Day 1 :
Keynote Forum
Carmen I Bigles
Coqui Pharma,USA
Keynote: Coqui-pharma solving the impending global shortage of molybdenum -99
Time : 09:00-09:30
Biography:
Carmen I Bigles is CEO of Coquí Radio Pharmaceuticals, Corp. a company with the goal of establishing a medical radioisotope production facility in the U.S. As co-owner of Caribbean Radiation Oncology Center, she learned that many patients were being misdiagnosed due to a global shortage of 99Mo. She sought to learn more about the Mo-99 industry and ultimately decided to establish a domestic source of the isotope. She earned a Bachelor’s degree in Mathematics from Inter-American University in San Juan and subsequently her Master’s degrees in architecture and suburban and town planning from the University of Miami.
Abstract:
Coquí Radio Pharmaceuticals Corp. is a medical isotope company dedicated to the production of Molybdenum-99, which is used in 20 million procedures each year in the U.S. The Puerto Rican company is based in Coral Gables, Fla., with the mission to bring the foremost medical isotope production facility to the Western Hemisphere and to create a commercially scalable, reliable supply of medical diagnostic and therapeutic radioisotopes in the U.S. This presentation will give an overview of the medical isotope 99Mo and its uses in modern medicine and explore the potential effects of an impending global shortage as nuclear reactors around the world begin to go offline. Carmen will give a thorough overview of Coquí Pharma and its mission to solve the impending shortage crisis as well as explain the technology the firm will employ at its medical isotope production facility.
Keynote Forum
Joerg Traub
Surgic Eye GmbH, Germany
Keynote: 3D interventional nuclear medicine imaging and therapy monitoring
Time : 09:30-10:00
Biography:
Joerg Traub has completed his PhD from TU Munich with highest distinction. After graduation, he was a co-founder of Surgic Eye GmbH. He is CEO and President of Surgic Eye, an innovator in the field of mobile nuclear imaging during therapy, for the past 8 years. He has published more than 50 peer-reviewed journals and full paper conference papers. He is co-inventor of more than 10 patents and has been serving as reviewer in several medical imaging and computer assisted surgery journals and conferences. rn
Abstract:
Radio-guided surgery is defined as any surgical procedure which utilizes a radiation detection device in a real-time fashion within the operating room for the identification of a radioisotope administered to a patient prior to the time of attempted detection and with the sole purpose of assisting in the successful performance of that surgical procedure. There is a wide application domain in the surgery room for sentinel lymph node marking, marking of primary tumors and also injection of radio-isotopes for selective internal radiation therapy.
Keynote Forum
Karl R Aigner
Medias Klinikum GmbH & Co KG, Germany
Keynote: High intra-arterial drug exposure for advanced head and neck cancer patients
Time : 10:00-10:30
Biography:
Karl R Aigner is Medical Director of the Department of Surgical Oncology in Medias Klinikum Burghausen (Bavaria)/Germany. He had his surgical training inrncardiovascular surgery at Friedrich-Alexander University in Erlangen. At Justus-Liebig University Giessen, he specialized in surgical oncology, focusing on vascularrntechniques of drug delivery such as Implantofix and Jet Port Catheters, and in 1981 first performed a technique of isolated perfusion of the liver with heart-lungrnmachine in man. Furtheron, he developed various techniques of segmental vascular isolation of body segments and organs, and the stopflow technique withrnadequately designed catheters. In 1982, together with Prof. Stephens from Sydney, he initiated the biannual International Congress of Regional Cancer Treatmentrn(ICRCT) and from 1987 to 1991 was President of the International Society for Regional Cancer Therapy. From 1985 to 1998, he was Managing Editor of thernInternational Journal Regional Cancer Treatment. He is author of numerous publications and book chapters, lectured and performed teaching operations onrnvascular perfusion techniques and oncological surgery in Europe the United States and Asia.
Abstract:
Introduction: Standard treatment for tumors of the head and neck are radiochemotherapy and surgery. In far, advanced orrnrecurrent cases surgery may be impossible or mutilating and side-effects from irradiation in terms of nerve damage and mouthrndryness are not reversible. In order to avoid toxicity and permanent tissue and nerve damage, we performed a study withrncarotid artery infusion and chemofiltration for simultaneous detoxification.rnMaterial & Methods: Carotid artery infusion was accomplished either via angiographic catheters in Seldinger’s technique orrnby means of end-to-side implantation of Jet Port Allround catheters into one or two carotid arteries respectively. Intra-arterialrninfusion time of a three-drug combination consisting of Cisplatin, Adriamycin and Mitomycin in 7 to 10 minutes short termrninfusions generates local drug levels eighty- to hundred-fold higher than during systemic chemotherapy. A total of 26 patientsrnwere included in the study, 18 patients in clinical stage IV, 5 in stage III and 3 in stage II respectively. For follow-up control andrndetermination of adverse effects, blood work (hemoglobine, white blood count, platelets, cardiac, kidney and liver enzymes),rnperformance scale, pain score, survival rate, hospitalization and side-effects were noted.rnResults: Five out of 26 patients died from their disease, one after a car accident. The average follow-up time was 45 months.rnStage IV patients who died had an average survival time of 11 months after onset of therapy. Surviving patients have notrnreached the median survival rate yet and are still alive on an average of 43 months after onset of therapy. There was no relevantrnhematologic toxicity (WHO Grade I – II) and there was no neurotoxicity. Vital parameters such as the ability to speak orrnto swallow usually improved after the second or third out of five treatment cycles. The major surgical complication was therndissection of the carotid artery in three cases.rnConclusion: Regional chemotherapy for advanced cancers of the head and neck area in terms of intra-arterial infusion withrnchemofiltration induces rapid tumor shrinkage without relevant toxicity and substantially improves quality of life.
Keynote Forum
Barry J Allen
University of Western Sydney
Keynote: Targeted radio-immunotherapy for metastatic prostate cancer
Time : 10:00-10:30
Biography:
Prof Barry Allen, DSc, OA, is an internationally recognized expert on Targeted Alpha Therapy (TAT) for cancer. He was successful in developing new preclinical agents for the treatment of melanoma, leukaemia, breast, prostate, pancreatic, ovarian and colorectal cancers, leading to world first phase 1 trials of intralesional and systemic TAT for metastatic melanoma. Prof Allen’s contributions to medical physics were recognized on his inclusion in the 50 outstanding medical physicists at the 50th Anniversary Conference on Medical Physics in 2013. He was appointed an Officer in the Order of Australia in 2015. He has published some 340 refereed publications
Abstract:
Prostate cancer claimed an estimated 136,500 lives globally in 2011. Recurrent disease is usually treated with androgen deprivation therapy (ADT), which provides outstanding early but transient control of progression. The tragedy here is that the benefits of ADT are lost within 2 years for most men as the cancer progresses to an incurable “late-stage†castrate resistant form of the disease (CRPC) with median survival of ~18 months. The minimal residual disease states derived from prostatectomy and ADT provide clear windows of opportunity for an effective systemic adjuvant therapy with minimal side effects. Targeted alpha therapy (TAT) is such a therapy, where antibodies specific for cancer biomarkers are labelled with alpha-radionuclides to more efficiently kill cancer cells with reduced adverse events. The success of systemic TAT in clinical trials for advanced metastatic melanoma indicates efficacy with minimal side effects. rnImproved molecular profiling of tumours now allows for therapies like TAT to be personalized for the patient’s cancer, leading to the next generation of adjuvants for the treatment of minimal residual disease states following prostatectomy and ADT. This paper examines the preclinical and clinical efficacy of TAT with c595 and J591 monoclonal antibodies, labelled with beta or alpha emitting radioisotopes, and its potential as an adjunctive therapy for the management of residual prostate cancerrn
Keynote Forum
Marc Griffiths
University of the West of England, UK
Keynote: The impact of new hybrid imaging technology on the nuclear medicine workforce: Opportunities and challenges
Time : 10:30-11:00
Biography:
Marc Griffiths is an Associate Dean within the Faculty of Health and Applied Sciences at the University of the West of England, Bristol and completed his Professional Doctorate in 2014. His Professional Doctorate evaluated the impact of the introduction of new hybrid imaging technology on the nuclear medicine workforce. He has published a number of papers in peer reviewed journals related to the development of the nuclear medicine workforce and associated factors, including mentorship, education and training competencies. His works are closely with education commissioners and is involved in healthcare workforce planning and scenario modeling.
Abstract:
Health professionals across the world now work within an environment of flux and uncertainty, which inevitably presents new opportunities and challenges for the workforce in terms of developing new skills and knowledge. The introduction of any new hybrid imaging technology may require appropriate staff training, considerations for service redesign and patient workflow dynamics, as part of the change process. Staffing a modern hybrid imaging environment requires a skilled and competent workforce, who should have the opportunity to further develop their working practice and clinical service provision. Balancing the needs of effective service delivery, workforce development and holistic patient-centric care requires careful planning and collaboration with a range of healthcare professionals. Introducing new hardware and software technology requires appropriate social frameworks, which may include ensuring clarity of role and responsibilities in order that the emerging relationship with the patient is maintained. There is a potential danger of ‘patient objectification’ during high technology examinations, such as hybrid imaging techniques and the subsequent dehumanization process that may occur. Creating an environment where workforce flexibility is present, in terms of understanding the position of new technology within the patients’ journey and a greater understanding of the need to reshape the delivery of such clinical services, is paramount to the ongoing development of hybrid imaging within the modern healthcare domain.
- Nuclear Medicine
Radiology& Medical Imaging
Chair
Hiroshi Kobayashi
Chiba University, Japan
Session Introduction
Marc Griffiths
University of the West of England, UK
Title: The impact of new hybrid imaging technology on the nuclear medicine workforce: Opportunities and challenges
Biography:
Dr Marc Griffiths is an Associate Dean within the Faculty of Health and Applied Sciences at the University of the West of England, Bristol and completed his Professional Doctorate in 2014. His Professional Doctorate evaluated the impact of the introduction of new hybrid imaging technology on the nuclear medicine workforce. He has published a number of papers in peer reviewed journals related to the development of the nuclear medicine workforce and associated factors, including mentorship, education and training competencies. Marc works closely with education commissioners and is involved in healthcare workforce planning and scenario modelling.
Abstract:
Health professionals across the world now work within an environment of flux and uncertainty, which inevitably presents new opportunities and challenges for the workforce in terms of developing new skills and knowledge. The introduction of any new hybrid imaging technology may require appropriate staff training, considerations for service redesign and patient workflow dynamics, as part of the change process. Staffing a modern hybrid imaging environment requires a skilled and competent workforce, who should have the opportunity to further develop their working practice and clinical service provision. Balancing the needs of effective service delivery, workforce development and holistic patient-centric care requires careful planning and collaboration with a range of healthcare professionals. Introducing new hardware and software technology requires appropriate social frameworks, which may include ensuring clarity of role and responsibilities in order that the emerging relationship with the patient is maintained. There is a potential danger of ‘patient objectification’ during high technology examinations, such as hybrid imaging techniques, and the subsequent dehumanization process that may occur. Creating an environment where workforce flexibility is present, in terms of understanding the position of new technology within the patients’ journey and a greater understanding of the need to reshape the delivery of such clinical services, is paramount to the ongoing development of hybrid imaging within the modern healthcare domain.
