This piece was originally published in the November 2016 issue of electroindustry.
Richard Frank, MD, PhD, FFPM (RCP), Chief Medical Officer, Clinical Strategy and Policy, Siemens Healthineers
The Cancer Cure Moonshot Initiative is an ambitious and exciting endeavor that MITA fully supports. Curing cancer is impossible without medical imaging. Screening, surveillance, diagnosis, staging, prognostics, choice of therapy, targeting radiation therapy, monitoring therapeutic benefits, and detecting recurrence of cancers are all possible because of ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), positron emission tomography/computerized tomography (PET/CT), positron emission tomography/magnetic resonance imaging (PET/MR), and single photon emission computed tomography (SPECT).
Imaging innovators have been working to discover and develop novel technologies to advance cancer care. Their efforts fall into three categories:
Advancing cutting-edge medical imaging technologies
Prior to the advent of medical imaging, diagnosis was often impossible without invasive exploratory surgery. Recent advances have allowed imaging to go beyond simply viewing anatomy, to characterizing and quantifying pathophysiology. We are still in the dawn of functional imaging and need to continue the development of novel imaging tracers. They contribute to understanding disease not only at an anatomic level but also at the molecular level, giving new insight into disease pathology.
Driving new applications of existing technologies
Even though great advances have been made in imaging technology, there is significant potential yet to be unlocked. We hope medical imaging will be able to
- screen for more cancers, allowing for earlier and less burdensome treatment, as seen with the recent adoption of low-dose CT lung cancer screening, which was a significant step toward detecting this disease at an earlier, more treatable stage;
- be value-additive to in vitro diagnostics—e.g., determining non-invasive score equivalents for prostate cancer by using a multi-parametric MRI after a suspicious prostate-specific antigen test;
- discern more accurately between aggressive and non-aggressive cancers, offering a more nuanced prognosis and informing disease treatment strategy—e.g., identifying which cancers can have an active surveillance approach versus those that need more aggressive treatments;
- optimize therapy decision making by enabling easy, accurate guidance of biopsies to the most aggressive or suspicious locations in a lesion—e.g., guiding prostate biopsy to hot spots visible on pre-procedural MRI but invisible on real-time ultrasound;
- facilitate minimally invasive treatment, which is possible due to advances in interventional radiology, allowing for more effective palliation of tumors that are difficult to access and treat, such as pancreatic cancer;
- identify potential side effects of treatment to minimize complications—e.g., using quantitative strain echocardiography to identify early cardiac toxicity from chemotherapy;
- monitor treatment in real time to maximize damage to cancerous tissue and minimize harm to healthy organs—e.g., using real-time MRI thermometry to guide high-intensity, focused ultrasound treatment of prostate cancer, and targeting radiotherapy to hit only cancerous, and not healthy, tissue;
- predict treatment outcomes earlier in order to quickly adjust treatment plans, improving patient health and reducing costs—e.g., using quantitative MRI to detect cellular changes representing early impact of chemotherapy, allowing change from an ineffective anti-cancer regimen to another method of treatment at an earlier point.
Improving imaging data infrastructure and analytics
Over the past several decades, billions of medical images have been acquired and stored on servers all around the world. This is an untapped wealth of knowledge that should be analyzed in conjunction with clinical metadata, treatments, and outcomes to accelerate our understanding of how cancer can be cured. Unfortunately, images often are siloed in hospitals, imaging facilities, and research centers without a central repository or easy mechanism for data sharing. Access to longitudinal imaging data in a way that does not disclose protected health information must be incentivized. Analysis of this data is a formidable endeavor. Not only is there a vast array of images, but there is also a huge amount of information in them that is accessible by newer technology.
Combining data with information about histological and molecular pathology, as well as clinical conditions and responses to therapy, will offer substantial insight and broad clinical relevance to improved medical outcomes and efficiency in the delivery of medical care.Read the November 2016 issue of electroindustry.