Hello, and welcome to the Physics World Weekly podcast. This episode explores how the concept of humanitarian engineering can be used to provide high quality cancer care to people in low and middle income countries around the world. Our guests are 2 medical physicists from the University of Washington in the US, and they've contributed to the ebook Humanitarian Engineering for Global Oncology. Here they are in conversation with Physics World's Tammy Freeman.
Cancer is increasing in prevalence around the globe with reports estimating that by 2030, more than 2 thirds of cancer related deaths will occur in low and middle middle income countries. As such, it becomes more important than ever to develop affordable, sustainable technologies for cancer care. One way to address this emerging need is via humanitarian engineering, a method that focuses on projects that are affordable, sustainable, and based on local resources.
This approach forms the central theme of a newly published ebook entitled Humanitarian Engineering for Global Oncology. In this text, a series of contributing authors take a look at various ways to address the worldwide need for access to quality cancer care with a particular focus on radiation therapy.
I'm joined today by the book's editor, Eric Ford, professor and director of physics at the University of Washington, and coauthor, Aphiya York, a medical physicist at the University of Washington's Department of Radiation Oncology. Welcome to the podcast, Eric and Thea. Yeah. Thank you, Tammy. It's nice to be here. Thank you. First of all, I wondered if you could provide a quick overview of what's meant by the concept of humanitarian engineering.
Sure. I guess I can start. I, humanitarian engineering, I think, one simple way to think about it is that it's a kind of a look at technology, but putting the person or the patient at the center. And so that kinda changes the way that you develop do development. Right?
And that especially is important for, you know, the marginalized and underserved and, in the anywhere in the in the world, but especially globally where on a global scale, there's some acute needs for health care, especially in low and middle income countries. So I think that's probably, like, the simple definition that I would use. Yeah. I I agree with Eric.
And and, you know, like Eric mentioned, these are, like, community, you know, centered designs, like, you know, technologies that have been designed with, you know, like, underserved communities in mind. And when you read this book, you would see a recurring theme, like, in the book where almost everything that we're talking about has to do with affordability.
Right? Like, how can these technologies that are being designed be afforded by, you know, communities or, you know, countries or environments that might otherwise not be able to, you know, like, purchase them or afford them. And and it requires, you know, we're physicists here talking about, like, humanitarian engineering,
you know, in global health. So, you know, obviously, it requires, like, a cross disciplinary approach, you know, bringing in, you know, some, you know, economic, approaches, you know, engineering approach, physics in in our context, and public health initiatives to solve, you know, issues that, you know, better serve these individuals in in in underserved communities. Yeah. Much of the book focuses on radiotherapy, which is one of the central components of cancer care.
Now delivering radiation usually requires large complex systems such as linear accelerators or linacs. Is access to these systems a problem in resource limited settings? It is. It is a very huge concern, and this has been the, you know, one of the, largest conversations in our field in radiation, you know, therapy when we talk about, global radiotherapy, one of the things that we talk about is how can we increase the access to linear accelerators, this radiation delivering
equipment to these individuals. When you go to the IAEA, the International Atomic Energy Agency, you know, website, they have a database called the direct database, which is a directory of, radiotherapy centers. And it looks at all these, like, countries and how many radiotherapy equipment are in these countries and the distribution. And, clearly, when you look at that map, you can see a very faint, you know, map for low and middle income countries. So this is a clear, you know, issue, in LMICs.
And, again, whenever people come back to the table to talk about, you know, access to radiotherapy care, most of the conversations start from there. How can we improve the number of machines in this area so that patients who have cancers in this environment can have access to radiotherapy?
