University Medical Centre Utrecht in The Netherlands is one of Europe’s most advanced hospitals. We’ve been to high end teaching hospitals and clinical research centers before, but UMC Utrecht still surprises by what challenges its scientists are willing to tackle. That was the impression we got while touring the facility on a recent trip to The Netherlands. UMC Utrecht is a place that combines medical with fundamental hard science research to solve some of the hardest technological puzzles in clinical practice.
While most clinical research facilities focus on developing new techniques and refining old ones, in the process using commercially produced tools, UMC Utrecht takes things a step further. The hospital focuses on image guided therapy and uses some of the most advanced commercial devices available to treat patients. In the meantime, though, it works to develop systems that aid patient care through improved imaging and targeting of tumors.
You might be surprised to learn that UMC Utrecht employs more than 70 physicists, as well as dozens of chemists, computer scientists, specialty technicians, and others that work side by side with clinicians. This results in constant collaboration, most critically the venting of medical needs by the clinicians and immediate consideration by the scientists and technical people of how to address those needs.
And these are not trivial problems. When the clinical teams asked if an MRI machine can be integrated with a linear accelerator (linac) to improve the targeting of tumors, the scientists could have honestly responded that this has been looked into by others and thought to be nearly impossible. That’s certainly what they were told by the folks at Philips and Elekta, makers of MRIs and linacs already used at UMC Utrecht. The UMC Utrecht scientists took that advice, but still decided to invest the effort into overcoming the physical challenges of shooting charged particles through a strong magnetic field and organizing the components of the MRI and linac machines into a non-interfering working whole.
The goal of integrating MRI and linac is to improve how tumors within moving tissues are targeted (one good example would be prostate and prostate cancer,). Currently, most patients treated in advanced hospitals around the world undergo separate imaging and radiotherapy sessions. Continuing with our example, because the prostate gets pushed around by the filling of the bladder and by other nearby organs, by the time therapeutic sessions are conducted the particle beam may be hitting healthy tissue. As a matter of fact, it turns out that because of the separation of imaging and treatment, when targeting moving organs, more than half of the tissue irradiated is healthy to start with.
The physicists at UMC Utrecht went ahead with trying to integrate MR imaging with accelerator radiotherapy. Their effort led to the world’s first MRI/linac, while the second was installed at MD Anderson Cancer Center shortly after UMC Utrecht was able to show the technology is possible.
Large machines limited by the laws of physics are particularly difficult to develop, requiring considerable theoretical work followed by engineering and assembly that involves constructing a new facility and bringing together the huge components (see pics). Typically, most of this kind of work is done outside the hospital by specialty firms and institutions. UMC Utrecht, on the other hand, starts with clinical end users and brings together various specialists to build technology that from its conception is designed to make a significant impact on patient care.
The hospital is also researching applications of high powered magnetic resonance imaging. For this end they have a 7 Tesla MRI machine, a rare sight inside a clinical facility. As an example, they’re studying the use of MRI for performing angiograms. Unlike X-ray angiograms, MRIs can be used to actually view the wall of an aneurysm, not just its size. Visualizing the exact nature of the vascular abnormality may help improve the choice of treatments, resulting in improved outcomes for many patients.
While UMC Utrecht has a focus on image guided therapy, it does a lot of work in other clinical fields, such as complete native skull replacement with a 3D printed plastic models.
Link: UMC Utrecht…