Optical Systems for Guidance in Surgery, PDT & Radiotherapy

Transcription

1 Optical Systems for Guidance in Surgery, PDT & Radiotherapy Brian W Pogue PhD Professor, Engineering Science, Surgery, Physics & Astronomy, Dartmouth College, Hanover NH 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 1

2 Optical 64% $73 billion Global Market for Medical Imaging Technologies Radiological 36% $40 billion + Mobile/Home Health $20-40 billion + large growth Pogue, SPIE Professional, January 2018 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: Surgical Robotics Intuitive Surgical Reference: 2

3 Molecular Guided NeuroSurgery Valdes et al, J. Neurosurg Roberts et al, J. Neurosurg, 2011 Roberts et al, Neurosurg Clin. NA 2012 Valdes et al, J. Neuropath. Expt. Neurol Valdes et al, Neurosurg Valdes et al, J. Neurosurg Fluorescence Imaging in Surgery 3X speed Laparoscopic surgery to extract SLNs in rectal cancer (white light RGB + green NIR fluorescence overlay Kazanowski et al.., Colorectal Disease, 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,

4 Review of Commercial FGS Systems DSouza et al, J. Biomed. Optics, Qualities of the ideal Fluorescence Imager 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 DSouza et al, J. Biomed. Optics, HDR Mode is needed in Fluorescence Imaging DSouza et al, J. Biomed. Optics,

5 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 5

6 Radiotherapy Positioning with laser lines Laser alignment Tattoo fiducials on skin Radiotherapy Positioning Verification & Gating Technologies 3D Surface scanning C-Rad VisionRT Initial Patient Set up Verification Intra-Fractional position Verification Motion Detection Respiration Gating A. J. Chang, Pract. Rad. Ther Radiotherapy Dose Verification with Scintillating Dosimeters 6

7 Cherenkov light imaging of delivered surface dose in whole breast radiotherapy 2 tangential treatment beams First real-time radiation dose ever visualized! Predicted Plan Raw Cherenkov Jarvis et al, IJROBP 2014 Filtered Cherenkov 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) 7

8 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 EPID Scintillator image

9 Radiotherapy Dose Verification with Time-Gated Scintillation Imaging Time-Gated ICCD camera system Solid water phantom A. Glaser, AAPM 2015 Bruza et al, (in preparation, 2017) Summary Optical imaging systems largest market Surgical guidance positioning & molecular Photodynamic Therapy ongoing Radiotherapy initial positioning & verification, gating, dose delivery cim.dartmouth.edu 9