Yeah. I think the other thing that we should think about at the beginning of the discussion about this is to, you know, like you said, Tammy, the book focuses a lot on radiation therapy, but there's there's other things in the book as well, surgery, diagnostic essays, and other things, AI, advanced imaging. But, you know, what why is radiation therapy so important, you know, when you think about humanitarian engineering? It's it's really because it's one of the major pillars of what is used
for cancer care of patients. Right? You know, roughly half of patients should get radiation therapy, but for you know, often for curative intent. But like Afiya said, you know, there's a huge gap in terms of what the access is there across the globe. You know, and it's also very cost effective when it's done. If you think about like, you know, for example, a breast cancer patient who, has treatment after surgery, for example. I mean, the part of that treatment is really key to her achieving
cure and from the disease. It it's, you know, it's gonna be much less likely. The outcome is gonna be much usually, in many cases, much worse if the full treatment isn't available. Right? Or head and neck cancer patient. Right? That's somebody who often can be treated with curative intent with a radiation therapy approach that preserves the voice, preserves swallowing, can preserve taste, and, you know, and that preserves nutritional status, which then means the patient doesn't suffer
from nutritional problems later. Right? So there's many downstream effects and many, cost savings to the healthcare system and to people as well. Right? Because these treatments can be very financially toxic to patients. And so we wanna do it the right way with really low toxicities, but you have to have all the tools in your tool belt in order to be able to do it the right way. And this that's the reason that the gap is so important to
address. Yeah. So, I mean, how how can the manufacturers help address this disparity in resources? Are they working to design lower cost, more efficient systems? Yeah. So we've addressed some of these, like, in the book. One of those, with them is the Halcyon, which, is designed by one of the radiation, equipment manufacturers.
The Halcyon increases, you know, the throughput, so you can treat patients, like, in less than 10 minutes, which is half the time that you will treat patients with the current, you know, linox, which are CR Linox, that is mostly used by a lot of us, like, in in our hospitals. And given, like, you know, Eric Eric mentioned, because there's lack of, you know, radiotherapy
machines in low and middle income countries. You have a lot of people waiting in line to be treated, you know, on on the available CRM Linacs. So machines like the Halcyon, which increases, you know, the throughput, reduces the time that you can get patients through the machine, helps clears these, like, backlogs or waiting times that, you know, are in these areas.
And, also, you know, other people are manufacturing the upright, you know, radiotherapy, systems where the patient sits and it's slowly rotated around a fixed, you know, beam machine. And so, these, you know, are very compact in nature. You need very little, shielding, which can be a cost, you know, an upfront cost when you're designing radiotherapy, rooms, and you need very little bunkers because you don't need a big room to install, you know, these
machines. And so you have people addressing them, and and I'll let doctor Ford, you know, take the other, technologies, you know, in the space. Yeah. I mean, I think that's a really good example of humanitarian engineering in action. You know? It's the system that Afiya mentioned. That was you know, I I guess for people who don't know these, radiation therapy machines, they're linear accelerators. You know? They typically operate up to 6 megawatts, you know, high energy, high output.
You know, they date back to 19 fifties. Right? So the technology has been around for a long time. Yeah. But, this one was a redesign, and it was it was, introduced in the commercial market in in 2017, but just sort of rethinking it. So, like, you know, in a in a normal machine, if you let the user pick, like, say let's say, 6 different energies to treat with. Right? In In this one, you don't do that. You just give them one energy.
And and you'd, like, just simplify everything, make it simple, make it robust to different users. And I think the other interesting thing about that example is that, it's sort of a good example of what, what I what you hear people call bidirectional learning. So in other words, you know, we learn from, say, a country in, East Africa and the country in East Africa learns from us,
like, back and forth learning. Because what, you know, what happened with that system was it was in designed with the intention to be robust and, you know, rugged and very, you know, harsh environments around the world. But then what what people found was that there was a huge demand for it in in the US and in Europe, in places that have a lot of resources because it just you know, like, a a few was mentioning, like, the throughput is so much better.
