Towards personalized medicine with theranostics: quantitative molecular imaging and artificial intelligence

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The exciting field of theranostics (i.e. therapy + diagnostics) in nuclear medicine involves usage of radiopharmaceutical imaging in tandem with (before, during or after) radiopharmaceutical therapy (RPT). Imaging is done with single photon computed emission tomography/computed tomography (SPECT/CT) or positron emission tomography (PET), while RPT uses alpha- or beta-emitting radioisotopes. Contrary to what is routine for external beam radiation therapy (EBRT), RPT is presently not planned based on individual patient characteristics. Dosimetry in RPT is believed to be difficult and time-consuming, and thus, radiation doses delivered to tumors/healthy organs are commonly not quantified. Basic science research involving physics, applied math, engineering, and computer science, while working closely with physicians and technologists, are essential in closing the gap between RPT and EBRT. My proposed program aims at bringing RPT on par with EBRT, utilizing quantitative imaging and artificial intelligence (AI), to allow for personalized dose assessments in RPT. My short-term objectives are: 1)Develop PET and SPECT imaging protocols to measure radiopharmaceutical biodistribution using theranostic pairs even for radioisotopes that cannot be directly imaged. 2)Develop robust image segmentation algorithms to accurately quantify tumor/organ radioactivity and mass (both required in dosimetry) from SPECT/CT and PET/CT images, and enable automated segmentation using AI. 3)Study contributions to uncertainties in the dose estimates from quantitative image generation and dosimetry method (e.g. organ level vs. voxelized methods). 4)Combine quantitative, texture, shape, and intensity image features (radiomics) from diagnostic PET, therapy SPECT, and dose images to improve/simplify dose estimates and build predictive models for doses/responses. My program is designed with a strong component in training of highly qualified personnel (HQP). HQP are mentored to become experts/leaders, whether they pursue a career in industry, academia, or healthcare practice. HQP will develop their own thinking and decision-making, while actively mentored and supported. They participate in and enhance our industry-academic collaborations. HQP will network and disseminate our work at scientific conferences and are encouraged to join committees of societies in our field. Scientific excellence will be pursued and propelled in the context of a multidisciplinary, multicultural, diverse, and inclusive team environment. Our experience with quantitative imaging, dosimetry, AI, and the support from both BC Cancer and the University of British Columbia make this program a great venue and opportunity to put Canada at the forefront of personalized RPT. The program will make critical contributions to enable simplified dosimetry protocols, establish tools for automatic segmentation, enable personalized RPT planning, train HQP, and expand collaborations with industry and academic partners.