Sometimes, it takes a multidisciplinary team to come up with innovative solutions that work. Case in point: reproducing patient's position during MRI to facilitate image fusion and prostate gland contouring during treatment planning prior to radiotherapy to the prostate, as existing positioning probes are not suitable for use in the MRI suite.

The MRI-safe pseudo ultrasound probe, an Allied Health Innovative Practice 2022 Ground Up & Emerging (GEM) Award winning entry, provides a simple yet clever solution to hold the prostate in place during an MRI scan – something previously impossible to achieve due to the use of metals in probes. It was the brainchild of Dr Eric Pang, Senior Manager, Radiotherapy Services, Division of Radiation Oncology (DRO), National Cancer Centre Singapore (NCCS).

Assisting Dr Eric Pang in manifesting this vision was an eight-member team comprising clinicians, radiographers, therapists, product designers, and engineers from NCCS's DRO and Department of Oncologic Imaging, and SingHealth's Institute for Patient Safety and Quality (IPSQ). The team worked on the probe for one year, with everyone bringing their different strengths to the table to bring the probe from the design screen to the MRI suite. 

The multidisciplinary team behind the MRI-safe pseudo positioning probe includes (pictured clockwise from top left) Mr Lim Yong Kang, Executive, IPSQ; Dr Eric Pang, Senior Manager, Radiation Oncology, NCCS; Mr Low Gee Keng, Radiation Therapist, Radiation Oncology, NCCS, together with five other members in the team.

Tomorrow’s Medicine speaks to team leader Dr Pang and product designer Lim Yong Kang from IPSQ, to find out more about their experience on this project and how they’ve since gone on to forge a dynamic partnership on more projects to come.

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More accurate and less positioning uncertainties for prostate patients

Accurately scanning and overlaying the prostate in prostate treatments has been a tricky task all these years. Before Dr Pang and team came up with this positioning probe, prostate patients have had to either endure an invasive procedure of gold fiducials insertion, or go for treatment with an additional 1cm margin buffered in for inaccuracies in the scans. This additional margin of treatment would end up destroying healthy tissue in the neighbouring rectum too, but it was necessary to account for discrepancies in prostate positioning.

“I first noticed this problem when I was working on my PhD thesis a few years ago. With the encouragement of my mentor Dr Jeffrey Tuan, I decided to try creating a positioning probe that would be safe to use in the MRI suite,” explained Dr Pang.

Dr Tuan agreed, pointing out how it was such a simple idea to overcome a previously unsurmountable problem, “I thought it seemed so obvious, yet no one had actually started or wanted to work on this before. The development in the quality of 3D printing has also made it possible to manufacture a prototype of suitable quality for medical use, at an affordable cost.”

The initial evolution of the MRI-safe Pseudo TPUS Probe created by the team from NCCS and SingHealth IPSQ. 

The results have been promising. “Since we used this probe on patients earlier this year, the radiation therapists and dosimetrists have been able to more accurately map and overlay the prostate images using both MRI and CT scans. This has helped shrink this margin down to 5mm, which is much better for the patient since the area exposed to the treatment is now significantly lesser,” shared Dr Pang with delight.

A collaboration of different expertise for good design

Putting Dr Pang, a radiation therapy researcher in a team with Yong Kang, who has a background in industrial design, has worked wonders in the development of the probe.

When working on a project, the team gathers to have deep discussions and walkthroughs on the processes, which encourages them to trigger new perspectives and think out of the box. “During these discussions, we can see the difference between a person with design background and a trained clinician approach a problem. Both strengths are benefits to the team,” added Dr Pang.

Watching how the probe was used in current clinical practice has also helped Yong Kang understand the considerations taken into account during the design process, such as the finishing of the material used on the probe so that it is not uncomfortable to the patient’s touch.

On the other side, Yong Kang’s work on-screen had helped speed up the prototyping and trialling process greatly. He explained: “The renderings and simulations were very useful in demonstrating how the probe could be manoeuvred. We could also immediately identify concerns we saw in the simulation and make corrections, before we spent the time and expenses to make an actual prototype.” 

Continuing to work together to bring more dreams to life

With the positioning probe already being used in NCCS on a selected group of prostate patients with promising results, the dynamic duo are set to continue collaborating and innovating for better patient and clinician experience.

“Two months back, we’ve already completed a redesign of a trolley to more easily and safely transport Vac-Loks, a special support used by patients during radiotherapy sessions,” enthused Yong Kang. ““We’ve since been in discussions on yet another project, an AIO (all-in-one) cabinet for convenient storage and smoother transferring of the Orfit AIO Solution, which is a medical device used for patient positioning in radiation therapy.”

And it is this hope that with every new collaboration embarked upon, the new development will ultimately improve the patient experience and ease the workflow processes for the staff of SingHealth.

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