Viewray‘s Demise

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Palex80

RAD ON
15+ Year Member
Joined
Dec 17, 2007
Messages
3,390
Reaction score
4,403
I thought, I’d start a thread on this.

Here are some interesting news:



1697302696817.png

Members don't see this ad.
 
There's so much to unpack with Viewray.

But specifically to this letter: I think this is awesome.

This is how it's supposed to work. That whole pesky "free market" thing.

We're in dangerous waters these days, with a decade of aggressive consolidation. Varian is a borderline monopoly, and I say that as someone who generally loves Varian's products. I just don't like monopolies (which hopefully...isn't a controversial take, but who knows).

What I really want to hear: who's got the good gossip about why there was never a CPT code for MRI-linac treatments. I've heard snippets. Give us the goods!
 
  • Like
Reactions: 6 users
Here's what Viewray has to say about the situation

October 12, 2023

Dear MRIdian Customer,

The purpose of this letter is to act as a follow up reminder to the official notice of discontinuance for the MRIdian system October 25, 2023. ViewRay was unable to secure a financial partner or a purchaser and will cease all operations as of that date. This includes all quality, regulatory, software support, service support, parts, upgrades, installations, and clinical research services.

We have communicated our plan to discontinue and no longer manufacture or support the MRIdian system to all applicable regulatory agencies. If you decide to continue to use your MRIdian system after the wind-down period, please consult with your local medical device regulations for guidance on safe and compliant use of a non-supported medical device. Also, please be aware, as of the date of this letter, no third party has been authorized to service or support the MRIdian system. Any predatory claims by a third party asserting that they have the rights to service the MRIdian or otherwise have intellectual property rights, are simply false, misleading, and not productive.

ViewRay will publish on the Customer Portal the following items by October 13, 2023, and customers are encouraged to download a local copy as it may likely be unavailable after October 25, 2023:
  • MRIdian service manual with instructions for key repairs
  • MRIdian preventative maintenance manual and check sheets
  • Instructions to de-energizing the magnets
  • Instructions to monitor and maintain the magnets
  • List of critical components, service tools, and vendor contact information
  • Service qualifications and a list of individuals who are qualified to perform service activities on MRIdian
As a reminder this information is available for your internal use only and none of the information contained, is to be reproduced, distributed, used or disclosed, either in whole or in part, except as specifically authorized by ViewRay or upon Chapter 7, the US trustee.

If you are having problems obtaining access to the Customer Portal, please contact for support: [email protected]
Those customers wishing to continue their programs past October 25, 2023, are reminded of the following:
  • Part availability is not guaranteed from vendors
  • Software support from ViewRay will not be available
  • ViewRay designed service tools will not be available
  • Any modification to the Bill of Materials likely has regulatory consequences. Please consult with your local medical device regulations for guidance.
It’s incredibly unfortunate that a restructuring path was not successful for ViewRay. This will be my last official customer communication as we prepare to cease operations and convert to Chapter 7. We appreciate the support you have shown and the lifesaving treatments you have provided with MRIdian.

If you have any further questions, please contact the head of customer service, Martin Cleaton at [email protected].

Sincerely,
Paul Ziegler President and CEO ViewRay, Inc.
 
Members don't see this ad :)
Departments that purchased Viewray's are going to write off $12 million?
 
  • Haha
  • Like
Reactions: 4 users
Departments that purchased Viewray's are going to write off $12 million?
I hope that was their financial plan from the beginning regardless the company’s going concern; smart people know how to write off 100% of their high dollar equipment
 
  • Like
Reactions: 2 users
Any pp dumb enough to buy one deserves what was coming
Very easy in retrospect to say that.

I don’t remember seeing much negativity about MRL until the failure. There was typical discussion about the margin study, but it wasn’t about the machine - it was a reasonable discussion about study design.

And many of us - me included - are really disappointed. High throughout MRL with less need for staffing through automation would have been an amazing product.
 
  • Like
Reactions: 2 users
Very easy in retrospect to say that.

