viernes, 21 de julio de 2017

Proscia introduces new concept to transform pathology labs, drive digital evolution

Proscia introduces new concept to transform pathology labs, drive digital evolution

News Medical - Medical & Life Sciences



Proscia introduces new concept to transform pathology labs, drive digital evolution

Proscia Inc., a software solutions provider for digital pathology, announced today the introduction of its new concept: Software as a Lab. Proscia’s President and CEO David West will outline how the pathology lab of the future will operate in a session at the 2017 Digital Pathology Congress: USA on July 10-11 in Chicago. He will address how the role of the pathologist will change as artificial intelligence (AI) and machine learning techniques are applied to digital pathology.
“Just as radiology has been transformed over the past decade, pathology is set to experience a similar disruption,” said West. “Proscia is building software that will augment the work of the pathologist through deep learning and image-based diagnostics. The concept of ‘Software as a Lab’ begins a deeper exploration of what this evolution means for the pathologist.”
Until recently, pathology labs have relied on the same optical microscopes and techniques in use for the past 150 years. With the introduction of whole slide imaging and artificial intelligence software, pathology labs are on the verge of a massive digital evolution. While a majority of pathology labs are just being introduced to whole slide imaging, those who have adopted this cutting-edge technology are already experiencing many of its benefits. This includes telepathology, where slides can be reviewed by experts located anywhere in the world, and whole slide image analysis, where software is trained to highlight features not easily visible to the human eye.
“It is inaccurate to think of this digital evolution as man vs. machine,” added West. “This is a great opportunity to develop innovative techniques that will ultimately improve the work of the pathologist when it comes to researching and diagnosing cancer. The transformation is happening, and we aim to educate pathologists on ways they can take advantage of our groundbreaking software.”
The 2017 Digital Pathology Congress attracts over 200 industry and academic experts in the field of pathology who want to fully understand both the technology and accompanying informatics and image analysis tools and utilize digital pathology to its greatest potential. In particular, the meeting will examine the applications and benefits of adopting digital pathology as well as the business case to be made for it.

