Out of the Dark
Revolution in Imaging Brightens Prospects for Diagnosis and Treatment

BY CHRIS VAUGHAN

Chief of Pediatric Radiology Richard Barth, M.D., is building a premier imaging program that will benefit children throughout the Hospital.

FALL 2002 - Sixteen- year-old Amanda Tracey had suffered from epileptic seizures for much of her life. Despite numerous brain scans, doctors near her Central Valley home couldn't pinpoint the source of the problem. Relief finally came when she was referred to Lucile Packard Children's Hospital, where neurologists and neuroradiologists used sophisticated MRI equipment to view thinner, higher resolution images of Amanda's brain. The improved scans allowed the physicians to spot one area that "looked a little funny," suggesting a subtle brain malformation. Subsequent surgery revealed a small tumor in her brain. The tumor was removed, and since then, Amanda has been seizure-free.

Welcome to the future of pediatric imaging. Using such dramatically improved images, Packard Children's Hospital is rapidly evolving into a key center for technology that will transform the way many children's illnesses are diagnosed and treated.

Technological Marvels

The field of radiology historically has played an important part in Stanford's efforts to advance the field of medicine and improve children's health. Much of the imaging technology currently used at Packard was developed, in part, at Stanford. Just over one hundred years after a German scientist first used X-rays to see inside the body, medical imaging is undergoing another revolution, providing pictures not only of tissue structure in the body, but also, remarkably, of the chemistry inside cells. Neurological activity, cardiovascular flow, even cellular health, will become visible in ways previously unimagined, giving physicians a new window on children's disorders.

"Packard Hospital is positioning itself to be among the medical leaders of this rejuvenated field by building a program that will benefit children in virtually every area within the Hospital," says Richard Barth, M.D., chief of pediatric radiology at Packard.

For the past two years, the basement of the Hospital has been home to a dedicated pediatric MRI/CT imaging suite, the first radiology facility built in Northern California exclusively for children, and one of approximately 15 such facilities in the nation. Armed with some of the most powerful scanners in the world, physicians probe electron density and the rhythmic wobbles of atomic nuclei in tissue, all to learn more about what afflicts Packard's young patients.

A top view of the brain looking down on temporal lobes.

"We have what may be the first 16-slice CT scanner within a children's hospital in North America," says Barth. The new scanner processes images 16 times faster than machines in use just three or four years ago. This speed, for example, allows radiologists to literally "freeze" the beating of the heart. That makes it possible for some children to get a simple scan to diagnose cardiac problems, instead of having to undergo a cardiac catheterization that requires threading a tube through the femoral artery and into the heart.

With the new scanner, a whole body scan of a child takes a mere 20 seconds. Because kids tend to fidget and change position, such fast scanning is especially important, and the speedy scan also permits many children to avoid sedation.

Packard's dedicated space for pediatric imaging also eliminates the need for children to be transported to Stanford Hospital for imaging procedures, where waiting times for the adult equipment are often lengthy.

A Move Toward Specialization

In addition to building a stronger technological base for pediatric imaging, Packard is recruiting radiology subspecialists -- physicians who have training and experience not only in general pediatric radiology, but also in other pediatric radiology subspecialties such as neuroscience, cardiovascular care, oncology, and minimally invasive surgery. With a cadre of accomplished subspecialists, the pediatric radiology program will be a critical part of the success of the Children's Heart Center and other Centers of Excellence at the Hospital.

Patrick Barnes, M.D., a pediatric neuroradiologist, was recruited to Packard last year from Harvard University and Boston Children's Hospital, where he was director of neuroradiology and the MRI center. Barnes says he came to Packard because he is excited by the prospect of helping to build one of the best programs in pediatric imaging.

"What we have here is a pediatric radiology program, in a pediatric institution, with pediatric specialists," says Barnes. "You can do great things when you concentrate this type of talent with these resources and focus it all on children's health." Barnes is currently involved in research to use imaging to spot brain changes that indicate a risk of cerebral palsy in the unborn and newborn child.

"Using subspecialists has transformed adult radiology, and we want to do the same in pediatrics," Barnes says.

