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What's Holding Back Adaptive Radiation Therapy?

A Look at the Tools Needed

Adaptive radiation therapy (ART) holds immense potential to improve cancer care by reducing treatment-related toxicity and lowering recurrence rates. However, despite its clear clinical and economic benefits, adoption remains limited. In Australia, for example, only about 3% of patients currently receive adaptive radiotherapy, leaving 97% without access to this enhanced approach. A key reason is the significant number of technical tools, processes, and human resources required to deliver ART effectively.

Essential Tools for Adaptive Radiation Therapy

First, let's start with some good news: Clinically Significant Adaptive Triggers
One of the most critical elements is identifying when a patient needs adaptation. Fortunately, recent research, such as the Energy Oncology review on ART, has provided strong clinical guidelines. These guidelines quantify what constitutes a significant change - whether it's a shift in the gross tumor volume (GTV), the planning target volume (PTV), critical structures, or major anatomical changes - helping clinicians make objective decisions about when to replan.

In-Room Imaging

Access to in-room imaging technology is essential for ART. The good news is that 80% of centers surveyed by ESTRO report having in-room imaging available. Imaging provides the necessary daily snapshots of patient anatomy to guide decisions about whether adaptation is required.

Unfortunately, access to more specific tools remains limited, creating key barriers to broader ART adoption: Deformable Image Registration and Contour Propagation

Adaptive radiotherapy often involves significant anatomical changes during the treatment course. For example, tumors can shrink substantially by the 12th treatment fraction, creating localized deformation. Accurate deformable image registration, which maps these anatomical changes and allows the propagation of treatment contours, is essential. Key performance metrics include the target registration error and clinician contour evaluation accuracy. Developing automated, reliable image registration solutions remains a technical hurdle for widespread ART adoption.

Synthetic CT Generation and Dose Calculation

Most adaptive workflows rely on cone beam CT (CBCT) imaging, but CBCTs can have a limited field of view and may have artifacts—especially in head and neck patients with dental fillings. To calculate accurate doses, clinicians need high-quality synthetic CTs derived from these CBCTs. These synthetic scans allow for proper dose recalculation and clinical decision-making based on how anatomical changes might impact treatment.

Decision Support and Automation

Perhaps the most significant enabler of scalable ART is automation. Clinicians need decision support tools that can integrate imaging data, clinical guidelines, and historical evidence to automate the triaging process. Ideally, the system would flag patients for immediate replanning (red light), ongoing monitoring (orange light), or continuation without changes (green light). Continuous, automated evaluation ensures every patient is assessed every day — something manual processes simply cannot achieve efficiently.

Moving Forward

Offline adaptive radiotherapy represents one of the most urgent needs in modern radiation oncology. It promises significant benefits for both patients and healthcare systems by improving outcomes and reducing overall costs of care. However, to unlock these benefits, access to key technologies - and overcoming technical and automation barriers - is critical.

At SeeTreat, we are working toward innovative solutions that address each of these challenges, making offline ART more accessible and practical for clinics worldwide.

SeeTreat will debut its first clinical product, ART.1, at Booth 820 during ESTRO 2025 in Vienna. ART.1 is a software as a medical device that delivers objective, evidence-based decision support for adaptive treatment re-planning in patients undergoing radiotherapy.

ART.1 automatically calculates delivered dose and propagates daily contours based on each patient's volumetric imaging, while displaying and reporting key clinical metrics. Running silently in the background, ART.1 prioritizes only the patient cases needing attention—allowing clinical teams to focus their time where it matters most. The software adds efficient, adaptive-quality treatment capabilities on any standard linear accelerator—without hardware upgrades or workflow disruption.

"Adaptive radiotherapy has traditionally been complex, costly, and limited to well-resourced centers," said Trang Nguyen, CEO and founder of SeeTreat. "We designed ART.1 to perform background analysis of every fraction, prioritizing major deviation, and give the clinical team a second set of eyes—without adding to the workload, resources or time."

What Makes ART.1 Different: Saving Days, Not Hours

ART.1 integrates seamlessly with existing linear accelerators and treatment planning systems, and automates the most resource-intensive steps in the adaptive workflow:

• Analyzes every structure for every fraction using synthetic CTs, daily dose calculation, and deformable contour propagation
• Sends alerts based on protocol thresholds for dosimetric and volumetric changes to treatment volumes and organs at risk
• Prioritizes patients for review—reducing unnecessary checks and freeing up staff
• Minimizes manual work by automating and prioritizing your adaptive workload

With detection, analysis, and alerts built into a single workflow, ART.1 reduces time to inform a decision from days to minutes—empowering the clinical team to act faster, with greater confidence.