I don’t remember seeing much negativity about MRL until the failure. There was typical discussion about the margin study, but it wasn’t about the machine - it was a reasonable discussion about study design.

And many of us - me included - are really disappointed. High throughout MRL with less need for staffing through automation would have been an amazing product.
I was not positive on MRgRT. After it had been on market for a while, lack of a different billing code baffled me as to how the company could make it long term. And insurance companies were not about to allow daily MRI charges as IGRT.

If a rad onc company wants to sell a new radiation device, if it uses linac treatment codes it’s gotta be not more expensive than a linac and be clinically better, or be less less expensive than a linac and be clinically linac equivalent, or that company won’t make it long term

Hard truth: adding 50 cents of lidocaine injection in a breast tumor cavity will save more lives than replacing a linac with a $12 million MRgRT machine ever could

50 cent laughing GIF
 
  • Like
  • Haha
Reactions: 5 users
@TheWallnerus nailed it. No dedicated cpt code plus 3-4x the cost of modern brand new SBRT capable linac did not inspire confidence for me esp in the current rad onc reimbursement climate
In retrospect :)
I never saw once 1-2 years ago: “this business will fail without cpt codes”
Which in retrospect is obvious
 
  • Like
Reactions: 1 users
A few more hints at what happened. I think the demise had a lot more to do with good old fashioned business stuff than failure to obtain a CPT code.

 
  • Like
Reactions: 3 users
In retrospect :)
I never saw once 1-2 years ago: “this business will fail without cpt codes”
Which in retrospect is obvious
I always meant to tell you. Just we always wound up talking about other stuff and I forgot!
A few more hints at what happened. I think the demise had a lot more to do with good old fashioned business stuff than failure to obtain a CPT code.

Good old fashioned business stuff = they didn’t sell enough machines. Because the machines weren’t lucrative enough and couldn’t beat the profit margin of a linac. Because…

This article mentions how hypofractionation and RO-APM would have supported a $12 million ViewRay. To me, APM would have supported buying a $200K Xstrahl unit and treating bone mets with it.
 
  • Like
  • Haha
Reactions: 4 users
Members don't see this ad :)
I always meant to tell you. Just we always wound up talking about other stuff and I forgot!

Good old fashioned business stuff = they didn’t sell enough machines. Because the machines weren’t lucrative enough and couldn’t beat the profit margin of a linac. Because…

This article mentions how hypofractionation and RO-APM would have supported a $12 million ViewRay. To me, APM would have supported buying a $200K Xstrahl unit and treating bone mets with it.
Probably VR should have dropped the price on the MR Linac and bumped up the price on the service contracts (both hardware and software). As with any new linac (forget the MR), up time to my understanding was ok; not great. If anyone remembers the original tomotherapy, would say VR was better, nowhere near say trilogy/truebeam uptime, but we all saw how tomo ended up -- another niche machine.

Throughput was always the main issue. Probably topped out at 15 a day, 10-12 with adaptive. Sims had to be done on the linac (and a CT to get electron density) which chewed up time (as an aside I just don't get doing fancy palliative on-line planning -- looking at you ethos).

From listening to their pro formas from 5+ years ago, the payoff was the multiple adaptive codes (look at the recent pancreas pub in IJROBP -- 93% of fractions were adaptive). No need for new CPT codes. Pretty sure those daily MRs were getting billed out as IGRT too. The one weird trick was getting all those adaptives actually paid -- dunno if institutions were. But given that a few sites had two, guess they were doing ok. RO-APM may actually have been a disaster for VR given the above, well a sooner disaster anyway.
 
  • Like
Reactions: 4 users
There is no appetite at any centralized level to expand radiation services for patients. We don’t have the lobby. That wasn’t the direct cause but the lack of a cpt code or clarity hurt.

Protons have a self contained huge lobby whose genesis was during easy $$ days.
 
