Modern imaging technologies are indispensable for the diagnosis and treatment of most disease processes. Radiology is the medical specialty is based on the use of these technologies. Radiological imaging methods are rather macroscopic than microscopic. The most common issues are cardiovascular, neurological and oncologic diseases. A basic understanding of the various pathologies is needed to select the most appropriate imaging technology to make the fastest and most cost-effective diagnosis. When selecting the most appropriate diagnostic method it is also indispensable to have some basic knowledge of the available imaging technologies. Currently, a wide array of diagnostic imaging modalities is available, including x-ray technology, ultrasound, computer tomography (CT), magnetic resonance imaging and spectroscopy (MRI/MRS) and nuclear medicine (e.g. PET scanning). It is important to know the physical principles underlying these technologies in order to understand why a specific technique may be the most appropriate choice to diagnose a specific disease entity. For example, understanding the high contrast resolution of MRI may help to explain the sensitivity of MRI for detecting subtle brain abnormalities like multiple sclerosis, that may go undetected by other imaging modalities. Other examples are the diagnosis and staging of tumors in the bone, the diagnosis and treatment of liver metastases and the diagnosis of heart disease. The selection of the best imaging strategy requires understanding of the pathology under investigation as well as the strengths and limitations of the available techniques. Also treatment of disease (e.g. liver tumors) is more and more based on guidance by radiological imaging. The CT scan can diagnose a liver tumor, but can also can be used to guide a needle or other instrument to a particular tumor location to deliver local treatment (e.g. by local destruction using thermoablation). In modern medicine the trend of ‘minimally invasive interventions’ will proceed and become more and more sophisticated. This development is also important to guide new treatments with gene products and other compounds.
This opens the field of ‘molecular imaging’. Radiology will play a significant role in diagnosing pathology, treating the abnormality and monitoring the success of gene therapies. A crossroad is now developing between non-invasive diagnosis and treatment as well as new developments in molecular imaging. The key question is how to use these technologies in an optimal way to improve patient care.The processing of all the data generated by the various scanners has to be analyzed in an effective manner to draw conclusions ‘on-line’. Image processing is an important and active field of research and clinical application which provides easy and immediate access to the diagnostic information generated by CT, MRI, PET, ultrasound and x-ray machines. Quantification of the available data is crucial for the actual diagnosis, but also for research purposes, e.g. to evaluate new therapies.
One goal of this module is to highlight current clinical applications (cardiovascular, oncology, neurology) of modern radiological imaging modalities (x-ray, ultrasound, CT, PET, MRI). The module will provide insight into the significance of these disease processes and discuss the current and future contribution of medical imaging technology. Next to visualization of organs for diagnostic purposes, imaging is also extensively used at the cellular, subcellular and even molecular level, using light microscopy (for instance fluorescence-based) or electron microscopy. Particularly, tagging of virtually any cellular protein with GFP (green fluorescent protein) allows the study of molecular dynamics in living cells, which is considered essential to unravel the molecular mechanisms (and the defects therein) that underlie disease.Especially for preclinical studies in live animals optical imaging is an extremely sensitive and relatively simple and inexpensive technology. Recent technical developments in optical imaging have made it possible to visualize non-invasively transgene expression in intact animals. This offers the possibility to study spatial distribution and temporal expression of the transgene and thereby enabling analyses of cellular and molecular events involved in many disease processes. Especially the development of extremely sensitive cooled CCD cameras and fluorescent (e.g. GFP) and bioluminescent (luciferase) gene reporter constructs have made non-invasive in vivo optical imaging a powerful new tool in the study of small animal models of human biology and disease. Optical imaging can be applied to study cell- and tissue specific promoters but also to follow trafficking and fate of GFP and/or Luciferase expressing cells, apoptosis, protein-protein interaction and gene-transfer. In cancer research, these applications have allowed quantitative measurements of tumor progression and metastasis and treatment response. Due to its high sensitivity FLI, and especially BLI, are extremely useful for early detection of micro-metastases and minimal residual disease states in animal models. Electron Microscopy (EM) has recently re-emerged as imaging tool in biomedical research, due to technological and computational advances. EM opens new roads to gain information on biological systems and their cellular regulation. For instance microtubular dynamics and the transport mechanisms of organelles and molecules to the plasma membrane can be now studied in great detail. Further topics of ongoing research are the structure of isolated virus particles and the biogenesis of virus within the cell. Imaging Mass Spectrometry is a new technology for mapping tissue sections. It combines the biochemical information provided by present-day mass spectrometry with the spatial distribution of a microscope. Parallel spatial analysis of hundreds of distinct biomolecules without the need of a label, combined with the ability to distinguish between isoforms, post-translational modifications and metabolites, has seen the technique identified as a powerful new discovery tool and lead to a rapid growth of interest in this field.
