Thursday, May 22, 2025
Personalized and more precise radiation treatments increase the chances of recovery and reduce side effects for women with cervical cancer. This has a significant social and societal impact. Prof. Dr. Remi Nout is conducting research in this area, linking radiotherapy with technical sciences. “Radiotherapy is by definition a field in which technology plays a major role.”
Remi Nout is Professor of Radiotherapy at Erasmus MC. He has also been appointed as a Medical Delta Professor, with a position at the Faculty of Mechanical Engineering at TU Delft.
What does the appointment as a Medical Delta Professor mean to you?
“For me, it’s an opportunity to strengthen the connection with TU Delft more broadly for our field. I’m really looking forward to that. As an academic hospital, we can benefit more from the expertise available there. I always enjoy going to Delft. There’s a creative atmosphere, and the way of thinking is truly different from that of a traditional medical faculty. That helps to view complex challenges from new perspectives. Every time I’m there, I come back with a fresh outlook.
We already collaborate in various ways, for example in education. Together, we train students in Technical Medicine. The Medical Delta appointment formalizes and hopefully strengthens this connection. I hope it will lead to more joint projects and grant applications. It’s a step forward in advancing our field together.”
Can you briefly describe your area of expertise?
“My expertise lies in the treatment of patients with gynecological tumors. In this context, we combine different radiotherapy techniques, such as external and internal radiation. Within this field, two key themes are central. On the one hand, we aim to avoid both over- and undertreatment — it’s about ensuring that each patient receives the right combination of therapies. On the other hand, there is a strong shift toward increasingly precise and personalized radiation treatment, with the goal of minimizing side effects.
Both aspects require advanced technology. That’s also what makes the collaboration with TU Delft so interesting: their technical domain is incredibly broad. There is a wealth of knowledge available to approach these kinds of challenges from multiple perspectives.”
How does technology help advance your work?
“Radiotherapy is by definition a field in which technology plays a major role. Many of the challenges we encounter lend themselves very well to collaboration with TU Delft, and there is still a lot of potential for growth.
My own research focuses on image-guided radiotherapy. In that context, we have been collaborating with TU Delft for quite some time, also through HollandPTC — a proton therapy clinic and research center that is a joint initiative of Erasmus MC, LUMC, and TU Delft. It’s an important hub where our areas of expertise come together.
With the prospect of increasing healthcare demand and a tight labour market, labour-saving innovations are becoming more and more urgent.
In addition, I’m collaborating with the Medical Engineering department at TU Delft on developing a more accurate and personalized form of internal radiotherapy. We combine image guidance with 3D printing techniques to better tailor treatments to individual patients. That project is in full development and offers a lot of room for expansion.
Another important theme is AI, for example in the automation of processes. With the prospect of increasing healthcare demand and a tight labour market, labour-saving innovations are becoming more and more urgent. There is still plenty of opportunity for further development in that area — especially in collaboration with the technical expertise at TU Delft.”
What is it like to start collaborating with someone from a completely different discipline?
“That’s very inspiring!
Radiotherapy is a field where two worlds come together. On one hand, it is very people-oriented — you support individuals during a vulnerable, often difficult phase of their lives. Around 60% of all cancer patients undergo radiotherapy at some point, either curatively, aiming for recovery, or to relieve symptoms such as pain. At the same time, it’s also a highly technical discipline. The treatment itself, and especially its delivery, requires extensive knowledge of imaging and technical systems.
TU Delft is a large organization with incredibly diverse expertise, and as an outsider, it’s not always immediately clear who is working on what. I clearly remember attending a symposium with various booths where researchers were presenting their work. I had been carrying around an idea for some time, and there I struck up a conversation with someone from the group of Medical Delta Professor Jenny Dankelman. They were working on a technique for needle guidance, which aligned well with my idea. That conversation eventually led to a first grant application — which was successful.
We then started a joint PhD project between TU Delft and Erasmus MC, focused on personalized treatments using 3D printing techniques, specifically for optimal and precise needle placement. It was exactly what I had been looking for. Since then, multiple students have contributed, and we’re now working on a follow-up project, this time also involving two industry partners.”
The healthcare system is under increasing pressure. How can your research help address this?
“One important direction is more accurate radiation of tumors. Besides potentially leading to better outcomes, it also means that with fewer treatment sessions, you can still achieve at least an equivalent result. That saves time and resources — without compromising effectiveness.
As mentioned earlier, we’re also working on labour-saving technologies, such as automating the creation of radiation treatment plans. These kinds of applications can ease the workload of healthcare professionals and make processes more efficient.
