Bone analogue phantoms: redefining standards in patient specific MRT dosimetry
Lead Research Organisation:
University of Manchester
Department Name: Physics and Astronomy
Abstract
Molecular Radiotherapy (MRT) is a relatively common procedure in counties with developed healthcare systems. In this
procedure, a labelled radioisotope is administered to the body in order to irradiate and kill tumour cells whilst sparing the
surrounding healthy organ tissue. In the UK alone, there are some 200 departments performing over 11000 MRTs annually
and ~200,000 therapies in some 28 EU countries.
In a recent development towards personalised healthcare, a new EU directive 2013/59 was introduced which requires that
all Member states performing any form of radiotherapeutics (including MRT) must provide dosimetry treatment planning for
each patient by 6th February 2018. Although this may sound like an obvious situation, MRT has in fact been used clinically
for around 75 years with no fully established dosimetry practice for calculating the absorbed dose delivered to tumour
targets or to organs at risk. Even though the general steps have been agreed, there still exists a wide variation in the
current acquisition, quality and treatment of images used to determine dose. As a result, treatment protocols have often
evolved locally, based on experience with a relatively small numbers of patients. Although such patients would all have
received similar administered activities, the actual dose received to particular organs could have large variations.
As a consequence of the complexities involved, the application of radionuclide dosimetry has been restricted to those
academic groups with the facilities to develop in-house techniques. Very few therapy centres currently can validate dose
calculations to a known level of accuracy and only a few academic therapy centres can perform MRT Monte Carlo (MC)
calculations. Our group, established between The University of Manchester and The Christie, has developed the ability to
deliver this within a very large MRT practice. We were recently selected to lead the EU work on validating dose calculations from simulated patient phantoms and physical 3D printed phantoms in the EMPIR MRTDosimetry project (2016-19). The
project will provide a standardised European framework for clinical implementation of MRT dose planning. In our approach,
developed with an STFC Mini-IPS grant, 3D-printed patient analogues (phantoms) are constructed based on patient CT
images. This novel technique has clear potential to provide the foundation of a clinical service to provide a basis for
improved activity quantification to all clinical centres and MRT patients in the UK.
We are uniquely positioned to deliver this work, having access to a large data base of MRT patient data at The Christie.
Working with these data, we can provide the foundation for establishing a future national clinical service. The Christie has
the experience in both MRT dosimetry research and in providing training and support for a national clinical service
(PET/CT) required to provide a MRT dosimetry service. In addition our collaboration has strong links with industry, in
particular Hermes Medical Solutions Ltd, a leading provider of nuclear medicine workstation software. By developing a
comprehensive validation methodology for clinical dosimetry systems, and thereby demonstrating that the HERMES
dosimetry system meets this standard, our collaboration will be able to provide a de-facto validation standard for clinical
dosimetry systems and a market leading package. These links provide a pathway to distribute the techniques to the wider
EU and international nuclear medicine market. In turn, this improves patient outcomes by allowing modification of therapy
based on disease response and also benefits the healthcare provider by maximising outcome for the same or reduced
resource.
procedure, a labelled radioisotope is administered to the body in order to irradiate and kill tumour cells whilst sparing the
surrounding healthy organ tissue. In the UK alone, there are some 200 departments performing over 11000 MRTs annually
and ~200,000 therapies in some 28 EU countries.
In a recent development towards personalised healthcare, a new EU directive 2013/59 was introduced which requires that
all Member states performing any form of radiotherapeutics (including MRT) must provide dosimetry treatment planning for
each patient by 6th February 2018. Although this may sound like an obvious situation, MRT has in fact been used clinically
for around 75 years with no fully established dosimetry practice for calculating the absorbed dose delivered to tumour
targets or to organs at risk. Even though the general steps have been agreed, there still exists a wide variation in the
current acquisition, quality and treatment of images used to determine dose. As a result, treatment protocols have often
evolved locally, based on experience with a relatively small numbers of patients. Although such patients would all have
received similar administered activities, the actual dose received to particular organs could have large variations.
