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Looking to the Next Frontier of Diagnostic Imaging and Radiology Research

The black, white and shades-of-gray images that outline human tumors is something that Paul Harari, MD, sees every day in his clinical oncology practice at the University of Wisconsin Carbone Cancer Center (UWCCC).


Thomas Grist (left) and Paul Harari confer in the Wisconsin Institutes for Medical Research PET/CT suite, which houses GE equipment.These images help Harari and colleagues gauge whether a cancer patient will need various combinations of surgery, radiation and/or chemotherapy. What these images do not yet predict is whether the prescribed treatment will be the absolute best approach for each particular patient.


Right now, Harari can see the anatomy and distribution of the tumor quite well, but he cannot assess the inner tumor biology that would allow him to predict response likelihood. He often won’t know whether a tumor is shrinking, growing or remaining unchanged until several weeks or even months after treatment has been completed.


Sometimes the initial treatment yields an excellent response. Other times, Harari and his patients are disappointed because the tumor does not respond favorably to treatment.


“We are poised to make remarkable progress in tailoring cancer treatments to individual patients based on the specific biology and genetics of their individual tumor,” notes Harari, the Jack Fowler Professor and Chair of the Department of Human Oncology at the UW School of Medicine and Public Health (SMPH). “We are keenly aware that treatment should not be ‘one size fits all.’ Advances in molecular and functional imaging will allow us to personalize treatments to maximize effectiveness.”


The answers to more individualized and effective cancer treatment could lie in a new innovative, collaborative research facility being planned at the School of Medicine and Public Health. The facility is being designed to provide answers in the “bench to bedside” model, aimed at quickly moving discoveries into practical applications to benefit patients.


In September 2012, School of Medicine and Public Health Dean Robert Golden, MD, announced a collaboration agreement with GE Healthcare that will produce a leading-edge imaging research facility at the school. The imaging center will expand radiology and medical physics research space by 12,500 square feet.


As part of the agreement, GE Healthcare has committed $32.9 million in funding, research personnel and diagnostic imaging equipment over 10 years to support its collaborative research program with the UW School of Medicine and Public Health's existing Departments of Radiology and Medical Physics. The research agreement will be re-evaluated and recommitted annually during the next decade. The implications of the innovative partnership are mind-boggling and revolutionary.


“The imaging center will be one of a few in the world that will bring together state-of-the-art diagnostic imaging systems with physicians, engineers and scientists focused on improved patient care and personalized medicine, in an environment that is connected to an outstanding academic medical center, including UW Hospital and Clinics,” says Thomas Grist, MD, the John H. Juhl Professor of Radiology, Medical Physics and Biomedical Engineering and chair of the Department of Radiology at the School of Medicine and Public Health.


'The Second Revolution of Medical Imaging Innovation'


Fluoro-L-thymidine (FLT) positron emission tomography (PET) scans of a patient with metastatic pulmonary disease (circled); left: pre-treatment; right: follow-up after two weeks of molecular targeted anti-angiogenic therapy showing dramatic decrease in FLT-PET uptake signal, indicating reduced cell proliferation.Grist and Harari have dreamed of the day when patients and their families can receive highly individualized treatment regimens that could increase response rates and diminish the time, side effects and expense associated with ineffective therapies.


For the past two years, Grist and his colleagues have been pursuing “the second revolution of medical imaging innovation,” he explains. The revolution centers on molecular imaging - the ability to look at cellular organ function and metabolism.


Grist knows that the end game is patients receiving more individualized care that will be delivered in a less invasive manner with image guidance. For example, physicians would be able to give a cancer patient an imaging agent before and after the first round of chemotherapy and call upon molecular imaging to find out if the tumor has changed.


Incorporating this type of technique early in the treatment of cancer patients could enable Harari and his patients to more rapidly assess the effectiveness of cancer treatment regimens. This early biological response of the tumor could allow physicians to alter the course of treatment if the initial approach is not showing favorable results.


“Molecular imaging is a key to shifting the healthcare model from population-based to personalized medicine,” says Grist, explaining that this trend will change the future of medicine and will improve patients’ overall quality of care through more precise diagnostic and treatment techniques.


