A Two-Way Street

Top technology and leading research exchange at UCLA's cardiovascular imaging program

Email Print

Part of the University of California - Los Angeles's cardiovascular imaging program is housed in the 300 UCLA Medical Plaza building. (UCLA/David Nelson)

A volume-rendered technique image of the heart acquired on Siemens' Definition Dual Source CT. (Praveen Jonnala, MD)

A volume-rendered technique image of the aorta, post-aortic endograft, acquired on Siemens' Definition Dual Source CT. (Praveen Jonnala, MD)

(Top left) Dieter Enzmann, MD, professor of radiological sciences at UCLA's David Geffen School of Medicine; (top right) Siemens Medical Solutions' Somatom Sensation 64 CT scanner (KPCC/Rachael Myrow)

Praveen Jonnala, MD, pulls up images on the Vitrea workstation. (UCLA/David Nelson)

Through a unique partnership with Malvern, Pa.-based Siemens Medical Solutions, UCLA's cardiovascular imaging program has become one of the country's most cutting-edge imaging facilities – one of many programs that has put UCLA on the map.

"The goal here is to have the research program and a clinical program really integrated closely, and when we look at the program, we look at it as a whole – the people involved and the direction of the research and direction of the clinical services," says Dieter Enzmann, MD, Leo G. Rigler chair and professor of radiological sciences at UCLA's David Geffen School of Medicine. "The goal really is to develop new techniques on the research side and to translate them as fast as we can to the clinical patient-care side."

Many of the faculty members at UCLA have a dual role. J. Paul Finn, MD, professor of radiology and medicine, chief of diagnostic cardiovascular imaging and director of MR research at David Geffen School of Medicine at UCLA splits his time equally with clinical work and research. When it comes to imaging, that combination of experience makes him extremely valuable to the cardiovascular program.

"It's a peculiar characteristic of MRI that, in many ways, research and clinical practice are flip sides of the same coin. New MRI techniques are most useful if they have clear clinical applications, and in most instances, the clinical advantages of new developments become clear very quickly," says Finn. "This is very much a moving target, with new and improved techniques sometimes evolving over a timeframe of weeks, not years. In this context, the advantages of having a strong technical and research team to keep clinical practice at the cutting edge are significant."

A Focus on Cardiovascular Imaging

During the past few years, the focus in cardiovascular imaging has greatly developed due to significant advances in the technology and evolution of the equipment.

Five years ago, CT and MR scanners performed decent cardiac imaging – images of the heart were clearly captured with reasonable motion, but they lacked the detailed anatomical analysis that can be achieved now.

"Cardiovascular imaging has always been a great interest, but until recently, it was mostly the interest of cardiologists. With the advent of MR and CT becoming relevant to cardiovascular imaging, the radiologists have renewed their interest in that field," says Enzmann.

Better software applications, better coils, better algorithms – better ways of looking at that anatomy have reduced motion artifacts and provide very detailed 3-D anatomical views.

"In the United States, we're very curative; we're not preventative focused. Cardiovascular disease is a huge cause of death, and one of those disease processes that remains silent for a very long time," says Brenda M. Izzi, RN, MBA, chief administrative officer of UCLA radiology.

What these CTs and MRs offer, says Izzi, is a way to get preventative information early on in people who have a family predisposition, or for those who have already been diagnosed with a problem, are being treated and now need to be evaluated to ensure that their treatment was effective.

"We're very good about developing a preventative program around screening mammography. These CTs and MRs now will allow us to develop those same kinds of screening programs as it relates to cancer and cardiovascular disease," says Izzi. "So it's just a very new and exciting endeavor."

The positive results from CT and MR have encouraged further development, and people are beginning to see the real value of these imaging techniques above and beyond the tried and true techniques that involve angiography and nuclear medicine techniques and echo.

"We're in the process of evaluating all of these techniques to see which provide the greatest benefit to a patient," says Enzmann. The increased speed, primarily, and resolution have made MR and CT relevant technologies to cardiac imaging, whereas before, Enzmann says it was a bit of a stretch.

A Strategic/Beneficial Partnership

Enzmann's relationship with Siemens originated at Northwestern University, Evanston, Ill., where he was chair of radiology. Siemens was willing to experiment in terms of their relationships with academic institutions and determine the value of having a corporate research and development (R&D) effort that takes place out on the field where the patients are actually being treated, as opposed to in a corporate R&D lab.

"Because of the specific individuals involved, their willingness to try this program and the trust that was evident between the individuals, Siemens put a portion of their corporate R&D at Northwestern," says Enzmann. "And part of the reason that it was successful is that Dr. Finn, who I recruited from Northwestern, was the head of the corporate R&D for about four years, and he decided to go back into the clinical environment."

Siemens sent some of those R&D researchers with Finn to determine how the relationship functioned in the clinical environment as opposed to the corporate lab environment. And Gerhard Laub, PhD, relocated from Germany to manage the Siemens R&D group in Chicago.

"The experiment in Northwestern was patterned after other research relationships that companies had with academic medical centers, but our relationship was much deeper in terms of the actual placement of engineer scientists and researchers at the academic medical site, as opposed to within the company," says Enzmann. "So, it was taking a model that was being followed by other academic medical centers, but to a greater degree."

While at Northwestern, the group developed several new MR techniques for cardiac and vascular imaging, which have become mainstream clinical tools, including SSFP cine, delayed contrast enhanced imaging for myocardial viability and time-resolved MR angiography.

