imaging in cancer therapeutics 2015

47
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

Upload: parminder-s-basran

Post on 12-Aug-2015

261 views

Category:

Health & Medicine


2 download

TRANSCRIPT

Page 1: Imaging in cancer therapeutics 2015

Imaging in Cancer Therapeutics!Past, Present and Future!

Parminder S. Basran, PhD, FCCPMSenior Medical PhysicistBCCA- Vancouver Island CentreAdjunct Associate ProfessorUniversity of Victoria- Dept. Physics & Astronomy

@psbasranwww.slideshare.net/psbasran!

Page 2: Imaging in cancer therapeutics 2015

Outline!

•  Introduction: What is Cancer?!

• Clinical Example: Lung cancer!

• Challenges!

• Conclusions / Future Directions!

Page 3: Imaging in cancer therapeutics 2015

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.”!

Page 4: Imaging in cancer therapeutics 2015

How do you detect cancer?!

Page 5: Imaging in cancer therapeutics 2015

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)!

Page 6: Imaging in cancer therapeutics 2015

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.!

Page 7: Imaging in cancer therapeutics 2015

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!

Page 8: Imaging in cancer therapeutics 2015

Evolution of Imaging Technologies!

Page 9: Imaging in cancer therapeutics 2015

Example: Lung Cancer!

•  Illustrative example on the role of imaging in cancer management!

Page 10: Imaging in cancer therapeutics 2015

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!

Page 11: Imaging in cancer therapeutics 2015

Diagnosis!

Tests that may be performed include:!

•  Chest x-ray!•  Sputum cytology test to look for cancer cells!•  Blood work!

Page 12: Imaging in cancer therapeutics 2015

Staging!

!!!!!

Page 13: Imaging in cancer therapeutics 2015

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!

!

Page 14: Imaging in cancer therapeutics 2015

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!

!

Page 15: Imaging in cancer therapeutics 2015

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!

Page 16: Imaging in cancer therapeutics 2015

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!

Page 17: Imaging in cancer therapeutics 2015

Radiation Therapy!

Page 18: Imaging in cancer therapeutics 2015

Radiation Therapy: CT imaging!

Page 19: Imaging in cancer therapeutics 2015

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. !

Page 20: Imaging in cancer therapeutics 2015

PET-CT in RT!

Page 21: Imaging in cancer therapeutics 2015

PET-CT in RT!

Page 22: Imaging in cancer therapeutics 2015

PET-CT in RT: other consequences!

Page 23: Imaging in cancer therapeutics 2015

Other hybridized imaging in RT!

PET = Tumor metabolism!

SPECT := Single Photon Emission Computed Tomography!

-  Tc-99m !

SPECT – CT !

Page 24: Imaging in cancer therapeutics 2015

SPECT-CT imaging system!

Single slice low dose CT imaging system!

Dual head gamma camera system !

Page 25: Imaging in cancer therapeutics 2015

SPECT-CT in RT!

Both anatomical and functional information together is more insightful that each independently assessed.!

Page 26: Imaging in cancer therapeutics 2015

Sparing functional lung tissue in radiation therapy!

Page 27: Imaging in cancer therapeutics 2015

GTV

CTV

ITV!!!!

PTV!

If you can’t see it…!

Page 28: Imaging in cancer therapeutics 2015

4D CT!

Page 29: Imaging in cancer therapeutics 2015

Challenges!

Page 30: Imaging in cancer therapeutics 2015

Clinical effectiveness, quality of life and costs!

Has changed the practice of management.!But challenges remain:!

Challenges: How much?!

Page 31: Imaging in cancer therapeutics 2015

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!

Page 32: Imaging in cancer therapeutics 2015

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?!

!!

Page 33: Imaging in cancer therapeutics 2015

Challenges: DR in RT!

Day !1!

Day !2!

Day !3!

T1 T2

Page 34: Imaging in cancer therapeutics 2015

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 !

Page 35: Imaging in cancer therapeutics 2015

!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!

Page 36: Imaging in cancer therapeutics 2015

Results – Ref (1)!

Page 37: Imaging in cancer therapeutics 2015

Results – Def (2)!

Page 38: Imaging in cancer therapeutics 2015

Results – Reg (3)!

Page 39: Imaging in cancer therapeutics 2015

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!

Page 40: Imaging in cancer therapeutics 2015

Example: Quantifying the Accuracy of Deformable Registration (CT-CT)!

!!

Original CT Dataset!!!!

Page 41: Imaging in cancer therapeutics 2015

Example: Quantifying the accuracy of Deformable Registration (CT-CT)!

!!

Deformed CT Dataset!!!!

Page 42: Imaging in cancer therapeutics 2015

Example: Quantifying the accuracy of Deformable Registration (PET-PET)!

!!

Original PET Dataset!!!!

Page 43: Imaging in cancer therapeutics 2015

Example: Quantifying the accuracy of Deformable Registration (PET-PET)!

!!

Deformed PET Dataset!!!!

Page 44: Imaging in cancer therapeutics 2015

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!

Page 45: Imaging in cancer therapeutics 2015

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 !

Page 46: Imaging in cancer therapeutics 2015

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!

…!!

+!

Page 47: Imaging in cancer therapeutics 2015

Thank You / Questions!

[email protected] / @psbasran!

!