1. ©2005 Surgical Planning Laboratory, ARR Slide 1 U41: Research resource for Image guided therapy PI: Ferenc Jolesz

2. ©2005 Surgical Planning Laboratory, ARR Slide 2 U41 Image guided therapy Background & Significance –IGT technology growth –Clinical imaging growth Aim –Advance and propagate novel image guided procedures To dev and implement IGT technologies and allow rapid deployment in clinic

3. ©2005 Surgical Planning Laboratory, ARR Slide 3 U41 program outline Technology Research & Development cores Admin core Biostatistics & Validation core Collaborations –Internal (11) –External (8)

4. ©2005 Surgical Planning Laboratory, ARR Slide 4 Program outline 5 TRD cores –Computational Leader: Ron Kikinis –Imaging Leader: Larry Panych –MRI-guided therapy Leader: Clare Tempany –Image guided Brain tumor surgery Leader: Alex Golby –Focused Ultrasound Leader:Kullervo Hynynen

5. ©2005 Surgical Planning Laboratory, ARR Slide 5 Training & Dissemination Leaders: John Carrino & Nancy Drinan Continuous activities on site –First Monday seminars R25 training grant Visiting fellowships Post docs, doctoral students Graduate and undergraduate students

6. ©2005 Surgical Planning Laboratory, ARR Slide 6 Collaborations Technology based –Advancing imaging and image processing into the OR of the future AMIGO Testing utility of IG –Interventional Radiology –Surgery –Cancer therapy –Cardiology (FUS ablation)

7. ©2005 Surgical Planning Laboratory, ARR Slide 7 U41 Collaborative projects Internal (11) NIH funded grants – d2.1 G CT R01 AG 19513 MR guided prostate diagnosis and brachytherapy External (8) NIH grants with BWH collaborators –d2.1p Christos Davatzikos 1R01 CA 104976 Targeted prostate biopsy using mathematical optimization

8. ©2005 Surgical Planning Laboratory, ARR Slide 8 External collaborations Major groups GE –Doumoulin/Pelc 3 projects stem from the Engineering research center for computed surgical systems and technology (CISST ERC)of Johns Hopkins –Targeted biopsy (Christos Davatzikos) –Transrectal prostate therapy robot in closed MRI scanner (Gabor Fichtinger)

9. ©2005 Surgical Planning Laboratory, ARR Slide 9 MRI guided therapy core Neurosurgery Prostate program Interventional radiology –Tumor ablation program (SGS0 –Spine interventions (JC)

10. ©2005 Surgical Planning Laboratory, ARR Slide 10 TRD core and collaborative interactions: An example Prostate intervention –Paradigm shift Improved image quality –Higher field strength magnets Magnet design issues –Closed bore systems MRT core Internal collaboration External collaboration

11. ©2005 Surgical Planning Laboratory, ARR Slide 11 Overlaid Choline/Citrate image Prostate Image guided diagnosis & therapy Infrastructure FEM Based Deformation Mutual Information MR Robotics Brachytherapy High Performance Computing Gigabit networkTerabyte storage Prostate biopsy Detection Staging Treatment monitoring SPL

12. ©2005 Surgical Planning Laboratory, ARR Slide 12 Optimized biopsy project * NIH R01 PI: Davatzikos et al left right Probability of cancer occurrence shown in green (left) and its adaptation (middle) to a stack of segmented intra-operative MR images obtained at the BWH (right). Optimal biopsy sites are transferred to the patient's space.

13. ©2005 Surgical Planning Laboratory, ARR Slide 13 Validation methods Pre-clinical –IGT technology-imaging system, guidance and monitoring techniques-organ/disease specific IGT Procedural –Image registration & segmentation DICE- Statistical analysis of registration matching Staple- analysis of expert and automated methods –Procedure Feasibility Safe and effective Treatment specific -Cancer specific goals –Patient safety, toxicity profiles, Cancer control-long and short term outcomes

14. ©2005 Surgical Planning Laboratory, ARR Slide 14 3T endorectal coil MRI Bob Lenkinsky & Neil Rofsky BIDMC

15. ©2005 Surgical Planning Laboratory, ARR Slide 15 Open vs Closed bore magnet design

16. ©2005 Surgical Planning Laboratory, ARR Slide 16 1. Tempany CMC, McNeil BJ. Advances in biomedical imaging. JAMA 2000; 285(5):562-567.