Imperial College Healthcare National Health Service (NHS) Trust is the largest teaching and research trust in the United Kingdom. It includes five hospitals in London: Charing Cross Hospital, Queen Charlotte’s and Chelsea Hospital, Hammersmith Hospital, St. Mary’s Hospital, and Western Eye Hospital.
NHS foundation trusts are not-for-profit, public benefit corporations that provide over half of all NHS hospital, mental health, and ambulance services in the United Kingdom. NHS foundation trusts were created to devolve decision making from central government to local organizations and communities. Read about Imperial Healthcare Trust.
Imperial College Healthcare’s focused ultrasound facilities are located solely within the Department of Radiology at St. Mary’s Hospital. Professor Wladyslaw Gedroyc, MD, Consultant Radiologist, first brought focused ultrasound to St. Mary’s in 2000 after recognizing that it was an important emerging technology for image-guided MR therapy and a natural extension of the work that was already being done there.
We interviewed Prof. Gedroyc to learn more about the program that he created and how it continues to expand. Read the following Q&A to learn about the past and see this visionary’s concept for the future, which includes exciting new neurological research that is now underway.
What is the organization’s vision and mission?
On its website, the Imperial College NHS Trust describes its ethos as follows: “To help everyone to be as healthy as they can be, we want to look out for the people we serve as well as to look after them. We look after people by providing care, whenever and however they need us, listening and responding to their individual needs. We look out for people by being their partner at every stage of their life, supporting them to take an active role in their own health and wellbeing. We are one team, working as part of the wider health and care community. We are committed to continuous improvement, sharing our knowledge and learning from others. We draw strength from the breadth and depth of our diversity and build on our rich heritage of discovery. By doing all this, we ensure our care is not only clinically outstanding but also as kind and thoughtful as possible. And we are able to play our full part in helping people live their lives to the fullest. Our promise is better health, for life.”
What types of focused ultrasound facilities, space, and equipment do you have at St. Mary’s?
We have had the Insightec body system, which we have used to treat uterine fibroids, prostate cancer, and several investigational applications (such as facet joint pain) since 2000. Thanks to a grant from Imperial College Healthcare Charity, we recently also installed an Insightec Exablate Neuro system and have already started several clinical trials and commercial treatments for patients with essential tremor, Parkinson’s, and other movement disorders.
Recent fundraising efforts ($1.6M) have made it possible for us to purchase and install a third MRI machine in our department. This additional capacity will allow us to dedicate one of the MRI systems solely for focused ultrasound treatments. We expect the progress to be complete in about nine months.
Where does the funding come from, and what is your annual budget?
All of our research funding is from the NHS Trust, industry partners, and charitable donations (especially for the capital equipment). We do not have a budget designated specifically for focused ultrasound. Some of the cases that we do are private pay.
How many total staff are in the focused ultrasound center, and who are your key investigators?
Although none of us work full time in focused ultrasound, we have a group of nine professionals who are currently a part of the focused ultrasound program, including the following individuals:
- Professor Wladyslaw Gedroyc, MBBS, MRCP, FRCR (consultant radiologist)
- Peter Bain, MBBS, MA (Oxon), MD, FRCS a neurologist
- Dipankar Nandi, MBBS, a neurosurgeon
- Olga Kirmi, MBBS, BSc, MRCS, FRCR, a neuroradiologist
- Brynmor Jones, MBBS, a neuroradiologist
- Four radiography technicians who operate the focused ultrasound systems
Furthermore, we have our imaging research coordinators and nurses, who are extremely helpful and without whom we would be lost. The people who fill these roles are vital to our program.
Who are your internal and external collaborators?
Our internal collaborators are listed above. Externally, we have a longstanding collaboration with Dr. Maya Thanou, a pharmaceutical scientist and senior lecturer at King’s College London. We have received several large grants and have been working together to develop a wide variety of novel oncology drugs for delivery via focused ultrasound release directly into tumors. Several of our published manuscripts describe our preclinical studies using ovarian cancer and breast cancer models. We have patented a few of the drugs that we developed using her sophisticated chemical engineering techniques for encapsulating chemotherapeutic payloads within inert carriers. We are looking to move into translation studies in this area. See publications from this work
Which focused ultrasound applications and biomechanisms are being investigated at Imperial College Healthcare NHS Trust?
