New Hi-Tech Images Guide Surgeons' Hands
That approach was very appealing to Charlie Kireker, 56, who had seeds implanted at Brigham last June. "If it's good enough for brain surgery, it's good enough for me," says the 56-year-old investment fund manager, who lives near Middlebury, Vt. Kireker got needled 23 times, with five seeds planted per stick. By January of this year, his score on the prostate-specific antigen blood test for cancer, which had shot up from less than 1 to 2.75 in the months before the procedure–speedy climbs like that are often signs that the cancer is growing–was back down to a negligible 0.63. "And I've had no physical problems," he says. "Everything works."
At this point, it's hard to say that using MRI in this way leads to more cures, cautions Ashutosh Tewari, a urologist and prostate cancer specialist at Weill Cornell Medical Center in New York City. "It's more precise than ultrasound, but that doesn't necessarily translate to better cancer care. I haven't seen any data on that," he says. (Brigham and Women's is the only institution currently using the technique.) Clare Tempany, a radiologist at Brigham, agrees, saying that because prostate cancer grows so slowly, doctors have to wait at least 10 years for real outcome data, and their first MRI patient won't reach the 10-year mark until this fall. The data on incontinence and impotence, however, are already becoming clear. When compared with ultrasound patients in a 2004 study, MRI patients fared much better in terms of side effects.
Other hospitals are not rushing to install the massive–and massively expensive–double donut for prostate surgery, because of reservations like Tewari's and because the cramped space limits a doctor's ability to move around for other operations. But for brain surgery, a few dozen, including the Cleveland Clinic, Children's National Medical Center in Washington, D.C., and New Jersey Medical School University Hospital in Newark, have bought the smaller, portable MRI, which brackets a patient's head but allows doctors more space. The $1 million to $2 million price tag is "a big upfront cost," says New Jersey's Schulder. "But we did a cost analysis and found there were significant savings because the patients had shorter hospital stays."
Beating Bad Heart Rhythms
At Mayo, Robb is now working toward shorter stays on the operating table for heart patients. Pushing beyond single-frame snapshots taken during surgery, he's experimenting with movies of the heart that combine several different types of scans to show detailed anatomical shapes as well as bursts of electricity while a doctor operates. "This is huge for treating bad heart rhythms," says John Haller, program director for image-guided interventions at the National Institute of Biomedical Imaging and Bioengineering, part of the National Institutes of Health. "These operations now take six or eight hours and someone could die on the table. Robb's technique could cut it down to just one or two hours."
That would come as good news to many of the country's 2 million people plagued by bad rhythm atrial fibrillation, which causes the upper chambers of the heart to flutter 300 or 400 times per minute. (A normal heart rate is between 60 and 100.) Those rapid flutters produce blood clots and strokes. To fix them, doctors snake several tiny catheters through blood vessels into the heart. Some of the catheters have an electrode at the end to pick up errant electrical signals. Currently, doctors track the electrodes with fluoroscopy, a kind of moving X-ray. When they suspect an area of being bad, they zap it with a tiny energy burst, killing the abnormal muscle sections. Or killing normal sections. If the heart rhythms don't return to normal, the electrodes were in the wrong spot. Doctors move them and try again.
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