Carina Mari Aparici
University of California San Francisco, USA
Title: Real-time molecular probe-directed intraprocedural biopsies
Time : 10:45-11:05
Biography:
Dr Mari Aparici, MD is an Associate Professor in Residence at UCSF. She is a Nuclear Physician with residencies in both Europe (Barcelona) and US (Stanford), and with Molecular imaging fellowships from Stanford University. She is a physician-scientist in the development of Molecular Imaging. She has about 20 years of clinical and research experience in the field, and 10 years of a leadership position as Chief Nuclear Medicine at the San Francisco VAMC as part of her faculty position at UCSF. She has published 100 papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
The clinical management of lesions suspicious for malignancy relies not only on diagnosis of benign versus malignant potential but also tumor grading, immunohistochemical and genetic information. Pathological analysis remains the gold standard for definite diagnosis. Hence, a carefully performed biopsy with low risk of complication is crucial. Compared to open biopsy, image-guided biopsies are minimally invasive and confer several advantages including low morbidity, low complication rate and cost savings. FDG-PET/CT has shown higher diagnostic accuracy than conventional imaging CT in characterizing tumor in initial staging, treatment response evaluation and follow-up. PET/CT guided biopsies may allow early histologic diagnosis and staging before morphologic changes are evident. PET/CT biopsy can therefore rule out/in malignancy in early stage of disease and re-stage different types of cancer. Non-real-time PET/CT biopsies have used the image co-registration of a prior PET with a intraprocedural CT. However, this method is inaccurate in time and space, takes long time and requires special software. The aim of this study is to report the initial experience of utilizing the real-time intraprocedural PET/CT guided biopsies, including feasibility and technical requirements.
Sarah Abdulla
Norwich Radiology Academy,Norfolk and Norwich University Hospital, UK
Title: Progression or pseudo progression? A review of nuclear imaging of post-treatment glioblastoma
Time : 11:05-11:25
Biography:
Dr Sarah Abdulla is a 4th year radiology registrar at the Norwich Radiology Academy, a centre with a track record in research. She completed her medical education at Cambridge University and University College London. She has published in Clinical Radiology and is currently a reviewer for a peer-reviewed journal.
Abstract:
Glioblastoma is a brain tumour in adults with poor median survival despite multimodality treatment. Efficacy of therapy for glioblastoma is assessed by clinical response and imaging features, mainly on magnetic resonance imaging (MRI). There is a subset of treated patients with imaging features in keeping with “progressive disease” but who then show stabilization or resolution despite no change in their treatment regime. It is thought that the “pseudo progression” is due to non-tumoural factors and incorrect diagnosis could lead to an inappropriate change of effective therapy. Conventional MRI is inadequate for differentiating tumour progression from pseudoprogression and nuclear imaging is increasingly being shown to be more sensitive and specific, especially with the development of new biomarkers such as 11C-methionine (C-Met), O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) and 3,4-dihydrocy-6-[18F]-fluoro-L-phenylalanine (18F-FDOPA). This is a review of the current research into radiological assessment of post-treatment GBM with nuclear medicine, specifically differentiating between tumour progression and pseudoprogression.
Hiroshi Kobayashi
Chiba University, Japan
Title: Gene expression and functions specific to acidic cancer nests
Time : 11:25-11:45
Biography:
Hiroshi Kobayashi received his PhD in Biochemistry from University of Tokyo in 1974. After his Post-doctoral training at Colorado University Medical Center, he started to study adaptation strategies of microorganisms to acidic environments at Chiba University in 1978. His research is focused on mammalian cell functions under acidic conditions from 1996 at Graduate School of Pharmaceutical Sciences, Chiba University. He retired in March 2012 and is a Professor Emeritus at Chiba University after his retirement. He works as an Associate Editor of International Immunopharmacology published by Elsevier B.V. from 2014.
Abstract:
Solid cancer nests are often acidified, which induces cytosolic acidification. Many metabolic processes may decline as cytosol is acidified and alternative processes are argued to work in acidic cancer nests to compensate the decrease in activities of the processes functioning at alkaline pH. We investigated the expression of 24,000 genes in cancer cells at pH 7.5 and 6.6 and found approximately 700 genes whose expression increased under acidic conditions, while expression of approximately 850 genes decreased at acidic pH. We found a protein named CTIB whose level was the same at pH 7.4 and 6.3, but it was essential for cell proliferation only at pH 6.3. Our result and reports by other groups suggest that mammalian cells have genes whose functions are required under acidic conditions but their expression is not affected by acidosis. Our study with specimens from cancer patients showed that different acidosis-dependent genes were expressed in different cancers. The analyses of acidosis-dependent genes specific to each cancer may be useful for diagnosis of carcinogenesis and cancer progression, because cancer nests are acidified with the cancer progression. The anti-cancer drugs whose target molecules function at acidic pH may show a clinical superiority because such drugs are less effective on cells in normal alkaline tissues, such as the body immune systems.
Saeed Shanehsazzadeh
University of Mons, Belgium
Title: Biodistribution assessment of 68Gallium radiolabeled PEGcoated superparamagnetic iron oxide nanoparticles in normal mice
Time : 11:45-12:05
Biography:
Shanehsazzadeh has completed his Ph.D. at the age of 33 years from Tehran University of medical sciences and postdoctoral studies from Biospion. He is the assistant professor of NSTRI, Tehran, Iran. He has published more than 40 papers in reputed journals and now he is doing his postdoc at Umons, Belgium in nano
Abstract:
Objectives: The purpose of this study is to evaluate the biodistribution of polyethylene glycol (PEG) coated superparamagnetic iron oxide nanoparticles radiolabeled with 68Ga in normal mice after intravenous administration of this probe. Materials and methods: Three mice were sacrificed at specific time intervals (5, 15, 30 and 60 and 120 minutes post-injection) and the percentage of injected dose per gram of each organ was calculated by counting of each organ of mice. Results: The biodistribution data revealed high amount uptake by liver and spleen (51.70 and 16.92 %ID/g by liver and spleen at 30 minutes, respectively and these values were 60.62 and 12.65 %ID/g at 120 minutes post injection). The clearance of other organs was fast. Conclusion: These results suggest that 68Gallium radiolabeled PEGylated superparamagnetic iron oxide nanoparticles (68Ga-PEG-SPIONS) has susceptibility for applying in Positron emission tomography- Magnetic resonance Imaging (PET-MRI) as a theranostic agent for detection of liver and spleen malignancies.
Karen Knapp
University of Exeter Medical School, UK
Title: Dual Energy X-ray Absorptiometry: Beyond Bone Mineral Density
Time : 12:05-12:25
Biography:
Karen Knapp is an Associate Professor in Musculoskeletal Imaging at the University of Exeter. Combining a passion for research and education with her clinical background, Karen utilises research-led teaching to inspire students. With a background in teaching undergraduate and post-graduate students and supervising PhD students, Karen is keen to engage at all levels of higher education. Karen’s primary research interest is in bone health, osteoporosis and associated pathologies, along with developing and testing computer aided detection (CAD) software in vertebral fracture patients. Karen is actively involved in the National Osteoporosis Society and the Society and College of Radiographers.
Abstract:
Osteoporosis is a common musculoskeletal disease in the western world characterised by reduced bone mineral density (BMD) and micro-architectural deterioration, resulting in an increased risk of fragility fracture. Dual energy x-ray absorptiometry (DXA) is the gold standard for the diagnosis of osteoporosis and provides an important element of fracture risk assessment. However, DXA is not a perfect tool and many patients diagnosed with low or normal bone mineral density (BMD) will still suffer a fragility fracture. This presentation look at the use of DXA beyond the measurement of BMD and how additional techniques such as vertebral fracture assessment, trabecular bone score and the use of clinical risk factors can provide better identification of those requiring treatment for fragility fractures. Consideration of the use of total body scans will also be covered, along with the precision errors associated with DXA across a range of population sizes. The presentation should provide clinicians with an understanding of the strengths and weaknesses of DXA underpinned by the current evidence-based.
Joerg Traub
Surgic Eye GmbH, Germany
Title: 3D interventional nuclear medicine imaging and therapy monitoring
Biography:
Joerg Traub has completed his PhD from TU Munich with highest distinction. After graduation, he was a co-founder of Surgic Eye GmbH. He is CEO and President of Surgic Eye, an innovator in the field of mobile nuclear imaging during therapy, for the past 8 years. He has published more than 50 peer-reviewed journals and full paper conference papers. He is co-inventor of more than 10 patents and has been serving as reviewer in several medical imaging and computer assisted surgery journals and conferences.
Abstract:
Radio-guided surgery is defined as any surgical procedure which utilizes a radiation detection device in a real-time fashion within the operating room for the identification of a radioisotope administered to a patient prior to the time of attempted detection and with the sole purpose of assisting in the successful performance of that surgical procedure. There is a wide application domain in the surgery room for sentinel lymph node marking, marking of primary tumors and also injection of radio-isotopes for selective internal radiation therapy.
Yicheng Ni
KU Leuven, Belgium
Title: OncoCiDia: A Novel Depersonalized Combination of Targeted Chemo- and Radio-Theragnostics for the Management of Solid Malignancies
Biography:
With a prior MD, upon receiving his PhD in 1995, Yicheng Ni initiated and heads a Theragnostic Lab at KU Leuven, Belgium. Being currently titled with full professor and Bayer Lecture Chair, he has published over 200 SCI journal papers, book chapters and patents, trained numerous PhD students, served as editor or reviewer in academic journals, and received tens of honors including Herbert M Stauffer Award (1993) and Elliott Lasser Award (2009). His academic career has been marked with innovative, translational, cost-effective and longstanding research. OncoCiDia introduced here presents one of his multiple inventions
Abstract:
Imaging and contrast media research has enabled discovery of small molecular necrosis-avid compounds (NACs) for the diagnosis of myocardial infarction and therapeutic assessment of tumor ablation with MRI, nuclear scintigraphy and optical imaging1,2. The in vivo affinity of NACs to necrosis appears orders of magnitude higher than antigen-antibody, ligand-receptor and biotin-avidin interactions in vivo. Based on a soil-to-seeds hypothesis3, this stroma targetability is extended from diagnostic to theragnostic utilities by combined use of vascular disrupting agents (VDAs) such as CA4P to formulate a novel pan-anticancer approach, namely a small-molecular sequential dual targeting theragnostic strategy3. The dual targeting properties and conjugated iodine-131 that emits both beta and gamma radiations provide solid cancers (Onco) with both tumoricidal (Ci) and imaging diagnostic (Dia) effects, hence an acronym OncoCiDia3. Instead of directly attacking multimutant and refractory cancer cells (seeds) as in other cancer therapies, OncoCiDia selectively destroys and radioactively sterilizes the tumor microenvironment (soil)4. Multicenter preclinical investigations on the efficacy, safety, formulations and dosimetry suggest that this novel and unconventional anticancer strategy may present a relatively simple, workable, affordable and generic solution for diverse cancer problems, and deserve further exploitation3,4. References: 1Ni Y, et al. Invest Radiol 2005; 40: 526-35. 2Ni Y. Current Medical Imaging Reviews 2008; 4: 96-112. 3Katholieke Universiteit Leuven-Oncocidia http://vimeo.com/44871398 . 4Li J, et al. Radiology 2011; 260:799-807.
Mohamed hamdy Ibrahim
GMU University and GMC hospital, UAE
Title: Could ambulatory blood pressure Monitoring be a routine investigation for Patients with mild cognitive impairment?
