Blog | Medical

The News From ASTRO 2021

Kristjan Anderle

Uros Mitrovic

This year’s Annual Meeting of the American Society for Radiation Oncology (ASTRO) was, again, a live event. It was held in Chicago between the 24th and 27th of October 2021 at McCormick Place West. After the radiation therapy (RT) community was predominantly sheltered from the COVID-19 pandemic for 18 months, it was good to see our friends and acquaintances from clinical oncology, research, and the radiation therapy industry.

ASTRO’s 2021 Annual Meeting hosted more than 140 exhibitors of cancer-care technology and devices and featured more than 1,500 research presentations and expert panels. The central theme was “Embracing Change, Advancing Person-Centered Care”.

First impressions

Undoubtedly, the worlds of radiology (medical imaging) and radiation therapy are coming closer to each other and starting to merge.

Regarding the companies exhibiting, our first impression is that medical radiology giants are cooperating more and more closely with their partners to provide better integrated medical imaging with radiation therapy solutions.

Collaborative efforts are already paying off. Some are initiatives in guiding adaptive radiation therapy with magnetic resonance imaging (MRI). We were impressed by the next-generation simulation platforms that can be adapted, for example, to external beam radiation therapy (EBRT), proton therapy (PT) and brachytherapy planning.

Others presented the upgraded software for MR-Linac systems to fully support magnetic resonance imaging during adaptive treatments.

Vendors continue to evolve their radiation therapy systems, adding image quality, workflow improvements, and clinical artificial intelligence (AI). They are also investing a lot of effort into advancing FLASH therapy research, including performing clinical trials of experimental treatments.

“It appears adaptive therapy is influencing the uptake of AI, as workflow automation is a must for effective adaptive RT systems.”

Artificial intelligence

Among the exhibitors, we observed an increase of artificial intelligence offerings of solutions and products, predominantly in AI contouring, with at least five companies providing a product for the latter use-case. It seems that AI contouring is already solidifying its place as a future industry standard.

Workflowing can be also used for online adaptive therapy, based on daily imaging of patient anatomy, real-time target tracking and smooth adaptive replanning. It appears that adaptive therapy is influencing the uptake of AI, as workflow automation is a must for effective adaptive RT systems.

New radiation therapy devices

Vendors of new radiation therapy machines are also on the rise this year, occupying larger and more strategic booth spaces, which is an optimistic sign. They are introducing new imaging modalities for the treatment room, such as PET-CT (positron emission tomography-computed tomography), enabling biology-guided radiation therapy (BgRT). The latter uses external beam radiation therapy delivery via a linear accelerator, combined with PET-CT. BgRT can utilise mainstream standards for diagnosing, orchestrating, and monitoring treatment progress for many cancer varieties.

Another exciting development is machines that merge Linac (linear accelerator) technology with magnetic resonance guidance by employing high-quality MR before-treatment and real-time imaging. Such systems may also allow for prior gating of tumour-tracking features and adaptive radiation therapy.

Another innovative idea is to accommodate the patient in an upright position while seated. At the same time, the positioning system helps deliver radiation therapy with improved patient experience, clinical effectiveness, and increased access to radiation therapy.

Hypofractionation with FLASH

We also noticed a rising tide of radiation therapy machine manufacturers advocating FLASH technology.

One type of such product are oncological devices for treating invasive breast cancer with IORT (intraoperative radiation therapy). With these devices, oncologist surgeons can perform simultaneous resection of the tumour and its irradiation with electron beams. However, the mentioned method is limited to superficial and intraoperative tumours. Devices with more than six degrees of movement freedom can easily reach all the patient’s anatomical regions.

However, the introduction of FLASH is not limited to photon radiation therapy but is also being studied for clinical implementation through proton therapy. There are ongoing human clinical trials of the PT FLASH underway.

Namely, FLASH therapy with proton beams is an experimental RT modality that promises to dramatically cut down on the number of fractions compared to conventional radiation therapy. The secret is in irradiating tumours at extremely high dose rates, usually less than one second.

Workflow automation tools

At ASTRO 2021, we also spotted a trend in workflow automation tools for radiation therapy. Besides the established players, we noticed a rising number of smaller software companies providing workflow automation tools. Everybody, small and large, seems to be talking about developing capabilities for increased cloud processing and storage. However, there is still a long way to go towards an industry-standard cloud solution that would be transnational.

In a nutshell

Last but not least, we noted that all the leading proton therapy vendors were in force at the event. While on our part, we were at ASTRO 2021 actively engaged in showcasing Cosylab’s full-stack of software products for radiation therapy-machine manufacturers called the OncologyOne suite.

Although this year’s ASTRO event was live, we observed fewer people than in past years. The battle against COVID-19 obviously took its toll. In our estimate, there were at least a third fewer participants from the States and even a lower percentage of visitors from overseas.

The role of artificial intelligence is increasing, mainly in contouring. Vendors of new machines are rising, reserving larger and more strategic booth spaces. Many startups are now providing at least partial workflow automation tools. Companies are actively pitching FLASH, while PT vendors maintain their market presence.

And we can confirm once again: ASTRO is one of the main events in radiation therapy that clinical, research and industry professionals should visit.


Kristjan Anderle, PhD, is Chief Scientific Officer at Cosylab. He joined the company in 2018 after spending almost nine years at the GSI Helmholtz Centre for Heavy Ion Research in Darmstadt. Kristjan holds a PhD in medical physics and is an expert in particle therapy, especially its enhancements. In his free time, he enjoys family life and reading.

Uros Mitrovic, PhD, is an industry expert with over ten years of experience in several medical device fields, including radiation therapy and medical imaging. He holds a PhD in medical image processing and is the author or co-author of several papers in prestigious journals, conference proceedings and US patents. At Cosylab, Uros is the Marketing Director and the Portfolio Manager of the OncologyOne product suite.

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