1. Surgical Planning Laboratory Brigham and Women’s Hospital Boston, Massachusetts USA a teaching affiliate of Harvard Medical School Visit of Barbara Alving, M.D. 8-15- 05 Ron Kikinis, M.D.

2. ©2005 Surgical Planning Laboratory, ARR Slide 2 Overview Prostate: –Clare Tempany, Noby Hata, Steve Haker Neurosurgery: –Alex Golby, Steve Pieper, Sandy Wells, CF Westin Programmatic targets: –NAC Ron Kikinis, BIRN: Steve Pieper, IGT: Clare Tempany, Randy Ellis Targets for your presentations: –What is your science (explanation targeted at a clinician) –How do you fit into the different programs

3. ©2005 Surgical Planning Laboratory, ARR Slide 3 Schedule Prostate Neurosurgery NCRR portfolio Discussion

4. ©2005 Surgical Planning Laboratory, ARR Slide 4 Prostate

5. ©2005 Surgical Planning Laboratory, ARR Slide 5 Neurosurgery

6. ©2005 Surgical Planning Laboratory, ARR Slide 6 Functional imaging and electrocorticography- guided surgery in eloquent cortex Surgical resection is most effective initial therapy for a variety of brain tumors Maximal surgical excision relieves mass effect, decreases tumor burden, decreases incidence of seizures and may prolong time to recurrence and survival Defining limits of the resection difficult due to gross similarity of tumor and brain tissue Adjacency of essential cortex (e.g. motor, language) makes distinction critical

7. ©2005 Surgical Planning Laboratory, ARR Slide 7 Intra-operative MRI at BWH Craniotomy=699 Brain biopsy=180 LASER ablation=9 Transsphenoidal pituitary adenoma resection Total=918

8. ©2005 Surgical Planning Laboratory, ARR Slide 8 MRT allows surgeon to visualize resection progress and brain shift F. Talos

9. ©2005 Surgical Planning Laboratory, ARR Slide 9 Motor, visual cortex well demonstrated Language lateralization Increasingly, language localization and memory Functional MRI can provide a pre-operative map of critical brain areas

10. ©2005 Surgical Planning Laboratory, ARR Slide 10 Imaging white matter tracts MRI measures diffusion of water. Water proton diffusion facilitated parallel to fibers and restricted perpendicular anisotropic diffusion tensor imaging Trajectory and location of white matter tracts Three types of lesion/fiber tract interactions may occur: –fiber tract displacement –infiltration –destruction Higher diffusion along fiber Lower diffusion across fiber axons

11. ©2005 Surgical Planning Laboratory, ARR Slide 11 Stimulation mapping to locate essential cortical areas Fiber tracts

12. ©2005 Surgical Planning Laboratory, ARR Slide 12 Image coregistration and fusion

13. ©2005 Surgical Planning Laboratory, ARR Slide 13 Intraoperative image fusion and display: fMRI and Cortical Stimulation

14. ©2005 Surgical Planning Laboratory, ARR Slide 14 Conclusions and Future Directions Multi-modality image fusion Intra-operative functional testing annotation Develop paradigms which work well for patients with neurologic deficits Integrate fMRI with DTI and other imaging modalities Improve ability to predict post-operative outcomes and avoid neurologic injury Correlate fMRI signal with neuronal activity

15. ©2005 Surgical Planning Laboratory, ARR Slide 15 NCRR portfolio

16. ©2005 Surgical Planning Laboratory, ARR Slide 16 NAC Focus: specific applications, custom software tools e.g. Tensor analysis for pioneering diffusion technology from BWH BIRN Focus: infrastructure, data, data distribution e.g. Provides shared image databases and high speed network/computing for NA-MIC & NAC NA-MIC Focus: algorithms, engineering, general software tools e.g. Analysis of tensor and non-tensor diffusion data at three algorithm groups (UNC, Utah, MGH), hosted on BIRN servers from four clinical sites (Dartmouth, Harvard, UCI, U of Toronto) National Level Science National Level Outreach Advances in medical image computing Data repositories and access Data Requirements, testing, tools Research Interactions between NA-MIC, NAC, BIRN Local Level Science National Level Outreach