You treat somebody in in 10 minutes, get them through, you know, and and it just all sure works works. So it was kind of like a win win kinda scenario, which A very good example of that. Yeah. It's just very satisfying to see that. Right? Like, where everybody is benefiting the whole, you know, around the world. Absolutely. Have one here. We have one in our clinic. Yeah. Yeah. Yeah. Right. We do. Yeah. Yeah. That's it's an interesting thing because if you, you know, if you go around the world
and you say, okay. Like, here's some technology that you could use in your in your clinic. It's low cost. The first question is gonna be, do do you use that in your clinic? Yeah. If not, why not? It's a great question. Right? I mean, like, why yeah. Because the the motivation behind that question is we wanna deliver high quality care, world class care, care that's delivered in premier centers Yeah. For the benefit of our patients. So, you know, we wanna make sure we can
do that. And is it so you have to be able to answer in the positive to that question. Right? Exactly. And and to add to what Eric said, like, if you go tell somebody that this is so good, the questions, if it's that good, why are you not using it? Right? And if you you use it, you can speak better to it, and and we do. We have it here. We see the advantages of that, you know, system and, yeah.
Excellent. So this is basically manufacturers developing lower cost, easier to use, maybe lower maintenance systems that, you know, more people can get hold of and use. Yeah. Yeah. And they're you know, honestly, they're not you know, the force the market forces don't always drive things in that direction. Right?
And I think that's one of the reasons why a book like this is important is to sort of, you know, shed some light on what the different aspects of the problem are and help people understand it. Because, you know, the market forces will will sometimes just push the solution organically into, whatever, like, a local minimum, so to speak, right, where it's like it works in an environment like, you know, New York City or, you know, Paris, but, like, you know, does it work in Kampala? You know?
It's a it's a good example. Okay. So this is, we're talking about external radiotherapy here, but but there's another type, which is brachytherapy. Does this treatment can you offer this with sort of lower expenses and running costs than external beam radiotherapy? Yeah. The capital is lower. The capital outlay is lower. So that and it's, you know, probably about a third of what it costs to, to, you know, put in a external beam therapy machine. I'm talking about the X-ray machines.
If we talk about protons, then we need to have a whole another discussion about coughs. Sure. A lot more expensive. But, anyway, yeah, it's May 3rd. Like, also the radiation shielding, like, Afiya was mentioning before the shielding their shielding needs, you have to build concrete walls around your around your machine so people are safe. So that's less of a con a concern because you can make it thinner because the energies are lower. Right? So, yeah, all of those are lower expenses.
But, you know, having said that, there are other things that are more complicated. So you have ongoing expenses where you have to these are radioactive sources, the high specific activity sources, typically uranium 192. And if you use uranium 192, it has to be changed out every 3 months. Right? Mhmm. Yeah. So so okay. So here here's actually another good example of the systems engineering human humanitarian engineering kind of approach, which is that could we use a different type of radioactive
source? Right? Uranium 1 92 developed for historical reasons. It was sort of a replacement for radium back in the day. And but, you know, it's not the only solution. It's a very good good choice because it has a very high specific activity, meaning you can make a very small source that you can introduce them into a catheter inside the patient. Typically, these are used for gynecological treatments as one of the major treatments for cervical cancer, which is a major women's health issue.
But could you could you redesign it? So so people did. They redesigned it with a cobalt source, a cobalt 60 source, and that has a half life of 5 years. So you don't have to replace the sources often, which obviously has many advantages if you, you know, practical advantages. So, you know, these cobalt sources are not common in the US or Europe. It's typically still iridium, but, you know, the the symmetry is fairly similar.
I don't know. We should pro we probably also should talk about staffing when we talk about brachytherapy because it's a lot more complicated. Right? Yeah. Training the staff to, you know, do the procedures for the brachytherapy, the the brachytherapy procedures. And that takes us into, like, a space where we start talking about the unavailability of these, you know, staff in in in underserved, you know, environmental resources.
And I think it's a very good segue to, you know, like, why AI could be very useful in this space where, you know, you can train individuals, like, remotely on how to, you know, perform these breaky procedures without putting them in the environment of, you know, these complex, you know, equipment or or devices. One thing Eric made such an excellent point. I feel like I don't have anything to add, but one thing that I wanted to add to, you know, his point was comparatively.
