Patients with a brain tumor undergo an intensive combination of surgery, radiation, and chemotherapy during treatment. Local recurrence of the cancer is highly likely after treatment; therefore the chance of survival is limited. Surgery and radiation are image-guided with high technical precision so that the visual treatment decision whether to treat or not has become crucial. A universal quality standard for this decision making still lacks because the exact localization of tumors in the brain is complicated by individual differences in brain part activity.
Project PICTURE aims to 'map' treatment decisions for the first time by merging routine brain MRIs with results of surgery and radiation of hundreds of patients in 3D-visualisation. These brain maps describe the tumor location and also the surgery and radiation results for patient groups. Also, blood flow complications, radiation damage and the location of the recurring tumor will be visible on this platform. Treatment methods and results between multidisciplinary teams can be compared in detail, and new patterns can be discovered. Decision processes can improve through this standardization and hopefully along with it the perspective of patients.
Along the way, the research group has developed the desire for an online tool in which neurosurgeons across the world can find, upload, share and compare treatment results. Digital agency ‘Active Collective’ has developed this intricate user-centered application which combines and presents a massive amount of MRI-data from patients with a brain tumor in a visual 3D-environment.
The goal of the PICTURE tool is to transcend from case-by-case discussions, based on a medical specialist his or her memory. Instead, we capture and save visual data from patients who were treated by connected multidisciplinary teams in an interactive online application. By doing this, individual patient cases can be compared to bundled results from thousands of patients. This will enable collaboration on a global scale because medical specialists can discuss objective brain tumor surgery patterns and as a result can locally enhance the quality of care for their patients with brain tumors.
In the first phase of the project, we primarily focus on the researcher and reviewer. Their goal is to assess to what extent the research meets the research guidelines. Their trust in the study and part of the publications and the resulting assessment contribute to the granting of the subsidy application by the research group. And also the dissemination of a positive message about the PICTURE application.
‘Secondary’ user groups (doctors, external parties, etc.) have been increasingly involved in the decision and development process and are highly valued. Their opinion about the application as influencers is critical because eventually, they will need to adapt, use and propagate the tool.
To live up to the expectations of these user groups the PICTURE application needs to be many things at the same time: visually inviting, technically groundbreaking, interactive, elaborate, intuitive and accessible on-the-go (mobile and tablet usage).
An online tool as specific and scientifically challenging as this application demanded close collaboration between medical and digital experts. Some co-creation workshops with the stakeholders resulted in the identification of challenges and solutions. In agile scrum terminology, we speak of User stories and Epics (see https://goo.gl/Mz1Ag4). An application prototype was designed and developed by using the following prioritized Epics:
During 2018 and beyond additional user tests will be carried out and further development will be based on new insights. An essential improvement during the next phase is the addition of managing (collecting, uploading and saving) MRI scans.
We are at the start of a multi-year open source project, in which the tool will be extended into a sophisticated medical instrument, throughout a number of design and development phases.
The current version will be brought to the attention of global medical specialists through press releases upcoming weeks by VUmc and Active Collective. Also, it will be presented at several international neuroscientific conferences. The application could become an integrated part of education programs of the connected partners and possibly even on a broader scale. The project already won a silver and golden SpinAward and has gained international media attention.
The PICTURE application was built during a unique collaboration process in which scientists, medical specialists, and digital developers combined their skills and discussed to co-create an online medical tool. This tool makes doctors aware of their results in relation to other specialists anywhere in the world. Collectively they will be able to enhance treatment decisions and care for people with brain tumors at a faster pace. So we have sped up the learning process. Hopefully due to this project future patients will get the best treatment in any hospital.