  • Like
Reactions: 2 users
Here's what Viewray has to say about the situation

October 12, 2023

Dear MRIdian Customer,

The purpose of this letter is to act as a follow up reminder to the official notice of discontinuance for the MRIdian system October 25, 2023. ViewRay was unable to secure a financial partner or a purchaser and will cease all operations as of that date. This includes all quality, regulatory, software support, service support, parts, upgrades, installations, and clinical research services.

We have communicated our plan to discontinue and no longer manufacture or support the MRIdian system to all applicable regulatory agencies. If you decide to continue to use your MRIdian system after the wind-down period, please consult with your local medical device regulations for guidance on safe and compliant use of a non-supported medical device. Also, please be aware, as of the date of this letter, no third party has been authorized to service or support the MRIdian system. Any predatory claims by a third party asserting that they have the rights to service the MRIdian or otherwise have intellectual property rights, are simply false, misleading, and not productive.

ViewRay will publish on the Customer Portal the following items by October 13, 2023, and customers are encouraged to download a local copy as it may likely be unavailable after October 25, 2023:
  • MRIdian service manual with instructions for key repairs
  • MRIdian preventative maintenance manual and check sheets
  • Instructions to de-energizing the magnets
  • Instructions to monitor and maintain the magnets
  • List of critical components, service tools, and vendor contact information
  • Service qualifications and a list of individuals who are qualified to perform service activities on MRIdian
As a reminder this information is available for your internal use only and none of the information contained, is to be reproduced, distributed, used or disclosed, either in whole or in part, except as specifically authorized by ViewRay or upon Chapter 7, the US trustee.

If you are having problems obtaining access to the Customer Portal, please contact for support: [email protected]
Those customers wishing to continue their programs past October 25, 2023, are reminded of the following:
  • Part availability is not guaranteed from vendors
  • Software support from ViewRay will not be available
  • ViewRay designed service tools will not be available
  • Any modification to the Bill of Materials likely has regulatory consequences. Please consult with your local medical device regulations for guidance.
It’s incredibly unfortunate that a restructuring path was not successful for ViewRay. This will be my last official customer communication as we prepare to cease operations and convert to Chapter 7. We appreciate the support you have shown and the lifesaving treatments you have provided with MRIdian.

If you have any further questions, please contact the head of customer service, Martin Cleaton at [email protected].

Sincerely,
Paul Ziegler President and CEO ViewRay, Inc.
These should be dumped into the public arena...
 
Hard truth: adding 50 cents of lidocaine injection in a breast tumor cavity will save more lives than replacing a linac with a $12 million MRgRT machine ever could
We are at that point as a field.

Even a hypothetically perfect XRT intervention, meaning perfect stereotaxy, accuracy and fall-off with every fraction, would have only marginal benefit on cancer outcomes relative to what a Truebeam with a reasonable doc can do today.

CMS gonna put their money elsewhere.
 
  • Like
  • Love
Reactions: 5 users
We are at that point as a field.

Even a hypothetically perfect XRT intervention, meaning perfect stereotaxy, accuracy and fall-off with every fraction, would have only marginal benefit on cancer outcomes relative to what a Truebeam with a reasonable doc can do today.

CMS gonna put their money elsewhere.
THIS.

This is what I argue about with physics. Physics is the only reason Elekta is still in business. For certain parameters, they have a small, tangible "win" over Varian.

Except...it has zero clinical relevance. I literally had this conversation on Friday with a physicist. If you give me a linac that has 2% MLC leakage vs 1% MLC leakage - I literally don't care. I know that, in a real live human, that's never been shown - even remotely - to make a difference.

You can only hypofrac down to zero or dose escalate up to....well I don't know, a neutron bomb or something?

Who cares. The point being is that the foundations of the field right now are too weak to innovate on some hyper-specific nuance at the cost of an additional $5 million dollars.

That ain't it.
 
  • Like
  • Love
Reactions: 10 users
THIS.

This is what I argue about with physics. Physics is the only reason Elekta is still in business. For certain parameters, they have a small, tangible "win" over Varian.

