Title: Respiratory Magnetic Resonance Imaging for Radiation Therapy and Treatment of Lung Cancer
1Respiratory Magnetic Resonance Imaging for
Radiation Therapy and Treatment of Lung Cancer
Imaging Research Laboratories Robarts Research
Institute Department of Medical
Biophysics Graduate Program in Biomedical
Engineering Department of Medical Imaging The
University of Western Ontario
Tuesday March 3, 2009
2London Lung Imaging Research Team
3LUNG CANCER IMAGING
4LUNG CANCER IMAGING
5Overarching Aims
Interconnecting factors contribute to lowering
the burden of disease
6Overarching Aims
Interconnecting factors contribute to lowering
the burden of disease
7Overarching Aims
Interconnecting factors contribute to lowering
the burden of disease
8Overarching Aims
Interconnecting factors contribute to lowering
the burden of disease
9Overarching Aims
Interconnecting factors contribute to lowering
the burden of disease
10Overarching Aims
Interconnecting factors contribute to lowering
the burden of disease
11Ongoing Projects
- Stroke and Heart Attack Risk
- MRI and 3DUS of carotid vessel disease as
predictors of patient risk, treatment effects,
disease progression - Rheumatoid arthritis, post kidney transplant,
dialysis, diabetes, stroke family history, stroke
symptoms - Lung Cancer Detection and Tumour Response
- 3D Endobronchial ultrasound for nodes
- Image analysis tools for tumour volume/shape
response - Respiratory Disease MR and CT imaging
- CF, COPD, asthma, Radiation-induced lung injury
123He MRI New tools for Respiratory Disease?
- Hyperpolarized 3He MRI
- 3He MRI Phenotypes of inflammation
-
- Application to Radiation-induced lung injury
-
13Respiratory Disease Current Diagnostic Tools
14Respiratory Disease Current Diagnostic Tools
15Respiratory Disease Current Diagnostic Tools
16Respiratory Anatomy Airways Airspaces
Adapted from Weibel E.R. Lung Morphometry and
Models in Respiratory Physiology.1989.
17Conventional Thoracic 1H MRI
18Hyperpolarized 3He MRI Facilities
193He Magnetic Resonance Image Center Coronal Slice
20RESULTS Older Healthy Volunteers
58 yr old healthy volunteer FEV1 108pred
69 yr old healthy volunteer FEV1 105pred
Mathew et al, Acad Radiol 2008 15776-785
213He MRI GOLD Stage II COPD
62y female FEV1 62pred
61y male FEV1 68pred
223He MRI GOLD Stage III COPD
62y female FEV1 42pred
72y male FEV1 49pred
23Assessing Function and StructureVentilation
Defects and Apparent Diffusion Coefficient
243He MRI Phenotypes of Lung Function
- Ventilation Defect
- Volume
Thoracic Volume
25Research Goals and Questions
- Establishing feasibility, clinical relevance and
utility - What regional lung functional changes can be
measured in vivo after treatment? - How do we validate our findings? (Pathology,
outcomes) - Developing new tools to translate method to
clinical trials and practice
26Coxson et al 2008 submitted
FEV149pred
FEV149pred
27Radiation Induced Lung Injury (RILI)
- Radiation Induced Lung Injury
- Pneumonitis Fibrosis
- Interstitial pulmonary inflammation
- Prevalence 5-37 of patients receiving thoracic
irradiation - Diagnosis
- Clinical Symptoms
- Chest x ray
- X-ray computed tomography (CT)
Mathew et al Med Phys 2008 submitted
28Radiation Induced Lung Injury (RILI)
Mathew et al Med Phys 2008 submitted
29Objectives
A
- Measure hyperpolarized 3Helium (3He) MRI
Phenotypes after RILI symptoms reported (BL) and
6 months later (FU) - Retrospective Analysis
B
A Subject 001 3He overlay B Subject 001
radiation treatment plan
Mathew et al Med Phys 2008 submitted
30Methods
- Seven subjects with RILI recruited, provided
written informed consent - Pulmonary function testing
- spirometry
- plethysmography
- CT
- MRI
31Results Subject Demographics
32Results Radiation Parameters
33Results Subject 004
- 76 year old male
- Bronchoalveolar carcinoma and adenocarcinoma
- FEV1 44pred
CT Axial
3He MRI
CT Coronal
34Results Subject 002
- 55 year old male
- Stage 3B squamous cell carcinoma
- FEV1 54pred
CT Axial
3He MRI
CT Coronal
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36Results 3He MRI Measurements
37Baseline and Follow up Ventilation Images
Radiation Start Date April 4th 2007
38Baseline and Follow up Ventilation Images
Radiation Start Date August 23rd 2007
39Longitudinal Differences
ND No data for one of the two visits
ND No data for one of the two visits
40Baseline to Follow up Comparison
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41Baseline to Follow up Comparison
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42Baseline to Follow up Comparison
43Summary
- Changes in contralateral lung function /
structure post-RILI - Registration methods determined to evaluate
changes in structure/function over time - Feasibility in severely compromised patients
- Future study to evaluate 3He MRI prediction of
RILI
44Acknowledgements Disclosures
Collaborators George Rodrigues MD Glenn Bauman
MD Dave McCormack MD Chris Licskai MD Nigel
Paterson MD Giles Santyr PhD Roya Etemad-Rezai
MD Aaron Fenster PhD GY Zou PhD Harvey Coxson
PhD (Vancouver) Trainees Lindsay Mathew
BSc Miranda Kirby BSc Laura Wilson BS Anna
Rozik Hassaan Ahmed BSc Stephen Choy BEng
Research Staff Andrew Wheatley BSc Alexei
Ouriadov PhD Chris Piechowicz BA RPT Shayna
McKay BSc Sandra Halko CCRC, RPT Liz Lorusso RTMR
RTR Cyndi Harper Little RTMR RTR
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