Focused Ultrasound Surgery Foundation

Training Site: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston

Mentor: Clare Tempany, M.D.

Fellowship Period: September 2009 – August 2011

I am currently working as a senior physician in IVF unit and MRgFUS unit at the Sheba Medical Center Tel Hashomer Israel. For the last 4 years I have been exposed to HIFU technology at the Sheba Medical center working with Drs. Inbar and Rabinovici. As a part of my duty, I take an active part in the ambulatory clinics treating patients willing to undergo routine treatments of uterine fibroids, as well as participate in clinical trials.

In September 2009 I intend to start a two-year research fellowship in the IVF unit at the Brigham and Women's Hospital in Boston. As Professor Tempany is one of the pioneers in the treatment of MRgFUS in the world, I plan to spend one day a week in her MRgFUS unit and collaborate with her team. I hope to perform preclinical research and data analysis in the treatment of uterine fibroids in Brigham. Our fields of interest include:

• Identifying the most suitable patients for the treatment of fibroids with MRgFUS.
• Evaluating the data of patients that were found compatible for the treatment in the first visit (by the Ob/Gyn), but not according to the screening MRI, in order to determine the cost effectiveness of the screening.
• Cost effectiveness analysis of the FUS treatment for fibroids (compared with myomectomy, hysterectomy and UAE).
• Assessment of the durability of MRgFUS treatment of fibroids.

In the future, once completing the fellowship, I plan to continue the collaboration between Brigham and Sheba and I'm sure that the knowledge from Brigham will clearly contribute to the on-going MRgFUS program at the Sheba medical center. The identification of the subgroup of women with highest success rates may result in higher satisfaction rates and increased durability of the treatment.

Training Site: Department of Radiology, University of California, San Diego

Mentor: William Bradley, Jr., M.D., Ph.D.

Fellowship Period: July – December 2009

My major clinical and research interests are in the field of therapeutic ultrasound applications in the human brain. My current main research focus is transcranial sonothrombolysis in stroke. Since July 2008, I have worked with an ExAblate 4000 headsystem on mechanical sonothrombolysis using high intensity focused ultrasound. Since then, 500 in vitro experiments have been accomplished, two different flow models have been developed, and an in vivo model (rabbit carotid artery) is currently being evaluated. First feasibility studies in two animals were successful. Besides HIFU, other research interests are in different sonothrombolysis approaches, such as transcranial sonothrombolysis using diagnostic ultrasound and prehospital sonothrombolysis in the emergency vehicles and helicopters. Further recent or current research activities are in the field of local drug delivery using acoustically active drug carrier systems, treatment of neurodegenerative diseases (mainly Parkinson) using transcranial HIFU, intraoperative neuronavigation using contrast-enhanced ultrasound, gene transfection through sonoporation, effects of primary/secondary radiation force on sonothrombolysis and drug delivery, transcranial sound field characterization, and flow mechanics in intracranial aneurysms and during sonothrombolysis using echo PIV and bubble tracking.

I am a true believer that the technology of MRI-Guided High Intensity Focused Ultrasound has the potential to change future medical treatment fundamentally. The technological potential combined with the biophysical effects of ultrasound are fascinating and have the potential to become a future landmark for various applications. To be a part of this development, to be able to actively contribute to improved stroke, neurodegenerative or tumor treatment in the brain using HIFU is my long-term goal in the field of MRI-guided focused ultrasound surgery.

Training Site: Department of Radiology, St. Mary’s Hospital, Imperial College, London

Mentor: Wladyslaw Gedroyc, M.D.

Fellowship Period: July 2009 – June 2010

I am a trained anesthetist currently working in the UK and my intention is to specialize in pain management as a career path. I have been involved in several projects in the field of pain management already, and following discussions with the pain management team at St. Mary's and Professor Gedroyc from Radiology, I am extremely keen to work on the evolving project that is being developed at St. Mary's for the treatment of facet joint pain using MR-guided focused ultrasound. There is a large practice of facet joint injections and facet joint radiofrequency (RF) ablation already in place at St. Mary's with up to 12 such procedures being carried out every week as pain control for the common problem of facet related back pain. The project will be to utilize focused ultrasound to perform noninvasive facet joint ablations using MR control withthe goal of replacing more invasive percutaneous RF ablation procedures.

Training Site: Department of Radiology, University of California, Los Angeles

Mentors: David Lu, M.D., Steven Raman, M.D.

Fellowship Period: July 2008 – June 2009

Dr. McClure recently changed from residency in urology to radiology at the University of California, Los Angeles. His transition stems in large part due to the promising possibilities that exist in minimally invasive image-guided treatments for a variety of malignancies, especially MRgFUS. During his transition year, Dr. McClure will work with clinicians and researchers in the development of MRgFUS at UCLA. This includes working with Dr. David Lu and Dr. Steve Raman for treatment of uterine fibroids as well as clinical trials investigating the use of MRgFUS in metastatic bone tumors, prostate cancer, and breast cancer. This fellowship will provide him the opportunity to develop a better understanding of MRgFUS and to be involved in the development of this new and exciting technology.