New MRI-guided cancer treatments could lead to fewer side effects for patients in the future, while also helping to reduce healthcare costs. A ‘hospital without beds’ where patients are mainly treated on an outpatient basis is possible. How do we achieve that? By opening the doors of our hospital to other public and private partners to jointly develop the next generation of imaging and image-guided therapies. That is what Professor Nico van den Berg of UMC Utrecht argues for in his inaugural lecture of 7 September 2022.
MRI imaging technology: a rich field
Since the invention of the MRI imaging technique in the late 1970s, enormous progress has been made in image quality and application possibilities. In addition to anatomy, we can now also map biophysical processes such as tissue perfusion and brain activity. In MRI imaging, raw signals from the body are captured and converted into fantastic images of the human body by a powerful computer.
Reason enough for Nico van den Berg, who was originally a physicist, to get involved in fascinating research into new MRI imaging techniques. Nico van den Berg: “The wonderful field of MRI is extremely rich, there is a lot to discover! The imaging process brings together a mix of disciplines. Within my computational imaging research group, we enrich MRI physics with disciplines such as computer science. But especially mathematics and artificial intelligence and the ever-increasing computing power. This has an enormous stimulating effect on our MRI research.”
Next-generation imaging and image-guided therapies
An innovative application of MRI developed by UMC Utrecht is the MR-Linac. This means that the MRI technique is not only used to make a diagnosis, but also directly used in treatment. The MR-Linac can directly image a tumor and the risk organs just before and during radiation. This leads to a more precise treatment of a tumor and fewer side effects for the patient compared to surgery.
Over the past four years, MRI-guided radiotherapies have been rolled out within UMC Utrecht for the treatment of various cancers. Such as for esophageal cancer, colon cancer, the irradiation of lymph node metastases, pancreatic cancer and prostate cancer. The number of times that a patient with prostate cancer, for example, must be irradiated, has been significantly reduced from twenty to five times. More nerve pathways are also spared, which reduces the risk of impotence.
Artificial intelligence
Van den Berg has been working for a number of years on developing and implementing artificial intelligence to automate and simplify the entire process of MRI-guided radiotherapy. This can reduce the duration of treatments by 30 to 50 percent. That is better for the patient and the care in general. He compares the developments with self-driving cars. “Where we used to plan the journey in advance and set out with the map on your lap, you can now sit in the car and enter your final destination. Your car then drives you autonomously through a combination of sensors and artificial intelligence to your destination. MRI-guided irradiation will also become a highly automated and autonomous process under human supervision of specialized lab technicians. In addition to their direct work with patients, they become more and more data analysts who work with image processing.”
Therapy with real-time imaging
Research continues and Van den Berg expects to see many more developments in his field. For example, the MRI will become a kind of fast motion camera with which realtime the position of the tumor and risk organs, which are often in motion, can be determined. Van den Berg: “This concept of real time imaging in which we constantly adjust the radiation based on the tumor and organ movement, will have to become the standard for all MRI-guided radiotherapy treatments in the coming decade.”
All in all, new MRI imaging techniques can provide patients with less and less invasive treatments and side effects. A ‘hospital without beds’, where patients are mainly treated on an outpatient basis, thus becomes a realistic picture of the future.
Public-private partnerships crucial
As an academic hospital, UMC Utrecht is strong in research into these new MRI image-guided diagnostics and therapies and their translation to the clinic. In order to really make a difference in practice and to be able to bear the costs of innovations, Van den Berg argues in his inaugural lecture to go a step further than science. “As an academic center we have to open our doors to close public-private partnerships. For example, without the engineering experience and capacity of Elekta and Philips, the MR-Linac would not have existed. You need a globally operating company to make a global impact on healthcare. I would like to see co-development field labs set up in our university hospital where both public and private parties come together to develop the new generation of imaging and image-guided therapies together. This is how we make an impact in patient care worldwide.”
The inaugural lecture by Nico van den Berg will take place on September 7, 2022 at 4.15 pm and can be followed live: https://video.uu.nl/lives/academiegebouw_aula/
Photographer: Ed van Rijswijk
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