- Essential tremor thalamotomy – unilateral and bilateral
- Parkinson’s dyskinesia pallidotomy
- Ablation of rectal and other pelvic cancers
- Uterine fibroid ablation
- Drug delivery for oncology (preclinical research)
Importantly, we have a large backlog of patients who are seeking treatment for movement disorders. Although reimbursement is not yet in place for these patients, I recently was asked to be the lead clinician on an NHS policy working group tasked with approving the use of this technology for patients across the UK who are suffering from movement disorders.
How many focused ultrasound clinical studies are currently active or completed?
- Staged Treatment of Bilateral Essential Tremor
- Parkinson’s Dyskinesia
- Rectal and Other Pelvic Cancers
Over the past 18 years, we have completed clinical trials for the treatment of large uterine fibroids, treatment for women who wish to pursue pregnancy after uterine fibroid ablation, prostate cancer, and the treatment of low back pain. The prostate work has now been transferred completely to the Department of Urology.
Do you have a favorite success story to share?
The brain cases are remarkable, and we have had a series of incredible results for patients whose lives were truly destroyed by movement disorders. It is a medical miracle to watch the treatment work in these patients.
The patient who was the first to receive the bilateral focused ultrasound essential tremor treatment accompanied us to the Houses of Parliament to make a presentation. He was not someone accustomed to public speaking, but he truly made an impact to the group of about 120 lawmakers when he relayed the story of the sandwich that he was given immediately after receiving the treatment. He said that he honestly held the sandwich in his hand for ten minutes before attempting to eat it because it was the first time in 20 years that he had picked up a sandwich without the filling falling out and getting all over him. It was such a vivid picture that the whole room erupted because everyone could relate to him on a personal level. The patient also said that it was the first time that his wife did not have to drink the first half of his drink before he could attempt the second. Essential tremor is not a malignancy, but it destroys people’s lives.
Has the Focused Ultrasound Foundation played a role in your work?
Yes, the Foundation provided research funding for our early work with facet joint pain. I also attended the Foundation’s Liver Cancer workshop and contributed to its resulting consensus paper. I am happy to serve as a member of the Foundation’s Research Advisory Committee.
What is your wish list to increase your impact (funding, people, technology)?
My research wish list is technology that will allow us to start to treat brain tumors and liver tumors with focused ultrasound.
What is your role in education?
We have a continual stream of students from around the U.K. coming through the focused ultrasound center to learn about the technology. In fact, one is coming to observe today’s essential tremor procedure. We are also establishing some links with several Asian institutes who are interested in sending students to us.
Past Coverage of Imperial College NHS Trust
Global Multicenter Pivotal Focused Ultrasound Trial for Parkinson’s Disease January 2019
St. Mary’s Hospital in London Hosts Event to Launch Focused Ultrasound Fundraising Campaign July 2018
UK Invests in Creation of FUS Research Network April 2016
London Hospital Initiating Brain Trials, Pioneering Drug Delivery October 2015
Investigator Profile: Q&A with Wady Gedroyc October 2015
Clinical Treatments Featured at 2015 European Symposium October 2015
Launch of RELIEF Registry to Collect Data on MR-guided Focused Ultrasound Treatment for Fibroids May 2013
Clinical Trial is Evaluating Theraclion’s Ultrasound-Guided Device in Treating Bone Tumor Pain January 2013
FUS Proves Safe, Effective in Treating Patients with Facet Joint Osteoarthritis October 2012
Focused Ultrasound Pioneer, Wladyslaw Gedroyc, MD, Named Honorary President of FUS Foundation’s 2012 International Symposium September 2011
UK Clinical Trial will Assess MR-guided Focused Ultrasound as Treatment for Back Pain Caused by Facet Joint Disease May 2011
Newsletter Spotlights Pancreatic Tumor Treatments January 2011
Pancreatic Patient Success Story: Doris McArdle, Chicago, IL, USA January 2011