Dr. Bogdan Chivu: Harnessing the Power of Imaging Data for Radiotherapy

Hello, Dr. Chivu! Thank you for taking the time to do this interview!

Could you share from your experience some of the challenges radiation therapists face when accessing, retrieving, and sharing patient data (including imaging data)?

The reality is that both clinics and patients need a nationwide communication platform through which they can transmit data. Doctors of any specialty should be able to access it anytime, even those who do not work in our clinic.

Most of the time, patients present to the doctor with documents in physical form. These must be copied to create the medical record (also in physical form) and the diagnostic imaging or assessment through CDs.

Imaging is needed to make an accurate, informed diagnosis and establish the subsequent therapeutic course in specialties such as radiotherapy, oncology, cancer surgery, pneumology, neurology, and neurosurgery.

In radiotherapy, however, imaging is the main element. This requires computer tomography, called CT simulation, in which the doctor works to delineate the tumor and target volumes, i.e., the lymph node stations affected or at risk for tumor involvement.

It is necessary to fuse the CT images of the treatment plan, almost every time, with diagnostic or assessment imaging, as appropriate, such as MRI, CT, or PET, to increase the accuracy of delineating the tumor and target volumes or region of interest.

Access to a platform through which one can quickly import, export, and view imaging and the patient's medical record shortens working time and redirects all attention to the patient. It should also be taken into account that the patient can thus have full control over their case information.

What is the role of the multidisciplinary committee in treating the cancer patient?

The multidisciplinary committee is a team of medical professionals from different specialties who aim to provide personalized treatment to the patient.

As a rule, the committee is made up of medical oncologists, radiotherapists, imagists, anatomopathologists, and surgeons, each member offering their expertise and being involved in the choice of the therapeutic pathway for each patient discussed. This ensures that the treatment is the best for each individual case, is individualised, and that the evolution is monitored appropriately.

The committee meets regularly, discusses cases, complications, or challenges encountered by members in their work, and may decide to change a patient's therapeutic pathway if the patient does not derive maximum benefit from the treatment received.

Finally, the multidisciplinary committee is essential for providing a patient-centered approach to cancer care, offering what is known as personalized cancer treatment.

Can you tell us how advances in radiotherapy could influence patient outcomes and how the Medicai platform could support the integration and use of these technologies?

Over time, more precise techniques for delivering radiotherapy treatment have gained ground. These include technologies such as IMRT (Intensity-Modulated Radiation Therapy), VMAT (Volume-Modulated Arc Therapy), SRS (Stereotactic radiosurgery), and SBRT (Stereotactic Body Radiation Therapy).

The great benefit of these techniques is the ability to deliver a more targeted beam of radiation, with greater damage to tumor tissue and sparing surrounding healthy tissue. This leads to fewer immediate and late adverse reactions to radiotherapy. These techniques are assisted by the daily acquisition of CB CT (Cone Bean CT) positioning imaging.

As mentioned above, access to a platform to easily extract the diagnostic or assessment images needed to merge with the treatment plan is required, thus shortening the overall time to therapy delivery.

How is radiotherapy influenced by AI integration in image analysis?

There are many ways in which radiotherapy can be beneficially influenced. A good example is the company I work for part-time, Synaptiq, which aims to streamline the radiotherapy cancer treatment procedure by automatically segmenting organs at risk and target volumes in just a few seconds.

From a technical point of view, Mediq is a fully functional software capable of contouring organs at risk across all cancer areas (head and neck, thorax, abdomen, pelvis). Implementing artificial intelligence in private and state-owned centers has shortened the time to achieve the treatment plan, the final beneficiary being the patient. Software such as this can contour organs at risk in a given area in as little as 30 seconds, with platforms that can be accessed from anywhere and on any device, giving doctors more flexibility.

How can Medicai be used in remote radiotherapists' collaboration?

By creating a platform with nationwide accessibility, available at the click of a button to physicians of all specialties, including third parties not working in our clinic, the workflow can be streamlined, paperwork can be reduced, time to diagnosis can be shortened, and information communication can be facilitated to a very high level.

6. What interests you the most in medicine today, and what are your hopes for the medical industry in 2024?

Fortunately, almost all state and private radiotherapy centers in our country have technology that meets international standards. I am convinced that shortly, there will be investment, at least in the private sector, in technology that will further increase the accuracy of treatment delivery.

Currently, in some centers in Europe and other countries, AI is integrated into treatment planning and/or adaptation to daily changes in the treatment plan.

From personal experience, AI-based software that adapts and learns from the operator's hand is very useful because it subtracts from the virtual element and retains the human element's sensitivity.

There is hope that improved technology and implementation of AI will lead to a better doctor-patient relationship by allocating more time to human interaction and the psycho-emotional factor.

Dr. Bogdan Chivu is a Radiation Oncologist at Neolife and Synaptiq.io, where he combines his clinical expertise with a passion for advancing cancer treatment through AI technology.

