An ultrasound idea

New U.Va. surgery center combines two technologies

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Print this page by Robert Burke

A new technology that could revolutionize the way doctors treat a wide range of life-threatening illnesses has taken root at the University of Virginia Medical Center in Charlottesville.

News The new Magnetic Resonance Guided Focus Ultrasound Surgery Center combines two technologies to create an approach that offers a less-invasive and more effective way to fight illnesses, including several kinds of cancer, epilepsy, strokes and Parkinson’s disease. It uses the pinpoint accuracy of magnetic resonance imaging to look inside the body and the power of multiple ultrasound waves to heat and destroy tissue. U.Va. neurosurgeon Dr. Neal Kassell, who has been leading the effort to put this technology into wider use, calls it “a game-changing technology that most people have not heard of. It’s the best-kept secret in medicine.”

Kassell’s goal now is to expand its use. The center will be treating patients with uterine fibroids, the only application that has been approved by the Food and Drug Administration. Those treatments will be done on an outpatient basis with minimal side effects, he says. Kassell launched the Focused Ultrasound Surgery Foundation in 2006 to support use of the new therapy. So far, the foundation has raised about $27 million from private, corporate and other foundations, he says. The new ultrasound center cost nearly $9 million, and Kassell says the foundation contributed $3.1 million of that cost. The center also received a $4 million state grant.
Later this year and early next year the center hopes to conduct clinical trials — pending FDA approval —on the treatment of several other conditions, including bone cancer, brain tumors and prostate cancer. Other clinical trials will deal with breast cancer as well as liver and kidney tumors, he says.

Ultrasound therapy also can be used to deliver an accurate dose of medications. Physicians can inject chemotherapy or other drugs into a patient, and those drugs can remain inactive until they reach the treatment site and are then activated by ultrasound beams.

If this technology proves effective, then doctors in specialties that could benefit will need to be trained on when to use it in place of traditional therapies such as surgery. “The reaction among physicians is generally a lot more positive than you would anticipate, given that this is a disruptive technology,” Kassell says. “There are political and turf issues, but we’ve sort of dealt with it up front by insisting that this be a multidisciplinary effort. The people who are trained to do this are really a new generation of surgeons and therapists, who can come from any tradition so long as they are trained.”

Ultrasound surgery won’t replace traditional surgery, Kassell adds. He says that if the procedure proves more effective and less invasive, a specialist trained in the new therapy could wind up with more patients referred to them. “It’s not a zero-sum game,” he says.

A bigger challenge, says Kassell, will be the reaction from insurers. They could view it as a threat to the bottom line and be reluctant to pay for the treatment. For example, he says, about a third of women with uterine fibroids currently seek surgical treatment. But if a less-invasive ultrasound surgery is available, more women will want to be treated. “So the insurance company ends up paying a lot more, because more people are getting treated,” he says. Large self-insured companies should see an advantage, because they’ll get their employees back to work sooner and with fewer complications, he says.

Doug Gray, executive director of the Virginia Association of Health Plans, rejected Kassell’s claim that insurance companies wouldn’t cover the procedure. If a new treatment passes muster in independent clinical studies, as well as in analysis done by researchers at the insurance companies, it will be covered, Gray says. “Cost is not the primary factor in making decisions about whether to cover a new medical procedure,” he says.” If something is effective ... then we’re going to cover it.”

Though the new technology’s current application remains small, Kassell is certain it will have a huge impact. At the unveiling of the new center in September he told an audience that focused ultrasound “may be the most important therapeutic advancement since the scalpel and could affect millions of people around the globe.”

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