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High-tech tools come together in new Imaging Center

A reporter entering the hightech realm of DHMC's new Imaging Center with tools as low-tech as a pen and notebook should be prepared for a little ribbing. After all, the interview subject—Justin Pearlman, M.D., M.E., Ph.D., the center's director —is accustomed to working at technology's cutting edge.

On this particular morning, Pearlman and some colleagues are studying MRIs of the heart on a computer screen. What's unusual is that the person in the MRI scanner is a volunteer who has swallowed an experimental coil attached to a tube. The coil is being tested to see if it will boost the radio signal from the scanner and produce enhanced views of the coronary arteries. In current practice, the coils used to apply the radio pulses during an MRI are attached to the outside of the patient's body. But current practice is old hat here.

Leap: Pearlman was recruited from Harvard just over a year ago to lead the way in a venture that marks a dramatic leap in imaging capabilities at DHMC. He is the first director of the Dartmouth Advanced Imaging Center. Work is already ongoing under the center's aegis, and it is scheduled to move into new facilities in mid-2003.

Formed as a partnership between the Departments of Cardiology and Radiology, plus the Norris Cotton Cancer Center and Thayer School of Engineering, the center brings diverse technologies and talents together in one place. Not only will the consolidation of resources promote multidisciplinary research, but expanded diagnostic capabilities will benefit the treatment of a range of conditions, from cancer to heart disease.

By summer, the Imaging Center will be housed in a 12,000- square-foot facility located one level below Radiology. Among the technologies that will be available are advanced cardiac MRI, real-time or "infinite slice" computed tomography (CT), 3D ultrasound, and electron paramagnetic resonance (EPR).

Tissues: "Adding microimaging methods that will enable us to get information at a molecular level is a high priority," Pearlman says. EPR, for instance, measures oxygen levels in tissues and provides other molecular information. A process called proton MRI can also detect molecular and microvascular changes. Procedures like this make it possible to detect a tumor early on, when cutting off its blood supply may be sufficient to stop the cancer.

Similarly, 3D ultrasound— which uses powerful software to combine a series of two-dimensional scans into three-dimensional images—is useful in early detection of both cancerous and benign tumors of the prostate, colon, rectum, and breast. This type of ultrasound also boosts doctors' ability to assess fetal development and to visualize blood flow in various organs.

For Pearlman, who holds a master's in biomedical engineering and a Ph.D. in applied sciences (both from the University of Virginia) plus an M.D. (from the University of Connecticut), the imaging advances of the past 20 years are thrilling. In 1977, when the first MRI was performed on a human, it took nearly five hours to produce one image. Today, it takes less than a second. As a clinician (he has appointments in both cardiology and radiology), Pearlman is most interested in the advances in patient care made possible by such innovations. The goal, he says, is to develop accurate, sensitive, noninvasive diagnostic techniques as well as minimally invasive treatment options.

The Imaging Center has received several major grants, including $1.4 million from the National Institutes of Health and $1 million from the Flight Attendant Medical Research Institute, plus support from General Electric and the Doris Duke Charitable Foundation.

Pearlman sees some immediate benefits for the community when the new facility opens. One of its first initiatives will be screening for people who live with secondhand smoke—a risk factor for cancer and heart disease nearly equal to smoking.

He has ambitious long-term plans, too. Among other collaborative ventures, he hopes to sponsor a training program in advanced imaging for both doctors and engineers. The better those who practice medicine and those who develop new technologies understand each other, Pearlman believes, the more patients will ultimately benefit.

Catherine Tudish

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