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Research Training in 3D Digital Imaging for Cancer Radiation Therapy

Final Report Summary - ENTERVISION (Research Training in 3D Digital Imaging for Cancer Radiation Therapy)

Cancer is a critical societal issue. Cancer costs are rising and putting a major burden on public healthcare budgets. In the EU, cancer costs exceed more than EUR 50 billion each year. Currently in Europe, about half of the patients diagnosed with cancer undergo radiation therapy (RT) and about 50% of all patients cured have had RT as part of their treatment. Consequently improvements in RT provision could have a dramatic impact on patient survival, quality of life and economic costs.
Particle therapy is a highly-advanced technique of cancer radiotherapy that uses beams of charged particles (ions) to destroy tumour cells. While conventional X-rays traverse the human body depositing radiation as they pass through, ions deliver most of their energy at one point. Particle therapy is most advantageous once the position of the tumour is accurately known, so that healthy tissues can be protected.
However, accurate positioning is a crucial challenge for targeting moving organs, as in lung cancer, and for adapting the irradiation as the tumour shrinks with treatment.
The ENTERVISION European training network in digital medical imaging for radiotherapy was established in February 2011 as a 4-year project in response to the critical need for reinforcing research in online 3D digital imaging and the training of skilled professionals. ENTERVISION brought together 10 beneficiaries - ten academic institutes and research centres of excellence (CERN, CNRS, GSI, CSIC, INFN, University of Cambridge, TUD, TERA, UCBL)) and the leading European company in particle therapy (IBA).

ENTERVISION (www.cern.ch/entervision) offered research and training opportunities to 15 young scientists (12 ESRs and 3 ERs) from all over the world. They came from different fields: physics, medicine, electronics, informatics, medical physics, radiobiology, engineering and together formed a collaborative network with a common goal: improved cancer treatment with early detection and more precise treatment of tumours. The institutes involved in the project are the leaders in their field and by training the fellows they are developing the specialists of the future.

In addition, the ENTERVISION researchers worked closely together with ENVISION (www.cern.ch/envision) an EC-funded Cooperation project which formed a platform for interactive and cutting edge research on imaging.

Intercalated into the multidisciplinary training programme, the researchers had the opportunity to perform hands-on work in the following fields:
- Development of in-beam Positron Emission Tomography monitoring techniques
- Development of Single Particle Tomography techniques
- Adaptive treatment planning, and organ motion
- Optical imaging, cell irradiation, and biological phantom design
- Monte Carlo simulation of in-vivo dosimetry.

The actual research and technology development of this next-generation image based in-vivo dosimetry was carried out in the ENLIGHT umbrella. Since ENVISION was not been designed to incorporate a platform for knowledge development for future generations of researchers and ENTERVISION was established to address this situation.

The following training courses were organised by the consortium during the project:
-‘Workshop on Treatment Delivery Systems and Dosimetry’ by HIT & GSI in March 2012,
- 'From physics to medical imaging through detectors’ which was held in Lyon in June 2012 (also included a cookery course as a social and team-building event)
- a Leadership Development Course in November 2012 in Guildford, UK offered by University of Cambridge
- Detectors and Electronics at IFIC in Valencia in September 2013
- Industrial course organised by IBA in November 2013.
- CV writing and IP course at CERN in July 2014

The researchers also had the opportunity to join the courses run by a previous Marie Curie Actions Initial Training Network, PARTNER: “Hadrontherapy: one name many different techniques. The impact of Gantries and Imaging” and “Image guidance in hadrontherapy” which took place in July 2012 at CNAO and gave the researchers the opportunity to network with the PARTNER researchers; they could also see functioning particle therapy facility at first hand and interact and discuss with the various personnel about the challenges and advantage of working in such a cutting edge field.

These were all wide-ranging multidisciplinary courses designed to build their scientific knowledge as well as communication and leadership skills, the overall aim being to greatly enhance their career development and employment prospects.

During the four year period of the project, the researchers have attended other ENLIGHT and EU project meetings. They have presented their work and listened to and interacted with the experts in the hadron therapy field leading to unique learning and networking opportunities.
- ENLIGHT Annual Meeting (Marburg, Germany, September 2011).
-The first Annual Meeting of ENTERVISION held in conjunction with the ENVISION MTR at UCLM (Ciudad Real, Spain, April 2012).
- ENLIGHT Annual Meeting (CNAO, Pavia, Italy, September 2012).
- ENTERVISION Mid Term Review, CERN, Geneva, Switzerland, January 2013
- ENLIGHT Annual Meeting (MedAustron, Wiener Neustadt, Austria, July 2013).
- ENLIGHT Annual Meeting (CERN, Geneva, Switzerland, July 2014)
- ENTERVISION final meeting (Rome, Italy, January 2015)

All scientific and complementary deliverables and milestones have been completed, with very good results. The Work Packages also established successful interactions among them, thus reinforcing overall collaboration. The quality of the research is demonstrated by the publications, conference presentations and winning posters based on the ENTERVISION results. The researchers have progressed well in their individual projects, most have successfully completed their PhDs and other are in the process of finalising them. A number of them have already found positions in the academic, scientific, health or the commercial sectors.

All of the researchers attended international conferences and meetings where they presented their work in oral presentations or/and in poster sessions. The overall success and the coherent approach to ENTERVISION’s training programme is illustrated by the fact that there will be a special single issue of the open access journal Frontiers in Oncology. It will be an issue dedicated to Particle Therapy and will also contain contributions from leaders in the field.
The project has been widely disseminated and much was done to promote ENTERVISION, including a web-based interactive map of a virtual hadron therapy facility and a 3D animation to explain hadron therapy from the patient’s viewpoint http://cds.cern.ch/record/2002120?ln=en
Several of the researchers took part in the European Researchers' night and the Open Days at CERN in September 2013. ENTERVISION also co-sponsored a panel at ESOF 2014 in Copenhagen chaired by the project coordinator on “Everything you wanted to know about cancer but were afraid to ask”

One of the exciting technologies emerging from ENTERVSION researchers working with ENVISION platform was the concept of Prompt Gamma imaging with a slit camera that would allow measuring in real-time the penetration depth of individual pencil beams in proton therapy. The research performed was oriented towards a practical solution for clinical application. IBA (commercial partner in this project) believes that such cameras will provide to the PT market an adequate answer to the problem of range uncertainty. The concept is protected by several patents and applications. IBA negotiated a license on the IP and has now all the rights to commercialize such camera, which is currently being clinically tested.
The researchers have formed a close-knit network which they are exploiting to their advantage now and for the future. A number of them have already used the contacts they established during ENTERVISION to find their positions as soon as they finished their Marie Curie projects.

Further information can be found at www.cern.ch/entervision