Jewish Hospital

Cincinnati, OH, United States

Jewish Hospital

Cincinnati, OH, United States
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News Article | April 27, 2017
Site: www.scientificcomputing.com

Removing a brain tumor requires walking a fine line: Remove too little, and the disease remains; remove too much, and sight, speech or movement may be impaired. To help strike that delicate balance, neurosurgeries often are performed with the aid of 3-D maps of patients' brains. But such maps typically show anatomical landmarks and don't indicate where critical brain functions such as language and motor function are found. Now, a $3.6 million grant from the National Cancer Institute of the National Institutes of Health (NIH) will fund a collaboration between researchers at Washington University School of Medicine in St. Louis and Medtronic, maker of a neurosurgery navigational system that enables physicians to track where they are operating in relation to the patient's brain anatomy. Together, the researchers will create a software program that uses information from MRI scans to build personalized 3-D maps of the location of brain functions, and integrates that information - along with an anatomic map - into a navigational system. These integrated maps can allow physicians to plan and perform surgeries more accurately and safely. "Every neurosurgeon uses a navigation system, but we want it to be even better," said Eric Leuthardt, MD, a professor of neurosurgery and of mechanical engineering and applied science, and the co-principal investigator on the grant. "We want to give them the ability not only to navigate the brain anatomy, but to know the implications of making incisions into each of those components of anatomy." When a part of the brain needs to be removed because of a tumor or other brain disease such as uncontrollable epilepsy, patients routinely undergo an MRI scan before the surgery to map the brain's anatomy surrounding the portion to be removed. However, mapping the functions those brain areas control is more difficult. The gold standard is cortical stimulation, in which doctors awaken patients during surgery and ask them to perform simple tasks - such as repeating a word - while they apply tiny electrical currents to the exposed surface of the brain. If the applied electrical stimulation interferes with a patient's speech, the doctors know they have found a speech-related area of the brain. But not everyone can be safely awakened during surgery, and some of those who can be awakened would really rather not be. Young children cannot undergo surgeries while awake or cooperate with the tasks. And the extent of damage to the brain caused by diseases such as brain tumors and epilepsy can make some adults unable to perform the tasks as well. Leuthardt, with co-principal investigator Joshua Shimony, MD, an associate professor of radiology, and colleagues from neurosurgery and neuroradiology, have developed a technique to map functional areas of the brain in advance of surgery. The technique works on people of all ages and doesn't require a patient to perform tasks. Called resting-state functional MRI (rsfMRI), the technique relies on the fact that the brain is always active, even when a person is daydreaming, sleeping or even unconscious. You may not be moving, or even thinking about moving, but the left side of the motor area of your brain is busily communicating with the right. By identifying which parts of the brain are in communication, scientists can delineate functional networks. "We have found a better way to create these functional maps, but even if we have them, the way functional information is handled can be very primitive," Shimony said. "In many hospitals, the radiologist produces pictures of where on the brain the motor system is, where the language system is, where they are located relative to the surgical site, etc., but the information is not always well-integrated into the surgical navigation system." The NIH grant will allow Leuthardt and Shimony to integrate data from resting state functional scans into the Medtronic navigational system to make a 3-D structural and functional map of each patient's brain. A decade ago, Shimony and Leuthardt led a project - with the cooperation of Medtronic ­- to interface with the company's StealthStation navigational system ­that is routinely used during neurosurgeries at Barnes-Jewish Hospital, where the two practice medicine. They set up the machine so it could take resting state functional data and produce individualized functional maps. The system has reduced by one-third the number of surgeries at Barnes-Jewish performed while patients are awake and is popular among neurosurgeons there. But it requires a full-time employee with specialized expertise to analyze the data and help produce the functional maps. The researchers reasoned that if resting state functional imaging were going to become a standard part of neurosurgical practice, it would be necessary to produce a user-friendly software program that does not require specialized training to operate. A key advance was made by MD/PhD student Carl Hacker, PhD, who figured out how to automate the analysis of resting state functional data so that it could be processed by an algorithm rather than an expert. "We're creating a software package that is going to combine our expertise in interpreting resting state data with the navigational technology at Medtronic, so that anyone who wants to use resting state MRI to map functional areas, or to make a brain map for use in surgical planning, can have that readily available," Leuthardt said. "We think it will be a win-win situation."


