Engineering Approach Could Change Brain Tumor Outcomes
A chance conversation that Jonathan H. Gillard, M.D., had with an engineer over lunch at the University of Cambridge may some day result in huge benefits for patients with brain tumors.
 Jonathan H. Gillard, M.D. University of Cambridge |
The meeting happened more than six years ago when Dr. Gillard, now a professor of neuroradiology in the University Department of Radiology at Cambridge, was working on a study funded by a 2000 Philips Medical Systems/RSNA Research Seed Grant. The study used diffusion tensor imaging to look at brain tumors.
The two men discussed why some victims are disabled and others recover, despite having the same size stroke. The engineer suggested an analogy.
"This guy said, 'Oh it is easy. It's like a piece of plastic.'" Dr. Gillard recalled. "'If you bend a piece of plastic a little, it just bends and then goes back to normal. If you bend it too much, it breaks.'
"That is a rather simplistic approach, but what it did was allow us to use engineering analysis tools in what we were doing in stroke," Dr. Gillard continued.
He and his colleagues then applied those tools to Dr. Gillard's seed grant project, "Assessment of Normal Brain Tissue Response Following Radiotherapy Using MR Dynamic Contrast Enhancement Imaging and Diffusion Tensor Imaging at 3 Tesla." Since receiving the seed grant, Dr. Gillard has gone on to receive more than $27 million in funding from other sources.
"I had a hunch that it would be useful," Dr. Gillard said of his conversation with the engineer at Cambridge. "We used the same mathematical tools that the engineers had been using for 20 years. That fundamentally changed our approach to the imaging."
Dr. Gillard's study found that diffusion tensor imaging could more accurately pinpoint the edges of brain tumor infiltration, thus allowing for more precise radiation treatment. Currently, radiation oncologists err on the side of caution to reduce the chance of damaging normal brain matter when treating high grade tumors with radiation. The precise edges do not show up in normal enhanced MR imaging. The study could have a significant impact on the quality of care and treatment for patients with brain tumors, said Dr. Gillard.
"It is one of those areas where in medicine when you do research, you just want to make that tiny bit of a difference," he said. "I think it might lead to some increase in survival in these patients, but also potentially better quality of life because you're damaging less normal brain. That is a big thing. If that happens, I would be very happy."
The process is ongoing. A trial using diffusion tensor imaging techniques on about 50 patients should wrap up within the next two to three years, Dr. Gillard said.
"You have to be cautious because it is a fundamental change from normal practice," he said. "You have to be very careful about how you introduce it. There are a number of centers around the world now that are actually using this method of analysis, which is quite novel for medicine, but for an engineer it is quite simple. The transition that is happening at the moment is getting used to how you analyze data and how you interpret it."
Working in his favor is the medical community's eagerness to do whatever it can when it comes to treating brain tumors, said Dr. Gillard.
"Generally for the aggressive brain tumors, the outcome is appalling," he said. "Anything you can do is usually of benefit."
Dr. Gillard said he knows his study may never have gotten off the ground without the seed grant he received from RSNA. Back then, he said, he was fresh out of residency and had little in the way of a reputation except for a relatively small number of scientific publications. The RSNA grant allowed Dr. Gillard and his group to produce enough data to lead to a larger grant from England's Department of Health New and Emerging Applications of Technology (NEAT) program.
NEAT, which initially provided nearly $300,000 for Dr. Gillard, helps researchers who have unique ideas but not necessarily large amounts of preliminary data to support them, which traditional funding agencies usually require.
"It was designed for new technologies that have no proven benefit but actually might have a much greater impact if it proves to be positive," Dr. Gillard said.
The NEAT grant has since grown to more than $20 million as Dr. Gillard has branched out beyond diffusion tensor imaging of brain tumors. His research now includes areas such as atheroma imaging, stroke, Huntington disease and traumatic brain injuries.
"The RSNA seed grant basically gives you academic credibility," Dr. Gillard said. "If we had not received the seed grant, it would have been virtually impossible to have received the other funding because it is such a novel area. It would have been much more difficult for us to get the next small grant, and the next grant."
Dr. Gillard further credited RSNA for taking a chance on his research even though he was relatively unknown in the research community. He added that seed grants are worth the risk, regardless of the study results.
Name:
Jonathan H. Gillard, M.D.
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Grant Received:
Philips Medical Systems/RSNA Research Seed Grant (2000)
Study:
"Assessment of Normal Brain Tissue Response Radiotherapy Using MR Permeability Imaging and Diffusion Tensor Imaging at 3 T"
Career Impact:
Dr. Gillard said that when he received the grant, he was in residency and had little in the way of a reputation except for a relatively small number of scientific publications. The RSNA grant allowed him and his colleagues to produce enough data to lead to another, larger grant from England's Department of Health New and Emerging Applications of Technology (NEAT) program. Dr. Gillard's NEAT funding now totals more than $20 million. "If we had not received the seed grant, it would have been virtually impossible to have received the other funding because our research is such a novel area," said Dr. Gillard.
Clinical Implications:
Dr. Gillard's study found that diffusion tensor imaging could more accurately pinpoint the edges of brain tumor infiltration, thus allowing for more precise radiation treatment. The study could have a significant impact on the quality of care and treatment for patients with brain tumors, he said. "It is one of those areas where in medicine when you do research, you just want to make that tiny bit of a difference," he said. "I think it might lead to some increase in survival in these patients, but also potentially better quality of life because you're damaging less normal brain. That is a big thing."
For more information on all Foundation grant programs, go to RSNA.org/Foundation or contact Scott Walter, M.S., Assistant Director, Grant Administration at 1-630-571-7816 or swalter@rsna.org.
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