Biography:
My name is Mohamed hamdy Ibrahim, Egyptian, born on 1/11/1975. I have been graduated form, FACULTY OF MEDICINE, AIN SHAMS UNIVERSITY, CAIRO, EGYPT. I joined the neuropsychiatry residency at Ain shams university Cairo, Egypt from 2001 till 2003, finished my MD in neurology and got my doctorate by 2008. I have been assigned as lecturer of neurology and my main concern was in the field of NEUROVASCULAR INTERVENTIONAL RADIOLOGY. I finished my fellowship in interventional neurology at ZURICH University, Switzerland as F.I.N.R. by 2013. Now I am an Assistant clinical professor of neurology, GMU University and GMC hospital, Ajman, united Arab of emirates (UAE) SINCE 2010. I had some publications in many journals as OPEN JOURNAL OF MEDICAL IMAGING (OJMI), The Egyptian Journal of Radiology and Nuclear Medicine, the European Journal of Neurology, Neurology of India. In addition I am Member of World Federation of Interventional and therapeutic Neuroradiology (WFITN), Member of ESMINT (European Society of Minimal Invasive Neurological Therapy). Member of European Society of Neuroradiology Diagnostic and Interventional (ESNR)
Abstract:
To study the ambulatory measured blood pressure (ABPM) profile in normotensive patients with mild cognitive impairment (MCI). Patients and Methods: The study was designed as a case control study including 50male patients with mild cognitive impairment in the age group of 30 - 50 years old. The control group included 30 volunteers with no cognitive impairment and in the same age group (30 - 50 years old) and same gender. Mini-mental estate examination, office and ABP monitoring (ABPM) and brain MRI scans were done for cases and controls. Results: Thirty patients (60%) with MCI revealed a non-dipper blood pressure pattern. Sleeping systolic blood pressure and sleeping systolic load were significantly higher in patients with MCI than in normal volunteers (p = 0.01). MRI brain showed more white matter lesions (WMLs) in patients with MCI than in normal volunteers; however, this didn’t reach significance level (p = 0.056). Conclusion: MCI in normotensive young adult patients could reflect an abnormal circadian blood pressure rhythm. Ambulatory blood pressure monitoring could be an essential investigation in young adult MCI patients.
Timo Joensuu
Docrates Cancer Center, Finland
Title: Multimodality approach in the treatment of metastatic prostate cancer
Biography:
Timo Joensuu is one of the leading European experts in prostate cancer with vast experience in both patient care and clinical studies. His special interests in the field of prostate cancer are multi-modality diagnostics, both internal and external radiotherapy and drug treatments. Timo Joensuu can well be called as one of the Nordic pioneers in radiotherapy. Joensuu is one of the founders of Docrates Cancer Center, the only Nordic private cancer center providing all aspects of cancer diagnostics and treatments under one roof. The patient-centric care model is a driving force in his medical work, resulting among other things active participation on the patient organizations’ work both home and abroad.
Abstract:
Androgen deprivation has been the only treatment recommended by guidelines for metastatic prostate cancer. The radiotherapy and radiopharmaceuticals like Samarium are used mainly as pain killers. Hormonal therapies are well established but the problem is that castration resistant disease eventually emerges and then our patients are expected to survive about two years. Our personalized clinical practice has been to combine different treatment modalities in primarily metastatic prostate cancer in order to decrease the number of cancer cells as low as possible. Diagnostic procedures we start with ermpMRI of the prostate which will be done in most cases already before biopsies, followed by NaF-PET-CT and/or choline-/PSMA-PET-CT. First goal is to get PSA down (<1). All men receive mamillar irradiation with 12 gy, 6/9 MeV. We combine LHRH analogs or Degarelix with bicalutamide plus zoledronic acid or denosumab and if it appears that we do not reach our first target we combine Docetaxel and most recently we have included also abiraterone/enzalutamide to the systemic therapy per need. Immediately, when our goal has been achieved we start radical VMAT radiotherapy of the prostate. We fuse all of our primary scannings with doseplanning-CT and try to irradiate also bone metastases including also the lymph nodes to the target volumes. In addition some patients have received samarium intensified by mitoxantrone. The good feasibility of this multimodality approach and follow up-results will be presented
Priyanka Debta
SOA UNIVERSITY, ODISHA
Title: Nuclear medicine as a unique diagnostic medical imaging
Biography:
Dr. Priyanka Debta has completed her M.D.S. in Oral Pathology and Microbiology (2006-2009) from Deemed University S.P.D.C., Sawangi, Maharashtra, INDIA. She has done research in the field of immunological cells infiltration in carcinoma and in odontogenic cysts & in forensic odontology. She has participated in national and international conferences and presented papers and posters. Presently she is working in I.D.S., SOA UNIVERSITY, BBSR, Odisha, India. Her studies and reports have been published in the national/international reputed journals. She is a dedicated, resourceful and innovative instructor for her students that helps in intellectual growth by creating an atmosphere of mutual respect and open communication.
Abstract:
Nuclear medicine is a new weapon against cancer cases for scanning as well as for treatment. While CT uses X-rays to deliver cross-sectional anatomical images PET spots cancerous cell by making visible their metabolism through tracers (radioactively labeled substances the patient is injected with). In the last fifteen years PET/CT has been successfully employed to assess how patients respond to chemo- and radiotherapy. Before treatment starts, patients undergo a PET examination in order to evaluate the malignancy and the extent of the tumor by measuring the tissue’s uptake of the radioactive tracer in relation to the administered dose and the body weight. After chemo- or radiotherapy- or a combination of both – a second PET examination is performed in order to evaluate the treatment outcome. The amount of tracer substance that can still be visualized now informs on how much the metabolic activity of the tumor as well as the extent of the cancerous areas have been reduced. The conventional imaging (CT) techniques, although very accurate in staging, have a low specificity in the assessment of therapy response in oncology. By contrast, PET allows to safely and precisely assessing the efficacy of chemotherapeutic or radio-therapeutic treatment in a non-invasive manner.
Carmen I Bigles
Coquà Pharma, USA
Title: Coqui-pharma solving the impending global shortage of molybdenum -99
Biography:
Carmen I Bigles is CEO of Coquà Radio Pharmaceuticals, Corp. a company with the goal of establishing a medical radioisotope production facility in the U.S. As co-owner of Caribbean Radiation Oncology Center, she learned that many patients were being misdiagnosed due to a global shortage of 99Mo. She sought to learn more about the Mo-99 industry and ultimately decided to establish a domestic source of the isotope. She earned a Bachelor’s degree in Mathematics from Inter-American University in San Juan and subsequently her Master’s degrees in architecture and suburban and town planning from the University of Miami.
Abstract:
Coquà Radio Pharmaceuticals Corp. is a medical isotope company dedicated to the production of Molybdenum-99, which is used in 20 million procedures each year in the U.S. The Puerto Rican company is based in Coral Gables, Fla., with the mission to bring the foremost medical isotope production facility to the Western Hemisphere and to create a commercially scalable, reliable supply of medical diagnostic and therapeutic radioisotopes in the U.S. This presentation will give an overview of the medical isotope 99Mo and its uses in modern medicine and explore the potential effects of an impending global shortage as nuclear reactors around the world begin to go offline. Carmen will give a thorough overview of Coquà Pharma and its mission to solve the impending shortage crisis as well as explain the technology the firm will employ at its medical isotope production facility.
- Radiation Therapy
Clinical Nuclear Medicine
Diagnostic Imaging
Chair
Mian M Alauddin
University Of Texas MD Anderson Cancer Centre, USA
Session Introduction
Mian M. Alauddin
University of Texas MD Anderson Cancer Center, USA
Title: Synthesis of a [18F]-labeled ceritinib analogue for positron emission tomography of anaplastic lymphoma kinase, a receptor tyrosine kinase, in lung cancer
Time : 10:45-11:05
Biography:
Dr. Alauddin has completed his PhD at the age of 39 years from the University of Manitoba, Winnipeg, Canada, and postdoctoral training from California Institute of Technology (Caltech), Pasadena, CA, USA. He is an Associate Professor at the Universityof Texas MD Anderson Cancer Center. He has developmed many PET radiopharmaceuticals for early detection of cancer and HSV-tk gene expression. He has published more than 100 preer reviewed papers in reputed journals and has been serving as an editorial board member of some reputed journals
Abstract:
Anaplastic lymphoma kinase (ALK), an oncogenic receptor tyrosine kinase, has emerged as a therapeutic target in solid and hematologic tumors. Although several ALK inhibitors have gained approval for therapy, non-invasive indicators of target engagement or predictive biomarkers in vivo are lacking. We designed and synthesized a radiolabeled analogue of the ALK inhibitor ceritinib, [18F]fluoroethyl-ceritinib, (]18F]-FEC), for use with positron emission tomography (PET). We used two methods to synthesize [18F]-FEC. Method 1: [18F]fluoroethyl-tosylate was prepared by radiofluorination of ethylene glycol di-tosylate, purified by HPLC and coupled with ceritinib at 120oC. The product was purified by flash chromatography to yield [18F]-FEC. Alternatively, a precursor compound, chloroethyl-ceritnib, was synthesized and fluorinated with K18F/kryptofix. The product was purified by HPLC or flash chromatography to yield [18F]-FEC. Method 1 produced [18F]-FEC with an average decay-corrected yield of 24% (n=4), specific activity of 1200 mCi/μmol, and >99% purity; synthesis time was 115 min from the end of bombardment (EOB). Method 2 produced [18F]-FEC with an average yield of 7% (n=4), specific activity of 1500 mCi/μmol, and >99% purity; synthesis time was 65 min from the EOB. Of these two methods, we judged Method 1 to be the better choice for producing a pure compound for biological applications. Synthesis of a novel [18F]ceritinib analogue has been achieved in good yields, with high purity and specific activity. The compound is a potential PET imaging agent for the detection of ALK overexpressing solid tumors, such as lung cancer, and should be tested in vitro and in vivo.
Karl Herholz
University of Manchester, UK
Title: Planning and Monitoring Brain Tumour Therapy by Positron Emission Tomography (PET)
Time : 11:05-11:25
Biography:
Karl Herholz is Professor in Clinical Neuroscience at the University of Manchester. He leads neuroscience research at the Wolfson Molecular Imaging Centre with particular research interest in positron emission tomography (PET). He is also Honorary Consultant at Salford Royal Hospital and the Nuclear Medicine Department, Central Manchester Foundation Trust. Before joining Manchester University he worked as a clinical neurologist and professor of neurology at University Hospital and the Max-Planck Institute for Neurological Research in Cologne, Germany. He has leading roles in several international multicentre PET studies. His research has been published in more than 400 research papers (ISI H-index 67) and several books.
Abstract:
Modern brain tumour imaging mainly relies on MR, while PET can provide additional information for grading, therapy planning and assessment of response to therapy. PET is most informative when used jointly with MR by image registration and fusion display. 18F-FDG does not provide good contrast from normal brain, but can predict prognosis and differentiate cerebral lymphoma from nonmalignant lesions. Amino acid tracers including 11C-methionine, 18F-fluoroethyltyrosine (FET), and 18F-fluoroDOPA provide high sensitivity, which is most useful for detecting recurrent or residual gliomas, including most low-grade gliomas. 18F-fluorothymidine (FLT) is a proliferation marker with potential for tumor grading and monitoring of therapy, but it can only be used in tumors with absent or broken blood–brain barrier. Ligands for somatostatin receptors are of particular interest in pituitary adenomas and meningiomas. Tracers to image expression of specific cellular markers, neovascularization, hypoxia, and phospholipid synthesis are under investigation for potential clinical use.
Michael Friebe
Otto-von-Guericke-University,Germany
Title: Intraoperative Radiation Delivery Concepts placed and monitored with handheld SPECT/US Hybrid Imaging Techniques
Biography:
Michael Friebe has been involved in diagnostic imaging and image guided therapeutic products and services, as founder / innovator / CEO investor, and scientist. Dr. Friebe currently is a Board Member of two startup R&D companies, as well as investment partner of a medical technology startup-fund. Dr. Friebe is an affiliated professor with the chair for Computer Aided Medical Procedures (CAMP) at TU München, and full professor of Image Guided Therapies at the Ottovon- Guericke-University in Magdeburg, Germany. He is listed inventor of more than 60 patent applications and the author of numerous papers.
