INNOVATION CAPSULES: Track 2: Tecnologías para la transformación del sistema sanitario

1. Virtual planning for IOERT:
radiance®
Manuel Desco
Dpto. Bioingeniería e Ingeniería Aeroespacial, UC3M
Hospital General Universitario Gregorio Marañón
Coordinador Red ITEMAS
desco@hggm.es

2. Outline
 Intraoperative Radiation Therapy
Planning Workstation: radiance®
 The problem and the solution
 How did we do it?
 Key points

3. IOERT: Definition
 Radiotherapy during cancer surgery
 Normal tissue protection (physical displacement)
 Minimal tumor burden

4. The problem with IOERT
 Patient anatomy changed
 Difficult dosimetry estimation
 Distrust, lack of confidence

5. The solution
 A Surgery – Radiotherapy planning
workstation which:
 Works on preoperative images
- Simulates surgery
- Deals with elastic anatomy changes
 Simulates application insertion
 Estimates dosimetry
 May work on real-time intraoperative /
radiation session imaging studies

6. Radiance®
 IEORT 2D - 3D planning
 Dosimetry estimation

7. IOERT Planning Workflow
Segmentation Simulation Dosimetric pre-planning
Define regions  Simulate the  Select applicator parameters
 Organs to patient position,  Dose estimated with PB
protect orientation and
surgical access
 Treatment energy defined with
 High risk areas the help of DVHs for different
regions

8. First prototype: 1997
No company found until 2006

9. radiance: IP
 Patent
 PCT/ES2008/000240
 WO 2009/127747 A1
 Agencia medicamento (2011)
 FDA approval (2012)

10. Validation
Real patient during CT study

11. Snowball growing
 Projects and partners
 Several industrial projects (2006-2013):
PROFIT, IMADE, INNPACTO
(“PRECISION”).
 2 clinical evaluation projects (ETES,
ISCIII)
 Growing consortium :
 Universities  Hospitals Industrial
• Complutense of Madrid (nuclear physics) • Gregorio Marañón (Madrid) • GMV (Madrid)
• Granada (physics) • Castellón (Castellón) • TRF (Zaragoza)
• Madrid Politechnical (biomedical imaging) • Ramón y Cajal (Madrid)
• Valencia (robotics) • La Luz (Madrid)
• San Jaime (Alicante)

12. radiance: on-going work

13. Key points
 Clinical initiative
 Solving a real problem
 Creates new market
 No competence
 Finding a company: A hard job
 Long times involved until success
 Technology transfer vs. PPP