The European QUSTom project, which under the coordination of the Barcelona Supercomputing Center – Centro Nacional de Supercomputación (BSC-CNS) aims to introduce a new medical imaging modality based on 3D tomographic ultrasound and supercomputing, has begun clinical validation with patients for the early detection of breast cancer at the Hospital Universitari Vall d'Hebron. This new technique could revolutionise the diagnosis of this type of tumour, as it is completely harmless for women and offers a much more complete image from a functional and multiparametric point of view.

For the next weeks, volunteers will be enlisted to take part in this initiative among women involved in the early breast cancer screening program at Vall d'Hebron University Hospital. Unlike traditional ultrasound devices used in gynecology, which provide real-time images, this innovative technology prioritizes maximum image quality to enhance diagnosis accuracy. It aims not only to complement and enhance breast cancer diagnosis but also potentially to replace current diagnostic methods, such as mammograms, which use X-rays.

A computer tomograph unique in the world

For imaging, a 3D Ultrasound Computed Tomography Scanner (3D USCT III) will be used, which has been designed and built by the Karlsruher Institut für Technologie (KIT) in Germany, one of QUSTom's partners. This is the only full 3D USCT device worldwide. Featuring a hemispherical 3D aperture consisting of 2304 individual transducers, which act as both transmitters and receivers, it is used to examine breast tissue for pathological changes. KIT has been working on developing further prototypes, but the first to undergo validation with patients for the full-wave inversion algorithms is the one currently in Barcelona.

Before the device reached its current stage, it underwent a series of electrical safety and ultrasound tests overseen by a certified medical device testing laboratory in Germany, all of which were successfully passed. Once all the data has been collected, it will be reconstructed using the 3D full-wave inversion algorithm and transformed into high-resolution medical images using the power of the MareNostrum5 supercomputer at the Barcelona Supercomputing Center, with FrontWave Imaging's UBIware software, a spin-off company of BSC and Imperial College London, which also sponsors clinical validation. The project also incorporates concepts such as multimodal imaging and the acquisition of real 3D images, representing an unprecedented combination in breast imaging using ultrasound.

Digital twin of breast tissue simulated on the MareNostrum 5

With MareNostrum 5 supercomputer, they need to conduct around 50,000 ultrasound wave simulations for each reconstructed image. In 2D, this task is not a significant challenge and can be computed on a few Graphic Processing Units (GPU) in a conventional cloud. However, in 3D, the problem becomes immense—so much so that no one has yet applied the best image reconstruction techniques through simulation to 3D data like those we'll use in this clinical validation. “We will be pioneers in this regard thanks to the utilization of MareNostrum 5. What we can accomplish in a few days at the BSC, a regular computer would take years”, says BSC researcher and QUSTom’s coordinator Josep de la Puente.

He explains that at its core, the project constructs a digital twin of breast tissue and the ultrasound measuring device. This digital twin replicates any ultrasound emissions emitted by the physical device used by the radiologist. “Consequently, we can acquire not merely an image post-process but a comprehensive, three-dimensional map detailing tissue properties at each pixel”, highlights de la Puente.

"This new diagnostic tool will allow offering a more complete image from a functional and multiparametric point of view, avoiding the use of ionizing radiation and improving the comfort of women during their annual radiological examination, in order to early detect breast cancer", highlights Ana María Rodríguez Arana, head of the Women's Radiology Service at Vall d'Hebron Hospital and principal investigator at the Molecular Medical Imaging group at Vall d’Hebron Research Institute (VHIR).

Harmless for women

Unlike other tests such as mammograms, QUSTom's technology does not use radiation. The new device offers potentially superior image quality and better tracking of tumors through the use of ultrasound and supercomputing. The examination is painless and more comfortable for the patient. The technology has a broad application but may be particularly beneficial for individuals with dense breast tissue, which represents 40% of women worldwide, according to the Spanish Society of Senology and Breast Pathology (SESPM).

For the development of the project, the BSC has used its experience in the detection and analysis of data obtained in mechanical wave problems, so that the algorithms used for medical imaging are inspired by other algorithms used in completely different areas of research, such as the analysis of the earth's subsoil.

In addition to BSC, the Vall d’Hebron Research Institute (VHIR) and the company FrontWave Imaging, the project has three other partners: Karlsruher Institut für Technologie, Arctur, and Imperial College London, as an associate. 

How it works:

1. The patient lies face down on a bed, while their breast is immersed in a container filled with water at a temperature of 36.5°C.
2. Ultrasound is then used to take data from each breast separately. 
3. The recorded data is transferred to a computer.
4. The procedure lasts approximately 3 minutes per breast.
5. In a matter of hours and after thousands of simulations, the software used on the supercomputer generates real 3D images of high quality, capable of providing a more precise diagnosis. These images are then ready to be analyzed by the doctors.

Breast cancer: the most diagnosed type of tumor in the world

Statistics from the Spanish Society of Medical Oncology (SEOM) shows that breast cancer is one of the most common tumors worldwide, with 2.3 million women diagnosed in 2020 and 700,000 deaths due to this disease during the same year.

In Spain, it is expected that in 2024 there will be approximately 36,395 new cases of breast cancer, according to REDECAN data, representing a slight increase compared to the previous year.

Early detection plays a fundamental role, as it can significantly increase survival rates. Although mammography is a widely used tool for breast cancer detection and has contributed to saving numerous lives, it is interesting to have a range of options for new non-irradiating technologies that can be used for diagnosis.

About the QUSTom project

QUSTom was selected in 2022 to be part of the first call of the Pathfinder Open program of the European Innovation Council, financed by the Horizon Europe Framework Program of the European Union and the English UKRI, aimed at supporting disruptive ideas and projects with great international potential. The project has received 2,744,300 euros for its European part. In this first call, the European Commission evaluated a total of 868 projects; of which only 56 were selected, 11 of them from Spain.