Abstract:
Intraoperative radiation therapy (Low Dose and High Dose nuclear and electronic brachytherapy) is a potential therapy option for local tumours, and oligometastatic cancer treatment. The main benefits are that it can deliver the cell-killing radiation (beta or gamma rays) through small incisions - after surgical treatment or removal - and that it spares healthy tissue of radiation exposure. Radiation protection issues, and accurate dose measurement and quality assurance are the main issues to be resolved. Imaging for placement and therapy verification are essential tools allowing the therapist to accurately determine the tumour location, to place the therapy catheter, and subsequently to quantify and measure the dose delivered and maybe even get a confirmation on the cell killing effects. The talk will give a short overview of some of the current technologies used (Re-188, Y-90, Ir-192, miniature X-ray tubes) and the shortfalls and possible solutions of these therapy approaches particularly when combined with functional (SPECT) and anatomical imaging (US) hybrids and combinations with MRI imaging.
Dimitris Drikakis
University of Strathclyde, UK
Title: Increasing chemotherapy efficiency via shock waves
Biography:
Dimitris Drikakis is the Executive Dean of the Faculty of Engineering and Professor of Engineering Science at the University of Strathclyde, Glasgow, UK. Prior to his current position he has held academic as well as academic management posts at Cranfield University, Queen Mary University of London, University of Manchester, University of Erlangen-Nuremberg, Germany, and University of Marseille, France. His expertise is in fluid mechanics, fluid/material interface, shock physics, and nanotechnology. He has received twice (2008 and 2011) the William Penney Fellowship Award by the UK’s Atomic Establishment Plc. in recognition of his contributions to shock waves and turbulence, and also received the 2014 Innovator of the Year Award by the Innovation Institute for gas filtration using carbon nanotubes. He has co-authored two books in the field of computational fluid dynamics and has published about 380 journal and conference papers in the above technical areas.
Abstract:
Application of ultrasound to biological tissues has been identified as a promising cancer treatment technique relying on temporal enhancement of biological membrane permeability via shock wave impact. The effects of ultrasonic waves on a 1,2-dipalmitoyl-sn-phospha- tidylcholine biological membrane have been examined through molecular dynamics simulations. Molecular dynamics methods traditionally employ periodic boundary conditions which, however, restrict the total simulation time to the time required for the shock wave crossing the domain, thus limiting the evaluation of the effects of shock waves on the diffusion properties of the membrane. A novel method that allows capturing both the initial shock wave transit as well as the subsequent longer-timescale diffusion phenomena has been successfully developed, validated and verified via convergence studies. Numerical simulations have been carried out with ultrasonic impulses varying from 0.0 to 0.6 mPa s leading to the conclusion that for impulses C0.45 mPa s, no self- recovery of the bilayer is observed and, hence, ultrasound could be applied to the destruction of localized tumor cells. However, for impulses B0.3 mPas, an increase in the transversal diffusivity of the lipids, indicating a consequent enhancement of drug absorption across the membrane, is initially observed followed by a progressive recovery of the initial values, thereby suggesting the advantageous effects of ultrasound on enhancing the chemotherapy efficiency.
Vladka Salapura
University Clinical Centre Ljubljana, Slovenia
Title: Percutaneous Biopsies of Musculoskeletal Lesions With Xperguide Cone Beam CT-Our Experience
Biography:
Vladka Salapura has completed her PhD at the age of 31 years from Medical Faculty Ljubljana, University of Ljubljana, Slovenia. She is the Head of Musculoskeletal Department at University Medical Centre Ljubljana, a vice-president of The Slovenian Association of Radiology and the president of National Medical Committee for Radiology. See has published more than 31 papers in reputable domestic and international journals. She is the editor of a book chapter in Radiology for Medical Students, Medical Faculty Ljubljana, Slovenia and author of a book chapter for Oncology: Research, Diagnostics and Therapy for Medical Students, Oncology Institute Ljubljana, Slovenia.
Abstract:
Purpose: The purpose of our study was to determine feasibility; accuracy and safety of cone-beam CT guided percutaneous biopsies of musculoskeletal system with computer planned needle guidance system. Materials and Methods: Our study included 28 patients who were referred to CT guided percutaneous biopsy of musculoskeletal lesion using cone-beam CT and XperGuide planning system (Allura, Philips) between August 2012 and July 2015 (18 patients from July 2014 were included prospectively). We determined technical and histological success rates. Technical success was defined as needle placement within 5 mm of the target center. Histological success rate was defined as collecting of tissue sample adequate to establish the diagnosis. Complication rate was observed, and sensitivity and specificity for differentiation between malignant and benign lesions were calculated. We measured preparation and procedural time as well as patients’ irradiation dose. Results: Technical success rate was 90%, and histological success rate was 89,3%. The highest histological success rate was observed for lesions in the pelvis and in the lower extremities (p=0,015, Fisher's exact test). We observed no periprocedural complications. Specificity and sensitivity were 100% and 83,3%, respectively. Mean patient preparation time was 49min and mean procedural time was 1h 40min. Mean patient preparation and procedural time was significantly lower for soft-tissue biopsies compared to bone biopsies (p<0,001, Mann Whitney U). Mean effective dose was 13,4mSv. Conclusion: Our findings indicate that computer guided percutaneous biopsy of musculoskeletal lesions using cone-beam CT and XperGuide planning system is a safe and successful diagnostic tool. It can represent a good alternative for standard CT-guided percutaneous biopsies.
Dante Amelio
Proton Therapy Center – Azienda Provinciale per I Servizi Sanitari (APSS), Italy
Title: 18F-DOPA PET for proton therapy treatment planning in high-grade gliomas
Biography:
Dante Amelio has completed his studies in Medicine in 2004 and his specialization in Radiation Oncology in 2008 at University of Perugia (ITA). He trained in Radiation Oncology and Proton Therapy at Paul Sherrer Institute (PSI) - Proton therapy center (Villigen, CH), Heidelberg University - Heidelberg Ion Therapy center (HIT) and Radiation Oncology Department (Heidelberg, GER), Proton Therapy Center and Radiation Oncology Department - Massachusetts General Hospital (Boston, USA). He is a Senior Consultant of the Trento Proton Therapy Center (ITA). His main area of interest is neuro-oncology. He has published more than 10 papers in reputed journals and several book chapters.
Abstract:
In high-grade gliomas (HGG), treatment planning and evaluation of local response to therapy are usually based on magnetic resonance imaging (MRI) and computed tomography. Although these investigations show the anatomy of the brain with high accuracy they seem insufficient for proper tumor visualization. At the same time, recent technical advances in radiation therapy such as intensity-modulated radiation therapy and proton therapy (PT) provide the ability to deliver higher radiation doses to the most resistant tumor regions as well as reduce the dose delivered to the surrounding normal structures. Therefore, there is an urgent need for new imaging approaches to increase accuracy in tumor delineation for high precision radiotherapy. Imaging the biological and molecular characteristics of tumor tissue by positron emission tomography (PET) is an interesting approach to improve treatment planning for high precision radiotherapy as well as to evaluate tumor response after treatment. In fact, amino acid transport is generally increased in malignant transformation due to high income of the amino acid to the tissue, the intrinsic activity of the amino acid transporter and the rate of the intracellular amino acid metabolism. From this standpoint the amino acid tracer 18F-DOPA (3, 4-dihydroxy-6-[18F] fluoro-L-phenylalanine) has a high tumor-to-background signal and high sensitivity for glioma imaging. For these reasons we routinely integrate our planning with 18F-DOPA PET in patients with HGG treated with PT post-operatively or at progression/relapse (re-irradiation). 18F-DOPA PET imaging may more accurately identify regions of tumor extension and change the expected planning, as determined just by MRI, in many cases. Even though data are not definitive effective chemotherapy combined with highly conformal radiotherapy targeted to areas at highest risk for tumor recurrence may allow us to improve the therapeutic index.
Heming Lu
People’s Hospital of Guangxi Zhuang Autonomous Region, China
Title: Challenges and prospects of adaptive radiation therapy in head and neck cancer
Biography:
Heming Lu is Vice Chairman of Department of Radiation Oncology at the People’s Hospital of Guangxi Zhuang Autonomous Region. His current interests include radiation therapy, especially high precision radiotherapy (IMRT, IGRT, ART) and integrated treatment for head and neck cancer. He has published more than 20 papers in reputed international journals and been serving as an Editorial Board Member for several academic journals.
Abstract:
Intensity-modulated radiation therapy (IMRT) has now replaced conventional radiation therapy and three-dimensional radiation therapy and become a standard treatment technique for head and neck cancer. This technique provides adequate target coverage while maintaining steep dose gradients at the border between the targets and adjacent normal tissues. However, significant anatomic changes may occur throughout the entire treatment course. These changes include the shrinkage of the primary disease and metastatic lymph nodes, external contour because of significant weight loss and displacement/size of the normal structures. As a consequence, the initial planning based on pretreatment condition may not truly reflect the dosimetric variations during the course of IMRT. Thus adaptive radiation therapy (ART), a plan modification and implementation according to tumor response and anatomic changes of normal structures, becomes particularly important. In recent years, many researchers have focused on ART for head and neck cancer patients. Results from dosimetric studies suggest that the initiation of ART during fractionated IMRT provides various benefits, particularly in preventing overdose to the critical structures. The feasibility of ART in clinical practice, both in online and in offline settings, has been broadly reported in the literature. However, many questions remain unanswered: Who would benefit most for ART? What is the optimal timing and frequency to perform ART? Whether ART re-planning can transfer into clinical benefits? Mature outcomes from basic and clinical researches will be necessary to appropriately mold ART into a future treatment standard.
Biography:
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Abstract:
In radiation therapy (RT) staging, treatment planning, monitoring and evaluation of response are traditionally based on computed tomography (CT) and magnetic resonance imaging (MRI). These radiological investigations have the significant advantage to show the anatomy with a high resolution, being also called anatomical imaging. In recent years, so called biological imaging methods which visualize metabolic pathways have been developed. These methods offer complementary imaging of various aspects of tumor biology. To date, the most prominent biological imaging system in use is positron emission tomography (PET), whose diagnostic properties have clinically been evaluated for years. The first rationale for using PET in target volume delineation for radiation treatment planning is the higher sensitivity and specificity of PET for tumor tissue in comparison to CT and MRI in some tumor entities. This has been demonstrated in many studies evaluating the results of PET with the results of radiological investigations and histology. The hypothesis tested in these studies was that using PET in addition to CT and/or MRI allows tumor tissue detection with a higher accuracy. The second rationale for integrating PET in the process of radiation treatment planning is the ability of PET to visualize biological pathways, which can be targeted by radiation therapy. The visualization of hypoxia, angiogenesis, proliferation, apoptosis, receptor expression, gene expression etc., leads to the identification of different characteristics of the tumors of different sub areas of the gross tumor mass which can be individually targeted. The aim of this presentation is to discuss the valences and implications of PET in RT. We will focus our evaluation on the following topics: The role of biological imaging for tumor tissue detection/delineation of the gross tumor volume (GTV) and for the visualization of heterogeneous tumor biology. We will discuss the role of FDG-PET and hypoxia-PET (FMISO-PET) in lung and head and neck cancer, the impact of amino acids (AA)-PET in target volume delineation of brain tumors and the role of Choline, Bombesine and PSMA-PET in prostate cancer. Furthermore, we will discuss the impact of animal-PET in the visualization of glioblastoma tumor stem cells. We conclude that, regarding treatment planning in radiotherapy, PET offers advantages in terms of tumor delineation and the description of biological processes.
