Feature | August 15, 2014

North American First in Children: SickKids Doctors Destroy Bone Tumor Using Incisionless Surgery

Ontario Canada The Hospital for Sick Children Bone Tumor MRI Guided Ultrasound

August 15, 2014 — A team of doctors at The Hospital for Sick Children (SickKids) in Ontario, Canada, have, for the first time in North America, successfully destroyed a bone tumor using high-intensity ultrasound guided by magnetic resonance imaging (MRI), rather than traditional surgery. 

“With high-intensity focused ultrasound, we are moving from minimally invasive to non-invasive therapy, significantly reducing risk to the patient and fast-tracking recovery,” says SickKids interventional radiologist Dr. Michael Temple, associate professor of Medical Imaging at the University of Toronto and leader of the team that performed the surgery. “The osteoid osteoma tumor was chosen as our pilot study because the lesion is easily accessible and, while the procedure is sophisticated, it is relatively straightforward. The success of this first case is great news for Jack [Campanile, the patient], and exciting for our team as we look at developing more complex incisionless treatments in the future.”

This breakthrough is the latest from SickKids’ Centre for Image-Guided Innovation and Therapeutic Intervention (CIGITI), a research program that brings together surgeons, radiologists, software developers and engineers to develop innovative technologies in robotic and minimally-invasive surgery. The CIGITI bone tumor treatment project is funded by the Canada Foundation for Innovation, the Ontario Research Fund, FedDev Ontario, the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada and the Garron Family Cancer Centre at SickKids. The clinical pilot study is funded by grants from the Focused Ultrasound Foundation’s Clinical Indication Track and the Mary Jo Haddad Innovation Fund from SickKids Foundation.

The osteiod osteoma had caused the patient, 16-year-old Jack Campanile, excruciating pain for a year before the procedure. By the time he went to bed that night, the athletic teen experienced complete pain relief.

In previous decades, osteoid osteoma was treated with orthopaedic surgery that involved scraping the tumor from the bone or removing the affected part of the bone. Since the mid-1990s, minimally invasive treatments have proven effective — using radio frequency or laser energy is delivered through a needle placed in the tumor using computerized tomography (CT) guidance.

However, these procedures still carry risks, including radiation exposure, infection, burning of the surrounding tissue and bone fractures resulting from the hole that remains following treatment of the tumor.

High-intensity focused ultrasound therapy uses sound waves, guided by MRI, to heat an area the size of a grain of rice to destroy the tumor. The treatment is completely non-invasive, so the skin and surrounding bone remain intact, greatly reducing the risk of complications such as infections. The use of MRI rather than CT scan to guide the sound waves means the patient avoids exposure to radiation. The risk of bone fracture is also likely lower than in other treatments, and recovery is quick. An added benefit is rapid pain relief.

SickKids staff performed the procedure using a specialized MRI table at Sunnybrook Health Sciences Centre, with support from Sunnybrook’s MRI and radiation oncology staff. While the surgery itself took 30 minutes, it required about three hours of preparation, including general anesthesia and precise placement of the patient on a table equipped with a built-in, high-intensity focused ultrasound transducer. The team used the MRI to determine the exact location of the tumor and to help target the ultrasound waves to burn the whole tumor one focal spot at a time at a high energy. The MRI also enabled them to ensure that there was no unexpected increase in heat in surrounding tissues. Accurate positioning and monitoring are critical, as the ultrasound waves could damage surrounding tissues, nerves or skin.

A few hours after the procedure, Jack was discharged home, where his recovery has been smooth and quick, with no complications to date. After dealing with a few hours of severe pain following the procedure, he was suddenly pain free. That night, he had uninterrupted sleep for the first time in months. Two days following the procedure, Jack was able to resume most daily activities, including a day trip to Niagara Falls on day four.

Before the surgery, Jack’s pain was so debilitating that he needed to take pain medication up to four times daily. “If I didn’t treat the pain attack early enough, it would be so strong that it felt like someone was trying to bend my femur into the shape of a hockey stick,” says the 16-year-old hockey player, snowboarder and wakeboarder, who took his last painkiller following the procedure.

The idea of being the first to undergo this new treatment was intriguing, Jack explains. “I wanted to see what it would be like. If it did work, it would be a whole new world for medical procedures and treating osteoid osteoma.”

This breakthrough is the latest from SickKids’ Centre for Image-Guided Innovation and Therapeutic Intervention (CIGITI), a research program that brings together surgeons, radiologists, software developers and engineers to develop innovative technologies in robotic and minimally-invasive surgery.