Beaumont Health's new Proton Therapy Center starts treating cancer patients

Beaumont Health's new Proton Therapy Center starts treating cancer patients

News-Medical

Beaumont Health's new Proton Therapy Center starts treating cancer patients

Bill Baker, an 86-year-old Mid-Michigan man with brain cancer, is the first patient to receive treatment at Beaumont Health's new Proton Therapy Center at Beaumont Hospital in Royal Oak, Michigan.
Said Craig Stevens, M.D., Ph.D., chairman, Radiation Oncology, Beaumont Health, "Beaumont's Proton Therapy Center is the first in Michigan to treat cancer patients with this powerful and precise form of treatment that deposits energy directly in the tumor, sparing nearby healthy organs and tissue from harm. It was many years in the making, but we never gave up in our efforts to bring this advanced cancer therapy to patients and families in Michigan."
Beaumont's center is one of just 25 operational proton therapy centers in the U.S.
"This means that cancer patients from other states and countries will travel to Michigan for proton therapy, making Beaumont even more of a destination center for cancer care," said Dr. Stevens.
According to independent research, conducted by NRC Health, Beaumont Health is one of the most preferred providers of cancer care in Wayne, Oakland and Macomb counties.
How proton therapy works
Proton therapy is a high-tech alternative to X-ray radiation. A scanning beam of proton radiation with online image guidance offers greater precision to destroy cancerous cells, sparing adjacent healthy tissue with fewer side effects.
Proton therapy uses positively charged atomic particles, traveling up to two-thirds the speed of light, to fight cancer. A cyclotron, or particle accelerator, creates protons from hydrogen molecules. The proton beam is sent to the treatment room through a transport system consisting of magnets, called the beam line, finally arriving in the gantry, a device that rotates around the patient. The beam is directed to the patient through a nozzle that targets the tumor.
While proton therapy is not effective against all cancers, Dr. Stevens explained it is effective in treating many solid and localized tumors, including:
  • pediatric cancers
  • soft tissue cancers that develop in bone or muscle
  • brain and skull base tumors
  • eye tumors
  • head/neck cancers
  • abdominal/pelvic tumors
  • liver tumors
  • lung and thoracic cancers
  • left-side breast cancer
"Proton therapy is an ideal treatment option for many patients, especially those with tumors close to vital organs," added Dr. Stevens. "For children, those most vulnerable and susceptible to the damage of traditional radiation therapy, proton therapy offers less radiation exposure while reducing side effects."
Advanced technology
"Our IBA ProteusOne single-room treatment system includes precision technologies," said Dr. Stevens. "Intensity Modulated Proton Therapy, which combines Pencil Beam Scanning and 3-D Cone Beam CT, can target a tumor within less than a millimeter."
Pencil Beam Scanning refers to the delivery of protons in a thin beam. Like a pencil, the beam uses back and forth motions to target the treatment area – the shape, size and depth. It "paints" a radiation dose on tumors layer by layer. Compared to X-ray beams, which pass through a patient, proton beams deliver targeted radiation to the tumor and then stop – resulting in no exit dose.
Radiation oncologists at Beaumont are well versed in precise image guidance, having developed cone beam CT technology almost 20 years ago. Image guidance allows doctors to analyze soft tissue and bone contrast to see tumor changes.
Single-room facility
Unlike larger, multiroom proton treatment facilities, Beaumont's compact, single-room treatment center is more affordable to build and maintain. Along with advanced, image-guided technology, Beaumont's facility includes the Philips Ambient Experience system that lets patients select a color theme, music and video for relaxation during treatment.
"Our center offers the most advanced proton technology available anywhere in the world," said Dr. Stevens. "We will have the ability to potentially cure patients that have failed conventional treatment at other centers."
In February 2015, construction began on the $40 million Proton Therapy Center. The two-story building is 25,200-square-feet, including a basement. The first floor houses the Proton Therapy Center, including a cyclotron and gantry that produces and delivers proton beams to a single-room treatment area. The second floor will soon be the home of Beaumont's Center for Children with Cancer and Blood Disorders.
Beaumont chose Ion Beam Applications S.A., or IBA, of Belgium, to manufacture, install and maintain the proton system. An Atlanta-based proton therapy development group, Proton International, is lending its operational expertise.
Beaumont's Facilities Management department oversaw design and construction, with Kasco Construction as the contractor and SmithGroupJJR, as the architect.
Comprehensive cancer care
Proton therapy is an important addition to Beaumont's comprehensive arsenal of leading-edge cancer treatments. Beaumont's Radiation Oncology department is ranked among the nation's best for advanced technology, innovative treatment and research. Advanced radiation treatments developed at Beaumont include adaptive radiation therapy, image-guided radiation therapy, intensity-modulated arc therapy, high-dose rate brachytherapy and hyperthermia therapy.

IBS scientists create first nanoparticle-based tissue adhesive to seal bleeding and guide surgery

IBS scientists create first nanoparticle-based tissue adhesive to seal bleeding and guide surgery

News-Medical

IBS scientists create first nanoparticle-based tissue adhesive to seal bleeding and guide surgery

