Center for Interventional Oncology

介入肿瘤学中心（CIO）于2009年末在美国国立卫生研究院临床中心（CC）成立，旨在开发和转化用于局部癌症治疗的图像引导技术。该中心是由CC和国家癌症研究所（NCI）以及较小程度上的NIBIB合作建立的。该中心利用每个合作伙伴的优势，研究成像技术和设备如何以精确靶向和微创或非侵入性的方式诊断和治疗局部癌症。它还将有助于弥合诊断和治疗之间的差距，以及新兴技术和程序性医学之间的差距。先进的成像技术开创了一个早期检测癌症的时代，这些癌症通常局限于单个器官或区域，如肝脏。介入肿瘤学通常为癌症患者提供局部或区域治疗选择，以增加标准的全身治疗选择，如免疫治疗、化疗、手术和放疗。CIO研究人员将利用CC的跨学科、转化环境来调查和优化如何以及何时结合药物、设备和多模态成像导航。例如，“可激活”药物可以注射到静脉或动脉中，然后使用“医疗GPS”用针或导管直接部署在肿瘤中，这项技术使医生能够利用最新的先进成像技术，如磁共振成像（MRI）、正电子发射断层扫描（PET）、计算机断层扫描（CT）、锥束CT （CBCT）或超声波，实时可视化地导航身体。手术前的图像被重复使用，以指导设备将靶向治疗送到疾病的位置，使手术更具成本效益，因为它不需要成像系统实际存在，以利用其中包含的信息。例如，先前的前列腺MRI可以通过使用“医疗GPS”启用针和超声来帮助引导活检或局灶消融，而无需在过程中占用或捆绑MRI系统。在另一个例子中，细针或声波可用于消融肿瘤并增强靶向药物输送。能量来源包括高强度聚焦超声、冷冻、微波、激光和射频。研究人员还扩大了对图像引导药物输送或图像引导“药物绘画”的研究，通过将靶向、可成像或可激活的药物与局部能量或热量结合起来，将药物部署在专门设计的微或纳米颗粒中，图像可以用来为特定区域开一种特定的药物。该中心提供了一个论坛，鼓励医学、外科、泌尿外科、放射肿瘤学和介入放射学领域的研究人员和患者护理专家之间的合作。CC为这种类型的合作转化研究和患者护理提供了一个特殊的环境。其他主要项目包括开发用于个性化药物研究的新图像引导方法（或在药物发现过程中跟踪组织对研究药物的反应），以及涉及新药、设备、图像引导机器人辅助以及微纳米药物载体的首次人体研究。靶向序贯活检是药物发现或生物标志物表征的有力工具。教育和交叉培训是该计划的另一个重要部分。各个学科之间、研究工作与病人护理之间、诊断与治疗之间存在着显著的差距。这些间隙可以通过先进的图像方法进行局部治疗。CIO受训者加强了现有的培训计划，并强调了NIH独特的转化氛围，在这里，从实验室到病床是规则。具体目标包括：1。开展介入肿瘤学的培训和教育。开发新的图像引导方法，用于智能活检和生物标志物采购，以支持靶向治疗。使用新型微创介入肿瘤学技术支持患者护理。从事介入肿瘤学新技术的研究。这个项目是理想的和独特的定位，提供一个跨学科的环境，结合培训，病人护理和转化研究，以加速介入肿瘤学和分子靶向干预的进展。重点是翻译模型，翻译工具，和实际的可交付成果的翻译多学科范式，以满足特定的临床需要。最近在癌症领域增加了深度学习，目标是整合特定癌症和癌症干预的数字病理学、分子和成像信息。CIO管理了10个临床前协议和5个临床协议。本财政年度，首席信息官将获得2个博士学位。CIO培养了许多学生、住院医师、研究员、博士候选人、初级教师、访问科学家、工程师和合作科学家，他们在学术生涯中取得了成功，并在介入放射学、放射学、泌尿学、放射肿瘤学、兽医学以及学术界和工业界的各种高级职位上执业（见指导附录）。建立土拨鼠肝细胞癌模型并进行IR表征。为患者开发了新颖的软件和硬件（Angle-Nav, OncoNav, PercuNav, UroNav, CystoNav, RenoNav, Airwaze, BronchMEMS）。智能手机的增强现实技术进入了红外诊所。人工智能资源是为了癌症生态系统而建立的。融合引导消融术被开发并应用于办公室环境，就像在直肠外用针和超声进行前列腺活检一样。智能手机干预被带到诊所。CIO完成了人类在热消融过程中首次使用人工智能进行分割和配位，无框架或步进阶段的经会阴手持式超声融合活检减少到实践中，这已经成为快速采用的主流。在转化动物实验室中，CIO表征了土拨鼠肝炎诱导HCC的分子免疫相关物，开发了一种用融合和可成像药物洗脱珠进行药物剂量描绘的药物传递模型（由NIH CIO发明和开发），开发并报道了兔VX2肝肿瘤中的拓扑替康药物洗脱珠，表征了土拨鼠肝癌中低温检查点抑制的临床前增强以及小鼠肿瘤中的低温和RFA。开发了多种器件，包括“Angle-Nav”MEMS夹针，Airwaze, BronchoMEMS, CystoNav。通过智能手机增强现实得到验证。研制小分子检查点抑制剂“药物洗脱免疫珠”。开发新型冠状病毒分类人工智能深度学习模型，并与PACS进行对接。

The Center for Interventional Oncology (CIO) was established in late FY 09 at the NIH Clinical Center (CC) to develop and translate image-guided technologies for localized cancer treatments. The Center is a collaboration involving the CC and the National Cancer Institute (NCI), and to lesser extent NIBIB. The Center draws on the strengths of each partner to investigate how imaging technologies and devices can diagnose and treat localized cancers in ways that are precisely targeted and minimally or non-invasive. It will also help bridge the gap between diagnosis and therapy, and between emerging technology and procedural medicine. Advanced imaging methods have ushered in an era of earlier detection of cancers that are frequently localized to a single organ or region, such as the liver. Interventional oncology often provides cancer patients with local or regional treatment options to augment the standard systemic treatment options like: immunotherapy, chemotherapy, surgery, and radiation. CIO investigators will leverage the interdisciplinary, translational environment at the CC to investigate and optimize how and when to combine drugs, devices, and multimodal imaging navigation. For example, "activatable" drugs can be injected in a vein or artery, then deployed directly in the tumor with needles or catheters using "medical GPS", a technique that enables the physician to navigate through the body with real-time visualization using the latest advanced imaging technologies, such as magnetic resonance imaging (MRI), positron emission tomography (PET), computed tomography (CT), cone beam CT (CBCT), or ultrasound. Pre-procedural images are reused to guide devices delivering targeted therapy to the location of the disease, making the procedure more cost-effective because it doesn't require the imaging system to be physically present to take advantage of the information contained within. A prior prostate MRI, for example, can be used to help with guided biopsy or focal ablation by using a "medical GPS"-enabled needle and ultrasound, without requiring, occupying or tying up an MRI system during the procedure. In another example, a thin needle or sound waves can be used to ablate tumors and enhance targeted drug delivery. Energy sources include high-intensity focused ultrasound, freezing, microwaves, laser, and radiofrequency. Researchers also expand investigations into image-guided drug delivery or image-guided "drug painting," where the image can be used