Viewray Chapter 11

[Rad Onc SK]

I hope debt relief can help Viewray through this rough patch

I think the field is stronger with them in it

Adaptive is to Viewray as arc therapy was to Tomotherapy and SBRT was to Cyberknife. These small companies have move the field forward by bringing new thinking.

ViewRay® Files Voluntary Chapter 11 Petitions

/PRNewswire/ -- ViewRay, Inc. (Nasdaq: VRAY) announced today that it and certain of its subsidiaries (collectively, "the Company") filed voluntary petitions...

www.prnewswire.com

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[RadOncDoc21]

Saw this… good thing I sold off my shares.. With that said, the stock is cheap!

 

[Fpg1245]

Was a good product. At least Ray station was

 

[medgator]

Saw this… good thing I sold off my shares.. With that said, the stock is cheap!

It's worth $0 if they are going bk in all likelihood

 

[RadOncDoc21]

It's worth $0 if they are going bk in all likelihood

Oh most def, but 5 cents a share could be worth the risk. I’ve invested in worse before!

 

[grenz]

From the article it looks like they’re hoping to get bought. I have little doubt varian will buy them to get in the mri-linac game

 

[RickyScott]

From the article it looks like they’re hoping to get bought. I have little doubt varian will buy them to get in the mri-linac game

The MRI linacs field may just not be profitable at all. Varian will not want to spread itself thin in terms of service and neglect their core business- thats why they left protons

 

[OTN]

With all the time we've been doing adaptive therapy/MRI-guided therapy, you would think there would be more clinical data suggesting a benefit. I'm not surprised the company went under. Very expensive machine with very questionable benefit over our standard linac setup we all have these days.

 

[grenz]

The MRI linacs field may just not be profitable at all. Varian will not want to spread itself thin in terms of service and neglect their core business- thats why they left protons

Where did you hear they left protons? They’re still marketing protons on their website, and Google News isn’t showing any press releases.

 

[medgator]

With all the time we've been doing adaptive therapy/MRI-guided therapy, you would think there would be more clinical data suggesting a benefit. I'm not surprised the company went under. Very expensive machine with very questionable benefit over our standard linac setup we all have these days.

And probably not enough extra reimbursement to offset machine cost? I see that as the existential elephant in the room to support newer tech

 

[RickyScott]

Where did you hear they left protons? They’re still marketing protons on their website, and Google News isn’t showing any press releases.

sales reps say they exited the proton business. They still service the ones they built, but dont think you can buy one from them.

 

[Doctorer]

Where did you hear they left protons? They’re still marketing protons on their website, and Google News isn’t showing any press releases.

It was news at ASTRO last year.

 

[grenz]

sales reps say they exited the proton business. They still service the ones they built, but dont think you can buy one from them.

weird they’re still paying for upkeep of its marketing page for protons

 

[evilbooyaa]

With all the time we've been doing adaptive therapy/MRI-guided therapy, you would think there would be more clinical data suggesting a benefit. I'm not surprised the company went under. Very expensive machine with very questionable benefit over our standard linac setup we all have these days.

Need to separate adaptive from MR-guided therapy, IMO.

I think good value in MR-linac for pancreas SBRT. Lap ablate will be interesting. Question of value in prostate as well although Mirage is a bit controversial. Perhaps some value in Liver as well in terms of fiducial-less liver SBRT...

 

[Fpg1245]

Need to separate adaptive from MR-guided therapy, IMO.

I think good value in MR-linac for pancreas SBRT. Lap ablate will be interesting. Question of value in prostate as well although Mirage is a bit controversial. Perhaps some value in Liver as well in terms of fiducial-less liver SBRT...

Problem is you likely won’t get wide spread adoption if you can’t use it for prostate etc. even larger community centers struggle get that type of volume.

 

[RickyScott]

Problem is you likely won’t get wide spread adoption if you can’t use it for prostate etc. even larger community centers struggle get that type of volume.

Know of quite a few large centers that dont use it much in prostate and prefer truebeam. Best use is in pancreas, but there may be no benefit to xrt in this disease to begin with.

 

[Palex80]

From the article it looks like they’re hoping to get bought. I have little doubt varian will buy them to get in the mri-linac game

A few years ago, Elekta bought and later sold a chunk of Viewray

Elekta divests its stake in ViewRay - Elekta

ir.elekta.com

 

[Palex80]

Need to separate adaptive from MR-guided therapy, IMO.

I think good value in MR-linac for pancreas SBRT. Lap ablate will be interesting. Question of value in prostate as well although Mirage is a bit controversial. Perhaps some value in Liver as well in terms of fiducial-less liver SBRT...