As a consequence of the complexities involved, the application of radionuclide dosimetry has been restricted to those
academic groups with the facilities to develop in-house techniques. Very few therapy centres currently can validate dose
calculations to a known level of accuracy and only a few academic therapy centres can perform MRT Monte Carlo (MC)
calculations. Our group, established between The University of Manchester and The Christie, has developed the ability to
deliver this within a very large MRT practice. We were recently selected to lead the EU work on validating dose calculations from simulated patient phantoms and physical 3D printed phantoms in the EMPIR MRTDosimetry project (2016-19). The
project will provide a standardised European framework for clinical implementation of MRT dose planning. In our approach,
developed with an STFC Mini-IPS grant, 3D-printed patient analogues (phantoms) are constructed based on patient CT
images. This novel technique has clear potential to provide the foundation of a clinical service to provide a basis for
improved activity quantification to all clinical centres and MRT patients in the UK.
We are uniquely positioned to deliver this work, having access to a large data base of MRT patient data at The Christie.
Working with these data, we can provide the foundation for establishing a future national clinical service. The Christie has
the experience in both MRT dosimetry research and in providing training and support for a national clinical service
(PET/CT) required to provide a MRT dosimetry service. In addition our collaboration has strong links with industry, in
particular Hermes Medical Solutions Ltd, a leading provider of nuclear medicine workstation software. By developing a
comprehensive validation methodology for clinical dosimetry systems, and thereby demonstrating that the HERMES
dosimetry system meets this standard, our collaboration will be able to provide a de-facto validation standard for clinical
dosimetry systems and a market leading package. These links provide a pathway to distribute the techniques to the wider
EU and international nuclear medicine market. In turn, this improves patient outcomes by allowing modification of therapy
based on disease response and also benefits the healthcare provider by maximising outcome for the same or reduced
resource.
People |
ORCID iD |
David Matthew Cullen (Principal Investigator) |
Description | More accurate patient dosimetry can be performed with the development of the phantoms which more closely resemble patient anatomies and densities. |
Exploitation Route | The Christie hospital is starting to use these techniques in their research. |
Sectors | Healthcare |
Title | Custom made 3D printed patient-specific organs. |
Description | Anonymised Patient specific CT images were used to derive 3D printed phantoms which could be filled with 177Lu and scanned with SPECT scanners. The outputs of these scans were used to validate Monte-Carlo simultions. |
Type Of Material | Improvements to research infrastructure |
Year Produced | 2018 |
Provided To Others? | No |
Impact | Publication in progress |
Title | Monte Carlo SPECT simulation validation |
Description | Developing a validation protocol that can be applied to Monte Carlo simulations of SPECT systems. Currently under development but plan to publish in the future. |
Type Of Material | Improvements to research infrastructure |
Year Produced | 2020 |
Provided To Others? | No |
Impact | This validation protocol is being used to extensively validate the simulation of the Mediso AnyScan SPECT system. Once complete, this protocol will be published and will be possible to apply to any Monte Carlo SPECT simulations. |
Title | Monte Carlo simulation of the Mediso Anyscan SPECT system |
Description | A detailed Monte Carlo simulation has been created in GATE for the Mediso AnyScan SPECT system. This model can be used to simulate SPECT acquisitions and has been used in a large amount of research for this project. |
Type Of Material | Computer model/algorithm |
Year Produced | 2019 |
Provided To Others? | No |
Impact | This simulation model is being used as the basis for a SPECT simulation validation protocol which we aim to publish. It has also been used to generate primary research data for the PhD project and has been used by other team members on related projects. |
Description | Terbium production with WMIC |
Organisation | University of Manchester |
Department | Wolfson Molecular Imaging Centre (WMIC) |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | We have provided a natural gadolinium foil to be irradiated with protons at the cyclotron at WMIC with the aim of studying terbium production. |
Collaborator Contribution | The Wolfson Molecular Imaging Centre (WMIC) has provided their cyclotron and expertise for this work. |
Impact | This collaboration has provided data for my PhD and will be used to study the feasibility of producing clinical-quantities of theranostic terbium from this method. |