Except...it has zero clinical relevance. I literally had this conversation on Friday with a physicist. If you give me a linac that has 2% MLC leakage vs 1% MLC leakage - I literally don't care. I know that, in a real live human, that's never been shown - even remotely - to make a difference.

You can only hypofrac down to zero or dose escalate up to....well I don't know, a neutron bomb or something?

Who cares. The point being is that the foundations of the field right now are too weak to innovate on some hyper-specific nuance at the cost of an additional $5 million dollars.

That ain't it.
i think this is the point in the conversation when i should say - this is why we need to support biology focused research! Better understanding of tumor heterogeneity, combination therapy, predictive biomarkers, tumor evolution, etc... can drive new indications for radiation and help us be certain we are using our treatment for those who need it most. Our technical ability can also enable us to reconsider the use of radiation in situations/diseases we walked away from decades ago.
 
  • Like
Reactions: 11 users
i think this is the point in the conversation when i should say - this is why we need to support biology focused research! Better understanding of tumor heterogeneity, combination therapy, predictive biomarkers, tumor evolution, etc... can drive new indications for radiation and help us be certain we are using our treatment for those who need it most. Our technical ability can also enable us to reconsider the use of radiation in situations/diseases we walked away from decades ago.
Pop Tv Bb21 GIF by Big Brother After Dark
 
i think this is the point in the conversation when i should say - this is why we need to support biology focused research! Better understanding of tumor heterogeneity, combination therapy, predictive biomarkers, tumor evolution, etc... can drive new indications for radiation and help us be certain we are using our treatment for those who need it most. Our technical ability can also enable us to reconsider the use of radiation in situations/diseases we walked away from decades ago.
Like anything else, yes and no.

To date, we only see biology used to eliminate adjuvant radiation through biomarkers or ctDNA, find indications to eliminate RT (mismatch repair for rectal cancer) or failed attempts to integrate other modalities (immunotherapy for abscopal, lack of efficacy so far for concurrent RT + immuno).

While 'biology' doesn't need to be a net negative for the field of radiation oncology in the future, would it be fair to say that thus far biology has not yet yielded a major advance that enhances our ability to practice?
 
  • Like
Reactions: 6 users
i think this is the point in the conversation when i should say - this is why we need to support biology focused research! Better understanding of tumor heterogeneity, combination therapy, predictive biomarkers, tumor evolution, etc... can drive new indications for radiation and help us be certain we are using our treatment for those who need it most. Our technical ability can also enable us to reconsider the use of radiation in situations/diseases we walked away from decades ago.
This is of course true, and I believe has been an emphasis for many years. However, I would claim that the narrative as presented to prospective radonc residents has been all wrong.

There are relatively small numbers of positions to be a physician scientist in radonc nationally, and although at one point, it is likely that radonc had successfully recruited probably close to 60-70 people in a given year who were nascently positioned to pursue such a career, there never were nearly this many opportunities.

Getting to be a physician scientist is remarkably competitive in any field, I would claim that it became most competitive in radonc in the 2010s (lots of wasted talent).

We should not be aggressively recruiting for these folks presently. But, we should be actively supporting those that presently have the positions.

It should also be clear to regular docs (like me) that biological research initiatives often take on the order of 30 years or so to manifest in the clinical setting, in those rare cases where the scientific narrative dovetails with what can be done in the clinic.

The fact that our intervention is so singular, makes the likelihood that any given biologic research initiative will be manifested as an expansion of radiation care markedly smaller than for other fields.

Has Tim Chan's work impacted how the radonc does their job is an expansive way?

I have a book that includes beautiful, foundational work on the interaction of chemotherapy and radiation. Published in the 90s. Not hot at all and everyone ignores it! Is anybody doing this sort of work now?
 
  • Like
Reactions: 1 users
Rad oncs need to remember we are more like surgeons than med oncs. Expanding our role can only go so far. They have a knife. They can study how to use the knife better with tech, how to do better knife wielding, practice patterns research, diversity research, and most relevantly - how to better use the knife as systemic therapies improve - meaning can we use a knife when we historically couldn’t?

