When James Drake, MD submitted his proposal for the “Chase an Idea” grant, pediatric focused ultrasound was the idea he wanted to chase. Drake, the chief of neurosurgery at the Hospital for Sick Children (SickKids) in Toronto, Canada, understood the potential of focused ultrasound and was eager to explore its use in children. Receipt of that grant, from the Centre for Brain and Behavior at SickKids, provided the means to establish the Center for Image Guided Innovation and Therapeutic Intervention (CIGITI) with Drake at the helm.
Today, CIGTI brings together physicians from numerous specialties, engineers, industry leaders, and graduate and undergraduate students on various research programs from focused ultrasound to robotics and simulation. “Our goal is to have the programs work collaboratively,” explains Drake. “For example, we are working to develop a robot to work within the MRI suite.”
Three areas of FUS research
Within the focused ultrasound field, Drake and his team have begun preliminary research on benign bone lesions, working to determine the appropriate temperature monitoring and modeling needed to sonicate bone lesions in real time. This work, a collaboration with the University of Waterloo’s Department of Applied Math, is made possible through a partnership grant with the Natural Sciences and Engineering Research Council of Canada (NSERC) provided by the Canadian Institute of Health Research.
CIGITI is also making strides in early stage research on using focused ultrasound to treat pediatric stroke, specifically intraventricular hemorrhage in neonatal patients. Drake notes, “We think neonates could be great candidates for focused ultrasound because of their open fontanelle and the skull is thin.” The thought is that the ultrasound beams can easily penetrate the more permeable barrier. This research is made possible through a grant from Brain Canada.
The final focused ultrasound research program at CIGITI is expected to begin in three to four months and will explore treating pediatric epilepsy. “About 90 percent of pediatric epilepsy patients are refractory to current medications, and typically they undergo major surgical interventions to relieve their symptoms,” Drake explains. Focused ultrasound could potentially provide a non-invasive alternative to such surgeries.
Less trauma, no radiation
This potential to be the ultimate in noninvasive treatment made focused ultrasound an obvious choice for CIGITI. “We are always looking to minimize surgical trauma for our patients,” Drake explains. “Adults can rationalize going through a painful procedure if it means a better outcome. However, children cannot, and families don’t want to see their kids go through something like that. The term ‘incisionless surgery’ is a very popular idea among the families.”
In addition, focused ultrasound eliminates the need for radiation. “Children are far more sensitive to the side effects of radiation, and we are always concerned about cumulative dose, especially in young patients.” Furthermore, the potential treatment indications are limitless. “I think there are diseases in every area that might be amenable to FUS,” Drake elaborates. Currently, the team at SickKids is focusing on targets that are safe, will move quickly into clinical use and offer good results. Then, they plan to expand their treatment scope.
As he looks toward the future, Drake sees the Focused Ultrasound Foundation as an integral part of the puzzle, firstly as a networking platform. “By hosting the semi-annual meetings and encouraging collaboration, the Foundation allows researchers to rapidly disseminate their discoveries,” he notes.
Likewise, the foundation is more apt to fund projects that may be considered high-risk but are necessary to drive the field forward. “There is such competition in Canada, as well as the United States,” explains Drake. “Funding agencies are very careful of the projects they will support.”