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Medical Marvels | Features | laduenews.com



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Mustafa Nazzal, M.D., a SLUCare transplant surgeon at SSM Health Saint Louis University Hospital, dons a virtual reality headset as he plans a surgery using technology developed by SLUCare radiologist Nadeem Parkar, M.D., (right) and Kyle Collins, assistant vice president of Information Technology at SLU.


Photos courtesy of SLUCare

With the 21st century well underway, people have become increasingly used to new technologies popping up, and medicine is one of the most tech-dependent sectors of American society. Yet some of the newest advances available at local hospitals are stunning, even for tech-savvy consumers, and one common theme is the increasingly transparent human body.

Consider, for example, the UroNav MRI-guided biopsy. The procedure, first introduced in St. Louis at Barnes-Jewish West County Hospital in 2014, allows physicians to pinpoint prostate cancers by merging two types of images: MRIs and ultrasounds. Men suspected of prostate cancer undergo an MRI, which shows suspicious lesions. During a subsequent ultrasound exam, the MRI image is fused with the ultrasound image in real time to allow for precise targeting of the suspicious site(s) by the biopsy needle.

“Conventional biopsies done with ultrasound [alone] are random and very much ‘hit-[or]-miss,’” says Dr. Gerald Andriole, the Robert K. Royce Distinguished Professor of Urologic Surgery, chief of the Division of Urologic Surgery and vice chair of the Department of Surgery at Washington University School of Medicine. “Thus, there is very small reassurance if such a biopsy does not show cancer. Also, it is important to realize that even when the conventional biopsy shows cancer, it typically underestimates the size of the cancer and the aggressiveness of the cancer. It provides very little information about the location of the cancer.”

However, studies conducted at Washington University and elsewhere clearly show that MRI-targeted biopsies, using the UroNav fusion software, are more likely to identify a man’s cancer and to more accurately characterize it. The result is “better decisions about how to treat it,” Andriole says.

“One very exciting prospect is to ablate [destroy] only the cancerous part of the prostate, as such a treatment is not associated with the most-dreaded side effects of other treatments that may cause incontinence and erectile dysfunction,” he adds.

A more recent innovation allows doctors to “map” the heart with noninvasive imaging in order to correct a serious heart condition known as ventricular tachycardia. Dr. Clifford Robinson, a radiation oncologist, and Dr. Phillip Cuculich, a heart rhythm specialist, both of whom are assistant professors at Washington University School of Medicine, published results of the procedure’s experimental use in the Dec. 14, 2017, issue of The New England Journal of Medicine. A formal prospective trial recently completed enrollment, and a multicenter clinical trial to further study the procedure is planned.


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SLUCare physicians created this 3-D model of a patient’s skull using personal X-rays, CT scans and MRI images. Doctors will use the model, viewed through a virtual reality headset, to determine the best way to approach a surgery. They say modeling coupled with virtual reality is a new frontier for medicine and minimizes surprises they encounter during procedures, which is better for patients.


Photos courtesy of SLUCare

In ventricular tachycardia, the heart beats exceedingly fast, and its chambers often fall out of sync, causing blood to stop. This is known as sudden cardiac death. For the lucky survivors, medications and an implanted defibrillator device are used. If the arrhythmia continues despite these efforts, an ablation procedure can be performed. During this procedure, several catheters are threaded through blood vessels in order to locate the scar tissue inside the heart. Once located, the tip of the catheter is heated, and the scar tissue is cauterized. The new procedure combines noninvasive radiation, similar to treating cancers, with noninvasive 3-D mapping of the heart created by using scans that include electrocardiographic imaging (ECGI), a technology that was created by Dr. Yoram Rudy at Washington University. Only seven medical centers in the nation currently offer ECGI.

“The traditional way to ‘map’ the inside of the heart involves inserting long catheters into a blood vessel, carefully maneuvering these catheters within a chamber of the heart and painstakingly sampling the electrical signal at hundreds or thousands of points within the heart,” Cuculich says. Most catheter ablation procedures take six to eight hours to complete and require general anesthesia and at least one night in the hospital. “We have developed a way to do a complex heart ablation procedure noninvasively in seven minutes,” he adds.

Instead of sending a catheter into the heart, patients don a “vest of electrodes” that captures panoramic electrical data from the body surface and creates an electrical map on a 3-D image of the patient’s heart. Once the diseased part of the heart is mapped, the problematic scar tissue is targeted for focused radiation, similar to the type of radiation used to destroy cancer cells.

“The entirely noninvasive ablation procedure is entirely outpatient, performed while awake, and takes about seven minutes,” Cuculich says. “Patients walk out of the room. In fact, our last patient was treated over his lunch break and returned to work in the afternoon.”

Meanwhile, over at Saint Louis University, SLUCare radiologist Dr. Nadeem Parkar collaborated with Kyle Collins, assistant vice president of ITS Enterprise Resources at the university, to develop a leading-edge technology that takes 3-D modeling to a new level for preoperative patients at SSM Health Saint Louis University Hospital.

Using X-rays, CT scans and MRI scans, a 3-D model of the patient’s surgical site is created. Surgeons then put on virtual reality (VR) headsets and use handheld controls, just like VR gamers, to navigate the patient’s body and to plan exactly how they will approach and perform the surgery. The VR preview provides insight into the patient’s individual anatomy so the surgeons are prepared with the most appropriate and accurate tools and surgical strategies.

“I have a friend in the gaming industry, and he suggested I do something in virtual reality,” Parkar says. “About a year ago, I started thinking about importing cardiac CT or MRI scans and developing a 3-D virtual reality format.” Collins provided the software know-how to build the program, which took almost a year to complete.

Parkar adds that surgeons who have a complicated case ahead typically request preparatory imaging. Now they can get the added benefit of those images being converted to VR. For instance, a neurosurgeon can get a 3-D immersive look at the nearby blood vessels and nerves in the brain before removing a tumor. “There are fewer surprises during the surgery itself as a result,” Parkar says. “It can be used by any surgical or other specialty that does procedures.” Feedback so far has been overwhelmingly positive as surgeons repeatedly come back to use the technology, he adds.

With all this happening already, you may wonder what’s next. Parkar, like most of St. Louis’ researchers and innovators in medicine, says he has more ideas to explore, no doubt revolutionizing the field even further.


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Jeffrey Brown, M.D., a SLUCare radiologist and chair of radiology at Saint Louis University School of Medicine, foreground, collaborates with SLUCare radiologist Nadeem Parkar, M.D., to create a 3-D model from a patient’s personal scans and images, seen on a computer. That model will be viewed through a virtual reality headset to plan a high-precision and complex surgery.


Photos courtesy of SLUCare



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