1. How hybrid tracers may help change treatmentparadigms and open up new commercial avenuesNynke S. van den Berg1,2, Tessa Buckle1, and Fijs W.B. vanLeeuwen1,21. Department of Radiology, LUMC, Leiden2. Department of Urology, NKI-AvL, Amsterdam

2. Find out what is wrong and take it out?!InterventionDiagnostics 3. Anatomical ImagingMRIUSFunctionalImagingX-ray fluoscopy Navigationperfusion CTMolecular ImagingPETGamma imagingCTCE USLuminescence imagingModalities for in-depthimagingPositron imagingModalities for superficialimagingvan Leeuwen et al.,, Accepted for publication in Radiology 2014 4. Can we combine various imaging technologies to allow for anintegrated pre- and intraoperative imaging procedure?InterventionDiagnostics 5. Concept: hybrid imaging agentsOptical guidanceduring surgeryPreoperativeimaging(often metal-based)Synthetic incorporation of different imaging features in a single molecule may satisfy a clinicalneed for better guidance 6. Imaging modalities: Sensitivity and resolutionPETSPECTFluorescenceMRICTE-15 molE-12 molE-9 molE-6 molE-3 molE-3mm E-2 mm E-1 mm 1 mm E+1 mmSensitivityResolutionMost suitable formolecular imagingpurposes 7. Show clinical potential of multimodal approachFocus on existing clinical procedureSentinel node procedure 8. Multimodal/hybrid tracer for sentinel node biopsynanocolloid 99mTc 99mTc-nanocolloidICG ICG-99mTc-nanocolloidstandard in EuropeHybrid tracerIn the Netherlands available via GE HealthcareBuckle et al., Nanotechnology 2011; Brouwer et al., Ann Surg Oncol 2012; Van der Poel et al., Eur Urol 2011; Brouwer et al., J Nucl Med 2012; van denBerg et al., Eur J Nucl Med Mol Imaging 2012; Mathron et al., Gynecol Oncol 2013; Schaafsma et al., Br J Surg 2013; Brouwer et al., Eur Urol 2014,KleinJan et al., Eur Urol 2014; van den Berg et al., Accepted for publication in Radiology 2014 9. Hybrid tracer for combined pre- and intraoperative sentinel nodeidentificationTOTAL Gamma imagingBODY800 participants) 25. Next step: Use virtual navigation technologies to guide the placementof fluorescence cameras 26. Interventional Molecular Imaging LaboratoryNynke van den BergTessa Buckle (PhD)Harmen KloosterboerMick Welling (PhD)Simone van Dijk (MD)Silvia SpaAnton Bunschoten (PhD)Mark RoodDanny van WilligenAldrik Velders (PhD)Jan-Bart ten HoveSteffen van der WalFijs van Leeuwen (PhD)Daphne Rietbergen (MD)Gijs KleinJan (MD)Renato Valds Olmos (MD, PhD)Frits Smit (MD)Oscar Brouwer (MD, PhD)Shaun Xavier (MD)Matthias van OosteromPaulo WaelkensThijs EngelenJulian Sprungwww.imageguidedsurgery.nl