2007 November NCIGT Delegation to JHU

From NCIGT Wiki
Jump to: navigation, search
Home < 2007 November NCIGT Delegation to JHU

Dates

November 8-9, 2007

Attendees

  • BWH Attendees:
    • Dan Kacher 617 584 7882
    • Angela Kanan 617 697 5210
    • Janice Fairhurst 781 844 9289
    • Kemal Tuncali 617 312 2738
    • Noby Hata 617 763 9805
    • Clare Tempany 617 543 3033
    • Stu Silverman 617 827 9173
    • Paul Morrison (781) 686 3492
  • JHU Attendees:
    • John Carrino
      • Administrative Assistant (Rebecca Grager): 410-502-2831
      • Telephone: 410-502-0615
      • Pager: 410-283-0760
      • Mobile: 443-851-4192
      • Wife 617-388-3636

Agenda

Highlights

Ncigt delegation jhu groupshot 20071108.jpg Ncigt delegation jhu siemens side 20071108.jpg Ncigt delegation jhu siemens 20071108.jpg
  • Facilities: Two XMR suites under IR control (not for surgery)
    • Philips Achieve 3T + portable c-arm
    • Siemens Espree 1.5T + Axiom Artis floor mounted single plane fluoro
    • Mixed animals and patient load


  • Lewin
    • – 1000 FTEs, 155 MD/PhD faculty in research, 7 divisions
    • Discovery -> Validation/Dissemination (Cleveland) -> Routine Clinical Service
    • 3T Philips Achieva + portable c-arm
    • 1.5T Siemens Esprit + single plane fluoro + Miyabi table
  • Tempany – Disseminate/inform/collaborate
    • Mutlidisciplinary / Multimodality / Mutlivendor / Multi Funding approach
    • Funding
    • Topics covered: Slicer/Body/FUS-thermometry/users of FUS/risks in FUS
    • Open source/cross-platform sharing
  • Silverman – TAP
    • Cross-sectional IR
    • Angio-IR
    • Interventioanl neuro
    • Each has own care system with some sharing of nurses and sharing of IR clinic
    • Shared order entry system to enable non-radiologists to refer patients – ordering system decides appropriate clinician for referral w/ contact info
    • Post-grad training
    • History of service
    • Charges – volume – procedure growth
    • MRI vs CT, RF vs Cryo
    • Publications
    • Research – lung, respiratory compensation, PET/CT, slicer for targeting,
  • Arepally –
    • IR Subsections – onclology/chemo embo/ renal stending/gyn /peds
    • IR (separate from diagnostic) Outpatient clinic, inpatient consult, billing
    • RVU?
    • 2 toshiba aquilion 16 slice ct
    • 2 XMR
    • innovative therapy to improve patient care – what procedures cannot be done in cath lab?
    • Siemens XMR: Dyna ct capabilities,
    • 5 IRBS submitted
    • Fibroids - SIR foundation – cryoablation of uterine fibroud
    • Liver cancer MRI guided RFA
    • Renal cancer hybrid XMR – embo + cryo or RFA
    • MSK hybrid XMR – angio to delineate tumor. Embo + ablation
    • Adrenal interventionasl- hybrid xmr
    • Avm embo XMR
    • Tips hybrid xfm = fusion of MR with realtime fluoro
    • Idea –use civco arm to remote organ from iceball
    • $8M in NIH grants
    • $325k w/ clinical studies
    • INTERESTS:
    • Crones disease – infuse agent into vein, image to target section of bowel
    • Carbon nanotubes into fracture site of bone
    • Gastric artery embo = appetite control
  • Q&A
    • What will be first procedure (PM)? BX will be first cases on Siemens 1.5T
    • How do you handle investigations software (CL) – broad vs procedure based – answer IRB for everything (CT) – answer at Case Western used vague language in IRB, i.e., pulse **sequence for faster imaging = umbrella
  • Comment: Build around programs that can grow with the referral paths (JHU person?)
    • What were challenges for reimbursement (JC) – work through radiology societies with third party payers. A lot of letter writing and reapplying after being turned down (KT)
  • Tuncali –
    • Path of patient admission
    • Clinical experience
    • Can treat tumors close to bowel or abutting caleces
    • Hydrodissection to displace bowel loop.
    • Manual dispalcemtn (cannot do in CT with hand)
    • Intralesional transient enhancement at 24hrs – 3 mo does not indicate TX failure
    • Complications
    • Adrenal/Bone/Liver/Kindney
    • Hypertension must be managed intraprocedurally
    • 3D monitoring
  • Macura
    • TRUS 15% ppv – not sensitive or specific
    • E-MRI sens/spec 0.7
    • T2w – poorly defined irregular lesion margins
    • DCE – cancer vs benign
    • CAD
    • DWI
    • MRSI
    • Overlay – semisilvered mirror – Gabor F
    • MRI Devices – manual prosate bx transrectal device
    • Russ Taylor – Greg Fischer/Axel Krieger – transreactal. Semi automated
    • Dan Stoianovici
  • Tempany – Prostace Cancer
    • Robitically removed prostate – DiVinci –high recurrence rate
    • External beam – 3D conformal/IMRT
    • FUS approaches
    • Unmet eneds
    • Hyperpolarized C13
    • PET C11
  • Hata
    • 3D Slicer – opensource, 500k lines of code, 3 grants, 9k downloads,
    • Registration
    • Endoscopic Navigation
    • Tracker
    • 3D US
    • CT RFA
    • Philips/Siemens interaction
    • Version control/bug checking
    • Toshiba collaboration
