Monday, May 13, 2013

Image-guided therapy challenge: Unique pediatric issues and the need for collaboration

Institute bioengineer and technical director Kevin Cleary, PhD, often talks about the lack of pediatric focus in image guided therapy development. The unique needs and challenges of treating children require completely unique approaches, not merely adaptation of technology from adult applications.

The recent National Center for Image-Guided Therapy Workshop included a visit to Children’s National Medical Center, and focused on issues in developing these technologies for children. Attendees toured the operating rooms, as well as the working laboratories of the Sheikh Zayed Institute.

Children’s National specialists discussed the need to develop treatments specifically for children—as an important, under-served area. Pediatric cardiologist Joshua Kanter, MD, pediatric urologist Amy Burns, MD, pediatric otolaryngologist Brian Reilly, MD, pediatric orthopaedist Matthew Oetgen, MD, and pediatric interventional radiologist Karun Sharma, MD, PhD, discussed the promise and need for further pediatric-focused development, as well as some of the challenges unique to caring for children.
  1. Smaller spaces for surgeons to maneuver in. Although laparoscopic tools, including those in current surgical robotics and interventional cardiology, appear small, they are designed for adults. Even smaller tools must be created to efficiently apply to children.
  2. The ongoing growth of the patient. Unlike adults, children are still growing, and their anatomy changes as they grow. This is of great concern, for instance, in interventional catheterization procedures—what happens if a child’s artery outgrows a stent? 
  3. Different movement. Pediatric procedures must consider that children climb, play, jump, and run. Any devices or interventions must be able to withstand the active pace of a child.  
Some career innovators in image-guided therapies are taking up this challenge because the need and the promise are so great. Through partnerships with pediatric-focused institutions, engineers and physicians work directly with surgeons, radiologists, cardiologists, and others to identify needs and explore new solutions.

One example is Gernot Kronrief, PhD, of the Austrian Center for Medical Innovation and Technology, who is investigating whether a novel robotic technology he developed—referred to in his lab as the “deck of cards” robot—could have pediatric applications. The benefits of his design? The robot itself is small, portable and could act as an extra set of steady, reliable hands for instrument placement which could increase efficiency, potentially reducing procedure time.

“It could be a good fit for pediatric or possibly even prenatal surgical applications,” Dr. Kronrief noted. “I’m looking forward to exploring the possibilities.”

Another pioneer investigating this space is Andreas Melzer, MD, of the Institute for Medical Science and Technology, Dundee, UK . Dr. Melzer has begun discussions with Children’s National radiologists and the Institute’s engineers to develop better programs in pediatrics using interventional magnetic resonance imaging to build more noninvasive procedures using techniques like high-intensity focused ultrasound. Dr. Melzer is helping to develop MR-compatible tools, including ultrasound probes.

“That’s where my interest lies, in using multiple modalities together—for example MR and ultrasound. This is quite important because the promise for these two modalities to have an impact on children is tremendous and would result in more procedures that require little or no exposure to radiation for children.”

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