August 28, 2020
The tools behind the treatment: Building image-guided devices for more accurate and effective cancer procedures
OICR-supported researchers develop multi-purpose AI algorithm to help track needle placement and improve the accuracy of several image-guided treatment techniques
Cancer patients often encounter many needles, some of which are used to collect tissue samples or deliver therapy directly to a tumour. Specialists who carry out these procedures are trained to place needles precisely in the correct location, but what if we could give these specialists a real-time GPS for needles? Would biopsies be more accurate? Could needle-related therapies be more effective?
Dr. Aaron Fenster’s lab is working to develop tools for these specialists to guide their needles and ultimately improve the accuracy of biopsies and therapies for patients. In their recent paper, published in Medical Physics, they describe their new deep learning method to track needles in ultrasound images in real time.
“It may be surprising to many individuals, but a lot of these procedures are still done based on skill alone and without image processing,” says Dr. Derek Gillies, medical physicist in training and co-first author of the paper. “We’re working to provide clinicians with tools so they can better see their needles in real time rather than going in blind for some procedures.”
The deep learning methods presented in this paper are applicable to many types of needle procedures, from biopsies – where a clinician draws a tumour sample from the body – to brachytherapy – where a clinician delivers radiotherapy directly to the tumour. The methods could also be applied to several cancer types including kidney cancer, liver cancer and gynecologic cancers.
“Developing artificial intelligence algorithms requires a lot of data,” says Jessica Rodgers, co-first author of the paper and PhD Candidate at Western University’s Robarts Research Institute. “We didn’t have a lot of imaging data from gynecologic procedures, so we decided to team up to develop a method that could work across several applications and areas of the body.”
“That’s the most exciting aspect of this effort,” says Gillies. “To our knowledge, we were the first to develop a generalizable needle segmentation deep learning method.”
Now, members of the Fenster lab are working to integrate these algorithms into the video software equipment used in the clinic.
“Our work is giving clinicians new tools, which can help them make these procedures more precise and more accessible,” says Rodgers. “These tools could ultimately help lead to fewer missed cancer diagnoses and fewer patients with cancer recurrence.”
June 2, 2020
Q&A with new OICR investigator Dr. Hartland Jackson on the latest in mass cytometry, single-cell imaging and his return to Canada
OICR welcomes Dr. Hartland Jackson back to Toronto as Lunenfeld-Tanenbaum Research Institute and OICR’s newest investigator
While he was a doctoral student developing experimental models of breast cancer, Dr. Hartland Jackson recognized the enormous potential impact of multiplexed imaging and single-cell technologies. If we could see how different cells interact within a tumour, what could we discover?
This question fueled his research over the last half decade, taking him to Switzerland to develop advanced imaging methods alongside experts at the University of Zurich. Now, returning to Canada, Dr. Jackson plans to collaborate across disciplines and sectors to apply this technology to solve more scientific and clinical questions. Here, he discusses his goal of bringing the benefits of this technology to more patients in Ontario and around the world.
What was your main research focus in Switzerland?
HJ: In a nutshell, I was developing a new technology, called imaging mass cytometry, which allows us to visualize and analyze tumour samples in more detail than ever before.
When I joined the research group at the University of Zurich, they had developed a prototype imaging system. My role was to take this system and be the first to apply it to a clinical problem. Ultimately, I helped shepherd the system from a prototype to a commercial product that is now used around the world.
What clinical application did you focus on?
HJ: I focused on investigating how this technology could help in the diagnosis and prognosis of breast cancer. Through this process, we made a lot of progress in developing analysis methods and optimizing the system. Whereas traditional imaging methods could see three or four markers on a cell, our system allows us to see 40 markers at the same time. With this technology and imaging system, we could visualize how different cells were organized within a sample, which revealed new types of breast cancer.
In addition to this discovery, my work showed that imaging mass cytometry can reveal information within clinical samples – meaning information that may be useful for patients. We pushed the boundary on what can be done with this system and now it’s used around the world to study different human diseases.