Start Year | 2018 |
Description | University of Birmingham |
Organisation | University of Birmingham |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | We have provided calculations of optimal proton and alpha energies for irradiation of gadolinium and europium targets with the aim of producing theranostic terbium isotopes. |
Collaborator Contribution | The University of Birmingham has permitted use of their cyclotron for irradiation of our natural gadolinium targets and their expertise in accelerator physics. |
Impact | This collaboration has provided data for my PhD as well as data for one of Birmingham's PhD students. |
Start Year | 2018 |
Title | 3-D printed moving mini SPECT model for outreach |
Description | A physical model of a SPECT system has been created out of 3D printed parts and Arduino motors. The model is used for outreach with schools and members of the public, in order to discuss the applications of nuclear physics in medicine. |
Type Of Technology | Physical Model/Kit |
Year Produced | 2019 |
Impact | This model has been taken to events at 3 different schools and was very well received by students and teachers. It forms part of an outreach project which aims to highlight the applications of nuclear physics in medicine. The model was also showcased at an open day event for members of the public at the Christie Hospital. Unfortunately, the pandemic meant that several more planned events had to be cancelled, such as more visits to schools and the Pint of Science evenings for the public. There are plans to develop this project further and print more models which can be sent to schools since visits are still difficult. |
Title | Software for 3D printing and Geant simulation |
Description | Software to convert between CT scan images and CAD drawing packages to that which can be printed by a 3D printer. |
Type Of Technology | Software |
Year Produced | 2016 |
Impact | We are being approached by other academics about producing 3D images and another group at The Christie hospital. |
Description | EANM presentation |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Presented work virtually at the European Association of Nuclear Medicine Conference. Awarded a 'Top-rated oral presentation'. |
Year(s) Of Engagement Activity | 2020 |
Description | GATE user meeting talk |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Gave a talk on my Mediso simulation and terbium SPECT imaging work at the Gate User meeting as part of the IEEE conference. |
Year(s) Of Engagement Activity | 2019 |
Description | IEEE poster presentation |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Presented a virtual poster and gave a 5 minute presentation on Monte Carlo SPECT simulation validation at the IEEE Nuclear Science and Medical Imaging Conference. |
Year(s) Of Engagement Activity | 2020 |
Description | INPC talk |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Gave talk at the International Nuclear Physics Conference in Glasgow on terbium standardisation and quantitative SPECT. |
Year(s) Of Engagement Activity | 2019 |
Description | MEDICIS-promed talk |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Gave talk on the quantitative Tb-155 imaging work. |
Year(s) Of Engagement Activity | 2019 |
Description | NuSPRASEN talk |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Gave talk on the terbium standardisation measurements and calibration factors for quantitative SPECT at the NuSPRASEN workshop on applications of nuclear physics. |
Year(s) Of Engagement Activity | 2019 |
Description | Online chats with school students-I'm a scientist |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Schools |
Results and Impact | I was asked to return to to I'm a Scientist take part in another online outreach event that ran for 10 weeks from April. 120 scientists and 1186 students from 52 schools took part in the event. The students voted me as 'scientist of the week' for one of the 10 weeks. |
Year(s) Of Engagement Activity | 2020 |
URL | https://imascientist.org.uk/ |
Description | Science Unlocked Talk |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Professional Practitioners |
Results and Impact | Gave a virtual talk as part of the University of Manchester's Science Unlocked program for academics and professionals at the University of Manchester and the Christie Hospital. Around 40 people joined the session. |
Year(s) Of Engagement Activity | 2020 |
Description | Step into the future event |
Form Of Engagement Activity | Participation in an open day or visit at my research institution |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Schools |
Results and Impact | Repeat of 'Step into your future' event. Spoke to around 60 students for 5 minutes each about my research and what studying physics is like. Part of a 'Step into your future' day designed to give school students information about careers in STEM subjects. |