Dr. Chivu is dedicated to exploring AI-based use-cases to enhance the efficacy and precision of cancer therapies. His approach aims to leverage artificial intelligence to optimize treatment plans, improve patient outcomes, and contribute to the evolving landscape of oncology. It also includes leveraging Medicai to assess medical imaging data and share images with colleagues in tumor boards, facilitating collaborative decision-making and optimized treatment plans.

FAQs:

1. What happens to your body during radiation therapy and what are its side effects?

   During radiation therapy, high-energy beams are directed at cancerous cells to destroy or damage them, inhibiting their ability to grow and divide. This type of treatment is a cornerstone in radiation oncology and can be used alone or in combination with other treatments such as surgery and chemotherapy.

   There are different types of radiation therapy, including external beam radiation, where the radiation is delivered from a machine outside the body, and internal radiation therapy (brachytherapy), where radioactive sources are placed inside the body near the cancer cells.

   Radiation targets cancerous cells and can also affect nearby healthy tissues, leading to side effects. Common side effects of radiation therapy include skin irritation at the treatment site, fatigue, and changes in the treated area depending on the location, such as difficulty swallowing if the throat is treated or urinary issues if the pelvic area is targeted.

   Medical imaging plays a crucial role in planning and delivering radiation therapy. Imaging techniques like CT scans, MRIs, and PET scans help oncologists visualize the tumor and surrounding structures, ensuring precise targeting of the radiation beams to maximize the treatment's effectiveness while minimizing exposure to healthy tissues.

   Throughout the treatment sessions, the body responds to the radiation, including acute side effects that appear during or immediately after treatment and chronic side effects that may develop months or years later. Understanding these potential outcomes helps patients and healthcare providers manage and mitigate side effects, ensuring the best possible outcome from radiation therapy.

   2. How will I feel after 5 sessions of radiotherapy?

   After five sessions of radiation therapy, many people with cancer may start to experience some side effects. However, the extent and nature of these effects can vary depending on the type of cancer being treated, the radiation dose, and the individual’s overall health.

   Radiation therapy, especially external beam radiation, is a local treatment that targets specific areas where the cancer is located. Because of this localized approach, the side effects often depend on the area of the body receiving the radiation. Common side effects after five sessions can include:

   1. Fatigue: Many people report feeling unusually tired, which can be a cumulative effect of the radiation treatments.

   2. Skin Reactions: The skin in the area receiving radiation may become red, irritated, or sensitive, similar to a mild to moderate sunburn.

   3. Localized Symptoms: Depending on the kind of cancer and its location, specific symptoms may appear. For example, if the therapy targets the head or neck, there might be soreness or difficulty swallowing. At the same time, treatment in the abdominal area might cause nausea or changes in bowel habits.

   The goal of these radiation treatments is often to shrink/downsize tumors, to sterilize the excisional bed, or even eradicate the entire tumor and manage the cancer effectively. It's important to communicate any side effects to your healthcare team, as they can provide strategies and medications to manage symptoms and improve comfort during the course of your therapy. The radiology team will monitor your progress and adjust the treatment as necessary to balance effectiveness and quality of life

   3. How long does it take to recover from different types of radiation therapy?

   Recovery from radiation therapy can vary widely depending on several factors, including the type of cancer, the location of the treatment, the total doses of radiation received, and the individual’s overall health. Here’s an overview of what to expect in terms of recovery:

   1. Immediate Recovery: The acute side effects of radiation therapy, such as fatigue, skin irritation, and localized discomfort, often begin to improve within a few weeks after the completion of the treatment. During this period, the body starts to heal from the immediate impacts of the radiation.

   2. Short-Term Recovery: For most people, the more prominent side effects subside within a few months. Energy levels gradually return, and the skin and other affected tissues begin to repair. However, some effects might linger, depending on the intensity and location of the radiation.

   3. Long-Term Recovery: Full recovery can take six months to a year or even longer. Some late side effects may emerge months or years after the therapy, depending on the area treated and the amount of radiation administered. For instance, patients who received radiation near the lungs might experience changes in lung function, while those who had brain radiation could face cognitive changes.

   4. Monitoring and Follow-Up: The cancer treatment process includes regular follow-ups with your radiation oncology team. These visits are crucial for monitoring any late side effects and managing them effectively. The healthcare team will assess the recovery process and adjust the care plan as necessary.

   5. Personalized Recovery Timeline: The radiation treatment plan, which includes the type of external beam radiation used and the doses given, significantly influences the recovery timeline. Each person’s body responds differently, so personalized care and attention to specific needs are essential for optimal recovery.

   In summary, while some people may start feeling better within a few weeks after radiation therapy, full recovery can take much longer and varies greatly among individuals. Continuous communication with the healthcare team is essential to manage both immediate and late side effects effectively.