Devices & Physical Therapies

Boron neutron capture therapy used to need a nuclear reactor. These hospital-sized accelerators make the neutron beam instead, and in 2020 Japan approved the first one, with its boron drug, for head and neck cancers that have come back or cannot be removed.

A radiotherapy machine with PET detectors built in: the tumour's own radioactive tracer signal tells the beam where to fire, hundreds of times a second, so moving tumours and several metastases can be tracked and treated without external markers.

The standard radiotherapy machine: an electron accelerator in a rotating arm that makes high-energy X-rays or electron beams, shapes them with moving metal leaves, and takes a CT of the patient before each dose. Most people who have radiotherapy are treated on one.

Carbon ions are twelve times heavier than protons, so every clinical facility uses a synchrotron ring tens of metres across and fixed or huge rotating beamlines. Only about a dozen centres exist, in Japan, Germany, Italy, Austria, China, South Korea and Taiwan.

Sealed connectors that let a pharmacist or nurse draw up and give chemotherapy without any drug vapour or droplet escaping, protecting the staff who handle these drugs every day.

Killing a tumour by freezing it through one or more needles, with the ice ball watched live on CT, ultrasound or MRI. It hurts less than heat, spares nearby nerves and collecting systems better, and is the usual choice for small kidney tumours, painful bone metastases and, in trials, small breast cancers.

The scanners that find and stage cancer are built by five companies in a dozen factories. Detectors, superconducting magnets and the helium that cools them are the parts that run short.

A small accelerator on an industrial robot arm that aims hundreds of pencil-thin beams from any direction and follows the tumour as the patient breathes, so brain, spine, prostate, lung and pancreatic tumours can be treated in one to five sessions without a head frame.

Brief electric pulses applied to a tumour open pores in cell membranes so that a tiny dose of bleomycin or cisplatin floods in; used for skin metastases and, increasingly, for deep tumours.

A pulse generator and needle electrodes that give a tumour a few brief electric shocks minutes after a small dose of chemotherapy, opening the cells so the drug floods in. Used mostly for cancer nodules in the skin, now also for tumours inside the body.

Electron beams stop within a few centimetres of the skin, so they treat surface tumours, scars and the whole skin without reaching the organs underneath. Most linacs make them; special set-ups spread them over the entire body or deliver them during surgery.

Where an ear, an eye socket or a nose cannot be rebuilt from the patient's own tissue, a silicone prosthesis is made and held by adhesive or by titanium implants in bone. Implant failure differs sharply by site: across 3,630 implants, 3.5 per cent failed at the ear, 8.8 per cent at the nose and 18.7 per cent at the orbit.

Machines built or modified to deliver a whole radiation dose in a fraction of a second, so scientists can test whether ultra-fast dosing spares healthy tissue in people the way it does in animals.

A machine that streams cells one at a time past lasers and reads the fluorescent tags stuck to each one, counting tens of thousands of cells a second. It is how leukaemias and lymphomas are typed, how residual disease is measured after treatment, and how cell therapies are checked before infusion.

Destroying tumours from outside the body with tightly focused sound waves, using either heat or microscopic bubbles.

Sound waves plus microbubbles briefly open the brain's protective barrier so chemotherapy or antibodies can get to the tumour.

The original radiosurgery machine: about two hundred cobalt-60 sources arranged in a shielded helmet whose beams cross at one point inside the brain, so a metastasis or benign tumour a few millimetres across receives a destructive dose in a single visit while the brain around it is spared.

The small radiation detectors that make nuclear medicine and sentinel node surgery work: a pen-sized probe that clicks when the surgeon nears the radioactive lymph node, and the well counter in the hot lab that checks every dose before it is injected.

Ultrasound probes the size of a phone that plug into a tablet, costing a few thousand pounds rather than tens of thousands, so a clinic nurse or district doctor can check a breast lump, a swollen neck node or a liver without sending the patient to a city hospital.

The pump and heater that circulate warm chemotherapy through the abdomen at the end of an operation for cancer that has spread across the abdominal lining, and the small nebuliser that sprays chemotherapy as an aerosol through keyhole ports when surgery is not possible.

Hyperthermia heats tumours to 40-43 °C to make radiation and chemotherapy work better.

Machines that warm a tumour to about 40 to 43 degrees for an hour using radio waves or microwaves from outside the body, making the radiotherapy or chemotherapy given alongside work better. Few hospitals own one.

Infusion devices are the implanted ports, smart pumps, and take-home pumps that deliver chemotherapy safely, including 46-hour infusions patients carry home.

Intratumoural gene electrotransfer injects a plasmid carrying the interleukin-12 gene into a tumour and pushes it into cells with electric pulses, so this T-cell-activating cytokine is made locally instead of at the toxic doses intravenous IL-12 needed. It produced responses with pembrolizumab in anti-PD-1-resistant melanoma, but the sponsor's programmes have stalled.

Treating early bladder cancer by putting the drug straight into the bladder through a catheter, so the whole body is spared.

Irreversible electroporation uses short high-voltage pulses that punch permanent holes in tumour cells while sparing nearby vessels and ducts.