News Article | April 27, 2017
Site: www.scientificcomputing.com

Removing a brain tumor requires walking a fine line: Remove too little, and the disease remains; remove too much, and sight, speech or movement may be impaired. To help strike that delicate balance, neurosurgeries often are performed with the aid of 3-D maps of patients' brains. But such maps typically show anatomical landmarks and don't indicate where critical brain functions such as language and motor function are found. Now, a $3.6 million grant from the National Cancer Institute of the National Institutes of Health (NIH) will fund a collaboration between researchers at Washington University School of Medicine in St. Louis and Medtronic, maker of a neurosurgery navigational system that enables physicians to track where they are operating in relation to the patient's brain anatomy. Together, the researchers will create a software program that uses information from MRI scans to build personalized 3-D maps of the location of brain functions, and integrates that information - along with an anatomic map - into a navigational system. These integrated maps can allow physicians to plan and perform surgeries more accurately and safely. "Every neurosurgeon uses a navigation system, but we want it to be even better," said Eric Leuthardt, MD, a professor of neurosurgery and of mechanical engineering and applied science, and the co-principal investigator on the grant. "We want to give them the ability not only to navigate the brain anatomy, but to know the implications of making incisions into each of those components of anatomy." When a part of the brain needs to be removed because of a tumor or other brain disease such as uncontrollable epilepsy, patients routinely undergo an MRI scan before the surgery to map the brain's anatomy surrounding the portion to be removed. However, mapping the functions those brain areas control is more difficult. The gold standard is cortical stimulation, in which doctors awaken patients during surgery and ask them to perform simple tasks - such as repeating a word - while they apply tiny electrical currents to the exposed surface of the brain. If the applied electrical stimulation interferes with a patient's speech, the doctors know they have found a speech-related area of the brain. But not everyone can be safely awakened during surgery, and some of those who can be awakened would really rather not be. Young children cannot undergo surgeries while awake or cooperate with the tasks. And the extent of damage to the brain caused by diseases such as brain tumors and epilepsy can make some adults unable to perform the tasks as well. Leuthardt, with co-principal investigator Joshua Shimony, MD, an associate professor of radiology, and colleagues from neurosurgery and neuroradiology, have developed a technique to map functional areas of the brain in advance of surgery. The technique works on people of all ages and doesn't require a patient to perform tasks. Called resting-state functional MRI (rsfMRI), the technique relies on the fact that the brain is always active, even when a person is daydreaming, sleeping or even unconscious. You may not be moving, or even thinking about moving, but the left side of the motor area of your brain is busily communicating with the right. By identifying which parts of the brain are in communication, scientists can delineate functional networks. "We have found a better way to create these functional maps, but even if we have them, the way functional information is handled can be very primitive," Shimony said. "In many hospitals, the radiologist produces pictures of where on the brain the motor system is, where the language system is, where they are located relative to the surgical site, etc., but the information is not always well-integrated into the surgical navigation system." The NIH grant will allow Leuthardt and Shimony to integrate data from resting state functional scans into the Medtronic navigational system to make a 3-D structural and functional map of each patient's brain. A decade ago, Shimony and Leuthardt led a project - with the cooperation of Medtronic ­- to interface with the company's StealthStation navigational system ­that is routinely used during neurosurgeries at Barnes-Jewish Hospital, where the two practice medicine. They set up the machine so it could take resting state functional data and produce individualized functional maps. The system has reduced by one-third the number of surgeries at Barnes-Jewish performed while patients are awake and is popular among neurosurgeons there. But it requires a full-time employee with specialized expertise to analyze the data and help produce the functional maps. The researchers reasoned that if resting state functional imaging were going to become a standard part of neurosurgical practice, it would be necessary to produce a user-friendly software program that does not require specialized training to operate. A key advance was made by MD/PhD student Carl Hacker, PhD, who figured out how to automate the analysis of resting state functional data so that it could be processed by an algorithm rather than an expert. "We're creating a software package that is going to combine our expertise in interpreting resting state data with the navigational technology at Medtronic, so that anyone who wants to use resting state MRI to map functional areas, or to make a brain map for use in surgical planning, can have that readily available," Leuthardt said. "We think it will be a win-win situation."