Right? He talks about the upfront cost and the cost of operating the brachytherapy, you know, devices. But, also, it's less, you know, costly to maintain those equipments compared to the external beam, you know, devices, which are very, you know, heavy machinery, have so many moving packs, you know, which can be, you know, much more expensive. And, also, you know, if you set up your brachytherapy, program very well, you you,
the sessions for brachytherapy are very minimal. It's like 5 sessions, 3 sessions, sometimes 1, unlike your external beam, you know, treatments, which can go for weeks and patients have to come in, you know, like, every day. So that's some of the contrast there between, you know, the brachytherapy procedures and, you know, the external beam, which tends to have some advantages for patient who have to travel hours on end to get to the nearest radiotherapy centers. Yeah. It's,
I think that's a really good point. It's, very practical, very usable in an environment like that because they're very short course treatments. Right? And it's very necessary. Like, if you if you if you don't do the brachytherapy part of it, the cure rates are much lower. And we know that there's very solid data on that.
So, you know, it's and, you know, I mean, just the control of cervical cancer is like a it's it's a major public health issue in a lot of parts of the world, especially, outside of, you know, the high human development index countries, like, over 90% of, cervical cancer cases are diagnosed in low and middle income countries. So be and it's because of the screening patterns. Right? So this is a failure of the public health system, that because
vaccines and screening work. Right? That's why there's not that much cervical cancer Yeah. Problem in in, like, the US, for example. But, you know, it needs to be addressed, and this is a practical way to do it. It it's, you know, relatively low cost technology, but, you know, you just, you got, you got to kind of be organized about it and have it in place. And, Yeah. And and so it sounds like, brachytherapy and external beam perhaps, will be used for treating different types of cancer.
Yeah. I mean, it it it's cut I mean, partly clinical, partly practical. So the thing is in brachytherapy, you can introduce, an, you know, an an applicator. So like a basically a little holder for the reactive source that puts it exactly where you need, like, into the cavity of a patient. Right? So and that the you know, so it's just like in cervical cancer, that's something you can do. Right? Or prostate cancer can be treated. Early stage prostate cancer can be treated with
needles inserted into the prostate. But, you know, not all cancers are accessible that way. Like, if you think about a cancer in the lung, it's gonna be very hard for you to introduce a needle into the lung in a way that's gonna be safe for a patient. Right? And people have done it, but it's very it it's very, very challenging. There's Yeah. Limitations to what you can safely do. And this is one of the things is you wanna do this in a way that's noninvasive and is safe for the patient.
A lot of times, there's not great access to surgery. That's one of the other major hurdles in in in areas of the world. There's a chapter in the book about that, about surgery, the issues around that. But, yeah. So it's sort of just a combination of the clinical need and the practical applicability of what can be done with brachytherapy. Okay. So we've talked about advances in hardware, but how could things like artificial intelligence improve access to high quality treatments?
AI is, you know, like, rapidly, like, gaining a lot of, like I I think at this point, it's gained a lot of momentum, like, around us and everything that we do. In in in radiation therapy, especially when you look at the benefits of AI for, low resource environment, which clearly we've seen that things that are designed for those environment tends to benefit everybody.
You look at, like, how rapidly we can create radiotherapy treatment plans that are very specific to, you know, patients that are undergoing, radiation treatment. AI can help, you know, create very precise plans, that, you know, can be done at a much faster rate. Hence, we can create more plans that can, you know, treat more patients.
In in doctor Ford's, like, you know, field of expertise, which is very quality and safety, AI can help, you know, for for for us as medical physicists when the treatment plants are created, we have to check, you know, the plans for equality, the beam the machine,
you know, beam parameters, and other things. If you have a very good AI tool, it can help, you know, check the quality of the treatment plan and even look at, you know, if there are any, like, missing, you know, parameters that, you know, were not included, like, in the treatment. And this could be a very good safety check before, you know, the plants end up, you know, on patients.
