Contents
- Critical Resources
The Operating Room of the Future
Critical Resources
The Operating Room of the Future
Forging new paths
The first step in applying any technology to a clinical area, such as prostate or brain tumor treatment, is to assess whether there is a need for it. "There has to be a clinical need to do something better than the current treatment," Jolesz explains. The second step is to look for a technology that can provide the needed improvement. "Technology is never the initiating process. We don't develop a technology and then look for an application."
NCIGT researchers benefit from working at a hospital and having access to and interactions with physicians who can both communicate their needs and provide feedback on new technologies. "When you are using imaging in either research or diagnosis, it is like reading pages in a book," Jolesz says. "But when you use it in therapy, the imaging system has to change in relation to what the surgeon is doing. It becomes an interactive system, so the requirements are different."
But the application of new technologies to the clinic doesn't require just collaboration with physicians. Usually new tools and instruments are needed, and researchers must work closely with industry to develop them. "We might have an existing technology available for a diagnostic system but need new features to make it suitable for surgery," Jolesz says. "You need a company to make the devices and components. They are complex and expensive and cannot be developed in our center."
The ExAblate 2000 ultrasound device, for example, was built by InSightec, a company based in Haifa, Israel. General Electric developed the MRI device used to image the uterus while ultrasound energy is applied to fibroids. "We are constantly meeting with people from different companies," Jolesz says, adding that for some applications, as many as 100 distinct companies may become involved at different stages of development.
During a surgical procedure, a clinician not only views the organ being operated on but also has access to digital displays of a variety of images obtained before or during the procedure. For example, several imaging technologies can be combined to provide neurosurgeons with unparalleled views of physical structures and functional areas of the brain. The images, such as the one shown to the right of the photograph, serve as roadmaps to guide a surgeon throughout a procedure.
Sometimes companies do not step forward to develop the needed tools. For example, NCIGT researchers developed a technology to improve the treatment of cardiac arrhythmia, a form of heart disease caused by abnormally fast or unusually slow heart rates, but the researchers are missing a crucial piece. To treat some types of cardiac arrhythmias, a physician guides a catheter with an electrode at its tip to the area of heart muscle at which there is abnormal electrical activity. The catheter is typically guided by X-ray imaging, but NCIGT researchers have developed a technology that uses more powerful and accurate MRI. "We need new types of catheters that are MR compatible, but there are no products available," Jolesz says. "Without them, the technique is not going to work. So we have to wait."
Collaborations also are ongoing between NCIGT researchers and researchers at other institutions and organizations. One such example is a collaboration to try to make surgery guided by powerful MRI instruments more widely used.
The collaboration involves Clare Tempany, who codirects NCIGT with Jolesz and heads the Image-Guided Prostate Therapy core. Over the past decade, she has pioneered many new procedures and tools to perform prostate biopsy and therapy under the guidance of MRI. Therapy for prostate cancer is often administered using "seeds," small radioactive rods implanted directly into the tumor and prostate gland. The seeds are very powerful but only deliver radiation within a few millimeters of where they are implanted, so their placement is of critical importance. Tempany and colleagues have developed MRI-based methods of imaging the tumor, mechanically controlling the needle that carries the seeds, and recognizing the placement of the needle. Now they are trying to adapt these same procedures to much more powerful, high-field MRI scanners, such as those that are 3 Tesla — the unit used to measure magnetic field — in field strength. During a surgical procedure, a clinician not only views the organ being operated on but also has access to digital displays of a variety of images obtained before or during the procedure. For example, several imaging technologies can be combined to provide neurosurgeons with unparalleled views of physical structures and functional areas of the brain. The images, such as the one shown to the right of the photograph, serve as roadmaps to guide a surgeon throughout a procedure.