The survey was conducted during the period of congressional debate over the American Health Care Act (AHCA), which was withdrawn the afternoon of March 24 when it became clear there were not enough votes to pass the legislation. Responding to the survey were 76 oncology professionals, including physicians, academic and community; nurses; physician assistants; pharmacists; industry professionals; payers and patient advocates. "The American Health Care Act is tabled and the ACA remains in place, but concerns about access to cancer screening, care, and research funding remain. Today, patients are in limbo, not knowing what action the federal and state governments will take," said Robert W. Carlson, MD, Chief Executive Officer of NCCN. "NCCN agrees there are ways to improve the current health care system for Americans with cancer, the clinical professionals who care for them, and payers. However, we are concerned for Americans with cancer that affordability, coverage of products and services in cancer treatment, and overall access will be impeded by allowing health insurers to set their own rates, or by providing states the ability to experiment with Medicaid coverage, without appropriate patient protections." "President Trump included three key elements in his approach to health coverage reform: repairing necessary aspects of the ACA, ensuring greater access, and lowering the total cost of care," Dr. Carlson said. "We are ready to share our Network's expertise with lawmakers to deliver a value-based health policy to ensure that all Americans with cancer have access to high-quality, effective, and efficient cancer care." Below is a link to Dr. Carlson's March 21, 2017 letter to Congress outlining NCCN's concerns about the health policy proposal and patient access to care: https://www.nccn.org/professionals/meetings/oncology_policy_program/pdf/2017_NCCN_AHCA_Letter_Walden_03-22-2017.pdf For more information about NCCN's health care policy initiatives, visit NCCN.org/policy. The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the world's leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/nccn-survey-reveals-oncologys-concerns-about-financial-distress-patient-access-to-care-300441795.html


News Article | April 19, 2017
Site: www.prnewswire.com

The NCCN Radiation Therapy Compendium™ provides guidance on all RT modalities recommended within the NCCN Guidelines, including Intensity Modulated Radiation Therapy (IMRT), Intra-Operative Radiation Therapy (IORT), Stereotactic Radiosurgery (SRS)/Stereotactic Body Radiotherapy (SBRT)/Stereotactic Ablative Radiotherapy (SABR), Image-guided Radiotherapy (IGRT), Low dose-rate brachytherapy (LDR)/High dose-rate brachytherapy (HDR), Radioisotope, and Particle Therapy. Transparency of NCCN Guidelines and Compendia development is central to the philosophy, policies, and procedures of NCCN. NCCN posts the policies and processes for developing and maintaining the NCCN Guidelines. These policies are available to the public on the NCCN website. Identification of newly published research, NCCN Member Institution review, external stakeholder submissions, and panel review occur on an ongoing basis with at least annual review performed for NCCN Guidelines for each disease. The NCCN Guidelines are the recognized standard for clinical policy in cancer care and are the most thorough and most frequently updated clinical practice guidelines available in any area of medicine. Other NCCN Guidelines derivative products include: For more information and to access the NCCN Radiation Therapy Compendium™, visit NCCN.org/RTCompendium. The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the world's leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/nine-new-disease-sites-added-to-the-nccn-radiation-therapy-compendium-300441832.html

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