Science fiction is a fascinating area of the arts . It makes a point of literally encouraging the imagination “to boldly go where no man has gone before.”
It is an ideal medium in which to explore all kinds of cultural and ethical questions, open up worlds of possibilities and demonstrate that there are no limits to the imagination except those boundaries we draw ourselves, whether personally or culturally.
Science Fiction: Life as it Could Be
However outlandish a science fiction story may be, it is worth noting that in this area of the arts, the word “Science” comes ahead of “Fiction”. I grew up watching Star Trek and always found the Star Trek medical facilities particularly fascinating, with a bed in the infirmary that told you exactly what your medical condition was, and the fact that all the medical operations on board were conducted with non-intrusive surgery. (Being quite chicken about hospitals, this had definite appeal)
“That”, I remember thinking, “is how things should be.”
One of the many pleasures of being a fan of the Science Fiction genre is that of discovering with increasing regularity that yet another of the wonderful fantasies once explored via the imagination, has now become reality.
In this video from TED talks, Dr Yoav Medan shares some of the incredible strides that have been made in the area of Ultrasound surgery – healing without cuts.
Star Trek revisited.
Focused Ultrasound Guided by Magnetic Resonance Imaging
For the last 13 years Dr Yoav Medan has been “part of an exceptional team at InSightec in Israel and partners around the world taking the idea – the concept of non-invasive surgery from the research lab to routine clinical use.”
This is a dream that has been enabled by the converging of two known technologies, one is the force of Ultrasound and the other is the vision enabled by Magnetic Resonance Imaging – Focused Ultrasound guided by Magnetic Resonance Imaging
To demonstrate the ability of the technology, Medan uses a “tissue mimicking phantom” – a piece of solid but totally transparent silicon, the size of a small whisky glass. This solid piece of crystal, referred to as the phantom is set up in the physics lab in front of an Ultrasonic Transducer this makes an ultrasonic beam that focuses inside the phantom.
You hear a click from the transducer when the energy starts to emit and you see in the center of the silicon a tiny cloudy spot begin to appear and grow as a small lesion is formed inside the phantom. None of the surrounding silicon is affected at all.
Revolutionising Brain Surgery
The significance of this becomes apparent if one considers the requirements of something such as brain surgery, which now becomes possible in a highly accurate way, without disturbing or harming any of the surrounding tissue.
Dr Medan describes this as being in his view, the “first kosher Hippocratic surgical system”
“Let’s talk a little bit about the force of Ultrasound – you know all about Ultrasound Imaging, you know also about Beta treatment for breaking kidney stones, but Ultrasound can be shaped to be anything in between because it’s a mechanical force – basically its a force acting on a tissue which it transverses
You can change the intensity, the frequency, the duration, the pulse shape of the Ultrasound to create anything from an airbrush to a hammer and I am going to show you multiple applications in the medical field that can be enabled just by physically focusing.
Harnessing Focused Ultrasound: the Missing Vision
”This idea of harnessing focused Ultrasound to treat lesions in the brain is not new at all. William Fry (1918 – 1968) discovered Focused Ultrasound. When I was born, this idea was already complete by pioneers such as the Fry Brothers (Francis (Frank) Fry – 1929 – 2005) and Lars Leksell (1917 – 1986) known as the inventor of the GammaKnife, but you may not know that he tried to perform lobotomies in the brain non-invasively with Focused Ultrasound in the 50’s.
He failed, so he then invented the GammaKnife and it makes you ponder – why those pioneers failed. and there was something fundamental that they were missing. They were missing the Vision. It wasn’t until the invention of the MR (MRI – (1984)) and really the integration of Magnetic Resonance with Focussed Ultrasound that we could get the feedback – both the anatomical and the physiological in order to have a totally non-invasive, closed loop surgical procedure.”
What the Future Operating Room Looks Like Today
Dr Medan then shows an image of what the operating room of the future looks like – today, surgeons operating using an MR (magnetic resonance) screen, with the patient in front of the Focused Ultrasound System
“I’ll give you several examples, but the first one is in the brain, One of the neurological conditions that can be treated with Focused Ultrasound are movement disorders, like Parkinson’s or Essential Tremors. What is typical to those conditions , for Essential Tremor for example, is the inability to drink or eat cereal or soup without spilling everything all over you, or write legibly so people can understand it and be really independent in your life, without the help of others.
