Periodic Reporting for period 2 - PRISAR (Preclinical Intra-Operative Image-Guided Surgery and Post-Operative Radiotherapy of Tumours)
Okres sprawozdawczy: 2017-02-01 do 2019-01-31
Medical imaging has several important roles to personalize oncological management to the individual patient, ranging from initial diagnosis and staging towards early monitoring of therapy response and assessment of systemic control in metastatic patients. However, adequate visualization of the primary tumour and metastatic lesions using current imaging techniques and protocols is challenging in patients with pancreatic cancer. In a considerable number of patients, the primary tumour cannot be visualized.
PRISAR stands for Preclinical Intraoperative Image-Guided Surgery and Postoperative Radionuclide therapy of Tumours and in this context, intraoperative fluorescence imaging is a promising technique which potentially allows a better detection of tumor cells left at the resection margins. Fluorescence guided surgery is the first part of PRISAR and can already lead to an enormous improvement in survival rates.
The use of intraoperative gamma imaging has the potential to further improve surgical outcomes. By also fusing optical and gamma images, there are medical advantages of having both anatomical and physiological information during surgical procedures. Furthermore, a handheld device provides practical benefits including bedside imaging for small targeted organs and tissues, such as thyroid gland and lacrimal ducts. Using this hybrid gamma-optical camera unit will provide the surgeon with fused optical and gamma images that can enhance the localisation of tumours and outline margins in critical surgical situations. Furthermore, the device would help to minimise the chance of leaving abnormal tissues behind after the surgical procedure is complete. There is currently no commercially available system that offers hybrid imaging for clinical use that combines fluorescence and gamma imaging into a single fused image. Development of such a system will have significant benefits for cancer diagnosis and treatment, especially in the case of head and neck cancers, and will be a unique offering in the healthcare arena which will make it extremely useful in-theatre for procedures such as sentinel lymph node biopsies.
Results
The PRISAR project brought to the forefront a new type of hybrid radionuclide-fluorescent imaging to aid the process of image-guided surgery. The visualisation of the probe by different imaging modalities enables the surgeon to identify tumours with far greater precision than current state-of-the-art methods. Where clinical imaging nowadays tend to rely on large single modality instruments, the PRISAR project resulted in the development of a multimodality handheld hybrid gamma-optical camera. Early development of these small field of view (SFOV) cameras was focussed on a single modality imaging. Now the combination of dual optical and gamma detection enables high spatial resolution multi-modal imaging, giving a superimposed scintigraphic and optical image. Hybrid imaging offers new possibilities for assisting clinicians and surgeons in localising the site of uptake in procedures such as sentinel node detection and intraoperative imaging. The hybrid camera concept can be extended to a multimodal detector design which can offer stereoscopic images, depth estimation of gamma-emitting sources, and simultaneous gamma and fluorescence imaging.
Socio-Economic Impact
The project will build upon the current SME expertise available in Europe where such relationships are easier to bridge and where access to academic insight and collaboration is less fraught with difficulties. By empowering people with the knowledge of cross-sector issues and the multidisciplinary requirements of imaging, a new foundation of understanding will be achieved. This will help to build a more competent and employable European molecular imaging work force – ready for the next era of molecular imaging. At the start of this project we already acknowledged the fact that this project had the potential to produce the much-needed multi-disciplinary young professionals by active transfer of knowledge across different disciplines, as well as across an academic-industrial axis. After two years into the project, we can say that there is a high level of interaction and transfer of knowledge between several partners and secondees, partners with different backgrounds can help each other further. For this the highly wanted helicopter view is developed for a truly multi-disciplinary approach. Furthermore, the processing of big data as mentioned under workpackage 4 in the previous section, was not mentioned in the proposal but is additional progress beyond the state of the art which is highly likely to be be used in a broad range of diseases and not only cancer.