Nanostructures are present everywhere in biological systems, from proteins to cytoskeletons and from molecular motors to nanopatterned leaves, and have specific structural or more complex functions.
In the past decades, also non-biological nanostructures have gained wide attention, from bio-mimetic structures like hydrophobic ‘self-cleaning’ surfaces, to self-assembling and self-healing materials. Non-natural nanomaterials can also be found in biological systems, e.g. administrated as medicine. The understanding of interactions of these non-natural nanosystems with bio-molecules and structures is of paramount importance, not only for medicinal purposes, but also for understanding nanotoxicological aspects. There are two main strategies to make nanoscale materials, the top-down and the bottom-up approach, and both will be covered in theory as well as in practical classes. The top down strategy is a more (microtechnological) engineering approach; the bottom-up approach finds its base in self-assembly and supramolecular chemistry.
In this minor we will touch on the various areas where nanomaterials play a role in plants and organisms, as well as in new (hard and soft) materials. In the ‘Introduction to Bionanotechnology’ course, the emphasis is on biological, bio-mimetic, bio-inspired or newly developed nanomaterials; particularly stimuli-responsive or sensing nanoparticles and functional surfaces will be treated. Microscopic and spectroscopic techniques play a crucial role in bionanotechnology and its applications, and ample attention will be given to imaging techniques (for example, in the ‘Cell Biology and Advanced Imaging Technologies’ course). In the master-course ‘Bionanotechnology: towards nanomedicine’, the focus will be more explicitly on applications of nanomaterials in medicinal applications, from diagnostics, devices and screening methods to antibacterial and cropprotection applications, to diagnostic, therapeutic and multimodality. Also ethical aspects of bionanotechnology research and applications will be covered.
For the fourth year in a row we organised a course on translational nanomedicine for the University of Wageningen “bionanotechnology” minor coordinated by prof. Velders and the BioNT-group. Lectures that link nanotechnology to medicine were combined with hands-on experience with different types of molecular imaging technologies. This year we included the topics: Image Guided Surgery, Cell-Tracking and Malaria.
On June 15th a workshop on Interventional Molecular Imaging and Radioguided Surgery in Urologic Oncology was realized in Toledo in the context of the Annual Spanish Congress of Urology. In the workshop the methodological aspects of laparoscopic sentinel node procedures in prostate cancer and other urological malignancies were presented and discussed by the urologists Manuel Martínez and César Vera Donoso (University Hospital La Fe, Valencia) together with the nuclear physicians Sergi Vidal Sicart (University Hospital Clinic, Barcelona) and Renato Valdés Olmos (LUMC).
On March 21th and 22th two workshops on Interventional Molecular Imaging and Radioguided Surgery were realised in Rome. The first workshop (chairman Prof. Riccardo Faccini) was effectuated at the Faculty of Physics of La Sapienza University (Fig. 1) and was principally oriented to physicists and technological specialists. This workshop included a visit to the laboratory of Prof. Faccini and his group, where a novel pencil-sized β- probe was demonstrated. The second workshop (chairman Prof. Alessandro Giordano) was held at the Gemelli Hospital of the Sacro Cuore University (Fig. 2) with participation of nuclear medicine and surgical disciplines. In this workshop the clinical applications and future possibilities of radioguided interventions as well as international cooperation in this field were discussed.
Workshop on Interventional Molecular Imaging and Radioguided Surgery held at the Sapienza University of Rome on Monday 21th March 2016
Workshop on Interventional Molecular Imaging and Radioguided Surgery held at the Gemelli Hospital of the Sacro Cuore University of Rome on 22th March 2016
On the 15th of Januari 2016 we had a visit from students attending the bionanotechnology minor at the University of Wageningen. For the third year in a row we join in on the exciting curriculum provided by prof. Velders and his colleagues at the BioNT-group. Next to lectures on the clinical translation of hybrid imaging agents and the use of nanoparticles in a clinical setting, the students got hands-on experience in different types of image guided surgery. It was fun to do and we are looking forward to next year!
