Radiomics - research challenges identified by EURAMED

Transcription

1 Radiomics - research challenges identified by EURAMED Prof. Christoph Hoeschen EURAMED Past-President, member of ExB, head of scientific committee

2 Vision To lead the European research activities in medical radiation protection and to assume an umbrella function for the harmonisation of practice to advance the European radiation protection safety culture in medicine. Mission To jointly improve medical care through sustainable research efforts in medical radiation protection To serve as a platform for medical radiation protection research, linking researchers and clinicians, adopting a harmonized approach to lobbying at European level to impact the European research funding landscape To develop an aligned approaches and responses to European research calls 2

3 Procedure to determine gaps Based on EURAMED SRA Also use Joint Roadmap draft, individual EURAMED roadmap, priority statements Analyse former and current projects regarding their results and/or proposed research Not exclusively 3

4 EURAMED Preliminary Gap Analysis: Short list of identified gaps 4

5 EURAMED Preliminary Gap Analysis: Short list of identified gaps 5

6 EURAMED Preliminary Gap Analysis: Short list of identified gaps 6

7 GAP 1 Fixed activity approach versus individualized dosimetry-based activity determination in radionuclide therapy Fixed activity approach: prescriptions in radionuclide therapy are based on a fixed amount of activity for all patients Individualized dosimetry approach in radionuclide therapy: treatment optimization by anticipating required activity to be administered to an individual patient 7

8 GAP 1 Fixed activity approach versus individualized dosimetry-based activity determination in radionuclide therapy For all medical exposure of patients for radiotherapeutic purposes, exposures of target volumes shall be individually planned and their delivery appropriately verified taking into account that doses to nontarget volumes and tissues shall be as low as reasonably achievable and consistent with the intended radiotherapeutic purpose of the exposure. EU directive 2013/59/EURATOM Article 56 Radiotherapeutic means pertaining to radiotherapy, including nuclear medicine for therapeutic purposes EU directive 2013/59/EURATOM Article 4 (Definitions) 8

9 GAP 1 Fixed activity approach versus individualized dosimetry-based activity determination in radionuclide therapy 9

10 GAP 2 Artificial intelligence in medical radiation protection Artificial intelligence, machine learning and deep learning can support medical radiation protection (dose estimation, dose management, image quality assessment and especially dose reduction). Translating approaches into clinical practice, determine drawbacks and limitations, evaluate systems are essential aspects of such approaches and are missing still 10

11 Artificial intelligence in medical radiation protection Development of dose and imaging biobanks for benchmarking, establishment of DRLs and research can help considerably in dose optimization from medical exposures. 11

12 GAP 2a Artificial intelligence in medical radiation protection Radiomics: a tool to extract quantitative information out of the images. Several software packages provide radiomic features from medical images using data-characterization algorithms. These features have the potential to uncover disease characteristics. Radiomics could be used together with texture analysis approaches to look for effects related to individual sensitivity of single organs. 12

13 Radiomics slides based on those of Ralph Leijenaar Disclosure Ralph Leijenaar Co-inventor of patents related to Radiomics Chief Technology Officer of the company OncoRadiomics Employed by pttheragnostic

14 Radiomics Radiomics first published by MAASTRO in 2012 Lambin P, et al. Eur J Cancer 2012;48:

15 Radiomics hypothesis The Radiomic hypothesis One can extract more quantitative information from standard imaging in contrast with RECIST, WHO ) Radiology: Implicit knowledge Interpretability QUANTIFICATION [Lambin P, et al. Eur J Cancer 2012;48: ] RADIOMICS Extract large amount of quantitative features from images 15

16 Radiomics - workflow The Radiomics workflow in a nutshell Imaging feature extraction modelling A high-throughput approach to convert medical images to minable data The analysis extracts diagnostic, theragnostic, prognostic and predictive Radiomics signatures 16

17 Radiomic features 1. Tumor image intensity 2. Shape 3. Texture 4. (multi-scale) filtering

18 Image acquisition & reconstruction [Mackin D, et al. Invest Radiol 2015;50: ] For all inserts: 1. Calculate normalized feature values 2. Hierarchical clustering

19 Radiomics: great potential Imaging is non-invasive Imaging is routinely and repeatedly performed in radiation oncology Radiomics utilizes the full 3D information of the tumor (in contrast to biopsies) Multiple imaging modalities even more information CT PET(CT) MR Novel: combined PET/MR, dual energy CT

20 Radiomics - animated 20

21 Radiomics ideas for radiation protection Use radiomics to develop markers to easily stratify patients for individualized therapies, interventions and also imaging procedures applying doses in the mid dose range Easy to transfer into clinical practice Verify radiation biology results in patients Improve radiation epidemiology based on patient cohorts due to improved inclusion or exclusion criteria and or feasibility to build sub-groups based on individual radiation sensitivity or susceptibility 21

22 GAP 3 Radiation protection approaches in medical applications based on individual radiosensitivity In many cases, patients are exposed to radiation in a region which is already affected by a disease. This might be correlated with higher or lower sensitivity to ionizing radiation of the exposed organs. It is important to develop methods for medical exposures in diagnostic, minimally invasive or radiotherapeutic procedures based on ionizing radiation to avoid side effects and adverse events by prediction of individual radiosensitivity and develop strategies for adjusting doses correspondingly Research should focus on medical applications. 22

23 GAP 3a Effects of low and high ionizing radiation doses on immune system There is quite some evidence to suggest that high-dose irradiation correlates with immunosuppression, while low-dose irradiation correlates with immunostimulation, at least for quite a number of patients. Animal and patient studies are needed to define radiation dose levels that will promote or suppress the development of an antigen specific and/or antigen non-specific immune response. It could e.g. be investigated on how far such mechanisms are depending on individual patient status or whether they are correlated with individual radiosensitivity. Advanced dosimetric methods should accurately estimate radiation dose to each specific tissue/organ of the body. 23

24 Radiomics entering a new fascinating world of (medical) radiation protection! Thank you for your attention! 24