BehindTheMedspeak: GPS — For the brain

Atamai of London, Ontario, Canada is the inventor of a potentially revolutionary approach to neurosurgery.

The company has combined MRI, CT and ultrasound imaging to produce a real–time 3–D map of a patient's brain.

Janet Morgan wrote about the new technology in an April 6 Financial Times article.

It differs from existing "virtual patient" imaging systems in that the image is that of the individual patient on the operating table rather than one based on a "representative' or "average" patient.

Traditionally, neurosurgeons carry out their procedures through a small access hole in the skull, going deep into the brain with a probe and only "seeing" the brain via readings from the probe and translating information from 2–D scans taken earlier.

The Atamai system, said neurosurgeon Dr. Yves Starreveld, one of Atamai's three founders, "provides an overlay on the image of functional information or anatomic information. This allows me to plan what portions of the brain can be safely resected, and which have critical function and need to be preserved."

Here is the article.

The Power of Thinking Small

When three Canadian PhD students started talking to each other about their doctorate projects, they could not have imagined it would lead to them working with Hollywood special effects wizards, computer programmers and leading hospitals.

Yet, just eight years after they started collaborating, the ground-breaking surgical software developed by David Gobbi, a medical biophysicist, Yves Starreveld, a neurosurgeon, and Kirk Finnis, a neuroscientist, is poised to enter operating theatres around the world.

"Each of us was working on different aspects of brain imaging techniques - ultrasound, deep brain stimulation and magnetic resonance imaging. But we saw that if we could combine this information, it had applications beyond our PhD projects," explains Mr Gobbi.

What they envisaged was a global positioning system for the brain that would help guide neurosurgeons around critical structures such as blood vessels.

The system would take the information from traditional imaging systems such as MRI, computer tomography and ultrasound and combine it to produce a real-time three-dimensional map of a patient's brain.

It differs from existing "virtual patient" imaging systems in that the image would be that of an individual patient, rather than an image based on a "representative" patient.

But the three students needed the resources and the time to develop the project.

Fortunately, Mr Gobbi and his colleagues were carrying out their doctorate work at Robarts Research Institute, in London, Ontario.

As an independent medical research centre, Robarts is keen to capitalise on the scientific discoveries of its staff, for which it set up the Robarts Business Development unit.

The unit helped Mr Gobbi and his colleagues establish Atamai in April 2000 as a collaborative venture with Robarts and the affiliated University of Western Ontario.

The founders own the majority of shares in the company, with other stakes coming from the university, the Robarts Institute and the university's hospital.

"We drew a lot on the expertise of the business development unit. We also had the advantage that Yves Starreveld ran a software company before he got into medicine," says Mr Gobbi.

Initially Atamai relied on grant money, but the founders recognised they needed to generate revenue as they developed their software.

Since researchers - their potential customers - use various imaging techniques, they conceived a business plan in which software could be modified and assembled to create a customised virtual imaging system.

They also decided to make the most of the computer code available to users under a non-restrictive licence and ensure that the systems run on a standard PC or Macintosh.

This made it particularly attractive to academic users.

Much of the programming underlying the system was originally open source.

In fact, it was through their collaboration on an open-source project with Sintef Unimed Ultrasound, a research institute in Trondheim, Norway, that the team found its first client, just one year after starting up.

Mr Gobbi says most of their clients have also come through word of mouth or via the open-source collaboration.

Now, five years on, Atamai has taken on three more staff and plans to expand its staff to 12 by 2007.

And the original concept - known as virtual augmentation for neurosurgery - is being tested in hospitals across Canada and one in Norway.

Dr Starreveld is one of the surgeons putting the technology through its paces. He explains the advantages.

Neurosurgeons traditionally carry out their procedures through a small access hole in the skull and go deep into the brain with a probe.

The neurosurgeon can only "see" the brain through readings from the probe and by translating information from two-dimensional scans that were taken earlier.

The software, says Dr Starreveld, "provides an overlay on the image of functional information or anatomic information. This allows me to plan of what portions of brain can be safely resected, and which have critical function and need to be preserved".

So far, the augmentation software has been used to plan and carry out neurosurgery in up to 100 cases.

Despite the risks in setting up their own venture, Mr Gobbi says the founders never considered seeking investment funds from a large company or venture capital fund.

"As a small company you can take the risk based on your own confidence in the future of your technology," he says.

"For a large company to take on something like this they would need to do projections of the promise and whether it was worthwhile. We knew it was worthwhile."

Now it is up to hospitals and neurosurgeons to prove its value.