The rural Alberta high school Dr. Tyler Meyer attended was so small, it didn’t offer Physics 30 on-site every year. So, Meyer persuaded two of his friends to sign up with him in Grade 12, to guarantee that the class would be offered. Meyer liked physics so much, he later applied to study the subject at the University of Calgary (U of C), even though he had no idea what a physicist’s job might be.
In the third year of his undergraduate program, he discovered medical physics, and he’s never looked back.
“In a lot of physics work, it’s hard to pin down the benefit of what you are doing,” says Meyer. “Sometimes, it’s hard to see where it’s all headed. But in medical physics, there are patients in the waiting room every morning, and you know why you are going to work every single day.”
Meyer is now a medical physicist at the Tom Baker Cancer Centre in Calgary. He is also an adjunct associate professor at the U of C in the department of oncology, with a secondary appointment in the department of physics and astronomy. The primary focus of his research and clinical practice is brachytherapy, a classification of radiotherapy where radioactive seeds or sources are placed in or near the target area. It’s commonly used in cancer treatment for prostate, cervical and other gynecological cancers. But Meyer is also doing groundbreaking research on breast brachytherapy.
Radiotherapy is indicated for about half of all cancers (while the other half benefit from different types of treatment). The most common radiation therapy is external beam radiation, where the radiation comes from a large machine, and the beam is directed at a target area in the body. This beam goes through the body and exposes a lot of tissue to radiation, so there can be side-effects. The advantage of brachytherapy is that the radioactive source is placed in or near the target area (using a needle to insert the radioactive seeds), so the treatment area is much more concentrated.
Meyer admits it’s not easy to explain his job to most people. The Canadian Organization of Medical Physicists defines medical physicists as health-care professionals with specialized training in the medical application of physics. “It’s a small field and not very well known, so it definitely requires frequent explanation,” he says.
“The Foundation has had a huge hand in almost all my major research projects. They’ve really helped me do work that has made significant improvements to the care that we can offer.” — Dr. Tyler Meyer
His research in prostate brachytherapy, which started at the end of his undergraduate program and continued during the five years he worked on his PhD at the U of C, can paint a clearer picture of exactly what his job entails. Using 3D ultrasound images, he worked on improving a newly developed brachytherapy delivery system for prostate cancer, enhancing the planning software, the dose calculations and the seed delivery mechanisms. Put simply, his role was to figure out “where the seeds should go and how to get them there.”
The treatment can involve High Dose Rate (HDR) brachytherapy, where the seeds are inserted temporarily, or Low Dose Rate (LDR) therapy, where the seeds remain in the body permanently. When the seeds are being inserted by the oncologist, medical physicists like Meyer are in the operating room, helping with the technical aspects of the procedure.
For Meyer, the joy of being a medical physicist is tackling new puzzles and revisiting old ones. He had plenty of opportunities to problem-solve while growing up on a mixed grain and cattle farm near Castor in central Alberta and says the skills he learned on a tractor or wielding a shovel have helped him throughout his career. His father still runs the family farm, and although Meyer occasionally thought about following in his footsteps, he pursued a career in medical science instead.
He chose the U of C because it was close to home and says he “got lucky because it has a great physics department.” After finishing his undergraduate degree, he spent a year working as a geophysical surveyor on the Montana plains. He then he returned to the U of C to start a master’s program in medical physics, soon transferring into the PhD program. Finishing his PhD in 2010, he began a two-year clinical residency in 2012 and took his national certification exam the following year. He joined the Tom Baker Cancer Centre as a certified medical physicist in 2013, and, not long after, became the team lead for the brachytherapy program.
In addition to continuing research and clinical work in prostate brachytherapy, Meyer and his team joined an existing pilot project in late 2013 to improve a new breast brachytherapy treatment developed by Dr. Jean-Philippe Pignol at Sunnybrook Hospital in Toronto. The procedure is technically challenging, so Meyer’s team researched ways to make it more accurate, simpler and easier to deliver. With funding from the Alberta Cancer Foundation, they were able to provide the treatment to 38 post-surgical women in Alberta.
Breast brachytherapy (also known as Permanent Breast Seed Implant or PBSI) offers a huge advantage over conventional radiation therapy. The standard treatment involves weeks of daily treatment, whereas brachytherapy is a single-day outpatient procedure. “The benefits to both the health-care system and the patients of only having to come in once are enormous, especially for rural patients,” says Meyer. “Where I grew up, I know of family members and others who struggled to get to the city for treatment every day for weeks on end.”
The 38 patients are still being tracked, and the study has found that the rates of recurrence and side-effects are similar to those observed in other techniques. The next step, says Meyer, is to acquire funding for more PBSI research on a larger number of patients, preferably across Canada.
Dr. Michelle Hilts is a senior medical physicist for BC Cancer and an adjunct professor at the University of British Columbia. Based in Kelowna, Hilts has collaborated with Meyer on testing and improving PBSI treatment.
“He’s got ambitious, innovative ideas and he is clinically practical, so he is very interested in moving things forward that will benefit the clinic and patients as quickly as possible,” she says.
Among the innovations that Meyer has shared with the Kelowna team is a breast phantom – essentially a false breast – that allows staff to go through the PBSI treatment process on a “pretend patient” as a training and quality assurance exercise.
“It’s a tool that allows us to continually improve the treatment,” says Hilts. In B.C., PBSI has recently moved from being an experimental treatment for breast cancer to a standard of care, although the procedure is still only available in Kelowna.
Meyer, meanwhile, is effusive in expressing his gratitude to the Alberta Cancer Foundation for its support of his research over the years, starting with his graduate work on prostate brachytherapy, its funding of the PBSI pilot project and, more recently, a three-year, $515,000 investment into a major “uplifting” of the provincial brachytherapy program at the Tom Baker Cancer Centre. The investment includes two clinical trials, which began in 2019 and are currently recruiting patients, and three development projects in various stages. The new investment’s subtitle is “The Next Stage of Brachytherapy Practice in Calgary.” It runs from 2019 to 2022.
“The Foundation has had a huge hand in almost all my major research projects. They’ve really helped me do work that has made significant improvements to the care that we can offer,” Meyers says. “They do excellent work in funding these projects. What’s important to them is how the research benefits patients and patient care.”
For Meyer, who divides his time between his clinical work, teaching and research, having the Foundation’s financial support has allowed him to pursue research projects that arise out of his clinical rotations. “Our research questions are clinically motivated, and everyone has direct patient benefit.”
7 Questions with Dr. Tyler Meyer
1. Describe what you do in 10 words or less.
Use physics topics and analysis methods to develop medical applications.
2. What’s the biggest misperception about what you do?
People often think physicists work behind the scenes or in a technical capacity on equipment or calculations. We are actively involved in patient treatments and therapy development or innovation.
3. Where do you get your best ideas?
Long drives. It’s rare to get three or four uninterrupted hours and having that time helps me think things through in detail.
4. If you weren’t a medical physicist, what would you be?
I had a lot of great jobs. It was hard to leave a few of them to take a risk on a small and competitive field like this. I did some work for the town where I grew up, including public works and some time at the rink and golf course. That was a satisfying and healthy lifestyle I considered pursuing instead of university.
5. What’s the hardest lesson you’ve learned?
It has been hard for me to learn the difference between what I can do, what I should do, and what should be done.
6. What motivates you?
The clinical aspect of our jobs generates research questions, which aim to solve problems we encounter every day, giving us personal motivation to solve them and providing clear evidence of direct patient benefit.
7. What do you do to recharge?
Puzzles, but not contrived ones. A complex problem that I’m uniquely suited to solve with a solution that actually helps people brings me to work with a smile.