As open surgery has gradually been replaced by minimally-invasive and image-guided procedures, tissue adhesives are taking the place of sutures and surgical staples. With countless applications, including: bleeding embolization, angioplasty, stent insertion, and biopsy, among others, new surgical glues are highly desired in medical clinics. Researchers at the Center for Nanoparticle Research, within the Institute for Basic Science (IBS) in collaboration with medical doctors in Seoul National University Hospital, created a surgical glue that is both adherent and visible in the most common imaging techniques: fluoroscopy, ultrasound, and computed tomography (CT). It is the first nanoparticle-based tissue adhesive that features these characteristics. Its properties were successfully tested in sealing a liver puncture and in conducting operations in moving organs, like lung and limbs. The full results of these surgical procedures conducted in animal models are available on Nature Communications.
IBS scientists in collaborations with researchers led by Nohyun Lee (Kookmin University), Hyo-Cheol Kim (Seoul National University Hospital) designed nanoparticles with a shell made of silica (SiO2) and a core of radiopaque tantalum oxide (TaOx). SiO2 holds the tissue together, while TaOx provides contrast enhancement on ultrasound and CT.
The research team tested the TaOx/SiO2 core/shell nanoparticle (TSN) glue and found that it is clearly visualized by real-time imaging modalities and exhibits adhesive properties similar to that of the U.S. Food and Drug Administration (FDA)-approved cyanoacrylate and Lipiodol (CA-Lp), a mixture of a tissue adhesive and radiopaque oil used in the clinical practice.
Its stickiness, due to the absorption of the silica surface to the tissues, was tested to suture a puncture in the liver of a rabbit in a minimally invasive procedure, without abdominal incision. "A plethora of surgical procedures create a liver puncture, which necessitates hemostasis to stop the bleeding. These include operations frequently used in patients with chronic liver disease and liver cancer, such as: liver biopsy, percutaneous biliary drainage, portal vein embolization, and portal vein angioplasty," points out SHIN Kwangsoo, the first author of this study.
Beyond adhesiveness properties, TSN is more biocompatible than CA-Lp, meaning that it causes less side effects. CA-Lp tends to trigger immune reaction within 3 days from the operation and inflammation after 14-65 days, while experiments showed that TSN did not show such adverse effects after 56 days.
TSNs also ensured accurate target localization during movement; when TSNs were injected in rat's thigh and calf muscles, they did not move even during the flexion and extension of the leg. "TSNs are well fixed to tissues so that nanoparticles and tissues move in unison. This is important because they could help surgeons to recognize a moving surgical target and perform a safe and accurate operation," explains HYEON Taeghwan, director of the IBS Center for Nanoparticle Research.
Finally, IBS scientists verified that TSN is stable in one of the most moving organs; the lungs. A fluorescent version of TSN visible under CT was successfully used to guide the resection of lung cancer in a rat. The opacity of TSNs was high enough to be clearly distinguished from the nearby ribs and vertebrae.

ASTRO releases updated insurance coverage recommendations for proton beam therapy to treat cancer

ASTRO releases updated insurance coverage recommendations for proton beam therapy to treat cancer

News-Medical



ASTRO releases updated insurance coverage recommendations for proton beam therapy to treat cancer