I think sometimes rank and file of us in general practice expect too much for there to be new indications. There aren’t new cancers.
 
  • Like
  • Love
Reactions: 7 users
Rad oncs need to remember we are more like surgeons than med oncs. Expanding our role can only go so far. They have a knife. They can study how to use the knife better with tech, how to do better knife wielding, practice patterns research, diversity research, and most relevantly - how to better use the knife as systemic therapies improve - meaning can we use a knife when we historically couldn’t?

I think sometimes rank and file of us in general practice expect too much for there to be new indications. There aren’t new cancers.
That's a reasonable point of nuance.

For me, I expect horizontal, not vertical innovation.

For "better knife wielding", we're generally bumping up against the limits of physics. And importantly, this is the area AI is actively taking over for us, for the better.

Practice patterns and diversity research IS MOST CERTAINLY NOT THE THING. It's complimentary. It's good for med students and residents to get pubs. But basically all of these studies are descriptive, and will include the lines "hypothesis generating" or "more work needs to be done".

Finding the synergy between the ionic knife and other, new therapies is definitely a good avenue.

But there are other things too. We've spent all this time decreasing our footprint. Technology will continue to help us in particular.

Which means we could expand our presence to other things, not just radiopharm but benign indications (cardiac, arthritis, etc), and longitudinal supportive care. We don't have to stay in our box, is my main message.
 
  • Like
Reactions: 5 users
.

But there are other things too. We've spent all this time decreasing our footprint. Technology will continue to help us in particular.

Which means we could expand our presence to other things, not just radiopharm but benign indications (cardiac, arthritis, etc), and longitudinal supportive care. We don't have to stay in our box, is my main message.
Window dressing. It'll help but it won't be bread and butter stuff to most people's practices and certainly won't be a way to counteract the long term trend of increasing efficiency in the face of more residents hitting the workforce than a decade or two previous
 
  • Like
Reactions: 1 user
i think this is the point in the conversation when i should say - this is why we need to support biology focused research! Better understanding of tumor heterogeneity, combination therapy, predictive biomarkers, tumor evolution, etc... can drive new indications for radiation and help us be certain we are using our treatment for those who need it most. Our technical ability can also enable us to reconsider the use of radiation in situations/diseases we walked away from decades ago.
On the topic of biology, why has xevinapant not gotten more attention in rad onc? This study was published and I heard crickets on Twitter. Meanwhile last week there was some negative phase I of a TKI and multiple academics were posting about continued potential

 
  • Like
Reactions: 5 users
Which means we could expand our presence to other things, not just radiopharm but benign indications (cardiac, arthritis, etc), and longitudinal supportive care. We don't have to stay in our box, is my main message.
I totally agree
 
  • Like
Reactions: 2 users
On the topic of biology, why has xevinapant not gotten more attention in rad onc? This study was published and I heard crickets on Twitter. Meanwhile last week there was some negative phase I of a TKI and multiple academics were posting about continued potential

You'll hear a lot more if the phase 3 is positive. Completely accrued and waiting on events.

My money on these apoptotic pathway modifying agents -- a core MOA of RT. Makes sense. The great thing is low toxicity signal and oral agents -- who needs med onc?
 
  • Like
Reactions: 8 users
You'll hear a lot more if the phase 3 is positive. Completely accrued and waiting on events.

My money on these apoptotic pathway modifying agents -- a core MOA of RT. Makes sense. The great thing is low toxicity signal and oral agents -- who needs med onc?
Good to hear. Was strange that we finally have a biologically based agent that looks to have so much promise, and the only academic on Twitter who posted about it was the chair at Pitt. Maybe they all just don’t care about anything that isn’t their own research sphere. Seemed like a stark contrast to the fervor when the abscopal case report was published.
 
