Next Five Years Will Be Crucial in MR-guided Focused Ultrasound Adoption


Executive perspective: Interview with Jacques Coumans, PhD (GE Healthcare)

MR-guided focused ultrasound has entered a crucial period in terms of adoption,says Jacques Coumans, PhD, general manager for premium and interventional MRI at GE Healthcare. The pressing challenge, he says, is to “cross the chasm to mainstream clinical use” by expanding the number of sites by tenfold.

Noting that there are now about 150 MR-guided focused ultrasound sites worldwide, Coumans explains, “We often call this the academic bolus range.” He says that more than 1,000 sites will be needed to achieve successful adoption of the technology.

Optimistic about the future, Coumans adds, “I would characterize the field of MR-guided focused ultrasound in the following way: in five years, we will all wake up stating that the overnight success of MR-guided focused ultrasound was 15 years in the making.”

Although the technology was pioneered primarily at the Brigham and Women’s Hospital in Boston more than a decade ago, the adoption of MR-guided focused ultrasound is happening faster outside of the United States. Coumans believes this trend is due to fewer regulatory and reimbursement hurdles in other countries.

“One of the big advantages of MR-guided focused ultrasound could be that the quality of care is significantly improved, but one of the hurdles that we see is the cost associated with it. Obviously, having an MR machine with a very expensive option called focused ultrasound increases the cost of a procedure. Certainly here in the west – in the United States, in particular – there are regulatory and reimbursement hurdles that are very significant and take a long time to sort out.”

There are also practical issues to address as more focused ultrasound therapies are introduced: who does the procedure and who owns the patient? Coumans foresees focused ultrasound expanding beyond radiology. The most likely users are oncologists and interventionists, he says.

Coumans has worked in the field of MRI since 1985 and has been following MR-guided focused ultrasound since its inception. GE supplies the MR scanner for InSightec’s ExAblate system, which has received CE-marking for treating uterine fibroids, adenomyosis and metastatic bone tumors. The system is also approved in the U.S. for the treatment of uterine fibroids.

“I think MR-guided focused ultrasound is an intellectually incredibly appealing combination of two modalities,” Coumans asserts. “The fact that you can [use it to] non-invasively treat and non-invasively deposit [drugs] is something that was not thought of 20 years ago. Non-invasive or minimally invasive therapies are the thing of the future, and patient centricity and humanizing radiology really stand in the forefront of why MR-guided focused ultrasound has this appeal for patients as well as for physicians.”

According to Coumans, “It’s not so much just the focus on focused ultrasound, it’s the focus on using MRI to guide therapy because of its extreme suitedness to get soft tissue contrast properly portrayed and to follow up treatments over time,” he explains.

Commenting on growing competition in the focused ultrasound marketplace, Coumans calls it a positive development. Intellectual competition, clinical case studies, multimodality and multicenter trials contribute to growth. “Any industry benefits from competition,” he notes. “We welcome it.”  – Written by Ellen C., McKenna

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