Precisely.
You need to have quite a big patient load to justify a machine like that. We don‘t see that many patients with these indications. Competition in the liver-field is fierce with interventional radiology.

 

[TheWallnerus]

Where did you hear they left protons? They’re still marketing protons on their website, and Google News isn’t showing any press releases.

Varian/Siemens definitely out of protons

Varian believes that CT’ing can be used to make images about as good as the MRI and that CT data will be more physically accurate for on the fly dose recalc

Viewray was never able to bring forth a new CPT code for their tech like Varian was able to do for the early IMRT codes or BrainLab was able to do for the first stereoscopic daily X-ray IGRT (there was a code specific for Exactrac for 2005). If there had been a code for daily adaptive, then Viewray has a business model… clinical results be damned. You could argue that if they got good clinical results without new CPT codes there is a business case for MRgRT, but even if there were good clinical data without increased reimbursement… what centers could truly afford to start trying to cure more cancers by buying more expensive equipment that reimbursed the same (or worse once you factor in treatment time and machine down time).

 

[Palex80]

SIEMENSVarian believes that CT’ing can be used to make images about as good as the MRI and that CT data will be more physically accurate for on the fly dose recalc

 

[RickyScott]

I actually agree with varian. With advanced on board Ct technology and an mri sim in the department, I am not sure how much an mri linac brings to the table, especially with fiducials. I think for a few very large centers, these machines probably justified for a few niche indications and research, but not the vast majority of hospitals. (Also these systems may compromise on planning due to lack of vmat, non coplanar beams, and good dosimetry planning software? Neuronix should weigh in here.

A few large cities probably need one. I do feel that almost all midsize and up departments could benefit from future mri/Ct sim technology.

Anyone know the deal with single photon emission Ct scanning. Will it impact radonc?

 

[ramsesthenice]

I actually agree with varian. With advanced on board Ct technology and an mri sim in the department, I am not sure how much an mri linac brings to the table, especially with fiducials. I think for a few very large centers, these machines probably justified for a few niche indications and research, but not the vast majority of hospitals. (Also these systems may compromise on planning due to lack of vmat, non coplanar beams, and good dosimetry planning software? Neuronix should weigh in here.

A few large cities probably need one. I do feel that almost all midsize and up departments could benefit from future mri/Ct sim technology.

Anyone know the deal with single photon emission Ct scanning. Will it impact radonc?

Spot on. We have a unity. The main things that I use it for are pancreatic SBRT (which as stated above could be debated) and then crazy pelvic and abdominal reirradiation cases where the issue has less to do with hitting the target and more to do with adapting to avoid the bowel. Just recontour and let the optimizer get you the best coverage possible. If you are getting more than 90% coverage, you probably don't need to be doing adaptive therapy in the first place. I think it is wonderful for very specific cases but it is not a particularly practical machine for the vast majority of practices. Most of the community centers in our region send me their 2-3 re-irradiation cases per year and call it a day.

 

[CaesarRO]

Spot on. We have a unity. The main things that I use it for are pancreatic SBRT (which as stated above could be debated) and then crazy pelvic and abdominal reirradiation cases where the issue has less to do with hitting the target and more to do with adapting to avoid the bowel. Just recontour and let the optimizer get you the best coverage possible. If you are getting more than 90% coverage, you probably don't need to be doing adaptive therapy in the first place. I think it is wonderful for very specific cases but it is not a particularly practical machine for the vast majority of practices. Most of the community centers in our region send me their 2-3 re-irradiation cases per year and call it a day.

I still can't grasp the business case for the MR Linac. On top of the limited utility it seems like a _hugggge_ time suck for multiple staff members. Low patient throughput, too.

 

[Rad Onc SK]

I still can't grasp the business case for the MR Linac. On top of the limited utility it seems like a _hugggge_ time suck for multiple staff members. Low patient throughput, too.

This was the original plan,…

This was also pre-77387

Radiation Renaissance

For a patient with a cancerous tumor, a new device being developed by a Gainesville-based technology start-up could considerably improve the effectiveness of a course of radiation therapy. The premis…

www.gainesville.com

 

[Neuronix]

I actually agree with varian. With advanced on board Ct technology and an mri sim in the department, I am not sure how much an mri linac brings to the table, especially with fiducials. I think for a few very large centers, these machines probably justified for a few niche indications and research, but not the vast majority of hospitals. (Also these systems may compromise on planning due to lack of vmat, non coplanar beams, and good dosimetry planning software? Neuronix should weigh in here.

A few large cities probably need one. I do feel that almost all midsize and up departments could benefit from future mri/Ct sim technology.

Anyone know the deal with single photon emission Ct scanning. Will it impact radonc?

