Diagnostics & Imaging Week Washington Editor

Washington — The fourth annual meeting of the International Brain Mapping and Intraoperative Surgical Planning Society (IBMISPS; West Hollywood, California) was not the most heavily attended conference of the year, but the organization has yet to hit its stride, a fact that was pointed out by several of the speakers on the first day.

All the same, a series of brief remarks made by representatives of the National Institutes of Health and the U.S. Department of Defense demonstrated that the federal government is keenly interested in the future of the association’s mission. And all indications are that the investment community and makers of imaging equipment would do well to take notice.

In his opening remarks, Babak Kateb, MD, founder and executive director of IBMISPS, said that the association’s “ultimate mission is to bring cutting-edge technology to those who need it most.” He also advised that nanotechnology is sure to play an important role in surgical imaging, saying that “more than 130 nanotech drug or delivery systems” are in development and that the public and private sectors are investing in these systems at a rate of about $3.8 billion a year.

Warren Grundfest, a professor of bioengineering and electrical engineering at the University of California at Los Angeles and a senior technical advisor for the Telemedicine & Advanced Technology Research Center (TATRC; Fort Detrick, Maryland), said that the public increasingly recognizes the need for new imaging technology for surgical use, but that existing technology has a lot to offer, too.

“We believe that there is a broad range of technologies” that can improve brain mapping and intraoperative imaging, Grundfest said, and that Congress has appropriated monies for traumatic brain injuries and other cranial conditions and diseases. However, he said that further funding is necessary to maximize the potential of intraoperative imaging.

Regarding the choice of Washington for this year’s meeting, Grundfest said, “[w]e felt it was important for the society to raise its awareness among government agencies,” and the society felt it needed a stronger East Coast presence, especially given that media outlets in the eastern U.S. cover medical science a bit more closely, in part due to the proximity of NIH, Congress and FDA.

Grundfest said that R&D efforts can waste resources by working in a vacuum and that it is important to get neurologists, neurosurgeons and interventioinal radiologists “involved in early stages of technology development so they can ask the right questions” as investments are made rather than after the fact.

John Haller, PhD, director of the division of applied science and technology at the National Institute of Biomedical Imaging and Bioengineering (NIBIB) at NIH, said that intraoperative imaging “is a high-priority area for my institute” and that its mission is “to improve health by leading the development and accelerating the application of biomedical technologies.”

To this end, NIBIB has set aside about $5 million a year in an effort to “deliver high clinical impact, disruptive technologies for image-guided intervention.” One such grant is for software that will render five-dimensional images for guided surgery in a project underway at the Mayo Clinic (Rochester, Minnesota) under the supervision of Richard Robb, PhD, a professor of biophysics and computer science at Mayo. NIBIB also supports the National Center for Image Guided Therapy at Brigham and Women’s Hospital (Boston).

However, Haller did not describe what constituted the fifth dimension.

“There are numerous solicitations out there,” Haller said, including R21 grants and bioengineering research partnerships, and he encouraged researchers to avoid sitting on their hands if they don’t see any requests for applications (RFAs) that dovetail with a researcher’s ideas.

“The main message I want to get across is that most applications are unsolicited. You don’t need an RFA,” he said.

Haller said that NIBIB’s budget for 2008 has topped $300 million and that the strategic plan at NIBIB for 2005-2010 includes an emphasis on “accelerated translation of promising technologies.”

“We’re very interested in technologies that will help reduce health disparities,” Haller said, adding that the institute “is about to support three new centers for point-of-care diagnostic tests” that may help reduce disparities.

As an example, NIBIB is funding a project headed by Rebecca Richards-Kortum, PhD, that will determine whether a small fiber-optic scope can accurately diagnose cervical cancer and possibly treat the lesion on the spot. Richards-Kortum’s project at the University of Texas (Austin), Haller said, is a way to keep the demands on medical resource low. “More important is the fact that the patient doesn’t come back for a second visit.”

Not to be left out, a representative of the DoD also gave some perspective on brain mapping.

Lt. Col. Christian Macedonia, MD, with the National Naval Medical Center (Bethesda, Maryland), discussed the emphasis at TATRC, which is looking into proteomics and genomics, among many other things.

“We’re very much interested in multidisciplinary projects,” Macedonia said. “We’d like to become a dating service” for collaborative research, he said, given the interest at TATRC in that mode of research, he said.

One of the areas of interest at TATRC is in developmental neurology, and Macedonia said that the fetal brain “is not a little adult brain. It changes morphologically over time.”

Macedonia said he knew he was “not hitting you with anything new. The idea that what happens in utero has significant effects” on later life, including susceptibility to stroke, is widely understood. The problem is that the knowledge has not been updated much of late.

“Most of our knowledge of the assembly of the human brain” is based on stored samples that date back to a collection started with funds offered by the early 20th century tycoon Andrew Carnegie. But there’s a reason for that lack, and it has to do with the reluctance to intervene in a developing life.

Any discussion of research involving the fetus tends to raise hackles, Macedonia said, especially at NIH, because such an effort is not seen as incurring minimal risk.

“We can zap adults with a lot more radiation” than fetuses and get away with it, he added.

Researchers are investigating the potential in this area for superconducting quantum interference devices, a.k.a., SQUIDs. The safety afforded by SQUID technology, which operates on largely the same principles as MRI, is due to the fact that the device relies on super-cooled conductors that are extraordinarily sensitive and can pick up a wealth of information without the need for contrast media, which are the objects of concern in terms of fetal health.

Any organizations that are into brain mapping that are not looking at genomics and proteomics “should reconsider that omission,” Macedonia said, adding that “opportunities abound for research, especially for multi-disciplinary research” for programs that will benefit unborn babies, mothers and those with brain damage.

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