So, you look at, you know, all the things that we do as physicists, for example, like image, you know, guidance where we have to do, like, imaging, you know, for precise radiation targeting for patient. AI tools can help, you know, take images rapidly, look at you know, analyze those images, and look at patients set up to reduce, like, setup uncertainty.
So, you look at how much it can help in our field of practice, and it it it it it helps, like, increase access to a lot of people because if you don't have, you know, planners or you don't you have, like, you're less you're understaffed. If you have AI tools and you know how to use them, how to troubleshoot them, I think it helps a lot to reduce this global burden in, you know, staffing or
even machine authority. Yeah. I think that's a really important point is, like, there's this gap, the gap in technology that we've talked about, but there's also a gap in in in staff and train you know, how like, staff that are trained to operate, you know, in an environment like this and know all the ins and outs of what, you know, a cancer care practices needs. Right? And
we know that. There's a study that came out in The Lancet this year, Zhu et al. And they made some estimates of staffing shortages in in in the field of oncology and radiation oncology specifically. And they said basically in all the different professional groups that are involved, so this is the doctors, the the people who deliver the the care of their Asian therapists, the medical phys basically, there there had to be a 70% growth of people.
Like, so, you know, 1.7 times as many people over the next, basically less than 20 years. So and and and we also know that that's an underestimate. So, like, you know, that in the context where right now, we're just really swimming to kinda keep our head heads just above water. I mean, even honestly in the in the United States. So, and, you know, huge growths in East Asia, China, India, Japan.
So there's just this huge gap that probably is gonna be nearly impossible to to close in any any foreseeable way in in the next less than 20 years. So so yeah. So this is where some of these tools can really help. Like, a few of us saying, I think, you know, it it's it targets efficiency. It also targets the quality of care of what we're what we're doing, like, in a way that can be very beneficial. There's a chapter in the book about, about automatic treatment planning, which is one of the
the things we just talk about. So, you know, and I think that's a great example. It's this this group at MD Anderson, Lawrence Court is the PI, and, they're they've developed a tool called the radiation planning assistant. Yep. And so and and it's now FDA approved and being used in clinics, including at MD Anderson. And and, basically, you know, the idea is you just it's it's AI tools under the hood that essentially you know, like, from the user's point of view, you click the button and
a a plan is made. Whereas previously, that would take, you know, many hours of some highly skilled person doing that work. Yeah. Right? So it's there and it's working and, you know, it and so I think it's really gonna change the way that care is done. Yeah. And and to add the cherry on top, Eric is right. That's chapter 3, by the way, for those who didn't be listening to the I I I just felt like I had to add that to it.
Then to add to Eric's point, you know, this, aggregation plan assistant has been used in South Africa. You know, and, you would be, like, for to to treat, like, cervical cancer, which in our, you know, part of the world, and when I sell part of the world here in North America and, you know, in high income countries, we don't do 4 field boxes in that. These are very simple, you know, plans. It's a huge improvement.
Right? It's like this was done on a 4 field box of a colon cancer, you know, patient and and and done seamlessly. Right? And that's a a typical example of how these, like, engineering devices that are designed to help, you know, environment that, you know, are are less resourced and understaffed. And for somebody who's listened, it's like, oh, but South Africa is, you know, very advanced compared to a lot of, like, you know, the African countries.
But, like, this was a very useful, you know, like, application, an example of how this can be translated and was easily translated in in a place that was very much needed. Excellent. So another chapter in the book looks at radiotherapy biomaterials, and the these are things used, for example, to improve targeting or to boost the immune system or even, to release drugs or increase the effects of the radiation.
Can you explain how these biomaterials could save time or money in the clinic, and why they might be particularly useful for low resource settings? Yeah. I mean, I think this is a more future looking view of things. But the basic idea is you're gonna improve the therapeutic ratio of the treatment that you're already delivering. So in other words, that means, either more effectiveness or less toxicity or hopefully
both for the same dose. And so do you know, you could offer you could deliver less dose from the radiation treatment for the same effect. So an example of that would be high, atomic number, nanoparticles, like gold nanoparticles. And because of the high z of the material, they actually, have a enhanced radiation effect is probably most of physicists listening would understand.
