Academic Center for Minimally Invasive Image-Guided Therapy (miIGhTy)

A promising future of therapy is minimally invasive, precise, and one-stop-shop interventions using high quality, intelligent and multi-modal reality image guidance.

Imaging is essential in patient-specific therapy decision-making and individual planning. Intra-procedural real-time imaging enables precise image guidance for those minimally invasive interventions.

Imaging is also crucial for therapy assessment. World-class research exists in the disciplines involved in this field, and we are convinced that a more synergistic use and development of imaging knowledge and technology will lead to better treatment outcome.

The goal for this ACE is to unite the various groups in Erasmus MC working on imaging in oncology and cardiology to foster collaboration and to develop novel minimally invasive therapies.

Academic Center of Excellence

Research Activities

Our ACE spans fundamental, translational and clinical research. At the fundamental level we aim to investigate the impact of the various treatment components on molecular pathways, such that mechanistic insight can feed translation research into improving therapies.

We will investigate molecular targets for imaging and develop novel tracers or MR imaging protocols to evaluate tumor response in real-time. Furthermore, the feasibility of integrating pre-interventional imaging into the images acquired during the intervention to optimize treatment times and increase peri-procedural safety will be explored.

The translational aspect of our ACE in general aims at real time measurements during intervention and treatment. For example, we will develop new sequences and segmentation/image fusion strategies for fast tumor segmentation to enable real time 4D guidance.

Our clinical research, driven by the results from the fundamental and translational research aims at assessing the clinical value of the improved imaging for cancer and cardiovascular disease, and objectively improve the interventional radiologist's tasks with a system of enhanced decision support based on multimodality image and instrument presentation, integration and manipulation. It is clear that these goals can only be achieved in a multidisciplinary context. Furthermore, mutual benefit can be obtained through (inter)national collaborations.

Type of

Collaborations

Educational

Contributions

Clinical education:

  • Bachelor program * Clinical Technology (Medical Delta) * Medical Imaging and Radiation Therapy (MBRT), training of radiographers
  • Master program Technical Medicine
  • Medical Curriculum (Erasmus MC), Bachelor-, Master-level.
  • Resident (AIOS) education
  • COEUR Course Cardiovascular Imaging and Diagnostics Research education: - Bachelor program NanoBiology (TU-Delft/Erasmus-MC)
  • Master program * NanoBiology (TU-Delft/Erasmus-MC) * Technical Medicine: final year of the master
  • Courses on fundamental aspects of NanoBiology
  • Master programs and PhD education within the MolMed, MGC, COEUR, NIHES, and ASCI research schools. - Doctorate education: combined number of PhD Students in all groups is ±16 FTE. - Local, national and international post-doctoral education via symposia, courses, hands-on workshops, dedicated schools, etc.. - The PIs are active in their respective (international) professional societies and the associated educational programs.
  • Level Doctorate/Post-doc. Future plans:
  • Integrate into the educational landscape of the Medical Delta
  • Continue to and improve on the current educational activities. * Contribute to or integrate the lecture programs of imaging, nuclear medicine, cardiology and radiotherapy to enhance overall quality, of various topics: real-time guidance, target definition and tracking and evaluation of response. * novel brachytherapy in combination with hyperthermia, nanoparticle therapies and radiobiology. * evaluation of therapy initiated tumor biological changes and their exploitation.
  • Strengthen and standardize the Erasmus MC-wide Medical Physics knowledge at a high level.
  • Develop relevant courses on fundamental molecular aspects of biology and imaging at the masters level
  • Further development of the new Master program in Clinical Technology (expected 2017) and the educational program of the Medical Delta Imaging Institute, an NWO-recognized Center of Research Excellence.

Patient

Care Activities

The patient care activities within this ACE focus on oncology and cardio- and neurovascular diseases, which all are treated at an academic level of patient care. Some examples are given. In all fields the focus of patient care is to provide real-time image guidance during therapy. Although the therapy objective and technique may differ between applications, the demands on imaging will have many similarities. For the various forms of cancer ablation therapies, including radio-frequency thermo-ablation, brachytherapy, or high precision radiotherapy including robotic radiosurgery and protons the precise location of the tumor/target volume must be known during treatment. For thermal ablation and hyperthermia treatments the demand is extended with temperature monitoring as relevant indicator for the effectiveness of the treatment. Moreover, in general patients with intra-abdominal tumor masses with a critical location are referred for image guided therapy available only in academic hospitals. Likewise to oncology, cardiology interventions in the coronary arteries due to atherosclerosis are centralized in the Netherlands within hospital approved by the WBMV (wet bijzondere medische verrichtingen). Within this ACE patient care for coronary artery is supported by several intravascular imaging techniques to continuous improve outcome of these inventions. These outcomes are registered in "Meetbaar beter" which is recognized within the ErasmusMC program of "Value Based Health Care".

