UC DAVIS CANCER CENTER

Transcription

1 UC DAVIS CANCER CENTER

2 Endoscopic Enhancement by a Spectroscopic Cancer Detection System Ralph W. devere White, M.D. Professor and Chairman, Department of Urology Director, UC Davis Cancer Center University of California, Davis Medical Center Stavros Demos, Ph.D. Associate Professor, UCD Davis Medical Center Senior Scientist, Chemistry and Material Sciences Lawrence Livermore National Laboratory

3 ENDOSCOPICALLY DETECTED TARGET CANCERS Colon (Lower GI) Lung CA Upper GI Bladder

4 Unanswered Endoscopic Questions Is what you see cancer? How deep does the cancer go? Have you removed all cancer? Our Spectroscopic Cancer Detection System will definitively and rapidly answer these questions, reducing cost and increasing patient satisfaction.

5 Spectroscopic Cancer Detection System Will Revolutionize Diagnosis and Treatment of Colon, Bladder, Lung, and Gastro Intestinal Cancer Real Time (in vivo) Subsurface Outpatient Reduces Current Cost Patient / Hospital / Insurance Driven Will Not Radically Change Work Flow

6 SPECTROSCOPIC CAMERA and CYSTOSCOPE

7 SPECTROSCOPIC CANCER DETECTION SYSTEM Camera Camera Box Integration Software Light Source

8 TESTING ORGAN SITE TCC of the BLADDER 55,000 cases per year in U.S. 75% superficial cancer 50% Recur - ⅓ due to undetected CA at initial treatment

9 CURRENT PROBLEMS in PROBLEMS ENDOSCOPY Delayed Diagnosis OR is Labor Intensive Patient Anxiety OR/Biopsy Additional Costs Failure to Determine Margin Status at Time of Surgery and Detection of Residual Disease Have to wait days for biopsy results Adversely affecting pts, their families, doctors, health systems, and payors Delay in diagnosis after viewing the worrisome pictures on TV monitor $12,000 Necessitates future operations

10 Can we do this using photons? Light can be used to probe both, structure and biochemical composition of the tissue. 10 Hemoglobin Water 1 Absorption.1.01 OPTICAL WINDOW We use this range Wavelength Absorption of light by tissue limits its penetration depth except in the Near Infrared (NIR) spectral region where photons can propagate 1-cm or more

11 Cancer Spectroscopic Lens No Cancer Flexible Cystoscope

12 Prototype-1 instrumentation for in-vitro imaging of human samples Absorption spectra of main tissue fluorophores We use longer wavelengths for selective excitation of Porphyrins Excitation wavelengths Illumination wavelengths for light scattering imaging Imaging spectral range

13 Is What You See Cancer? What stage is it?

14 Is All Cancer Gone? RESECTION for CURE (In ⅓ of cases, the answer is NO)

15 Spectroscopic images of a bladder tissue specimen containing cancer C-P LSI NIR 532 nm NIR 633 nm Ratio Images Direct Images NIR 633 / NIR 532 C-P 1000 NIR 532 H&E stain

16 SPDI imaging using a cystoscope and an animal tissue model Images of a 2.5-cm thick breast chicken tissue containing other tissue components located below its surface 690 nm illumination direct image 820 nm illumination direct image 970 & 820 nm illumination SPDI image Tendon ( 2 mm thick) located 5 mm below the surface Fat lesion ( 2 mm thick) located 10 mm below the surface

17 We are working on prototype-3 system with dual-image capabilities System under construction displays simultaneously conventional color images and cancer enhancing NIR images The system in its final form will include the subsurface imaging module This system will be readily adaptable to any type of endoscope

18 Figure 1 Breast Cancer NIR autofluorescence image under a) 532 nm excitation and b) 632,8 nm excitation of a 4-cm X 3-cm human breast tissue, 6- mm thick. c) A contrast-enhanced H&E stained paraffin section of the same specimen with tumor location indicated by an arrow. d) Intensity profiles of images (a) and (b) along a vertical line passing through the middle of the tumor.