Antonis Kalemis
Philips, UK
Title: New Technologies in PET imaging and their applications into the Clinic
Biography:
Antonis Kalemis studied biomedical engineering, medical physics and business management, in Greece and the United Kingdom. After his PhD from the Institute of Cancer Research (University of London), he held R&D positions in GE Healthcare and Philips. Since 2007 he works in Philips’ Advanced Molecular Imaging business, looking after research collaborations with academic partners worldwide. He also represents Philips in AIPES (the EU molecular imaging industry association) and is the Chairman of its New Technologies Working Group. He is reviewer in several national/international research grant organisations and scientific journals.
Abstract:
Positron Emission imaging was introduced in the early ‘50s and after the advent of Positron emission tomography in early ‘70s few distinct technological leaps improved the performance of the tomographs and rendered them clinically relevant. A major component that has remained unchanged since its introduction is the photon detection chain based on photomultiplier tubes, rendering nuclear medicine the imaging modality still based, technologically, on vacuum tubes. The recent introduction of solid-state detectors, in this field, allows significant opportunities in the areas of novel imaging modality combinations (e.g. PET/MR) as well as dramatic improvement of image quality and quantification performance. This new generation of hybrid tomographs, in combination with novel highly-specific radiotracers have allowed clinicians to consider PET imaging for new applications or to reconsider its performance in more traditional applications. The proposed talk aims to review the major new (or improved) technologies in PET imaging, such as time-of-flight, solid-state detectors, Anger-logic, iterative reconstruction and corrections and consider the performance benefits that each of them brings. The ultimate aim is to link these technological advancements with expected improvements in clinical performance and provide examples for various different clinical applications
Tejinder Kataria
Medanta Cancer Center, India
Title: Can PETCT parameters predict survival for recurrent head and neck cancer with cyberknife stereotactic body radio therapy (SBRT)?
Biography:
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Abstract:
There are established guidelines for baseline diagnosis and post treatment surveillance among head and neck cancer (HNC) patients with PET-CT parameters like standardized uptake value (SUV), metabolic tumor volume (MTV) and Total lesion glycolysis (TLG). The same remains controversial and experimental among post irradiation (RT) recurrence especially with Stereotactic Body Radiotherapy (SBRT). We analyzed the PET-CT parameters with the intent to co-relate the response and survival among post RT recurrent HNC (rHNC) undergoing Cyberknife SBRT. Materials & Methods: Thirteen (10 male and 3 female) HNC patients with post RT recurrence undergoing Cyberknife- SBRT were analyzed. Six patients had loco-regional recurrences, five had nodal while one each had distant nodal and 2nd primary HNC. All patients had post treatment follow up PET scan and in case of residual disease being a suspicion, had biopsy/FNAC to prove a recurrence. All patients received Cyberknife- SBRT alone with median dose per fraction 6 Gy (5-12 Gy) in 5 fractions (3-7 fractions). Pre Cyberknife median SUVmax, MTV and TLG were calculated using custom-designed software. Post Cyberknife at 10-12 weeks the values were recorded again. At the time of analysis the last follow up status, objective response and median values of PET parameters were used as cutoffs while assessing their prognostic potential through Chi-sqaure test, Cox regression analyses, ROC analysis and Pearson's correlation respectively.
Jun Deng
Yale University School of Medicine, USA
Title: Conscientious Medical Imaging: To Image or Not To Image
Biography:
Jun Deng received his PhD from University of Virginia in 1998 and completed his postdoctoral study at Stanford University School of Medicine in 2001. Currently, he is an Associate Professor of Therapeutic Radiology at Yale University School of Medicine, an American Board of Radiology certified medical physicist, a Fellow of Institute of Physics and a Fellow of American Association of Physicists in Medicine. At Yale, his research has been focused on medical imaging and its impact on cancer radiotherapy and public health. He has published 65 papers in peer-reviewed journals and been serving on editorial board of 14 international journals.
Abstract:
Medical imaging has revolutionized medical practices in the past hundred years, particularly in the radiotherapeutic management of cancers where anatomical and functional imaging procedures are applied routinely in the clinic worldwide for more precise tumor targeting and better soft tissue visualization. Yet, driven largely by technological advances as well as a fee-for-service healthcare model, the use of medical imaging modalities in cancer diagnosis and radiotherapy has increased dramatically in the past thirty years. Moreover, while modern cancer therapy is shifting toward individualized treatments based on patient-specific biology, the application of imaging procedures in cancer radiotherapy remains non-personalized: a ‘one-protocol-fits-all’ practice is often applied in the clinic worldwide. Essentially, the imaging protocols provided by manufacturers are uniformly applied without considering individual differences of patients being scanned. As such, radiation exposure to individuals from medical imaging nowadays has increased over 8 times since 1980, which may become a serious public health concern due to increased secondary cancer risk. Whether to image and how to image an individual patient is not only an ongoing technical issue but also becoming an ethical concern in the clinic. In meeting these challenges, personalized imaging protocol could assist clinicians in making the best use of medical imaging with their patients worldwide. This lecture will address the trend and issues of medical imaging in the US and around the world, and highlight approaches to apply medical imaging more conscientiously in the clinic to minimize radiation exposure and cancer risk, reduce medical costs and improve patient care.
- Radiation Therapy
Radiation Oncology & Cancer
Interventional Radiology
Chair
France Carrier
University Of Maryland, USA
Session Introduction
Raoul Saggini
G. d'Annunzio University, Chieti, Italy
Title: Extracorporeal shock wave therapy: An emerging treatment modality for retracting scars of the hands
Time : 12:55-13:15
Biography:
Raoul Saggini has graduated in Medicine and Surgery in 1979, specializing in Orthopedics and Traumatology (1982), Physical Therapy and Rehabilitation (1985) at the University of Florence and "Sports Medicine" at the University "G. d'Annunzio", Chieti, (1997). He is an ordinary University Professor in Physical Medicine and Rehabilitative in the University degli Studi G. D’Annunzio Chieti since 2003. He is the President of Physiotherapy degree course in the University of Medicine and Surgery of the University “G. D’Annunzio” in Chieti and currently the Director of Physical Medicine and Rehabilitation service of ’University of Chieti by University Centre of Medicine of Sport University of Chieti and Director of the Postgraduate School of Physical Medicine and Rehabilitation, University "G. d'Annunzio" of Chieti. He is also the President of Faculty of Physiotherapy of University “G. d’Annunzio” of Chieti.
Abstract:
Prolonged and abnormal scarring after trauma, burns and surgical procedures often results in a pathologic scar. We evaluated the efficacy of unfocused shock wave treatment, alone or in combination with manual therapy, on retracting scars on the hands. Scar appearance was assessed by means of the modified Vancouver Scar Scale; functional hand mobility was evaluated using a range of motion scale, whereas a visual analogue score was implemented for detecting any improvements in referred pain. Additionally, biopsy specimens were collected for clinico-pathologic correlation. For each active treatment group, statistically significant improvements in modified Vancouver Scar Scale were recorded as early as five treatment sessions and confirmed 2 weeks after the last treatment session. Analogous results were observed when assessing pain and range of movement. Histopathological examination revealed significant increases in dermal fibroblasts in each active treatment group as well as in neoangiogenetic response and type-I collagen concentration.
Michael Friebe
Otto-von-Guericke-University, Germany
Title: Intraoperative Radiation Delivery Concepts placed and monitored with handheld SPECT/US Hybrid Imaging Techniques
Time : 13:15-13:35
Biography:
Michael Friebe has been involved in diagnostic imaging and image guided therapeutic products and services, as founder / innovator / CEO investor, and scientist. Dr. Friebe currently is a Board Member of two startup R&D companies, as well as investment partner of a medical technology startup-fund. Dr. Friebe is an affiliated professor with the chair for Computer Aided Medical Procedures (CAMP) at TU München, and full professor of Image Guided Therapies at the Otto-von-Guericke-University in Magdeburg, Germany. He is listed inventor of more than 60 patent applications and the author of numerous papers.
Abstract:
Intraoperative radiation therapy (Low dose and high dose nuclear and electronic brachytherapy) is a potential therapy option for local tumours, and oligometastatic cancer treatment. The main benefits are that it can deliver the cell-killing radiation (beta or gamma rays) through small incisions - after surgical treatment or removal - and that it spares healthy tissue of radiation exposure. Radiation protection issues, and accurate dose measurement and quality assurance are the main issues to be resolved. Imaging for placement and therapy verification are essential tools allowing the therapist to accurately determine the tumour location, to place the therapy catheter, and subsequently to quantify and measure the dose delivered and maybe even get a confirmation on the cell killing effects. The talk will give a short overview of some of the current technologies used (Re-188, Y-90, Ir-192, miniature X-ray tubes) and the shortfalls and possible solutions of these therapy approaches particularly when combined with functional (SPECT) and anatomical imaging (US) hybrids and combinations with MRI imaging.
France Carrier
University Of Maryland, USA
Title: Chemopotenetiation By Low-Dose-Fractionated Radiation Therapy
Time : 13:35-13:55
Biography:
Dr. France Carrier is a tenured Associate Professor in the Department of Radiation Oncology at the University of Maryland, School of Medicine in Baltimore, MD, USA. Her laboratory focuses on basic and translational cancer research with emphasis on molecular events underlying cancer progression and most specifically DNA damage responses. She is particularly interested in the activation of RNA binding proteins, HDACIs and Low Dose Fractionated Radiation Therapy. She is a National Institutes Health funded investigator and has published more than 60 peer reviewed articles and book chapters. Her papers have been cited more than 6,500 times.
Abstract:
The emerging concept of chemopotentiation by Low Dose Fractionated Radiation Therapy (LDFRT) is not fully understood but builds on the phenomenon of low-dose hyper-radiosensitivity (HRS). This new paradigm allows the use of full dose systemic chemotherapy safely in combination with LDFRT, where the low-dose radiation sensitizes the tumor to subsequent chemotherapy. Using a RT2 PCR Profiler Array we identified Dual Oxidase 2 (DUOX2), an enzyme functioning in the production of hydrogen peroxide, as a major mediator of chemopotentiation by LDFRT. Down regulation of DUOX2 increased radioresistance at every radiation doses tested. In addition, our data indicate that Reactive Oxygen Species increase up to 3.5 fold in cells exposed to LDFRT and a modified regimen of Docetaxel, Cisplatin, and 5’-fluorouracil (mDCF). Furthermore, inhibition of NADPH oxidase abrogated the killing efficiency of this combined regimen in human gastric cancer cells. Taken together these data suggest that chemopotentiation by LDFRT may be due, at least in part, to increased ROS production (DUOX2) without upregulation of the DNA repair machinery. These data thus provide a rationale for further explorations of potential clinical applications of LDFRT, such as in Whole abdominal radiotherapy, as a chemopotentiator for advanced and metastatic gastric cancers.
Walter Noordzij
University of Groningen,The Netherlands
Title: Ra-223-For the treatment of symptomatic osseous metastases in patients with metastatic castration resistant prostate cancer
Time : 13:55-14:15
Biography:
Walter Noordzij has completed his medical training in nuclear medicine, along with a PhD in cardiac sympathetic innervation, at the department of Nuclear Medicine and Molecular Imaging at the University Medical Center Groningen. Besides his work as a nuclear medicine physician, he is the coordinator of the research lines ‘nuclear intervention’ and ‘medical education’.
Abstract:
More than 90% of patients with metastatic, castration-resistant prostate cancer have radiological evidence of bone metastases, which are a major cause of death, disability, decreased quality of life, and increased treatment cost among these patients. Radium-223-dichloride is a targeted alpha emitter that selectively binds to areas of increased bone turnover in bone metastases and emits high-energy alpha particles of short range (<100 µm). As a bone-seeking calcium mimetic, radium-223 is bound into newly formed bone stroma, especially within the microenvironment of osteoblastic or sclerotic metastases. The high-energy alpha-particle radiation induces mainly double-stranded DNA breaks that result in a potent and highly localized cytotoxic effect in the targeted areas. The short path of the alpha particles also means that toxic effects on adjacent healthy tissue and particularly the bone marrow, may be minimized. A phase 3 study showed that radium-223 significantly prolonged overall survival in patients who had castration-resistant prostate cancer and bone metastases, with a 30% reduction in the risk of death, as compared to placebo. The median survival was longer among patients who received radium-223 than among those who received placebo, the difference being 3.6 months. This presentation will provide an overview of the present literature, first experience in our academic center, and future perspectives of this radiopharmaceutical.