“This achievement is both a technical and organizational feat and required several years of collaborative work and fine tuning. We see huge potential in using this technology to develop new, non-invasive therapies in a number of other medical and surgical areas, including the treatment of soft-tissue tumors, paediatric stroke and epilepsy,” said Dr. James Drake, lead of CIGITI; head of the Division of Neurosurgery and Senior Associate Scientist at SickKids; and professor of surgery at University of Toronto.

High-intensity focused ultrasound therapy is available in pediatric and adult centers in Europe. The procedure was first performed on patients with osteoid osteoma in Italy in 2010 and is currently used in North America to treat uterine fibroids and bone metastases in adult patients. Osteoid osteoma occurs most commonly in males 10 to 35 years of age. The condition has been reported in patients as young as seven months. Despite its small size — about 1 cm —  the tumor is known to cause extreme pain. SickKids sees as many as 18 patients per year with this condition.

This breakthrough was made possible with the efforts of a multidisciplinary team at SickKids: Drs. Adam Waspe, Joao Amaral, Thomas Looi, Maria Lamberti-Pasculli, Joost de Ruiter, Fiona Campbell, Sevan Hopyan and Jane Church. From Sunnybrook: Greg Czarnota, Yuexi Huang, Ruby Endre, Claire McCann, Young Lee and Kullervo Hynynen.

For more information: www.sickkids.ca

Related Content

World's largest radiation oncology meeting will offer full conference on interactive platform October 25-28, 2020
News | ASTRO | July 09, 2020
July 9, 2020 — Registration opens today for the American Society for Radiation Oncology's (...
Simulation finds starting at age 30 with MRI and mammography to be the preferred strategy; starting at 25 prevented marginally more deaths, but with more testing and emotional stress

Getty Images

News | Breast Imaging | July 09, 2020
July 9, 2020 — Chest radiation is used to treat children with Hodgkin and non-Hodgkin lymphoma as well as lung metast
At the American Association of Physicists in Medicine (AAPM) 2019 meeting, new artificial intelligence (AI) software to assist with radiotherapy treatment planning systems was highlighted. The goal of the AI-based systems is to save staff time, while still allowing clinicians to do the final patient review. 
Feature | Treatment Planning | July 08, 2020 | By Melinda Taschetta-Millane
At the American Association of Physicists in Medicine (AAPM) 201
 Many patients with severe coronavirus disease 2019 (COVID-19) remain unresponsive after surviving critical illness. Investigators led by a team at Massachusetts General Hospital (MGH) now describe a patient with severe COVID-19 who, despite prolonged unresponsiveness and structural brain abnormalities, demonstrated functionally intact brain connections and weeks later he recovered the ability to follow commands

Getty Images

News | Coronavirus (COVID-19) | July 08, 2020
July 8, 2020 — Many patients with severe coronavirus disease 2019 (...
Changes outlined in new draft U.S. Preventive Services Task Force (USPSTF) lung cancer screening recommendations will greatly increase the number of Americans eligible for screening and help medical providers save thousands more lives each year.

Image courtesy of Cerner

News | Lung Imaging | July 08, 2020
July 8, 2020 — Changes outlined in new draft U.S.
Radiotherapy has been used to treat cancers for more than a century and continues to be utilized in cancer treatment plans today. Since the introduction of radiotherapy, clinicians have been working tirelessly to further refine treatments to better target cancer.
Feature | Radiation Therapy | July 06, 2020 | By Yves Archambault
Everything has room for improvement, right? Right. When it comes to cancer care, it is no different.
Proton therapy has evolved, and future predictions include smaller systems, more sophisticated proton dosimetry and devices that manipulate the proton beam
Feature | Proton Therapy | July 06, 2020 | By Minesh Mehta, M.D.
The field of proton...
A patient implanted with the Axonics System can undergo MRI examinations safely with radio frequency (RF) Transmit Body or Head Coil under the conditions outlined in the Axonics MRI Conditional Guidelines.

A patient implanted with the Axonics System can undergo MRI examinations safely with radio frequency (RF) Transmit Body or Head Coil under the conditions outlined in the Axonics MRI Conditional Guidelines.

News | Magnetic Resonance Imaging (MRI) | July 02, 2020
July 2, 2020 — Axonics Modulation Technologies, Inc., a medical technology company that has developed and is commerci
This data represents wave 2 of a QuickPoLL survey conducted in partnership with an imagePRO panel created by The MarkeTech Group (TMTG), regarding the effects of COVID-19 on their business

Getty Images

Feature | Coronavirus (COVID-19) | July 01, 2020 | By Melinda Taschetta-Millane
Researchers reviewed results of prostate biopsies on over 3,400 men who had targets identified on prostate MRI and found that the positive predictive value of the test for prostate cancer was highly variable at different sites
News | Prostate Cancer | July 01, 2020
July 1, 2020 — Prostate MRI is an emerging technology used to identify and guide treatment for...