SeeTreat at ESTRO 2025

Attendees can see ART.1 in action and meet the team behind it at Booth 820. To schedule a 1:1 demonstration, visit: https://tinyurl.com/3yy6fa34

ART.1 is available for research use. UKCA and CE mark pending.

About SeeTreat

SeeTreat is an Australian medical technology company focused on making adaptive radiotherapy safer, faster, and more accessible. Founded in 2023 by Dr. Trang Nguyen and Prof. Paul Keall, SeeTreat enables equitable access to precision cancer treatment, potentially reducing the burden of cancer worldwide. The company builds intelligent software that automates the most difficult parts of the adaptive workflow— helping more clinics deliver adaptive-quality care, every day.

Adaptive Radiation Therapy (ART) has been a concept in radiation oncology for nearly three decades, yet its widespread implementation remains limited. The foundation of ART can be traced back to a pivotal paper published 28 years ago by Di Yan and colleagues at William Beaumont Hospital in Michigan. Their study demonstrated the potential of using multiple CT scans to refine treatment planning for individual patients. Despite the clear benefits of this approach, ART is still not routinely available in a fast, automated, and cost-effective manner. This underscores the urgent need to expand access to this transformative technology.

The Complexity of Adaptive Radiation Therapy

The ART workflow can be defined in three key steps:

1. See - In radiation therapy, this involves acquiring daily patient images.
2. Think - Clinicians analyze these images to determine if an adaptation is necessary.
3. Act - Treatment plans are either continued or modified based on real-time assessments.

There are three primary timescales in ART:

1. Offline ART - Adjustments made between treatments.
2. Online ART - Adjustments made before a treatment session begins.
3. Real-time ART - Adjustments occurring dynamically during treatment.

Each approach involves multiple decision points, such as evaluating treatment contours, clinical objectives, and quality assurance benchmarks. The complexity of ART means that while it holds great promise, its integration into clinical workflows remains a challenge.

The Global State of ART Adoption

A recent ESTRO study surveyed 177 institutions across 40 countries, revealing that while 61% of centers perform ART, only 6% conduct online daily replanning. Furthermore, 80% of institutions have access to ART tools, but only 3% of patients in Australia, for example, receive adaptive treatments. This gap highlights the pressing need for streamlined, scalable solutions.

Barriers to ART Implementation

Three major barriers to widespread ART adoption were identified:

1. Human Resources - The specialized expertise required is often in short supply.
2. Technical Limitations - The complexity of integrating ART into clinical workflows.
3. Equipment and Financial Constraints - The high costs associated with ART technologies.

To overcome these barriers, ART solutions must be automated, accurate, and cost-effective. Current workflows introduce additional resource strain, making it clear that existing models are not globally scalable.

Moving Forward

The need for ART is undeniable. With growing access to advanced tools, the priority now is making ART efficient, accessible, and sustainable for all patients. By focusing on offline ART as the first step, we can bridge the gap and ensure more patients benefit from personalized, adaptive treatment plans. This is a call to action for the industry to innovate and scale ART solutions that can transform cancer care on a global level.

To learn more about expanding global access to offline adaptive radiotherapy, watch the on-demand webinar with Prof. Paul Keall, Chief Scientific Officer at SeeTreat, as he discusses this important topic.

Imagine a world where every cancer patient has access to life-saving radiation therapy.

Adaptive Radiotherapy (ART) ensures treatment plans stay aligned with a patient's changing anatomy. However, widespread adoption remains a challenge—ART is traditionally expensive, resource-intensive, and requires specialized equipment, advanced software, and significant clinical oversight. Identifying and executing a replan can take hours or even days, delaying critical treatment.

Replans are often identified ad hoc, requiring:

• Detecting discrepancies in daily treatment imaging scans
• Escalating for investigation
• Importing data into multiple systems for evaluation
• Qualitatively Comparing daily treatment scans with planning scans
• Re-scan the patient if daily treatment scans are poor quality
• Contour critical anatomy on daily scans and compare to planning anatomy
• Quantitatively compare treatment dose across daily and planning data
• Compiling findings for radiation oncologist review
• Decision-making on whether to replan

Mid-treatment replans (e.g. at fraction 15) follow a time-consuming workflow:

• Scheduling and performing a re-planning scan
• Re-plan dose on the new scan and contours
• Radiation oncologist determining if the new plan should be adopted

Every step adds delays, drains resources, and slows the path to optimal patient care.