The American Society for Radiation Oncology (ASTRO) has issued an update to its recommendations for medical insurance coverage regarding the use of proton beam therapy to treat cancer. The updated Proton Beam Therapy Model Policy provides guidance to payers on clinical indications that are appropriate for treatment with proton therapy and should be covered by health insurance, including Medicare, Medicaid and private insurance.
Proton beam therapy is an advanced type of external-beam radiation therapy that uses proton rather than photon beams to deliver radiation doses to a tumor. Proton therapy offers a high degree of precision, which allows radiation oncologists to target an escalated dose of radiation directly on a tumor and spare nearby healthy tissue. Proton therapy is particularly beneficial for patients with tumors that are near critical structures, such as lung tumors near the heart.
Based on new evidence published since the original policy was issued in 2014, the updated model policy outlines two categories of appropriate clinical indications, or diagnoses, for proton beam therapy. For indications in Group 1, coverage is recommended; for Group 2, coverage is recommended if additional requirements (outlined below) are met. Disease sites were assigned to one of the two categories based on evidence in published clinical data and current Medicare coverage.
Group 1 indications, or the clinical scenarios that frequently support the use of proton therapy based on medical necessity and published clinical data, were updated with five additions and one modification. Group 1 indications, with additions marked by asterisks, include:
* Malignant and benign primary central nervous system (CNS) tumors
* Advanced (e.g., T4) and/or unresectable head and neck cancers
* Cancers of the paranasal sinuses and other accessory sinuses
* Nonmetastatic retroperitoneal sarcomas
* Reirradiation cases where cumulative critical structure dose would exceed tolerance dose
* Hepatocellular cancer (no longer required to be treated in a hypofractionated regimen)
* Ocular tumors, including intraocular melanomas
* Tumors that approach or are located at the base of skull, including but not limited to chordoma and chondrosarcomas
* Primary or metastatic tumors of the spine where the spinal cord tolerance may be exceeded with conventional treatment or where the spinal cord has previously been irradiated
* Primary or benign solid tumors in children treated with curative intent and occasional palliative treatment of childhood tumors when one of the criteria noted above apply
* Patients with genetic syndromes making total volume of radiation minimization crucial, such as but not limited to NF-1 patients and retinoblastoma patients
The policy recommends coverage for Group 2 indications if the patient is enrolled in either an Institutional Research Board (IRB)-approved study or in a multi-institutional registry adhering to Medicare requirements for Coverage with Evidence Development (CED). These indications also represent the disease sites for which evidence is accumulating and may support future Group 1 coverage. While the policy specifies that no indications are deemed inappropriate for CED, it also specifies several systems for Group 2 indications:
* Non-T4 and resectable head and neck cancers (previously all head and neck malignancies)
* Nonmetastatic prostate cancer (previously grouped with genitourinary carcinomas)
* Breast cancer
* Thoracic malignancies, including nonmetastatic primary lung and esophageal cancers
* Abdominal malignancies, including nonmetastatic primary pancreatic, biliary and adrenal cancers
* Pelvic malignancies, including nonmetastatic rectal, anal, bladder and cervical cancers
"Recent research has expanded our understanding of the types of malignancies and clinical scenarios where proton beam therapy is most advantageous. This policy update reflects the most current knowledge regarding which patients will benefit from--and therefore should have access to--this cutting-edge treatment," said ASTRO Chair David C. Beyer, MD, FASTRO. "We also remain firmly committed to developing evidence to identify new areas where this technology might be beneficial as well as situations where it is not needed."
The model policy update was developed by ASTRO’s Payer Relations Subcommittee, reviewed by the Health Policy Council and then approved by the Board of Directors in June 2017. Model policies differ from practice guidelines, which are written for physicians and outline recommendations to optimize clinical care. ASTRO also provides model policies for brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS).

Dementia researchers to receive £1.9 million funding for brain imaging project

Dementia researchers to receive £1.9 million funding for brain imaging project

News-Medical



Dementia researchers to receive £1.9 million funding for brain imaging project

Dementia researchers are to receive a £1.9 million investment to identify the earliest brain changes associated with conditions such as Alzheimer's disease.
The brain imaging project - known as the TriBEKa Consortium - involves research teams from three countries. It will paint the clearest picture yet of the first factors that determine risk of dementia.
Although the condition is associated with old age, changes in the brain that lead to dementia can occur decades before symptoms appear.
Experts say that understanding these changes are key to developing ways to intervene before irreversible damage has been done.
The initiative - the largest of its type to focus on this age group - brings together experts led by the University of Edinburgh in the UK, the BarcelonaBeta Brain Research Centre in Spain and Sweden's Karolinska Institute.
Researchers will use a brain scanning technique known as positron emission tomography (PET) to detect harmful build-up of chemicals associated with dementia. Brain structure will be measured using a tool known as magnetic resonance imaging (MRI).
Participants in the study - aged between 40 and 65 - will also take part in memory tests, family history and lifestyle assessments and will be invited to take part in a three-year follow-up.
Data gathered from the project will be made available to the global science community using data-sharing platform known as the Global Alzheimer's Association Interactive Network (GAAIN).
The funding boost comes from the US-based Alzheimer's Association and donation from an anonymous international charitable foundation. The project will be launched on Friday in London at the Alzheimer's Association International Conference.
Dementia affects 47 million people worldwide, with Alzheimer's disease the most common cause. There are 9.9 million new cases diagnosed globally each year.
Professor Craig Ritchie, Director of the University of Edinburgh's Centre for Dementia Prevention, said: "Dementia is an urgent health issue and requires forward-thinking international collaboration to defeat it. As brain changes that cause dementia happen many years before symptoms, we have an opportunity to prevent progression before people are affected. TriBEKa puts us in a unique position to understand how we might do this."
Professor José Luis Molinuevo, Scientific Director of the BarcelonaBeta Brain Research Centre, said: "Modelling and understanding early changes in Alzheimer's disease is key for understanding the role of the different risk factors and designing prevention trials. The TriBEKa Consortium will become a key source of information to give those answers."
Dr Maria C. Carrillo, Chief Science Officer at the Alzheimer's Association, said: "We are proud to contribute the TriBEKa Consortium. We know that it is essential that we learn how to identify Alzheimer's brain changes at the earliest point, with the goal of understanding risk factors to ultimately intervening in the disease process before cognitive decline and dementia symptoms are present."