And so that, you know, that allows lower doses, potentially shorter treatments if you can get through more of the treatment more quickly. Maybe more accurate targeting. For example, if you can put something in there that has an high z material that can enhance the visibility on CT imaging. Yeah. So that can help with targeting and visualization for targeting. So, yeah, there's lots of different ways that can happen.
Okay. And and you mentioned, for example, the use of, nanoparticles that enhance the effect of the radiation. And I guess this allows you to give fewer fractions, so that's in turn gonna reduce cost and, you know, make things more convenient for the patient.
Yeah. Exactly. Yeah. If you look at, like, for example, early stage prostate cancer and the new trials that are coming out have come out about how to treat that, If you can treat in 7 fractions, let's say instead of 39 fractions, this fraction is a day of treatment. So so, you know, you get your treatment done in 7 days versus 39 days. I mean, you can I think all of us even without any direct experience can imagine the impact of that on a place like
Sub Saharan Africa? Right? I mean, where sometimes the travel time to a clinic is days. Like, you know, and I, spend some time in in Uganda where we have a partner clinic, and, you know, that's a country of 40,000,000 people, one clinic where people can get treated, which is great. They do a very advanced care in this in this clinic, but it's only one clinic. They're gonna expand to more clinics
in the near future. But right now, you know, you can you can imagine a large number of people traveling for 7 days to get treatment. It's a little harder to imagine many people traveling for 39 days and all this involved in that. Get treatment. Right? Yeah. Eric is right. We have, you know, early data that shows that a lot of these patients are not completing the radiotherapy treatment. Right? Because they have to come every day,
every day. And so sometimes, like and the the, you know, the variable reasons why this could be, you know, It could be fatigue. It could be, you know, financial, you know, reasons. It could be other socioeconomic factors.
But I think, as Eric mentioned, what these, like, biomaterials, like, the advantage it gives, especially when you're given these, like, very because this 39 days that the patients get to have, you're condensing the treatment that would have been spread out for those days into a very small time. Right? So it means that you're given very high radiation at one time compared to what would have been spread out over a couple of, you know, a period of time. So you leave very little room
for error. So how do you improve, like Eric, you know, used the word, reducing toxicity for the patient, because you just wanna target the the tumor and spare, you know, the tissues around it.
So developing these, like, biomaterials, that can be dig that are degradable helps you target, you know, the tumor very well and spare the surrounding tissues, and also some helps in better visualization when you don't have enough contrast between, you know, the surrounding tissues and the, you know, tumor as well. And and so, you know, it helps a lot in hyperfractionated cases where we cannot you know? First of all, we our we do our best not to do wrong, but then it
leaves, like, very little room for error. So you wanna make sure that you're targeting precisely the tumor and and nothing else. Yeah. Okay. And then another really essential task that we haven't mentioned yet is, a cancer diagnosis. So you've included a chapter in the book looking at the emerging technology of polymer dots and how they're used in diagnostics. Can you describe what these polymer dots are and why you chose this as an example to include?
That was an important thing to include, I thought, in the book, because it's an example, from another it serve as applications in other branches of oncology, for example, medical oncology. And the chapter describes, a fluorescent probe assay that was developed. And the PIs of this are a chemist, Daniel Chu, and who's a professor in of chemistry and and then working with Jerry Radich, who's a medical oncologist at the Fred Hutch. And so they've developed these,
fluorescent probe assays. And so that, you know, that's that part of it is nothing new. You know, there's fluorescent probes that can be attached to a protein, and that, for example, can tell you how much of a protein is present in the blood. But true the traditional assays require, you know, very expensive equipment, a laser to fluorescent the protein, expensive optics, high end cameras, computing power. Right? So these polymer nanodots,
they're like 30 nanometers or less. They're they're extremely bright and you can, and they're chemically stable. They can be easily conjugated to a protein. And so that allows you to do an assay in a much more sort of accessible way.