Imagine if you didn't need to wait for a new sim and new plan to confirm whether a replan is necessary. Imagine if all decision-making data was automatically available for every patient, for every treatment fraction.

The Solution: Automate, Accelerate, Treat More Patients

Imagine if we could revolutionize this process

• Automatically generate comparative dosimetric analytics from every patient's daily treatment scan
• Instantly flag deviations in treatment volumes or organs at risk
• Put all replan decision data at every clinician's fingertips - instantly

At SeeTreat, we're making this vision a reality. Our goal is to bring automated, scalable, and accessible Adaptive Radiotherapy to the world—allowing more cancer patients to get the treatment they need, exactly when they need it.

Today, on International Women in STEM Day, we proudly acknowledge the incredible women making groundbreaking contributions in the fields of science, technology, engineering, and mathematics—especially in the critical intersection of healthcare and technology.

At SeeTreat, we are inspired by the brilliant women on our team who are driving innovation in medical software engineering. As a female founded business, we are committed to fostering an environment where women thrive, lead, and push the boundaries of wha's possible.

For more information on some of the incredible women working at SeeTreat, visit our About Us page.

SeeTreat is pleased to announce we are the recipient of the CUREator+ Grant to clinically evaluate and commercialise a new medical technology to enhance breast cancer radiation therapy treatments. The product is expected to improve treatment effectiveness and mitigate risks of complications due to radiation exposure to the heart and other non-target tissues.

This grant will enable key developments towards the commercialisation of a novel medical software for breast cancer radiation therapy which is not only poised to enhance the accuracy of treatment delivery but do so cost-effectively with minimal overheads for the radiotherapy centre.

The Curator+ Grant will see SeeTreat partner with Australian radiotherapy centres for clinical evaluation and pilot use of the medical software supporting validation and pursue regulatory clearance.

About SeeTreat

SeeTreat Medical, is developing AI-enabled software in breast cancer to improve the accuracy and precision of radiation therapy, in turn increasing treatment effectiveness and mitigating risks of complications due to radiation exposure to the heart and other non-target tissues. CUREator+ funding will be used to further advance the development of SeeTreat software technology, complete a clinical trial supporting validation and pursue regulatory clearance.

About CUREator

CUREator is a national biotechnology incubator by Brandon BioCatalyst that supports Australian biomedical research and innovation development. Funded by the Medical Research Future Fund and Australia's national science agency, CSIRO, CUREator provides grant funding programs for opportunities spanning from discovery research to clinical development.

Funding is provided like an investor with clear milestone-driven tranches to achieve key value-adding and de-risking development milestones. CUREator works closely with project teams to guide them through the early development phases, offering scientific and commercial expertise and networks to support projects meeting key outcomes. https://brandonbiocatalyst.com/cureator/

About ANDHealth

ANDHealth is Australia's only organisation specialising in commercialising evidence-based digital health technologies. We work with Australian digital health companies to commercialise and scale their clinical-grade technologies through the entire commercialisation pathway, from idea to exit.

ANDHealth's investment readiness program suite and non-dilutive investment programs prepare companies for institutional investment and global enterprise customers and have been proven to positively impact both the number and maturity of companies in the Australian evidence-based digital and connected health sector. Since 2018, ANDHealth has supported over 900 high-growth-potential digital health companies across Australia and delivered over 2,400 hours of direct programming to over 1,680 participants. https://www.andhealth.com.au

About Brandon BioCatalyst and Brandon Capital

Brandon Capital is Australasia's leading life science venture capital firm, with a solid global presence supported by key partnerships and team members across the US and UK. Brandon Capital supports life science companies from early-stage seed investment to expansion capital from proof-of-concept to commercialisation. Managed by Brandon Capital, Brandon BioCatalyst is a unique collaboration of over 50 leading medical research institutes, investors, and government united by a single purpose: progressing the next generation of medical therapies and technology that improve health and save lives. https://brandonbiocatalyst.com/ and https://brandoncapital.vc/

We are proud to be part of eight Australian startups developing innovations with the potential to save lives and improve wellbeing receiving grants totalling $18.5 million thanks to the first CUREator+ funding round 🎉

Delivered in partnership with Brandon BioCatalyst (Brandon Capital) and ANDHealth, CUREator+ is a national program focused on accelerating the research translation and commercialisation of preclinical and clinical early-stage Australian medical research and medical innovations with commercial potential.

