The inspiration for a scientific breakthrough can sometimes be surprisingly simple. Medical physicist Hugo de Jong came up with an idea for using nuclear imaging technology alongside the usual X-ray technology in the operating room from the same viewpoint without them interfering with each other, in the same way as our eyes manage to look round our noses. A Eureka! moment. The prototype had so much potential that it convinced the ERC committee. With the development of this hybrid instrument, surgeons will be able to get a far more informative image during operations, which will be of great benefit to the patient.
"The problem with hybrid instruments is that, during an operation, the nuclear technology totally interferes with the standard X-ray technology", explains De Jong. "So the current combined scanners are only suitable for scanning the patient before or after an operation. During the operation itself, only X-ray scanners are available. The disadvantage of this is that X-rays can only provide anatomical images. This means that surgeons can see the positions of organs, blood vessels and their instruments, for example, but not whether those organs are functioning properly. Nuclear technologies can show this. They enable you to see where tumours are, because cancer cells more readily absorb radioactive sugar. Other – very specific defects – also become visible, so there is huge added value in using a combination of X-ray and nuclear technology. This combination, known as hybrid imaging, has already been available for decades as a diagnostic tool by superimposing the two images after the operation. But we were unable to create these images from the same viewpoint simultaneously in the operating room."
Modern operation techniques demand clear images. "Particularly with today's minimally invasive surgical techniques, in which the surgeon operates using instruments via the smallest possible incision, visual support is very welcome. Cancer patients, for example, experience relatively fewer negative outcomes from such operations, and this is hugely important for their quality of life."
When building the prototype – which De Jong and his colleague literally screwed together themselves using wood from Hornbach, the local DIY store – De Jong already started to encounter problems. "It's 'high risk, high gain'. As yet I am unable to control the overspill of radiation, the effect they have on each other. And the image quality needs improvement."
De Jong is not sure whether it will actually work in the end. The film demonstrating the prototype with a kind of burning match was already a breakthrough, and every step further is exploring new territory. Using this combined technology also requires practical considerations. "The great thing about the design is that it fits into the operating room, where space is limited. I am building the nuclear eyes into the existing mobile X-ray C-arm between which the patient lies on the operating table. Everything is moving, the patient is breathing, so you have to make two images at the same time and from the same viewpoint; one device has to look around the other. At present I have the X-ray device in the middle and four nuclear eyes on the other side, because with this radiation you can't work using optical instruments like a mirror."
De Jong is working together with a team of young physicists. The business sector is also getting involved; after all, they will be the ones making the equipment. "In the UMC Utrecht, I can carry out trials on a test object. After that of course we also want to make 3D images. Before too long, we hope to wheel the instruments into an operating room and test the technology on real patients."
Written by: Youetta Visser