More precise irradiation of tumors saves time and resources, without compromising effectiveness.In addition, personalized care is playing an increasingly important role. We want to better identify which patients truly benefit from radiotherapy — possibly in combination with other therapies — and for whom a different approach would be more suitable. That depends on both tumour-specific and patient-specific factors. Better decision-making allows us to target treatments more effectively and avoid unnecessary burdens on patients.
Finally, we’re also looking into combination treatments, such as radiotherapy combined with immunotherapy or hyperthermia — a heat-based treatment that is being actively developed in Rotterdam. Here too, we’re collaborating with TU Delft.
In short, by focusing on the patients who benefit most from a particular treatment, and by delivering fewer but more precise radiation sessions, we can help counterbalance the growing pressure on the healthcare system.”
What will a (potential) patient, (healthcare) professional, or Dutch citizen notice from your work and this collaboration? What do you hope to have achieved for them in five years?
“In my broader role as head of the department, I hope that in five years we’ll have built an even stronger connection with TU Delft across all areas that are important for quality patient care. Personally, I would love it if, in clinical practice — particularly for the patient group I focus on — we could make treatments even more precise. That outcomes for patients genuinely improve, and that the follow-up research is then in an advanced stage.
Concretely, I imagine that the entire process around internal radiation therapy — which is currently still quite complex and labour-intensive — will have become much more efficient. At the moment, patients often spend an entire day on it. They go from the operating room to the MRI, wait for the treatment plan, and then finally receive the radiation — which itself only takes about fifteen minutes. Using automation, we aim to reduce that total burden to about two hours.
We’re already making significant progress. For instance, creating a treatment plan used to take about 45 minutes. We’ve now developed our own software that brings that down to just 6 minutes. That’s already a major gain — for both patients and healthcare professionals.”
What is the importance of real-world clinical settings for your research? And how do you incorporate the needs of healthcare practice into your work?
“Our department is very strong in introducing innovations into daily practice. We aim to bring technical advancements really close to the patient. Clinical technologists play a key role in this: they bridge the gap between innovation, radiotherapy technicians, and physicians. They operate at the intersection of healthcare and technology and are capable of effectively translating new developments into clinical practice. Education also plays a role in this.
We aim to bring technical advancements really close to the patient.
The goal is always to treat patients better and address societal challenges. For example, by delivering more precise radiation therapy that leads to better treatment outcomes — but also allows us to achieve the same results with fewer sessions. This means patients need to come to the hospital less often, which has a huge impact on their lives and helps reduce pressure on the healthcare system.”
How do you involve patients in your research?
“For needs assessments, we involve patients and patient organizations in our work. In addition, we conduct our own research into patient satisfaction. That involvement often provides valuable insights.
One example is how we presented patient information for a study. Thanks to patient feedback, we gained a better understanding of how that information was actually perceived. This led to important adjustments in the wording and tone. Another example is our research into patients’ experiences with internal radiation therapy. It revealed which aspects of the treatment were perceived as most burdensome. We’re now using those insights to explore how we can improve the process — with the goal of making the treatment better not just medically, but also in terms of patient experience.”
Major and complex challenges like the healthcare transition require comprehensive solutions. How should we approach this? And what role does collaboration between academic (wo), applied sciences (hbo), and vocational (mbo) education play?
“At our department, we work closely with various educational levels. For example, we offer an in-service training program for radiotherapy technicians here in Rotterdam, and we collaborate with universities of applied sciences — particularly in the field of medical imaging and radiotherapy (MBRT). This area also involves a lot of technology, from operating equipment to understanding the underlying processes.
Our department is built on a multidisciplinary structure: we work with technicians from hbo engineering programs, hbo-level IT specialists, and of course healthcare professionals. The collaboration between hbo- and wo-trained staff is strong, and there’s still great potential for further development. For instance, our technicians also contribute to research. One of them recently even started a PhD in the field of hyperthermia. We want to encourage these kinds of crossovers, because there’s a lot of room for career development in our field.
To retain skilled personnel, it’s important to offer fulfilling work with opportunities for growth and specialization — whether that’s in teaching, research, or innovation. If we manage to keep offering the full spectrum within the profession, we’ll also be better equipped to meet the demands brought about by the healthcare transition.”
Which other scientists or practice partners have truly surprised you, or really helped you move forward?
“My own PhD supervisor has always been a major mentor to me. Carien Creutzberg, professor at LUMC, has played an important role in my development both as a researcher and as a physician. I’m still incredibly grateful to her for that.
More recently, and in the context of Medical Delta, I also want to mention Jenny Dankelman, professor at TU Delft, and the members of her research group. She and her postdoc have been closely involved in our collaboration from day one. That support was incredibly helpful in getting the partnership off the ground.”
Click here for the portrait and video series about the new Medical Delta professors.
