Title: Information Guided Therapy Resources Laurence P. Clarke Ph.D. Branch Chief Imaging Technology Development Image Guided Therapy NCI: Biomedical Imaging Program, USA

Biomedical Imaging Program(BIP) Diagnostic Imaging Branch Molecular Imaging Branch Image-guided Therapy Branch Imaging Technology Development Branch Division of Cancer Treatment and Diagnosis (DCTD) Cancer Diagnosis Program (CDP) Develop- mental Therapeutics Program (DTP) Cancer Therapy Evaluation Program (CTEP) Radiation Research Program (RRP) NCI

Branches: ITDB and IGT Support basic research, technology development, integration, and feasibility testing for novel imaging sensors and contrast materials. Develop initiatives to facilitate partnerships with academia/ industry/ SBIR/STTR. Develop of centers of excellence, imaging networks and research resources to promote translational research. Promote programs:(NIH inter-institute and inter- agency programs within the USA) and international.

NCI:Types of New Initiatives ( ) Research Centers of Excellence (Molecular Imaging) Small Animal Resource Centers (Molecular Imaging) National Distributed Research Resources Research Interface Software ( Ultrasound). Image Databases for Software Evaluation (Lung CT). Platform Independent Imaging Methods (MRI). NCI/NIBIB: New funding mechanisms tailored for Imaging Technology Development, including IGT/IGS.

NCI/NIBIB: Novel Imaging Technologies Aim: Support high risk/high gain imaging technologies, such as molecular imaging, including proof of feasibility studies as opposed to hypothesis based research. Goal: Full support for the development and/or integration of novel technologies with traditional imaging methods with specific deliverables at the end of the funding period. Areas: 1.Early cancer detection/ other disease processes. 2.Large screening applications/ other disease. 3.Imaging for diagnosis, staging, therapy. 4.Image guided biopsy and novel forms of therapy.

PAR: Novel Imaging Technologies NCI/NCRR: Phased Innovation Award (R21/R33). Specifically designed for technology development, with provision of academic/ industry partnerships. Combined R21/R33 or R33 alone: R21: Feasibility study. R33: Technology development / feasibility. Parallel SBIR/STTR: Similar scope and timetable. NCI Review: Reviewers: Academia and Industry and small business. Applications: 1 st Round 40; 4 funded, 2 nd Round 70 Future: Multiple Prototypes: SB Joint Ventures.

Cars 2000: Panel Report Challenges and Opportunities in Computer –Assisted Interventions. Laurence P. Clarke Richard D. Bucholtz Henry Fuchs Ron Kikinis Richard A. Robb Ramin Shahidi Michael Vannier

Visualization Standards In order to make 3D imaging more reliable and widely used, the following protocols are recommended to be developed: Standards for 3D image Acquisition. Standards in visualization parameters to categorize various types of tissues in 3D models. Standards for interpretation of 3D images.

Validation Standards In order to make the validation process more compatible across platforms, recommend protocols: Breaking down “ overall systems error”in a given system to its basic components. Protocols wherein all basic errors components can be tested and measured using the same criteria. Initiating open dialogue between centers for communication and sharing validation results.

Automatic Segmentation Need for involvement of non traditional disciplines and approaches: Attract new investigators ( Computer scientists, mathematicians and pattern recognition experts). Identify and distribute international requirements for image segmentation verses diagnostic requirements for the scientific community. Specific segmentation research for IGT, such as interactive methods as necessary to enhance reliability.

Real Time Visualization Need for implementation techniques for real time image rendering: Real time volumetric data deformation techniques. Fast 3-D visualization of inter-operatively-acquired data, such as US images. Mechanisms for intuitive presentations of 3D information during ongoing surgical procedures, such as augmented reality

Data Correlation Need to address one of the large sources of error, namely tissue deformity that occurs between per- operative and tissue intervention using methods such as: 2D/3D registration (e.g. intra-operative X-ray or endoscopic data registration with CT/MRI). Identifying and development of quantifiable methods for the prediction and interpolation of tissue deformation during therapeutic procedures. Development of novel algorithms for more robust registration methods.

Tracking techniques Significant improvement is necessary for tracking of surgical tools in a stereotactic space, and thus the following is recommended: Design of novel instruments for tracking with emphasis on miniaturized systems using NANO/MEMS fabrication technology. Investigation of the effects of tissue types on such systems. Computer controlled effectors and interface standards, in a flexible plug and play format

Machine and Human Interface There is a need to focus on the human operation of computer assisted systems and develop more advanced systems: Smart tools that can conduct intra-operative anatomical/ functional imaging and access trajectory of the surgical path. Smart displays that minimize the surgeons need to coordinate eye hand movements and enhance target recognition. Customized human/computer interfaces for sterile environments ( I.e. eliminate keyboards/mouse) Robotically activated devices for scaling macroscopic and microscopic movements.

New Clinical Applications for Emerging Technologies Systems need to be evaluated based on cost increase verses potential health benefit and thus the following is recommended: Set the gold standard for assessing the impact of specific technologies on medicine. Measure the benefits and drawbacks for different IGT technologies. Create a training programs for IGT technologies for next generation of physicians.

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