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Vol. LXVII, No. 15
July 17, 2015

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‘Medical GPS’
Image-Guided Therapy Helps Surgeons See Procedures

Dr. Bradford Wood

Dr. Bradford Wood

“At times I go through the day and I feel like I’m playing video games.” That’s how Dr. Bradford Wood described his work developing image-guided therapies at a recent Contemporary Clinical Medicine: Great Teachers Grand Rounds held in Lipsett Amphitheater.

Essentially, Wood and his colleagues develop and refine image-guided procedures to deliver cancer drugs, “cook” cancer with needles and improve cancer detection.

“We can use imaging while we’re treating the patient,” said Wood, director of NIH’s Center for Interventional Oncology and chief of the interventional radiology section in the Clinical Center’s radiology and imaging sciences department.

He compared image-guidance during surgery to the beams of a car’s headlights—both allow someone to maneuver in dark places. Recently, he said, a patient came to the Clinical Center with a tumor on his spinal column. A PET scan pinpointed the tumor’s location and Wood’s team then transposed the resulting image on top of an X-ray image of the patient’s bones.

The procedure to kill the tumor was done through a small needle-hole (minimally invasive and guided by images, but not surgery). During the procedure, Wood’s team brought the image to the patient and consulted that image to map out and refine the plan for treatment. When they began operating, they tracked their progress with fusion, which can be done with a rotating X-ray or with an ultrasound-guided “smart” needle that reports its location in real-time in relation to the prior images, taken pre-procedurally. The system is sometimes referred to as a “medical GPS.”

Relying on the image to guide them, the team navigated around blood vessels and nerves to deliver energy that kills tumor cells by heating them up.

“I felt like I was using skills learned in video games,” said Wood.

He said his team’s translational research is focused on helping patients. They define a clinical problem and work backward.

Wood (l) was introduced by Dr. Melinda Merchant, clinical director of NCI’s Pediatric Oncology Branch. She said Wood “excels in using biomedical engineering to solve real-life clinical problems.”

Wood (l) was introduced by Dr. Melinda Merchant, clinical director of NCI’s Pediatric Oncology Branch. She said Wood “excels in using biomedical engineering to solve real-life clinical problems.”

Photos: Ernie Branson

As an example of this approach, he cited the development of imaged-guided prostate biopsies at the CC and NCI. Over the past 10 years, Wood has worked with urologists, MRI radiologists, oncologists and engineers to develop methods that accurately detect and locate prostate cancer. His team developed a software program that allows an MRI image to be transposed on top of an ultrasound image. This provides a detailed image of the whole prostate.

He said the fused image is then used as a map to guide a needle during biopsy, which would otherwise be blind.

Doctors can then recommend the best treatment option, based on biopsy results. If a tumor is aggressive, the prostate can be removed. If it remains non-aggressive, doctors can periodically monitor the tumor, or even propose focal thermal ablation (cooking tumors). Wood said the technique has allowed doctors to identify more aggressive cancers earlier, so they can be treated before they cause problems.

One of his current projects involves development of small drug-loaded beads that are imageable and delivered by catheters via the bloodstream. The drug location can be imaged, as can the tumor, so that the operator can fuse these images to see where drug is, and where drug is not, in order to better treat the tumor. “We can actually see the beads on X-ray while we’re doing the treatment,” he said. “We’re actually deciding based on that where to place the needle.”

So far in 2015, Wood has co-authored collaborative material in Science, The Lancet and JAMA, all due to multi-disciplinary team science. “A lot of the true team-oriented people are critical for the success of the machine, but don’t often get credit for what they do,” said Wood. “It’s these people who really make this great place hum, and that includes fellows, administration, scientists, students, police, maintenance and the coffee shop.”

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