Visit of Barbara Alving, M.D. 8-15-05

1. Ron Kikinis, M.D. Visit of Barbara Alving, M.D. 8-15-05

2. Overview Prostate: Clare Tempany, Noby Hata, Steve Haker Neurosurgery: Alex Golby, Steve Pieper, Sandy Wells, CF Westin Programmatic targets: NAC Ron Kikinis, BIRN: Steve Pieper, IGT: Clare Tempany, Randy Ellis Targets for your presentations: What is your science (explanation targeted at a clinician) How do you fit into the different programs

3. Schedule • Prostate • Neurosurgery • NCRR portfolio • Discussion

4. Prostate

5. Neurosurgery

6. Functional imaging and electrocorticography-guided surgery in eloquent cortex • Surgical resection is most effective initial therapy for a variety of brain tumors • Maximal surgical excision relieves mass effect, decreases tumor burden, decreases incidence of seizures and may prolong time to recurrence and survival • Defining limits of the resection difficult due to gross similarity of tumor and brain tissue • Adjacency of essential cortex (e.g. motor, language) makes distinction critical

7. Craniotomy=699 Brain biopsy=180 LASER ablation=9 Transsphenoidal pituitary adenoma resection Total=918 Intra-operative MRI at BWH

8. MRT allows surgeon to visualize resection progress and brain shift F. Talos

9. Functional MRI can provide a pre-operative map of critical brain areas • Motor, visual cortex well demonstrated • Language lateralization • Increasingly, language localization and memory

10. Lower diffusion across fiber axons Higher diffusion along fiber Imaging white matter tracts • MRI measures diffusion of water. • Water proton diffusion facilitated parallel to fibers and restricted perpendicular • anisotropic diffusion tensor imaging • Trajectory and location of white matter tracts • Three types of lesion/fiber tract interactions may occur: • fiber tract displacement • infiltration • destruction

11. Fiber tracts Stimulation mapping to locate essential cortical areas

12. Image coregistration and fusion

13. Intraoperative image fusion and display: fMRI and Cortical Stimulation

14. Conclusions and Future Directions • Multi-modality image fusion • Intra-operative functional testing annotation • Develop paradigms which work well for patients with neurologic deficits • Integrate fMRI with DTI and other imaging modalities • Improve ability to predict post-operative outcomes and avoid neurologic injury • Correlate fMRI signal with neuronal activity

15. NCRR portfolio

16. Research Interactions between NA-MIC, NAC, BIRN BIRN Focus: infrastructure, data, data distribution e.g. Provides shared image databases and high speed network/computing for NA-MIC & NAC NA-MIC Focus: algorithms, engineering,general software tools e.g. Analysis of tensor and non-tensor diffusion data at three algorithm groups (UNC, Utah, MGH) , hosted on BIRN servers from four clinical sites (Dartmouth, Harvard, UCI, U of Toronto) National Level Science National Level Outreach Data Requirements,testing, tools Data repositories and access Advances in medical image computing NAC Focus: specific applications, custom software tools e.g. Tensor analysis for pioneering diffusion technology from BWH Local Level Science National Level Outreach