Societal Relevance to Research, Education and Patient Care

Minimally invasive image guided therapies are innovative and expected to contribute to society via a sustainable health care. The formation of this ACE will speed up collaboration between disciplines thus accelerating innovation. To succeed in medicine new treatment options require swift evidence based guidelines and educational material.

Since minimally invasive image guided therapies replace traditional therapies a specific curriculum for the education of medical students and aspiring doctors is required. The latter will be rapidly and best achieved through the multi-disciplinary collaboration within the ACE. Knowledge of and approaches to developing randomized trials between traditional therapies as well as fundamental research are similar and can be shared between disciplines within the ACE.

Education within the context of the ACE strongly benefits from a multi-disciplinary approach ranging from fundamental to clinical and allows a truly translational education from molecule to bedside. Minimal invasive image guided therapies has revolutionized the face of medicine over the last few decades by reducing morbidity and complication rates while increasing treatment options in wide range of disease, especially for oncology and cardiology.

In combination with screening it has improved public health by increasing the possibilities for low impact preventive therapy and reducing health burden in advanced disease. The proposed ACE provides an ideal and mandatory platform for development of care standards and guidelines to facilitate controlled dissemination to smaller centers.

Viability of Research, Education and Patient Care

The ACE is good balanced regarding age distribution, gender, PhD's, junior and senior researchers . In total 18 PhD students are active within the ACE demonstrating the high interest in the field of the ACE. All PhD students participate in international conferences.

The ACE has an excellent viability which is reflected in the number of research grants of different funding agencies and a strong financial support of the research by multiple industry partners (GE, Elekta, Accuray, Astra-Zenica, Pyrexar). The impact of the ACE on the development of the minimal invasive image guided therapy is also reflected by the initiation of two start-ups. Members of the ACE actively participate in (co-)organizing international conference, participate in scientific committees , editors of scientific journals, are board members of International Societies.

Through the well-established international contacts members of the ACE are frequently joining international grant application within the EU-H2020 program for Cost-Actions, International Training Networks and other grant applications. The scientific publications in international peer reviewed journals by the partners of the ACE, contribute strongly to the overall scientific knowledge in the field, which is reflected in the average citation score of the departments of the partners, varying from 1.66 to 2.09 (Erasmus MC average is 1.82).

