Entries in medicine (2)

Monday
Jun152015

Intraoperative PET Imaging: The Advanced Multimodality Image Guided Operating Suite (AMIGO)

Several weeks ago, at the World Medical Innovation Forum, doctors and scientists from Brigham and Women’s Hospital presented their 20 million dollar AMIGO imaging suite complete with an operating room, MRI room, mass spectrometry instrumentation, and a PET/CT room for image-guided neurosurgeries. The current foci for this high-tech operating suite – which all rely heavily on the MRI functionality – are: 1) correcting preoperative brain images during surgery for navigation, 2) monitoring temperature for brain tumor thermal ablations, and 3) identifying residual tumor tissue at the end of surgery.1 More recently, mass spectrometry has been used intraoperatively in the AMIGO suite to map brain tumor margins through detection of an onco-metabolite,  2-hydroxyglutarate, which is produced in relatively large quantities by gliomas with mutations in isocitrate dehydrogenases 1 and 2.2 Considering my current research focus is development of new radiotracers, I was especially intrigued by the addition of PET imaging to this operating suite, which appears to be included for applications in tumor mapping and validating tumor excision completeness during surgery.3 Beyond tumor imaging, there are many radiotracers that provide important molecular and functional information about the brain, particularly the occupancy of neuroreceptors. Is there a place for these radiotracers in intraoperative neuroimaging?

~GV

1)      Jolesz, FA. (2011) Intraoperative imaging in neurosurgery: where will the future take us? Acta Neurochir Suppl, 109, 21-25.

2)      Agar, YR et al. (2014) Intraoperative mass spectrometry mapping of an onco-metabolite to guide brain tumor surgery. PNAS, 111, 11121-11126.

3)      http://brighamandwomens.org/Research/amigo/inside_suite.aspx. Accessed 06/15/2015

Wednesday
Apr012015

Shadowing physicians and the impact of imaging on patients

Through collaborations with the Hooker Lab, I have been fortunate enough to shadow doctors who have specialized in different fields of medicine.  I am often asked what I learn from these observational visits. Besides witnessing doctor-patient encounters and getting a glimpse into what being a doctor entails, I have noticed how key components in clinical medicine overlap with ongoing research projects within the Hooker Lab. Clinical research plays a critical role in medical advances.  I know that I certainly enjoy reading the latest findings in medical research, but I was surprised to see the frequency in which patients come to doctors with newspaper clippings or printouts on recent studies.  For instance, a patient mentioned a newspaper article promoting the wonders of a recently published study in which tetanus vaccine in glioblastoma patients increased survival time and slowed tumor progression. The news article did not address the limitations of the research, including the issue of a small sample size and the fact that participants were required to have met strict eligibility criteria.  Therefore, it is important for doctors to be aware of the latest medical developments to help patients understand the limitations to the generalizability and realistic implications of research findings.

Many of the studies being conducted within our research group involve imaging techniques, which are widely used in medicine for making diagnoses, as tools during surgical or interventional procedures, and for monitoring specific cancers and other medical conditions.  The images obtained from scans can also evoke emotional responses from patients. This was the case when a patient, who had previously undergone surgery and treatments for a brain tumor, viewed an MRI brain scan revealing that the cancer was still kept at bay ten years later.

The role of imaging in medicine benefits both clinicians and patients, but there are still limitations to these techniques (e.g., with MRI, it is difficult to distinguish recurrent cancer cells from those of inflammation due to treatment).  This is why it is important to continue research aimed at improving imaging methods, particularly through designing radiotracers with targets that will help improve diagnostic and therapeutic techniques. 

-AB