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Surgical Oncology:

Theo Ruers

Prof. dr. Surgeon, Professor

About Theo Ruers

Image guided interventions in oncology: An innovative concept was developed and implemented to improve surgical outcome in oncology by image guided surgery. This new approach is concentrated around the following sequential steps within the surgical work flow: tumour localization, tumour treatment and assessment of tumour treatment. For the first step a surgical electromagnetic navigation system was developed and implemented that guides the surgeon with high accuracy to the place of tumour tissue. The second step, surgical resection, is monitored by smart susrgical instruments and   optical imaging such as optical spectroscopy, able to differentiate real time tumour tissue from normal tissue at the tip of the surgical instrument. This approach enables radical resection of all tumour tissue. In the third step, success of treatment is evaluated by smart camera systems such as multispectral camera images of the specimen and resection area to assure that all tumour tissue has been removed. We succeeded to bring these techniques from bench to bedside and currently we are introducing this technology within the surgical work flow. Within the project there was a strong collaboration with the Technical University Twente and commercial partners (e.g., Philips).

Technology development was allied to the design and realization of a new operating theatre complex with specific facilities for image guided surgery. After safely bringing the technology for image guided surgery into the surgical work flow, the technology is now being evaluated within a broad range of surgical procedures and tested for efficacy and cost effectiveness. 

Focus:

During surgery tumor tissue is often difficult to identify. This may result in either too close tumor resections with a positive resection margin or too wide resections with increased morbidity or poor cosmetic outcome.

Within this research line we aim to tackle the described shortcomings in cancer surgery by the application of image guidance. Our approach consist of two interlinked and supplementary techniques:

1. By the introduction of navigation techniques we will enable the surgeon to follow the exact position of  his instruments in relation to tumor tissue and vital structures. This technology provides the surgeon with real time anatomical feedback and guidance during the surgical procedure with an accuracy of 2-3 mm.

2. By the introduction of real time intra-operative optical tissue characterization we enable the surgeon to determine the tissue properties real time at the tip of the surgical instrument. This technique allows refining surgical guidance up to a microscopic level. The technique is based on incorporation of optical technology in smart surgical tools.

Co-workers

Dick Sterenborg

Sterenborg, Dick

Professor

Experience

Dick (H.J.C.M.) Sterenborg received a M.Sc. in Applied Physics from the University of Eindhoven, The Netherlands in 1982 and he has been active in Biomedical Optics Research since then. From 1988 to 1998 he was a staff member of the Medical Laser Centre of the Academic medical Centre in Amsterdam. In 1998 he moved to the Erasmus Medical Center and (co)founded the Centre for Optical Diagnostics and Therapy and 2008 he was appointed Professor of Photodynamic Therapy at the Erasmus University. Since 2013 he is back in Amsterdam where he has a joint position at the department of Biomedical Engineering and Physics of the Academic Medical Centre in Amsterdam and the Surgical Innovations Group at the Netherlands Cancer Institute. His main focus of research is currently Elastic Scattering Spectroscopy and Hyperspectral Imaging.

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Jasper Nijkamp

Jasper Nijkamp

Senior Post doc

Experience

In 2004 I did my master internship medical informatics at the radiotherapy department of the NKI-AvL. The subject was setup error correction during radiotherapy. Subsequently, in 2005 I started working at the RT department in the Image-Guided Adaptive RT  group. The work was focused on clinical implementation of image-guidance solutions from the research. Topics I worked on were respiratory correlated CT scanning of lung tumors, and adaptive radiotherapy for prostate cancer. In 2009 I started on my PhD project titled (un-)certainties in radiotherapy of rectal cancer. Results of my research were new national guidelines in the definition of the target volume, and also novel safety margins for accurate radiotherapy.  In 2012 I made a switch to the surgery department of the NKI-AvL, to work on image-guided surgery. My main topic is surgical navigation for mobile tumors.

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Oleksandra Ivashchenko

Oleksandra Ivashchenko

Post doc

Experience

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Bas Pouw

Bas Pouw

Post doc

Experience

I studied technical medicine at the university of Twente. After completing my clinical internships in 2012, I started my master's project in breast cancer imaging with freehand-SPECT at the nuclear medicine department of the Netherlands Cancer Institute. This project turned out to be the subject of my PhD. After defending my PhD in 2016, I started working as a technical physician in a clinical implementation team on image-guidance during complex surgical procedures in the group of Theo Ruers. Together with industry and research groups in the NKI we implement new imaging modalities and navigation methods for surgery.

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Susan Brouwer de Koning

Susan Brouwer de Koning

Ph.D. Student

Experience

I graduated from my studies in Technical Medicine (University of Twente) in early 2016, with a special interest in medical imaging and interventions. During my graduation project at Guy's Hospital, London, I validated a device to evaluate tumor margins during breast-conserving surgery. Due to my interest in intra-operative imaging technologies, I began working at the NKI as a PhD student and as a member of the Clinical Implementation Team, responsible for the implementation of new technologies in the operation room. At the moment I am researching the potential for diffuse reflectance spectroscopy to assess tumor margins intra-operatively.

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Elena Beletkaia

Elena Beletkaia

Post doc

Experience

My current research is focusing on the application of Coherent Anti-Stocks Raman spectroscopy (CARS) to differentiation of the healthy breast tissue from the cancerous tissue. Even though, breast cancer treatment achieved great success in the past decades, up to 10% surgeries result in positive margins of the resected tumors. CARS is a non-invasive spectroscopic method capable of revealing chemical composition of the material at high spacious and temporal resolution, making it a great candidate for an intra-operative support tool. 

