Clinical translational studies

Clinical-translational studies are a fundamental focus of our group. In these studies, we aim to transition scientific research into clinical practice where it can be of direct benefit to patients.

Ongoing clinical translational studies | Completed clinical translational studies

Ongoing clinical translational studies

In-situ MRI guided audiovisual biofeedback for precise lung cancer radiotherapy

Project description: In clinical practice, indirect respiratory motion management methods with external surrogates are used for “respiratory gating” and “breath-hold” techniques. However, significant variations in the cycle-to-cycle breathing may lead to the beam being on at the incorrect time or with the target in the incorrect location. Inaccurate correlation between the motion of a tumour and its external surrogate due to the patient’s irregular breathing can exacerbate this issue. The aim of this project is to develop a novel direct respiratory motion management system using an internal surrogate such as the diaphragm, visualised by real-time MR imaging and audio. This type of audiovisual biofeedback, termed MRI guided audiovisual (MRI-AV) biofeedback will be tested on healthy human subjects.

Protocol No: 05-2011 / 13778
Study size: 15 healthy volunteers
Site: Brain and Mind Research Institute (BMRI)
Contact: Sean Pollock, sean.pollock@sydney.edu.au
Audiovisual biofeedback

Investigation Investigating CT ventilation as a functional imaging modality for lung cancer radiotherapy

Project description: This study will investigate the use of four-dimensional computed tomography imaging in providing accurate ventilation imaging for lung cancer radiotherapy planning. Incorporating lung functional imaging, such as ventilation, enables the differentiation of normal functioning lung tissue and diseased lung. This can be used to optimise treatment planning to minimise lung toxicity and improve treatment outcomes for lung cancer patients. CT ventilation imaging will be validated against nuclear medicine ventilation imaging.

Protocol No: ACTRN12612000775819
Study size: 30 lung cancer patients to be treated with RT
Site: Department of Radiation Oncology and Nuclear Medicine at the Royal North Shore Hospital
Contact: Dr. Enid Eslick , enid.eslick@sydney.edu.au
CT-based ventilation imaging

An investigation into the patient experience of single, slow rotation in the upright and lying positions

Project description: This project will provide the first quantitative data on patient response to slow rotation in both the lying and upright positions. To do this we will use existing TGA approved medical equipment (The Epley Omniax ) from the field of balance disorder therapy to slowly rotate patients. Validated psychometric questionaries will be used to assess whether any noticeable increase in patient anxiety levels or motion sickness occurs.

If patient rotation is shown to be a feasible in radiotherapy, it will vastly simplify the engineering challenges associated with delivery of radiotherapy. This is particularly true for advanced new treatment options such as MRI guided radiotherapy , Proton Therapy and Heavy Ion Therapy. Patient rotation would mean that these advanced techniques could be made accessible to a far wider population than the limited few who can currently benefit from them. To date, patient response to slow rotation has not been tested.

Ethics: RPAH Ethics Review Committee, Protocol Number X12-0390
Study Size: 15
Site: Royal Prince Alfred Hospital
Contact: Brendan Whelan, brendan.whelan@sydney.edu.au

Completed clinical translational studies

In-situ MRI guided audiovisual biofeedback for precise lung cancer radiotherapy

Project description: Lung cancer is the most common cancer related cause of death. Many patients rely on radiotherapy treatment as part of their disease management. However, the precision of radiotherapy is affected by involuntary movements such as respiratory motion, which results in poor targeting and therefore, poor tumour control. In this project an audiovisual (AV) biofeedback respiratory motion management system will be developed using the Real-time Position Management (RPM, Varian) device. This system utilizes an external marker to track a patient's breathing motion and uses visual cues such as a trace, and audio cues to help the patient to keep to regular breathing motion. Concurrent MRI will be acquired which will allow the study of the motion correlation between an internal breathing surrogate (e.g. the diaphragm) and the real-time external marker. The reproducibility of breathing motion will be studied with and without the use of AV biofeedback.

Protocol No: 05-2011 / 13778
Study size: 15 healthy volunteers
Site: Brain and Mind Research Institute (BMRI)
Contact: Dr. Taeho Kim, taeho.kim@sydney.edu.au
Audiovisual biofeedback

Kilovoltage Intrafraction Monitoring: A Novel Real-time Tumour Localization Modality

Project description: Prostate tumours move during radiotherapy treatment. This results in reduced geometric and dosimetric accuracy. Typically this motion is not observed during treatment. Several real-time tumour localization modalities exist i.e. ultrasound, magnetic resonance imaging (MRI), optical, MV, combined MV/kV, Calypso electromagnetic guidance and the Navotek radioactive fiducial implant. However, some of these are under development, not easily available or expensive. An ideal solution would be to use existing linear accelerator (linac) systems. Kilovoltage intrafraction monitoring is a novel intrafraction real-time tumour localization method. It involves a single gantry-mounted kV x-ray imager (widely available on most linacs) acquiring 2D projections of implanted fiducial markers. 3D positions are then reconstructed by maximum likelihood estimation of a 3D probability density function. Recently, this novel modality has been clinically implement for the first time for patients with localized prostate cancer undergoing intensity modulated arc therapy (IMAT).

Protocol No: 1106-196M
Study size: 10 prostate cancer patients
Site: Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards
Contact: Jin Aun, NG , jin.aun@sydney.edu.au
Kilovoltage intrafraction monitoring