The diagnosis of cancer is of major impact for each new patient faced with this dreaded diagnosis. At the beginning of every individual treatment planning the correct staging of the disease is of utmost importance. It is inalienable to know if the tumour has spread to the lymphatics. To exclude any regional metastases, different tumours warrant different staging procedures. Evident regional disease is most often treated surgically in the context of tumour ablation for many different tumour sites (e.g., breast cancer, melanoma). In head and neck squamous cell carcinoma (HNSCC) the removal of the lymphatics is called neck dissection. The neck contains dozens of lymphatic vessels and draining nodes in a complex anatomic area. The procedure harbours a variety of potential risks such as nerve injury resulting in shoulder dysfunction, dysphagia, or facial asymmetry. Before the removal of the regional lymphatics, clinical examination and imaging will be performed to assess any potential extent of spread. If there is no clinical and radiologic evidence of regional involvement the term ”clinically negative neck” (cN0-neck) is used.
In this research, we focused on developing a portable gamma-ray detector with augmented reality for the rapid and precise identification of radioactively enriched sentinel lymph nodes (SLN). This detector is integrated into a surgical navigation system and can be supplemented with ultrasound images. This device provides the specialist with better support during the biopsy of the SLN and increases the effectiveness of the procedure for the subsequent tissue analysis of the lymph nodes. The 1st project stage includes the creation of a functional model. The 2nd stage of the project ultimately aims to create a prototype that can be used for clinical trials.
With the sensor developed in this way, sentinel lymph node biopsy can be significantly improved and also accelerated.
What is special about the project?
If we are able to provide the planned mobile SPECT camera device in a handy and surgeon friendly manner the device could be a major step towards hand-held radio-guided sentinel node biopsy technique not only for head and neck surgeons but also for breast and melanoma surgeons. Globally there exists a total of about 20'000 hospitals (US 7'000, EU 10'000, Others 3'000) of which about 20% perform sentinel node biopsies, translating into about 4'000 hospitals worldwide with a potential use of our device. If we calculate 10% applicability for MOONSTAR there is a market for about 400 devices. Besides the technically-inspired research aims, the study will provide new insights into basic lymphatic drainage pathways. There is an increasing interest how malignant drainage is functioning. If one could minimally invasive apply drugs or other agents into the drainage basin one could imagine of minimally invasive target imaging and therapy in the future.
The initially proposed idea of augmenting the image of an optical camera with the tracer activity measured with a gamma camera has shown to be feasible. In the middle of the project, we realised, however, that our multi-pinhole collimator design enabled a richer analysis of the data. More precisely, one single image of the multi-pinhole collimator allows calculating the three-dimensional distribution of the radioactive tracer using techniques known in mathematics from ill-posed inverse problems. This more powerful analysis enables not only to visualise the direction of the activity to the surgeon but also provide depth information. Even more important, we can also visualise this rich data using Virtual or Augmented Reality glasses. Currently, we are preparing for a first application of the sensor on tumour patients. Patents have been filed.
von Niederhäusern, P. A.; Maas, O. C.; Rissi, M.; Schneebeli, M.; Haerle, S. & Cattin, P. C., Augmenting Scintigraphy Images with Pinhole Aligned Endoscopic Cameras: A Feasibility Study, Medical Imaging and Augmented Reality (MIAR), 2016, 175-85;
Seppi, C.; Nahum, U.; von Niederhäusern, P. A.; Pezold, S.; Rissi, M.; Härle, S. & Cattin, P. C., Compressed Sensing on Multi-Pinhole Collimator SPECT Camera for Sentinel Lymph Node Biopsy, Medical Image Computing and Computer Assisted Interventions (MICCAI), 2017, 415-22;
Nahum, U.; Seppi, C.; von Niederhäusern, P.; Pezold, S.; Haerle, S. & Cattin, P., Sentinel Lymph Node Fingerprinting, Physics in Medicine and Biology, 2019, accepted;
Cattin, P. C. & Haerle, S., Imaging Device and Method of Visualizing a Sentinel Lymph Node, 2016, Patent EP16180176.6;
Cattin, P. C. & Haerle, S., Imaging Device and Method of Visualizing a Sentinel Lymph Node, 2018, Patent WO 2018/015437;
Nahum, U.; Seppi, C.; von Niederhäusern, P.; Pezold, S.; Härle, S. & Cattin, P. C., Imaging Device, Process of Manufacturing Such a Device and Visualization Method, Swiss Patent CH 00089/18, Date 25/01/2018;
Nahum, U.; Seppi, C.; von Niederhäusern, P.; Pezold, S.; Härle, S. & Cattin, P. C., Imaging Device, Process of Manufacturing Such a Device and Visualization Method, Patent PCT/EP2019/051828;
von Niederhäusern, P. A.; et al., Depth Statistics Learning from Modeled Multi-Pinhole Collimator Data, MICCAI Conference, submitted
Persons involved in the project
Prof. Dr. Philippe C. Cattin
, Projektleiter, Leiter Dept. of Biomedical Engineering, Center for medical Image Analysis and Navigation (CIAN), Universität BaselProf. Dr. med. Stephan Haerle
, Co-Projektleiter, Zentrum für Kopf-Hals-Chirurgie, Hirslanden Klinik St. Anna Luzern, Lehr- und Forschungsbeauftragter an der Universität Basel
Uri Narhun, PostDoc, Departement of Biomedical Engineering, Universität Basel
Simon Pezold, PostDoc, Departement of Biomedical Engineering, Universität Basel
Peter von Niederhäusern, PhD Student, Departement of Biomedical Engineering, Universität Basel
Carlo Seppi, Mathematician, Departement of Biomedical Engineering, Universität Basel
Dr. Ole Maas, Departement für Nuklearmedizin, Universitätsspital Basel
Michael Rissi, DECTRIS AG, Baden/Dättwil
Last update to this project presentation 11.10.2019