19 Ex Vivo Results TCC 25/25 Accurate 100% All Tumors 80/81 Accurate

20 Delivered to Date 1 Grant 3 Papers Required Patents Ex-Vivo 80/81 Tissues Accurately Analyzed In-Vivo NIR Tissue Analysis Prior to Clinical Testing Beam Splitter to show Tumor/Tissue on TV Monitor ( wvl) NIR on TV Monitor ( wvl)

21 TABLETOP Proton Radiotherapy System We will bring the pinpoint accuracy and efficacy of proton radiotherapy to every cancer patient

22 THEME C: Cancer Therapy Technology Compact Proton Accelerator MD Anderson Proton Beam Facility ($200M) Built CPA to fit in Linac Vault ($10M)

23 Proton therapy is the most precise form of advanced radiation treatment available for certain cancers and other diseases -- Jerry D. Slater, MD Chair, Department of Radiation Medicine Loma Linda University The device would revolutionize radiation oncology NIH Summary Statement The only serious discussion concerning proton therapy implementation is cost, not rationale Suit 2002

24 PRS TEAM LLNL: Dennis Matthews, PhD -Director, Center for Biotechnology, Biophysical Sciences and Bioengineering George Caporaso, PhD - Program Leader for Beam Research Program UCDHS: Ralph devere White, MD Director, UC Davis Cancer Center, Chairman, Department of Urology Srinivasan Vijayakumar, MD Chairman, Radiation Oncology James Purdy, Ph.D Chief Physicist, Radiation Oncology

25 Equipment Manufacturer Perspective Clinic-sized proton therapy system sales projections in the US at target price point: Penetration rate Sales in Billions Sales price (bil) 1% 2% 5% 10% 15% 20% $ 5 $ 93 $186 $ 465 $ 930 $1,395 $1,860 $ 10 $ 186 $372 $ 930 $1,860 $2,790 $3,720 $ 15 $ 279 $558 $1,395 $2,790 $4,185 $5,580 Assumptions: Rad Onc Clinics in the US: 1,860 LINACS in the North America: 3900 (per Varian) No analysis of consumables, service revenue or foreign markets

26 The Compact Proton Radiotherapy System Concept* Pencil beam is mechanically scanned in x and y Flexible dose delivery via pulse-to-pulse variable energy and intensity Energy range MeV Dose range 0-20 Gy/sec/beam cross section area (cm 2 )at the Bragg peak Multiple patient delivery configurations possible to accommodate available space Vertical option Isocentric option * Patent pending Horizontal option with in-situ CT scan

27 While risks remain, we believe a compact proton accelerator based on DWA technology is feasible Multiple viable architectures exist Two promising switch candidates are being developed There are multiple dielectric material sources Pulse format consistent with treatment needs Pencil beam scanning can be achieved without bending magnets Beam dynamics appears straightforward Novel compact proton source can deliver high peak current In continuing development we must demonstrate HGI performance for large lengths ( 6-8 cm) Multiple pulse operation of source with acceptable beam quality Integrated system performance

28 John M. Boone, Ph.D. Principal Investigator Karen K. Lindfors, M.D. Thomas R. Nelson, Ph.D.

29 Mammography: the superposition problem mammography

30 CT: the superposition problem solved breast CT

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32 Breast CT Prototype Albion at the University of California, Da

33 The UC Davis Breast Tomography Project

34 pectoralis 296 Healthy Volunteer

35 mlo cc 316 implant patient with cancer indicated with arrows

36 Contrast Enhanced Breast CT (injected iodine contrast agent shows additional cancer)

37 Clinical Studies Underway Phase I clinical trial: 10 healthy volunteers Phase II clinical trial: 190 BIRADS 4 and 5 women (going to be biopsied) Phase II clinical trial: Iodine injection 3 BIRADS 5 women 10/10 26/190 3/3 Funded other developments PET / CT dedicated breast imaging system Ultrasound / CT dedicated breast imaging system