Two commercial systems thread a laser fibre through a hole the width of a pencil into a brain tumour and cook it while the surgeon watches the temperature on live MRI. They reach tumours too deep or too risky to remove with open surgery.

Radiotherapy machines are built by a very small number of companies. Two of them make most of the world's linear accelerators, a handful build proton systems, and installing, commissioning and servicing a machine is as much a part of the supply chain as building it.

Red and near-infrared light from a cap, comb or in-clinic device, sold for hair growth and tested twice in breast cancer. Adding it to scalp cooling did not improve on scalp cooling alone, and a separate caution applies to shining light at tissue where a tumour may be.

Magnetic nanoparticle hyperthermia injects iron-oxide nanoparticles into a tumour and heats them from outside with an alternating magnetic field.

Cooking a tumour from the inside through a needle. Radiofrequency current was the first method and is proven for small liver cancers; microwave energy heats faster, makes larger zones and is less troubled by nearby blood vessels carrying the heat away, so it is now the more common choice.

Cameras that watch the patient's skin in three dimensions, robotic couches and moulded shells that hold the body still, so each radiotherapy dose lands where the plan says without tattoos and with the beam paused if the patient moves.

Isolating the liver's circulation with catheters and balloons so that high-dose melphalan can be pumped through it and filtered out before it reaches the rest of the body; approved in 2023 for eye melanoma that has spread to the liver.

Shining low-power red or near-infrared light on the inside of the mouth before and during treatment prevents severe mouth ulcers in people having head and neck radiotherapy or high-dose chemotherapy for transplant. Mucositis guidelines recommend it, though few centres yet have the equipment.

Red or near-infrared lasers and lamps that switch on a light-sensitive drug sitting in a tumour. Each drug has its own colour, so the machine is matched to the drug: skin lamps for sun damage, fibre-optic lasers for the oesophagus, lung and bladder, and a new near-infrared laser for the head and neck.

An antibody carries a light-sensitive dye to the tumour; shining near-infrared light then bursts the cells.

Gold nanoshells that accumulate in a tumour and cook it when a near-infrared laser is shone on them.

Proton centres are built around one of three accelerators, a cyclotron, a synchrotron or a compact synchrocyclotron, feeding one or several treatment rooms through magnets and a rotating gantry the size of a house. Single-room systems have cut the price of entry, and upright treatment chairs may shrink the building again.

The measuring instruments that prove a radiotherapy machine gives the dose it claims: ionisation chambers, detector arrays, water tanks and plastic stand-in patients, checked every day, month and year and before every complex plan is delivered.

The machine that makes modern brachytherapy safe for staff: a shielded safe holding one tiny, intensely radioactive source on a cable, which it drives out through tubes into applicators inside the patient, dwells at programmed positions, and pulls back before anyone re-enters the room.

Hardware that copes with tumours that move when the patient breathes: belts and cameras that switch the beam on only in part of the breathing cycle, devices that hold the breath, and implanted beacons or X-ray tracking that let the beam follow the tumour.

A radiotherapy machine built like a CT scanner: the accelerator spins inside an enclosed ring, must image the patient before every dose, and treats fast. Ethos adds software that redraws the plan to the anatomy of the day while the patient lies on the couch.

A tightly fitted cap chilled to a few degrees above freezing, worn before, during and after each chemotherapy infusion, narrows the blood vessels of the scalp so less drug reaches the hair roots. In a randomised trial about half of women on taxane-based chemotherapy kept most of their hair, compared with none who went without.

A surface electrical device that is said to replace pain signals with signals the brain reads as normal. People treated with it often feel better, but in the only trial that compared it with a dummy device there was no difference between the two, so what is being felt may be the attention and the expectation rather than the machine.

A drug that does nothing until ultrasound hits it, then kills the cells that took it up. Being tested in brain tumours because sound reaches where light cannot.

The surgeon sits at a console and moves wristed instruments through keyhole ports while a 3D camera shows the inside of the body magnified. Intuitive's da Vinci has dominated for two decades; Medtronic's Hugo and CMR's Versius are the first serious rivals, and single-port robots work through one incision.

A breast prosthesis, a limb prosthesis, a compression garment, a voice valve, a dental implant and a hearing aid are each the difference between a function working and not working, and each is funded differently. In the United States a federal law requires plans that cover mastectomy to cover prostheses and lymphoedema treatment.

Radiotherapy delivered the way a CT scan is taken: a small accelerator circles the patient while the couch slides through, painting the dose slice by slice with a fast shutter-like collimator. It handles very long or oddly shaped targets and images the patient with the same beam before each session.

A helmet of a thousand ultrasound emitters, or a small implant under the skull, that sends sound through the bone into the brain. Approved for tremor, it is being tested in brain tumours to open the brain's protective barrier for a few hours so that drugs can reach the tumour.

Wearable electrodes that deliver alternating electric fields disrupting cancer cell division.

A self-shielded brain radiosurgery machine: a compact accelerator swings around the head on two nested gantries inside its own steel shell, so it needs no concrete bunker and no radioactive cobalt, and can be installed in an ordinary outpatient building.