The concept is futuristic and complex - truly the next frontier of diagnostic imaging and radiology research - but Grist is able to break it down in an understandable way:


“Think about a mechanic who is trying to figure out what’s wrong with a car,” suggests Grist. “The mechanic needs to look at the engine, but also must check to see how it functions and drives. In a similar way, radiologists and physicians can now see the patient’s engine, but can’t necessarily tell how it’s functioning. Molecular imaging is designed to show us the engine and how it works.”


A History of Collaboration


While the newest research is on molecular imaging using positron emission tomography (PET) and magnetic resonance imaging (MRI), the center will pull together in a single space many imaging modalities, including computed tomography (CT), ultrasound, angiography, digital radiography, optical scanning, radiotherapy and magnetoencephalography.


The new facility will be housed on the second floor of the Wisconsin Institutes for Medical Research’s under-construction second tower. It will be just steps away from Harari’s office in the UW Carbone Cancer Center, the only cancer center in Wisconsin within the National Cancer Institute’s “comprehensive” designation.


Driving the recently announced collaboration is a partnership between School of Medicine and Public Health and GE Healthcare that has lasted more than 30 years. The long list of innovations produced through the partnership includes:

  • UW researchers inspired four of seven major GE products introduced in 2010 from research on MRI. Another four major MRI clinical applications could be produced by the collaboration next year.

  • In CT, the partnership has resulted in novel technology that significantly reduces radiation doses for pediatric and adult patients. Those protocols already are in place at American Family Children’s Hospital and UW Hospital and Clinics.

  • Other researchers have rolled up their sleeves to use functional MRI for early diagnosis and monitoring of treatment in patients with the most common cause of liver disease.

  • Patients at risk for heart disease are benefitting from new non-invasive imaging techniques to assess blood flow in entirely new ways.

New Standards of Clinical Care


Specialized PET imaging using a hypoxia tracer to highlight regions of high (red/yellow) and low (blue/green) oxygen levels within the tumor.Concurrent with the creation of the research collaboration, the Wisconsin Alumni Research Foundation and GE Healthcare forged a new patent and technology agreement that governs the intellectual property and licensing practices of the research contract. During the past 11 years and under a previous agreement, the collaboration resulted in nearly 200 invention disclosures, more than 80 filed U.S. patents and a number of licensing agreements and technology improvements.


Grist notes: “The center will be a nexus for the development of new products for GE Healthcare and other Wisconsin-based start-up companies that arose from research in the Departments of Radiology and Medical Physics, like Neuwave, Novellos and Tomotheraphy.”


The significance of the latest agreement was not lost on GE Healthcare Systems President and CEO Tom Gentile, who flew from India to Madison to participate in the announcement. Gentile looked and sounded fresh when he remarked that his company could have partnered with other research institutions to advance imaging research. But Gentile thinks that the 30-year history of collaborative innovation makes the new venture with the UW School of Medicine and Public Health a natural fit.


“GE Healthcare’s research collaboration with UW-Madison not only will yield significant economic benefits to the state of Wisconsin, but it will enable us to partner to create protocols that will fundamentally change clinical care both here and around the world,” says Gentile. “I’m proud of GE Healthcare’s long-standing relationship with important thought leaders in medical imaging.”


The next steps toward changing clinical care around the world could be taken soon. Grist says some of the new equipment will be installed by the end of this year. The imaging research center could be fully functional by the end of 2013 or early in 2014.


“We are so excited about the emerging advances in patient diagnosis and treatment,” says Harari. “Seeing more accurately the inner biological workings of diseases before and during treatment will have an enormous impact on patient care, and allow us to deliver personalized therapies in a more cost-effective manner.”


By Toni Morrissey

This article appears in the fall 2012 issue of Quarterly.

Date Published: 11/29/2012

News tag(s):  quarterlyresearchwisconsin idearadiologyqarchivedfeatures

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Looking to the Next Frontier of Diagnostic Imaging and Radiology Research

Last updated: 03/27/2013
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