Imaging in cancer therapeutics 2015
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Guest lecture for medical image processing course in engineering department.
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Imaging in cancer therapeutics 2015
- 1. Imaging in Cancer Therapeutics! Past, Present and Future! Parminder S. Basran, PhD, FCCPM Senior Medical Physicist BCCA- Vancouver Island Centre Adjunct Associate Professor University of Victoria- Dept. Physics & Astronomy @psbasran www.slideshare.net/psbasran !
- 2. Outline! • Introduction: What is Cancer?! • Clinical Example: Lung cancer! • Challenges! • Conclusions / Future Directions!
- 3. Introduction: Cancer! http://en.wikipedia.org/wiki/Cancer! “a class of diseases in which a group of cells display uncontrolled growth, invasion that intrudes upon and destroys adjacent tissues, and sometimes metastasis, or spreading to other locations in the body via lymph or blood.”!
- 4. How do you detect cancer?!
- 5. Detection & Screening! • Not only is imaging used to measure the extent of the disease, it is commonly used to screen patients (generally higher risk patients) to mitigate morbidity from cancer. ! • Breast Cancer / Mammography! • Colorectal Cancer / CT Colonoscopy (iScanImaging. “3D Virtual Colonoscopy." Online video clip. YouTube. YouTube, 18 Apr. 2012. Accessed May 20, 2015)!
- 6. Individualized Cancer Care! • As our understanding of cancer increases, so does the recognition that each tumor is unique.! • In the last decade, the focus in cancer research on the genetic make-up of cancer! • Now it is clear that the tumor microenvironment, cellular and protein interactions affect disease progression, aggressiveness and response to treatment.!
- 7. Individualized Cancer Care! Subsequently, imaging the ! • tumor micro-environment! • host/stem cell interactions,! • various proteins ! can be used to assess ! • disease progression! • aggressiveness ! • response to treatment!
- 9. Example: Lung Cancer! • Illustrative example on the role of imaging in cancer management!
- 10. Patient Consult! • 70 year old male! • Smoker for 20 years, quit 2 years ago! • Painter! • History of cancer in family! • Father had prostate cancer! • Uncle had lung cancer! Symptoms! • Coughing starting about 3 years ago, persistent for 2 years but got worse over last year! • Dull chest pain over the last year! • Wheezy/hoarsness in breathing ! • Weight loss over the last year!
- 11. Diagnosis! Tests that may be performed include:! • Chest x-ray! • Sputum cytology test to look for cancer cells! • Blood work!
- 13. Staging! Stage 0 - the cancer has not spread beyond the inner lining of the lung! Stage I - the cancer is small and hasn't spread to the lymph nodes! Stage II - the cancer has spread to some lymph nodes near the original tumor! Stage III - the cancer has spread to nearby tissue or spread to far away lymph nodes ! Stage IV - the cancer has spread to other organs of the body such as the other lung, brain, or liver!
- 14. Staging! Stage 0 - the cancer has not spread beyond the inner lining of the lung! Stage I - the cancer is small and hasn't spread to the lymph nodes! Stage II - the cancer has spread to some lymph nodes near the original tumor! Stage III - the cancer has spread to nearby tissue or spread to far away lymph nodes ! Stage IV - the cancer has spread to other organs of the body such as the other lung, brain, or liver!
- 15. Prognosis! Stage! Survival rate after 5 years! Treatment! 0 / 1! 80%! Surgery (segmentectomy/wedge resection), photodynamic therapy, cryotherapy, radiation therapy! 2! 40-50%! Lobectomy; pneumonectomy; or segmental, wedge ! Radiation therapy, Adjuvant chemotherapy (Cisplatin) after curative surgery. ! 3! 10-23 %! Chemo-radiation therapy for patients with stage IIIA- N2 disease.! Radiation therapy alone for patients medically unfit! 4! <10%! Chemotherapy, Radiation for palliative/symptom relief!
- 16. Treatment Strategy! Radiation Therapy! • Deliver high dose (60 Gy) with multiple photon beams (6 MeV range)! • Need to simulate the treatment virtually! • Obtain a CT scan to define the tumor and normal tissues! • Simulate the radiation beams in the CT dataset!
- 19. PET-CT! Positron Emission Tomography (PET), is a non-invasive molecular imaging technique that uses various radio-labeled compounds and visualizes metabolic differences between tissues, thus depicting the functional status of a suspicious lesion. !
- 20. PET-CT in RT!
- 21. PET-CT in RT!
- 22. PET-CT in RT: other consequences!
- 23. Other hybridized imaging in RT! PET = Tumor metabolism! SPECT := Single Photon Emission Computed Tomography! - Tc-99m ! SPECT – CT !