Interestingly, the technology that I was working on was an adaptation of an earlier technology developed in Toronto by DVS Sciences, which was supported in part by OICR. My plan was to work with the imaging experts in Switzerland and bring these developments back to the place where the technology was created and is now manufactured as a commercial product by Fluidigm.
Is that what brought you back to Canada?
HJ: Yes, one of the reasons I’ve returned to Canada is to bring this expertise back to Toronto. In addition to that, the research community here is very impressive. The universities, research institutes and hospitals are all tightly knit. This makes for an excellent environment to develop new technologies that can address clinical health challenges. I find that researchers here are like-minded in their goals and collaborative spirit. We enjoy working through technical challenges and delving into the mysteries of cell biology, and – at the same time – working on research that really matters to patients.
What will your future research focus on?
HJ: I plan to continue developing some of the methods that I was working on in Europe while expanding my research in a few exciting areas.
We’re looking to apply this technology to different types of cancer and different diseases in collaboration with clinician scientists. I’m interested in applying this technology in drug clinical trials to help us understand how patients respond to different therapies. In parallel, I look forward to using this technology to study experimental model systems to better understand how cells are communicating with each other and what goes wrong in the communication between cells during cancer development.
Our work has shown what this technology is able to do and that has only opened more avenues for future research. I’m excited because these new applications are now within our reach. To date, collaborations have allowed me to make more progress than I could have ever made on my own and I look forward to building new collaborations to make new discoveries in the future.
March 12, 2020
OICR Imaging Program co-director, Dr. Aaron Fenster, awarded the province’s highest honour
OICR congratulates Dr. Aaron Fenster who was recently appointed to the Order of Ontario – the province’s highest honour.
The Order of Ontario recognizes individuals whose exceptional achievements have left a lasting legacy in the province, in Canada and beyond.
“Members of the Order of Ontario exemplify, individually and collectively, the best qualities of good citizenship,” said Her Honour Elizabeth Dowdeswell, Lieutenant Governor of Ontario. “Through their voluntary service, creativity, and the relentless pursuit of excellence, they demonstrate how we in Ontario are working to build a more just and sustainable future.”
In Fenster’s case, that means developing new medical imaging technologies and the infrastructure for new inventions to help more patients, sooner. Over four decades of medical imaging research and development, Fenster has invented dozens of new techniques, systems and devices that help scientists better understand cancer and clinicians deliver better treatment.
One of his systems for ultrasound image-guided prostate cancer treatment is in use around the world. Another one of his image-guided systems that could improve the accuracy of gynecologic cancer treatment is currently in clinical trials.
Fenster, who is a scientist at Robarts Research Institute and a professor at Western University, is well-recognized in the community for his commitment to translational research. For him, having the greatest impact on the health of patients requires collaboration across disciplines, industries and geographies to work on common challenges.
We work across disciplines like engineering, biology, physics and computer science, to design the best solutions. We work with clinicians, surgeons and radiologists to ensure these solutions can help patients. This is a special community.Dr. Aaron Fenster
The programs Fenster has established, including OICR’s Imaging Program, have helped train the next generation of researchers who will continue to improve how we diagnose and treat cancers for years to come. Fenster’s imaging program in London – which he built from scratch – now includes more than 250 researchers and staff, including more than 100 graduate students.
“I am honoured to be named to the Order of Ontario,” Fenster said in an interview with the Schulich School of Medicine & Dentistry. “Although I will receive this honour, my staff and students deserve all the credit.”
The Lieutenant Governor bestowed the honour upon the newest Order of Ontario appointees during an investiture ceremony at Queen’s Park on March 11.
