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Optical Systems for Guidance in Surgery, PDT & Radiotherapy

Brian W Pogue PhD Professor, Engineering Science, Surgery, Physics & Astronomy,

Dartmouth College, Hanover NH 03755 President, DoseOptics LLC

Disclosure

Brian Pogue is President and Co-Founder of DoseOptics LLC developing Cherenkov imaging for

radiotherapy dosimetry

Outline

Marketplace for optical systems Surgical Guidance Photodynamic Therapy Radiation Therapy

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Global Market for Medical Imaging Technologies

Pogue, SPIE Professional, January 2018

Optical 64%

$73 billion

Radiological 36% $40 billion

+ Mobile/Home Health $20-40 billion + large growth

Optical Imaging in Medicine: Scopes

By 2020 – $42 Billion/year market 7% growth rate Detection, minimally invasive, increasing # digestive disorders Aging population & FDA approvals have fueled growth

Reference: http://www.mordorintelligence.com/

Surgical Robotics – Intuitive Surgical

Reference: http://www.mordorintelligence.com/

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Molecular Guided NeuroSurgery

www.zeiss.com http://www.meduniwien.ac.at/

Valdes et al, J. Neurosurg. 2011 Roberts et al, J. Neurosurg, 2011 Roberts et al, Neurosurg Clin. NA 2012 Valdes et al, J. Neuropath. Expt. Neurol. 2012 Valdes et al, Neurosurg. 2014 Valdes et al, J. Neurosurg. 2015

Fluorescence Imaging in Surgery

8 Kazanowski et al.., Colorectal Disease, 2015

3X speed

Laparoscopic surgery to extract SLNs in rectal cancer

(white light RGB + green NIR fluorescence overlay

Growth in FDA 510(k) clearances for surgical indications

Perkin Elmer Solaris Novadaq SPY-Elite Quest Spectrum

Fluoptics Fluobeam Hamamatsu PDE Neo Curadel LAB-Flare

DSouza et al, Journal of Biomedical Optics, 2016

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10

Review of Commercial FGS Systems

DSouza et al, J. Biomed. Optics, 2016

Real-time overlay of white light and fluorescence images

Fluorescence-mode operation with ambient room lighting present

High sensitivity to tracer of interest

Ability to quantify tracers in situ

Ability to image multiple fluorophores simultaneously

Maximized ergonomic use

Qualities of the ideal Fluorescence Imager

11 DSouza et al, J. Biomed. Optics, 2016

HDR Mode is needed in Fluorescence Imaging

12 DSouza et al, J. Biomed. Optics, 2015

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R&D Surgical Guidance Positioning Technologies

AAPM Task Group: Fluorescence Guided Surgery Imaging Systems Guidance for Technical Performance Evaluation

i. Nomenclature & definitions ii. Background

a. Theory of light-tissue interaction b. System use and performance expectations –Fluorophores , intensity measurements, Background

signals & dynamic range

c. Phantoms - Common choices, materials, tests, validation, verification

iii. Protocol

a. Methods - image quality, characteristics confounding factors, repeatability and reproducibility

b. Performance testing – calibration, system validation, clinical trial standardization & implementation of

QA

c. Considerations for clinical implementation Manuf. QC, Failure Modes & Effects Analysis (FMEA)

d. Clinical Implementations & performance req.

iv. Recommendations on systems a. technical evaluation

b. technical guidance for the new systems c. “qualified personnel” d. service requirement for a staff

v. Limitations of this report vi. Summary vii.References

Chair: B. Pogue (Dartmouth) Co-Chair:T. Zhu (UPenn)

Optics in Radiotherapy

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Radiotherapy Positioning with laser lines

Laser alignment Tattoo fiducials on skin

Radiotherapy Positioning Verification & Gating Technologies

3D Surface scanning

VisionRT C-Rad

• Initial Patient Set up Verification • Intra-Fractional position Verification • Motion Detection • Respiration Gating

A. J. Chang, Pract. Rad. Ther. 2012

Radiotherapy Dose Verification with Scintillating Dosimeters

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Cherenkov light imaging of delivered surface dose in whole breast radiotherapy

Jarvis et al, IJROBP 2014

2 tangential treatment beams

Predicted Plan

Raw Cherenkov

Filtered Cherenkov

First real-time radiation dose

ever visualized!

• High resolution gated-intensified CMOS w onboard FPGA • Output direct Cherenkov/Dose images • Dose Imaging at the right price point…

Cherenkov vs Treatment Delivery – DoseOptics LLC

Cherenkov live video MLC (grey) & planned dose (blue)

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Imaging Goal: Single MLC delivery on patient Overlay display on 3D anatomy

One MLC

Total Skin Electron Therapy Imaging: Chernkov vs Dose

Andreozzi et al, Med Phys 2016

Radiotherapy Dose Verification with Scintillation Imaging

2015

EPID Scintillator image

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Radiotherapy Dose Verification with Time-Gated Scintillation Imaging

Bruza et al, (in preparation, 2017)

Solid water

phantom

Time-Gated ICCD

camera system

A. Glaser, AAPM 2015

Summary • Optical imaging systems – largest market

• Surgical guidance – positioning & molecular

• Photodynamic Therapy – ongoing

• Radiotherapy – initial positioning &

verification, gating, dose delivery

cim.dartmouth.edu