I love our Viewray and hope it doesn't go away.
We have a big enough center, volume, and satellites that it has always made us enough revenue to justify the device. We also generate academic productivity from the new technology.

They have sold enough of these that I think they have a reasonable business model for this niche device for centers who want the niche technology.

I suspect they will be back again with more capital or a buyout.

 

[elementaryschooleconomics]

This was the original plan,…

This was also pre-77387

Radiation Renaissance

For a patient with a cancerous tumor, a new device being developed by a Gainesville-based technology start-up could considerably improve the effectiveness of a course of radiation therapy. The premis…

www.gainesville.com

Wow, I've mostly ignored this space and wasn't aware of the timeline.

Investing in a long-term, high-capital venture in RadOnc in 2006 is like...well, building a huge real estate portfolio in 2006.

 

[medgator]

View attachment 374536

Wow, I've mostly ignored this space and wasn't aware of the timeline.

Investing in a long-term, high-capital venture in RadOnc in 2006 is like...well, building a huge real estate portfolio in 2006.

View attachment 374537

Or SPACs/crypto 2021

 

[TheWallnerus]

I love our Viewray and hope it doesn't go away.
We have a big enough center, volume, and satellites that it has always made us enough revenue to justify the device. We also generate academic productivity from the new technology.

They have sold enough of these that I think they have a reasonable business model for this niche device for centers who want the niche technology.

I suspect they will be back again with more capital or a buyout.

I know you love your MRgRT and hope it doesn’t go away

But it’s going to take a low information, bad-at-business type to buy out ViewRay or give them a capital infusion

That said, it’s likely to happen!

 

[Palex80]

So, the market capitalization of ViewRay is now apparently less than 10 million dollars.
One can actually buy the whole company for the price one MR-Linac?

 

[RickyScott]

So, the market capitalization of ViewRay is now apparently less than 10 million dollars.
One can actually buy the whole company for the price one MR-Linac?
View attachment 374589

Would you be also buying a lot of debt?

 

[Palex80]

Would you be also buying a lot of debt?

I wouldn´t be buying. My Cayman islands off-shore company would be buying. They would be also bankrupt the next day after I cleared out the viewray warehouse and started selling replacement parts to all you guys that still have ViewRay machines for $$$.

 

[Fpg1245]

So, the market capitalization of ViewRay is now apparently less than 10 million dollars.
One can actually buy the whole company for the price one MR-Linac?
View attachment 374589

Assets minus liabilities?

 

[sirspamalot]

Common worth nothing in BK. Have you had your BK your way today?

 

[Radonc 2013]

Is there any real chance that hospitals could be left with an $8 million dollar machine without any support in the future? How is this even navigated if it plays out in this manner? Should I start packing my things if I pushed/sold the hospital administration on the miracles of the MRI Linac (joking!)?

 

[Chartreuse Wombat]

Gravy train is over for a few

Open Payments Data - CMS

openpaymentsdata.cms.gov

 

[sirspamalot]

'member when they had those nice Viewray dinners at ASTRO I think it was..oh well.. so long ago now.. and I remember thinking.. how the hell is anyone gonna buy a machine if there are no codes? CODES I TELL YOU... CODES ARE LIFE!

 

[radoncftw]

Gravy train is over for a few

Open Payments Data - CMS

openpaymentsdata.cms.gov

alot of consulting fees

 

[TheWallnerus]

 

[NotMattSpraker]

alot of consulting fees

Some are surprising.

Im pretty sad about LAP-ABLATE. They were the sponsor and it sounds like it will not go on. If positive, it could have made a big splash for radiation in pancreas. Maybe Varian will eventually fund a CT-based trial.

 

[elementaryschooleconomics]

Ah.

My favorite time of the year.

Time to go after the Demon Gel again.

Palette trying to steal Orio away from pushing SpaceOAR eh?

Hey HROP kids, I know you read this - has Boston gone Team Barrigel?

(I won't derail the whole thread with this, just wanted to remind everyone the gel is bad and is not standard of care)

 

[sirspamalot]

Mark Storey just did a substack article on VRay BK, nice summary. Sorry, don't have the link handy.

 

[RickyScott]

Ah.

My favorite time of the year.

Time to go after the Demon Gel again.

View attachment 374790

Palette trying to steal Orio away from pushing SpaceOAR eh?

Hey HROP kids, I know you read this - has Boston gone Team Barrigel?

(I won't derail the whole thread with this, just wanted to remind everyone the gel is bad and is not standard of care)

Have had a number of pts complain of minor rectal pressure from the gel on one one month follow up.

 

[sirspamalot]

Demon Gel. Love it.