May 17, 2019
OICR-supported trial finds new, more sensitive imaging technique can inform treatment decisions and benefit those with recurring prostate cancer
Prostate cancer is the most common type of cancer found in men, but managing the disease is difficult because not all prostate cancers are aggressive and overtreatment can lead to unnecessary side effects, such as hormone imbalances, bowel function issues and erectile dysfunction. After initial treatment, prostate cancer patients are often monitored with a prostate specific antigen (PSA) blood test, but this test provides no information about the location and the extent of the disease. Even with traditional bone scans and CT scans, remnant traces of the disease are difficult to find and often go undetected.
A few years ago, a new, more sensitive type of imaging technique had shown promise in early clinical studies abroad and Dr. Glenn Bauman, Radiation Oncologist at the London Health Sciences Centre, wanted to bring this technique into his practice. He recognized the potential benefits of this method, but didn’t realize how much it could impact the lives of his patients.
Bringing advances to local patients
The new technique, which was originally developed at the John Hopkins Hospital in Baltimore, consisted of a chemical probe, called [18-F]-DCFPyL, which would attach only to prostate cancer cells and light up in positron emission tomography (PET) scans. It can detect very small traces of a tumour that has returned after treatment or spread to a different part of the body.
Bauman teamed up with the co-inventor of [18-F]-DCFPyL, Dr. Martin Pomper, and the Centre for Probe Development and Commercialization (CPDC) to bring this probe to patients in Ontario. CPDC implemented the stringent manufacturing processes needed to create this probe and in March of 2016, Lawson’s researchers were the first to use this technique to scan a patient at St. Joseph’s Hospital in London.
“We teamed up with experts in [18-F]-DCFPyL from the U.S. and experts in prostate PET/CT from Australia to adopt this new technique, benchmark our methods and learn from their experience,” says Bauman. “It’s with collaborations like these that we can accelerate the implementation of new methods to help patients in Ontario.”
Evaluating the benefits for those with prostate cancer
Clinical studies are needed to evaluate the effectiveness new medical techniques in practice. For this technique, Bauman and collaborators needed to test whether it’s improved accuracy and sensitivity could help make better treatment decisions.
“Treatment plans for prostate cancer differ depending on the cancer’s size and location. Whether a cancer returns in the prostate, the pelvic area or elsewhere makes a big difference,” says Bauman. “We needed to test if more sensitive imaging techniques could help patients make better treatment decisions.”
Bauman led the design and development of the Advanced Prostate Imaging of Recurrent Cancer After Radiotherapy (PICs) study to evaluate [18-F]-DCFPyL PET/CT imaging. With OICR’s support over the following two years, PICs enrolled 80 men and scanned them with both traditional imaging methods and with [18-F]-DCFPyL PET/CT.
The study group found that not only can [18-F]-DCFPyL PET/CT detect smaller traces of the disease earlier when it is more manageable, this technique changed treatment recommendations for two in every five patients.
“With this technique, we were able to clarify and reclassify a lot of the traditional scans that were previously uncertain,” says Bauman. “This means that we were able to give prostate-directed treatment with confidence for patients whose cancers reemerged in their prostate and avoid the negative side effects of systemic hormone therapy for these patients.”
Bauman says that the technique also detected double the number of cancers outside of the prostate which were too small to be detected using traditional imaging alone.
Translating clinical findings into practice
Just three years after the first [18-F]-DCFPyL PET/CT scan was taken in Canada, Bauman has embarked on the next stage in translating these findings into routine practice. He and collaborators have teamed up with Cancer Care Ontario to provide access to the [18-F]-DCFPyL PET/CT technique in Toronto, London, Hamilton, Ottawa and Thunder Bay as part of a provincial registry program.
[18-F]-DCFPyL PET/CT can be applied to other challenges that patients and clinicans face with managing prostate cancer, including monitoring how patients respond to treatments. Notably, investigators in Hamilton are investigating how these scans can help predict a patient’s response to treatment in the OICR-supported MISTR trial.
“We have been sufficiently encouraged by our results from the PICs study, through which we have demonstrated the value of this intervention and how it can benefit men with prostate cancer,” says Bauman. “I’m proud to help bring better technologies to our patients in need and enable the adoption of these technologies throughout the province.”
