Evaluation of cancer risk from imaging with ionising radiation.

Euroatom funded SINFONIA project (https://www.sinfonia-appraisal.eu/#about) is developing novel methodologies and tools that will provide a comprehensive risk appraisal for detrimental effects of radiation exposure on patients, workers, carers, and comforters, the public and the environment during the management of patients suspected or diagnosed with lymphoma and brain tumours.

Prof. John Damilakis is the scientific coordinator of the SINFONIA project and is in charge of the overall scientific, technological and ethical management for the project.

John Damilakis holds senior positions in several European and worldwide research platforms and medical and scientific societies in the Medical Physics field. He is full professor and chairman of the Department of Medical Physics, Faculty of Medicine, University of Crete and director of the Department of Medical Physics of the University Hospital of Heraklion, Crete, Greece.

John Damilakis is at CESGA in Santiago the Compostela participating in the SINFONIA Machine Learning Workshop (https://www.cesga.es/workshop-sinfonia-ml/). We have taken advantage of this opportunity to talk with him in order to better understand the relevance of this project.

John Damilakis

John Damilakis

– What are the main aims of the project and what tools you expect SINFONIA project will develop?
J.D. – The main objective of the SINFONIA project is to develop novel methodologies and tools that will provide a comprehensive radiation risk appraisal for detrimental effects of radiation exposure on patients, workers, the public and the environment during the management of patients suspected or diagnosed with lymphoma and brain tumours.
SINFONIA will develop several tools including a) dose estimation tools based on personalised dosimetry methods, powered by artificial intelligence, b) a novel patient radiation risk appraisal tool and c) a platform for dose, imaging, and non-imaging data. The data platform (repository) is currently being developed by CESCA. This is a very important task for the development and deployment of computational tools.

– Why is it important to develop these tools? / Does the lack of these tools limit practitioners decision making in their everyday practice today?
J.D. – Currently, there is lack of personalised, organ-specific, dose estimation in radiological examinations that can be used as input to risk appraisal models, lack of AI-powered tools that will increase the speed and accuracy of organ dose estimation and there is also lack of a framework for the determination of patient-specific out-of-field dose estimations from photon treatments. Brain and lymphoma patients seldom undergo whole-body CT scans for treatment planning purposes. To address this situation, a software tool will be developed to adapting of habitus-dependent virtual phantoms to planning CTs to be subsequently used for patient-specific dose estimations. An online dosimetry system for monitoring staff of nuclear medicine departments will also be developed. The main objective of this tool is to calculate radiation doses delivered during the handling of radionuclides. The lack of the above tools currently limits practitioner’s decision making in their everyday clinical lives.

– What are the benefits you expect these tools will provide to practitioners in the fields of radiotherapy and oncology?
J.D. – SINFONIA dosimetry studies and tools will provide essential information for the justification and optimization of patient diagnostic and therapeutic procedures. In addition, radiation biology studies may help identify those individuals with increased susceptibility to cancer from ionising radiation exposure. This will allow significant progress in the evaluation of cancer risk from imaging with ionising radiation. Tracking of medical radiation exposures of an individual patient is very useful for individual patient protection but also for radiation protection of patients with the same type of disease. This is the only way to get information about the cumulative dose from repeated exposures of ionising radiation to individual patients suspected with or diagnosed with a certain type of diseases such as lymphoma or brain tumour.

– How will patients benefit from wide adoption of these tools?
J.D. – Proper knowledge of doses and risks delivered by various imaging modalities are essential to ensure that medical procedures adhere to up-to-date appropriateness and optimisation criteria. This is very important for all patients. SINFONIA tools and methodologies will produce new knowledge on parameters affecting radiation detriment. This, in the era of personalised medicine, will help clinicians to properly balance risks and benefits of ionising radiation procedures and practitioners and medical physicists develop dose optimisation strategies. SINFONIA results can also be used for better radiogenic risk communication and this is a great benefit to patients who have the right to know the doses and risks associated with their medical procedure.

– Why is it important to have a supercomputing centre onboard in the team developing these tools?
J.D. – Data from imaging and non-imaging examinations and radiation therapy sessions, histologic results and demographic information related to individual patients with lymphoma and brain tumours will be collected and pooled in a shared repository. The repository will be used in developing methods and techniques for patient-specific dose estimation, risk assessment and uncertainty determination. CESGA is currently working to develop the repository, in fact the first version has already been developed and this is a great achievement.

Further learn about SINFONIA project here: https://www.sinfonia-appraisal.eu/#about