* Image-based multi-scale physiological planning for ablation cancer treatment

IMPPACT is a European FP7 ICT-Project (STREP) started on 1.09.2008 with the end on 31.08.2011. It aims to develop an intervention planning system for Radiofrequency Ablation of malignant liver tumours.

Radiofrequency Ablation (RFA) is a minimally invasive form to treat cancer without open surgery, by placing a needle inside the malignancy and destroying it through intensive heating. Though the advantages of this approach are obvious, the intervention is currently hard to plan, almost impossible to monitor or assess, and therefore is not the first choice for treatment.

Description of the way to implement the initiative

IMPPACT will develop a physiological model of the liver and simulate the RFA intervention's result, accounting for patient-specific physiological factors.

• Closing gaps in the understanding of particular aspects of the RFA treatment by multi-scale studies on cells and animals
• Transforming microscopic findings and into macroscopic equations
• Extending the long-established bio-heat equation to incorporate multiple scales
• Validating results at multiple levels
• Cross-checking validity for human physiology by comparison to images from ongoing patient treatment
• Visual comparison of simulation and treatment results gathered in animal studies and during patient treatment
• Extensive validation together with a user-centred software design approach guarantee suitability of the solution for clinical practice

Mathematical modelling together with experimental validation lead to a patient specific intervention planning system.

Patients can only be examined radiologically and prediction therefore has to rely on macroscopic parameters and tissue properties that can be measured minimally invasive. However, during the heating process microscopic changes at a cellular level affect the end result and should be incorporated the macroscopic equations to allow patient specific prediction. Therefore, both scales are dynamically linked together implying the multi-scale modelling approach to gain iteratively the optimum description. IMPPACT will use several approaches on the macroscopic scale:

• Creation of a complete virtual liver model and simulation of changes in computational results as a function of variations in the complete model. This will investigate the accuracy and tolerance with regards to macroscopic properties such as blood pressure and temperature, but also patient-specific tissue properties.
• Visualization of the RFA process subject to variations in the models parameters in the ablation algorithm. By providing visual comparison of the results from RFA simulations one can better investigate the impact of different parameters on the ablation outcome.
• Developing empirical models for different ablations in identical tissue properties as well as across tissue properties.

On the microscopic scale the key feature of the modelling approach is the characterisation of detailed models at one length scale such that they provide 'lumped' parameters for use at larger length scales:

• Developing a model of cell death due to heating based on existing models of cellular death but adapted specifically for the liver.
• Construct a model of a region of cells: The 'empirical' results obtained from the cellular model yield microscopic behaviour over a larger length scale. Treat the model with different heating rates and doses.
• Incorporate models of the micro- and macro-vasculature into the 'super-cellular' model, to link the behaviour to the blood supply and blood pressure.

By integrating modelling, imaging and visualization in a full simulator, IMPPACT will create the Intervention Planning System (IPS) as a clinically relevant application. Creating a tool for validation on the highest level by visualizing treatment results together with simulation results, the models will provide input to the clinical practice whereas feedback from the clinical practice will in turn support the modelling. This way confidence in the model predictions will be established.

Main results, benefits and impacts

IMPPACT will be modelling a physiological organ including the metabolism and patient-specific tissue properties. This alone is a huge step forward as compared to the state-of-the-art intervention planning systems that do not address this issue.

The IPS will allow prediction of treatment results on a patient-specific base. It will therefore bring down the risk of local recurrences and eliminate the nowadays so common repeated treatments of the same tumour, making RFA a treatment as effective as resection.

At the same time the IPS will make RFA treatment much safer. By reliably predicting tissue heating it will warn of possible damage to surrounding organs in advance and allows choosing a safe needle position and path.

The greatest impact will be achieved by installing the created application in many hospitals in Europe. To be able to directly use the IPS in clinical practice medical personnel in those hospitals needs to be trained in using it. The augmented reality training simulator provides an excellent opportunity as it trains surgeons directly with the IPS

All developed software will be open source and run with common hospital equipment. Its deployment to virtually every hospital in Europe is solely a question of using a deployment infrastructure.

Progress

1st year:

During the first year of the project, the consortium has set up a common framework for an experimental cycle to be conducted on pigs. The framework structure defines a closed-loop experiment with several complementary components. Each component generates a set of data in a compatible format to be consumed by one or several other components.

Modelling approaches and algorithms were developed for each component of the experimental cycle. These included several modelling activities such as 1) macroscopic mathematical description of bio-heat processes on macroscopic and single-cell levels, 2) numerical modelling of heat transfer, and 3) visualisation model. Algorithmic solutions for automatic and semi-automatic image analysis have also been part of this objective.

The modelling activities were based upon experimental data obtained in animal experiments with pigs. As stated by the objectives, the modelling activities and corresponding algorithms had to address the macroscopic and microscopic nature of the problem at hands. The experimental objective for the reporting period was to conduct extensive animal experiments in order to collect a sufficient amount of macroscopic and microscopic experimental data. In particular:

• Gather macroscopic data and CT images before, during, and after the RFA treatment of pigs.
• Gather microscopic data using specific histological samples, histology images, cell culture experiments, etc.

2nd year:

Key objectives for the second reporting period Month 12-Month 24 was to 1) conduct the complete the RFA experimental loop using pigs; 2) register data resulted from each step of the loop into a unifying 3D reference model of liver structures; and 3) perform cross-validation of the developed RFA modelling within the reference model. While conducting the experimental loop the consortium has further developed necessary methods, algorithms and procedures used in different experimental components leading to a much higher level of their maturity. Novel procedures and algorithms were established to close the experimental loop in a way, which allows optimal cross validation of the physiological / numerical model with established radiological understanding about RFA related processes.

Experimental loop using pigs

The aim of the experimental loop on pigs was to establish understanding of the RFA processes in terms of:

• Short-term development of the RFA induced lesion within the first 1 to 7 days after the RFA intervention;
• Long-term changes in the RFA lesion taking place between 1 week and up to 1 month after the RFA intervention;
• relation between 1) the RFA induced area as visible on control CT images reflecting the changes during 1 day / 1 week / 1 month after the RFA intervention and 2) the actual lesion size resulted from the RFA intervention as established from histology images.
• numerical modelling of the RFA processes that provides best match between the simulated volume and the lesion volume reconstructed from histology.

In support of the above, IMPPACT consortium scheduled a set of RFA experiments with healthy pigs sacrificed 1) right after the RFA intervention; as well as 2) one day; 3) one week; 4) one month after the RFA intervention.

Lessons learnt

This field will be completed by the submitter when the lessons learnt have been identified and understood.