Health science meets computer science

Surgeon using electromagnetic navigation system

Exciting translational research at Hotel Dieu Hospital is literally mapping a new and groundbreaking way to perform breast cancer surgery that could allow for complete excision of the tumor and improve the cosmetic results of the surgical procedure.  The result of a collaborative effort between hospital surgeons and researchers at the Queen’s University School of Computing, the transformative surgical technique has the potential to significantly improve surgical outcomes.

Currently, breast tumor surgery utilizes wire localization, a technique in which a radiologist uses mammography or ultrasound to insert a fine wire into the tumor site.  The surgeon then follows the wire to locate and remove the tumor.  In cases where the tumor is hard to see and feel, however, obtaining cancer-free margins at the excision site can be a challenge.

By contrast, the electromagnetic navigation system under study at Hotel Dieu gives the surgeon a clear visual of the targeted area.  Using ultrasound to map out the breast tumor, a computer generates a 3D model of the tumor site with a virtual margin and provides real-time tracking information that better equips the surgeon to remove the tumor cleanly and with less healthy surrounding tissue.

“The whole point of this technique is to reduce the incidence of positive margins,” explains Dr. Jay Engel, Hotel Dieu surgeon and Chair of Surgical Oncology at Queen’s University. “If you get the margins right the first time because you’ve taken a very planned approach, then you reduce the need for further surgery and you also conserve healthy breast tissue.

“If the technique proves effective—and I think it will—then it will make a big difference in breast tumor surgery.  It could also be applied to other soft tissue cancer surgery, such as liver surgery, where you need a clear picture of where you’re cutting in relation to the tumor.”

At Hotel Dieu, the breast-conserving surgical technique has been successfully piloted on patients with a single palpable tumor, a study geared to testing the feasibility of using the electromagnetic navigation system in the operating room.  In January, 2016 Dr. Engel’s research team started clinical trials with patients with non-palpable tumors to prove the benefits of the system compared to conventional methods.

That research team—a hybrid of surgeons and computer scientists—tapped into Queen’s University’s internationally-recognized expertise in image-guided surgery for their project.  Dr. Engel consulted with Dr. Gabor Fitchinger, Professor, Cancer Care Ontario Research Chair, and Director, Laboratory for Percutaneous Surgery (Perk Lab) in Computing Science at Queen’s.  Dr. Fitchinger and his team of scientists jumped at the opportunity to find a novel solution for improving positive margin results, describing the innovative navigation system as the “right problem at the right time” for The Perk Lab.

Dr. Engel’s team aims to build an electromagnetic navigation system that will be highly affordable for most hospitals, which translates into better use of health care dollars.  And given its potential for allowing a surgeon to obtain clear margins at the first surgery, the system can also reduce the burden on Operating Rooms in terms of decreasing the need to repeat procedures to get a clear margin.

In 2014, the research project won the Canadian Society of Surgical Oncology poster competition at the Canadian Surgery Forum in Vancouver, as well as grabbing attention at other national and international conferences.

The project is a testament to translational research, says Dr. Engel, an idea that was once an abstract concept that has now led to potential changes in clinical practice.

"It’s amazing that everyone has been able to get together, see the potential and translate that into a practical solution,” he says.

This research is an example of how Hotel Dieu Hospital is contributing to a healthier, wealthier, smarter Ontario.