Right? So they can then be used for assessing for protein biomarkers, for example, for cancer screening or even like tumor paint that's being used during surgery where you can have the ligand bind to tumor cells and then you can with under fluorescence, actually see where there's residual disease during surgery. That's another use. Okay. So so for guiding surgery, you you can see these, or for example, for testing, like a biopsy or a blood sample to look for cancer biomarkers?
Yeah. There's this example of how you could use this to in the treatment of chronic myeloid leukemia. And for people who don't know about that, it's a it's a, you know, blood cancer, that can be pretty well managed for many patients now, but you need to have an assay to know how much if the disease is present, how much of it is, how it's responding to treatment for follow-up and so on. So that's very important in the management of that of that disease.
Right? And so the way that it's done now is you measure the levels of the mRNA protein in the blood of this particular protein. And this is what drives CML is is this fusion protein of BCR ABL. The 2 genes get fused, and that's sort of necessary for CML to develop. So if you can measure the level of BCR ABL, in these assays, then you can tell how patients are responding. The the treatments that's used is is this, tarsine kinase inhibitor, Gleevec. That's the trade name.
But, you know, you need the technology to be able to do that assay. So so so there are there are such devices out there. There's this big one, the Cepheid, and it's does quantitative PCR, polymerase chain reaction, but it's very expensive. So so, you know, you can imagine that sort of assay with a simple nano dot type assay where you can do, you know, read it out just in a small reader because it's so bright and and very sensitive and specific, then, you know, you can that
opens the doorway to do screening. So I think this falls into a general a general, approach in in the public health space where you've got it it's very in some cases, very advantageous to combine screening with treatment. Right? Yeah. And and to do that, you need the right screening tools and you need the right treatment tools available
real time in the clinic. And an example of that is the cervical cancer case where there are, you know, there are screening tools available, you know, but you need devices available as well-to-do treatment of early stage disease on-site. And if you can't do both of those together, it's gonna be very difficult in some of these under resourced areas of the world. Right? Like, it it might work in North America. Right?
Like, patient comes in, you do a screening, they find they find some evidence of disease, so the patient comes back a week later and gets the treatment. Right? You can't do that in right? You right? If you can't do that and you got I I agree. Yeah. It just doesn't work. Yeah. There's you know, in most cases. You send somebody away, they're you know, it's a good chance they can't come back.
I know. I I agree with you. Like, if you can have that combination in in the environments that we are familiar with, I think that's, like, a huge game changer for how these diseases would be managed, you know, in in in those places. Yeah. Eric is right. Okay. And then the final chapter of the book considers the education of current and future medical physicists, radiotherapists, oncologists, etcetera. Can you comment on the challenges with this and and how this could be addressed?
I I think we've I reckon I we've hinted at this, like, throughout, like, our, you know, this conversation that it's it's it's very clear that, in in low and middle income countries or underserved communities, we have, like, you know, understaffing, which relates back to, you know, how many people are being trained, you know, to do the work in in in radiation therapy.
And I think, in in our field, you know, in radiation oncology, in medical physics, we have a lot of, like, you know, stakeholders or, you know, individuals who are very, interested in reaching out to these communities to help fill that gap of education and training.
The several, you know, NGOs, our, you know, professional organizations, the American Society For Aviation, for American Society For Physicists and Medicine, and then ASTRO, you know, are very, involved in, committees that, you know, reach out
to lower and middle income countries. We have Eric and I, we're in this committee in APM where it's called the ICAMP, the International Council For, you know, associate mentorship program, where it is, designed to get early career physicists involved, for, you know, training and education for, you know, physicists in low and middle income countries. So there's a clear gap. You know, there's a clear need to train, folks.
