Improving Personalized Cancer Care in Less Developed Countries

Published Nov. 11, 2018

EmpowerRT is a newsocial 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 traveled 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.

UNC startup EmpowerRT offers personalized cancer care anywhere

Technology will be a game changer in the fight on cancer for developing countries, secures first test site in Zambia, Africa

Published Jan. 8, 2018

Cases of cancer continue to steadily rise across the globe, particularly in developing countries. According to Harvard’s School of Public Health, the percentage of new cases of cancer was similar for developed and developing regions 20 years ago. But today, 55 percent of new cancer cases arise in developing nations—a figure that could reach 60 percent by 2020 and 70 percent by 2050.

One early stage company at the University of North Carolina at Chapel Hill is looking to address this challenge with their unique technology solution. 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.

In many developing countries, there is a lack of resources dedicated to cancer research and treatments. Many radiotherapy clinics still rely on basic or outdated equipment and lack the funds, training and supporting infrastructure to implement modern 3D and IMRT (intensity-modulated radiation therapy) that is more effective in treating cancer with less side effects.

EmpowerRT offers clinically-proven and user-friendly software, patient-specific device fabrication knowledge, and hands-on training to enable resource-limited cancer clinics to reduce treatment toxicity similar to high-tech solutions, but at five-to-ten percent of the cost. The company’s three-prong solution of software, existing hardware and training, allows cancer clinics in low and middle-income countries to save up to $3 million in medical technology expenses.

“We want to enable developing countries to do more with what they have based on UNC experience,” says Sha Chang, EmpowerRT founder and professor in UNC’s School of Medicine’s Department of Radiation Oncology. “Most radiation therapy clinics in developing countries think they need new and expensive equipment to advance, but there is another way.”

When Chang came to UNC’s oncology department more than 20 years ago, she had the idea to develop the technology. She knew the high-tech commercial IMRT and commercial products were being developed and as an innovator and visionary, had the idea to also develop a cost effective, manual approach to benefit UNC patients in the meantime. EmpowerRT’s technology enables old machines to perform better, achieved with a simple device – a compensator – which is both recyclable and affordable. At the end of a treatment course, the compensator can be re-used.
Basic (non-personalized) radiation treatments damage both healthy and cancerous tissue
EmpowerRT’s solution optimizes radiation to cancer and spares normal tissue with a simple compensator device

Sha Chang, EmpowerRT founder and professor, UNC School of Medicine, Department of Radiation Oncology
Sha Chang, EmpowerRT founder and professor, UNC School of Medicine, Department of Radiation Oncology

“Our technology is very relevant to developing countries. They are where the U.S. was two decades ago. What we develop – our experience in the field – can be of great value to them.”

The company is now avidly working to register test sites around the world. After many persistent conversations, EmpowerRT is thrilled to announce Zambia Cancer Disease Hospital in Africa is their first test site. Other potential test sites include Brazil, India and Honduras or Peru.

EmpowerRT licensed from UNC the clinical software PLUNC, which was an in-house developed radiotherapy treatment planning system that was used to treat 22,000 cancer patients at UNC Hospitals and thousands more in Duke University School of Medicine and St. Jude Children’s Research Hospital. In addition, the EmpowerRT solution was used to treat 1,500 patients at UNC Hospitals. The in-house software and the EmpowerRT solution are no longer used at UNC Hospitals today as they have been replaced by modern, state-of-the-art technologies that are automated and more sophisticated.

As a startup, Empower RT continues to leverage multiple groups across campus as they continue their innovation journey, including UNC’s Kenan-Flagler Business School, CUBE, and LAUNCH Chapel Hill, where EmpowerRT is a member of Cohort 8. In addition, EmpowerRT was named to the latest class of Kickstart Commercialization Venture Award winners. The award will enable for test site implementation demonstration.

“At UNC, there is so much we develop that can really be transferred through startups, through entrepreneurship,” Chang says. “That’s a very natural channel to bring what has been developed and tested at UNC and carried to developing countries, to help them by offering feasible, low-cost solutions. I am very grateful for the tremendous encouragement and support EmpowerRT received from the department, hospital, university, my professional society and the international community.”

To extend their reach and further their mission, EmpowerRT is looking to form new partnerships with organizations like the Clinton Foundation as well as DAI, a company with expertise in global development. They are also working to form partnerships with international organizations in Brazil, Denmark and India as well.

EmpowerRT is looking to launch additional test sites throughout 2018 and aiming for ten customers by 2019. Moreover, to support their growth as an organization, they are avidly seeking additional team members – particularly at the senior management level.

EmpowerRT needs all kinds of help and support, from students interested in gaining experience in global health startups to senior management. To find out more and to follow their journey, contact Professor Sha Chang at empower.rt@gmail.com.

EmpowerRT Wins Global Health Innovator Award Recognizing Standard Radiation Therapy To Developing Countries

EmpowerRT, a North Carolina based social enterprise startup, whose mission is to empower low-resourced cancer clinics in developing countries with standard of care radiation therapy, announced that it has received the 2018 Global Health Innovator Award presented at this year’s The MedTech Conference powered by AdvaMed in Philadelphia, PA.
October 3, 2018:  EmpowerRT training radiotherapy physicists and therapists on IMRT at the Cancer Diseases Hospital in Lusaka, Zambia.

The Global Health Innovator Award was created as a part of the new Innovations in Global Health Program at The MedTech Conference, aimed at identifying ways to accelerate innovation and support the deployment of affordable and appropriate medical technologies in the developing world. While innovative medical technologies have the potential to impact the lives of patients and healthcare workers worldwide, significant barriers keep many resource-constrained populations from accessing these technologies.

According to the World Health Organization, 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). As Sha Chang, Founder of EmpowerRT, emphatically states, “This huge disparity between High-Income Countries (HICs) and LMICs is simply unacceptable.”

“The MedTech Conference, aimed at identifying ways to accelerate innovation and support the deployment of affordable and appropriate medical technologies in the developing world. While innovative medical technologies have the potential to impact the lives of patients and healthcare workers worldwide, significant barriers keep many resource-constrained populations from accessing these technologies.”

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 a clinically-proven, low cost Intensity Modulated Radiotherapy solution that has been standard of care for years in HICs and has been successfully used to control cancers in HICs for the same cancers that are contributing to an extremely high mortality rate in LMICs. Not only is this solution low-cost, but it is also recyclable and retrofittable.

Sha Chang, Founder of EmpowerRT, added, “As an organization, EmpowerRT is honored to receive this award, and we are excited because the TEAMFund initiative aligns so well with our vision of creating a world where people in every country can have access to standard of care radiation therapy, regardless of income. We are progressing quite well with the Republic of Zambia – Cancer Diseases Hospital, our first early adopter of EmpowerRT.  With our low-cost solution, Zambia will be able to offer IMRT to their people for the first time ever.”

Chang, a Professor of Physics in the Department of Radiation Oncology at the University of North Carolina in Chapel Hill, is the leading authority on recyclable compensator-based IMRT and the in-house development of PLUNC – UNC’s radiotherapy planning software. EmpowerRT has licensed and is currently commercializing the same compensator-based IMRT solution that UNC has used for decades and aims to bring standard of care radiotherapy to cancer clinics, globally.