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Computer Assisted Proton Beam Radiotherapy for Intraocular Tumors

English title Computer Assisted Proton Beam Radiotherapy for Intraocular Tumors
Applicant Weber Stefan
Number 144312
Funding scheme Project funding (Div. I-III)
Research institution ARTORG Center Medizinische Fakultät Universität Bern
Institution of higher education University of Berne - BE
Main discipline Information Technology
Start/End 01.03.2013 - 28.02.2017
Approved amount 250'000.00
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All Disciplines (3)

Discipline
Information Technology
Biomedical Engineering
Clinical Cancer Research

Keywords (4)

Patient specific Tumormodeling ; Eye-Tracking; Computer Vsion; Proton Beam Radiotherapie

Lay Summary (English)

Lead
Das Auge ist das wichtigste Sinnesorgan des Menschen. Externe Strahlentherapie zur Behandlung von Tumorerkrankungen am Auge erfordern eine sehr präzise Planung und Ausführung um gesundes Gewebe weitestgehend zu schonen sowie erkranktes Gewebe wirkungsvoll zu bestrahlen. Basierend auf moderner Video-und Bildverarbeitung wird im Rahmen des Projektes ein neues Behandlungskonzept entwickelt was erstmals eine nicht-invasive Therapie mit gleichzeitig erhöhter Patientensicherheit bietet.
Lay summary

Bei der Behandlung von Augentumoren hat es in den letzten Jahren, durch Entwicklungen  in der Strahlentherapie, grosse Fortschritte gegeben. Melanome im Choroid werden häufig durch Protonenbestrahlung behandelt, welche sich durch präzise Strahlführung und Energiedosierung im Tumorvolumen auszeichnet.

Das ermöglicht die Erstellung eines detaillierten Behandlungsplans und erlaubt gesundes Gewebe weitestgehend zu schonen sowie erkranktes Gewebe wirkungsvoll zu bestrahlen. Externe Strahlentherapie erfordert keinen invasiven Eingriff. Allerdings werden heutzutage bei einer Protonentherapie Tantalum Marker auf den Bulbus genäht, um Tumorgrenzen zu kennzeichnen.

In diesem Projekt soll ein neues Behandlungskonzept entwickelt werden, das diesen Eingriff obsolet macht. Das wird sowohl die Akzeptanz einer solchen Therapie nachhaltig verbessern sowie die Sicherheit erhöhen.

Durch die Vereinfachung wird die Therapie einem grösseren Kreis von Ärzten zugänglich gemacht da die aufwendige Marker-Operation entfällt.  Mit Hilfe eines patientenspezifischen Augenmodells werden anteriore und posteriore anatomischen Strukturen (zB die Tumorerkrankung) in eine räumliche Beziehung zueinander gesetzt. Das Augenmodell wird Informationen von verschiedenen Bildmodalitäten wie zB MRI, CT oder Fundus Bilder in einem Modell verbinden, und so einen umfassenden Überblick über die Erkrankung geben. Zusätzlich wird ein neues video-basiertes Trackingverfahren entwickelt, das die 3D Position der anterioren Strukturen bestimmt. Mit Hilfe des Modells kann dann die Tumorosition bestimmt werden.

Das vorgeschlagene System bietet erhöhte Patientensicherheit, verbesserte Kosteneffizienz, und wird durch die Vereinfachung der Behandlung einem grösseren Patientenkreis den Zugang zur Protonentherapie ermöglichen.

Direct link to Lay Summary Last update: 03.05.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Multi-channel MRI segmentation of eye structures and tumors using patient-specific features.
Ciller Carlos, De Zanet Sandro, Kamnitsas Konstantinos, Maeder Philippe, Glocker Ben, Munier Francis L, Rueckert Daniel, Thiran Jean-Philippe, Bach Cuadra Meritxell, Sznitman Raphael (2017), Multi-channel MRI segmentation of eye structures and tumors using patient-specific features., in PloS one, 12(3), 0173900-0173900.
With Gaze Tracking Toward Noninvasive Eye Cancer Treatment.
Wyder Stephan, Hennings Fabian, Pezold Simon, Hrbacek Jan, Cattin Philippe C (2016), With Gaze Tracking Toward Noninvasive Eye Cancer Treatment., in IEEE transactions on bio-medical engineering, 63(9), 1914-1924.
Automatic Segmentation of the Eye in 3D Magnetic Resonance Imaging: A Novel Statistical Shape Model for Treatment Planning of Retinoblastoma.
Ciller Carlos, De Zanet Sandro I, Rüegsegger Michael B, Pica Alessia, Sznitman Raphael, Thiran Jean-Philippe, Maeder Philippe, Munier Francis L, Kowal Jens H, Cuadra Meritxell Bach (2015), Automatic Segmentation of the Eye in 3D Magnetic Resonance Imaging: A Novel Statistical Shape Model for Treatment Planning of Retinoblastoma., in International journal of radiation oncology, biology, physics, 92(4), 794-802.
Landmark detection for fusion of fundus and MRI towards a patient-specific multi-modal Eye model
De Zanet S., Ciller C., Rudolph T., Maeder P., Munier F., Balmer A., Bach Cuadra M., Kowal J. (2014), Landmark detection for fusion of fundus and MRI towards a patient-specific multi-modal Eye model, in IEEE transactions on biomedical engineering, 62(2), 532-540.

Abstract

Technology plays an increasingly important role in modern medicine - and ophthalmology is no exception. Various new laser treatments, optical coherence tomography, digital fundus photography are only a few of the many advancements in recent years. Ocular oncology is another field that has been revolutionized by the progress of radiotherapy. Today, tumors of the eye such as choroidal melanoma are often treated by charged particle beam irradiation. Within this general class of radiotherapies, proton beam therapy is particularly successful, because it allows for a very accurate and sharp delineation of the irradiated volume. This enables the radiologist to spare as much healthy tissue as possible, but at the same time maximize the therapeutic success. Due to the close proximity of many crucial structures in the eye, such as the optic nerve head, the macula, the ciliary body and the lens, this is especially important.By nature, proton beam radiotherapy is a non-invasive treatment. However, the way it is performed today requires a surgery prior to the actual radiation treatment. Apart from being associated with some risk, the sole purpose of this surgery is to suture reference markers onto the bulbus that are used later for spatial referencing of the tumor during irradiation. In this project we propose a new treatment scheme which will eliminate the need for a pre-treatment surgery. This will significantly increase the patient's safety and comfort, but also considerably reduce the overall cost. It will also open the treatment to more ophthalmologists, because the currently required surgery is technically very demanding and consequently the outcome of the whole treatment procedure is therefore highly observer dependent.The proposed treatment scheme requires a completely new spatial referencing method. We suggest to use a video based eye tracking system for spatial referencing of the patient's eye. A patient specific eye model will be used to infer the position and orientation of the posterior structures of the eye from the tracked anterior parts. The model will incorporate various imaging modalities, such as MRI, CT and fundus photographs, to improve the tumor modeling and hence to provide higher accuracy and better diagnostic value. Moreover, the use of a fully automatic eye tracking system will increase the patient's safety during the irradiation session. Currently, a technician supervising the treatment actively monitors the gaze direction of the patient and interrupts the procedure if necessary, for example in case of sudden eye motions. Compared to the human observer the eye tracking system will react to problems with less delay, which eliminates yet another risk factor of the procedure.We are confident that thorough validation of the system will prove the superiority of the new treatment regime over the current strategy. Our proposed system will be safer, more cost-effective and more accessible to patients suffering from these serious diseases.
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