One of the reasons could be the, lack of access to these technologies that are otherwise available in high income countries, but are not available, you know, in low you know, middle income countries. Because if you read textbooks and you don't have the, you know, opportunity to practice hands on, it doesn't really translate
very well. Right? And so one of the ways that, you know, AI could help fill this gap is having virtual education, you know, VR type of trainings that can give folks this hands on practical, you know, approach, to learning. Or, one of the things that, you know, Eric is such a good advocate for is, like, having those bidirectional, you know, knowledge transfer. So, for example, we went to
Uganda to learn from them. We're gonna bring some folks to our clinic to learn from us and look at you know, like, observe how we practice, like, in our setting. It is very important to give folks that, you know, opportunity to get to see that because it cannot be one-sided. Right? We know what goes on. It's good to have people learn what goes on here so they can take it with them so that they can, you know, practice in their clinic be depending on what resources are available
to them. So there's that, you know, challenge, and and a lot of works that are going on to support that. Then I'll let Eric, you know, chime in in as well with his thoughts. Yeah. No. I totally agree. I don't have much more to add to that. The need is huge. I agree. I mean, I I guess, if you think about a future where, you know, AI plays more of a role hopefully in a positive way, we hope. You know? But, how do we make sure that it's doing
the job that it's supposed to do? Well, you know, we need a workforce of highly trained experts who can oversee and manage the the operations of of all these assistive tools that we have. You know, for example, like, you know, the products that are FDA cleared now for mammography, for AI reads of mammography are often operating in combination with a radiologist. Right? So it's not like the the technology is just out there doing everything
in the autopilot mode. No. It needs some oversight, and you need, you know, highly trained people to Yeah. Be there working alongside it. So it it's like it's almost like the education need becomes even more with all these Yeah. Tools. Exactly. And troubleshoot. Like, when something goes wrong, if you're not well trained, how how can you, you know, troubleshoot, like, an AI device or an AI software? You know? Or how do you even interpret the results that that AI software is giving
you? Like, when do you know when to double check it? Do you, like, take whatever AI, like, output the AI software is giving you as face value? Or Mhmm. You train well trained enough to understand and interpret, you know, those results. Totally. Yeah. It's that kind of, like, unknown unknown. You know? Like, how do you exactly. Right? Like, you don't even know when to ask the question sometime. Yeah. That's when you really get into a danger. Yeah. Yeah.
So AI is gonna make a big difference, but we still need the staff to ensure that it's working properly. Absolutely. Without a doubt. Yeah. And then my final question for you is, who are the targeted readers for your book? I think it's a wide spectrum of people who might be interested in the topics in this book. Mhmm. Health care professionals for sure in the oncology space, but also beyond, people in radiation oncology space for sure.
Public health, people interested in public health and policy, I think you really benefit for some of the ideas here. I'm also hoping that, you know, some engineers and people in the industry will pick this up because Yeah. You know, there there's many lessons here to be learned, many examples and many sort of, you know, paradigms for how to think about the issues that I think are productive.
Yeah. You know, we talked about trainees, like Kaffia was saying, but the next generation, early career people with an interest in this these things Yeah. I think, you know, they benefit from reading through these things. Yeah. Yeah. Okay. Great. Well, I mean, if our listeners want to find out more, you can find the ebook, Humanitarian Engineering for Global Oncology, on the IOPscience website, and it's part of the IOP book series in Global Health and Radiation Oncology. So take a look.
So, well, thanks again, Eric and Ofia, for speaking with us today. Thank you. Thank you for giving us the opportunity. Great to be here. That was Afiya York and Eric Ford of the University of Washington, and they were in conversation with Physics World's Tammy Freeman. Thanks to all 3 for a fascinating discussion. I'm afraid that's all the time we have for this week's podcast. A special thanks to our producer, Fred Iles.
We'll be back again next week. But in the meantime, do check out the latest episode of the Physics World Stories podcast. Host Andrew Glester meets Mark Levinson, a former theoretical particle physicist who is now an acclaimed filmmaker. They chat about his latest work, The Universe in a Grain of Sand, which has been described as a visually rich meditation on how science and art both strive to make sense of the natural world.
The episode is called From Physics to Filmmaking, Mark Levinson on his new documentary. And you can find it on the Physics World website or at your favorite podcast provider.