Year(s) Of Engagement Activity | 2019 |
Description | Talk to a primary school class |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Schools |
Results and Impact | Gave a talk on my research area to a class of around 30 10 - 11 year old students. Sparked a lot of questions from the students about my work and general science. |
Year(s) Of Engagement Activity | 2019 |
Description | Talk to school students |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Schools |
Results and Impact | Talk to students from a few visiting schools describing my research area and my path to this PhD. Run by the Manchester INFUSE project. |
Year(s) Of Engagement Activity | 2019 |
Description | Talk to the Trafford Ogden Partnership of schools |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Schools |
Results and Impact | Gave a talk on nuclear medicine and isotope production over Zoom to around 50 Year 12 students from schools around Trafford as part of a Year 12 Study Week with the Trafford Ogden Trust. |
Year(s) Of Engagement Activity | 2020 |
Description | Talk to undergraduate society |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Undergraduate students |
Results and Impact | Gave a talk over Zoom to the University of Manchester's undergraduate Nuclear and Particle Physics Society on my research area. Around 50 people attended the session and the talk was recorded for the society's Facebook page. |
Year(s) Of Engagement Activity | 2020 |
Description | UK Nuclear Physics Lockdown Seminar Series |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | I gave a 20 minute presentation over Zoom on validation of Monte Carlo SPECT simulations as part of the UK Nuclear Physics Lockdown Seminar Series. |
Year(s) Of Engagement Activity | 2020 |
URL | http://www.lockdownseminars.co.uk/ |
Description | Videos for Ogden Trust schools |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Schools |
Results and Impact | I have been producing short videos on nuclear physics for school students at the Challenge Academy Trust. I have also started putting together videos from other PhD students. This project continues to expand with more talks on different subjects from different students. I have been informed the videos have been added to the schools' Schemes of Work for the curriculum and will continue to be shown to science GCSE students across the Trust of schools. |
Year(s) Of Engagement Activity | 2020,2021 |
Description | Visit to school - Loreto Grammar school |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Schools |
Results and Impact | Gave 6 10-minute talks to groups of year 10 school students from Loreto Grammar School and nearby schools as part of an event organised with the Trafford Ogden Trust partnership. |
Year(s) Of Engagement Activity | 2020 |
Description | Visit to school- Ashton on Mersey |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Schools |
Results and Impact | Spoke to around 40 female pupils from year 9 and 10 in small groups about my research and what working in physics is like. |
Year(s) Of Engagement Activity | 2019 |
Description | Visit to school- Manchester Academy |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Schools |
Results and Impact | Participating in a exhibition being hosted at Manchester Academy for roughly 1000 school students from the area. The day aims to raise aspirations and enthusiasm for different areas of STEM during British Science Week. I discussed my research area and its impact with small groups of students for the whole day. |
Year(s) Of Engagement Activity | 2020 |
Description | Visit to school- Stockport Grammar |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Schools |
Results and Impact | Gave a lunch time talk on nuclear medicine to a group of ~30 students from year 7 to 13. Also showed the SPECT camera Raspberry Pi model built with the I'm A Scientist money. |
Year(s) Of Engagement Activity | 2019 |
Description | Visit to school- Urmston Grammar |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Schools |
Results and Impact | Repeat of the 'Speed networking' evening event for mums and year 8 daughters to give girls an idea of what a career in physics or engineering would be like. Around 40 mum-daughter pairs and 24 women in STEM attended. |
Year(s) Of Engagement Activity | 2019 |
Description | Winner of online outreach activity- I'm a Scientist- Get me out of here! |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Schools |
Results and Impact | An on-line activity where school students connect with scientists. A total of 3,863 school students from participating schools across the country could ask questions to scientists through live chats and the website. I was the winner in the "nuclear zone" which was supported by STFC. For winning I received £500 to put towards other outreach activities. |
Year(s) Of Engagement Activity | 2019 |
URL | https://imascientist.org.uk/ |