As part of a refresher course of Nuclear Medicine in Oncology for Argentinian nuclear physicians and other clinical disciplines, a 3-day Workshop on Interventional Imaging and Radioguided Surgery was realized at the Instituto de Oncología Angel Roffo of the University of Buenos Aires in the second week of November 2015. Multidisciplinary presentations and hands-on sessions were transmitted by real-time teleconferencing to enable interactive participation at distance from regional Argentinian hospitals. The organization of the event was supported by the Comisión Nacional de Energía Atómica (CNEA) and the International Agency for Atomic Energy (IAEA).
In light of the collaboration between our group, the department of Head and Neck Surgery and Oncology of the Antoni van Leeuwenhoek Hospital and the department of Otorhinolaryngology & Head and Neck Surgery of the Radboud UMC, there were demo’s given on fluorescence guided surgery at the opening of the new MITeC (Medical Innovation & Technology expert Center) operating rooms in Nijmegen.
The movie that was shown at the opening of the MITeC Radboud UMC to illustrate the concept of image-guided surgery that will be pursued in our collaboration:
(Intervention) Radiologists; Nuclear Medicine Physicians; Surgeons, Urologists, Gynaecologists; Residents, trainees, PhD students, post-docs and technicians interested in the field of image-guided interventions; Engineers; Researchers interested or practicing in any of the above-mentioned fields.
Certificate of attendance
Upon request, participants receive a certificate of attendance upon completion of the meeting.
CME accreditation points
This symposium has been accredited for 7 European CME credits (ECMEC) by the European Accreditation Council for Continuing Medical Education (EACCME). Upon request, participants receive a certificate.
This symposium is supported by
EANM translational molecular imaging committee; Radioguided surgery network; The European Robotic Urology Society (ERUS) of the European Association of Urology.
The two-day event will cover the (clinical) state-of-the-art in image-guided interventions. Through the combined set-up, interventions in interventional radiology, radioguided surgery and fluorescence-guided surgery will be covered. We aim to educate the participants on the variety of the available image?guidance technologies and discuss their potential in clinical practice. Didactic activities are coupled to a number of hands-on sessions that will allow clinicians and researchers to "experience" what commercially available image guidance technologies have to offer and how they may be implemented in the routine clinical workflow.
Upon completion of this meeting the attendee will be able to:
Evaluate the role of interventional molecular imaging in diagnosis and therapy of patients;
Indicate the scope and limitations of the various surgical guidance modalities (radiological, nuclear medicine, and optical);
Describe the various techniques that are available for image-guided interventions and assess how they can be used in a clinical setting;
Establish which criteria (handling, physics and associated-costs) are instrumental for the selection of an imaging modality for a particular clinical application;
Evaluate (criticize and assess) the clinical application of (new) interventional imaging research lines;- radioguided approach;- optical imaging based approach (fluorescence or Cherenkov).
Friday April 10th 2015
PSMA guided resection of metastatic prostate cancer lesions
Tobias Maurer, MD, PhD (Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany)
Radioguidance technologies for gynaecological applications
Sergi Vidal-Sicart, MD (Department of Nuclear Medicine, Hospital Clinic Barcelona)
Cerenkov imaging for surgical guidance
Jan Grimm, MD, PhD (Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York City, NY, United States)
What do we need to make new technologies for image-guided interventions commercially interesting?
Jonathan Sorger, PhD (Intuitive Surgical Inc., Sunnyvale, CA, United States)
Use of iodine seeds as guidance method during a neo-adjuvant treatment protocol for breast cancer
Marie-Jeanne Vrancken Peeters, MD, PhD (Department of Surgery, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands)
Use of 3D imaging technologies during needle based interventions
Marco van Strijen, MD, PhD (Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands)
Ultrasound based navigation to enable ablation of lesions in the liver
Mark Burgmans, MD (Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands)
Cross sectional imaging during angiography in Interventional Radiology: What value does it add?
Bien Soo Tan, MD, PhD (Department of Diagnostic Radiology, Singapore General Hospital, Singapore)
Saturday april 11th 2015
First-in-human experience fluorescence based C-Met imaging during colonoscopy
James Hardwick, MD, PhD (Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands)
Fluorescence guidance during laparoscopic robot-assisted procedures
Henk G. van der Poel, MD, PhD (Department of Urology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands)
Fluorescence guidance in gynaecology
Alexander L. Vahrmeijer, MD, PhD (Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands)
Sentinel node procedure for melanoma patients
Omgo E. Nieweg, MD, PhD (Melanoma Institute Australia, Sydney, NSW, Australia)
The poster session on Friday afternoon (5.45 till 7.00 pm) is aimed to encourage discussions between the participants of the congress. Such discussions can provide a basis for (research) collaborations between the participants with a different background.
