What Does Mixing Math, Physics, Computers, and Imagination Give You? A Pioneer in Radiation Oncology.

Ian R. Crocker, MD, FACR, is a radiation oncologist specializing in brain and eye tumors, who worked at Winship Cancer Institute for over 30 years. Throughout his career, Crocker was an active member of multiple innovation and research teams that sought to develop new medical technologies and methods to improve treatment outcomes and patient care. Some of his most notable successes include his co-invention of the BetaCath system to prevent the re-narrowing of arteries after an angioplasty and his involvement in the Emory start-up, Velocity Medical Solutions, which produced new, widely used imaging software to improve cancer treatment. Now retired from Emory, Crocker continues to be involved in medical innovation by continuing his work for Velocity under the larger umbrella company of Varian Medical Systems.

What drew you to radiation oncology?

I always found the field of oncology to be very interesting because there was a lot to be done to improve it. When I was in the first year of the medical oncology program I was exposed to radiation oncology for the first time. I loved that it combined math and physics and computers, things that I was interested in and curious about. So rather than pursing medical oncology, I chose to transfer into radiation oncology.Ian Crocker

I finished my residency in radiation oncology and took a faculty position at Duke University for three years. In 1986, I came to Emory, which at that time only had a very small radiation oncology department. At first, when I started seeing and treating patients at Emory, I would see anyone that walked in the door including pediatric and adult patients, all with different types of ailments. There was not really an opportunity to specialize in any area. But over time, I restricted the types of patients that I saw to adult patients with certain conditions.

You worked both in a clinical and research setting, how did you balance the two and what were the challenges and rewards of working in both practices?

I loved patient care and I found it very rewarding. Patients by-and-large were very grateful and appreciative of everything that we did for them and what is not to love about that? In working with patients, I saw the need to improve and change things about existing treatment methods. I would say that my clinical work helped inform my research and vice versa. They were complementary of one another.

What has your involvement in commercialization been during your career?

In academic medicine, there is an underlying interest in research and teaching as well as clinical care. When I came to Emory, I initially became involved in an ophthalmology project that was looking at whether radiation could help fix retinal detachment. Our study indicated that the radiation seemed to work great. But I later found out that the study was only meant to be a lab experiment and it was never meant to be used as a patient treatment. I was disappointed because I was hoping that we were doing something that would help people.

Fast forward a couple years and a cardiology fellow from Israel named, Ron Waksman, asked me whether I though radiation could be used to prevent the re-narrowing of arteries after a coronary angioplasty. I told him that I thought radiation could help and I had in mind a system to combat the issue. But, I emphasized that if we found radiation to be effective, I wanted to see it translated into patient care. We did the animal experiments and radiation worked great. We decided to work with this small start-up company in Atlanta called Novoste to help further develop our product, with the goal of launching a clinical trial and receiving FDA approval for that product. In the end the product reduced the occurrence of re-narrowing from 80% to about 10-20% and really changed a lot of people’s lives.

After that I became involved in more attempts to develop and commercialize products to improve patient treatment and care. The next thing that I worked on was macular degeneration, the most common cause of blindness in adults after diabetes. I believed that applying radiation to the area where the blood vessels were proliferating, the cause of this type of macular degeneration, would reduce the incidence of blindness. I worked with two separate companies to develop radiation devices to be used in humans to halt macular degeneration. Although these showed efficacy, they never received U. S. Food and Drug Administration (FDA) commercial approval due to the development of a drug that was equally effective and easier to administer.

After this I embarked on research with Tim Fox, PhD, formerly with Emory, in automating the radiation planning process. We received funding from the Georgia Research Alliance (GRA) to create a company, Velocity Medical Solutions, to do this. We ended up not developing the automated radiation planning software, but instead developed a product which would allow physicians to use biologic information in the treatment planning and follow-up process. The product is FDA approved and is now installed in over half the top 50 cancer centers in the U.S. It was so successful that Varian Medical Systems, the biggest manufacturer of radiation treatment, came along and bought our company two years ago. I recently retired from Emory but have now resumed working with the Velocity group, helping them create new products for the market place.

What have you found most satisfying in being part of the innovation teams and being one of the first doctors to implement these new innovations?

I love having the opportunity to use my imagination. Medicine is in general very deductive. It is like being a detective and trying to uncover what the problem is so you can do something about it. Trying to imagine or invent a solution to a problem uses a whole different skill set. It allows you to think outside the box and I like that.

I am proud of being one of the first doctors to use the technologies and methods that I helped develop. But, I am probably prouder of having created the products and brought them to the market place, because when you do that anyone can use the product and even more patients can benefit.

You are a founding member of the Emory start-up, Velocity. What was your experience of getting that project off the ground l like?

It was hard. We had an idea for a product that we thought was needed. We had a bit of intellectual property around our ideas and GRA awarded us some funding to help commercialize those ideas. Unfortunately, it was not near enough money to finalize the product, get it FDA approved, start selling it and trying to develop a successful company around it. But, we believed enough in the company and the idea that we put in our own money. I still had a full-time job at Emory and when I finished work there, we would get together and work on company related issues. This was both stressful and rewarding. At the start, it was a month-to-month question of whether the business could stay operational. But, we managed to make the money last until we could turn a profit. We were lucky that many people saw the value of our product and purchased it as soon as we started selling it.

How has your work in the field of radiation oncology changed over your time in practice and how do you think it will change in the future?

The practice of radiation oncology today is completely dissimilar to what I learned as a radiation oncology resident. The roles of the personal computer, imaging, 3D visualization of the treatment plan, and the capacity of newer treatment machines to deliver precision radiation treatments are developments we could not have imagined when I was in residency. I feel very lucky to have been at an academic medical center where we were involved in implementing and practicing these new medical advances. I got to be part of so many firsts in my field like the first image guided radiosurgery.

Moving into the future, one of the projects that I am working on is using imaging to characterize the biology of a cancer much like people in genomics do to predict how a tumor might grow. There is this developing field of radionics which looks at the imaging characteristics of a tumor and trying to predict how it might grow and respond to treatment. I think this is going to be important moving forward.

Who has influenced you the most in your career and why?

The person that inspired me the most was the former head of Radiation Oncology at the Princess Margaret Hospital in Toronto, Dr. Bill Ryder. When I began training people did not know what you could and could not accomplish with radiation treatment. Unlike many people who just stick to established guidelines, Bill Ryder was someone who explored what you could do with radiation. He was on the forefront of multidisciplinary cancer care. He used to have a clinic for residents called the “odds and sods” clinic, where he would show you all these advanced cancers that he had taken on, treated and cured, when others had labeled them incurable. He made me believe in radiation and what it might accomplish.

What would your advice be to your younger self?

I would tell myself to balance my life a little bit better. It takes a lot of time away from family and friends to be at the forefront of new developments in any field. When I look back on it, maybe I tried to do too much.

Tell me something about yourself that many people do not know.

When I was growing up I raced sailboats competitively and at one time was a Canadian champion in sailing. I got invited to try out for the Canadian Olympic sailing team. The same day I got that invitation, I was also accepted to medical school. I showed my mother the letters and she took the Olympic sailing one and ripped it in half and said, “You’re going to medical school.” I think she made the right decision for me.