Research Spotlight

This month we’re taking a close look at the Institute for Medical Science and Technology – a joint initiative from the University of Dundee and the University of St. Andrews – whose research projects tackle some interesting areas in the Image-Guided Therapies sector.

Introduction to the Institute for Medical Science and Technology (IMSaT)

IMSaT is an interdisciplinary institute for future Medical Technologies, positioned at the interface of Physics, Engineering, and Clinical and Life Sciences, founded in 2006 as a joint initiative by the University of Dundee and the University of St. Andrews, and supported by the EU. IMSaT hosts GE’s First European Centre of Excellence for Pre-Clinical Image-Guided Interventions and Surgery. Since its formation six years ago, IMSaT has attracted research project funding totalling more than €25M.

The primary focus of the MRI group at IMSaT is the therapeutic use of High Intensity Focused Ultrasound (HIFU, or FUS). In many countries, FUS is used to treat uterine fibroids, liver tumours, and functional neurological disorders such as essential tremor, neuropathic pain and tremor-dominant Parkinson’s disease. Recently FUS has been used in place of conventional external-beam radiotherapy to deliver palliative treatment for painful bone metastases. Pre-clinical laboratory testing of image-guided FUS-activated delivery of highly toxic chemotherapy drugs, to combat brain cancers, is also underway.

At IMSaT, our longer-term focus is on the ablation of abdominal cancers, specifically in organs which move during respiration, such as the liver and kidney. The presence of the ribs, in addition to respiratory motion, makes effective ultrasonic targeting of underlying tissues particularly difficult, and we have been instrumental in acquiring significant levels of European funding in the quest to address these issues.

Facilities & Group Members

Figure 1: TRANS-FUSIMO project team: (l-r) Baljit Jagpal, Chief Radiographer; Lukasz Priba, Medical Physicist; Andrew Dennison, Lead Researcher; Prof. Andreas Melzer. Pictured in front of GE 1.5 T scanner (GE), InSightec ExAblate table (InSightec, Israel), and INNOMOTION robot (Innomedic, Germany).

The core group at IMSaT is shown in figure 1, comprising chief radiographer, medical physicist, lead medical supervisor and project supervisor (Prof. Andreas Melzer), postdoctoral researchers (Dr. Senay Mihcin, not shown), project manager (Dr. Andy Liken, not shown), and Operating Room / Thiel-enbalmed cadaver / X-Ray facility staff (Helen McLeod, not shown).

Prof. Andreas Melzer is Professor of Medical Technology and Founding Director IMSaT. He is a highly experienced academic with enterprises crossing the clinical / technology interface. He has been a key player in seven medtech startup companies and has experience of a wide range of relevant technology including development of the world’s first MRI-compatible robot, research into tissue motion and perfusion of soft-embalmed cadavers for pre-clinical demonstrations, and exploration of new applications for FUS. Prof. Melzer is a recognized opinion leader with >100 patents and >200 papers and book chapters as well as >300 invited talks.

The bulk of the work at IMSaT revolves around the GE 1.5 Tesla MRI scanner, and X-Ray arm. The unit is fully equipped with all required facilities for interventional surgical research including the latest Focused Ultrasound system ExAblate (Insightec, Israel) with body and confomal system, and MR compatible Robotic Arm for percutaneous interventions Innomotion (Innomedic, Germany). IMSaT is also located close to the Clinical Research Centre, a joint venture of NHS Tayside and University of Dundee, providing additional access to a clinical imaging suite with a 3 Tesla MRI scanner, as well as PET/CT facilities. Our collaborations with industry partners, and collaborations both with NHS boards and other academic centres of excellence within Scotland, makes IMSaT an excellent partner for FUS-related research activities, and we welcome enquiries from both the corporate and academic sectors.

To study the effects of FUS upon the human body, we primarily use tissue-mimicking phantoms in the first instance, with additional use of soft-embalmed Thiel human cadavers as a simulator for MR-guided interventional procedures including real-time MR imaging of breathing motion. These approaches are the first effort in research procedures designed to be applicable in pre-clinical (usually pig) and clinical environments.

Research Projects

Figure 2: The FUTURA Consortium at the final project review, Pontedera Italy, December 2016. Prof. Andreas Melzer is front 2nd from right.

FUTURA (Focused Ultrasound Therapy Using Robotic Approaches) is a recently completed 3 year project funded under the European Community’s 7th Framework Programme (611963), led by the Scuola Superiore di studi universitari e di perfezionamento Sant’Anna In Italy, and including additional Italian, French and Czech industry partners (Figure 2).

FUS was deemed to be the ideal benchmark for FUTURA. While its medical effectiveness has previously been well demonstrated, limitations in accuracy, precision, repeatability and a strong reliance on medical skills have hampered its adoption in routine clinical applications. FUTURA addressed these issues by integrating cognitive processes in the operational workflow, all blended with state-of-the-art, flexible and safe instruments and techniques for therapy planning, delivery and monitoring.

The FUTURA project was highly successful in designing, developing, and assessing an innovative multi-robotic platform for the delivery of non-invasive therapy by means of HIFU, under ultrasound guidance (USgFUS). The project addressed all specific issues necessary for a concrete and effective transfer of robotic technologies into operating rooms. The robotic platform was expected to operate in an unstructured and extremely critical environment.

The next stage of the work will focus on additional funding for a continuing joint international effort to move FUTURA into pre-clinical and clinical environments.

TRANS-FUSIMO is an ongoing EU funded project (611889) involving 11 partners from Europe and Israel (including GE, InSightec, Fraunhofer Institute, ETH Zurich, University of Rome, University of Palermo). The project is a follow up project of FUSIMO (Focused Ultrasound in Moving Organs), wherein a planning system for MR-guided Focused Ultrasound Surgery (MRgFUS) in moving abdominal organs has been developed. MRgFUS combines HIFU for thermal ablation of diseased tissue with MR imaging to visualise the tumour and surrounding anatomy, and to provide MR thermal feedback.

TRANS-FUSIMO was designed to translate the FUSIMO demonstrator into a clinically applicable system spanning the full clinical workflow of planning, conduction and assessment as well as learning from the procedure: Extension of the FUSIMO demonstrator to support conduction and assessment of the intervention under breathing motion; Interfacing state-of-the-art FUS hardware and imaging devices to build an integrated real-time-capable system for liver FUS; Improving model components for optimized clinical workflow, real-time applicability and validated outcome prediction; Allowing training and learning using the FUSIMO software system by building a case and result database; Conduction of pre-clinical (phantoms, cadaver, animal) experiments of the FUSIMO system.

Work to date has focused on the use of tissue-mimicking phantoms (similar to FUTURA), with plans to use Thiel cadavers later in the work. The University of Palermo have as of March 2017 received ethical approval for use of the TRANS-FUSIMO system in a pig trial. In a clinical trial, to be conducted by the University of Rome later in 2017/2018, the feasibility of using the integrated system for neoadjuvant MRgFUS to achieve prolonged survival will be investigated.

As a final project result, the integrated system will be close to certification status and subsequent commercialization. With such an integrated real-time system, FUS can become a commercially and clinically competitive alternative to current surgical and minimal-invasive oncological interventions, thus providing a non-invasive treatment, reducing side-effects, and healthcare costs.