October 16, 2018
OICR offers new CT calibration service as part of its Collaborative Research Resources portfolio
Using imaging devices to help make treatment decisions in the clinic requires rigorous testing, quality assurance and routine calibration of the imaging machinery. These standards are especially important when the imaging technology is novel or unique, such as in the case of perfusion imaging – a relatively new technique used to diagnose a cancer’s stage by showing how blood flows through the tumour.
September 25, 2018
Breast cancer radiotherapy in a single visit provides more convenient option to patients, reduces burden of therapy
Cross-Canada research team moves image-guided ultrasound system into clinical development
Traditional breast cancer radiation treatment requires multiple hospital visits over a period of weeks or months, which may be onerous to patients who live far from hospitals or in remote communities. An alternative radiotherapy technique, Permanent Breast Seed Implantation (PBSI), requires only a single hospital visit, but it involves the implantation of multiple small radioactive metal pellets into the breast of the patient within millimetres of a target. The procedure to administer this treatment is difficult to plan and complex to execute – impeding the adoption of PBSI in the clinic.
September 13, 2018
Sunnybrook researchers develop new magnetic resonance imaging methods to help differentiate between aggressive and non-aggressive prostate cancers
Current needle biopsy techniques have limited accuracy in detecting prostate cancer and determining the tumour’s aggressiveness. New methods are needed to better detect and characterize prostate cancer so that each patient can get the treatment that is most appropriate for them.
August 2, 2018
The Centre for Probe Development and Commercialization (CPDC) awarded $10.5 million to expand molecular imaging probe work in Ontario
Translating new scientific discoveries into products and moving those products to the market is a challenging process. This is especially the case for highly-regulated medical products such as radiopharmaceuticals – a special class of drugs that are used to accurately diagnose and treat diseases. Over the past decade, the CPDC in Hamilton has been bridging the gap between the innovation and commercialization of radiopharmaceuticals in Ontario and, in turn, reaping benefits for patients and the province’s economy.
August 9, 2017
The Centre for Imaging Technology Commercialization (CIMTEC) has appointed Mr. Justin Leushner as Chief Executive Officer. CIMTEC was established to accelerate the development of medical imaging technology and commercialize new technologies. Leushner brings extensive experience in both the private and public sectors. Most recently he was the Vice President at the TechAlliance of Southwestern Ontario, where he and his team worked with more that 300 companies in the region.
March 8, 2017
In London, OICR leaders discussed cancer research advancements being made in the city. How can OICR help further translate these breakthroughs to patients?
Ontario’s wealth of cancer research expertise is not limited to one city or region. Innovations from researchers and clinician-scientists across the province are changing the approach to cancer worldwide. London is one of Ontario’s major cancer research nodes and boasts a particular strength in developing medical imaging technology. The city is home to the Lawson Health Research Institute, Robarts Research Institute and the Centre for Imaging Technology Commercialization. Life science and biotechnology research is the source of $1.5 billion in economic activity for the city annually.
September 16, 2016
Photo-thermal therapy, a type of treatment that uses light and heat to destroy cancer cells, has shown great promise, but is still not widely used. A group in Toronto recently developed a technology that may go a long way in making the use of this type of therapy more effective and common.
June 1, 2016
Dr. Laurence Klotz of Sunnybrook Health Sciences Centre is a world leader in the field of prostate cancer research. He has been a champion of active surveillance (also known as watchful waiting) for over 20 years, an approach to prostate cancer treatment that has allowed thousands of men with low-risk prostate cancer to avoid or delay therapy by monitoring it closely instead of immediately treating it.
Now Klotz has launched a new clinical trial called PRECISE, funded with $3 million in support by the Movember Foundation, the Ontario Institute for Cancer Research and Prostate Cancer Canada, that will use MRI to help to better diagnose prostate cancer without invasive biopsy.