Researchers discover reason for chemoresistance in small cell lung cancer

Researchers discover reason for chemoresistance in small cell lung cancer

News-Medical



Researchers discover reason for chemoresistance in small cell lung cancer

Approximately one year after successful treatment with cytotoxic chemotherapy and radiotherapy, patients with advanced Small Cell Lung Cancer (SCLC), which primarily affects heavy smokers, generally relapse with recurrence of tumors that are resistant to further chemotherapy. At this point, the affected patients usually only have a few months to live. The reason for this was hitherto unknown. Researchers at MedUni Vienna, led by Gerhard Hamilton (Department of Surgery), have now discovered that circulating tumor cells combine, making previously chemo-sensitive cells into chemo-resistant cell complexes.
"The circulating tumor cells aggregate to protect themselves from chemotherapy - like a circle of covered wagons - thereby preventing any active agents from entering," says Hamilton, describing the process. These "aggregates" can comprise hundreds of thousands of cells, be up to 2 mm in diameter and be eight times more resistant to chemotherapy drugs - firstly because hypoxic conditions are created inside the aggregates and secondly because these tumor cells reduce growth and are therefore less sensitive. The results were recently published in the prestigious journal "Scientific Reports" from Nature Publishing Group.
These results were facilitated by the permanent cultivation of circulating tumor cells of patients with advanced SCLC in Vienna. This was the first time in the world that this had been done. The research group headed up by Hamilton and Robert Zeillinger (Molecular Oncology Group, Department of Obstetrics and Gynecology, MedUni Vienna) and Maximilian Hochmair (Otto-Wagner Hospital) successfully developed seven cell lines from blood samples and then analyzed these in the laboratory.
"And so, after 30 years of uncertainty, we managed for the first time to identify the causes of chemo-resistance," explains Hamilton. The scientists now intend to conduct further studies to find out how to either prevent or destroy these cell aggregates. According to the MedUni Vienna expert, a highly promising approach is to break up the cell complexes using enzymes or inhibitors.
Lung cancer now leads the field when it comes to cancer-related mortality in women
15% of people with lung cancer have Small Cell Lung Cancer.  By the time of diagnosis, SCLC has usually already formed metastases and surgery is no longer an option - the prognosis for those patients is therefore poor. Their prospects are even worse if they have developed resistance to chemotherapy. "In such cases, patients usually only survive a few months," says Hamilton. "In view of the fact that lung cancer has now overtaken breast cancer as the commonest cause of death from cancer among women, that is alarming. Since 1972, the proportion of deaths among women due to lung cancer has increased from 10% to 22% - a figure backed up by the latest results from Statistik Austria. Young people, in particular, young women, who smoke should be aware of the high risk of developing SCLC, as well as other nonmalignant diseases."