Osman Beton
Title: The practical value of technetium-99m-ΜΙΒΙ SPET to differentiate between ischemic and non-ischemic heart failure presenting with exertional dyspnea
Time : 14:15-14:35
Biography:
Osman Beton has completed his MD from Trakya University School of Medicine and Post-doctoral studies from Ankara University School of Medicine, Departement of Cardiology. He is the Director of Catheterization Laboratory and Co-director of Heart Failure Program in Cumhuriyet University School of Medicine, Heart Center, Department of Cardiology. He has published more than 20 papers in reputed journals.
Abstract:
Objective: We aimed to differentiate ischemic heart failure (HF) from non-ischemic HF in patients presenting with non-acute onset exertional dyspnea using technetium-99m methoxyisobutylisonitrile gated single photon emission tomography (99mTc-MIBI gSPET) imaging. Subjects & Methods: 179 consecutive patients with exertional dyspnea without concomitant chest pain referred to 99mTc-MIBI gSPET imaging were included in this study. All patients had a newly diagnosed HF with reduced ejection fraction (HFrEF). Imaging findings were compared between ischemic HF and non-ischemic HF groups. Results: Of the 179 patients, 127 had ischemic HF and 52 had non-ischemic HF. There was no difference between ischemic and non-ischemic groups in terms of age, gender, body mass index, any smoking history, diabetes mellitus, history of hypertension and hyperlipidemia. Global dysfunction of left ventricule was more common in non-ischemic HF group than ischemic HF group (82.7% vs. 41.7% respectively, P<0.001) . Presence of severe (3+/4+) ischemia and large perfusion defect were higher in ischemic HF group compared to non-ischemic HF group (45.7% vs. 15.4%, P<0.001 and 23.6% vs. 3.8%, P=0.003, respectively). Summed stress score (SSS), summed rest score and summed difference score were higher in ischemic HF group compared to non-ischemic HF group (P<0.001, P<0.001, and P=0.021, respectively) . In multivariate analysis, absence of global dysfunction (P<0.001, OR=10.338, 95%CI: 3.937-27.405) and SSS (P<0.001, OR=1.208, 95%CI: 1.090-1.339) were the independent predictors of ischemic HF. Absence of global dysfunction had 58.3% sensitivity and 86.7% specificity for diagnosis of ischemic HF at gSPET imaging in patients presenting with newly diagnosed HF and exertional dyspnea without concomitant chest pain (AUC=0.705, 95%CI:0.632-0.771, P<0.001), whereas SSS>8 had 65.4% sensitivity and 75.0% specificity (AUC=0.732, 95%CI:0.661-0.795, P<0.001). Conclusion: Absence of global dysfunction and SSS on SPET imaging were the independent predictors of ischemic etiology of HF presenting with dyspnea without concomitant chest pain. These findings had a low sensitivity, but acceptable specificity.
Jawa Zabah Muhammad
National hospital Abuja, Nigeria
Title: Radionuclide shuntography for evaluation of V-P shunt in hydrocephalus
Time : 14:35-14:55
Biography:
Jawa Zabah Muhammad is a Senior Consultant in Nuclear Medicine and European Board Certified in Nuclear Medicine. He has dual specialist qualifications in Nuclear Medicine and Radiology and received his training at the Stellenbosch University. He is a fellow of the College of Radiologist of Nigeria, fellow of the South African College of Nuclear Physicians, fellow of the European Board of Nuclear Medicine. He has presented papers at various national and international conferences. In 2013, his research presentation received an award of distinction at the IMIC conference in Vienna, Austria. He is the Chief Editor of the MDCAN Journal of Medical Sciences.
Abstract:
Background: Radionuclide shuntography is a safe, simple and non-invasive functional imaging technique for determining V-P shunt tube patency and analyze changes in CSF with minimal radiation burden. This is particularly useful in children with hydrocephalus in whom V-P shunt is inserted to divert CSF drainage. V-P shunts are permanent treatment option for children with hydrocephalus and radionuclide shuntography is becoming a very popular technique because of the increasing numbers and survival of children with shunt-treated hydrocephalus. Objective: The aim of this study is to analyze and document the usefulness of shuntography in the evaluation of V-P shunt in children with hydrocephalus. Method: All shuntograms performed in our institution between 2008 and 2015 were included in this study. Radionuclide shuntography was performed with Tc99m DPTA injected into the shunt reservoir and images acquired using a dual headed MEDISO camera. A normal shuntogram is considered as free flow of radiotracer from site of injection to the distal end of shunt tube with evidence of spillage into the peritoneum. Results: A total of 56 children were studied comprising of 32 males, 24 females with age ranges between 5-11 yrs. Different patterns of results were found, normal functioning shunt, total blocked tube due to mechanical defects, partial block tube due to infection or inflammatory debris and overflow of CSF. About 45% of our patients with suspected V-P tube malfunction had partial blockage. Conclusion: Patients who are diagnosed with a partial tube blockage will require only flushing of the tube and antibiotics treatment, while mechanically block tube will require replacement. This distinction is critical considering the cost of replacement of tube and manpower time for surgery.There are currently no existing protocols for radionuclide shuntography, but critical attention to details, observation of strict aseptic technique and close collaboration between the nuclear medicine physician, pediatricians and neurosurgeons would improve diagnostic accuracy, this paper will also highlight this aspect.form site of injection to the distal end of shunt tube with evidence of spillage into the peritoneum. Results: A total of 56 children were studied compressing of 32 males, 24 females with age ranges between 5-11yrs. Different patterns of results were found, normal functioning shunt, total blocked tube due to mechanical defects, partial block tube due to infection or inflammatory debris and overflow of CSF. About 45% of our patients with suspected V-P tube malfunction had partial blockage. Conclusion: Patients who are diagnosed with a partial tube blockage will require only flushing of the tube and antibiotics treatment, while mechanically block tube will require replacement. This distinction is critical considering the cost of replacement of tube and manpower time for surgery. There are currently no existing protocol for radionuclide shuntography, but critical attention to details, observation of strict aseptic technique and close collaboration between the Nuclear medicine physician, Pediatricians and Neurosurgeons would improve diagnostic accuracy, this paper will also highlight this aspect.
Chinedu Simeon Aruah
National Hospital Abuja, Nigeria
Title: Anemia in cancer patients undergoing radiotherapy and chemotherapy in National Hospital Abuja, Nigeria
Time : 14:55-15:15
Biography:
Chinedu Simeon Aruah graduated in 2004 from University of Nigeria Nsukka (UNN) where he obtained MBBS Nigeria, and enrolled for residency training in Radiation Oncology at the National Hospital Abuja, Nigeria, qualified in 2014 and got inducted as a Fellow of West African College of Surgeons (FWACS) Radiation Oncology in March 2015. He won National Hospital Abuja Research Grant 2013 during his dissertation work. He has a Master’s degree in Public Health (MPH) from University of Nigeria Nsukka (UNN). He found an NGO Pathfinder Healthcare Foundation (PHF) to create cancer awareness among rural dwellers. He is currently working at the National Hospital Abuja, Nigeria as a Researcher and Consultant Radiation Oncologist with interest in Public Health.
Abstract:
Introduction: Many cancer patients present with anemia prior to radiotherapy and chemotherapy or may experience anemia/ worsening of anemia at some point during treatment. Aims & Objectives: The aim of the study was impact of anemia in cancer patients undergoing Radiotherapy and Chemotherapy. Methodology: 201 cancer patients of both sexes with histopathologically confirmed malignancies (solid cancers). Patient’s pretreatment Hb was taken. Patients were distributed into Radiotherapy, Chemotherapy and Chemoradiation. Their Hb was measured once every 2 weeks. The blood film pictures of the patients were examined. The whole process was terminated after 3 consecutive Hb reading or after week 6. Anemia was classified into: Less than 10 g/dl (Severe anemia), 10-10.9 g/dl(moderate anemia), 11-12 g/dl (mild anemia) and 12 g/dl and above (no anemia). Results & Analysis: Out of 201 cancer patients, 86.1% were female and 13.9% were male. Age range, 25-75 years, 100 patients were on Chemotherapy, 63 patients on Radiotherapy and 38 patients on Chemoradiation. The prevalence in anemia in cancer patients undergoing radiotherapy and chemotherapy was found to be 63% as shown by blood film picture (i.e., average of 72%, 42.9% and 73.7%). At the end of therapy, 62% (100) patients on Chemotherapy and 55.6% (63) patients on Radiotherapy had their Hb level between 11-12 g/dl, 39.5% (38) cancer patients on Chemoradiation arm had Hb value of 10-10.9 g/dl. At P-value>0.05, there was no statistical significance on distribution of mean Hb, standard deviation based on sex and treatment type. Conclusion: Prevalence of anemia in the study group was found to be 63% while 37% had adequate hemoglobin (Hb) after the therapy as reflected in the blood film picture. At 95% confidence interval, Chemotherapy had greatest impact on Hb level during therapy. Thus Chemotherapy: 9.60-10.62 g/dl, Radiotherapy: 11.52-12.13 g/dl and Chemoradiation therapy: 10.98-11.36 g/dl.
- Therapeutic Nuclear Medicine
Patient Safety And Practice Management
Case Reports
Chair
Ken W D Ledingham
University Of Strathclyde, UK
Co-Chair
Nina Tuncel
Akdeniz University, Turkey
Session Introduction
Nina Tuncel
Title: The environmental dose measurements of high dose Iodine-131 treated thyroid cancer patients during hospitalization period.
Time : 11:45-12:05
Biography:
Nina Tunçel has completed her PhD at the age of 35 years from Istanbul University Oncology Institutes in medical radiation physics. She is the chief medical physic from 1999 to 2013 at Akdeniz University medical school radiation oncology department. She has her career as teaching staff for training Medical Physics at physics department of science faculty of Akdeniz University. She has published more than 30 papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
Radioiodine mostly 131I is one of the oldest clinical radionuclide types which used widely spread in diagnosis and currently used in the treatment of both thyreotoxicosis and thyroid cancer. For most thyroid cancer treatments, large doses of 131I are administered to ablate residual thyroid tissue and functional metastases from thyroid cancer. Because of radiation safety considerations, application of large doses of 131I (greater than 800 MBq) requires patient hospitalization. For most patients, 35%-75% of the administered dose is excreted within the first 24 h after dose administration. This study presents the risks associated with high dose 131I treatment which is used in nuclear medicine. Patients were confined to two isolation rooms which were completely covered with lead. Each room is designed for two beds which are separated by lead separators. In the fixed activity protocol, a high activity 3.7-7.4 GBq (100-200 mCi) 131I was administered to12 patients. In general, the patients were isolated for a period of 2-3 days. The dose rates were measured at 1 m from the patient's thyroid and abdominal levels at different interval times. The clean and unclean room dose rate measurements were performed at each isolated room. These were 0.43+0.56 mRh-1 and 1.49+1.99 mRh-1 respectively. The maximum dose rate was measured at the toilet bowl. Moreover the pillow had 5.02+4.35 mRh-1 at the unclean room. Surrounding rooms and service door-corridor measurements were done with patients 7.06+10.33 ïRh-1 and 87.75+91.87 ïRh-1 respectively, and without patients 1.17+8.84 ïSvh-1 and 32.92+12,98 ïRh-1 respectively.
