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January 16, 2002

Molecular Imaging with Optical, Magnetic Resonance, and Radioisotope Techniques:
Potentials and Relative Limitations

Jonathon Maltz
Lawrence Berkeley National Laboratory
Advances in optical techniques of fluorescence and bioluminescence; molecular engineering of tracers or probes for magnetic resonance, ultrasound, and emission tomography have lead to new directions in research and new strategies for the diagnosis and treatment of diseases. In the last 10 years the resolution, speed, volume of coverage and commercial availability of non-invasive imaging methods have improved many fold. At the same time the contrast resolution for metabolic and functional imaging of the body has shifted the thrust of medical imaging from anatomy to function and identification of specific molecules and genes by in vivo imaging.

The technology advances include photodiode arrays for optical methods, high field magnets proposed to 12 Tesla for functional imaging and multinuclear spectroscopy, 3D ultrasound and positron tomography systems with 2mm resolution for animals and people. The engineered molecular probes have the potential to image specific enzyme expression and protein receptor patterns specific to diseases such as breast cancer, congestive heart failure, drug addiction and progressive stroke. This presentation will highlight current and future technological advances in the context of major diseases such as Alzheimer's disease, manic depressive diseases, heart failure, spinal vertebrae diseases, breast cancer, and prostate cancer.

February 20, 2002

The BioX Project
A New Approach to Collaborative Research and Teaching Programs at Stanford

Channing R. Robertson
Ruth G. and William K. Bowes Professor in the School of Engineering
Department of Chemical Engineering
Stanford University

In the summer of 2003, 50 faculty will move into the new Clark Center for Biomedical Engineering and Sciences. From that time on, Stanford will be forever changed in how it approaches and conducts teaching and research across multitudes of departments within the Schools of Medicine, Engineering and Humanities & Sciences. A new institutional structure will be born and from it will emerge discoveries in science and technology spanning the breadth of molecules to man. For the first time in an academic setting, professors and their students will inhabit a facility designed for the sole purpose of creating and sustaining intellectual interactions among the residents to enhance the potential for discovery beyond what we can now imagine. Investigators will study the smallest details of life itself - the molecules that make up the building blocks of larger biological structures. They will examine the interactions of these molecules as they come together to form coherent cellular structures and beyond that cellular systems and tissues. At an even higher level of organization they will address the complex systems formed by these structures and the functions they perform including high level neurological connections. Linking all these activities will be some of the most advanced computing resources in the world. Referred to as the BioX Programs, these endeavors reach far beyond the walls of the Clark Center and serve to galvanize the Stanford community in an enterprise that initiates the coalescence of engineering, the physical, chemical and biological sciences and medicine. Professor Robertson, a founder of the BioX Programs will give a first hand view of the present status of the project and its vision for the emergence of new discoveries we can only begin to contemplate.

March 20, 2002

Development of Endoscopic Cardiovascular Surgical Techniques

Albert K. Chin, M.D.
Vice President of Research, Guidant Corporation

Conventional surgical therapy utilizes the elements of surgical exposure, tissue retraction, direct visualization, tissue resection, and wound closure. Large skin incisions required for adequate anatomical exposure result in considerable morbidity associated with traditional surgery. Minimally invasive surgical techniques employ endoscopes and endoscopic instrumentation to perform surgery via small incisions. Endoscopic techniques as applied to cardiovascular surgery will be reviewed. Specialized instruments provide access to the heart and peripheral vessels, and allow cardiovascular exposure and repair to be performed through minimal incisions. New applications of endoscopic technology to cardiac disease will be presented. Research in these new areas may provide therapy for previously inadequately treated disease entities. The ability to apply novel therapeutic modalities in a minimally invasive manner has large implications for patient care and satisfaction.

April 17, 2002
Image-guided Stereotactic Radiosurgery

Mohan Bodduluri, Ph.D.
Accuray Inc.

Mohan Bodduluri will describe the CyberKnife(r) Stereotactic Radiosurgery System, which combines image guidance, robotics, computerized treatment planning, and a compact x-band linear accelerator (linac) to accomplish non-invasive surgery for destruction of solid tumors and certain other conditions.

The CyberKnife technology was developed by Accuray Incorporated (Sunnyvale, CA) in cooperation with Stanford University and was cleared by the FDA in August 2001 to provide radiosurgery for lesions anywhere in the body when radiation treatment is indicated. Over 2,000 patients have been treated worldwide.

The CyberKnife treatment is planned using CT (and, in some cases, MR) images that relate the position of the target to skeletal features or implanted radiopaque fiducial markers. During radiosurgical treatment, a proprietary x-ray image-guidance system tracks the position of the skeletal features or fiducials, and thus the tumor. Information about tumor position is communicated to the robotic arm, which can re-position the radiation-generating linac to compensate for changes in patient position. Up to more than one hundred pencil beams of 6 MeV radiation are cross-fired along trajectories and in doses dictated by the treatment plan. Because of the system's high level of accuracy, high doses of radiation can be used while minimizing damage to normal tissues. Thus, the technique is surgery-like.

Dr. Bodduluri also will describe an accessory to the CyberKnife that allows the robotic arm to follow the motion of tumors during respiration. This minimizes the "margin" of normal tissue that must be irradiated in order to assure that the treatment dose is given to the target.