The experiment turned out to be a successful one, and the cardiovascular program at Northwestern reached a high level of recognition quickly because of its accomplishments. Due to that success, when Enzmann transferred to UCLA, he took the model with him.

"I thought I would try to transplant that model out here, because I thought the environment here was fertile for that similar type of experiment, similar type of model," says Enzmann. "Turns out that worked out quite well."

Cutting-Edge Expertise

UCLA continues to develop its unique relationship with Siemens, providing locations for research to be developed. Siemens scientists and engineers collaboratively live onsite, developing different platforms; and their presence at UCLA provides an endless supply of knowledge to cardiovascular imaging.

"Siemens offers a great deal of expertise, and that expertise is here daily because the people are located here. They certainly offer training to our faculty, but they also offer a great deal of training to our technologists, and that's very symbiotic in the sense that we have a lot of new high technology equipment here," says Enzmann. "It's a combination of having access to new technology and making sure that the faculty and the technical staff really know how to use it to its best extent."

Along with their overall expertise, the Siemens scientists at UCLA provide monthly lectures in both MR and CT.

At these lectures, they discuss new developments and protocols, offer sessions that are interactive, listen to the concerns or difficulties the technologists might be having with a certain sequence or study to work through those together.

Siemens also assists with educational forums, not only providing physician education on certain platforms, but also offering larger technologist forums.

"It's a nice collaboration, whereby we have educational money that we can use at our discretion for furthering the education of both faculty, fellows, residents and techs. But, Siemens also offers these independent programs that we're able to tap into and work on, as well," says Izzi.

A Two-Way Street

"Due to our relationship with Siemens, we have access to the latest developments in MRI and CT hardware and software," says Finn. "We work very closely with Siemens research scientists on a daily basis, where we share ideas for ongoing and new projects and developments."

Specifically, these research scientists are Gerhard Laub, PhD, director, cardiovascular collaborations; Vibhas Deshpande, PhD, senior scientist; and Christoph Panknin, MS, scientific collaborations manager.

Having the highest level of equipment on a regular basis is fairly unique; few academic centers can maintain that level of equipment upgrade because it's very costly.

"Because of the relationship that we have, we're able to test and evaluate things before they become product," says Izzi. "Most of those things are in the early stages of [U.S.] FDA approval, but we're able to impact those items that are going to make a difference going forward."

The cardiovascular program is composed of two major technologies – MR and CT. "In MR, we have basically 1.5[Tesla (T)] and a 3T right next to one another. So these machines allow us to do cardiovascular development in two field strengths, pretty much simultaneously," says Enzmann.

They also have fairly rapid turnover involving the fast CT scanners, quickly going from 16 slices to 64 slices, and now to the dual-source CT scanner. "The reason for this rapid replacement of these machines and updating is because they're designed for the cardiovascular market, and it fits into our overall cardiovascular program where the goal really is to obtain the best cardiovascular imaging techniques, be that MR or CT," says Enzmann.

For Siemens, the value is the clinical feedback it receives from UCLA, says Laub. "As UCLA gets access to technology and research support, for Siemens, the value is the clinical feedback that we get much faster than we would possibly do otherwise when we are not working together onsite," says Laub.

Laub gives the example of the value of time-resolved MR angiography. "Dr. Finn can point and show me clinical examples nearly on a daily basis, and we have a very rapid prototyping face as a result of this because, on a weekly basis, we can update protocols and sequences and come up with optimum solutions, which are clinically validated," he says.

The clinical feedback Siemens receives is more than just in the form of images and written results; additionally, it receives patient histories.

"In my experience, it goes beyond just looking at images," says Laub. "It is hearing from the experts – from the clinicians what they need to see, what they currently see with this new equipment and new technology and also what is left to do. Where do we go from here? What is the next cutting edge in medicine?"

Successes Improve Patient Care

Every discovery such a partnership achieves leads to increased quality of care for patients. Currently, there are several ongoing projects in the area of cardiac MR, vascular MR and cardiac CT.

"Our major cardiac focus has been on adult and pediatric congenital heart disease. And, on the vascular side, we are working actively on advanced carotid angiography, thoracic angiography and respiratory mechanics, extremity MR angiography and whole-body MR angiography," says Finn. "We will also serve as the Cardiac MRI Core Laboratory for the DETERMINE project, the largest multi-center clinical trial in cardiac MRI undertaken to date."

The overall study is sponsored by Memphis, Tenn.-based St. Jude Children's Research Hospital and is administered by Northwestern University, under the direction of Alan Kadish, MD.

The MR portion of the trial involves the analysis of 10,000 cardiac MRI scans at the UCLA Core Laboratory. "When the trial is fully underway, we expect to receive an average of 10 to 15 new cardiac MRI cases per day for analysis," says Finn.

UCLA is also planning to implement training fellowships for advanced cardiovascular MR and CT, targeting interested physicians and technologists. "We are in the process of consolidating space and infrastructure for an ambitious training program, which we hope to launch in the late fall of this year," says Finn.

Such strides in radiology ultimately trace back to the patient. "When you look at the total picture, it really does provide better imaging outcomes for patients and certain disease processes," says Izzi. "And the collaboration between what the vendor can provide, based on what we think is a necessary product, really assists those people outside of a research environment with providing top quality and top-of-the-line care to patients all over the world."

— Janine Kusza is a freelance writer based in New Jersey. Questions and comments can be directed to editorial@rt-image.com.