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An Introduction to Molecular Imaging in Radia-
tion Oncology :A report by the AAPM Working Group on Molecular Imaging in Radiation
Oncology(WGMIR)
Tuesday Seminar 24th, Dec, 2013
Radiological Physics Lab, Seoul national university
Seongmoon Jung
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Outline
• Introduction
• Molecular Imaging Modalities and Techniques
• Molecular Imaging Challenges in Clinical Radiation
Oncology
• Conclusion
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Introduction• Definition
“ Directly or indirectly monitor and record the spatiotemporal distribution
of molecular or cellular processes for biochemical, biologic, diagnos-
tic, therapeutic applications.”
– Radiological Society of North America(2005)
“ The visualization, characterization, and measurement of biological
processes at the molecular and cellular levels in human and other liv-
ing things……”
– Society of Nuclear Medicine(2007)
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Molecular Imaging
Tumor cells
Biological Character
Physiologicalchange
Spatial extent
Define Target
Treatment Planning
Introduction• Background
Accurate &Optimized
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• Interest to the radiation oncology community
- Imaging of biological tumor characteristics Such as presence of hypoxia, proliferation rate
- diagnosis, radiation treatment, evaluation in the molecular manner
Introduction
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Molecular Imaging Modalities
and Techniques
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Molecular Imaging Modalities and Techniques
• 5 devices for molecular imaging
(a) PET
(b) SPECT
(c) MRI
(d) Optical imaging
(e) Ultrasound
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Molecular Imaging Modalities and Tech-niques
A. PET – (1) Basic Principle
• Simultaneous detection of annihilation X-rays ( two 511 KeV) of a positron
- coincident event - random(false) event - scatter event
• Positron emitting Radionuclides(Short half life) + biological tracer molecule(Ligand) to localize in vivo in tissues
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Molecular Imaging Modalities and Tech-niques
A. PET – (2) Spatial Resolution
• The finite positron range - depends on the radioisotope, the type of tissue
• Noncolinearity of the annihilation photons
• Pet scanner itself (detector size)
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Molecular Imaging Modalities and Tech-niques
A. PET – (3) application in oncology
• FDG to image metabolically active, increased glycolysis - presence of tumor, inflammation
• Cerebral blood flow using 15O H2O, tumor hypoxia with 18F fluo-romisonidazole, cell proliferation with 11C thymidine
• The hybrid PET-CT
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A. PET – (4) application in oncology
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Molecular Imaging Modalities and Tech-niques
B. SPECT –(1) basic principle
• Detection of gamma decay X-rays by radiolabeled agents
• Gamma emitting radioisotopes + Ligand (99mTc, 111In, 67Ga, 131I, 201Tl )
• Detector called the Anger gamma camera rotated around the object 3 or 6 degree, 120 or 60 projection data mathematically reconstruction
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Molecular Imaging Modalities and Tech-niques
B. SPECT – (2) Compared to PET
• Disadvantage - Using a collimator reduction of sensitivity - Less radiation event poorer spatial resolution
• Advantage - Multiple radiotracers can be administered and detected - Relatively long half life radioisotopes slow biological pro-
cesses - Availability for research even at labs far away from cyclotron facilities
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Molecular Imaging Modalities and Tech-niques
B. SPECT – (3) application in oncology
• A number of radiolabeled tracer for specific tumors
• In early work, pre- & post- optimization of lung treatment plans also in brain tumor and malignant lymphoma
• Different organs or functions monitored simultaneously
• Hybrid SPECT-CT in oncology, cardiology and neuropsychiatry
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B. SPECT – (3) application in oncology
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Molecular Imaging Modalities and Tech-niques
C. MRI – (1) Basic Principle
• The origin of signal is the magnetic dipole moment - External magnetic field(B0) - RF coil - Gradient coil
• Signals (SNR, signal-to-noise ratio) - T1, T2, T2* relaxation time
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Molecular Imaging Modalities and Tech-niques
C. MRI – (2) Four types of MR
• MRSI
• Perfusion MRI
• Diffusion MRI
• Functional MR(fMRI)
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Molecular Imaging Modalities and Tech-niques
C. MRI – (3) fMRI & MRSI application
• MRSI detect, quantify, differentiate neo-plastic disease processes in the brain, breast and prostate
- By changes of N-acetylaspartate(NAA) choline lactate, creatine citrate
• fMRI - Using BOLD (blood oxygen level-dependent) contrast Relative concentration of deoxyhemoglobin and oxyhemoglobin