Key and relevant publications of the last five years

  • J. Banerjee, C. Klink, W.J. Niessen, A. Moelker and T. van Walsum, 4D Ultrasound Tracking of Liver and its Verification for TIPS guidance, IEEE Transactions on Medical Imaging, 2016.
  • Ameziane, N., May, P., Haitjema, A., Van de Vrugt, H.J., Van Rossum-Fikkert, S.E., Ristic, D., Williams, G.J., Balk, J., Rockx, D., Li, H., Rooimans, M.A., Oostra, A.B., Velleuer, E., Dietrich, R., Bleijerveld, O.B., Altelaar, A.F.M., Meijers-Heijboer, H., Joenje, H., Glusman, G., Roach, J., Hood, L., Galas, D., Wyman, C., Balling, R., den Dunnen, J., De Winter, J.P., Kanaar, R., Gelinas, R. and Dorsman, J.C., A novel Fanconi anemia subtype associated with a dominant-negative mutation in RAD51, 2015, Nature Comm, 6, 8829.
  • Olvert A. Berkhemer, M.D., Puck S.S. Fransen, M.D., Debbie Beumer, M.D., Lucie A. van den Berg, M.D., Hester F. Lingsma, Ph.D., Albert J. Yoo, M.D., Wouter J. Schonewille, M.D., Jan Albert Vos, M.D., Ph.D., Paul J. Nederkoorn, M.D., Ph.D., Marieke J.H. Wermer, M.D., Ph.D., Marianne A.A. van Walderveen, M.D., Ph.D., Julie Staals, M.D., Ph.D., Jeannette Hofmeijer, M.D., Ph.D., Jacques A. van Oostayen, M.D., Ph.D., Geert J. Lycklama à Nijeholt, M.D., Ph.D., Jelis Boiten, M.D., Ph.D., Patrick A. Brouwer, M.D., Bart J. Emmer, M.D., Ph.D., Sebastiaan F. de Bruijn, M.D., Ph.D., Lukas C. van Dijk, M.D., L. Jaap Kappelle, M.D., Ph.D., Rob H. Lo, M.D., Ewoud J. van Dijk, M.D., Ph.D., Joost de Vries, M.D., Ph.D., Paul L.M. de Kort, M.D., Ph.D., Willem Jan J. van Rooij, M.D., Ph.D., Jan S.P. van den Berg, M.D., Ph.D., Boudewijn A.A.M. van Hasselt, M.D., Leo A.M. Aerden, M.D., Ph.D., René J. Dallinga, M.D., Marieke C. Visser, M.D., Ph.D., Joseph C.J. Bot, M.D., Ph.D., Patrick C. Vroomen, M.D., Ph.D., Omid Eshghi, M.D., Tobien H.C.M.L. Schreuder, M.D., Roel J.J. Heijboer, M.D., Koos Keizer, M.D., Ph.D., Alexander V. Tielbeek, M.D., Ph.D., Heleen M. den Hertog, M.D., Ph.D., Dick G. Gerrits, M.D., Renske M. van den Berg-Vos, M.D., Ph.D., Giorgos B. Karas, M.D., Ewout W. Steyerberg, M.D., Ph.D., H. Zwenneke Flach, M.D., Henk A. Marquering, Ph.D., Marieke E.S. Sprengers, M.D., Ph.D., Sjoerd F.M. Jenniskens, M.D., Ph.D., Ludo F.M. Beenen, M.D., René van den Berg, M.D., Ph.D., Peter J. Koudstaal, M.D., Ph.D., Wim H. van Zwam, M.D., Ph.D., Yvo B.W.E.M. Roos, M.D., Ph.D., Aad van der Lugt, M.D., Ph.D., Robert J. van Oostenbrugge, M.D., Ph.D., Charles B.L.M. Majoie, M.D., Ph.D., and Diederik W.J. Dippel, M.D., Ph.D., for the MR CLEAN Investigators*, A randomized trial of intraarterial treatment for acute ischemic stroke, N Engl J Med, 2015 1;372:11-20.
  • Oberg K, Modlin IM, De Herder W, Pavel M, Klimstra D, Frilling A, Metz DC, Heaney A, Kwekkeboom D, Strosberg J, Meyer T, Moss SF, Washington K, Wolin E, Liu E, Goldenring J, Consensus on biomarkers for neuroendocrine tumour disease, Lancet Oncol., 2015 Sep;16(9):e435-46.
  • Tham, K.C., Hermans, K., Winterwerp, H., Cox, M.M., Wyman, C., Kanaar, R. and Lebbink, J., Mismatch repair inhibits homeologous recombination by coordinating directional unwinding of trapped DNA structures, 2016, Mol. Cell 51, 326-337.
  • Datta NR, Ordóñez SG, Gaipl US, Paulides MM, Crezee J, Gellermann J, Marder D, Puric E, Bodis S. Local hyperthermia combined with radiotherapy and-/ or chemotherapy: Recent advances and promises for the future. Cancer Treatment Rev, 2015 Nov; 41(9):742-753
  • Baka N, Leenstra S, van Walsum T. Ultrasound Aided Vertebral Level Localization for Lumbar Surgery. IEEE Trans Med Imaging. 2017 Oct;36(10):2138-2147
  • Heijmen B, Voet P, Fransen D, Penninkhof J, Milder M, Akhiat H, Bonomo P, Casati M, Georg D, Goldner G, Henry A, Lilley J, Lohr F, Marrazzo L, Pallotta S, Pellegrini R, Seppenwoolde Y, Simontacchi G, Steil V, Stieler F, Wilson S, Breedveld S. Fully automated, multi-criterial planning for Volumetric Modulated Arc Therapy - An international multi-center validation for prostate cancer. Radiother Oncol. 2018 Aug;128(2):343-348.
  • Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial. Incrocci L, Wortel RC, Alemayehu WG, Aluwini S, Schimmel E, Krol S, van der Toorn PP, Jager H, Heemsbergen W, Heijmen B, Pos F. Lancet Oncol. 2016 Aug;17(8):1061-1069.
  • Lutgens LC, Koper PC, Jobsen JJ, van der Steen-Banasik EM, Creutzberg CL, van den Berg HA, Ottevanger PB, van Rhoon GC, van Doorn HC, Houben R, van der Zee. Radiation therapy combined with hyperthermia versus cisplatin for locally advanced cervical cancer: Results of the randomized RADCHOC trial.J. Radiother Oncol. 2016 Sep;120(3):378-382.

PhD theses of the last five years

  • Jyotirmoy Banerjee (2016) Fast 4D Ultrasound Registration for Image Guided Liver Interventions
  • Valerio Fortunati (2015) Automatic Patient Modelling for Hyperthermia Treatment Planning of Head and Neck Cancer
  • Steven van de Water (2015) Optimizing planning & delivery of high-precision robotic radiotherapy & intensity-modulated proton therapy
  • R. Verhaart (2016) Patient Modeling for Simulation Guided Head and Neck Hyperthermia
  • Esther van Vliet (2013) 177Lu-octreotate in Neuroendocrine Tumors: Treatment Effects
  • N. van den Tempel (2017). Hyperthermia-induced degradation of BRCA2 : from bedside to bench and back again.
  • F. Adibzadeh (2017) Exploring the Safety Margin in Current Guidelines for Electromagnetic Exposure.
  • S. Aluwini (2016) Hypofracionated radiotherapy for prostate cancer: How far can we go?
  • Luu Manh Ha (2017) Image Analysis for Guidance in Minimally Invasive Liver Interventions
  • S.T. Heijkoop (2017) Plan-of-the-Day Adaptive Radiotherapy for Locally Advanced Cervical Cancer.

Non-scientific publications related to the ACE

Principal coordinator(s)

Last updated: 365 days ago.