 x radiation oncologists
- 2 x medical physicists
- 7 x radiation therapists
- 6 x radiation nurses
- 10 x radiation assistants
Equipment
- 1 x CT simulator (Siemens SOMATOM go.Sim)
- 1 x brachytherapy afterloader (Elekta Flexitron®)
- 2 x linear accelerators (Elekta Precise® and Elekta Harmony)
Radiation therapy patient throughput
120-150 patients per day
Looking to technology to meet regional needs
Surin Hospital is a major regional public healthcare facility, serving the population of Surin and other provinces in the Northeast region of Thailand. The hospital’s cancer center is the main referral center for cancer treatment in the region, with patients often travelling some distance to receive vital care.
In 2021, the hospital’s division of radiation oncology extended their radiation therapy capabilities by purchasing an Elekta Harmony Pro linac. Prior to this, the department performed only 3D conformal treatments without image guidance. For more complex treatments, patients had to be sent to a hospital in Bangkok, around 430 kilometers away, which created a significant barrier to appropriate and timely care.
“The number of cancer patients in Surin Province has risen to 3,000 cases per year, of which around 1,500 will require radiation therapy,” comments Dr. Supapan Witthayanuwat, Radiation Oncologist and Head of Department. “This number continues to rise, and so having the right radiation therapy solution is critically important. It must be efficient, user-friendly, and capable of streamlining workflows while providing features that help prevent errors in a high-volume clinical environment.
With a growing patient population and the need to provide more sophisticated treatments locally, the hospital believed that the precision, versatility and productivity of Elekta Harmony Pro would transform their capacity and clinical capabilities.
“We chose Harmony Pro because of its ease of use, and its potential to improve treatment accuracy and access to care.”
“We chose Harmony Pro because of its ease of use, and its potential to improve treatment accuracy and access to care,” explains Narueporn Pischom, Medical Physicist. “Everyone was used to Elekta OIS, so it was a natural choice for us.”
“Harmony Pro meets our requirements exceptionally well,” agrees Dr. Witthayanuwat. “Also, importantly, it can be installed in a compact linac bunker where space is limited.”
Expanding capabilities locally
Installation of the machine began in September 2021 and, by February of the following year, the team was treating their first patient (figure 2).
Installation
15 September 2021
Testing
4 October 2021
Training
19 November 2021
Go Live
11 February 2022
Figure 2. Implementation of Elekta Harmony Pro at Surin Hospital
The team at Surin Hospital quickly harnessed the system’s integral image guided radiation therapy (IGRT) capabilities to begin treating patients using intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic radiosurgery (SRS), stereotactic radiation therapy (SRT), and stereotactic body radiation therapy (SBRT), as well as 3D conformal RT. Having Elekta Harmony as part of their linac fleet means that patients no longer need to travel to the country’s capital for more advanced radiation therapy techniques.
“Now, we are able to offer a wide range of treatment techniques, enabling us to select the most appropriate option for each patient’s condition,” says Dr. Witthayanuwat. “Harmony is used to deliver VMAT treatments, which is particularly valuable for head and neck, prostate, and lung cancer patients.”
“We are able to offer a wide range of treatment techniques, which enables us to select the most appropriate option for each patient’s condition.”
“IGRT has been a great introduction for our patients as this allows us to offer more complex treatments locally,” Pischom adds. “One of our key successes using the Harmony Pro solution is the implementation of VMAT technology for the treatment of head and neck cancer patients. This technique enables us to deliver radiation with greater precision, while providing significantly better protection of surrounding critical structures compared to conventional treatment approaches.”
“Another memorable example was our first pediatric patient treated using VMAT CSI (figure 3). This was an 11-year-old patient with a CNS germ cell tumor and spinal cord metastasis. When the child first arrived at the hospital, they were lethargic and unable to walk. However, after completing approximately six months of treatment on Harmony Pro, the child regained their ability to walk independently, reported a return to normal energy levels at the six-month follow-up, and showed age-appropriate developmental progress. This outcome has been a tremendous source of pride for our entire team.”
Accelerating growth to meet demand
Harmony Pro is designed to address high demand for radiation therapy through an ideal balance of productivity, precision and versatility. Its advanced, streamlined workflows offer the potential to reduce average treatment time slots by up to 25%*, allowing clinicians to deliver safe, personalized treatments to more patients.
“Due to the solution’s ease of use and operational efficiency, we can typically accommodate 80 to 120 patients per day, and have reached a peak capacity of 150 patients in a single day.”
“Due to the solution’s ease of use and operational efficiency, we can typically accommodate 80 to 120 patients per day, and have reached a peak capacity of 150 patients in a single day without any reported radiation treatment incidents or errors,” Dr. Witthayanuwat comments.
This significant growth is largely due to the advanced, streamlined workflows available on Harmony Pro.
For example, the integration between Harmony Pro and Elekta OIS supports a much more ergonomic in-room experience for radiation therapists compared to conventional C-arm linacs, providing all the information they need directly at the linac. A simple hand-held device enables them to control the linac, table and imaging panel with ease, allowing them to perform patient setup without having to leave the patient’s side. Helping to reduce patient setup time by up to 50%*, these features allow the team at Surin Hospital to maintain an average of 15-minute treatment time slots with the new linac.
“Having all the details needed for that patient at the Hub in the center of the gantry saves a lot of time, which is great for patients and the RTTs.”
“Having all the details needed for that patient at the Hub in the center of the gantry saves a lot of time, which is great for patients and the RTTs,” Pischom comments. “They can stay at the patient’s side and setup is so fast. Previously, information was far away and difficult to see. Now, all we hear from our RTTs is how easy the process is—both inside and outside the treatment room.”
Radiation Therapist, Panadda Poonsritanakoon agrees: “The solution includes a facial recognition and patient verification feature that helps to ensure treatment is delivered to the correct patient, which significantly reduces the risk of operational errors.”
A platform for innovation
Surin Hospital’s investment in new technology has not only increased their capacity to meet the growing demand for radiation therapy in their region, but it has also expanded their treatment portfolio significantly. This allows them to offer patients the advanced techniques required for more complex cases closer to home.
“Harmony Pro is not just a tool, but a catalyst for growth and innovation… It’s the foundation for everything we’re now able to achieve.”
“Harmony Pro is not just a tool, but a catalyst for growth and innovation,” says Pischom. “The implementation of this technology has pushed us to go beyond our limits. It’s the foundation for everything we’re now able to achieve.”
“Being the first hospital to implement this technology is a significant achievement for us,” concludes Dr. Witthayanuwat. “It allows us to bring advanced medical innovation directly to patients in our local community. We hope our experience can serve as a model and an inspiration for other hospitals across Thailand to invest in new technologies that enhance the quality of patient care. Harmony Pro enables us to overcome previous limitations and opens the door to even more advanced radiation therapy techniques. In the future, we plan to expand our treatment capabilities to include CSI VMAT in both pediatric and adult patients, as well as to fully implement SRS and SRT programs. Our goal is to improve access to highly precise and advanced radiation therapy treatments for patients in the region.”
*Elekta data on file
Contributors
Dr. Supapan Witthayanuwat
Radiation Oncologist and Head of Radiotherapy Department
Mr. Teerawut Sangsing
Radiation Technologist of Radiotherapy Department
Ms. Narueporn Pischom
Medical Physicist of Radiotherapy Department