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C. MRI – (3) fMRI , MRSI application
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Molecular Imaging Modalities and Tech-niques
D. Optical Imaging – (1) Basic Principle
• Detection of visible and infrared photons transmitted through biological tissues
• Short penetration depth - In vitro measurements - Surface in vivo of small animals
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Molecular Imaging Modalities and Tech-niques
D. Optical Imaging – (2) Four types
1. Bioluminescence
2. Fluorescence – GFP
3. Diffuse optical tomography(DOT)
4. Optical coherence tomography(OCT)
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Molecular Imaging Modalities and Tech-niques
E. Ultrasound
• Development of ultrasound- Characterization of tissues through Spectral analysis- Enhancing image quality by the use of specialized contrast agents
• High spatial resolution, real-time imaging• But poor image quality
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Molecular Imaging Modalities and Tech-niques
E. Ultrasound• Contrast Agent, Microbubbles
- Small gas-filled bubbles(1~10μm diameter, 10~200nm shell thickness)- Provide contrast due to echogenicity of its gas or shell- Attachment of antibodies, peptides, ligands
• Application- Blood vessel detection- Assessment of perfusion and vascular delivery of drugs- Detection of inflammation and angiogenesis of tumors
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Summary
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Summary
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Molecular Imaging Challenges in
Clinical Radiation Oncology
A. Spatial scale in molecular imaging
B. Image quality
C.Biologic structure definition and response
D.Biological modeling & application for treatment planning and response assessment
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Molecular Imaging Challenges in Clinical Radiation Oncology
A. Spatial scale in molecular imaging
• Spatial scale covers 4 orders of magnitude presents challenges with respect to integrating such data into a clinical radiation treatment system
• Although resolution is improving due to technological advantages, fundamental physical limits exist
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Molecular Imaging Challenges in Clinical Radiation Oncology
B. Imaging Quality• It depends on a number of complex interacting factors including - the physical processes affecting the signal - origination(depth and surrounding tissues) - spatial & temporal resolution - noise …..
• Each modality requires specialized QA and quality control - individual calibration or QA for each patient
• Standardized phantoms, QA tests and benchmark data for various lesion locations would be valuable for future work
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Molecular Imaging Challenges in Clinical Radiation Oncology
C. Biologic structure definition and response
• Challenges in radiation treatment1. Image transmission
2. Registration of multimodality images
3. Image interpretation
4. Composition of the target and critical volumes from a set of multi-modality image
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Molecular Imaging Challenges in Clinical Radiation Oncology
C. Biologic structure definition and response• Accurate image interpretation is required - Experts - Software tools
• Even above challenges are accepted, the clinical use of molecular images is still challenged by the needs to
define a target volume
• Biological target volumes for multimodality image sets will not be congru-ent in size or shape
• Temporal effects must also be addressed when defining the target
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Molecular Imaging Challenges in Clinical Radiation Oncology
D. Biological modeling & application for treatment planning and response assessment
• Predicted models based on biological data from molecular images provide information to therapeutic decisions and prognoses
• Standardized image acquisition and processing techniques required To routinely use in biological modeling of radiation dose response
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Conclusion• Molecular imaging is not only imaging a specific cell or molecular di-
mensional objects, but also imaging their molecular or biological pro-cesses
• High resolution anatomical imaging + high sensitivity molecular imaging can achieve volumetric tumor characterization and quantitative model-ing of tissue irradiation
• For the clinical application - accurate registration- clinical interpretation of data
- target definition- image quality
• Great challenges and opportunities for collaborations through the con-vergence of molecular biology, diagnostic radiology, radiation oncology, physics, imaging science, chemistry, and other fields
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Discussion & Question
Thank you for your attention !
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MRI
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