Please submit a 300-word abstract (structure: introduction, purpose/aim, material and methods, results and conclusion/discussion) to N.S.van_den_Berg@lumc.nl before March 15th 2015. Notification of abstract acceptance will be sent out on March 22nd 2015.
Portable gamma camera technologies for radioguided surgery
Ultrasound and radioguided-based navigation (declipseSPECT) technologies
A hybrid trachnology for combined gamma- and near-infrared fluorescence tracing
KARL STORZ Endoskope
Near-infrared fluorescence guided surgery for endoscopic applications
Near-infrared fluorescence guided surgery for open surgery procedures
Intuitive Surgical Inc.
Robot-assisted near-infrared fluorescence guided surgery using the da Vinci XI platform
(Navigated) Ultrasound-guided interventional radiology: Needle placement using a navigation option
An impression of the hands-on sessions is given below.
During the Leiden International Medical Student Conference the IMI-lab will be giving a workshop on Saturday the 14th of March: "Hands-on introduction into radio-, fluorescence- and ultrasound-guided interventions"
A short overview of what will be covered in this workshop:
Navigation technologies (radio-, fluorescence- and ultrasound-guided) are becoming more and more important for local-regional interventions as such to further minimize this type of image-guided surgical procedures. In this workshop you will be getting a hands-on experience with the latest technologies used in modern-day interventions. The participant can explore the use of an intraoperative navigation system combined with a mobile camera for the localization of radioactive hotspots (representing e.g. tumors, sentinel nodes). Moreover, the participant will be able to experience the concept of navigated ultrasound-guided biopsy for the precise needle positioning in a liver phantom containing lesions. Finally a fluorescence imaging system will be demonstrated and the participant will be able to experience hands-on how fluorescence-guidance can help excise target lesions. Through the various phantom experiments the participant will get a feel for the available navigational technologies and their clinical potential.
On the 12th and 13th of february a symposium on radioguided surgery was held in Barcelona as part of the radioguided surgery network. Dr. Fijs van Leeuwen gave a talk on specific hybrid tracers for various surgical applications. In the image below you can see Renato Valdes-Olmos, Sergi Vidal-Sicart and Omgo Nieweg in the midst of a presentation.
32 students from the bionanotechnology minor in Wageningen visited the LUMC. Next to lectures on the clinical translation of imaging agents and the use of nanoparticles for surgical guidance, they participated in workshops on radio guided surgery (declipseSPECT technology; SurgicEye), fluorescence guided surgery (Firefly technology; Intuitive Surgical Inc.), and interventional radiology (Logic E9 technology; GE Healthcare). It was a very successful day!
A hands-on workshop was organised by Prof. Dr. Hans-Jürgen Wester, Prof. Dr. Nassir Navab and Dr. Fijs van Leeuwen at the laboratory of Prof. Dr. Navab at the Technical University of Munich. The day was organised to demonstrate the use of both intraoperative navigation and fluorescence imaging. Dr. Fijs van Leeuwen gave a presentation on the use of both techniques during surgery.
Working with the SurgicEye DeclipseSPECT system.
Excising a fluorescent node in a silicone phantom using the Hamamatsu PDE camera.
The first hands-on laparoscopic fluorescence workshop in Amsterdam. Thanks to all for your attendance and input!
Top row, left to right: Thijs Engelen, Miguel Ramirez Backhaus, Angela Collarino, Sergi Vidal-Sicart, Cenk Acar, Maureen Kraaijenbrink(Karl Storz), Henk van der Poel(Organiser), Seçkin Yilmaz(Karl Storz) Bottom Row: Matthias van Oosterom, Nynke van den Berg
During the ERUS urology conference 2014, a live surgery was performed in front of 800 urologists from all across the world. A video of a fluorescence and radioguide sentinel node biopsy performed by dr. Henk van der Poel using the Da Vinci Surgical robot by Intuitive Surgical and presentations by Dr. Fijs van Leeuwen can be found at the Multimedia page.