By: Lennard M. Gettz / NYCRA NEWS Editorial Team
On April 20, NYCRA NEWS conducted a special interview with DR. RAJ ATTARIWALA, Nuclear Medicine Radiologist, PhD Biomedical Engineer and Founding Radiologist of Prenuvo. Known commonly as "Dr. Raj", he shares his commitment to improving on the current state of modalities in cancer diagnostics by offering advancements on the performance, range and design of our current MRI technology.
I bought my first MRI machine in 2009 and published my concepts about the very first whole body diffusion images at a conference called the International Society for Magnetic Residence and Medicine or ISMRM back in 2011. It was well received and led to an invited review on the topic in the Journal of MRI in 2013. The imaging society recognized this as a powerful and highly beneficial solution at a time when most facilities can only scan individual organs or body parts (ie. prostate, breast, chest, abdomen etc). Scanning the entire body is really challenging from an MRI hardware and software point of view because MRI machines and associated software were simply not designed to do that.
This collaboration cycle to build the whole body paradigm was a continuous process between MRI Physicists/ ENGINEERS and RADIOLOGISTS to expedite the design and prototyping stage. Having a doctorate in both fields made me the translator to both groups who commonly do not 'speak' the same language. Materializing concepts mean communicating features radiologists need to see with those who could build programs and luckily, the progress became fairly streamlined and this process does not alter the FDA approval of a MRI.
In simplistic terms, having a full-body access comports to the fact that everything is connected in one way or another. Tumor cells start somewhere, but they can spread almost anywhere they want. If we find a cancer in stage one (which usually means confined to the organ of origin) what happens afterwards is to ask if it is IN FACT confined to that organ, or if it has spread somewhere else. This is called staging.
After a cancer is detected, patients often go into a panic asking "What stage is it? ... Is it metastatic?" Working with the conventional MRI or CT of the past, they would have to wait to get a brain MRI, then a chest, abdomen, pelvis study and a bone scan etc. With our technology, we already have all that. We've routinely found people with stage one cancer as part of early detection. This is a good basis where you want to find it. From here, searching 'full body' is the best next step to make sure that it's not anywhere else in the body. Using an MRI with diffusion, we can see it all.
From a tumor perspective, you frequently get an increased number of cells which contributes to increased metabolism which often requires more energy. Injecting contrast – ie MRI gadolinium or CT iodine – ends up going to areas of increased blood flow where there is more energy needed, whereas FDG Positron Emission Tomography delivers increased glucose to the cells that are growing and have more energy demand. Instead of contrast our diffusion system works to track cellular density – whereby increased cellular density usually means a high concentration of cells (which is a tumor) which gives off a lot of signal. So as a result we're actually looking with diffusion at cells at a cellular level to see how dense (or hard) they are. That's how we're able to characterize what the tissue is composed of with that functional diffusion sequence.
COMMUNICATION TOOLS FOR EARLY DETECTION
Ideally, we want to find things in stage one, but the only way we can do that is to SCREEN. To create a full-body baseline scan of anyone offers a new layer of peace of mind whether we find something or not. In our decade long history, we have luckily found many early stage cancers in patients who were not expecting anything wrong – and this adds to the success and fortunately efficacy of the treatment phase.
After a Prenuvo scan, diagnostic-quality images are provided to each patient, which are available for review between patient and physician. For those who receive a Prenuvo scan because of potential concerns, correlating what is on the images with their possible symptoms is a major benefit to confirming a disorder. If a patient has concerns of symptoms expressing as night sweats, unusual weight loss, bone pain etc, a one hour Prenuvo scan can provide almost unequivocal imaging answers, or at the very least eliminates most major concerns and provide peace of mind, because with MRI we have looked through the entire body where the eyes cannot see.
|5/20- Dr. Bard receives the 2023
NY Cancer Resource Award
TECH TALK: PRENUVO'S UNIQUE APPROACH TO WB-MRI
MRI technology has now matured over the past 20-years where we can actually effectively perform diagnostic-quality WB-MRI. Via careful MRI protocol design and optimization, we have developed a specialized WB-MRI focused screening service that has been of significant clinical utility to our patients and referring-clinician colleagues.
What makes our approach different from traditional MRI approaches, which typically rely primarily on more anatomically-focused imaging, is that we also combine this with an important specialized functional-focused MRI-technique known as Diffusion-Weighted-Imaging (DWI) covering the whole body. DWI has been clinically-demonstrated to play a very valuable role particularly in oncological-imaging; and, in the screening setting DWI significantly enhances our ability to discriminate oncologically-concerning lesions from benign lesions. DWI can be thought of as an MRI-analogue to PET-imaging (whereas PET highlights hypermetabolism of cancerous tissue, DWI highlights hypercellular-density or “tissue hardness” characteristic of cancerous tissue).
Our DWI technique, in conjunction with the multiple other well established multiplanar multiparametric MRI sequences in our protocol, afford us the requisite level of sensitivity and specificity needed to provide clinical value in the context of desired proactive screening. Most standard MRI systems are not capable of performing these specialized WB-MRI sequences at an acceptable speed, image resolution, and similar multiparametric comprehensiveness.
MRI SCREENING vs HOSPITAL CONVENTION- Prenuvo scans capture 2000 images in 28 areas in under an hour at diagnostic quality, with 1B+ data points acquired, compared to the 4-5 hours it would take through conventional MRI. Conventional MRIs also use pre-programmed protocols that are not optimized for whole-body speed capture without compromising diagnostic quality. We've taken a different approach and verticalized our hardware and designed software acquisition protocols for whole-body diagnostic yield in under one hour.