Invited Speakers

Focused ultrasound (FUS) is a clinically relevant therapeutic technology that delivers spatially accurate mechanical stress and heating to solid tumors, avoiding collateral toxicity to healthy tissues. FUS also has the potential to promote immunogenic recognition and clearance of tumor cells by the immune system. Our research demonstrates that FUS-induced local heating and stress, combined with nanoparticles, can modify the tumor microenvironment to yield several benefits, including enhanced solid cancer chemotherapy, release of tumor antigens, and stimulation of antitumor immunity compared to conventional therapies. In this seminar, I will discuss the concepts and techniques for drug delivery and immunomodulation, providing examples of clinical translation in canine cancer treatment.

Brain tissue is unique in terms of texture and material properties. The nature of tissue, physiological importance, high blood supply are formidable factors for consideration for surgery. Brain surgery has evolved only over the past century. The current practise of micro neurosurgery established more than half a century ago has dramatically improved outcomes following brain surgery. 

Asset Integrity and Process Monitoring technologies have a logical impact on operational costs. Efficiencies realized by effectively managing labor, inventory and other support services directly impact the bottom line by helping to control costs. More timely and precise user intervention can improve productivity, reduce materials use and decrease the cost of doing business.

Ultrasound (US) in combination with gaseous microbubbles has come into focus as a potential new drug delivery technology. Indeed, beyond their exploitation for diagnosis, microbubbles and US, today represent an emerging technology for localized drug delivery. Recent research shows that under the action of US waves, microbubbles transiently perforate biological barriers (e.g . cell membrane, endothelial barrier) thus leading to the uptake and enhanced accumulation of drugs in the targeted region. Hence, the bioavailability of therapeutic agents is sitespecifically augmented only in the zone where the US waves are focused. Commonly referred to as sonoporation, it offers real promises as a drug delivery tool with potential of alleviating the limitations encountered by traditionally available therapeutic arsenal.

The process of elastography allows one to quantify any tissue's hardness in kilopascals. Since an ultrasound machine is typically used to produce elastography waves, this technique is frequently referred to as sonoelastography. Sonoelastography is typically produced using two methods: shear wave elastography (SWE) and acoustic radiation force impulse (ARFI) elastography. In clinical practice, both of these methods are employed to quantify stiffness. Elastography is most frequently utilized in the diagnosis of cancer because malignant tissue is frequently hard. This causes it to become more stiff, and one can determine whether or not there is a soft tissue lesion by measuring the stiffness.

Ultrasound imaging has become an important point of care of modality for medical diagnosis due to its non-invasive nature and real-time imaging capabilities. As artificial intelligence (AI) continues to revolutionize healthcare, integrating AI into ultrasound image analysis presents both opportunities and challenges. This talk aims to explore the multifaceted challenges in the development of AI tools for ultrasound image analysis. Variability in image quality, noise, and artifacts inherent in ultrasound scans poses a significant obstacle for AI algorithms aiming for accuracy and reliability. Furthermore, the need for robust AI models capable of handling anatomical variations and change in depth of focus adds complexity to the development process. Standardized data sets, including ground truth (expert annotations) availability limits quick development of supervised AI models. Much needed deployment of these AI models for online analysis during the ultrasound scan is also a serious challenge to make AI appealing for ultrasound image analysis. 

Immune Checkpoint Inhibition (ICI) has led to improved survival for some cancers yet failed to demonstrate benefit in others. Limited efficacy of ICI is seen in ‘cold tumors', characterized by a paucity of T cells. Converting cold tumors into hot tumors could improve the efficacy of ICI. A promising technique is (boiling) histotripsy (HT). HT results in mechanical fractionation of tissue, rapid tissue lysis, release of tumor-associated antigens and danger-associated molecular patterns (DAMPS). Together with the Children's National Medical Center and the NIH, we have shown that HT worked synergistically with ICI in a neuroblastoma animal model leading to increased survival, abscopal and vaccination effects (Eranki et al. CCR 2020). HT caused upregulation of dendritic cells, tumor infiltrating T-cells, proinflammatory cytokines, and DAMPs, while reducing pro-tumor regulators such as regulatory T-cells.

Ocular B-mode ultrasonography (US) is an important adjuvant tool for the clinical diagnosis and prognosis of various retinal and choroidal lesions. It has become widely used because it can easily be performed at the bedside with a relatively small apparatus and does not expose the patient to any ionizing radiation. Although this technique has seen widespread acceptance in other fields such as cardiology, obstetrics, and gynecology, its general use in ophthalmology has been somewhat limited. The current application of USG in ophthalmology is in patients with media opacities to see posterior segment pathologies such as vitreous hemorrhage, retinal detachment, and foreign body. It also plays an important role in the diagnosis of tumors (e.g., choroidal melanoma, metastases, hemangioma) by documenting tumor size, location, and internal reflectivity. In this talk, I will focus on current applications of ultrasound in ophthalmology, challenges ahead, recent advances, and a few unanswered research questions to brainstorm.

This talk will share experiences with the cutting-edge technology of MR-guided Focused Ultrasound, in the Indian context.