Sonic Boom

Breakthrough Procedure Uses Sound Instead of Scalpels

Medical teams at the University of Virginia Health System are among the first in the world to conduct groundbreaking research and testing of focused ultrasound technology on certain brain disorders and tumors. The work brings into focus a futuristic reality in which doctors perform surgical procedures without cutting into the body, or one day may treat cancer without producing traditional side effects. Focused ultrasound concentrates high-intensity sound waves to generate heat, much like aiming a magnifying glass at a leaf. Guided by magnetic resonance imaging (MRI), the physician can target sound waves with fine accuracy to ablate, or burn away, the specific area without damaging surrounding tissue. The procedure requires no incisions, no radiation, no anesthesia and usually no hospitalization. At UVA, radiologist Dr. Alan Matsumoto first used focused ultrasound to treat noncancerous growths called uterine fibroids, a procedure approved by the Food and Drug Administration (FDA) since 2004. After the outpatient procedure, patients return to regular activities the next day.

Dr. Jeffrey Elias, a UVA neurosurgeon, first tested focused ultrasound technology on patients with essential tremor, a common movement disorder, in 2011. A “cousin to Parkinson’s disease,” as he described it, essential tremor affects 5 million to 10 million people in the U.S. and causes uncontrollable shaking of the hands and sometimes forearms, head, neck and voice. Elias and others recently completed a multicenter, international study to further assess the safety and long-term effectiveness of focused ultrasound in treating essential tremor. The FDA is considering approval of the treatment.

As he performs the procedure on trial participants, Elias said, he can monitor the intensity of the ultrasound and actually witness the shaking stop—the results are that dramatic. The focused ultrasound treatment can often restore or greatly improve a person’s ability to perform simple tasks independently, such as eating or signing one’s name. “We’re in the early stages, but it’s easy to envision the technology being used for a lot of medical problems. This is just the tip of the iceberg,” he said. Elias has begun another trial to see if the technology will work as well to reduce shaking associated with Parkinson’s disease, which afflicts 1 million to 2 million Americans.

UVA physicians continue to collaborate in designing innovative, minimally invasive, image-guided procedures. Two other trials with focused ultrasound are under way: one for treating benign breast tumors, and the latest one targeting prostate cancer. Specialists in the departments of radiation oncology and urology recently opened a clinical trial testing MRI-guided, focused ultrasound in trial participants with low-risk, localized prostate cancer. “This new treatment approach uses MRI to target tumors directly, treating part of the prostate gland rather than the entire gland,” said Dr. Timothy Showalter, associate professor of radiation oncology and lead investigator. “The hope is that partial gland treatment with focused ultrasound ablation will effectively treat tumors with a lower risk of side effects than standard whole-gland treatments such as radiation and surgery.” Dr. David Brenin and his team are the only group in the U.S. using the procedure to target tumors in the breast. In their current study, benign tumors called fibroadenomas are being ablated. The study, likely to be completed in June, looks promising enough that Brenin is organizing a national effort with other locations to expand the testing. If successful, the approach may be applied to malignant breast tumors.

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