These innovations include drugs (novel and repurposed), devices, diagnostics and digital technologies that address unmet needs.

The first-round recipients are:

1. ⭐️ Amplificare: Enabling rapid assessment of the efficacy of cancer treatments
2. ⭐️ Baymatob: AI-powered platform providing early warning for treatable pregnancy and labour complications
3. ⭐️ Currus Biologics Pty Ltd: Technology to develop CAR T-cell Therapy in tumours
4. ⭐️ Kinoxis Therapeutics Pty Ltd: An alternative to antipsychotics for managing agitation and aggression in dementia
5. ⭐️ Micromune Therapeutics: A therapy for treating inflammatory bowel disease
6. ⭐️ Mirugen: Utilising gene therapy to restore vision in patients with 'incurable' blindness
7. ⭐️ OncoRes Medical: Imaging technology which differentiates cancer from healthy tissue
8. ⭐️ SeeTreat Medical: Software to improve the accuracy and effectiveness of radiation therapy for breast cancer

The Hon Mark Butler MP, Minister for Health and Aged Care, said, “Turning new research into medicines and tools which can be used to treat patients is often a long and costly process. Our support will ensure innovative research can become life changing and lifesaving treatments.”

ANDHealth CEO Bronwyn Le Grice said, “In the current market, substantive equity-free funding such as provided under CUREator+ and access to global industry leaders with proven track records, can make a material difference to the speed and success of commercialising these exciting new technologies.”

👉 Learn more: https://loom.ly/pUOUliw

CUREator+ is supported by funding from the Medical Research Future Fund (MRFF) BioMedTech Incubator (BMTI) program.

SeeTreat, a software medical device company with a vision to 'turn on the light' for oncology treatments enabling affordable personalised and precise treatment for every patient, is pleased to announce new Board directors as SeeTreat prepares for commercial release of its first products to clinics. We welcome Dr Richard Hausmann, Associate Professor Tee Lim and Dr Shane La Bianca to our Board from October 2024. They will join existing executive Board members Dr Trang Nguyen (CEO and Co-Founder), Professor Paul Keall (Co-Founder) and Antonia Dalton (Chief Strategy Officer).

Dr Richard Hausmann brings decades of experience in the medtech industry in both publicly listed companies and start-ups in multiple jurisdictions globally. His experience spans GE's Magnetic Resonance division as President and CEO and holding several senior positions at Siemens over more than twenty years. Until recently he was global CEO of Elekta, one of the largest radiation therapy device manufacturer in the world, and has also served as CEO of Combinostics, which uses AI technology to manage the care pathway and improve the lives of patients with neurological disorders. Richard is a member of the board of directors of IBA SA, a global market leader in proton therapy.

Associate Professor Tee Lim is a leading Australian radiation oncologist with a diverse clinical interest in breast, urological cancers, gastrointestinal and lung cancers. He has a broad clinical practice with experience in Canada and the US completing fellowships at both Sunnybrook Toronto and at the University of California, San Francisco Medical Centre. In addition to his oncology work, A/Prof Lim is pioneering in specialised cardiac treatments such as cardiac ablation therapy for cardiac arrythmia and total lymphoid irradiation for cardiac transplantation rejection in Western Australia. As a clinical associate professor at the University of Western Australia, he has made significant contribution to cancer research, co-authoring over 40 published papers and abstracts. He is actively involved in clinical trials, and regularly presents at scientific meetings.

Dr La Bianca is a Urologist with international experience in Australia and Vancouver, Canada. He is an adjunct senior lecturer at the University of Notre Dame. He has over 25 years of clinical uro-oncology experience in the management of bladder and prostate cancer, PSA and hormonal therapy. A self- proclaimed technophile, Dr La Bianca offers a different perspective on SeeTreat technology and the potential applications to improve interventional treatments beyond radiotherapy.

Together these independent Directors will bring new insights to SeeTreat to support us at this critical juncture of taking product from development to clinical practice.

SeeTreat has grown from 2 to 15 full time employees in 18 months and is planning to release two SeeTreat products to market in 2024. The Company has successfully raised over $6m in capital executed two commercial partnerships in Australia and the US. This success is a testament to the market need for our products, our software development team's delivery capability, and our opportunity to truly improve patient outcomes through more precise and personalised radiotherapy treatments. We're looking forward to the next 12 months to focus on getting these products into the hands of the clinical teams and making an impact on patients' lives.