Why
do you think your paper is highly cited?
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“This is the first non-invasive 'surgical' option for women with fibroids; it is also a major advance for the field of focused ultrasound…”
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This is the first non-invasive "surgical" option for
women with fibroids; it is also a major advance for the field of
focused ultrasound (FUS) as this is a very important clinical
application of a thermal ablation method that has a long history of
research and investigation.
What
are the circumstances which led you to your work?
I am a diagnostic radiologist with expertise in pelvic MRI and
have been working in image-guided therapy for many years. This work
is the result of basic research in our department, done by Dr.
Kullervo Hynynen's group and with the MR-guided therapy program led
by Dr. Ferenc Jolesz. These two major research programs collaborated
with InSightec Inc., Haifa, Israel, (device manufacturer) to
develop, test, and ultimately bring to clinical trial the first FDA
approved MR-guided (MRg) FUS device—the so-called ExAblate 2000.
Would
you describe the significance of this work for your field?
This is a major advance as it now demonstrates the application of
imaging in therapy to do three things: 1) define the target/lesion
for treatment, 2) provide real-time thermal imaging as the therapy
is being delivered, and 3) provide immediate post-treatment measures
of tissue necrosis. The thermal imaging is the most important and
unique feature of the entire system. No other image-guided therapy
has such an accurate and rapid online feedback mechanism.
What
are the advantages of MR image-guided focused ultrasound surgery over
other methods for the treatment of uterine fibroids? What are the
disadvantages, and how do they compare to other treatments?
The advantages include the fact that it’s non-invasive, day
surgery—patients are back to work the next day—it’s less
expensive than surgery, compared with patient hospitalization and
6-8 weeks of recovery at home before returning to work or normal
life.
The disadvantages lie in the fact that the long-term durability
of this method is not known, and that it also is currently limited
to relatively small volumes of tissue and 1-3 fibroids per treatment
session.
Where
has this research gone since the publication of your paper?
Since the publication of our paper, two other papers have
appeared, reporting the results from the Phase I/II and Phase II
trials, and there continues to be long-term follow-up of all
patients, evaluation of symptom response, new technical
improvements, faster treatments, attempts to treat larger volumes of
tissue, and optimization of the technique.
Where
do you see it going 10 years from now?
MRgFUS will become a broadly applied thermal ablation method for
many tumors and multiple diseases, allowing for non-invasive,
image-based, individualized treatments.
n
the interview below, Professor Clare Tempany-Afdhal talks
about her paper, "MR image-guided focused ultrasound
surgery of uterine leiomyomas: a feasibility study," (CMC
Tempany et al., Radiology 226: 897-905, 2003). This
paper has been cited 14 times to date, making it the third
most-cited paper over the past two years in the Special Topic
of uterine fibroids. Professor Tempany-Afdhal is a professor
of Radiology and Director of Clinical MRI at Brigham and Women’s
Hospital in Boston, Massachusetts.