Intraoperative fluorescence imaging : clinical translation of targeted and non-targeted tracers

Surgery is the cornerstone of curative treatment of many malignancies. However, incomplete resections and avoidable iatrogenic damage during surgery increase morbidity and mortality rates in patients. Although advances in preoperative imaging modalities have improved adequate patient selection and surgical planning, during procedures surgeons rely mainly on inspection and palpation. It is often very difficult to distinguish between fibrotic, inflamed, or malignant tissues [1]. Inspection and palpation are highly subjective and have low sensitivity for detecting cancer, especially for subcentimeter lesions [2].Near-infrared fluorescence (NIRF) imaging is a technique that enhances contrast of certain structures during surgery and thereby improves their detectability [3, 4]. It uses targeted and non-targeted fluorescent tracers in combination with dedicated NIRF imaging systems. These tracers consist of fluorophores; molecules that emit fluorescence with a certain wavelength upon excitation by an external light source. These fluorescence signals can be captured by an imaging system optimized for that specific wavelength. Especially near-infrared wavelengths (i.e. 700-900 nm) have excellent characteristics, including relatively high tissue penetration capacity and low tissue autofluorescence, and are therefore preferably used for clinical applications [5]. NIRF imaging can identify targets covered by up to 10 mm tissue.Non-targeted fluorescent tracers such as indocyanine green (ICG; emission peak 830 nm) and methylene blue (emission peak 700 nm) have been available for several decades, albeit for different indications. Their off-label use is safe and cheap, which contributed significantly to clinical experience and enabled NIRF imaging research to get momentum (chapter 2 and 3). NIRF imaging systems could be developed simultaneously with improved fluorophores. In general, NIRF-guided surgery has the potential to increase radical resection rates, while reducing avoidable iatrogenic damage. Both non-targeted as well as targeted tracers will be discussed, followed by the future perspectives of NIRF imaging.Non-specificLUMC / Geneeskund

Intraoperative fluorescence imaging to localize tumors and sentinel lymph nodes in rectal cancer

Surgical oncolog

Development of a national medical leadership competency framework: The Dutch approach

Background: The concept of medical leadership (ML) can enhance physicians' inclusion in efforts for higher quality healthcare. Despite ML's spiking popularity, only a few countries have built a national taxonomy to facilitate ML competency education and training. In this paper we discuss the development of the Dutch ML competency framework with two objectives: to account for the framework's making and to complement to known approaches of developing such frameworks. Methods: We designed a research approach and analyzed data from multiple sources based on Grounded Theory. Facilitated by the Royal Dutch Medical Association, a group of 14 volunteer researchers met over a period of 2.5 years to perform: 1) literature review; 2) individual interviews; 3) focus groups; 4) online surveys; 5) international framework comparison; and 6) comprehensive data synthesis. Results: The developmental processes that led to the framework provided a taxonomic depiction of ML in Dutch perspective. It can be seen as a canonical 'knowledge artefact' created by a community of practice and comprises of a contemporary definition of ML and 12 domains, each entailing four distinct ML competencies. Conclusions: This paper demonstrates how a new language for ML can be created in a healthcare system. The success of our approach to capture insights, expectations and demands relating leadership by Dutch physicians depended on close involvement of the Dutch national medical associations and a nationally active community of practice; voluntary work of diverse researchers and medical practitioners and an appropriate research design that used multiple methods and strategies to circumvent reverberation of established opinions and conventionalisms. Implications: The experiences reported here may provide inspiration and guidance for those anticipating similar work in other countries to develop a tailored approach to create a ML framework

Intraoperative fluorescence imaging : clinical translation of targeted and non-targeted tracers

Surgery is the cornerstone of curative treatment of many malignancies. However, incomplete resections and avoidable iatrogenic damage during surgery increase morbidity and mortality rates in patients. Although advances in preoperative imaging modalities have improved adequate patient selection and surgical planning, during procedures surgeons rely mainly on inspection and palpation. It is often very difficult to distinguish between fibrotic, inflamed, or malignant tissues [1]. Inspection and palpation are highly subjective and have low sensitivity for detecting cancer, especially for subcentimeter lesions [2].Near-infrared fluorescence (NIRF) imaging is a technique that enhances contrast of certain structures during surgery and thereby improves their detectability [3, 4]. It uses targeted and non-targeted fluorescent tracers in combination with dedicated NIRF imaging systems. These tracers consist of fluorophores; molecules that emit fluorescence with a certain wavelength upon excitation by an external light source. These fluorescence signals can be captured by an imaging system optimized for that specific wavelength. Especially near-infrared wavelengths (i.e. 700-900 nm) have excellent characteristics, including relatively high tissue penetration capacity and low tissue autofluorescence, and are therefore preferably used for clinical applications [5]. NIRF imaging can identify targets covered by up to 10 mm tissue.Non-targeted fluorescent tracers such as indocyanine green (ICG; emission peak 830 nm) and methylene blue (emission peak 700 nm) have been available for several decades, albeit for different indications. Their off-label use is safe and cheap, which contributed significantly to clinical experience and enabled NIRF imaging research to get momentum (chapter 2 and 3). NIRF imaging systems could be developed simultaneously with improved fluorophores. In general, NIRF-guided surgery has the potential to increase radical resection rates, while reducing avoidable iatrogenic damage. Both non-targeted as well as targeted tracers will be discussed, followed by the future perspectives of NIRF imaging.Non-specific</p

Two different approaches to treat tumor-positive resection margins using targeted radioactive imaging and fluorescence-guided surgery

Surgical oncolog

A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery

Surgical oncolog

Real-time near-infrared fluorescence guided surgery in gynecologic oncology: A review of the current state of the art

Surgical oncolog

Portable hybrid gamma-near-infrared fluorescence imaging

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Application of near-infrared fluorescence imaging during modified associating liver partition and portal vein ligation for staged hepatectomy

Surgical oncolog

Intraoperative Near-Infrared Fluorescence Imaging of Multiple Pancreatic Neuroendocrine Tumors: A Case Report

Surgical oncolog