Parallel Session 6 - Technology Application - Making a Difference to Allied Health Services

The Community Rehabilitation Services Support Center (CRSSC) is a specialized center within the Hospital Authority that connects patients with special needs with the application of innovative and interdisciplinary technology to advancing ability, restore hope and enrich life choices. Our interdisciplinary team of therapists and engineers provide tailor-made solutions for the activities of daily living of people with severe disabilities. One of our main services is the use of digital technologies to enhance communication and interaction with people and the environment. Human-Machine Interface (HMI) is our latest development, which involves the study of the design and use of computer technology, with an emphasis on the interface between a human (user) and a computer/machine. In this presentation, we will share our experience using innovative or self-invented devices to facilitate human-computer interaction, thereby increasing independence in everyday life.

Mitochondrial diseases are genetic disorders with multi-system involvement. They can be caused by alterations in mitochondrial genome or nuclear genome. These alterations disrupt the normal functions of mitochondria and subsequently lead to dysfunctions of energy-demanding organs such as skeletal muscles, heart and brain. Before the era of next-generation sequencing (NGS), molecular diagnosis of mitochondrial diseases caused by mitochondrial DNA mutations was usually made by targeted analysis of mutation hotspots using Sanger sequencing. However, there were two major limitations: (1) structural rearrangements or other uncommon mutations could not be identified; (2) mutations at low heteroplasmy levels (i.e. 2% heteroplasmic level can be confidently called. From 2019 to 2022, we have received samples from 71 families for mitochondrial DNA testing. We identified pathogenic variants in 9 (12.7%) families, and variants of uncertain significance (VUS) in 7 (9.8%) other families, for which further investigations would be required. Among the positive results with pathogenic variants detected, 5 out of 9 were not reported in an early version of morbid map of the human mitochondrial genome (i.e. not mutation hotspots). To conclude, the testing modality can expand the genetic analysis of mitochondrial diseases from several mutation hotspots to the whole mitochondrial genome. The application of NGS also enables a promising analytical sensitivity in the detection of low-level heteroplasmic mitochondrial variants.

Introduction:
Magnetic resonance imaging (MRI) plays an important role in our healthcare delivery system. This versatile technology creates images of soft tissue parts of the body that are sometimes hard to see using other imaging modalities. Since its first introduction in the early 80s, MRI has experienced rapid development in recent years and has found wide applications in the imaging of various diseases including cancers. The Hong Kong Cancer Statistics of 2019 showed that new cancer cases reached a record high of 35,082, up from 25,977 ten years ago (or an increase of 35 % in ten years). With such a rapid rise in the number of patients with cancer, it is expected that MRI technology will continue to play an important role in HA providing timely information on cancer diagnosis, treatment delivery and disease progression monitoring.


Objectives:
The aim of this presentation is to describe some of the recent advances of MRI techniques that are available in HA hospitals and to explain how they could benefit our patients. In the diagnosis space, advanced techniques such as diffusion and perfusion imaging are increasingly being used to identify cancers in the brain, neck, breast, abdomen and prostate. As this technology continues to develop, some future trends will be discussed and to present arguments in favour of their adoption in HA for the benefits of our patients.


Methodology:
A brief overview how these techniques are being used to diagnosis cancer will be presented. As MRI offers very precise anatomical details, several HA hospitals have recently implemented MRI technology to delivery precise radiation therapy treatment. A brief overview how MRI is being employed in radiotherapy will be shown. With better cancer treatments available to patients in recent years, their post-treatment survival has also improved. Follow-up MRI surveillance for cancer survivors is an important aspect of their continuous care. However, disease recurrence may be difficult to identify as treatment induced changes may often confound with real disease. This presentation will also demonstrate how the emergence of new MRI techniques such as CEST-MRI (Chemical Exchange Saturation Transfer MRI) could provide cost-effective means to monitor disease recurrence. 


Results and Outcome:
Advanced MRI techniques are being used in HA hospitals to provide timely care to our patients with cancer requiring accurate diagnosis and disease monitoring. In the near future, more advanced MRI techniques will be adopted in HA hospitals to improve patient care and management.

Breast cancer is the most common cancer for women in Hong Kong, with 4988 new cases diagnosed in 2020. Among them, 1289 patients were treated in Queen Elizabeth Hospital (QEH), of which 769 patients received radiotherapy. Radiotherapy is an important treatment modality to reduce the risk of recurrence after breast conservation surgery or mastectomy for high risk cancers.


The majority of breast cancer patients undergo radiotherapy in supine position. However, there are drawbacks with this setup for patients with large pendulous breasts. They would usually experience more severe acute skin toxicities with moist desquamation especially at the axilla and infra-mammary fold, due to the increased separation distance of the target volume and the shape of the breast tissue which flops over laterally. Also, a larger lung volume would be irradiated which may be clinically unacceptable.
 
Studies have confirmed that treatment in prone position decreases desquamation in women with large pendulous breasts, and facilitates the avoidance of lung irradiation when compared with supine position, while delivering the same treatment coverage and clinical outcomes. 


The prone set up position has been introduced in QEH in recent years. QEH is the only center equipped with prone breast board among the six oncology centers in Hospital Authority. The board platform has a modifiable aperture through which the target breast is positioned away from the thorax. The use of a wedge under the contralateral side achieves axial rotation of the patient towards the target breast. The process of radiation therapy includes set-up of the prone breast board, CT imaging, computer planning, image verification and treatment delivery.


The challenge with the prone set up is that some elderly patients may have difficulty in maintaining a stable prone position. But for most patients with large pendulous breasts, the prone set up is a valuable option offering significant advantages in reducing treatment toxicity while achieving equivalent clinical outcomes.