to prescribe a particular drug to a specific region, by combining targeted, image-able-able or activate-able drugs with localized energy or heat to deploy the drug within specially engineered micro- or nano-particles. The Center provides a forum to encourage collaborations among researchers and patient-care experts in medical, surgical, urologic, and radiation oncology and interventional radiology. The CC provides an exceptional environment for this type of collaborative translational research and patient care. Other major program components include the development of new image-guided methods for personalized drug investigations (or tracking tissue responses to investigational drugs during drug discovery) and first-in-human investigations involving new drugs, devices, image-guided robotic assistance, and micro- and nano-sized drug vectors. Targeted sequential biopsy is a powerful tool for drug discover or biomarker characterization. Education and cross-training is another important part of the program. Significant gaps exist between the various disciplines, between research efforts and patient care, and between diagnosis and treatment. The gaps may be integrated through advanced image methods for localized therapy. CIO trainees augment existing training programs and underline the unique translational atmosphere at the NIH, where bench-to-bedside is the rule. Specific aims include: 1. Develop training and education in Interventional Oncology 2. Develop novel image-guided methods for smart biopsy and biomarker procurement to support targeted therapeutics 3. Support patient care using novel minimally invasive Interventional Oncology techniques 4. Pursue research in novel techniques and technologies in Interventional Oncology. This program is ideally and uniquely positioned to provide an interdisciplinary environment that combines training, patient care, and translational research to accelerate progress in interventional oncology and molecularly targeted interventions. The focus is upon translational models, translational tools, and actual practical deliverables of translation of multidisciplinary paradigms that meet specific clinical needs. A recent addition of deep learning in cancer was begun with the goal of integrating digital pathology, molecular and imaging information for specific cancers and cancer interventions. CIO managed 10 preclinical protocols and 5 clinical protocols. CIO staff are due to receive 2 PhDs this fiscal year. The CIO has trained many students, residents, fellows, PhD candidates, junior faculty, visiting scientists, engineers, and collaborating scientists, who have successfully advanced in their academic careers and are practicing in interventional radiology, radiology, urology, radiation oncology, veterinary medicine, and various senior positions in academics and industry (see mentoring appendix). The Woodchuck HCC model was established and characterized for IR. Novel software and hardware was developed for patients: (Angle-Nav, OncoNav, PercuNav, UroNav, CystoNav, RenoNav, Airwaze, BronchMEMS). Augmented reality for smartphones made it to IR clinic. The AI Resource was established for an ecosystem for cancer. Fusion guided ablation was developed and deployed for the office setting, as was prostate biopsy with needle and ultrasound totally outside of the rectum. Smartphone interventions were brought to clinic. CIO accomplished the 1st in human use of artificial intelligence for segmentation and registration during a thermal ablation procedure, Transperineal hand held ultrasound fusion biopsy without a frame or stepper stage was reduced to practice, which is becoming more main stream already with rapid adoption. In the translational animal lab, CIO characterized woodchuck molecular immune correlates for woodchuck hepatitis-induced HCC, developed a drug delivery model for drug dose painting with fusion and image-able drug eluting beads (invented and developed at the NIH CIO), developed and reported topotecan drug eluting beads in rabbit VX2 liver tumors, characterized preclinical augmentation of check point inhibition with cryo in woodchuck liver cancer and cryo and RFA in mouse tumors in vivo, Multiple devices were developed including "Angle-Nav" MEMS clip to needle, Airwaze, BronchoMEMS, CystoNav. Augmented reality via smartphone was validated. Developed small molecule checkpoint inhibitor "drug eluting immuno-beads". Artificial intelligence deep learning models for classification of COVID-19 were developed and interfaced with PACS.