So I would like you to meet John. John is a retired professor of history from Virginia. He suffered from Essential Tremors for many years, medication did not help him any more, and many of those patients refused to undergo surgery, to have people cut into the brain, and about four or five months ago he underwent an experimental procedure (approved by the authorities) at the University of Virginia in Charlottesville using Focused Ultrasound to ablate a point in this thalamus.
“This is his handwriting on June 20th 2011, if you can read it (he shows very shaky and almost illegible sample of writing) This is his handwriting in the morning of the treatment before the MR.
So now I’ll take you through the procedure – how non-invasive surgery looks.”
Is Your Surgeon a Man or a Mouse?
“We put a patient on the MR table, we attach a computer and link it in this case to the brain, but if it would be a different organ, it would be a different computer attached to the patient.”
The physician will then take a regular MR Scan, with the objective of delineating the general area of the treatment as a safety boundary around the target.
Once those pictures are acquired and the physician has drawn all the necessary safety limits and so on, he selects a point with the mouse on the computers, and presses this blue button called Sonicate because this instant of injecting the energy – we call it Sonication. The only hand work the physician does here is moving a mouse. This is the only device he needs in this treatment.
So.. he presses Sonicate and this is what happens – you see the transducer the light blue, the water in between the scull and the transducer , as he does, this burst of energy elevates the temperature. We first need to verify if we are on target, so the first sonication is a “glow energy” it doesn’t do any damage, but it elevates the temperature by a few degrees, and one of the unique capabilities we leverage with the MR is the ability to measure temperature noninvasively. ”
Unique Capability: Anatomical Imaging and Temperature Map in Real Time
”This is a really unique capability of the MR, it is not being used in regular diagnostic imaging but here we can get both the anatomical imaging and the temperature map in real time and we can see the points here on the graph the temperature was raised to 43 degrees temporarily. This doesn’t do any damage, but the point is here – we are right on target.”
“So once the physician has verified that the focus point is on the target he has chosen then we can move to perform the full energy ablation, like you see here, the temperature rises to 55 to 60 degrees. If you do it for more than a second its enough to destroy the targeted cells. “
“This is the outcome from a patient’s perspective. Same day, after this treatment (Medan shows the 2nd sample of handwriting) this is an immediate relief, and here you see it. “(applause from the audience)
“John is one of dozens of very heroic, courageous people who volunteered for the study, and you have to understand what is in people’s minds when they are willing to take the risk. This is a quote from John, after he wrote it, he said: “miraculous”, and his wife said “this is the happiest moment of MY life” and you wonder why. One of the messages I would like to carry over is what about descending quality of life, I mean, those people who lose their independence, they are dependant on others and John today is fully independent, he has returned to a normal life routine, and he is also playing golf, which is what you do in Virginia when you are retired.”
“You can see here this point, about 3 millimetres in the middle of the brain, with no damage on the outside, he suffers from no neurosensities, there is no recovery is needed, no nothing, he is back to his normal life.”
Medan then proceeds to give further examples of non-invasive surgery that has been successfully carried out with this new brand of non-invasive Ultrasound surgery.
About Dr Yoav Medan
Yoav Medan is Vice President and Chief Systems Architect for the company InSightec®, the pioneer and global leader in Magnetic Resonance guided focused ultrasound technology for image guided acoustic surgery.
Dr Medan is responsible for developing new platforms for the Magnetic Resonance guided Focused Ultrasound technology.
Prior to joining InSightec in 1999, Dr. Medan spent 17 years in various senior research and management positions at the IBM Research Division and was elected to the IBM Academy of Technology.
In addition to technical and managerial experience, Dr. Medan has academic experience as well, teaching at the EE department at the Technion, Israel Institute of Technology, in addition to serving as a lecturer for Avionic Systems at the Aeronautical Engineering faculty. He is also a Senior Member of the Institute of Electrical and Electronics Engineers.
Dr. Medan has widely published and holds nine IBM as well as several other patents. He was awarded the IBM Outstanding Technical Achievement Award, the 3rd Invention Achievement Award and the Outstanding Research Division Award.
Dr. Medan received his D.Sc. and B.Sc.(Summa Cum Laude) in Aeronautical Engineering from the Technion, Israel Institute of Technology, and a M.B.A diploma from Bradford University, UK.
