Prof Keall, and his research team at the Image X Institute, have improved the lives and livelihoods of millions of cancer patients by inventing, advancing, and translating to industry new ways to image and treat disease. His pipeline of innovation is expected to improve the lives of millions more cancer patients in the future. His research harnesses mathematics, physics, engineering, and artificial intelligence to create solutions that improve cancer outcomes for all, with a particular focus on Aboriginal people, regional, rural and remote communities, and people from lower socioeconomic backgrounds—the Cancer Plan’s identified focus populations. Prof Keall and his team commitment to equity is embedded in its partnerships with cancer consumers. Two key contributors, Miriam Cavanagh, a lecturer in Aboriginal and Torres Strait Islander health, and Lee Hunt, a regional cancer advocate, ensure that Aboriginal and regional voices shape research priorities. Ms Cavanagh promotes culturally safe and responsive care, while Ms Hunt has championed radiation therapy access in Dubbo and other regional centres. Image X trials have included Dubbo and Orange cancer centres, where the proportion of Aboriginal patients is 3-4 times higher than in metropolitan centres, demonstrating a community-led, equity-first approach. Seventeen years after the Closing the Gap initiative, Aboriginal and Torres Strait Islander people with cancer have a 5-year survival rate of 40% lower than non-Indigenous Australians. Indigenous Australians are still twice as likely to be diagnosed with – and die from – lung cancer compared with non-indigenous Australians (Australian Institute of Health and Welfare). In response, Prof Keall and his team invented and clinically pioneered CT ventilation imaging, a software tool integrated into the radiation therapy workflow. Unlike nuclear medicine or MRI-based ventilation imaging, CT ventilation is cost-effective and geographically accessible, enabling healthy lung sparing during treatment. This technology is now licensed and used clinically, improving outcomes for patients in underserved communities. For people with prostate cancer, Prof Keall and team have invented and clinically pioneered the Kilovoltage Intrafraction Monitoring (KIM) technology. KIM was tested in the TROG 15.01 SPARK trial, Stereotactic prostate adaptive radiotherapy utilising KIM. The increased targeting accuracy of KIM enabled cancer patients to be treated in 5 days, rather than 40 days. The first patient on the trial lived in rural Aberdeen, a two-hour drive to his Newcastle treatment centre. As patient Steve told ABC News, “I am a great believer in new technology, and I loved the idea of only having five visits with minimal chances of major side effects”. KIM is being commercialised by Sydney company SeeTreat and will be available to nearly half of the world’s prostate cancer radiation therapy patients by 2026 – an example of value-based care that is patient-led, efficient, and scalable.

Paul Keall is a Professor in the Faculty of Medicine and Health at the University of Sydney, an NHMRC Leadership Fellow and the Director of the Image X Institute. He was previously the Director of Radiation Physics at Stanford University. He returned to Sydney as an NHMRC Australia Fellow, one of only 39 people given this award. His contributions to cancer research are internationally recognised. He has been ranked #1 worldwide from over 10,000 scientists and clinicians in Image Guided Radiotherapy by ExpertScape. Technology he pioneered, notably ‘4D CT’ to image lungs during breathing, is the global clinical standard for lung cancer radiotherapy patients and has improved the lives of millions of patients. His team have also invented technologies that have been used in eight first-in-human trials to improve cancer imaging and targeted radiation therapy. Outputs from his research include multiple bench-to-bedside clinical trials, over 400 scientific publications, and over 350 invited lectures. He works closely with industry to ensure his research has real-world impact with 29 current and completed industrial research agreements. His 42 awarded or in-process patents for medical devices have led to 20 inventions being licensed or assigned to ten companies, resulting in five global products to date. He has founded three start-up companies that have developed, or are developing, medical devices for cancer imaging and targeted radiation therapy.