Training Site: Department of Radiology, The Methodist Hospital Research Institute

Mentor: King Li, M.D, F.R.C.P. (C), M.B.A.

Fellowship Period: August 1, 2011 – July 31, 2012

I am applying to the Focused Ultrasound Surgery Foundation for a clinical fellowship because I believe that I am a qualified candidate for this unique opportunity.

My interest in High-Intensity Focused Ultrasound (HIFU) began in 2006 when I,  as a pre-doctoral fellow from Rosalind Franklin University of Medice and Science, conducted basic research in HIFU at the National Institutes of Health’s Radiology Department.  One of my projects was the investigation of in vivo mechanisms of pulsed HIFU in drug delivery using a mouse model.  Another was the feasibility of a CT-guided HIFU system.  Now as a post-doctoral fellow in the Radiology Department at the Methodist Hospital System in Houston, I continue my investigation into HIFU mechanisms in a rabbit model using the ExAblate MRI-guided HIFU system.  The investigative transition from studying HIFU in a rodent model to that in a rabbit model will enable me to better understand HIFU mechanisms in animals of increasing size.  In yet another project using the ExAblate, I am studying the feasibility of treating pancreatic cancer in a porcine model.

As a medical graduate, my interest in HIFU extends beyond its basic research in the laboratory.  I always think about how a non-invasive and non-radiation therapy such as HIFU can complement or challenge the conventional treatments for many diseases such as prostate cancer, bone cancer, breast cancer, and fibroids.  I am very motivated by the possibility that this new and exciting technology may offer new hopes to those in whom other treatments might have yielded suboptimal results.  Under the mentorships of Dr. King Li and Dr. Denise Nebgen, I will learn to treat diseases using the ExAblate MRI-guided HIFU system.   After the fellowship, I intend to enter internship followed by a radiology residency during which I hope to train other residents in MRI-guided HIFU.

In the long-term, I am committed to treating patients using MRI-guided HIFU whenever possible.  Furthermore, as this new technology matures and gains greater acceptance among physicians and patients, I may consider opening a dedicated MRIgHIFU center to accommodate greater patient needs.

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

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

Fellowship Period: June 2011 – May 2012

I am interested in evaluating the application of MRgFUS for management of urologic oncologic diseases and investigate its use as a treatment modality for prostate cancer. Current therapies for prostate cancer cause significant morbidity; given that most prostate cancers are indolent, complications from treatment can negatively impact patients' quality of life for a prolonged period of time. Studies in MRgFUS for a number of diseases have been promising and similar potential is apparent for prostate cancer. My goal is to assess safety, feasibility and efficacy of MRgFUS for urologic diseases and become a leading expert in this area. To achieve this mission, I plan on spending my fellowship exploring MRgFUS in both the commercial and research use. I am already highly involved in the UCLA comprehensive fibroid center by partaking in management of patients with symptomatic fibroids. This experience has allowed me to understand the pre-treatment evaluation, delivery of treatment and follow up after the procedure. Moreover, I have ventured in scholarly projects and have successfully completed a chapter describing the Gynecologic Application of High Intensity Focused Ultrasound Surgery for the first edition of the book titled Image-guided Cancer Therapy: A Multiple-disciplinary Approach; we have also prepared and will be submitting an original manuscript describing the treatment patterns after our fibroid center was implemented two years ago; and I will be presenting our findings at the MRgFUS Symposium. All of these experiences have been satisfying and I look forward to continuing my work with expansion of MRgFUS for other applications.

Training Site: Deparmtent of Radiology, Charité Berlin, Germany

Mentors: Bernd Hamm, M.D.; Alexander Beck, M.D.

Fellowship Period: November 2009 – November 2010 (50% effort)

I am working as a resident at Charité − Universitätsmedizin Berlin, Department of Radiology. At Charité, high focused ultrasound has been used since 2001. It is especially applied for women with unterine fibroids. Currently, a new porspective study is in preparation comparing surgical myomectomy with MR-guided hight focused ultrasound (MRgFUS) in women seeking pregnancy.

Dr. Alexander Beck, the responsible physician and investigator concerning MRgFUS at the Charité, introduced the whole project to me three months ago. Since then, I have ascertained that this is an excellent, non-invasive alternative to surgical myomectomy or even hysterectomy. Taking part at a few invesitagtions strengthened my motivation to put more effort into this project. I would be very glad to get the opportunity to explore MRgFUS further.

My short-term goal for the fellowhsip period is primarily to become part of the Charité MRgFUS project. Long-term goals are to perform treatments on my own and to force clinical research about MRgFUS at Charité now and in the future.

Progress Reports: 6-month progress report; Final progress report

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

Mentor: Clare Tempany, M.D.; Fiona Fennessey, M.D.

Fellowship Period: September 2009 – August 2011 (20% effort)

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.

Progress Reports: 6-month progress report; 12-month progress report; 18-month progress report; Final progress report