Researchers develop metal-free contrast agent that could be safer for high-risk patients

Researchers develop metal-free contrast agent that could be safer for high-risk patients

News-Medical



Researchers develop metal-free contrast agent that could be safer for high-risk patients

To enhance the visibility of organs as they are scanned with magnetic resonance imaging (MRI), patients are usually injected with a compound known as a contrast agent before going into the scanner. The most commonly used MRI contrast agents are based on the metal gadolinium; however, these metal compounds can be harmful for young children or people with kidney problems.
Researchers from MIT and the University of Nebraska have now developed a metal-free contrast agent that could be safer to use in those high-risk groups. Instead of metal, this compound contains organic molecules called nitroxides.
Furthermore, the new agent could be used to generate more informative MRI scans of tumors because it can accumulate at a tumor site for many hours without causing harm.
"This is an entirely organic, metal-free MRI contrast agent that would allow cancer researchers to start to think about how to image tumors in a dynamic way over long periods of time," says Jeremiah Johnson, the Firmenich Career Development Associate Professor of Chemistry at MIT.
Johnson is the senior author of the study, which appears in the journal ACS Central Science. The paper's lead author is MIT graduate student Hung Nyugen. Other MIT authors are former postdoc Qixian Chen, postdoc Peter Harvey, graduate student Yivan Jiang, and professor of biological engineering Alan Jasanoff.
Alternatives to metal
MRI scans often rely on contrast agents that interact with water, influencing how the water molecules respond to a magnetic field. Contrast agents that exert a strong effect are said to have high "relaxivity," which enhances the visual contrast between the target organ and surrounding tissue.
Most MRI contrast agents are based on gadolinium, which has very high relaxivity. These agents are usually excreted by the kidneys within about half an hour, so they can't be used in people with certain types of kidney problems because the gadolinium will build up and exacerbate the kidney damage. Some agents are also considered potentially unsafe to use in babies.
"Gadolinium agents are by far the most commonly used, clinically," Jasanoff says. "However, people do have some safety concerns about them, despite their wide use. There has been interest in going to non-gadolinium-containing contrast agents."
Less often used are contrast agents made from iron oxide nanoparticles, which are considered somewhat safer because the body already contains iron. But some of these have also generated safety concerns recently.
As a possible alternative, scientists have tried developing nonmetal agents such as organic radicals, which are organic compounds that have unpaired electrons. However, these compounds tend to be very unstable, so they are usually broken down in the bloodstream within minutes. Also, these molecules generally have only one unpaired electron, so they don't produce as much MRI contrast as metal agents.
In a study published in 2014, Johnson and his colleagues tried to improve the relaxivity of nitroxide radicals by assembling them into a structure known as a bottle brush polymer. This improved their stability and relaxivity, but not enough for imaging over long time periods, which is often necessary in cancer imaging. In the new paper, the researchers loaded the nitroxide molecules into a different type of polymer structure known as a brush-arm star polymer (BASP). This structure consists of many polymer chains arranged so that the spherical particle has a hydrophilic (water-attracting) core surrounded by hydrophobic (water-repelling) shell.
The researchers found that creating a high density of nitroxide molecules at the interface between the shell and core of the nanoparticles greatly increased the MRI relaxivity of the overall particle, to a level similar to that of metal-based agents.
The polymer shell also protects the radicals from being broken down in the bloodstream. The particles are stable enough to last in the bloodstream for up to 20 hours, long enough to accumulate in a tumor in mice. The researchers also showed that the nitroxide BASP nanoparticles are not harmful to mice even at very high doses.
Long-term monitoring
Johnson says that these particles could be designed to carry drugs as well as an MRI contrast agent, which would allow for long-term imaging of a tumor to monitor whether the drug is shrinking it. He is also working with researchers at MIT's Koch Institute for Integrative Cancer Research to attach the contrast agent particles to antibodies that would help them to target specific cells for imaging and possibly drug delivery.
Another possibility is attaching the contrast agent to immune cells engineered to attack a patient's tumor, allowing the cells to be tracked inside the body. "We're trying to make particles that we can dock on cells and then watch the cells move in vivo," Johnson says.
His lab is also working on improved versions of the contrast agent which have an even higher density of nitroxide, thus improving their relaxivity and enhancing the MRI contrast even more.