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Roeland Eppenga

Roeland Eppenga

Ph.D. Student

Experience

In 2008 I got my Master's degree in Biomedical Engineering at the Twente University, after finishing my Master's thesis on motion artifacts in gait analysis using inertial sensors. After my graduation I started working at the Saint Antonius Hospital in Nieuwegein, providing technical support to the OR and IC while being a coordinator of a medical technical team. At the end of 2011 I decided to fully focus on product development and started working via recruitment agency YACHT in High Tech Eindhoven. I worked for ASML, Philips , VDL ETG and DAF as a LabVIEW and Simulink software engineer and mechatronics test engineer. After these interesting four years I wanted to go back to academic medical research and finally found that opportunity in my current PhD position here at the NKI-AvL, which is about navigation for mobile tumors. 

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Nikie Hoetjes

Nikie Hoetjes

Research assistant

Experience

My name is Nikie Hoetjes and I am the research assistant/ data manager of the clinical implementation team for image guided surgery.  I am responsible for the patient logistics, which means the following; patient inclusion, logistics, practical assistance during surgical procedures, and collection of data.

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Janssen, Natasja

Natasja Janssen

Ph.D. Student

Experience

I studied Technical Medicine at the University of Twente (Enschede) and received my Master's degree in 2013. I performed my masters' internship at the Biomedical Physics & Engineering department at the Academic Medical Center in Amsterdam and worked on an automatic detection and scoring system for patients with a stroke, based on CTA images.  In 2013 I moved to the NKI-AvL and started my PhD project which is focused on optimizing breast conserving treatment. This entails e.g. improved pre-operative tumor visualization using MRI, as well as improved navigation during breast conserving surgery using a novel navigation system.  I enjoy the multi-disciplinary aspect of my research very much, since we work closely with radiologists, surgeons, physicists, technical physicians and of course patients which are enrolled in the clinical trials important for our research. 

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Lisanne Baltussen

Lisanne Baltussen

Ph.D. Student

Experience

In 2014 I received my Master's degree of the study Technical Medicine in Enschede. My graduation project focused on navigation during laparoscopic colorectal surgery and was a co-operation between the surgical department in the NKI and Philips. Currently I'm working as a PhD student on the subject of diffuse reflectance spectroscopy during colorectal surgery. This can be used to prevent positive resection margins and postoperative complications.   

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Melanie Lindenberg (phd)

Melanie Lindenberg

Ph.D. student

Experience

After the bachelor Healthcare and Technology (BN) I finished the master Health Sciences at the University of Twente (Health Services and Management) in 2015. In September 2015 I started my PhD project "Health Technology Assessments on Early Stage Innovative Technology used in Oncology" in which three main projects, currently running at the NKI-AVL, are included: The Coverage with Evidence Development (CED) program for Tumor Infiltrating Lymphocyte (TIL) treatment, Image Guided technologies used in oncologic surgeries and Robot Assisted Surgeries. We aim to conduct (early) Health Technology Assessments in which we will focus on organizational, ethical, societal, clinical, safety, financial and technological issues in order to facilitate the translational process (from bench to bedside) of these technologies.

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Experience

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Niels Schurink

Niels Schurink

Master student

Experience

Currently I am performing my master thesis in the HOD department of the NKI. My master thesis is part of the Medical Imaging and Interventions track of the Technical Medicine master of the University of Twente. The study itself is an interesting new field in medicine focused at bridging the gap between the medical and technical disciplines, implementing and improving treatment methods to improve patient healthcare. The master thesis project itself is focused on developing an intraoperative surgical resection margin assessment method using a specialized camera. The rationale is, that instead of determining the surgical success after the surgery has been performed and the patient is in recovery, we determine the success during surgery so that we can intervene if this is necessary. This approach will hopefully improve surgical success even further than it is now, leading to even better patient care!

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Research updates View All Updates

Key publications View All Publications

  • Real-time in vivo assessment of radiofrequency ablation of human colorectal liver metastases using diffuse reflectance spectroscopy.

    02-2016, European Journal of Surgical Oncology

    Tanis E, Spliethoff JW, Evers DJ, Langhout GC, Snaebjornsson P, Prevoo W, Hendriks BH, Ruers TJ

  • Differentiation of healthy and malignant tissue in colon cancer patients using optical spectroscopy: A tool for image-guided surgery

    20-07-2015, Lasers Surgical Medical

    Langhout GC, Spliethoff JW, Schmitz SJ, Aalbers AG, van Velthuysen MF, Hendriks BH, Ruers TJ, Kuhlmann KF

 
 

Recent publications View All Publications

  • Detection of melanoma metastases in resected human lymph nodes by non invasive multispectral photoacoustic imaging

    16-06-2017, International Journal of Biomedical Imaging

    GC Langhout, DJG, OE Nieweg, Michel WJM Wouters, JA van der Hage, JJ, H van Boven, W Steenbergen, S Manohar, TJM Ruers

  • Real-time In Vivo Tissue Characterization with Diffuse Reflectance Spectroscopy during Transthoracic Lung Biopsy: A Clinical Feasibility Study

    01-2016, Clinical Cancer Research

    Spliethoff JW, Prevoo W, Meier MA, de Jong J, Klomp HM, Evers DJ, Sterenborg HJ, Lucassen GW, Hendriks BH, ...

 
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