    • Slicer/Neuromate/Stealth (peter at JHU) – high speed cutting tool restricted to safety zone – virtual fixture and actor for tool visualizaed on slcicer not on stealth
    • Tracking of moving organ – nav echo
  • Kraitchman
    • Stem cells
    • Track them to determine fate and monitor biodistribution to target and non target
    • Mechanism of efficacy
    • Combine with cells/genes
    • Reporter genes still 5 years away before clinica trans
    • Magnetofectoin (coating iron oxide with transfection agent) add to cell culture, package in IV back.. most common technique
    • Magneto electro poration to get iron oxide inside cell
    • SPIO direct lvballing anti-dextra immonustaining
  • Active catheter GUI to see cath (GE then Siemens)
    • Cine (ejection fraction) first pass perfusion, tagging (regional function)
    • 3T for better iron oxide imaging
    • Siemens interface
    • Type I diabetes – engraftments of islet cell from cadavers. Immunosuppressive agenst toxic to islet cells.
    • Encapsulate islet in alginate (seaweed). Let’s little things in/out (O2, glucose, waster, glucose). Big molecules cannot.
    • Alginate poly-l-lysine alginate encapsulation + iron oxide
    • 650k percutaneous cardiovascular intervention in 2004
    • x-ray visible capsules – radioopaque (x-capsules)
    • cannot put x-ray agents in cell- cytotoxic. Can release cyokines
    • can resolve two x-caps in Philips poor mans’ ct
    • biostable past two months
    • can stem cells release cytokines and induce angiogenesis without physical contact?
  • QA:
    • Frequency of imaging during cryotherapy (PM),
  • Lorenz –
    • “MR Enhanced procedure” to augment another modality (XMR)
    • 125cm wide 70cm wide
    • Axioms Artis dFA
    • Miyabi MRI: Patient transfer from angio to MR
    • IMRIS iSpace
    • MR to Dyna CT= rotational x-ray
    • MR to MR
    • MR to live fluoro
    • IFE
    • Lederman – image fusion XFM infarct – bi-modality fiducials registration
    • Rapid prototyping of vessel for valve stent selection t
    • MR over live x-ray for deployment
    • 3D data MR, 2d x-ray
    • IFE interactive front end-
    • IRTTT – interactive real time tip tracking
    • BEAT – interactive sequence - multislice
    • History stamp
    • Avi maker
    • Northwestern, Olmary
    • AXIOM Sensis – physiological montoring
    • Inline technology to accelerate MR imaging (ADC, diffusion, perfuiosn)
    • Celon AG Teltow, Germany- bipolar RF electrode , cooled
    • MR m-mode- regional wall thickness detection. Change detection during procedure
    • Valve plane tracking
    • Automated detection/alignment of MRI devices rectal tube fidicual, finds end of tube. Will needle reach target?
    • RadBuilder- rapid prototyping enviforment. Visual programming. Internally at siemens. Lymph node task card.
    • XIP – extensive imaging platform. Open source platform. Siemens will contribute.
    • Parallel imaging – yes. GRAPPA2 will run in
    • What pulse sequences?
  • Taylor –
    • Closed loop medicine – statistical processing on data from intervention
    • Image-guided placement of therapeutic devise
    • Davinci telesurgery - warn surgeon he is pulling so hard he is about to break sutures
    • Engineering Research Center - $30M govermnemt $30M other in year 10
    • Engineering systems and applications
    • +engineering core technology
    • +fundamental knowledge
    • Statistical model of bony anatomy (pelvis), three 2D x-ray projections for best guess at shape of patient’s pelvis.
    • 3D recon from CT (QCT) quantititiave CT VS 3 xrays - assess risk of fracture p=0.9
    • Dan S’s robot for placing seeds
    • Needle steering with bevel
    • Endoscopic Video processing to draw circle around tumor. Register US
    • Optical sensors on micro instruments
    • Kidney ischemia assement during partial nephrectomy – during clamping
    • Force sensor on robot – remove hand jitter- cannulating 100um vessel in chicken embryo (to proactice for eye)
    • Drilling skull base
    • Nitononal ribs that bend:
    • -Snake line robot for MIS – upper airway, suturing
    • -Active control of shape of cochlear implant
    • Modelling the limits of human intention (JAPP candy bar) – pusing porcsch
    • Be conservative in design
    • We can know what we did – data mining – used in making computers.
    • Of 50k patient in national databasse, here are three that look most like you. Here are the rank order of possible complications.
    • Sponge count RFID
    • Lia Assumpcao, Michael Marohn, Rosemary Mountain, Nilo Rivera, R
    • I4m – integrating imaging intervention and informatics in medicine
  • Idea: aggregates of brass in this capsule
    • Surgical Flow monitoring – how long doe sit take Kemal to place each cryoprobe
  • Provide new capability that transcend human limitations in surgery


  • National Center for Image Guided Therapy (BWH)
    • Delegation to Johns Hopkins University

Powerpoint Presentations

Flights and Hotels