  • Like
Reactions: 1 user
Good to hear. Was strange that we finally have a biologically based agent that looks to have so much promise, and the only academic on Twitter who posted about it was the chair at Pitt. Maybe they all just don’t care about anything that isn’t their own research sphere. Seemed like a stark contrast to the fervor when the abscopal case report was published.
We have discussed xevinapant on this board before! :)
We are better than Twitter!
 
  • Like
Reactions: 2 users
I am excited about xevinapant as a rad onc

I would be even more excited about xevinapant if I were a med onc ;)
Doesn’t seem like there are any significant drawbacks that would limit its uptake in the US like with nimorazole. If it works in other disease sites then this could be the biggest advance in RT since cisplatin
 
  • Like
Reactions: 1 users
Doesn’t seem like there are any significant drawbacks that would limit its uptake in the US like with nimorazole. If it works in other disease sites then this could be the biggest advance in RT since cisplatin

Very impressive data. Just sent a message to the company asking if they had research interest in locally advanced lung cancers.
 
  • Like
Reactions: 1 users
Rad oncs need to remember we are more like surgeons than med oncs. Expanding our role can only go so far. They have a knife. They can study how to use the knife better with tech, how to do better knife wielding, practice patterns research, diversity research, and most relevantly - how to better use the knife as systemic therapies improve - meaning can we use a knife when we historically couldn’t?

I think sometimes rank and file of us in general practice expect too much for there to be new indications. There aren’t new cancers.
There are not new cancers, but there are epidemics of arthritis and Alzheimer's dementia that if proven to benefit from low dose XRT would make the IMRT glory days look like a blip.

There is some very hot radiobiology research going on in Alzheimer's and radiation right now, and hopefully an RTOG study will not be too far behind.
 
  • Like
Reactions: 1 user
That's a reasonable point of nuance.

For me, I expect horizontal, not vertical innovation.

For "better knife wielding", we're generally bumping up against the limits of physics. And importantly, this is the area AI is actively taking over for us, for the better.

Practice patterns and diversity research IS MOST CERTAINLY NOT THE THING. It's complimentary. It's good for med students and residents to get pubs. But basically all of these studies are descriptive, and will include the lines "hypothesis generating" or "more work needs to be done".

Finding the synergy between the ionic knife and other, new therapies is definitely a good avenue.

But there are other things too. We've spent all this time decreasing our footprint. Technology will continue to help us in particular.

Which means we could expand our presence to other things, not just radiopharm but benign indications (cardiac, arthritis, etc), and longitudinal supportive care. We don't have to stay in our box, is my main message.

I like the knife analogy too. Remembering to consider all of our modalities in the toolbox and expanding that tool box will help us invent new indications, just like the Gamma Knife and Cyberknife invented/ enabled single fraction SRS and 5 fraction SBRT.

I personally believe we need much better knives and more of them, and since it takes about 10 years to get to market, I guess now is the time to start making one.
 
There are not new cancers, but there are epidemics of arthritis and Alzheimer's dementia that if proven to benefit from low dose XRT would make the IMRT glory days look like a blip.

There is some very hot radiobiology research going on in Alzheimer's and radiation right now, and hopefully an RTOG study will not be too far behind.

Wow I would be so surprised and so super hyped if NRG did an alzheimers or arthritis study!

Alzheimers its wayyy early for NRG, but that would be a cool future.
 
  • Like
Reactions: 1 users
Wow I would be so surprised and so super hyped if NRG did an alzheimers or arthritis study!

Alzheimers its wayyy early for NRG, but that would be a cool future.
Rad oncs would find a way to mess things up. We’re the equivalent of Congress.
 
  • Like
Reactions: 2 users
the incentive to treating dementia with radiation would be our aging “leaders” wanting to hang around longer and soap warm bodies just one more time. be careful what you wish for!
 
  • Like
  • Haha
Reactions: 5 users
Our team gave two oral talks with data from MRIdian at ASTRO on the day the Chapter 7 was announced, and a third one the day after.

I was expecting someone to walk up to the mic after one of the talks and say "who cares?" but fortunately nobody did.
 
  • Like
  • Haha
Reactions: 9 users
Top