- 24. SPECT-CT imaging system! Single slice low dose CT imaging system! Dual head gamma camera system !
- 25. SPECT-CT in RT! Both anatomical and functional information together is more insightful that each independently assessed.!
- 26. Sparing functional lung tissue in radiation therapy!
- 27. GTV CTV ITV!! ! ! PTV! If you can’t see it…!
- 28. 4D CT!
- 29. Challenges!
- 30. Clinical effectiveness, quality of life and costs! Has changed the practice of management.! But challenges remain:! Challenges: How much?!
- 31. Tools (WHAT)! • A better mouse-trap! • Efficiency vs. efficacy! • Risks! • $! ! Techniques (HOW)! • When you have a hammer …! • Diagnosis, Prognosis, Follow-up! • Clinical Indications! • Clinical Adoption! ! Semantics in a Multi-disciplinary world! ! Challenges in Cancer Management!
- 32. Challenges: Example! Tools (WHAT = DEFORMABLE REGISTRAION) ! • A better mouse-trap : A vendor’s black-box algorithm! • Efficiency vs. efficacy ! • Risks : ! • $! ! Techniques (HOW = USE OF DR in Radiation Oncology)! • Diagnosis, Prognosis, Follow-up! • Clinical Adoption : is there a clinical impact?! ! !
- 33. Challenges: DR in RT! Day ! 1! Day ! 2! Day ! 3! T1 T2
- 34. Example: Quantifying the Accuracy of Deformable Registration! CATPHAN 600 Phantom Reference CT! • Scanned at high resolution! • CT image quality phantom! • Various testing disks! Matlab ! • Deformed datasets (CT)! ! GE Workstation! • Deformed CT=> Ref CT! • Registered CT! ! Matlab! • Quantitatively examine Reg CT ! • Compare with Ref CT !
- 35. ! Deformed in Y and Z (2cm) ! Deformation ranged from 1 – 3 cm! dY = couch change! (curved to flat)! dX = curved spine! (scoliosis)! dZ = curved neck! (chin up/down)! Combined deformations! Example: Quantifying the Accuracy of Deformable Registration!
- 36. Results – Ref (1)!
- 37. Results – Def (2)!
- 38. Results – Reg (3)!
- 39. If using deformable registration with GE, consider! ! 1) Contouring errors of at least few mm! ! 2) Image quality is largely retained! - So suspicious high / low contrast objects are likely correlated! 3) Patient rotations will cause headaches! - Especially yaw rotations! ! ! Example: Quantifying the accuracy of Deformable Registration!
- 40. Example: Quantifying the Accuracy of Deformable Registration (CT-CT)! ! ! Original CT Dataset! ! ! !
- 41. Example: Quantifying the accuracy of Deformable Registration (CT-CT)! ! ! Deformed CT Dataset! ! ! !
- 42. Example: Quantifying the accuracy of Deformable Registration (PET-PET)! ! ! Original PET Dataset! ! ! !
- 43. Example: Quantifying the accuracy of Deformable Registration (PET-PET)! ! ! Deformed PET Dataset! ! ! !
- 44. Conclusions / Future Considerations! Bold Prediction (2012)! Multi-modality imaging will replace ‘gold standard’ ! • PET-CT is now standard of care for Lung, HN, Cervical and other cancers (limited only by availability)! • MR-PET is now a commercially available product!
- 45. PET-MR! Siemens: mMR! See http://www.healthcare.siemens.com/magnetic-resonance-imaging/mr-pet- scanner/biograph-mmr! GE: Signa Pet MR ! (GE Healthcare, “PET/MR Design” Online video clip. YouTube. YouTube, 12 Nov. 2014. Accessed May 20, 2015)! see http://www3.gehealthcare.com/en/products/categories/ magnetic_resonance_imaging/signa_pet-mr !
- 46. Merging of Diagnostics + Therapeutics! - MRI+ treatment delivery systems! - Co-60+MR ! (UW Health, “MRI-Guided Radiation Therapy” Online video clip. YouTube. YouTube, 13 Feb. 2015. Accessed May 20, 2015)! ! - Protons + MR ! - (job add: http://www.radiotherapie.nl/research/jobs/feasibility-of-a-mri-guided-proton-radiotherapy )! ! ! Big (Imaging) Data (at 44s)! (Cisco, “The Big Data Opportunity in Medicine” Online video clip. YouTube. YouTube, 16 Oct. 2014. Accessed May 20, 2015)! ! Relational ! Data Processing! …! ! +!
- 47. Thank You / Questions! pbasran@bccancer.bc.ca / @psbasran! !