Bengul Gunalp
Title: The role of 18F-FDG-PET/CT in primary staging and restaging of breast cancer- The impact of findings on therapeutic management of patients
Time : 12:05-12:25
Biography:
Bengul Gunalp graduated from Hacettepe University Medical Faculty and completed nuclear medicine residency and received Associate Professor degree in Gulhane Military Academy and Faculty. She is still working in Gulhane Military Faculty Hospital, Department of Nuclear Medicine. She has published more than 35 papers in reputed journals.
Abstract:
Accurate staging of breast carcinoma is important for determining prognosis and planning treatment of patient. Although the clinical role of PET/CT for initial staging of breast carcinoma still controversial and the guidelines recommendations haven’t been changed yet, there is robust evidence on superiority of PET/CT to conventional imaging modalities for the detection of local and distant metastases. We discuss the importance of FDG PET/CT findings, especially axillary/extra-axillary nodal and distant metastases, in different categories of breast cancer and also performance of FDG PET/CT on restaging of patients with suspected disease recurrence.
Ken W D Ledingham
University of Strathclyde, UK
Title: Towards Laser Driven Hadron Cancer Radiotherapy: What Progress has been made?
Time : 12:55-13:15
Biography:
Ken W. D. Ledingham has completed his PhD at the age of 26 years from University of Glasgow and postdoctoral studies from University of Glasgow. He is the professor of Physics at University of Strathclyde. He is also recognized as William Penney Professor of Laser Nuclear Physics AWE plc.
Abstract:
It has been known for about sixty years that proton and heavy ion therapy is a very powerful radiation procedure for treating tumours. It has an innate ability to irradiate tumours with greater doses and spatial selectivity compared with electron and photon therapy and hence is a tissue sparing procedure. For more than twenty years powerful lasers have generated high energy beams of protons and heavy ions and hence it has been frequently speculated that lasers could be used as an alternative to RF accelerators to produce the particle beams necessary for cancer therapy. The present talk discusses the progress made towards laser driven hadron cancer therapy and what has still to be accomplished to realise its inherent enormous potential. In addition the use of lasers for cancer diagnostics will also be discussed
Maciej Budzanowski
Institute of Nuclear Physics Polish Academy of Sciences, Poland
Title: Occupational doses from ionizing radiation in nuclear medicine in Poland
Time : 13:15-13:35
Biography:
Maciej Budzanowski has completed his PhD in 2001 from Institute of Nuclear Physics Polish Academy of Sciences and Postdoctoral studies in 2012. He has started working as an Associate Professor in 2014. He has published more than 80 papers in JCR journals. He is a Scientific and Technical Director of the Institute of Nuclear Physics in Krakow, Poland.
Abstract:
Based on statistical data from the Laboratory of Individual and Environmental Dosimetry at the Institute of Nuclear Physics (IFJ) in Krakow nuclear medicine is the main source of occupational doses for medical staff in Poland. More than 1000 occupational persons working in nuclear medicine in Poland are wearing dosimeters from our dosimetry service. Only during industrial use of radiation the higher dose levels are recorded. According to statistic only about 65% individual doses for whole body and 55% individual doses for extremity ring dosimetry in nuclear medicine in Poland are on the level of the natural radiation background, while for conventional radiology this parameter reaches ca. 90%. In nuclear medicine staff could be divided into doctors, nurses, technicians. Also regarding to different procedures and applications of beta, gamma or positron emitters and place (laboratories of scintigraphy, isotope therapy or department of PET-CT) different dose levels are observed. The doses to medical staff in are measured in terms of the personal dose equivalent Hp(10) for whole body, Hp(0.07) for hands and Hp(3) for eyes. The doses are measured using thermolumiescent detectors placed in individual dosimetry badges. The study includes analysis of the doses for whole body, extremity ring and eye lens for medical staff (technical staff, nurses and doctors) exposed to radiation in nuclear medicine.
Abdulkarim Jamal
George Eliot Hospital/ Warwick Medical School UK
Title: A reduced dose of iodinated contrast medium can be used in CT pulmonary angiography without adversely affecting image quality.
Time : 13:35-13:55
Biography:
Dr. Jamal Abdulkarim finished his radiology training in university hospitals of Leicester UK and obtained the FRCR, Currently he is a consultant Radiologist at George Eliot Hospital, He has interest in research particularly in the field of intravenous iodinated contrast media where he had published and presented several papers over the last few years.
Abstract:
A good quality negative CT pulmonary angiogram (CTPA) can reliably exclude the presence of pulmonary emboli. In order to obtain good quality studies without unduly increasing the risk of contrast mediated nephrotoxicity one must aim to achieve optimal opacification of the pulmonary arteries using the minimum dose of contrast medium. This study aims to demonstrate that a smaller volume of a more concentrated contrast medium can be used to achieve a lower iodine dose without adversely affecting the quality of the images obtained. The CTPA images for 69 consecutive patients who received 100mL of Optiray 300 and 70 patients who received 75mL of Optiray 350 were reviewed. The degree of opacification in the pulmonary trunk and right and left main pulmonary arteries was measured in terms of Hounsfield Units (HU). Data regarding patient’s age, sex and weight was obtained from the hospital records. The groups did not differ significantly in terms of age, sex distribution or weight. Mean opacification in the pulmonary trunk was greater in the 75mL group (365 HU vs 331 HU) although this was not quite statistically significant (p=0.0546). This was despite the mean dose of iodine being lower in this group (26.2g vs 29.5, p=0.0001). There was no increase in the number of investigations considered non-diagnostic (defined as opacification of less than 250HU in pulmonary trunk) in the 75mL group. Use of the low dose technique, whilst conferring patient safety and cost saving benefits, is not associated with a deterioration in the pulmonary artery opacification of CTPA investigations or an increase in the number of suboptimal studies.
Mahmoud Elsherif
Children’s Cancer Hospital 57357, Egypt
Title: Initiation of Nuclear Pharmacy for Pediatric Oncology at Developing Count
Time : 13:55-14:15
Biography:
Mahmoud Elsherif has completed his studies of Pharmaceutical Sciences at Helwan University. He joined the Hospitals of the Egyptian Armed Forces for one year then joined Children’s Cancer Hospital 57357 as a clinical pharmacist since March 2014. He is a radiology and nuclear pharmacy specialist since Sep. 2015 and is a candidate of a training program for the use of radioactive materials and Radiation protection procedures, enrolled by The Egyptian Atomic Energy Authority (March 2016) .
Abstract:
Nuclear Pharmacy for Pediatric Oncology at Developing Countries: Radiopharmaceuticals are not treated with the same care and focus as chemotherapy and other supportive care medication. For expanding the pharmaceutical services at a pediatric oncology hospital to Nuclear Medicine Department, Basic Knowledge about radiopharmaceutical and their use should be present. Advanced information about commonly used radiopharmaceuticals at your hospital should be gained, including Preparation procedures, Dosing, Precautions, Drug-Drug interactions, Drug-Chemotherapy interactions, Drug-Food interactions and also Radiation protection issues. Standards of medication ordering process, order reviewing and verifying, dose preparation and dispensing should be applied to radiopharmaceuticals management and use. Nuclear Pharmacist should also has an active role at Patient Education Process. All these considerations should be taken in mind in a relation with the fact of dealing with a pediatric cancer patient
B Ravi Shankar
Gitam Institute of Medical Sciences, India
Title: Role of PET-CT in Modern Radiotherapy Planning Process of Solid Tumours
Time : 14:15-14:35
Biography:
Regarded as an eminent oncologist and having experience of visiting renowned cancer hospitals around the world, Dr. B. Ravi Shankar is presently working as a senior consultant and a clinical oncologist at Queen's NRI Institute of Oncology. Dr. B. Ravi Shankar is one of the most renowned Cancer Specialist (Oncologist) of Visakhapatnam.Gold medalist in MBBS and has a Post Graduate Masters Degree in Radiation Oncology.
Abstract:
Background: Positron emission tomography (PET) allows functional imaging of structures by virtue of their ability to metabolise glucose and concentrate specific molecules which are labelled with positron emitting Radionuclides. Integrated computed tomography (CT) and PET more accurately characterise the metabolically active tissue. Together PET-CT has shown more sensitivity and specificity for diagnosis, staging, response assessment, during follow up for early detection of recurrence and target volume delineation in radiotherapy planning. Aim: Aim of the study is to evaluate the technical challenges in the image registration of PET/CT and planning CT done in our hospital. Methods & Materials: Our study included the patients who have attended OPD and received Radiotherapy (RT) during year 2014-2015 for various sub-sites. We have patients received RT for head and neck region, abdominal region, thorax and pelvis. The PET/CT images of the respective sub-sites were fused with the planning CT images using rigid registration fusion software and the target was delineated using the fused images. Conclusion: Apart from few technical difficulties, rigid registration fusion algorithms of PET/CT images to the planning images after careful patient positioning helps the radiation oncologist in proper delineation of target volume.
Jawa Zabah Muhammad
National hospital Abuja, Nigeria
Title: Pneumocystis pneumonia mimicking lung metastasis in a HIV- positive patient with metastatic follicular thyroid cancer
Time : 14:35-14:55
Biography:
Dr. Jawa is a senior consultant in Nuclear Medicine and European board certified in Nuclear medicine. He has dual specialist qualifications in Nuclear Medicine and Radiology and received his training at the Stellenbosch University. He is a fellow of the college of Radiologist of Nigeria, fellow of the South African college of Nuclear Physicians, fellow of the European board of Nuclear Medicine. He has presented papers at various national and international conferences. In 2013, his research presentation received an award of distinction at the IMIC conference in Vienna, Austria. He is the Chief Editor of the MDCAN journal of medical sciences.
Abstract:
The lung is a common site for metastasis from follicular thyroid cancer. Pneumocystis pneumonia is a fungal lung infection commonly seen in HIV-positive patients. The clinical presentation and radiological features of pneumocystis pneumonia and lung metastasis from follicular thyroid cancer are very similar and often indistinguishable, however, their management differs. Pneumocystis pneumonia is treated with a simple course of antibiotics, while lung metastasis from follicular thyroid cancer requires high dose therapy with radioactive I-131. In patients with metastatic follicular thyroid cancer that are HIV-positive presenting with lung infiltrations, it is important to make a proper diagnosis in order to institute appropriate and prompt treatment. We present an unusual case of a pneumocystis pneumonia mimicking lung metastasis in a HIV-positive patient with stage-IV follicular thyroid cancer. To our knowledge, this is the first documented case of a HIV-positive patient with metastatic follicular thyroid cancer presenting with pneumocystis pneumonia mimicking lung metastasis. The rarity of this case and the importance of creating awareness among clinician of the existence of this disease are emphasized.
- Workshop On Intraoperative Cell Killing Radiation – New Approaches Using Nuclides, Photodynamic Therapy, Photons
Session Introduction
Michael Friebe
Otto-Von-Guericke-University, Germany
Title: Minimal-Invasive And Image-Guided Radiation Therapy Products – How Important Is 'Affordable' And 'Intuitive' As Value Proposition?
Time : 15:55-16:25
Biography:
Michael Friebe has been involved in diagnostic imaging and image guided therapeutic products and services, as founder /innovator / CEO investor, and scientist. Dr. Friebe currently is a Board Member of two startup R&D companies, as well as investment partner of a medical technology startup-fund. Dr. Friebe is an affiliated professor with the chair for Computer Aided Medical Procedures (CAMP) at TU München, and full professor of Image Guided Therapies at the Otto-von-Guericke-University in Magdeburg, Germany. He is listed inventor of more than 60 patent applications and the author of numerous papers.