May 15, 2002

Startup 101

William New MD, Ph.D.
Natus Medical Inc.

All successful business satisfies customer need. Understanding that need is where to start. The second leg on the stool is developing a product to serve that need. The third critical leg is creating a sustainably profitable method to deliver that product. Three simple concepts are the zen of building a successful startup company. Identifying markets, creating products, finding financing, gathering the right people, organizing properly, focusing on core competence, getting useful advice -- a few of the fundamentals to be covered with levity and insight by a engineer-doctor-entrepreneur now venture capitalist sharing wisdom from 25 years of successful startups aimed at healthcare improvement.

June 19, 2002

Noise Reduction in Hearing Aids

Dr. Harry Levitt

Methods of noise reduction for hearing aids can be subdivided into two broad groups, single-microphone and multi-microphone techniques. Much of the research in this area has focused on single microphone techniques because of the convenience and cosmetic appeal of small single-microphone instruments. This approach has been moderately successful in reducing noise levels and improving ease of listening, but has not been successful in improving speech intelligibility to any significant degree. Multi-microphone hearing aids, although larger and less convenient to use, are now receiving more attention. The methods of noise reduction vary from innovative implementations of adaptive noise cancellation to wearable directional microphone arrays. The improvements in signal-to-noise ratio obtained with experimental multi-microphone hearing aids can exceed 10 dB under ideal conditions, such as a reverberant-free environment. In practice, however, improvements are much smaller, depending on factors such as the acceptable size of the microphone array, the number of noise sources and amount of reverberation.

Dr. Levitt will present both theory and practical applications pertaining to improving speech intelligibility in hearing aids.

July 2002 (no program)

August 2002 (no program)

September 18, 2002

A Web-Enabled Medical Informatics System for Clinical Genetics

Carl Taswell, MD, PhD
Global TeleGenetics, Inc.

Computerized medical records are neither new nor revolutionary with a history dating back many decades. However, web-enabled medical informatics systems built recently over the past few years can truly be considered both.

They do permit a significant change in the fundamental paradigm from one in which medical records have been created and accessed solely by health care providers under time and space restrictions to one in which these records can now be created and accessed by both providers and consumers anywhere anytime. Of course, these systems require all of the necessary safeguards for security and confidentiality with both role- and rule-based access to different parts of the medical record.

GeneScene ( with its specialty focus on clinical genetics is one example of this new paradigm. The design and development of GeneScene will be discussed from the perspective of the integration not only of different modes of use, and different components of the medical record, but also of different tools ranging from symbolic to numeric.

October 16, 2002
Advances in Vascular Tissue Characterization and Imaging

Brian Courtney, MSEE
Stanford University

Cardiovascular disease remains the leading cause of death in North America and is a substantial health issue for patients and caregivers alike. Over 1 million people experience acute myocardial infarctions each year, causing over 450,000 deaths. Advances in the understanding of biological mechanisms of acute coronary syndromes, such as plaque rupture and plaque erosion, coupled with new interventional techniques and pharmacological agents, have greatly improved the likelihood of survival for such patients in recent years.

A significant clinical challenge is developing sufficiently advanced techniques to identify foci of pathological changes in coronary arteries that present a high-risk for causing clinical events. These foci would include lesions that are increasingly being referred to as "vulnerable plaques." Methods to identify vulnerable plaques and other pathological changes in vascular tissue with greater resolution and certainty would have the potential to further enable physicians to effectively treat their patients. Furthermore, such methods would become important research tools in furthering an understanding of the progression and regression of vascular disease while providing improved ability to evaluate the efficacy of various treatment modalities.

Relevant technologies with significant potential in the field of vascular tissue characterization and imaging include Radiofrequency Intravascular Ultrasound (IVUS-RF), Optical Coherence Tomography (OCT), Magnetic Resonance Imaging and Thermography. IVUS-RF, OCT and Thermography are catheter-based diagnostic technologies at various stages of development, each with unique sets of properties. MRI techniques currently under investigation include both intravascular and non-invasive techniques. The principles, capabilities and limitations of each of these modalities will be discussed and representative images will be presented.

November 20, 2002
Identification of Bio-Threat Agents
using DNA Sequence Detection Technology

Kurt Petersen, PhD
President and Co-Founder, Cepheid

Recent Advances in genomic discovery have made it possible to definitively distinguish not only the identity of an infectious organism but also its virulence and its antibiotic resistance characteristics. Such identification and characterization routinely employ DNA sequence detection technologies such as the Polymerase Chain Reaction (PCR). Traditional methods for such analysis, based on culturing, typically require a skilled scientist and take several days to accomplish. Only very recently have miniaturized fluidic systems become available which perform this complex biochemical processing automatically, in less than 30 minutes, even by an unskilled operator. In this talk I will describe the difficulties of finding and analyzing the bio-threat "needle in a haystack". Microfluidic-based solutions to this problem will be presented, including a totally automated PCR system which is currently being evaluated by the US Postal Service for detecting bio-threat agents in the US mail. Additionally, I will describe how the DoD application is also transforming numerous other areas of human health, safety and diagnostics.

December, 2002 (no program)

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