Patrick Barnes, M.D., (pointing) a pediatric neuroadiologist, is one of the first pediatric radiology subspecialists recruited to Packard. Here, he examines a brain scan with neuroadiologist fellow W. Bryan Winn, M.D.

For example, an interventional radiologist uses imaging to carry out diagnostic and therapeutic procedures without resorting to major surgery. Imaging technology and a catheter can be used to guide placement of a device to treat vascular aneurysms or abscesses in the body that would otherwise require open surgery. "Interventional radiology is quicker, easier, safer, and provides a faster recovery," Barnes says. "It also frees up surgeons and operating rooms for other surgeries."

At the Forefront of Science

To be at the leading edge of any medical field demands a strong research program. Packard is well situated to take advantage of the computer and imaging research capabilities of Stanford and Silicon Valley. "We have the scientists at Stanford who develop the software and hardware that is used to create the most sophisticated imaging possible with magnetic resonance," Barth says. "New software is being used exclusively at Stanford right now that will someday be used in machines all over the world."

Stanford researchers also are conducting laboratory testing on a three-tesla magnet, the strongest clinical magnet in the world. Such a magnet will be the basis for the next generation of MRI machines, which Packard hopes to acquire next.

With these new technologies, radiologists do not simply image the tissue of organs such as the heart or the brain; they can also look inside the cells of these organs and see their cellular metabolism.

"Physicists, engineers, and other scientists are working together, integrating patient care and science to produce some incredible results," Barnes says.

The implications are enormous. Packard radiologist Francis Blankenberg, M.D., for example, has been able to image the cellular changes that tumors undergo when they are exposed to anti-cancer agents. By analyzing the reaction, physicians can determine almost immediately if a particular anti-tumor therapy is working. "You don't have to wait for days or weeks to see if the tumor shrinks. You can tell right away and switch to another therapy if one is not working," Barth says.

Imaging also can be used to spot the first signs of organ rejection after transplantation. Currently, a patient is watched for the most obvious signs of organ rejection, which typically surface when the rejection process is well under way. Newer forms of imaging could reveal immediately the cellular changes that accompany organ rejection, allowing doctors to take action before the rejection process becomes dangerous.

The Human Component

The revolution in imaging also is bringing radiologists back in touch with families. "It used to be that a child would come in with a broken arm and I would do the x-ray, but the patient and the family wouldn't really talk to me," says Barth. "Now, with fetal imaging, interventional radiology and so on, we are an active and visible part of diagnosing and caring for a child."

Next to the rooms with clanking magnets and machines that monitor the annihilation of subatomic bits of matter and anti-matter, there is a bright green room with puzzles and games. On any given day, someone will scrunch down into a little chair, pull up to the pint-sized table and gently tell a young patient and her family what is about to happen and why. For a child, those small gestures are the biggest part of bringing every standard of care to the next level.

	The Campaign The development of a premier pediatric imaging program is one of the objectives of the Campaign for Lucile Packard Children's Hospital. The program already has benefited from generous philanthropic support. Gifts from an anonymous donor and AMD (Advanced Micro Devices) provided funding to establish a dedicated pediatric imaging center at Packard, which features the latest imaging technology along with child life specialists who help prepare patients to cope with the sometimes lengthy scanning procedures. A recent gift from the Oak Foundation will provide support for the Pediatric Radiologist in Chief and his recruitment of six subspecialists and three research scientists in pediatric imaging. The gift includes start up funding for one subspecialist and for the research scientists. In addition, Packard's Woodside-Atherton Auxiliary provided initial funding for an imaging digital storage and distribution system, making it easier for Hospital staff to track and access radiology results. Gift Opportunities The Lucile Packard Foundation for Children's Health is currently seeking gifts to fund the expansion of the pediatric imaging suite to include an interventional imaging facility. This addition will greatly enhance Packard's ability to use imaging technology as an option to invasive surgery to diagnose and treat certain conditions in children. The cost of the expansion is estimated at $7 million. For more information about the imaging program and gift opportunities, please call 650-498-7641 or e-mail campaign@lpfch.org.