Abstract:
Innovative university based medical technology product development is largely dependent on the availability of external research funding from industry or public / private non-profit institutions. Research by definition is highly speculative and comes with a great risk of failure, which makes it largely unattractive for industry. Government and other non-profit funding agencies require that uncertainty and the reviewers of the programs also like to see a high-tech component and a great amount of scientific complexity. So, there is a clear focus on expensive complexity in current research funding.Especially in the medical technology segment there is a need for innovative tools and devices however, that also enable new minimal invasive radiation therapy therapies. Medical doctors as the users of that technology do appreciate easy to use devices with a low error margin as the final use of the product is on a sensitive living patient. Additionally, the healthcare system has yearly decreasing funds available, developing countries cannot afford the systems made for the developed world, and complexity also requires dedicated support and application staff. The talk will highlight some of the attributes and value propositions that to be developed medical technology devices should have. These may not always be considered scientifically 'cool' from a funding perspective, but that are faster applicable, and more widely useable than the complex and expensive high-tech devices that are often proposed.These features could open new market segments and increase the speed acceptance of new therapies.
Alfredo Illanes
OvG University, Germany
Title: Photodynamic therapy: an attractive but complex multivariable process
Time : 16:25-16:55
Biography:
Alfredo Illanes is a researcher at the Chair of Catheter Technologies of the OvG University, Magdeburg. After obtaining a master degree in Signal Processing with applications in cardiac signals, he received a Ph.D. at INRIA, Rennes, France, in the area of electrocardiogram (ECG) signal processing and modeling in 2008. Since then, he has been involved in several applied research projects in the field of biological signal and image processing and modeling as assistant professor at the Engineering Faculty of the Southern University of Chile. His current main research interests involve biosignals feature extraction and parametrical modeling in biological processes.
Abstract:
Photodynamic therapy (PDT) is a minimally invasive therapeutic procedure consisting in a photochemical reaction that involves three main components: a photosensitizer, oxygen and light at an appropriate wavelength. These components interact with each other and with the tissue resulting in a reaction having as main objective to generate Reactive Oxygen Species (ROS), which can rapidly cause significant toxicity in the cells. If one of the main components involved in PDT is not there, then the reaction will not take place and then no ROS can be generated. Despite that photodynamic effects has been first described in the early 1900s and that since the 80s PDT has been largely studied involving the generation of more than 250 trials, where essentially, all types of solid tumors have shown positive response, PDT has not yet been currently introduced in clinical practice for tumor therapy. The complex and still hardly understood dynamical relationship between the involved variables, which makes the process difficult to monitor and optimize can be the major reason of that. This work intends to describe, in a systemic point of view, the process behind PDT in order to understand the time/spatial variant characteristics that make this process difficult to control, and therefore, difficult to assess in terms of dosimetry. The focus will be pointed on the dynamical relationship between variables and parameters and on how they vary on time and on space, analyzing the time constants involved in the process, as well as, the existing techniques for monitoring these dynamical changes.
Joerg Traub
SurgicEye GmbH, Munich, Germany
Title: 3D interventional nuclear medicine imaging and therapy monitoring
Time : 16:55-17:25
Biography:
Joerg Traub has completed his PhD from TU Munich with highest distinction. After graduation he was co-founder SurgicEye GmbH. He is CEO and President of SurgicEye, an innovator in the field of mobile nuclear imaging during therapy, for the past 8 years. He has published more than 50 peer-reviewed journal and full paper conference papers, is co-inventor of more than 10 patents and has been serving as reviewer in several medical imaging and computer assisted surgery journals and conferences
Abstract:
Radio-guided surgery is defined as any surgical procedure which utilizes a radiation detection device in a real-time fashion within the operating room for the identification of a radioisotope administered to a patient prior to the time of attempted detection and with the sole purpose of assisting in the successful performance of that surgical procedure. There is a wide application domain in the surgery room for sentinel lymph node marking, marking of primary tumors and also injection of radio-isotopes for selective internal radiation therapy. A commonly used radiation detection system during radio-guided surgery is a handheld gamma probe. The use of imaging during surgery is in general not facilitated since it is only available in a few high-tech operating rooms. Freehand SPECT was introduced as a technology for 3D radio-guided surgical procedures such as sentinel lymph node biopsy. In addition to the information provided by conventional gamma probes, freehandSPECT allows a 3D reconstruction and a visualization of the distribution of radioactivity in the region of interest. freehandSPECT is combined with a navigation system facilitating precise guidance to radioactive marked lesions, provides depth measurement, and an intuitive augmented reality visualization. A summary of currently available clinical data on the use of freehandSPECT will be provided for sentinel lymph node biopsy of various malignancies, and for radio-guided localization of primary tumors. A comprehensive technology review of mobile SPECT solutions will be provided along with advanced features e.g. image fusion with diagnostic ultrasound or with a cone beam CT in an interventional radiology suite
Alexander van Oepen
Otto-von-Guericke University, Germany
Title: Radionuclide based intraoperative irradiation - current and future approaches
Time : 17:25-17:55
Biography:
Alexander van Oepen completed his studies at the age of 25 years and graduated with a Master of Science from the University of Luebeck, Germany. He is a research associate of Prof. Dr. Michael Friebe at the Chair for Catheter Technologies and Image guided Interventions of the Otto-von-Guericke University in Magdeburg. His research topics are focused on the field of nuclear medicine and biomedical optics for cancer treatment.
Abstract:
The possibility to use ionizing radiation in form of x-rays for therapeutic purposes was recognized early after their discovery by Wilhelm Conrad Roentgen. Therapeutic irradiation can be applied mainly in three different ways: external beam radiation, sealed source radiation and unsealed source radiation. The most significant medical applications of irradiation therapies are in the field of cancer treatment. The cell-killing biological effects of the irradiation are utilized to minimize the risk of cancer recurrence after surgical tumor removal or to directly irradiate the tumorous tissue. In the case of breast surgery, external beam radiation therapy is often performed post-operatively in multiple fractions. This leads inevitably to damage of healthy tissue along the beam path and is also stressful for the patient due to repeated attendance in the hospital. To overcome these problems, new approaches to deliver the irradiation doses to the tumor side were devised. Based on radionuclides, which emit ionizing radiation in a finite range around the source, therapeutic radiation can be delivered directly to the tumor within or immediately after surgery via special applicators. Tumor removal and irradiation could be completed in one session. These intraoperative approaches can lead to less trauma and bed time for the patient with the same therapeutic outcome. Concepts for intraoperative radionuclide based irradiation approaches are presented in this work. Different applicators and operation room settings are discussed as well as current developments for the systems of the future.
- Special Session On Laser Driven Proton Therapy
Session Introduction
Ken W D Ledingham
University of Strathclyde, UK
Title: Towards Laser Driven Hadron Cancer Radiotherapy: What Progress has been made?
Time : 15:30-16:00
Biography:
Ken W. D. Ledingham has completed his PhD at the age of 26 years from University of Glasgow and postdoctoral studies from University of Glasgow. He is the professor of Physics at University of Strathclyde. He is also recognized as William Penney Professor of Laser Nuclear Physics AWE plc.
Abstract:
It has been known for about sixty years that proton and heavy ion therapy is a very powerful radiation procedure for treating tumours. It has an innate ability to irradiate tumours with greater doses and spatial selectivity compared with electron and photon therapy and hence is a tissue sparing procedure. For more than twenty years powerful lasers have generated high energy beams of protons and heavy ions and hence it has been frequently speculated that lasers could be used as an alternative to RF accelerators to produce the particle beams necessary for cancer therapy. The present talk discusses the progress made towards laser driven hadron cancer therapy and what has still to be accomplished to realise its inherent enormous potential. In addition the use of lasers for cancer diagnostics will also be discussed.
Satyabrata Kar
Queen’s University of Belfast,UK
Title: Laser driven ion acceleration towards medical applications: current status of the A-SAIL project
Time : 16:00-16:30
Biography:
S. Kar obtained his Ph.D. in 2005 from Queens University Belfast and is currently employed as a lecturer at QUB since 2013. He holds a Career Acceleration Fellowship from EPSRC, UK (2012-2016) and an honorary joint appointment with Central Laser Facility of STFC, UK (2017-2018). His track record includes 96 publications including 1 Nature Physics, 2 Nature communications and 19 Physical Review Letters (h-index 23 and total citation-2200).
Abstract:
A-SAIL (Advanced Strategies for Accelerating Ions with Lasers) is a UK-wide consortium aimed to the development of ion acceleration towards medical applications. The main objective of the project, which is funded by an EPSRC Programme Grant (2013-2019), is to assess the potential of the laser-driven ion approach as an alternative source for cancer therapy, by demonstrating controlled, all-optical acceleration of dense bunches of protons and other low-Z ion species in the 60- 300 MeV/nucleon range of interest for therapy of deep-seated cancer. Radiation Pressure Acceleration approaches are highly promising for this purpose and currently pursued by the consortium at UK and international facilities. A novel scheme of guided post-acceleration of the laser driven ion beams was recently developed within the team which brings the all-optical scheme one step closer to the realization of compact beam lines. Achieving this objective requires a coordinated effort involving development of new target media, understanding and controlling the physical processes of the relevant interaction regimes, and developing innovative solutions to a number of technical bottlenecks. The ultrashort duration is a distinctive property of laser-driven ion beams, as ions are emitted in bursts of picosecond duration at the source and their therapeutic use may result in dose rates up to many orders of magnitude higher than normally used in therapy. In parallel to the source development, the consortium is therefore pursuing a programme of investigations of the dynamics of cellular response to ion irradiation at these unprecedented dose rates. The talk will discuss the aim and structure of the project, will review the progress so far and discuss the next developments and project outlook.
Elke Beyreuther
Helmholtz-Zentrum Dresden – Rossendorf, Germany
Title: Radiobiological Characterization of Laser Driven Particles
Time : 16:30-17:00
Biography:
Elke Beyreuther has completed her PhD at the age of 28 years and postdoctoral studies from Helmholtz-Zentrum Dresden. She has published more than 15 papers in reputed journals.
Abstract:
The long-term aim of developing laser based particle acceleration towards clinical application requires not only substantial technological progress, but also new technical solutions for dose delivery and quality assurance as well as comprehensive research on the radiobiological consequences of ultra-short radiation pulses with high pulse dose. During the last years the laser driven technology was developed at such a rate that cell samples and small animals can be irradiated. Within the joint research project “onCOOPtics” extensive in vitro studies with several human tumor and normal tissue cells were already performed revealing comparable radiobiological effects of laser driven and conventional electron and proton beams1,2. Using the same cell lines, these results were substantiated comparing the radiobiological response to ultra-short pulsed electron bunches (pulse dose rates of ≤1012 Gy/min) and continuous electron delivery at the radiation source ELBE3. In a second translational step, in vivo experiments were established. Although the experiments were motivated by future proton trials, first attempts were performed with electrons at the laser system JETI4, since the delivery of prescribed homogeneous doses to a 3D target volume is easier for electrons than for protons. A full scale animal experiment was realized for the HNSCC FaDu grown on nude mice ear. The radiation induced tumor growth delay was determined and compared to those obtained after similar treatment at a conventional clinical LINAC. Again, no significant difference in the radiation response to both radiation qualities was revealed, whereas the successful performance of such a comprehensive experiment campaign underlines the stability and reproducibility of all implemented methods and setup components5. During this experiment campaign the changing tumour take rate and a high rate of secondary tumours were identified as limitations of the model that have to be improved before proton experiments and tumour control studies can be performed. In order to optimize the model Matrigel as medium for tumor cell injection and the glioblastoma cell line LN229 as interesting entity for proton treatment were introduced. Results of this optimization process and the status of the experiments with laser driven protons at the laser system DRACO will be presented. The work was supported by the German Government, Federal Ministry of Education and Research, grant nos. 03ZIK445 and 03Z1N511.