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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

My background is Medical Physics, mainly medical image analysis. During my Master's education at the Taras Shevchenko National University of Kyiv (Ukraine), I started working at a Rapid Prototyping company Materialise. There, my work mainly focused on the development of personalized cutting guides for orthopedic surgeries, digital surgical planning and automated cartilage segmentation from MR images. After obtaining my Master's degree in 2012, I moved to the Netherlands and started my PhD research in the area of molecular imaging. This project focused on the development and preclinical evaluation of SPECT/PET/CT instrumentations and was a collaboration between TU Delft and MILabs BV.. Since 2016, I work as a member of the clinical implementation team for image-guided surgery at the NKI.

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Harald Groen

Harald Groen

Post doc

Personal details

Groups

Experience

As a biomedical engineer, I'm working in a clinical implementation team on image image-guided surgery. In collaboration with surgeons, research groups and industrial partners new imaging modalities and surgical navigation methods for complex procedures are being developed and applied.

I obtained my PhD at the Erasmus MC, Rotterdam on the role of shear stress in atherosclerotic plaque rupture in human carotid arteries, followed by a post-doc period at the nuclear medicine department. Then I moved to the industry for 5 years as an application and sales scientist for micro PET/SPECT/CT systems.

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Elena Beletkaia

Elena Beletkaia

Post doc

Experience

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Ruben van Veen

Ruben van Veen

Post doc

Experience

During my technical medicine masters I specialized in medical imaging and interventions. Going through my clinical rotations in the AMC, Meander MC, St. Antonius and NKI, I developed a special interest for the surgical field. I am passionate about the use of modern techniques to improve surgical outcome.

After two years of research on early detection of complications after endovascular aortic repair I returned to the NKI in 2017. Here in the NKI I work with researchers and surgeons on the development and implementation of image guided navigation during complex surgical procedures.

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Nikie Hoetjes

Nikie Hoetjes

Research assistant

Personal details

Groups

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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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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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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Lisanne de Boer

Lisanne de Boer

Ph.D. Student

Experience

I graduated in the master track Robotics & Imaging in 2013 at the University Twente. After receiving my master degree I proceeded my graduation project with a PhD-position. My research focuses on the use of Diffuse Reflectance Spectroscopy (DRS) for the detection of positive resection margins during breast conserving surgery. Because surgeons cannot always see or feel the tumor during surgery, some breast cancer patients need additional therapy for the left behind tumor. DRS is a light based technology that allows to discriminate normal tissue from tumor tissue based on light-tissue interactions. The aim is to detect the positive resection margins with intra-operative DRS measurements and provide this information to the surgeon, thereby avoiding additional treatment. 

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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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Baltussen, Lisanne2

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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Esther Kho

Esther Kho

Ph.D. Student

Personal details

Groups

Experience

In 2014, I received my Master's degree Biomedical Engineering, with specialization Clinical Physics, from the University of Groningen. Since 2015, I have been working towards the Ph.D. degree at the NKI-AvL. My research concerns the development, testing and clinical evaluation of a hyperspectral imaging system. This technique has already been used for various application by NASA  but was only recently introduced in the medical field. With hyperspectral imaging, we are able to see tumorous tissue in healthy tissue. This is of major importance during breast conserving surgeries, where the surgeon aims to only remove the tumor and preserve as much surrounding healthy tissue. By using hyperspectral imaging, we will be able to help the surgeon, during the operation, to see weather indeed the whole tumor has been removed. This prevents incomplete tumor removal and therefore avoids additional treatment.

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Bram Schermers

Bram Schermers

Ph. D. Student

Personal details

Groups

Experience

I earned my Master's degree in Medical Imaging & Interventions from Technical Medicine, University of Twente in 2014 after completing my graduation research at the NKI. The subject of my graduation work was MaMaLoc: the development of a magnetic marker for surgical localization of breast cancer. During my subsequent PhD I work on the clinical validation of the MaMaLoc technology, both for breast cancer and for other clinical applications. My interests lie on the intersection of medical technology, product development and clinical applicability. ​

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Melanie Lindenberg

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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Jasper Smit

Jasper Smit

Ph. D. Student

Experience

In september 2017, I got my Master´s degree in Technical Medicine at the University of Twente. After four clinical rotation internships in different hospitals, I did my graduation internship at the surgery department of the NKI-AVL with interests for oncology and image-guided surgery. The work was focused on the feasibility of ultrasound-guided navigation for liver lesions. Right now, this is the subject of my PhD project in the clinical implementation team with the goal to improve the surgical resection and ablation of lesions in the liver with ultrasound-guided navigation.

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Freija Geldof

Freija Geldof

Master student

Experience

I am studying the Technical Medicine master at the University of Twente, with a specialization towards medical imaging and interventions. In my second master year, I performed four short internships in different hospitals and a medical technology start-up in the Netherlands. Research subjects I have been working on are the use of EM tracking for knee instability measurements, an algorithm for motion analysis of aortic stents, vertebral segmentation for a scoliosis surgery drill guide and muscle fiber orientation detection in dynamic ultrasound images. Currently, I am doing my graduation project at the Surgical Oncology department of the NKI. My project focuses on surgical navigation in head and neck surgery, especially the tracking of oral cavity carcinomas using electromagnetic tracking. The ultimate goal is to make the determination of the surgical resection margins more accurate.

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Experience

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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, Ruers TJ

 
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