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  • 1

    „Personalized Medicine“ – Challenges & Chances for

    Imaging

    Konstantin Nikolaou Abteilung für Diagnostische und Interventionelle Radiologie

    Increase in Workload + Costs of Imaging  „Value-based Healthcare“

    Imaging Biomarker  Quantatitive Imaging

    Radiomics  „Big Data“ + Artificial Intelligence

    Potential & Innovations in Magnetic Resonance Imaging

    Personalized Medicine at the University Hospital Tuebingen

    „Personalized Medicine“ Challenges & Chances for Imaging

  • 2

    Transforming Radiology: Large (functional) information in relation to „Big Data“

    Imaging Business

    Information Business

    Decision making

    business

    1895.........................................1997.................................2025

    Personal Communication

    PACS

    WEB 2.0/CLOUD

    Courtesy of Maximilian Reiser, LMU Munich

    Department of Radiology, UKT

    Diagnostic CT

    McDonald, Acad Radiol 2015

    15000

    16000

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    18000

    19000

    20000

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    22000

    23000

    24000

    2008 2009 2010 2011 2012 2013 2014 2015 2016 7600

    7800

    8000

    8200

    8400

    8600

    8800

    9000

    9200

    2008 2009 2010 2011 2012 2013 2014 2015 2016

    Diagnostic MRT

  • 3

    Radiology, 2010Kashani, Perspective for Managers Newsletter, 2010

    „Value-based healthcare“

    Modified from: Jakka and Rossbach, The HUGO Journal, 2013

    Radiology

    Surrogate Imaging, Imaging Biomarker and Radiomics as an Integral Part in Precision Medicine

  • 4

    Imaging Biomarkers

    Courtesy of G. Krestin, Rotterdam

    • can reliably be used to test medical hypotheses, cross the first gap • becoming useful ‘medical research tools’

    • Any new biomarker has to cross the gaps of technical validation, biological/clinical validation, and cost effectiveness

     then it becomes a ‘clinical decision-making tool’

    To generate QUANTITATIVE Imaging Biomarkers….

    • …medical images have to be within describable limits of bias and variance.

    • …imaging protocols have to be standardized across imaging centers.

    • …acquisition and reconstruction standards have to be defined.

    NATURE REVIEWS | CLINICAL ONCOLOGY, 2016

    Inter- and intratumoral tumor heterogeneity Do we have to biopsy every lesion?

    “Intratumor heterogeneity can lead to underestimation of the tumor genomics landscape and may present major challenges to personalized-medicine and

    biomarker development.” New England Journal of Medicine 366;10 nejm.org march 8, 2012

    Radiology, 2016

    “Multiscale HCC”, eMed BMBF project, University Hospital Tuebingen

  • 5

    (Advanced) Imaging Big data Artificial intelligence

    Scan Images Features Prediction   Biomarkers 

    Radiomics

    Courtesy of F. Nensa, University of Essen

    Adap+ng to ar+ficial intelligence

    • Radiologists and pathologists need to adapt

    • Artificial Intelligence will (partly) perform the information extraction from imaging data

    • Radiologists/pathologists will transform to…

     Information Specialists:

     information processing

     putting it into clinical context

     communication

    Artificial Intelligence

  • 6

    Why Tübingen?

    Why MRI?

    OK!, but….

    Tübingen: Center for Personalized Medicine (ZPM)

  • 7

    Patient  management

    (SAP)

    Clinical  Cancer Registry GTDS

    HL7

    Web Interface

    Biobanking Pathology

    Biobanking University 

    gynecological hospital

    Biobanking Neuropathology

    by MPI

    XML

    by MPI XML

    XML

    Clinical  Study  center

    XML

    CentraXX Biobank / Study Mgt. / Research

    data integration solution Research data

    Identified an validated User (pseudonymized web‐view)

    Courtesy of N. Malek, Chairman, ZPM & Med. Dpt., University Hospital Tuebingen

    1972 1975 1980 1983 1990 2000 2003 2005 2010 2015

    Milestones of MRI development

    0,5 Tesla

    Clinical MR Systems4

    1,5 Tesla 3 Tesla 7 Tesla

    Lauterbur & Mansfield

    1

    Basics for modern MRI

    First MR images in humans3

    First experimental MR Systems

    2

    PET-MR6

    MR Fingerprinting7

    Hyperpolarized MRI8

    Noble Price for Lauterbur und Mansfield

    5

    Innovations in MRI

  • 8

    Motivation Motion Artifacts

    Motion Blur

    Aliasing• respiratory motion • cardiac movement • patient and organ movement

    with motion w/o motion

     Need for adaptation and motion correction strategiesCourtesy of Th. KüstnerDpt. Radiology, UKT

    Personalized Medicine: Role of (standardized) Imaging, Quantification & Reporting

    Res- ponse Res-

    ponse

    Therapy Relevance Therapy

    Relevance

    Quantitative / Structured Data

    Quantitative / Structured Data

    Reading / AnalysisReading / Analysis

    Image AcquisitionImage Acquisition

    PatientPatient

  • 9

    Role of imaging in personalized medicine

    27.02.2017

    Acquire, identify, structure and curate data • Radiologist as an INFORMATION SPECIALIST

    Multidisciplinary research • clinical partners, IT, Statisticians, data scientists

    Apply classifications to new data  Provide decision support

    Where do we see the MAGNETOM VIDA?

    Modified from: Jakka and Rossbach, 2013

    Test

    Thank you!

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